“The Doctor will see you (and your data) now”

The Doctor Will See You and your data Now

Fortune features extracts from a new book “The Lucky Years” by David B. Agus MD, Professor of medicine and engineering at the University of Southern California’s Keck School of Medicine, that promises to unlock “The secrets to your health and longevity that are hiding within you“.

The article caught my attention as David’s previous books are a great read and I also believe we all hold enormous potential to heal ourselves​. The title of the article is an interesting play on the “The Doctor Can See You Now” strapline that we launched with 3G Doctor in 2006.

mHealth Insights:

​”​Today when you go to the doctor for a wellness checkup, you make an appointment far in advance and then visit the doctor’s office to get your data collected, including blood pressure, weight, and other routine lab tests. The only preparation you make beforehand is probably mental: organizing any questions you might have for your doctor and trying not to feel nervous about the visit. Several days after your appointment, someone in your doctor’s office calls you back with the results of any tests or lab work that was performed. Sometimes no one even bothers to call you if everything comes back as “normal.” A future doctor’s visit, on the other hand, will be all about putting the data collected into context so you can know what’s best for you. You won’t go there to collect data. Instead, you will go in with your data

I think this situation is completely outdated and have no doubt that we’ll look back on today’s situation in just a few years time just like we look back today at medieval practices like blood letting etc.

This suggestion of what the future might look like (eg. “you will go in with your data“) is also an indicator of how challenging it is for many Doctors to think beyond the idea of the product they produce being an office visit.

It’s important to recognise that there are Patients who are making the effort to prepare themselves and their Doctors before visits eg. Patients consulting with us here at 3G Doctor, NHS Patients who have GPs who are adopting AskMyGP, Patients who are working with smart Doctors at the Mayo Clinic, etc.

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Some examples that I foresee: A week prior to your appointment, you will mail a biochip to your doctor’s office that contains a drop of blood from a finger prick that can be analyzed. Your smartphone and other portable devices, some of which will be wearable like watches or bracelets, will be equipped with all sorts of technologies to measure various features about your health. They can listen to your heart and send an EKG to your doctor, as well as transmit the sounds of your heart to a sound cloud to compare and analyze against people who share the same age and lifestyle

Clearly we can already go far beyond this and need (eg. read about our experiences using the Alivecor ECG 4 years ago and note that this doesn’t need to be used before an appointment rather it can be used to determine if you need an appointment at all) but I think this highlights the need for Doctors to get mHealth training (click here to apply to take the first CPD accredited mHealth course that we produced for the Healthcare Informatics Society and click here to watch the introductory Diabetes module).

please-be-patient-im-still-practising

If you’re pregnant, those routine prenatal exams will also be transformed through technology, allowing you to monitor the health of your baby all on your own and send data to your obstetrician for review

I think it’s interesting that the tech is already available to enable this in GP settings but the rising costs of medical insurance are preventing adoption happening anytime soon eg. here in the UK/Ireland we have lots of GPs who can’t even afford insurance coverage to just consult with mothers who plan to have home births and GPs have no practically no interest in ultrasound machines because the cost of insurance is so exorbitant (one wonders how expensive it might be for obstetricians to get cover to read scans that are being conducted in the home by untrained/unpaid parents?).

With all these innovations, your doctor won’t have to spend much time collecting your information during your appointment. He or she will sit there with you and devise a game plan based on the data you provided before stepping foot in the office

Most Doctors still can’t even see the opportunity for Patients to help them in sharing their medical history so one wonders how they’re going to transform to the stage where they’re working with Patients devising a ‘game plan’ based on data that Patients collect. It still amazes me that anyone thinks that by the time we get to that stage that we will still want to ‘sit there’ in the Doctors ‘office’? Isn’t that the way we thought about how we’d continue to work with travel agents before Ryanair.com, Tripadvisor, Skyscanner, etc.

The whole notion of even going to the doctor when you are sick may change. If you think about it, it actually doesn’t make much sense. When you don’t feel well, you have to drive to an office and sit in a waiting room with others who may not like your contagious runny nose. In fact, there are now several startup companies with doctors on call to come to your house on a moment’s notice so you can get medical assistance at home

We all need to get over the whole notion of requiring someone to go somewhere before care can be provided: 92 year old Patient’s already have

Many of those old-fashioned house calls will be virtual—part of the rapidly growing field of telemedicine, which promises to bring doctors and nurses to you rather than having you travel to their offices or enter an ER for care. In some cases it entails live video consultations with doctors available 24 hours a day, who can offer advice, prescribe medicine, and suggest follow-up care

Having provided documented video consultations 24×7 through 3GDoctor for nearly 10 years in the UK and Ireland let me assure you: There is nothing virtual about a registered Doctor video consulting with a Patient (2010).

Some towns have installed kiosks where patients can enter and have their vital signs checked while talking with a doctor at a distant major university. All of this will help achieve the best outcome if used correctly

I think the installed kiosk business is a tech solution that in looking for a problem to solve has found a way of boosting retail pharmacy sales, but when we know that 40% of Family Doctor consultations can be managed right now through just a mobile phone with internet access we really do need to focus on that enormous opportunity before wasting capital investment on the build out of physical kiosk networks that will only serve to further distance Patients from having a relationship with a Family Doctor.

I realize that there’s already some debate about whether doctors will want to deal with copious amounts of data provided by the patient, but that information ultimately helps reduce errors. A blood-pressure reading at noon in the doctor’s office is metric, but imagine coming in with three months’ worth of data: measuring it at bedtime, early in the morning, and when you are relaxed with a glass of wine. More data means less room for error. You may have missed the time of day when your blood pressure spikes if your physician took only one reading in his office. The slope, or the trend, in your data is more illuminating than a single data point. And the amount of data doesn’t have to be overwhelmingly large; the basics will suffice

Doctors already face this challenge with Diabetes (as Diabetics all have electronic glucometers that should be connected) eg. when they fan their faces with a Patient’s DiarySee the recent mHealth course I led at the IDF’s World Diabetes Congress in Vancouver.

Aggregate Data Sets Will Save You. Data-informed visits with your doctor are just a part of this new era. Another key element here is that all your data—stripped of information that can identify you to outsiders—can go into a centralized database, which will create an anonymized profile of you compared to others with similar features. That database can give you advice about what to do based on your information and what you might expect to happen, much in the way you’d plug a car into a computer to diagnose mechanical issues

As we enter 2016 I think the question is how will aggregate data sets save us? I’m confident that the mobile first approach Apple is taking to this with Researchkit that is going to break some great ground in this area (click here to watch the talk I gave earlier this year at the Mobile Clinical Trial Congress in Edinburgh).

Check out the mTech ResearchKit app by Saranpreet Nagra at University of the Pacific launched this month to study the long term health effects of energy drink use and imagine the opportunity it offers organisations like the IDF, Diabetes UK, Cancer UK, etc to get the communities they represent to get behind research into sugary and artificially sweetened drinks?

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This test, called VirScan, requires just a drop of blood and can broadcast nearly every virus a person has been exposed to throughout life, past and present. First reported about in the journal Science in 2015, VirScan can currently identify more than a thousand strains of viruses from 206 species, which reflects the entire human “virome,” or all the viruses known to infect humans, from the common cold to HIV. The test works by detecting antibodies, which are the body’s defense mechanisms against an invader. They are highly specific proteins that the immune system manufactures to combat germs such as viruses. And once you are exposed to a virus and have an immune response, the antibodies stay around and provide a “record” that you were exposed to that virus

The Economist’s editor predicts that wearables are going to kill the health insurance model but can you imagine what will happen when you can combine this collected data with the results of a VirScan test?

Until very recently, when most doctors saw a patient, it was largely the same as it was a decade ago. All of a sudden, though, that’s changing. More than 80% of physicians in the U.S. now use some form of electronic medical records [see chart in the above article]. Thanks to these large data sets, we now have the ability to look for trends and associations that we would have utterly missed a decade ago

I think the challenge is EMR’s haven’t been designed to serve Patients or Doctors needs. The shift still needs to be made to make them evolve from billing/administrative engines into tools that advance how Doctors and Patients communicate eg. if they had already evolved you wouldn’t be able to discover basic things as serious as sexual abuse by simply surveying Patients in the waiting room.

Importantly, the Genetic Information Nondiscrimination Act, signed by President Bush in 2008, makes it illegal to discriminate on the basis of an existing or genetic condition. And I respect that there are real concerns out there, but there’s a prevailing myth too—this notion that health care data is special and has to be kept sealed in a box. When I explain to patients what can be done with this information, nobody has ever told me, “Don’t share my data.” We bank online and use our ATM cards every day. Putting anonymized health care data into a data set will soon feel as normal

I don’t think many people are going to be happy to share their comprehensive medical history because there is a government assurance in place (the public know that the US government couldn’t protect the privacy of the emails of it’s most senior politicians) and we have to stop trying to draw comparisons with ATM cards (when you have fraudulent charges on your banking account I can repatriate you perfectly with a refund and a token gift voucher whereas there’s no way when your private information has been shared and it’s not going to be as easy for you to know if it has happened as it’s not like you’ll immediately see a change when a hacker or personal data collecting organisation gets to see your medical information).

I look forward to reading The Lucky Years: How to Thrive in the Brave New World of Health (published by Simon & Schuster on Jan. 5, 2016).

About 3G Doctor

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