Digital technology has transformed virtually all aspects of how we live and now it’s ready to revolutionize health care. In The Creative Destruction of Medicine, Dr. Eric Topal makes a convincing argument that the digital revolution will deconstruct how health care is delivered. For example, hand-held digital devices will provide precise diagnostic information virtually anywhere and transmit it instantaneously wherever needed. Smart phones and e-tablets will give individuals access to applications allowing them to understand and manage their health or disease. Inefficient, inconvenient, and expensive physician office or hospital visits will be far less necessary as distant monitoring goes online. The power of digital technology in health care is clear; but what hasn’t been described is how such devices can be used to facilitate the creation of a better health care system.
A major flaw in health care today is that it’s focused on treatment of disease events after they develop rather than on preventing them. This approach is partly responsible for the massive increase in preventable chronic diseases. Digitalizing today’s “fix what’s broken” approach to health care would be akin to adding GPS to a horse and buggy. While improved technologies can enhance the effectiveness of treating disease events, the real opportunity lies in using them to create a new approach to care that enables individuals to improve their health, diminish their chance to develop preventable diseases, and minimize the consequences of diseases if they occur. A more rational model of care is within our grasp and digitalization can make it far more effective. This approach is termed Personalized Health Care.
To understand how it works, let’s start with the basics. Each individual is born with a unique set of genes which, in combination with their environment, determines their health and their risk of developing diseases. Diseases develop over time with symptoms frequently not evident until damage is considerable. Our current medical practice is to intervene after symptoms have manifested using “one-size-fits-all” treatments. With digitalization and ongoing medical breakthroughs, we can change health care to be personalized, predictive, preventive, and more effective as individuals become central players in their care. Personalized health care recognizes the dynamics of how diseases develop, the uniqueness of individuals, and what can be done to maximize health. With personalized health care, the annual medical visit, which is currently acknowledged to be of little value, is redesigned to identify the patient’s immediate and long-term health risks and establish goals and actions to decrease risks and improve health through a personalized health plan.
Imagine the annual physician office visit with personalized health care in the digital world. No longer will there be a cursory visit with the physician entering information into a laptop without ever looking the patient in the eye. Prior to their visit, the patient will complete an easy, yet comprehensive health questionnaire electronically on their smart phone or e-tablet. Relevant laboratory tests and other diagnostic information will be obtained at home or in the local pharmacy using point of care tools coupled to a smart phone or similar device. This information will be analyzed electronically in a format designed to support the physician’s assessment of the patient’s health status and risks at the time of the visit, and to facilitate discussion of the best options to enhance the patient’s health over the course of the year.
During the appointment, the physician will have access to powerful digital diagnostic devices to refine the clinical evaluation far more accurately than with current instruments, such as the stethoscope. Cost-effective digital technologies in the physician office will greatly reduce expensive and inconvenient visits to other health care facilities. Discussions between the physician and patient now will focus on creating a joint understanding of the patient’s health needs. A clear-cut plan with measurable objectives for minimizing disease risks and enhancing health will be developed collaboratively thereby enhancing the patient’s engagement. The personalized health plan will be linked securely to the patient’s smart phone and during the course of the year, relevant data such as weight, blood pressure, laboratory tests, lung function, and electrocardiograms will be collected via smart phone applications or similar devices. Other tests will be available at local pharmacies or supermarkets. This information will be analyzed and transmitted to the patient and health care team and progress will be tracked largely through mobile devices. Communication with the physician or health coach will occur conveniently through digital means without unnecessary utilization of health care resources. At appropriate intervals, the plan will be updated to meet the patient’s evolving needs. Of course, if disease events or emergencies occur, physician offices, urgent care clinics, emergency rooms, and hospitals will be available along with access to the data contained in the personalized health plan.
Personalized health care on a digital platform can reconstruct our current expensive and inefficient sick-care approach into a cost-effective, health-enhancing system with individuals at the center of their care. While the practice of personalized health care is in its infancy, “ObamaCare” is encouraging its adoption through reimbursement for preventive care and financial incentives for better outcomes, rather than more procedures. Importantly, as technologies enable individuals to become more informed and empowered about health care, they will be a major force for insisting on care that is designed to improve their health personally.
