Big (data) Medicine

People like to say that we can send a man to the moon, but still can’t cure the common cold.  It’s become such an enduring cliche because, in fact, there is some truth to it.

While the promise of new technologies like genomics and stem cell research suggest breakthroughs, a visit to the doctor is very much like it always was.  We go in, a nurse checks our vitals, the doctor asks us some questions, prescribes treatment and sends us on our way.  That’s about to change.

Much like other industries, technology is about to give healthcare a major makeover and no stone will be left unturned.  Everything from examination to diagnosis to treatment is becoming a hotbed of innovation.  While much of the medical establishment is skeptical, even obstructive, there are unmistakable signs that a transformation is underway.

A Day At The (Doctor’s) Office

If someone from the 1950’s walked into a doctor’s office today, they would probably feel very much at home.  In the reception area, they might be somewhat surprised by the computer on the receptionist’s desk, just as they would find the mobile phones of the other patients and the amount of skin on the magazine covers a bit odd.

Once inside the examination room, however, they would find much that is familiar: thermometers, an inflatable cuff to take blood pressure, a stethoscope, some models and charts of human anatomy and a hardbound copy of the Physicians Desk Reference.

The doctors methods haven’t changed much either.  While there are a vast array of newfangled (and often expensive) tests they can order along with some high tech pharmaceutical treatments, a doctor’s primary tools remain training and experience. For an elite field requiring extensive education, medicine seems oddly like a throwback.

The New Doctor’s Interface

The first sign of change is the ever growing self-monitoring movement.  There are a vast array of low-cost sensors that can track everything from your heart-rate to your blood pressure to your sleep patterns in easy-to-use smartphone apps.  So rather than getting poked and prodded when we get to the doctor’s office, we’ll soon just transfer a file.

There are also emerging developments that will replace a lot of those expensive tests.  T-Ray technology, which is currently used in the new generation of airport screening machines, can also examine the chemical content of our bodies tissues while lab on a chip techniques will quickly and cheaply do a more extensive analysis.

Although much of this is still in its infancy, Qualcomm has sponsored a tricorder X Prize that will award $10 million to develop a portable, noninvasive device that can diagnose 15 diseases without the input of a healthcare professional.  One of the competitors, Scanadu, has recently released an early version.

When piggybacked onto a smartphone, we can expect a lot of this monitoring and basic diagnostic technology to be available to consumers for a few dollars within five years.

Bringing Diagnosis into the 21st Century

Most ailments are common.  A simple blood test along with other vital signs derived from self-monitoring can point the way to a diagnosis.  Others, however, are more involved. They require sophisticated tests such as MRI’s, Mammograms and Pap smears to be evaluated by qualified (and expensive) radiologists and pathologists.

Here too, we’re seeing a change.  A recent study found that computers can greatly decrease the false negative rate of mammogram screenings while reducing costs by obviating the need for two human evaluations.  Similar results have been found when imaging software has been applied to Pap smears and other screening tests.

As the technology continues to improve, costs can come down dramatically while maintaining margins in the industry.  There may also be an ancillary benefit: as demand goes down for high priced specialists, more medical students might be willing to help alleviate the shortage of general practitioners.

Accelerating Returns for Treatment

Technologists have become used to the idea of accelerating returns, the idea that things can get exponentially better, while also becoming cheaper over time.  Unfortunately, up till now the phenomenon has passed the healthcare industry by.  Results have improved somewhat over the years, but costs have absolutely skyrocketed.

As information technology becomes increasingly applied to medicine, the economics might very well be transformed.  The journal Nature, recently announced a machine that will soon be on the market that can sequence a genome in 15 minutes for $900, while the ENCODE project seeks to translate genomes into actual cures.

It doesn’t end with gene sequencing either.  Synthetic blood is already a reality and is saving lives.  Scientists are working to enhance it further with nanotechnology called respirocytes that can store hundreds of times more oxygen than natural hemoglobin does. Others are working on using our own cells to create 3D printed organs.

One of the most exciting applications of information technology comes from IBM, who is adapting their Watson project to medicine.  Watson, the supercomputer that beat humans on Jeopardy!, will search the world’s databases and suggest treatments to medical professionals.  Healthcare giant Wellpoint has already signed on.

A System That Learns

Probably the most promising aspect of the new face of health care is that it will increasingly be a system that learns.  Presently, practitioners share their experience through academic papers and conferences, but very little patient treatment data is actually made available.  With the advent of electronic health records, that will change drastically.

Both Obamacare and the stimulus package had provisions for healthcare digitization, but the digital tools mentioned above will accelerate the process further.  For instance, ailments detected by a “lab on a chip” can be cheaply and seamlessly uploaded to a central database that epidemiologists can use to pinpoint new outbreaks.

But it goes much further than that.  With increasing size and complexity of medical databases, artificial intelligence can detect patterns that will help personalize treatments and minimize problematic drug interactions.  With doctor’s input, computers that are designed to limit false negatives in screenings can be refined further to limit false positives.

This isn’t just speculation.  This article shows how Intermountain Healthcare, a company that runs hospitals in Utah and Idaho, has used digital records and a data driven approach to achieve superior results.  As digitization expands and big data methods become widely employed, we can bend the cost curve downward and improve care.

Flying By Wire

If all this seems fantastically unrealistic, it’s important to note that we’ve seen it before. Pilots, much like medical professionals, are highly skilled specialists who make life or death decisions.  What they don’t do, however, is fly planes anymore.  Not really.

The instruments in their cockpits do not connect to the plane’s mechanism, they connect to computers, which in turn are informed by data from thousands of other flights.  It’s called flying by wire and it has, over the past few decades, become so standard that nobody would think of operating a commercial flight any other way.

Clearly, we are seeing the beginning of the same transformation in medicine.  The result will not only be longer, more productive lives, but lower costs and fewer errors.  In just a few years, a trip to the doctor’s office will look less like Marcus Welby and more like CSI.

– Greg