By Brian Chapman
“Do you want to share pulse information from your Garmin watch with Apple Health?”
I don’t know… Maybe?
Many of us have seen this type of message on our wearable devices and smartphones, and we’re often hesitant. Notice that the device doesn’t ask “Do you want Apple to collect information to diagnose potentially harmful cardiac conditions?” or “Do you want us to use your fitness app to calculate your insurance rates?” And the question certainly isn’t “Would you like me to collect information about your sleeping patterns to let your employer know when you aren’t at your best?”
Data in health care is so incredibly fraught.
In theory, we all see the opportunities that exist for digital health solutions. We see how often our primary care doctor doesn’t really remember our situation, or when he struggles to connect the results from our past diagnostic tests to our current health status. We see how endocrinologists don’t really have any basis to know how we are responding to their prescriptions or how well we are following their nutrition advice. We realize that cardiologists have no real understanding of our status in the real world when they rely on a blood pressure cuff and miss the other 23 hours and 50 minutes of the day. We watch as the cardiologist orders tests that the electrophysiologist already ordered. We watch an ER doctor battle an acute episode of an unknown condition that the general practitioner already knew about. We see how poorly care is coordinated across settings.
But with digital health solutions, we can imagine routine diagnoses being delivered and remedies dispensed by an expert system that doesn’t require an appointment or a visit. We can imagine a system that uses genetic profiling on a tumor or rare disease just once, instead of cycling through countless individual diagnostic tests to find the needle-in-the-haystack remedy to cure a rare condition. We also see how activity data from the simple accelerometer of a consumer electronics watch can quantify the previously unquantifiable outcomes of a joint replacement. Or how a GPS can track an elderly patient with mild cognitive impairment to help him stay independent and avoid an institution. Speaking of cognitive impairment, we can use activity from a smart phone to diagnose it early—earlier than any brain scans or mental acuity tests—and maybe soon enough to arrest the progress.
I get excited just thinking about the many opportunities for digital health, but advancement isn’t happening very quickly at all. Why? Because we choose to click “maybe.”
From a human perspective, I can’t help but feel a little apprehensive with the associated privacy risks of this “perfect” data scenario. Just think of Equifax, Target, Facebook and Capital One: Many organizations have fallen victim to data breaches and put consumers’ security at risk. How good do we feel about all of this data-sharing when the stakes are so high?
From a system perspective, I see just how hard it is to address entrenched perspectives. What does a radiologist do when an algorithm does her job only better—and sends her looking for a new vocation? What does an anesthesiologist do when biofeedback and automated delivery make his job redundant? How does the current health care delivery system cope when rewritten in the radical transformation envisioned above? How does medicine look in the deterministic eyes of all-knowing and all-seeing artificial intelligence? What does it mean to influence standard of care when an algorithm is already the steward of some black box of status quo? As attractive as the future can be in terms of all of the promises, there are just as many dark sides and barriers that exist to thwart that utopian vision.
One of the true joys of my job as an industry consultant is that I get to watch the future unfold and think about all of the implications. I get to help medtech companies understand and navigate this shifting landscape and, in my own small way, I get to exert a tiny influence on how things unfold to balance the enormous benefits with the looming risks.
If this topic fascinates you as much as it does me, please join me for a panel that I’ll be moderating at The Medtech Conference in Boston on Sept. 24. My colleagues and I—Richard Loomis of Elsevier, Cindy Perettie of Foundation Medicine and Yvonne Bokelman of Zimmer Biomet—will discuss all of this and more.