Internet pioneer and venture capitalist Marc Andreessen famously said, “Software is eating the world.” In other words, information technology is transforming the structure and sociology of virtually every economic sector.
In health care, advances in information technology, algorithmic analytics, robotics, and a hundred other realms are reshaping the delivery of care itself. Software’s capabilities depend on the quality and quantity of underlying data, and perhaps more than anywhere, it is an explosion of data that is driving the transformation of medicine.
Wearable telemetry (Jawbone and FitBit are familiar examples) is helping to overturn 2,500 years of medical tradition. For the first time, wearables offer convenient, passive, continuous monitoring of vast numbers of human bodies. Implications for the doctor-patient relationship are profound.
Since the time of Hippocrates (460 B.C. — 370 B.C.), health care was paternalistic, reactive and episodic. Only the physician could collect most of the important data, thus giving the physician a superior position over submissive patients. Ethical precepts over the ages reiterated that doctors, not patients, were entitled to the data from medical encounters.
Furthermore, most of the data were collected under unnatural circumstances. A doctor’s knowledge of an individual patient depended on sporadic observations — mostly during uncharacteristic moments of illness. Even data from routine wellness check-ups — pulse rate, blood pressure, electrocardiograms — were collected at unnatural moments in uncomfortable surroundings. (For example, after driving to the doctor’s office, searching for a parking space, and sitting uncomfortably in a waiting room full of sick people.)
In contrast, consider my FitBit. Unless I’m in the shower or the swimming pool, it’s wrapped around my wrist day and night. It shows the pace of my heartbeat at virtually any minute of any day since I purchased it a year ago. It gives a relatively accurate count of the steps I’ve taken each day, the number of hours of sleep on any given night, the amount of time I’ve spent on the treadmill, the flights of stairs I’ve ascended — all instantly readable on my phone or laptop. I was alarmed by a brief acceleration of my heartbeat around 7 p.m. on June 3, 2016, and I was able to email a graph of the data to my doctor (and still can).
But my FitBit is a primitive device compared with others now either available or quickly becoming reality. I often write about the AliveCor device on my iPhone that allows me to perform an electrocardiogram on myself in 30 seconds, but those readings are episodic. For decades, heart patients have been able to monitor continuously cardiac rhythms for several days by wearing a cumbersome Holter Monitor. But recently, Scripps Translational Science Institute tested a small wireless device that sticks to the patient for weeks and is usable in a swimming pool or shower. And, going a step further, technology is moving into the realm of implantables — microscopic versions of wearables that can be planted within the body.
Wearables go far beyond the individual. Jawbone’s devices collect, anonymize and aggregate the data from millions of users — enabling researchers to explore patterns of health and sickness as never before. So far, Jawbone (whose devices are FDA-approved) has collected 500 trillion data points from users. Going forward, these devices will likely be integral to the management of diabetes, stress and other dangerous, expensive conditions.
Wearables place medical data in patients’ hands and encourage individuals to proactively manage their health during stretches between visits to the doctor. They monitor patient behavior around the clock, around the calendar, in sickness and in health. And, they enable patients to visit physicians armed with more data than any patients in prior history.
Not long ago, I quoted a friend, Rich Schieken, who described the changes over 40 years as a pediatric cardiologist:
“When I began, parents brought their sick and dying children to me. I said, ‘This is what we’ll do,’ and they said, ‘Yes, doctor.’ Nowadays, they bring 300 pages of internet printouts. When I offer a prognosis and suggest treatment, they point to the papers and ask, ‘Why not do this or this or that?’”
Going forward, patients will increasingly come armed with more data than doctors a few decades back could have ever imagined.
