Actionable Information, Wearables, IoT and Seeing a Doctor?

I went polar bear wake surfing in Kansas on January 1st, 2015. As stated in the Osage County Herald-Chronicle, “Some members of the Pomona Lake Ski Team will go a long way to be the first water skiers on the lake every year. As part of a 24-year tradition, they took to the lake Jan. 1 for the club’s annual New Year’s Ski. … In the first New Year’s Ski in three years, skiers were greeted by 33- degree F [1- degree C] water and 34-degree F [1- degree C] air temperatures.”

https://www.och-c.com/?q=article%2Fskiers-brave-frigid-air-water-annual-event

The lake was a little icy and I was the first person to be in the water. I was having a good time. The boat speakers were playing the song “Let it Go” from the group Collabro from the movie Frozen. Thought it was appropriate song for the event.

https://www.youtube.com/watch?v=Ba8uz1335zE

Unfortunately, on the last chorus of “let it go,” I was inspired to let go of the rope. Normally I can free surf without a rope without a problem but I was not behind my boat and the water was a little choppy (and icy) – so in I went. I was in the water for a few minutes before getting into the boat. Even though I had diving gloves on, my tips of my fingers started to turn numb. I got them warmed up in a car and all seemed well except for one finger that started to turn a little black.

There was just a little stiffness and not much pain and the tip of my finger was still pink (from my engineering point of view - I thought that was a good sign). I figured I had either frost bite or a bruise (from the rope). I was not too concerned but the next morning, the discoloration in my finger was worse, I was trying to decide if I should go to the doctor’s office to get it checked or not. I had the day off and it would cost me a $20 co-pay for a regular office visit and the doctor could see me that day. It was Friday and if I waited and had to go to the urgent care center over the weekend, it would cost me $35.

I showed my finger to a teacher friend who plays softball and she thought it was just a bruise like she had gotten in the past from a jammed finger. She also thought that surfing in 1 deg. C water was not the smartest idea. I sent the picture to a nurse friend and she thought maybe I should go have the doctor look at it. I decided to get it checked out just in case there was something I needed to do other than to just wait and let it heal. My concern was if it got worse over the weekend and it was a bruise, maybe ice was the best treatment for it but if it was frost bite, more ice would not be the best.

Initially, I saw a Physician Assistants and even she was not sure what was the problem. She had a Doctor come in and look at it and the Doctor did not seem to be too concerned. The doctor did say I could have it X-rayed (my guess it looked black enough that he thought it could have been broken) but since I had minimal pain and I was sure I had not broken it, I did not get the X-ray. I asked what I should look for to be concerned. I was looking for “actionable information.” He said as long as the pain did not get worse, I should be fine. Now 15 days later, my finger is fine and my trip to the doctor’s office was unnecessary.

This experience got me thinking of “Actionable Information” and when should you seek professional medical help? Or just wait and see if it would get better on its own? The risk is that if you do not receive the right treatment early and you have a serious problem, by addressing the problem earlier, you could have had a better outcome.

I believe the medical diagnostics industry is poised to make dramatic changes in the next few years. Advances in diagnostic testing, wearables, smart phones and the IoT (Internet of Things) can make a significant improvement to people’s health by providing actionable health information at low cost. The challenge for our society is what to do with all this information to improve health and not just irritate medical professionals or self-misdiagnose.

According to Wendy Everett at Institute for the Future in 2000 “50% of health is determined by lifestyle, 20% by genetics, 20% by environment, and 10% by health care access.” In the article “We Can Do Better — Improving the Health of the American People” by Steven A. Schroeder, M.D. states: “Health is influenced by factors in five domains — genetics, social circumstances, environmental exposures, behavioral patterns, and health care. When it comes to reducing early deaths, medical care has a relatively minor role. Even if the entire U.S. population had access to excellent medical care — which it does not — only a small fraction of these deaths could be prevented. The single greatest opportunity to improve health and reduce premature deaths lies in personal behavior. In fact, behavioral causes account for nearly 40% of all deaths in the United States.” https://www.nejm.org/doi/full/10.1056/NEJMsa073350

These quotes are not really telling you information that you don’t already know. We have the information but we are not acting on the information. It is not ignorance but apathy. The best way to maximize health is to do what our mothers told us long ago: eat right, exercise, get plenty of rest, do not smoke or do drugs; drink in moderation, do not do stupid things (like falling in 1 degree C water), make friends, go outside and play and do not stress out about life (especially when using Google for medical information). This advice will not solve all the health problems in the country but action on this information will make a big difference.

One area that early low cost monitoring may significantly impact our society is on prevention. One example is drug abuse of the young. If at risk 11-16 year olds can be monitored daily to see if they have started to take drugs, early intervention could be introduced to stop the drug use before there is addition. “Forty million Americans ages 12 and older (16 percent) have the disease of addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions, diabetes or cancer; another 80 million people are risky substance users – using tobacco, alcohol and other drugs in ways that threaten health and safety.” https://www.casacolumbia.org/templates/NewsRoom.aspx?articleid=678&zoneid=51

“The United States accounts for only 5% of the world’s population. However, two-thirds of illegal drugs are consumed in America.” Low cost monitoring, IoT and wearables may help provide for intervention. I realize there are privacy concerns for the youth but as long as the goal is treatment for those who need it and not punishment, I believe low cost monitoring could be of significant benefit.

“In modern medicine, Dr. Atul Gawande said, there are 13,600 diagnoses, or ways in which the human body can fail, and no patient comes in with just one diagnosis at a time. Now more than 6,000 drugs can be prescribed, and 4,000 medical and surgical procedures can be performed.” https://news.harvard.edu/gazette/story/2011/09/the-battle-for-medicine%E2%80%99s-soul/

https://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine

The key question is how do we maximize positive health outcomes for the individual? One way is to focus on the 4 Ps of medicine: Personalize, Preventive, Predicted and Participatory. https://p4mi.org/4-ps-quantifying-wellness-and-demystifying-disease

Today we treat disease for the general population. In the future we will have target actionable information specific to the individual. There is a term in medicine “number to treat.” That is the number of people that need to be treated so a single person has benefit. This number can be over 100 or more. With new technology, we should be able to be better than having 100 people going through unnecessary treatments to aid 1 person. With better personalized actionable information, we can shift from population medicine (that many people do not follow the recommendation anyway) to personalized information that will maximize that individual’s health.

Today, the laboratory-diagnostic industry is a $76 billion industry that “According to American Clinical Laboratory Association, more than 7 billion lab tests are performed in the U.S. annually and lab results dictate 80% of clinical decisions." https://money.cnn.com/2014/10/16/technology/theranos-elizabeth-holmes/

New technology is poised to make dramatic changes to this industry to lower the cost and accessibility. I am really excited about what the near future can hold for companies like Theranos with the mission "to make actionable information accessible to everyone at the time it matters. By making actionable health information accessible to people everywhere in the world at the time it matters most, we’re working to enable early detection and intervention of disease and empower individuals to live the lives they want to live." https://www.theranos.com/our-company

I was also pleased that Nokia sponsored the $2.25 MILLION NOKIA SENSING XCHALLENGE where Nokia states: “Envision a future where everyone has access to affordable, personalized healthcare through sophisticated sensing technologies that put you in charge of your own health. Where sensors and devices recognize and measure your personal health information, provide insights and recommendations relevant to you and communicate that information to your physician. That’s the aim of this competition: a whole new level of personalized, digital health.” https://sensing.xprize.org/ I wanted to highlight the 2 grand prize winners:

Nanobiosym Health Radar Grand Prize award in 2013: “Enables testing of a drop of blood or saliva with a nano chip inserted into a mobile device. It detects the presence (or absence) of selected disease's pathogen in real-time, with gold standard accuracy.”

DNA Medicine Institute (DMI) Grand Prize award in 2014: “DMI has developed a portable device that can run hundreds of clinical lab tests on a very small sample of blood. Results are available in a matter of minutes and are highly accurate despite the matchbox size of the device.”

Another prize to follow is: “The Qualcomm Tricorder XPRIZE is a $10 million global competition to stimulate innovation and integration of precision diagnostic technologies, helping consumers make their own reliable health diagnoses anywhere, anytime.” https://tricorder.xprize.org/about/overview

Tricorder X Prize announced 10 finalists for hands-on diagnostic tests with the winner to be selected in early 2016. https://mobihealthnews.com/36113/tricorder-x-prize-announces-10-finalists-for-hands-on-diagnostic-tests/

We may look back in the near future and realize that these prizes have done to health what the Orteig Prize did to aviation in the 1920s. The health and medical community needs to encourage more “Charles Lindbergh” to help transform the health and medical community. This new low cost technology could help bring the 4 Ps of medicine to reality.

But with all this promise of health technology, for the medical professional, if you think you have problems now with patients Googling health information about their health problems and second guessing your decades of medical experience, just wait until patients have access to low cost sensors that measure their health and biomarkers with lab on a chip technology on their smart phones or even smart toilets. https://thecolbertreport.cc.com/videos/9nzwjt/vessyl-digital-cup

I am sure these medical professionals roll their eyes when a patient starts a sentence with “Well, WebMD said…” Now it will be, “my smart phone said …”

Medical Professionals need to realize that when someone is ill, they are looking for actionable information. If you do not guide them to the right information, they may find the wrong information. Patients need to feel like they are partners in their health care process. The best medical advice or treatment plan from the best doctor is worthless if the patient does not follow the plan.

In the presentation by Jordan Shlain, MD and Ben Rosner, MD, PhD of HealthLoop.com: “Why Healthcare is not Like Instagram - Redesigning Healthcare for the IoT” they highlight the following key points:

• “Healthcare is a people business in need of technology, not a technology business in need of people.”
• “Healthcare at its best is a conversation between a doctor and a patient trying to solve a problem”
• “WHAT PATIENTS WANT…
  • To live their lives with minimal impact of illness
  • To have trust in their medical teams
  • Convenient communication channels
  • To get support and sense of control
• “WHAT DOCTORSWANT…
• Practice medicine without hassle factor
• Actionable information
• Incentives that make sense
• Innovation that really makes a difference
• Improve reputation via great outcomes”

The startup community is extremely interested in improving the health of people. As stated in the StartUp Health Insights Annual Report: 2014: The Year Digital Health Broke Out “Funding in 2014 more than doubled from last year with $6.5B invested compared to $2.9B in 2013, with each quarter in 2014 attracting more capital than all of 2010. Signs of a maturing market continue, as investors place larger bets on fewer companies.” The top 4 area of investment all are related to Actionable Information:

1. Big Data / Analytics $1.46B
2. Population Health $1.14B
3. Navigating the Care System $974M
4. Diagnostics $962M

I am encouraged to see what IoT and wearables can bring to improve health. If it was easy, we would all work to improve our health. The problem is we usually only focus on our health when we have a problem. “Personalize, Preventive, Predicted and Participatory medicine” are the keys to improving heath. Abraham Lincoln said “The best way to predict your future is to create it.” I am encourage that so many people are investing their time, talent and treasures to create a future to help people improve their health and I am excited to see what the future holds to make a healthy world.