The progression of science in medicine has been as remarkable as it is relentless. From alchemy, chants, purges, and leeches, medicine has progressed to a deep understanding of human form and function through biology, anatomy, and physiology.
Microbiology and pathology revealed details and causes of diseases while chemistry and pharmacology opened the doors for advanced diagnostic testing and a variety of therapies. Physics added more diagnostic capabilities and additional options for therapy and genomics offers insight into more targeted individual care.
This history is marked by breakthrough moments: The germ theory of disease (1870), general anesthesia (1874), penicillin (1928), polio vaccine (1952), organ transplants (1960s), MRIs and CT scans (1971), and the Human Genome Project (2000). Billions of people benefit from these advances.
We are on the cusp of another breakthrough era when data, technology, and artificial intelligence — thanks to the growing importance of mathematics as a foundational element in the healing arts — will advance patient care to a new level.
The transition to this new era — well underway — is an uneasy one. Many thoughtful health care stakeholders fear technological overreach where patient privacy is threatened, computer screens wall off patients from doctors while technology chills a physician’s touch. The fear is that the flesh and blood patient becomes a digital construct as data overrides empathy.
We believe this view — though certainly not entirely unfounded — is flawed and threatens medical progress in the digital age. We recognize the often frustrating and awkward challenges clinicians and patients encounter during this period of disruptive digital transition, but we are convinced that on the other side of this transition lies better access, quality, equity, and affordability.
The transition from the industrial to the information age of health care is well underway, manifest by the increasing role of data and technology – the mathematical age of medicine where the physician’s brain contains important knowledge even as computers store vastly more information than any physician could conceivably hold.
It is clear — though perhaps counterintuitive — that data and technology are leading to more personalized care than ever, liberating physicians from non-doctor work and enabling them to focus on more complex patients. Atul Gawande, the surgeon and author, observed some years ago that technology, “oddly enough, may be holistic medicine’s best friend’’ as it frees physicians “to embrace the humanistic dimension of care.’’
The data/technology combination covers both ends of the spectrum: Enabling more comprehensive care for large populations of patients with chronic conditions while simultaneously facilitating more personalized care to individual patient’s unique needs.
Managing populations of patients with a particular condition such as diabetes can improve quality and length of life. The limitation of population management is its broad brushstroke application of similar approaches to all patients. Data now enables physicians to target the specific individual needs of each patient within a population helping to predict which patient needs a different therapy than others within the registry. This, in turn, improves outcomes while saving money by avoiding ineffective treatments.
A burgeoning number of technology companies — ranging from tiny startups in Silicon Valley to IBM and GE — promise to turbo-charge this work. Omada Health in San Francisco exemplifies many technology companies helping clinicians manage chronic conditions among large populations of patients. Ingestible sensors from Proteus Digital Health in the U.S. and U.K. allow uninterrupted monitoring of patient’s medication levels 24/7.
Watson, the IBM supercomputer, has been developed as a cognitive system with advanced textual, image processing, and visual reasoning abilities that is able to gather information from across an enterprise and identify important elements in the data to help clinicians make decisions. In less than three seconds, Watson sifts through 200 million pages of research and provides a response at the point of care. Watson processed nearly 700 pages of medical records and images for a cancer patient at Memorial Sloane Kettering and, within seconds, recommended a drug treatment drawn from a two week old article in an Israeli medical journal — an article the physicians might never have heard about.
A leading authority in the technology word, Vinod Khosla, co-founder of Sun Microsystems, argues that technology will enable “continual monitoring and ubiquitous information leading to personalized, precise and consistent insights. Hundreds of thousands or even millions of data points will go into diagnosing a condition and, equally important, the continual monitoring of a therapy or prescription.’”
When we look broadly at the imprint of this mathematical age of medicine, we are exhilarated by the power of data leveraged by aggregation and analysis. We see routine use of big data for risk stratification, decision support, and shared decision-making. We see mathematical modeling augmented by genomic information.
The current transition period is difficult, but we will maneuver through its challenges — sometimes awkwardly — to a new era when data and technology will support better population and individual care than ever before.
Jack Cochran is executive director of The Permanente Federation. Charles Kenney, is a health care author. Paul Grundy is global director healthcare transformation, IBM. John Merenich is medical director, clinical informatics & decision support, Kaiser Permanente, Colorado.
