In 2011, during a domestic flight in the US, a man doubled over in pain where he sat. It was a fateful moment for his fellow passenger, cardiologist Eric Topol, who quickly came to his aid. Dr. Topol didn’t have any medical equipment with him but did have his smartphone, which allowed him to run an electrocardiogram (a charting of the heart’s electrical activity, ed.) on the man. Although nothing was amiss with the passenger, this event became very significant for Dr. Topol, who has since become known as one of the foremost proponents in the US for digital, patient-directed treatment. Dr. Topol was additionally able to demonstrate the potential of smartphones as a health care tool when, several years after the plane incident, he ran an ultrasound on himself using his phone and successfully diagnosed that he suffered from kidney stones.
Dr. Topol has gone out of his way to spread the word that we as patients will be able to take care of our health in the future thanks to smart technology and devices. his prediction is clear:
“One fine day, all blood samples that normally would be taken in a hospital or clinical lab will also be able to be carried out by smartphones.”
As a medical researcher specialising in wireless digital medicine, Dr. Topol’s point is that technology is democratising health care to such an extent that it will eventually make doctors superfluous. he imagines a future where both healthy and sick people assume a greater responsibility for their own health instead of being passive recipients in a treatment process that’s designed to only be understood by arcane health care personnel – a future where all of us can be our own doctor.
Dr. Topol calls this paradigm shift “medicine’s Gutenberg moment”. just as the printing press in the 1400s wrested the written word from the control of a small cadre of wealthy and powerful individuals, he believes new technology, ioT and especially the spread of smartphones is in the process of “commonising” medicine. in this new paradigm, the patients are in control of their own data and are freed from the tyranny of what Dr. Topol calls a “paternalistic health care regime”, where the doctor always knows best. It should be noted that Eric Topol is a doctor himself and is thus of course far more qualified to take his health into his own hands than the average patient would be. Today, six years after Dr. Topol’s plane episode, there are still very few people who know how to run an electrocardiogram on their smartphones – even if they theoretically have the technology to do so.
Although Dr. Topol represents the most die-hard faction of techno-optimists in the medical research community, he’s nevertheless not the only one who sees a future where health care is increasingly driven by technology at the individual’s disposal. A large-scale project by the Copenhagen institute for futures Studies in cooperation with 30 of the leading health care organisations in Denmark (and managed by one of this article’s authors) seeks to examine how health care will look in 2030. One of the project’s conclusions is that health care in the future will need to be more automated, data-driven, and self-sufficient in order for us to be able to respond to the coming demographic and economic challenges. instead of being large, centralised institutions, the hospitals of the future will need to act more like network nodes, where all the knowledge and data from a network of “satellite hospitals” are aggregated and analysed. If you’re suffering from one or more diseases, you’ll get unique insight into your treatment process via genetic data enabling treatment that’s tailor-made for you based on your genome (your genetic composition, ed.), your attitude toward health, and your lifestyle. The project paints the picture of a future where healthy people are much more engaged and interested in their physiological well-being.
HEALTH AND MOBILITY
In recent years, a seismic shift in our understanding of health care has occurred. It will potentially affect us all, and established health care institutions have already begun to adapt to this new reality. Our understanding of what it means to be healthy has changed from just defining good health as the absence of disease to focusing on clean, healthy living. Thus, we’re healthy when we actively prevent the risk of disease. And prevention is the ordre du jour for this shift in our understanding of health. On an individual level, preventative health includes everything from exercise and diet to high-tech self-monitoring. it’s all about well-being, life satisfaction, and social adjustment. Already today, some take advantage of wearables, various health apps, and online services like 23andMe, which analyse their genetic data and provide health advice based on their genetic profiles. we’ve become steadily more diligent in monitoring not only our health, but also our biological functions, psychological state and physical abilities. The booming interest in health is also reflected in the yoga business, which has experienced tremendous growth over the last decade.
One of the main driving forces for preventative health care – both with respect to individual health care systems and society in general – is online health care apps. Just as it’s become easier and simpler to do our banking and order package tours and rental cars online, “i-consultations” with doctors and psychologists have become increasingly widespread – especially in the US. According to a survey carried out by the statistics portal Statista in 2016, one of every five Americans had virtual doctor consultations and over half of those surveyed were “very interested” in more online solutions, such as dietary advice and psych consults. At Kaiser Permanente, which is one of the largest private health care insurers in the US, over half of their physician consults in 2016 were virtual, i.e. carried out via telephone, e-mail, or video. New opportunities in telemedicine and distance therapy using mobile technology can promote the use of these types of consultations and potentially improve their effectiveness.
But it’s not just the contact medium that’s become more mobile. In order for online consultations and treatments to be able to seriously change the way we practice health care, technology must be able to do more than simply facilitate communication. Today, we primarily use our smartphones for simple health care tasks, such as measuring our heartbeat, sleep cycles, or calorie intake, but more advanced task such as measuring O2 saturation or analysing blood samples are also becoming technologically possible. This development means that companies that aren’t traditional health care businesses, such as Google, Apple, and patient networks like Chronology.com, as well as numerous smaller start-ups, are now setting their sights on the health care market. In other words, the established health care system has increasingly become just one of many participants in a widely expanding health care network. The developments point toward a future health care universe where patients don’t revolve around different health care solutions, but where the services themselves orbit around the patient.
DOCTOR-PATIENT RELATIONSHIP TURNED ON ITS HEAD
In his 2015 book The Patient Will See You Now, Eric Topol calls the shift from doctor-prescribed health care to user-driven health care “bottom-up health”. The expression describes the fact that the doctor-patient relationship is being turned on its head, so the patient doesn’t just receive treatment and knowledge from one single practising doctor, but rather from several different sources. instead of a top-down health care paradigm, where doctors and nurses determine the role of the patient, Dr. Topol proposes that in the future, patients will determine the roles of health care personnel and health care systems. According to Dr. Topol, this paradigm shift is already technologically feasible, especially since our smartphones can replace many of the tasks currently carried out by doctors. Thus, he feels that smartphones can and will play a different and more significant role than just being passive sources of information. They’ll provide us with access to (and also the opportunity to edit) our own patient records and allow us to generate our own medical data. As Dr. Topol points out, the technology is already on its way here and the only question now is the extent to which patients will embrace it. Dr. Topol is optimistic on this front, but the wide variety of different mobile medical apps all require a considerable investment of time to learn. It’s certainly not a given that the average patient will be willing to do this.
As with all technological advances, technology doesn’t change things in and of itself – change occurs within a wider social and cultural context. Another possible future that’s different from Dr. Topol’s “Doctors without Patients” scenario is one in which technology and automation take over in some areas, but not all. The assumption here is that face-to-face contact with a doctor will still exist to satisfy a need for “hands-on treatment” and human contact that can’t be replaced by robots and self-diagnosis.
THE COST OF DISEASE IN THE FUTURE: CHRONIC AND DEMOGRAPHIC
Since we’re living longer and health care technology is providing us with better yet costlier options – not just for treating disease, but also for improving our general well-being – the strain on the health care system is increasing. The longer we live – with or without disease – the more health care services we require. And the better the quality and variety of health care services, the greater the demand. if we consider the trends of an ageing population and a growing global middle class in conjunction with new, advanced health care treatment options, then there is a risk that health care systems as we know them today will become overburdened and very expensive to operate. The world health Organization (WHO) estimates that the number of people 60 years and older will double by 2050. At the same time, the world’s middle class is growing rapidly and the demand for health care and treatment options from this larger middle class and ageing population is rising proportionately. Along with the chronically-ill and sufferers of lifestyle-resultant diseases, the elderly already constitute one of the largest health care burdens. And all calculations of the future health care burden point in the same direction: the challenges will only become greater. WHO also calculates that the number of diabetics will more than double from 1993 to 2025 and that 60 per cent of the global health care burden from chronic disease will come from developing countries. The main task will therefore be to tackle the challenges posed by ageing and chronically-ill patients and prevent the development of psychological conditions and lifestyle diseases. In regard to this, a challenge comes from the fact that the mobile health care options that could relieve the strain on our health care system primarily benefit the healthy and the privileged. A patient needs to have the time, resources, and knowledge to use new technology – this applies in particular to the elderly, the chronically-ill, and sufferers of lifestyle diseases. The imminent future promises not only a greater disease burden, but also new challenges in providing equal access to health care.
THE CONTROL TOWER: HOSPITAL OF THE FUTURE
Nevertheless, with the right organisation, part of the answer to these challenges can in fact be found in decentralised and automated solutions. The more patients that can be treated remotely, the less of a burden there is on hospitals, and the more automated and intelligent solutions are available, the more time and resources a hospital’s doctors and nurses have to spend on other tasks or on patients who aren’t able to monitor, diagnose, and treat themselves. One example of this is the O2Matic robot developed by the Danish iT firm PACTOR. it’s designed to improve safety for COPD patients (COPD is a widespread chronic lung disease, ed.) by ensuring that they receive constant, precisely-measured oxygen flow. Not only does it ease the burden on health care personnel, it’s also been shown to shorten the patient’s hospital stay. And many studies have shown that treatment and healing improve outside the hospital setting. A common attitude among health- care practitioners is that patient-focused solutions, wherein patients can control the treatment process themselves and more easily maintain their daily living habits, are also more meaningful for patients. With respect to sick and healthy individuals’ responsibility for their own health, there’s been a marked change in how we perceive hospitals. instead of being the focal point of all treatment, it’s possible that the hospital of the future becomes a type of control tower where teams of medical staff evaluate and react to data flows – a facility that simply houses the most expensive equipment for surgery or urgent care intervention. This is at any rate how The Cleveland Clinic, a not for profit academic medical center in Ohio, visualises the approach the hospital of the future will take. They’re in the process of re-thinking the functional design of their hospital and, among other things, are setting up remote iCUs, where both monitoring and patient care are done online from a type of command centre. instead of hospitals being equipped according to the needs of clinical staff and doctor’s shift rotations, they’ll be designed to serve the needs of patients – who are no longer patients in a traditional sense. bernard j. Tyson, the CEO of Kaiser Permanente, believes that we’re on the threshold of a completely new health care system, which requires a reboot in our perception of how hospitals should look and what kind of role they should have. He’s based Kaiser Permanente’s business model on the idea that the hospitals we have today are outdated. They operate under a “fix me” paradigm, but health is no longer simply about avoiding and treating disease. It’s becoming more and more about quality of life and disease prevention. This leads to a “care anywhere” health care model, where the hospital as we know it is replaced by a more decentralised model.
Dr. Topol expresses his vision in similar terms:
“The hospital as we know it today will end up going extinct,” he alleges in The Patient Will See You Now.
This may be a wild allegation but recent developments suggest that the most important tasks of the hospital of the future will be taken care of behind the scenes. One day a hospital bed may end up being your own familiar mattress at home and you’ll call all the shots on your own health care.