Dr. Bertalan Meskó, Director, The Medical Futurist Institute, Hungary
Technological transitions have taken place in healthcare before. However, in terms of the great number of novelties, as well as the scope of their applications in healthcare, what we are seeing today is causing a meaningful, qualitative transformation of the status quo at a rate never seen before. When personal computers became widely available in the 1990s, large hospitals and medical facilities began to store their medical records and general administrative paperwork, such as billing or scheduling, electronically. Later, with the advent of online networking, the world saw the birth of telemedical services. By 2016, the global telemedicine market was already valued at USD 24.9 billion, and the industry is expected to grow at an annual rate of 18.3% over the next four years.a The increased popularity of social media networks paved the way for the emergence of medicine 2.0 and health 2.0 in the early 2000s.
The rise of mobile phones, and later smartphones, then led to mobile health — otherwise known as mHealth. As the use of smartphones spread rapidly across the globe within just a handful of years, the development of healthcare applications inevitably followed. According to Grand View Research as reported in 2017, the global mHealth market is expected to reach USD 111.8 billion by 2025, growing at an annual rate of 44.2%.b
Since 2010, the rate at which disruptive technologies are emerging is prompting significant technological change in healthcare, resulting in a qualitative transformation for both patients and their caregivers. We are witnessing the beginning of a paradigm shift: artificial intelligence (AI), robotics, 3D printing in healthcare, wireless health sensors, and wearables or direct-to-consumer genetics are restructuring the patient–doctor relationship, as well as reconfiguring the entire organizational structure of medicine. The Medical Futurist Institute has come to define this phenomenon as digital health.cThe institute considers digital health tantamount to a cultural transformation, the reason being that disruptive technologies make digital and objective data accessible to both caregivers and patients. This allows for a more equal doctor–patient relationship, centered on shared decision-making and the democratization of care.
Patients Will be Empowered
Digital health contrasts with the more traditional, asymmetrical approach to the doctor–patient relationship, where the healthcare provider is the ultimate source of wisdom and knowledge, and the patient a passive recipient of the diagnosis, treatment, and outcome of the prescribed medical care. Based on the wide availability of information available today, as well as online patient communities, this older model is facing challenges, many of which may be to its detriment.
In today’s technologically-driven world, patients are more informed: they simply Google information, speak up, and ask questions of service providers. Medical professionals will have to accept this new reality and be proactive in suggesting trustworthy sources of information and digital health devices or services if they are to keep abreast of these developments. In addition, the modern healthcare professional must engage in forms of communication other than personal visits. If this does not come naturally, it is in their best interest to identify a tour guide to help them navigate the jungle that is current and future healthcare. Patients aren’t only becoming active shapers of their own health, a growing number of patients are also enjoying the opportunity to sequence their genomes and adjust their medication or lifestyle in accordance with the health risks that they identified. Thanks to a plethora of online patient communities, patients now have the means to recognize and address any gaps in their healing process. The online forum, diaTribe, a resource for diabetes sufferers, is just one example of this.d
According to the latest estimates provided by the World Health Organization, 422 million people suffer from diabetes worldwide, and the number is growing steadily. This means that 1 in 11 persons lives with the chronic condition, which may lead to stroke, blindness, heart attack, kidney failure, or amputation, daily. The management of diabetes is especially challenging considering that patients must monitor blood glucose levels day and night, follow strict meal plans, and measure their blood pressure and weight frequently. Diabetes sufferers are also required to undergo numerous blood tests throughout their lives. Several apps have now been designed to help patients, such as pocket-sized blood glucose meters by Dario and/or wireless glucose monitors by Medtronic. In the future, various electronic skin patches or digital tattoos could further improve the quality of life for diabetes patients.e
Meanwhile, true revolutionary empowerment, from the perspective of the patient, comes in the form of a grassroots movement called #wearenotwaiting, which aims to introduce a DIY artificial pancreas to the market. Reports indicate that the device is able to measure blood glucose levels independently and then determine the patient’s required dose of insulin. One of the leading figures of the movement Dana Lewis shared with The Medical Futurist how she built an artificial pancreas using existing technologies, emphasizing how it has eased her everyday life. When the US Food and Drug Administration approved the device in 2016, Lewis had already been using it for almost two years. Lewis’ experience is but one example of the positive benefits of digital medicine. That being said, there are also many potential dangers that come with the digital medicine movement. It is for this reason that regulators and healthcare professionals should work together with empowered patients to enable the safe and secure utilization of technologies in the medical field, both now and in future.
Artificial Intelligence Will Support Physicians
Research on computers’ ability to understand images, text, and videos in the form of artificial narrow intelligence (ANI) is skyrocketing. Medical imaging, healthcare data management, diagnostics, oncology, and several other fields could profit tremendously from the innovation of ANI. Data mining and analytics, coupled with algorithms that are able to learn over time, will have an impact on entire healthcare systems and on the flow of health system processes, but most of all on patients’ and doctors’ roles.
Medical professionals will be able to obtain information much faster and more easily. One of the most frequently used online resources for biomedical literature is PubMed, which contains 28 million citations for biomedical literature. Obtaining this information is time-intensive, but this can change with the help of IBM Watson, a program that can already process a million pages in seconds. It seems that we’ll soon get to the point when doctors will get a summary of the latest studies in their field as compiled by an algorithm.
ANI could also optimize doctors’ messaging platforms by prioritizing their emails and thus save invaluable time normally spent on the most tedious task in the healthcare sector: administration. IBM’s Medical Sieve could become the next generation ‘cognitive assistant’ with analytical reasoning capabilities and a wide range of clinical knowledge. The algorithm may well be qualified to assist in clinical decision-making in radiology and cardiology.
The impact of AI will also be felt in the field of diagnostics and the design of treatment plans. Precision medicine, targeted treatments, and personalized solutions will thrive as a result of these new technologies. Instead of one-size fits-all therapies and prescriptions, the medical community can move towards finding the most effective individual solutions, based on genetic information, personal data, or medical history. IBM Watson recently launched a special program for oncologists that is able to provide clinicians with evidence-based treatment options. Watson for Oncology has an advanced ability to analyze the meaning and context of structured and unstructured data in clinical notes and reports that may be critical to selecting a treatment pathway. By combining attributes from the patient’s file with clinical expertise, external research, and data, the program identifies potential treatment plans for a patient.
You may be asking yourself about the possibility of AI taking doctors’ jobs. This is unlikely as inventors may find it difficult to bestow algorithms with creative problem-solving and complex thinking abilities, as well as the capacity for empathy and altruistic patient care that remains (for the time being) unique to human doctors. It is important, however, to keep in mind that doctors who use AI will definitely replace those who don’t.
The Traditional Structure of Healthcare Systems Tumbles Down
Digital health makes it possible, then, to move from reactive care towards preventive and personalized care. Globally, the frameworks of healthcare systems have to be adjusted in accordance with the massive technology-driven changes we are witnessing, and decision-makers are advised to stay ahead of times.
The Canadian and New Zealand governments are making good progress in this regard by recognizing the current challenges in their healthcare systems and acting accordingly. Canada recently engaged several researchers, ethicists, entrepreneurs, and futurists to discuss the way forward and the government has since realized the transformative power of 3D printing, AI, and robotics. New Zealand is also in the process of shaping the country’s digital health strategy and, as a responsible government, is listening to its citizens and inviting them to express their opinions on the matter.