The Futurist

Dr. Eric Topol on a fu­ture with in­di­vid­u­al­ized medicine and a learn­ing health sys­tem

Modern Healthcare - - CONTENTS - BY DR. ERIC TOPOL

The great in­ver­sion of medicine, with its roots just start­ing to take hold now, will have been fully achieved over the next few decades.

In­stead of per­va­sive med­i­cal pa­ter­nal­ism that dates back cen­turies, each in­di­vid­ual will have much more than ac­cess to their med­i­cal data—they will be gen­er­at­ing and own­ing it.

The smart­phone, which en­gen­dered a rev­o­lu­tion­ary change in how we go about our lives, will ul­ti­mately re­place (with some key hard­ware at­tach­ments) the stetho­scope as the iconic sym­bol of medicine. It will be used to cap­ture biosen­sor real-time, real-world phys­i­o­logic data from any spe­cific or­gan or sys­tem of the body, to run routine labs and se­quence po­ten­tial pathogens, to per­form med­i­cal-grade scans of one’s body, to track en­vi­ron­men­tal ex­po­sures and food in­gre­di­ents, to do most of the phys­i­cal exam, and to con­nect with a doc­tor or health­care pro­fes­sional at any mo­ment in time.

But this pocket de­vice ca­pa­bil­ity will be much big­ger than just amass­ing mul­ti­di­men­sional data. No hu­man be­ing could as­sim­i­late the con­tin­u­ous flow of mul­ti­scale, tor­ren­tial data, which, in con­trast, is per­fect for ma­chines to process us­ing ar­ti­fi­cial in­tel­li­gence and deep learn­ing from and for each in­di­vid­ual. The out­put will be like that of su­per­com­puter IBM Wat­son, only to the 4th power, with al­go­rith­mic rec­om­men­da­tions yield­ing the ex­cit­ing po­ten­tial to pre-empt many acute med­i­cal con­di­tions—like asthma at­tacks, heart at­tacks, seizures, ar­rhyth­mias and heart fail­ure.

Such ex­ter­nal wis­dom of body guid­ance will be con­stantly fed back to the per­son us­ing their choice of voice, text or avatar com­mu­ni­ca­tion. Just as most peo­ple have so quickly and heav­ily come to rely on their smart­phones to­day for the pur­veyor of al­limpor­tant in­for­ma­tion, health and medicine will have been fully in­te­grated.

The doc­tor’s role will shift

This power of in­for­ma­tion and ma­chine sup­port will have a strik­ing ef­fect on the patient-doc­tor re­la­tion­ship, along with how clin­ics and hos­pi­tals func­tion. Since the patient is au­tonomously gen­er­at­ing most of the data with val­i­dated al­go­rith­mic in­ter­pre­ta­tion, the doc­tor’s role will shift to pro­vid­ing over­sight, map­ping out ther­a­peu­tic and pre­ven­tive strate­gies, and tap­ping into one’s knowl­edge base, ex­pe­ri­ence and wis­dom. Em­brac­ing the shift of much re­spon­si­bil­ity for data col­lec­tion to pa­tients, and its in­ter­pre­ta­tion by ar­ti­fi­cial in­tel­li­gence, the hu­man fac­tor of the doc­tor—es­tab­lish­ing trust and sup­port with ex­tra­or­di­nary com­mu­nica­tive skills and real in­tel­li­gence—will be in­dis­pens­able.

The phys­i­cal of­fice visit will be un­usual, save for very im­por­tant in­ter­ac­tions such as the dis­cus­sion of a new, se­ri­ous di­ag­no­sis. In­stead, com­pre­hen­sive data ex­change, far greater than to­day, will take place vir­tu­ally along with face-to-face dis­cus­sion. Both the patient and doc­tor will be equipped with aug­mented re­al­ity to see all of the data vi­su­al­iza­tion and pre­dic­tive analytics. The record of the visit will be cre­ated via nat­u­ral lan­guage pro­cess­ing, edited by the patient and the doc­tor (the lat­ter with the help of ma­chine learn­ing to ac­cel­er­ate it). The idea of us­ing key­boards or hu­man scribes will be as for­eign as pre-Guten­berg print­ing us­ing scribes.

Hos­pi­tals will un­doubt­edly be used quite dif­fer­ently than to­day. While in­ten­sive-care units, op­er­at­ing rooms, emer­gency care cen­ters and so­phis­ti­cated im­age equip­ment will be main­tained, the rest of the hos­pi­tal func­tions will be ex­ported to the home. Data sur­veil­lance cen­ters will be the norm to re­motely mon­i­tor large num­bers of peo­ple in a com­mu­nity, staffed by health­care pro­fes­sion­als to in­ter­vene when nec­es­sary. Of note, the hos­pi­tal in­for­ma­tion sys­tem of to­day will be con­sid­ered a relic.

Af­ter all the bil­lions of dol­lars that have been put into health in­for­ma­tion sys­tems in hos­pi­tals, how could these no longer be used or re­quired? The an­swer lies in the need to com­pletely de­cen­tral­ize the data to units of one or a few, rather than ag­gre­gate peo­ple’s data into thou­sands or mil­lions. Coin­ci­dent with this de­cen­tral­iza­tion is the in­for­ma­tion power shift that sets up in­di­vid­ual own­er­ship of all of one’s data—the bulk of which will be gen­er­ated by that per­son.

A peer-to-peer net­work, such as via a blockchain model, will be used to pro­vide each per­son their en­crypted data—in an elec­tronic wal­let or locker—to share when and with whom the in­di­vid­ual chooses. Fi­nally, the civil right of in­di­vid­u­als to own their med­i­cal data will have been ac­tu­al­ized through gov­ern­men­tal leg­is­la­tion.

One more thing that we’ll see by then: the plan­e­tary med­i­cal knowl­edge re­source. Med­i­cal data-shar­ing to help one’s fel­low man will be the norm when in­di­vid­u­als have out­right own­er­ship of their data, with­out con­cern over a breach of pri­vacy or rei­den­ti­fi­ca­tion. All the big data per in­di­vid­ual can be col­lated for more than a bil­lion peo­ple (some­day bil­lions) and near­est-neigh­bor match­ing anal­y­sis from this re­source will be crit­i­cal for se­lect­ing the best preven­tion and treat­ment op­tions. We will have reached the era of datafied, in­di­vid­u­al­ized medicine and a true, self-per­pet­u­at­ing learn­ing health sys­tem.

The civil right of in­di­vid­u­als to own their med­i­cal data will have been ac­tu­al­ized through gov­ern­men­tal leg­is­la­tion.

Dr.EricTopo­lis di­rec­tor oftheScripps Trans­la­tion­alS­cience In­sti­tute,chiefa­ca­demic of­fi­cerofScripp­sHealth and­pro­fes­so­rofge­nomics attheScripp­sRe­search In­sti­tute.He’sal­sothe au­tho­rof The Patient Will See You Now and The Cre­ative De­struc­tion of Medicine.

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