Power to the Patient: Health Apps, Data & Biosensors Redefine Healthcare

New biosensors, health data, digital access – not to mention, expectations – are redefining the doctor-patient relationship one app at a time.

Original Article By Chuck Salter – Fast Company Content Studios

Until recently, the notion of a more informed and independent patient was more promise than reality. But thanks to a new wave of biosensors, smartphone apps, and innovative medical services, the age of the Empowered Patient has arrived. He is armed with exhaustive healthcare data, more than at any moment in human history, and that data is poised to multiply in the coming years – data about his day-to-day fitness, his genetics, his blood work, patients who are similar to him, his doctor, even the doctor’s notes scribbled on the medical chart.

The torrent of information engenders expectations that are reshaping the one relationship that has traditionally defined healthcare: the relationship between doctor and patient. The Empowered Patient population expects greater access to their physician and any medical particulars, from genetics analysis to pricing. When it comes to care, they expect to be part of the decision-making process, a departure from the profession’s ingrained paternalism. And most demanding of all, they expect options.

The result is a moment of unprecedented change for the $3.8 trillion U.S. healthcare industry. The various players are trying to figure out how even the most elemental aspects of healthcare should work going forward. Should doctors email and text with patients? Allow patients to read their exam notes? “We’re in a field of medicine that none of us is familiar with,” says Dr. Robert Wachter, professor and associate chair of the department of medicine at the University of California, San Francisco, and author of the upcoming book, The Digital Doctor.

Dr. Eric Topol, a pioneering cardiologist, believes that healthcare is experiencing its Gutenberg moment.  In his upcoming book, The Patient Will See You Now, Topol writes that just as the movable-type printing press liberated knowledge in the 15th century through the written word, empowering the masses as never before, the smartphone liberates healthcare and empowers patients to a new degree.

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Smartphones are now used by nearly 60 percent of Americans, according to the Pew Research Center. As a result, much of modern healthcare can be not only mobile but also instant. It’s the antithesis of the typical experience at a jammed-up doctor’s office, where the average wait time for an appointment is nearly three weeks and the time spent waiting in the office is nearly 20 minutes. American Well, MDLIVE and other companies now offer 24-hour virtual access to a doctor – the new frontier in telemedicine.

Smartphones can even replace doctors for certain medical needs. Using patients’ digital photos, apps such as SpotCheck and DoctorMole help identify potentially cancerous moles from benign ones, eliminating unnecessary appointments. Other apps such as Medicast and Pager apply a modern twist to a traditional service, allowing you to find a local doctor for a house call (or office or hotel call) any time, day or night.

Patients can also tap their way to sites such as PatientsLikeMe, which connect patients suffering from the same condition, and Smart Patients, which links patients and clinicians to talk about the latest trials and other medical research.

A smartphone, Topol suggests, upends the old paternalistic relationship. The patient is, in effect, promoted to COO, “who monitors all the operations of the body.” He reports to the doctor, who as CEO, offers guidance but doesn’t micro-manage.

Power play

If the dramatic changes and their implications sound familiar, they should. What’s happening in healthcare is similar to the democratization of information that digital technology brought to real estate, retail, entertainment, journalism, and other fields. “Whether you’re talking about an actual revolution fomented by Twitter or disruption by a service like Uber or Yelp,” says Wachter, “technology creates a lever by which people who have trusted experts say, ‘I can have much of the same data, and I can make my own decision,’ which is thrilling and correct in many ways, yet also fraught.”

In healthcare, the shift is particularly fraught. “Doctors are massively conflicted about this,” Wachter says. Many are thrilled to work with patients who are more informed and engaged in their care but also worried when the stakes and the anxiety are high and medical issues are far more complex than, say, refrigerator reviews. “Most of the stuff I learned from medical school and residency now can be found by patients with a good Google search,” he says. “But the problem is they also find gobbledygook. You have to parse that, and that’s what I learned to do in those eight years.”

Patients are encountering new-found access to their now-digitized medical record, which offers benefits as well as unintended consequences. In a handful of hospitals, a program called OpenNotes tested the impact of physicians sharing exam notes with patients. The experiment led to better outcomes; after a year, about two-thirds were more inclined to take their prescribed medication, a common problem in healthcare. And nearly all of them wanted continued access to their charts.

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But opening up the notes for patient consumption can also affect how doctors work. A physician’s job is considering all the possibilities for a given set of symptoms, even the most remote and life-threatening. While everything may indicate seasonal flu, says Wachter, chief of hospital medicine at UCSF Medical Center, “I’m not doing my job if I don’t say in my notes, ‘ wonder if TB or lupus or lymphoma may be present.’ In the old days, those are reminders to me or to my colleagues so they know what I was thinking. But I’m reluctant to write that if I know you’re going to see the note. You want me thinking it and writing it, but not saying it to you.”

Body of data

The rise of the quantified self is transforming patients into walking databases. A host of new wearable sensors and apps can track our sleep patterns, our caloric intake, our heart activity, everything. The next step is integrating all this data into the healthcare system to anticipate and even prevent issues.

Chances are, your doctor won’t be crunching the numbers (just as he won’t be explaining the nuance of genetic probabilities in your 23andMe DNA report). The technology will give rise to a new specialty or service, a care team focused on separating the signals from the noise. “The amount of information that a smart care team would have about a consumer is at least 1,000 times greater than what we had before,” says Tom Main, a partner at Oliver Wyman and consultant specializing in healthcare innovation. “The expectation is that the care team would receive the body narrative in real time every day.”

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The ultimate expectation is that remote or passive monitoring will keep us out of the doctor’s office. It’s already happening with people suffering from chronic diseases. Increasingly, because they’re wearing sensors, says Main, “they’re expecting their medical provider to prevent all ER visits and avoidable acute exacerbations of the diseases.”

That’s a significant boon. By staying healthier, these individuals avoid the most expensive care.

From patient to consumer

This industry-wide transformation is “the biggest business opportunity of our lifetime,” says Main. The more routine aspects of medicine will lead to more options and allow patients to shop by price, convenience, or reputation.

Theranos, a Palo Alto company that’s revolutionizing blood diagnostics, is one of these options. Started by Elizabeth Holmes when she was a 19-year-old Stanford sophomore, Theranos has created an innovative method to perform dozens of medical tests using a pin prick of blood, as opposed to the conventional vial or two. Results are ready the same day, and the process costs far less than traditional testing. With its rollout in Walgreens stores across the country, the company is making a more comprehensive blood test more convenient.

“We’re on the verge of the next generation of home-based diagnostics,” says Main. “Think about the home pregnancy test. We’ll have 50 or 100 tests like that within a few years – strep or not, elevated cholesterol or not.”

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The combination of more convenient and DIY alternatives makes the unthinkable possible: the doctorless patient. Not in every case, of course, but in some, enough to reduce Americans’ 600 million or so general practitioner visits a year. If 4o percent of those appointments are replaced by virtual visits or other services, that represents a $60 billion market, according to the consulting firm Deloitte.

A prescription for transparency

Just as people now have information at our fingertips about virtually any consumer product, we also know more about doctors and their practices, too. Healthgrades, RateMDs and other sites include patient ratings and reviews, and in the case of ZocDoc, even doctors’ availability. It’s only a matter of time, says Main, before today’s byzantine and secretive fee structure is simplified and shared in this emerging consumer healthcare market. You’ll pull out your smartphone and decide if you want to instantly book, say, a $40 telemedicine appointment, a $45 kiosk appointment, a $50 Walgreens appointment, or a $90 primary care visit, and you’ll know the waiting time and patient rating for each option. For a more complex procedure, like knee-replacement surgery, you’ll know the price and have a guaranteed outcome.

“The notion that providers begin to compete with each other in a transparent consumer marketplace is, in my mind, the single most exciting and powerful thing that can happen,” says Main. “You have a talented group of people who would be highly innovative in a $3 trillion marketplace that has been opaque.”

The transition is underway. More sensors, services, and data are coming. The result is that we’re all about to become more empowered, more consumer-like, when it comes to our healthcare. “The hope is that, when the dust settles, you create a new normal,” says Wachter. “You learn to use all these tools in ways that work.”

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Jeff Dachis
Jeff Dachis

Jeff Dachis is CEO and Founder of One Drop. Type 1 LADA since September, 2013. Low carb, Pescatarean. Skier, Runner, Cyclist. DJ. West Side Story fanatic. Cheese lover. @jeffdachis