Published on December 9th, 2014 | by David Bott0
People get ready…
Being healthy is one of the basic needs of humanity. For centuries we have treated illness once it occurs but are increasingly aware that we could prevent it and preserve good health. Meanwhile the risks to health are changing, our understanding of diseases is increasing and the tools of technology are evolving to meet our needs, so we ought to have a plan.
There are three, very different, factors that are causing us to have to look again at how we approach health and care.
The first is the changing nature of the health challenges we face. Having mostly addressed childhood diseases in the developed world, and identified some of the more common self-inflicted problems, we are now living longer. That means we are running into the degenerative diseases that affect older adults. We are also travelling more and therefore spreading exotic diseases into populations that are not immune or at least resistant to them. This alone means that the way we approach health has to change.
The second factor is our growing understanding of how diseases affect our (human) biology and the way they impact on individual patients. We have realised that the symptoms we observe are indicators of the underlying biological problems that cause disease, and are exploring these – even down to the molecular level. However, we have also realised the complexity of most diseases and the need for co-ordination of multiple diagnostic techniques to identify the specific way a disease affects a specific person.
The final factor – and one that we can use to offset the extra challenges caused by the first two – is the huge developments in digital technology. We can now collect, analyse and interpret information about ourselves (sometimes called “biomarkers”) and see long-term trends about our basic physical well-being and the progression of diseases. However, making this work inside the existing way we do things can cause its own challenges.
There are three main types of information that we can identify within the evolving health and care system:
There is the information that we increasingly collect ourselves. A growing number of people use a whole range of self-monitoring devices to collect information about their own health over time. Whether it is your weight, the number of steps you take, the changes in your pulse rate when exercising, your blood pressure or your blood oxygen level, all these data can be used to indicate how healthy you are. At the more sophisticated end of the spectrum, you can even have your genome read – although the detail depends on how much you are willing to pay. However, this is an unregulated and non-standardised market and the accuracy of the data and its ownership is still a matter for debate.
There are also data collected by doctors. This is part of the diagnostic process – a process which is getting more complicated. As well as measurement of parameters we are used to (temperature, pulse, blood pressure, blood components and so on) we are increasingly using imaging to understand the physical nature of disease effects. We are familiar with X-rays, but have learned the power of Magnetic Resonance Imaging and a whole range of more specific ways to see what is going on inside our bodies – as it happens. All these different sets of data have to be shared between doctors and consultants, GPs and hospitals and used in combination to identify the specific effect of the disease on the individual patient. And all this has to be carried out in a confidential and secure manner.
Finally, the pressure on all health services caused by the increased number and complexity of unhealthy patients means that we need to improve the efficiency of the medical system at many different levels. This is analogous to the change from craft to industry in manufacturing and it is not surprising that there is crossover between the established field of manufacturing efficiency and hospitals and general practice workflows.
The developments in these three areas are not separate. Although the personal information is currently not routinely used in diagnosis, if its provenance and quality could be better assured and securely communicated, this information about a person’s health over time could be an important input to accurate diagnosis. Also, feedback from the data provided by the doctors and hospitals could be used to modify self-help health regimes to make them even more effective at keeping people healthy and fit. Similarly, knowing the average journey patients with specific diseases make through the health system is vital to ensure the system is optimised for the real world and not an “average” patient.
So, there are plenty of opportunities to make the health system that looks after all of us more effective at preventing us from falling ill in the first place, providing early therapy to inhibit or stop the progression of a disease and treating us as quickly and effectively as possible if we do fall ill. The problem is that we already have a system designed for an older approach – to treating sick people. It has legacy systems for collecting and communicating patient data that cannot cope with the scale and complexity of what we need for this new approach. And it seems to be permanently short of money. The new frontier of user-collected health data needs to recognise its potential contribution to healthcare and either standardise itself or submit to government regulation.
Everyone knows that we have to change, but change will be difficult and cost money. The change is coming, it’s just a matter of how long it will take, and since it is the patients who will lose out if it takes longer, we need more information about what is possible and when we will currently get it, and a debate about whether that’s good enough.