As governmental leaders and public health experts around the world struggle in their efforts to deal with the Covid-19 pandemic, we look forward to the day when effective vaccines and therapeutics put this troublesome episode behind us. When this happens, we are likely to come out of this pandemic with a firm resolve that this must never happen again. Hopefully, the sense of urgency that will spring from this resolve will open our eyes to a far more serious public health crisis that has been hidden in plain sight: a digitally primitive healthcare system.
One of the most disturbing facts about dealing with pandemics is that there has been little innovation in battling invisible enemies. In speaking about the SARS epidemic of 2003, Dr. Anne Schuchat, Principle Deputy Director of the Centers for Disease Control noted, “The only tools we had to control SARS were the ones we’ve had for hundreds of years.” In other words, the tools used to fight pandemics in the Agrarian Age are the same ones we are using in the Digital Age.
How can this be when we supposedly have the most advanced medical technology in the world? The answer is rather simple. The healthcare industry is a woeful laggard in embracing the digital revolution. While our physicians and hospitals may have state-of-the-art digital machines, these machines are not connected, depriving us of the sophisticated data analytics that are commonplace in other industries. The troublesome fact is that, despite being the most consequential industry from a human life perspective, healthcare may very well be the least digitally transformed industry in the world.
If we want pandemics to never happen again, we will need a moonshot project to digitally transform the fundamental practice of healthcare. While transforming healthcare may sound like a tall order, we know it is possible because a similar transformation that we now take for granted has already radically changed how we get from here to there.
A Framework for Digital Transformation
In the 1990’s, if you were commuting to work or embarking on a long-distance trip, you relied upon experts to guide you through your journey. Airborne reporters provided regular traffic reports and suggested alternate routes every ten minutes on local radio stations. For the most part, these frequent reports were very helpful. However, because airplanes and helicopters can’t be everywhere at once, traffic reports sometimes missed an accident on the other side of town or advised of a slowdown that had already cleared up.
Similarly, before setting out on a long distance drive, people would visit their local automobile clubs where staff would prepare customized booklets to map out the best routes for completing their journeys. While these maps were useful for trip navigation, they, understandably, were incapable of providing real-time information about traffic conditions. Despite these glitches, people were appreciative and understood that the traffic experts were providing us with the best information that was humanly possible at the time.
Today, airborne traffic reporters and customized automobile club booklets are obsolete as the individual experts have been replaced by artificial intelligence (AI) applications. The most popular app is Google Maps, which is used regularly by over a billion users. Real-time data analytics derived from a digital information network have supplanted expert observations to provide a far superior navigational experience.
This game-changing application is possible because mobile phones are interconnected by the Internet of Things (IoT) into a global network that expands the volume of data stocks and accelerates the velocity of data flows far beyond the capacity of the single human brain. As this data is continually collected, the network uses sophisticated AI algorithms to recognize traffic patterns and volumes to provide a comprehensive picture of actual road conditions as well as automated customized alternate routes when traffic warrants. Google Maps is, in effect, a limitless brain that has the capacity to view the state of the entire world’s traffic in real-time.
If we can build a rapid intelligence framework to radically transform how we navigate traffic, why can’t we use this framework to build a similar capability to change the way we practice medicine? While the healthcare challenge will certainly be greater than traffic navigation, the technological and organizational building blocks already exist. All we need is the will to think differently.
The Digital Future of Medicine
Jeremy Rifken, the economic and social theorist, describes the emerging IoT as the first smart-infrastructure revolution in history. This infrastructure will connect every person and every thing in an integrated global operating system that will rapidly take shape over the next decade as the number of sensors grows at exponential speed. In 2007, there were 10 million sensors, by 2013 we achieved 3.5 billion sensors, and by 2030, it is projected that 100 trillion sensors will connect to the IoT.
The IoT transforms intelligence by making everything more intelligent. This is the phenomenon that we take for granted when we use Google Maps. The mere act of connecting the mobile phones of all the drivers on the road creates the capability for a level of intelligence that greatly exceeds the thinking capacity of any single person. This means that connected intelligence is able to think more resourcefully than individual experts.
For example, one of the most valuable attributes of the IoT is its ability to recognize weak signals before they become strong ones. Weak signals are patterns that a human mind doesn’t notice because these signals are usually understated when they first emerge and are easily missed. The technology to rapidly mine data to provide accurate early warning indicators is an example of how the IoT’s artificial intelligence gives us the unprecedented real-time ability to recognize troubling patterns well before they erupt into full-blown problems. Perhaps no industry would benefit more from an acceleration in AI applications than our current healthcare system.
While most hospitals today are full of smart devices, few of the sensors in these devices communicate with each other. This is about to change according to the recently published report by Great Britain’s National Health Service, Preparing the Healthcare Workforce to Deliver the Digital Future. Also known as the Topol Review, after its principle author Eric Topol, the American cardiologist and author of several books on the future of medicine, the report describes how the practice of healthcare will be dramatically transformed once sensors in devices and people are fully connected via the IoT.
In this new world of digital medicine, the IoT will be able to warn patients - at home via Amazon’s Alexa or on a smartphone - of blood clots before impending strokes or heart attacks. Sensors linked to electronic medical records will allow the IoT to quickly diagnose a patient’s likely physical state to assist emergency medical personnel and expedite treatment. Skin patches will capture vital data, measuring heart rate, food consumption, and other factors, and will communicate this information to patients and providers through third-party apps. And these apps, using sensor data will become vital conduits of healthcare, providing reliable instant diagnoses.
Rather than waiting for the presentation of symptoms, the IoT will recognize the weak signals of cellular anomalies, notify both patients and doctors through apps, and even set up doctor appointments. As the IoT matures and fully integrates with advances in biogenetics, it may automatically correct the medical malady and notify both patient and doctor of the aborted illness.
Digital healthcare technologies will have the potential to empower individuals to be more directly informed about their care. For example, genomics is likely to provide more accurate diagnoses of genetics-based diseases, allowing individuals to know their likelihood of developing one of these diseases and to take proactive steps to better manage their health. Advances in sensors and wearables will make it possible to bring diagnostics closer to patients, and the proliferation of bodily sensors, in particular, will enable a new generation of medical procedures, such as liquid biopsies that identify circulating tumor DNA in blood and other bodily fluids to better detect and monitor cancer. Perhaps most promising is the expanding capability of genomics to make corrections to an individual’s DNA that could lead to cures for previously untreatable maladies. This will be possible because genomic-editing and synthetic biology will provide us with the tools to “write” as well as read genomic information.
The Topol Review exhorts healthcare experts to recognize that we are at a critical juncture in medical history with the convergence of multiple transformative technologies that will usher in the new age of digital medicine: genomics, biosensors, artificial intelligence, and robotics. These emerging technologies will have a major impact on both what healthcare is and how it is delivered as the fusion of these digital applications enables a more holistic approach to both personalized healthcare and population health management.
A New Form of Intelligence
Until now the major roles in healthcare delivery have been individual doctors, nurses, and pharmacists, who are generally trained in highly compartmentalized specialties. The Topol Review sensibly points out that this is likely to change because, as healthcare becomes more data intensive and artificial intelligence becomes more proficient at instantaneously processing large volumes of disparate and complex data, the new digital medicine will require a more cross-functional approach that includes data scientists, computer scientists, engineers, and bioinformaticians. This highlights the new reality that digital medicine is indeed both digital and medicine.
The traditional healthcare system is designed to leverage the individual intelligence of the physician. Healthcare data and information is typically gathered and processed by individual health specialists whose judgments and opinions steer the course of patient treatments. This is also likely to change with the development of AI systems capable of making rapid and accurate diagnoses from the collective intelligence garnered from information gathered by the Internet of Things.
Amir Husain, the author of The Salient Machine: The Coming Age of Artificial Intelligence, makes the point that AI is not just another technology, it is a new form of intelligence. With its vast capacity to store information and its ability to rapidly process and retrieve information at the speed of Google searches, AI doesn’t need to engage in the heuristic short-cuts that are prevalent in all human professions. Medical doctors, like all other professional experts, are prone to construct mental narratives based upon their individual and shared experiences. However, these narratives, while useful most of the time, can often get in the way of accurate diagnoses. For example, a recent study from the Oregon Research Institute found that an algorithm was more effective at diagnosing cancer than a group of doctors and outperformed even the single best doctor.
With its almost limitless data capacity, AI is far more capable of thinking statistically and holistically, and, thus, is able to weigh the relative content of multiple perspectives in a matter of seconds. Should this happen, the locus of intelligence in the healthcare industry will shift from the individual intelligence of healthcare experts to the collective intelligence of AI systems. Digitization is likely to radically change the basic rules for how the healthcare industry works. It could also transform the tools we use to manage future pandemics.
New Digital Tools
Rather than defaulting to conventional thinking and authoritarian mandates based on centuries-old tools to manage the social interactions of whole populations, the combination of IoT and AI could provide us with new digital tools that would allow us to trust the evidence of data over the opinions of experts and to use a network to defeat a network. These networked tools would include sensors inside our bodies that could immediately identify the presence of a new virus at its origin, data analytics that could instantly assess the risk calculus of the pathogen, biogenetical applications that could possibly extinguish the virus, or customized risk mitigation guidance for individuals if needed. Additional tools might include online apps that could provide access to personal risk assessment tools and real-time data on the all-important actual number of infections as well as the true asymptomatic, recovery, and mortality rates.
Another important value of the digital transformation of healthcare is that we would no longer be dependent upon hardware to manage future possible pandemics. We are already hearing calls for the stockpiling of tests and equipment needed to be prepared for the next novel infectious disease. Despite such preparedness, however, we would still face the challenge of providing the most important hardware in the war against a future invisible enemy: vaccines.
Developing vaccines and manufacturing hundreds of millions of doses takes precious months, or even years, and is only possible after a new virus has presented itself. Digital medicine could be a game changer because the primary remedial protocols could shift from hardware to software, reducing the time for effective treatment from years or months to days or hours. The integration of sensors and biogenetics would make software treatment protocols a real possibility.
Connecting all the data in healthcare into a single global network could mean that there would never be another pandemic again. We just need to think differently and be willing to engage in what is clearly a moonshot project. Such an endeavor will certainly be difficult and challenging, but as President Kennedy urged us when he boldly challenged a nation to think big, “We do these things not because they are easy, but because they are hard.” If we learn anything from the Covid-19 episode, it’s that the time for a healthcare moonshot is now.