One of the recurring themes at the recently-concluded Precision Medicine Leaders Summit in San Diego was how to digest the plethora of information available in healthcare. Whether it’s coming from next-generation sequencing, electronic health records or consumer devices, how do clinicians and patients make the data useful? “In chronic disease, if we don’t solve the problem of how to adapt these tools to clinical practice and patient care, we’re not going to make much progress,” said Michael Hodgkins, chief medical information officer at the American Medical Association, to the audience. “You can’t manage patients who have chronic diseases in the four walls of the clinic. You have to meet them where they live.”
Hodgkins outlined a host of problems, starting with the sheer numbers of devices and apps. He noted that devices can monitor heart rate, blood pressure, glucose and other functions, generating thousands of data points each day, but clinicians don’t have time to drink from that fire hose. “Let’s not confuse the exchange of data with the exchange of knowledge,” he said. One problem is that physicians and developers aren’t communicating. A recent AMA survey found that docs want clinical evidence, but they also want to know how they’re going to be paid and how these tools will affect their daily routines. “How adaptable will it be in a way that creates efficiency rather than disrupts the practice?” asked Hodgkins.
But connectivity is going way beyond remotely monitoring vital signs. A whole generation of connected inhalers, injectors, packaging, and pills are just over the horizon. “Asthmatics can now have solutions that take environmental data, weather data, traffic data, etc., and combine it with their use of therapeutic inhalers,” said Don Jones, chief digital officer at the Scripps Translational Science Institute. One of the issues is making connected pharmaceuticals prescribable. The sheer complexity of these systems can make that seemingly simple equation look daunting. But there also may be the problem of unintended consequences when patients use devices to monitor their vital signs, predicted Jones. “Large numbers of patients, with wearable devices that continuously monitor their blood pressure, will be in a feedback loop,” he said. “And what are they likely to do with that feedback loop? Self-titrate.”
Zakiuddin Ahmed is project director for [email protected], which stands for Remotely Accessible Healthcare at Home, at King Saud University. The program integrates devices, apps, telemedicine, electronic health records, patient education and other functions into a single platform. “The monitoring is the sexy part of connected health, but I believe that patient education, engagement, and influence are key important factors,” said Ahmed. “Otherwise you get carried away with technology.” Circling back to the earlier point, Fishburn wondered how physicians feel about this level of connectivity. Ahmed noted that the patients are connected to a response center, where the queries get triaged by a team of clinicians. Physicians are notified in emergent situations, or earlier if they prefer.
Not surprisingly, the panel kept coming back to data handling. How do we use device data to improve care? Earlier in the panel discussion, Fishburn had asked the audience to raise their hands if they’d ever used a wearable and keep them up if they still used one. Many hands came down. Journalist David Ewing Duncan was not surprised. “I think one of the reasons a lot of you lower your hand is once you get over the initial excitement of ‘oh wow, I went that many steps today,’ then what?” he said. “I think when you take this to physicians, they really don’t know what to do with it.”