Embracing the New Science of Medicine
By JACK COCHRAN and CHARLES KENNEY
Is healthcare in the United States entering a big-chill era?
Is it losing its warmth and humanity? Patients and physicians worry that computer screens wall them off from one another, thus transforming the flesh-and-blood patient into a digital construct as data override empathy.
While this point of view is not entirely unfounded, we believe it is a potential obstacle to medical progress in the digital age. Our country is in the midst of an awkward transition from the industrial age of healthcare to the math-based information age. While the transition will continue to be disruptive, the end result is greater access, quality, equity, and, perhaps most urgently, affordability.
The current transition period will also lead to another breakthrough era when data, technology, and artificial intelligence — thanks to the growing importance of mathematics as a foundational element in the healing arts — will advance patient care to a new level.
It is clear — though perhaps counterintuitive — that data and technology are leading to more personalized care than ever, liberating physicians from non-doctor work while enabling them to focus on more complex patients. Surgeon and author Atul Gawande observed some years ago that technology, “oddly enough, may be holistic medicine’s best friend’’ as it frees physicians “to embrace the humanistic dimension of care.’’
The data/technology combination covers both ends of the spectrum: enabling more comprehensive care for large populations of patients with chronic conditions while simultaneously facilitating more personalized care to individual patients’ unique needs.
Managing populations of patients with a particular condition such as diabetes can improve quality and length of life. Population management is limited by its broad brushstroke application of similar approaches to all patients. Data now enable physicians to target the individual needs of each patient within a population.
A burgeoning number of technology companies — ranging from tiny startups in Silicon Valley to IBM and GE — promise to turbocharge this work. Omada Health in San Francisco exemplifies many technology companies that are helping clinicians manage chronic conditions among large populations of patients. Ingestible sensors from Proteus Digital Health in the U.S. and Britain allow uninterrupted monitoring of patients’ medication levels 24/7.
Watson, the IBM supercomputer, has been developed as a cognitive system with advanced textual, image-processing, and visual-reasoning abilities that is able to gather information from across an enterprise and identify important elements in the data to help clinicians make decisions more quickly and effectively. In less than three seconds, Watson sifts through 200 million pages of research and provides a response at the point of care. Watson processed nearly 700 pages of medical records and images for a cancer patient at Memorial Sloane Kettering and, within seconds, recommended a drug treatment drawn from a two-week old article in an Israeli medical journal — an article the physicians might never have heard about.
When we look broadly at the imprint of this mathematical age of medicine, we are exhilarated by the power of data leveraged by aggregation and analysis. We see routine use of big data for risk stratification, decision support, and shared decision making. We see mathematical modeling augmented by genomic information.
The current transition period is difficult, but the medical community will maneuver through its challenges — sometimes awkwardly — to a new era when data and technology will support better population and individual care than ever before.
Dr. Jack Cochran is executive director of the Permanente Federation. Charles Kenney is author of several books on healthcare innovation. Dr. Paul Grundy, global director of healthcare transformation at IBM, and Dr. John Merenich, medical director of clinical informatics at Kaiser Permanente Colorado, also contributed to this article.