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amithThe conventional model of medicine had only two players. The doctor alone had access to all medical information and his encounter with the patient was the only way to obtain health-related information. The dawn of the information age led to a change in the dynamics in this relationship. A consumerist model of healthcare has emerged where doctors partner with patients in managing the patient’s illness. The advances in systems biology, big data and consumer health care electronics will add patient data as a new element to the patient-physician interface. In the next decade, individual patients will generate billions of data points (Observations of daily living, symptom logs, biomarkers, genetic tests) that will reside in their personal data cloud. There will be development of analytical tools and models that will utilize this data to supplement the physician’s decision making and disease management. This patient cloud will interface with both patients his healthcare providers in a continuous, real time manner which will be paradigm shift in patient-physician interactions.

This new addition to the conventional patient-doctor relationship has the potential to improve the practice of clinical medicine. The typical patient-physician interaction is aimed at being a patient-centered and inclusive of the physical, psychological and social aspects of patient’s ailments. The physician-patient interaction is expected to provide emotional support to the patient and provide counseling and administer preventive services. All these demands compete for attention during the brief (20-30 minutes) patient encounter2. In the conventional model, the patient provides relevant information during this interaction. Often in real life patient might fail to recall key symptoms. They may omit mentioning symptoms if they feel that it is not related to their disease. One in four Americans have multiple chronic conditions, and its prevalence rises to three in four Americans aged 65 and older2,4. Multiple chronic medical conditions and the resultant long list of medications have increased the workload of the physician during the patient visit. The time constraints during patient visit leads to ineffective delivery of preventive services and decreased attention to psychosocial aspects of the patient’s illness2.

The personal data cloud derived intelligence can offload the physician and free up time during patient visit by presenting the clinician with summary of the main elements of clinical importance (medication compliance, symptom severity, quality of life etc.). The patient’s personal cloud will have more longitudinal data about the patient than what the patient is consciously aware during his visit to the clinic. It will serve as a virtual surrogate for the patient and will enhance the effectiveness of patient-physician interaction by supplying the doctor with accurate information on the trends in symptom severity and treatment effectiveness. It will serve to legitimize patient suffering by serving as a witness to the patient’s struggle and will hopefully lead to the quicker switch to alternative treatments and interventions and thereby letting him focus on psychosocial aspects of health care.

This future state of patient-patient data-physician interaction will have more room for empathy and connection. There will be more time to establish rapport and to collaborate in disease management. The detailed physical exam of the patient and psychosocial aspects of the patient’s illness will be thrust into the forefront of an office visit.

Self-management was defined by Barlow et al as “an individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences, and lifestyle changes inherent with living with a chronic disease9. The need to be diligent with maintaining symptom diaries or food logs are difficult for patients to comply and adhere to due to the need for active patient participation. The advances in technology can make way to passive data collection. In the future, the devices (Wearables, home based IoT devices, implants) can collect information passively from the patient as they go about their daily life. The symptoms that are forgotten after entry into the symptom diary, the occasional lack of sleep, the periods of inactivity and failure to take meds for a few days- all such information will be recorded and insights from these observations can be triggers for patient’s behavioral change and improved self-management. Predictive models based on patient cloud can alert patients who need hospitalization and thus allowing the patient to get medical attention quicker leading to improved outcomes5.

Empowerment is a process that facilitates patient participation with health care providers and is demonstrated by awareness of choices available for treatment and disease management. The patient needs to learn about incorporating patient cloud to aid in optimizing his health. The health care provider should train the patient to interpret the insight from the data cloud to help patient feel empowered and confident about his health. It is important to eliminate the fear and intimidation that might come with perpetual presence of wearables and the data cloud.

The patient’s personal health information will be collected by different sources (wearable devices, mobile apps and social networks) and stored in servers of different entities .The personal cloud will eventually become a digital clone of the actual patient. It will lead to an explosion in the abilities to run analytics on patient data to serve commercial and research interests. The patients also need to be made aware of the common good in sharing de-identified information for the purposes of data mining for research into cures for the disease2. The patient should have the freedom to share sensitive personal information with people and entities that they want to share with for only the duration of time they wish to do so. The laws surrounding the use of the data should be drafted to allow patient complete control of his data and consent processes should be of the same high standard as for clinical research.

The next decade is going to be exciting for healthcare. The developments in various fields (consumer healthcare electronics, systems biology) are going to result in a patient data cloud with billions of data points for each patient. There will be need for medical care to become predictive, preventive, personalized and participatory (P4 medicine) to incorporate the technological developments1,9.

References:

  1. Hood L, Auffray C. Participatory medicine: a driving force for revolutionizing healthcare. Genome Medicine. 2013;5(12):110. doi:10.1186/gm514.
  1. Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Primary Care: Is There Enough Time for Prevention? American Journal of Public Health. 2003;93(4):635-641.
  1. Thilakanathan D, Calvo RA, Chen S, Nepal S, Glozier N. Facilitating Secure Sharing of Personal Health Data in the Cloud. Eysenbach G, ed. JMIR Medical Informatics. 2016;4(2):e15. doi:10.2196/medinform.4756.
  1. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ: Canadian Medical Association Journal. 1995;152(9):1423-1433.
  1. Smarr L. Quantifying your body: a how-to guide from a systems biology perspective. Biotechnol J. 2012 Aug;7(8):980-91. doi: 10.1002/biot.201100495. PubMed PMID: 22887886.
  1. Multiple Chronic Conditions. (2016). Retrieved November 10, 2016, from http://www.cdc.gov/chronicdisease/about/multiple-chronic.htm
  1. Barlow J, Sturt J, Hearnshaw H. Self-management interventions for people with chronic conditions in primary care: examples from arthritis, asthma and diabetes. Health Educ J. 2002;61:365–378.
  1. Sit JW, Chair SY, Choi KC, et al. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial. Clinical Interventions in Aging. 2016;11:1441-1450. doi:10.2147/CIA.S109560.
  1. P4Medicine. (n.d.). Retrieved November 10, 2016, from http://p4mi.org/p4medicine

Dr. Amith is a physician with specialization in clinical pharmacology. He has experience in clinical research and pharma IT consulting. He is interested in intersection of health care and technology and the empowerment it brings to the patient. His interests include permaculture and trekking the wilderness.