Balancing act: prevention and treatment in the doctor’s office 2050
As medical treatments become more proactive and less reactive,
visits to the doctor’s office will continue to change. We’ve already
seen a multitude of technological improvements that make a
healthcare visit less stressful, but what could these visits look
like in 2050?
Gillian Davies, Innovation &
Technology Management Specialist at Sagentia, explores.
15 October 2012
“Time to see the doctor,” a thought prompted by the feeling of
nausea that accompanies the lethargy that has dogged the past weeks.
Fortunately, the year is 2050 and my bathroom has become the new
doctor’s office. I come here as regularly as I like, avoiding the delays
of the waiting room and the inevitable cold I catch from my fellow
In the present era, growth of healthcare spend is slowing in
developed countries, but demand on healthcare services increases
driven by an aging population and prevalence of lifestyle diseases.
In an attempt to balance this dichotomy payers and providers push
for value in healthcare, a trend that looks to medical technology as
the enabler. Disruptive innovations in home healthcare and
telehealth technologies will be key to delivering the efficient
decentralised service required to balance the books of healthcare
The efficiency challenge is compounded by patients becoming savvier
about medicine; no longer happy to simply accept the old adage that
Doctor Knows Best. Public access to medical knowledge has boomed
with the internet, and is set to continue as more social media
platforms such as “Patients Like Me” enter the arena.
These platforms allow communities of patients to share knowledge and
experiences around disease, diagnosis and treatment. Informed
patients expect the best, often most expensive, medicines. Payers
and providers seeking to balance this are pushing for
stratified/personalised medicine, or precision medicine as
pharmaceutical companies are beginning to know it. Such medicines
work with diagnostics tests to confirm patient suitability and
inform therapeutic regimes — a boom for medical technology companies
that learn to speak the language of pharma.
Prevention of illness is another strategy encouraged by payers.
Integrated home monitoring networks that employ non-healthcare
professionals, like the Care Coordinators of New York based
Montefiore Medical Center, are reaping the rewards of proactive
monitoring. Montefiore reports in the Economist a 30%
reduction in hospital admissions of diabetic patients enrolled in
their home monitoring system. Across the pond similar drives are
underway, the UK Department of Health promoted smart phone health
Apps that should be ‘prescribed’ to patients by family doctors.
Back to 2050, and my reflection in the bathroom mirror is replaced
by that of a digitised triage nurse. She already knows my heart rate
and blood pressure; the sensors in the mirror measured them when I
touched the selection menu. That data has been processed in relation
to my genetic profile and medical history. The genetic information
was previously gathered by my GP and integrated with all my other
medical data in my personal healthcare record, stored in a cloud
Cloud computing and the masses of data it allows to be stored and
processed has the potential to benefit both the individual and the
community. For the individual it forms a comprehensive, centralized
medical database able to be regularly updated by a plethora of
telehealth and clinical diagnostics.
The cloud can manage big data of medical images and genetic
signatures as well as simpler in vitro diagnostic results.
This medical data is seamlessly accessed by the patient’s doctor;
providing a single consolidated resource available at the point of
care that captures disease progress, medical history, insurance
claims, lab reports and prescriptions. A platform that has potential
to improve accuracy, negate communication errors and ultimately
enhance healthcare efficiency.
The introduction of datamining tools allows us to go even further;
red flags will alert us to illness before symptoms develop enabling
prevention regimes. With personal healthcare records (PHR)
telehealth will come to maturity, and with it shepherd in home
For the community, cloud computing provides an exciting application
for big data tools. The analysis and visualization of anonymous
population data will allow the global tracking of disease to prevent
epidemics; new causes of disease and thus new ways to treat them
will be uncovered as a result of mapping health trends in
conjunction with interrogating physiological data.
At a local level we are already seeing results. Hospital systems
such as Seton Healthcare Family in Texas (US), which is using
datamining tools to uncover and implement new patient triaging
methods that are realising real efficiencies within the hospital
Back in the bathroom in 2050 I still feel unwell. My digitised
triage nurse, Sarah, speaks from the mirror to greet me. I can
respond in kind thanks to speech recognition and semantic search
software. I know that Sarah is actually a computer generated image
running through a set of clinical questions generated in response to
my symptoms, medical history and genetic profile, but still I like
the familiar face. Not surprising, as I selected the preferences for
my virtual triage nurse.
The algorithms that make up Sarah employ artificial
intelligence-like learning, constantly interrogating the data in my
PHR thanks to the wireless connectivity of my home monitoring and
telehealth tools. Sarah concludes that I most likely have a low
grade viral infection but recommends that if symptoms persist I get
a blood test when I’m near a kiosk.
First steps to the future
The scales of industry and government are already tipped in
favour of this image of healthcare provision in 2050. The UK
Department of Health is conducting the world’s largest randomised
clinical trial of telehealth technology, the Whole System
Demonstrator study. This year’s interim results revealed a
significant reduction in Accident & Emergency admissions, mortality
and ‘bad days’ as described by the patient. It speaks volumes that
the world’s largest public healthcare provider is promoting and
exploring telehealth in such depth.
However, there is still some way to go before these savings are
realised. Despite showing improvements in clinical outcomes, the
Whole System Demonstrator study has not yet shown a reduction in
healthcare costs. Medical technology companies that can innovate to
create telehealth systems that translate to savings in the overall
healthcare system will secure market penetration in the future.
A move to telehealth-enabled decentralised healthcare will bring
a new decision maker to the fore — the patient. Enabled by the
abundance of home monitoring and big data, the current shift to
primary care health provision will have moved further to
patient-centric health provision.
The emerging market of home healthcare requires consumer focused
sales and marketing, a very different behaviour for most medical
device companies. Consumer companies like Philips are already
leveraging their expertise and driving hard with home healthcare
divisions, while other companies such as Intel and GE form
partnerships to gain traction with their Care Innovations joint
Medical technology companies have traditionally focused sales
efforts on the physician as decision maker. Now we see teams of
physicians and hospital administrators working through committees to
grant procurement approval. Such committees focus on the balance of
clinical outcome versus cost, drastic changes in business models
Take for instance the ‘money-back guarantee’ approach of
pharmaceutical giant GSK. When it launched its kidney cancer drug
Votrient the company agreed a partial rebate to the UK's National
Health Service if the results of a study, known as COMPARZ, didn’t
favour their drug over rival Pfizer’s Sutent. Later this year the
study will conclude and GSK will find out if the gamble paid off.
Medical technology companies should consider whether similar
disruptive models could help secure their market position in 2050.
Balance is the key to success in the dynamic world of the
Doctor’s Office 2050. Whether it is balancing cost and clinical
outcomes, big data and privacy, prevention and treatment,
biopharmaceutical and medical technology, or consumer and medical
applications, start now and you may find the scales of 2050 tip in
Gillian Davies is a Senior Consultant in
Innovation & Technology Management at Sagentia, a global product
development and outsourced R&D company. Gillian has experience
spanning pharmaceutical, biotechnology and medtech industries and a
PhD in oncology.