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 patients.

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 expenditure.

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 system.

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 healthcare.

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 system.

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 venture.

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 have resulted.

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 your favour.

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.


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