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Mike Johns: Healthcare’s New Home: Everywhere

”I’ve never had but one wrinkle, and I’m sitting on it,” said Jeanne Calment, who died of natural causes at age 122 as the oldest person on record in 1997.

 

While you can argue the actual number of wrinkles on her body, it’s more interesting to consider how Calment lived so far beyond average life expectancy when the vast majority of human lives are cut short by disease.

Recently, I had the opportunity to hear Mark Little, senior vice president and chief technology officer at the GE Global Research Center, explain how GE is monitoring and “diagnosing” jet engines during flight to avoid unplanned downtime. The discussion centered on this formula: machines + sensors + connectivity + cloud + analytics.

Listening to Little discuss how GE is converting the data gathered from flights into usable information, I was struck by the similarities between jet engine analysis and the future of medicine and healthcare — only in healthcare, we replace “machines” with “people.”

With the passage of the Affordable Care Act — which encourages and rewards health outcomes and the further integration of medicine, technology and entrepreneurism — we are living through a time of great transformation in healthcare.

We are moving from a physician-led, hospital-centric system to one that will be team-based and consumer-centric; from a focus on managing disease and sickness to an emphasis on health, wellness and prevention. And we are evolving toward a system where healthcare — like health information — is available anywhere, anytime.

Healthcare Whenever and Wherever You Want

The uncomfortable truth for traditionalists is that healthcare is no longer confined to the doctor’s office. In the near future, it will be available wherever you are and whenever you need it. Conventional channels of care will still exist — hospitals, clinics, doctors and nurses aren’t going anywhere. But they will be supplemented by mobile medicine — worn or implanted health monitors and wireless sensors that send information to the cloud to be crowdsourced and analyzed on the fly, just as GE is monitoring jet engines. Think healthcare = people + sensors + connectivity + cloud + analytics.

There is a profusion of wireless health monitors, smartphone apps, point-of-care diagnostics, telehealth and care coordination programs that gather person-specific information. The goal is to use this data to adjust or change your health at the precise moment in time that you need it. It also helps prevent hospital admissions and re-admissions, a tenet of the philosophy driving accountable care organizations.

Today, there are estimated to be more than 50,000 health-related apps for the smartphone. There are devices and apps that can monitor your heart rate, take your EKG and transmit it to your doctor. Yet a 2013 report by the IMS Institute for Healthcare Informatics found that of nearly 43,700 purported health or medical apps available on Apple’s iTunes store, only 159 were consumer-focused apps that could track or capture user-entered data. Fewer than 50 related to condition management or provide tools and calculators for users to measure their vitals. Clearly, we are at the beginning of a fast-growing area of healthcare and significant market opportunities exist.

Clinical Innovation + Technology

At the same time consumer-focused innovation is accelerating, innovation around the science driving medicine is experiencing a seismic shift. We are watching the expansion of molecular diagnostics — the result of the discovery of genomic and metabolomic markers that can diagnose disease before it occurs or at an early treatable stage.

Just look at the new approaches to measuring routine blood chemistries. A powerful new tool is being developed by QuantuMDx that employs precise DNA sequence-detection cartridges for looking at a specific disease, malaria. The device will take a finger prick of blood, extract the malarial DNA, then detect and sequence the specific mutations linked to drug resistance using a nanowire biosensor. The chip electronically detects the DNA sequences and converts them directly into binary code, which can be readily analyzed and shared with scientists for real-time monitoring of disease patterns. What is amazing is the potential it holds for eliminating costs and complexity that are barriers to care for infectious diseases in many places in the world.

And while we are talking about blood chemistries, why not replace them altogether when it comes to routine healthcare. Research by Dean Jones, a professor in the Department of Medicine at Emory University, has explained how most biomarker studies fail because human genetics, diet, environmental exposures and infections are too complex to address disease with a small number of measures.

Jones and other medical scientists have suggested that the only way to develop truly accurate predictive health models would be through routine, affordable and powerful blood chemistry analysis obtained over one’s lifespan. With this, we can analyze the metabolome, the adaptive interface between our environmental and behavioral exposures and our genome. Already, we can replace routine blood chemistry done as part of your annual physical with a high-resolution metabolomics analysis, for about $125.

Thermo Fisher Scientific makes a line of high-resolution mass spectrometers that make Dr. Jones’ work possible. He created a grid of 40 prevalent diseases, including the top causes of death and rising healthcare costs and already has data for 22 of these. With this database, the metabolome of any individual can be compared for initial classification and prediction, using Thermo Fisher spectrometers. Once a cloud version of the database is in place, cumulative data from annual physicals will enable the system to become increasingly more precise — similar to the concept used to build accuracy into weather forecasting.

Another important similarity to weather forecasting is using multiple predictive algorithms to check reliability. This will enable health professionals to do a better job and even provide real-time progress reports to patients using personal monitoring devices.

All these innovations and technologies will make healthcare more medically meaningful with personalized information that is accessible whenever and wherever we want it. This will take us to a new era, which Kenneth Brigham and I described in our book, “Predictive Health.”

Think about it. If smart health algorithms can replace clinics as the front line for health and sickness care, we will have enabled consumers to do their own physical exams at home. If wireless in-home measurement and monitoring of multiple health and physical parameters — including metabolites — can be fed into a cloud-based virtual health universe, the most common diagnoses can be made and treated at home with the help of the sophisticated analytics. Healthcare is everywhere!

So, it turns out that Jeanne Calment really is a presage to our future. We all may not want to live to be 122, but I believe many more of us will age with grace and die with painless dignity of natural causes — just like Calment — thanks to the countless, clinicians, scientists and health entrepreneurs that see opportunity in today’s health challenges.

Mike Johns is the University of Michigan’s interim executive vice president for Medical Affairs, as well as a professor in the schools of Public Health and Medicine at Emory University. From 2007 to 2012, Dr. Johns served as Emory University’s fifth chancellor. From 1996 to 2007, he led Emory’s Robert W. Woodruff Health Sciences Center. Prior to his roles at Emory, Dr. Johns was dean of the Johns Hopkins School of Medicine and vice president of the Johns Hopkins medical faculty.

 

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