Power to the Patient

By Catherine
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By Catherine Bolgar

Senior Patient Having Consultation With Doctor In Office

The explosion of chronic diseases threatens to be a major health issue in coming years, especially with the baby boomers entering old age. Getting patients to participate in, and assume responsibility for their own care, is key to keeping health care costs in line. In 2050, the number of people older than 60 is expected to reach 2 billion.

Indeed, health budgets are under pressure in all countries, causing a rethink of how to structure the way it’s delivered and paid for. For example, both the U.S. and U.K. are moving toward value-based or outcome-based care, with incentives for providers to coordinate care and improve quality of care, rather than payment based on the number of procedures done.

“The key word is going to be patient engagement,” says Felipe Lobelo, associate professor of global health at Emory University in Atlanta. “That means not just taking care of someone who’s sick, but also preventing someone from getting sick in the first place. The health-care system is going to be more proactive in working with people to make healthy choices.”

Doctor and patientOne study found that having a voice in decision-making led patients to better adhere to treatment, with better outcomes. Another found that patients who used online systems to see test results, manage their medication list and exchange secure messages with their providers felt more in control of their own care and were more satisfied.

“The bigger challenge is what to do to keep patients well,” says Phil Koczan, chief clinical information officer at UCL Partners, a health-science partnership linking higher education and National Health Service (NHS) members in the U.K.

The difficulty is how to identify those patients, many of whom don’t see a doctor on a regular basis, and how to change their behavior.”

Five key behaviors are related to avoiding chronic disease—never smoking, regular physical activity, no or moderate alcohol consumption, normal weight and enough sleep. In a recent study, only 6% of Americans do all five.

While physicians try to offer advice and support to people with risky behaviors, “it’s quite difficult and time-consuming, and resources are limited to offer that sort of support,” Dr. Koczan says. “But there’s a lot of benefit if we can get it right.”

Wearable devices and mobile applications can help—if patients stick with them. A device “doesn’t say how to change eating habits or how to change exercise habits. It’s not personalized enough,” says Vibhanshu Abhishek, assistant professor of information systems at Carnegie Mellon University in Pittsburgh. “Devices need to get more personalized and give specific recommendations based on current behavior. Just walking 10,000 steps isn’t enough. It has to give goals and specific instructions to individuals—if I ate a big lunch, then here’s how much more I need to work out today.”

Devices are most useful “when the intervention is tailored to the patient,” agrees Dr. Lobelo. For each patient, “it needs to be tweaked. It’s a never-ending series of projects and applications, not one universal solution.”

Another aspect of prevention involves keeping patients with diseases or chronic conditions from becoming sicker. Most patients with chronic conditions are at home, not hospitalized, so no doctor or health professional regularly observes whether they follow the recommendations they’ve been given, Dr. Abhishek says. “Mobile apps provide an opportunity to collect this information in a cost-effective manner on a continuous basis. Using algorithms or health-identification tools, a doctor can figure out whether a treatment is working. It hasn’t been possible to do this in a generalized way because data collection has been so expensive. In the future we can say treatment A works for this type of patient, and treatment B works for this other type of patient, based on the data from mobile devices.”

Measuring the pulseA number of online platforms offer information and support for self-care by patients with different diseases. The University of Pittsburgh developed iMHere, a mobile health platform to empower chronic-disease patients for self-care under a clinician’s guidance. For example, iMHere aims to help spina bifida patients avoid secondary complications, such as skin problems and urinary tract infections, through remote monitoring, with clinicians sending patients customized treatment plans. Other programs aim to help cancer patients manage their care, such as managing the accumulation of lymph fluid after breast cancer treatment.

Health systems are going to be more proactive in working with people to make healthy choices,” Dr. Lobelo says. “Including patients—that’s the center of the whole thing. We want to encourage people to self-measure and use the data to improve their health. An active dialog needs to happen.”

 

Catherine Bolgar is a former managing editor of The Wall Street Journal Europe, now working as a freelance writer and editor with WSJ. Custom Studios in EMEA. For more from Catherine Bolgar, along with other industry experts, join the Future Realities discussion on LinkedIn.

Photos courtesy of iStock

How Medicine Makes Sense of Big Data

By Catherine
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Written by Catherine Bolgar*

Big data for Medical

Big data is a game-changer for medical research. The ability to analyze vast sets of information, thanks to bigger and faster computers, is helping researchers to understand diseases, tease out genetic factors and spot patterns.

More researchers are looking at big data and understanding how we can utilize [it] in a better manner,” says Ervin Sejdic, assistant professor of electrical and computer engineering at the University of Pittsburgh, U.S., and founder of its Innovative Medical Engineering Developments lab.

In the past, clinicians would get data from patients and hold it up to metrics to try to see something by looking among different patient groups. “What they’re doing is flushing out the details. But the devil lies in the details,” Dr. Sejdic says. “The details are where we start understanding things. What’s really shifting in medicine is the fact that, yes, there is data, but let’s look at whole data sets.”

At the same time, better and smaller electronics, from smartphones to sensors you can wear, can compile more information at a detailed level and over bigger populations. “Researchers are looking at the interactions between different physiological systems. Sometimes these interactions break down in people with various diseases. Sometimes you have to look at the level of a minute, or an hour, or a day,” Dr. Sejdic says. “What big data is going to enable us to do is finally look at a human system as a system, rather than as individual components put together.”

Big data also is helping doctors and researchers to view diseases in shades of gray, rather than with a purely black-and-white outlook.

In the past, diseases were viewed in a simplistic way: a person is healthy or a person has disease. We would get specific information about the two states and compare the difference,” says Sergei Krivov, research fellow at the University of Leeds, U.K., who recently published research on the monitoring of kidney-transplant patients using big data techniques.

With transplants, he says, “There are two outcomes: perfect or problems. We are trying to find a single parameter to describe where you are between these two stages and what is the prognosis.” Based on the indicator, doctors can decide at an earlier stage whether to intervene into the process.

What I would like to see in the future is the following picture,” Dr. Krivov says. “A sizable part of the population frequently gives blood for analysis, for example during regular visits to their doctors. This would go to a data center. Based on this data for five or 10 years, we could determine indicators describing the degree of progression or the likelihood to occur for different diseases. We will give back this information as numbers, which is easy to interpret. This, in turn, will encourage patients to participate.”

One indicator patients might get with this approach is their biological age. “So you’re 30 years old, but your biological age is 20—or 40,” Dr. Krivov says. “Changes in your diet, exercise or lifestyle affect biological age. You might get younger, biologically. That would be reinforcement to the patient that he or she is doing well.”

DNA moleculeSome recent uses of big data include predicting the future of metabolic syndrome, advancing neuroscience, identifying dangerous pathogens, and conducting cancer research, among many others. DNA sequencing is getting cheaper thanks to big data, and genetic sequencing with big data is becoming a key part of epidemiology, because it helps trace chains of infection. Big data is helping researchers not only to understand the different genetic mutations in cancer, but also to personalize medicine: different mutations respond differently to treatments, and getting the right treatment straight away spares patients from side effects of treatments that aren’t effective for their particular kind of cancer.

However, challenges remain for big data to reach its full potential of analyzing many kinds of information from many patients. With computers, it’s “garbage in, garbage out,” so data needs to be structured to ensure consistency. Information often isn’t shared because organizations lack procedures or systems for communication. Advances in technology are helping to overcome some of those challenges, according to “The ‘Big Data’ Revolution in Healthcare,” a study by McKinsey & Co.

Big data is still a work in progress in medicine. “If a certain number of people have a disease, the task of searching for them will take minutes instead of days,” Dr. Sejdic says. “But for other things, it will still take days because you need to develop software first for analyzing the data.”

Too much data can be a problem, too. “When you know what you want to find out, it’s a much easier problem,” he says. “But if you’re looking for new patterns, it’s more of a fishing expedition. Whenever we do clinical trials, we are flushing out the details. There’s so much information that it’s hard to track it. Until we do that, we won’t have a good understanding. The major change will occur in the next 10 to 15 years.”

*For more from Catherine, contributors from the Economist Intelligence Unit along with industry experts, join The Future Realities discussion.

How to Make a Human Heart

By Alyssa
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A pain in your chest that quickly spreads to your arm causes you to fall to your knees. Inside your body, oxygen-rich blood that normally flows to the heart muscle is suddenly blocked. If blood flow isn’t restored quickly, your life hangs in the balance.

Chest pain

In the United States, someone has a heart attack every 34 seconds. While stents, transplants, angioplasty, by-pass operations, drugs and improved patient care have dramatically cut deaths from heart disease, it remains the number one killer. The World Health Organisation (WHO) estimated in 2013 that the disease globally accounted for 17.8 million, or one in three, deaths.

But what if one day doctors could simulate an exact replica of your heart, imitating its unique electrical impulses, muscle fibre contractions and potential abnormalities? The model would not only allow doctors to observe how the heart had changed after the attack to help treatment, but might even have prevented it in the first place.

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