Physician Patient

Archive for April, 2014

How will information technology (IT) affect the doctor-patient relationship?

Friday, April 18th, 2014

MPPA Colleagues,
Vivek Wadhwa opines that Medicine has become an information technology, and he cites examples of IT applications which can potentially provide a patient-centered approach to medical diagnosis and treatment. Clearly informatics is already transforming medical care and has great potential to improve the health and wellness of patients and populations. However, there are many caveats, and Wadhwa’s assertion requires important qualifications.
How and when are doctor-patient alliances necessary or enhancing to the application of technology and data? And, under what circumstances are professional physician-patient relationships actually necessary to achieve cost-effective patient care? Answers to these questions depend on the particular clinical challenge and the scope of practice for a given medical specialty. For example, how does one compare the work, value, venue, and necessary toolboxes for diagnostic radiologists, psychiatrists, cardiac surgeons, or forensic pathologists?.
Technology can enhance the personalization of medical care only when the indications, need for, and effectiveness of physician-patient alliances are explicitly identified and described. This varies greatly by specialty and the specific patient encounter or task at hand.
Patients and families are the ultimate arbiters of their health care quality, access, and cost — rather than governments or health care systems. Consumers are encouraged to weigh in on the use and impact of IT regarding care effectiveness and data privacy, and MPPA welcomes this discussion.

Vivek Wadhwa: How technology will drive the promising future of medicine

By Vivek Wadhwa

POSTED: 04/17/2014


Health care is a misnomer for our medical system. It should be called sick care. Doctors, hospitals and pharmaceutical companies only make money when we are in bad health. If we could instead prevent illness and disease, it would turn the entire medical system on its head and increase the quality of our lives.

The good news is that technology is on its way to letting us do this. It is now moving so rapidly that within a decade the small handheld medical reader used by Dr. Leonard McCoy in “Star Trek” — the tricorder — will look primitive. We are moving into an era of data-driven, crowd-sourced, participatory, genomics-based medicine. Just as our bathroom scales give us instant readings of our weight, wearable devices will monitor our health and warn us when we are about to get sick. Our doctors — or their artificial intelligence replacements — will prescribe medicines or lifestyle changes based on our full medical history, holistic self and genetic composition.

It wasn’t long ago when our only recourse when we doubted our doctor’s prescription was to seek a second opinion. Now when we need information about an ailment, we search on the Internet. We have access to more medical knowledge than our doctors once had via their medical books and journals, and our information is more up-to-date than those medical books were. We can read about the latest medical advances anywhere in the world. We can visit online forums to learn from others with the same symptoms, provide each other with support and discuss the side effects of our medicines. We can download mobile applications that help us manage our health. All of this can be done by anyone with a smartphone.

Our smartphones also contain a wide array of sensors, including an accelerometer that keeps track of our movement, a high-definition camera that can photograph external ailments and transmit them for analysis, and a global positioning system that knows where we have been. Wearable devices such as Fitbit, Nike and Jawbone are commonly being used to monitor the intensity of our activity; a heart monitor such as one from Alivecor can display our electrocardiogram; several products on the market can monitor our blood pressure, blood glucose, blood oxygen, respiration and even our sleep.

Soon we will have sensors that analyze our bowel and bladder habits and food intake. All of these will feed data into our smartphones and cloud-based personal lockers. Our smartphone will become a medical device akin to the “Star Trek” tricorder.

When we get sick, we won’t need to go — in high temperature and in severe pain — to our doctors’ offices, only to wait in line with patients who have other diseases that we may catch. Our doctors will come to us, over the Internet. Telemedicine is already a fast-growing field; doctors have been assisting people in remote areas by using two-way video, email and smartphones. They will increasingly assist us in our homes. Our smartphone and body sensors will provide them with better medical data than they usually have today.

Then our smartphones will evolve further and do part of the job of doctors.

The same type of artificial intelligence technology that IBM Watson used to defeat champions on the TV game show “Jeopardy” will monitor our health data, predict disease and advise on how to improve our health. Already, IBM Watson has learned about all the advances in oncology and is better at diagnosing cancer than our human doctors. Watson and its competitors will soon learn about every other field of medicine and will provide us with better, and better-informed, advice than our doctors do. They will take a more holistic view of our bodies, lifestyles and symptoms than our doctors can.

They will, after all, have our full medical history from childhood, know where we have been, and keep track of our medical data on a minute-by-minute basis. Most doctors still work from brief, unintelligible, hand-scribbled notes and try to make a judgment about what medicines to prescribe us in a 10- to 15-minute consultation; they treat symptoms of interest but can overlook the bigger picture of where the treatment leads.

Artificial intelligence technologies will also analyze continual data from millions of patients and on the medications that they have taken to determine which of these truly had a positive effect; which simply created adverse reactions and new ailments; and which did both. This will transform the way in which drugs are tested and prescribed. In the hands of independent researchers, these data will upend the pharmaceutical industry — which works on limited clinical-trial data and sometimes chooses to ignore information that does not suit it.

This is just the tip of the iceberg.

We learned how to sequence the genome about a decade ago, and sequencing it cost billions. Today, a full human genome sequence costs as little as $1,000. At the rate at which prices are dropping, it will cost less within five years than a blood test does today.

So it is now becoming affordable to compare one person’s DNA with another’s, learn what diseases those with similar genetics have had in common, and discover how effective different medications or other interventions were in treating them. Today, medicines are prescribed on a one-size-fits-all basis. In the future, you can expect to see doctors tailor treatment for diseases on the basis of an individual’s genomic information and lifestyle.

We can also now “write” DNA. In the emerging field of synthetic biology, researchers and even high-school students, are creating new organisms and synthetic life forms. Entrepreneurs have developed software tools to “design” DNA. These technologies provide the ability to generate designer drugs, therapeutic vaccines and microorganisms. Like all technologies that modify fundamental biology without a complete understanding of how environment, DNA, protein production and cell biology interact, this introduces new risks, because we could engineer dangerous new organisms. But used appropriately, this field may dramatically affect the development of novel, and more effective, therapeutics.

Ultimately, disease prevention is about lifestyle and habits as well as about genome and exposure to disease. Technology combined with good habits can create the health care system that we really need. We’re not dependent on Big Pharma, the medical establishment, or even the Food and Drug Administration. Medicine has become an information technology. The advances in health care are being developed by entrepreneurs and scientists all over the world. There is no stopping this.


Vivek Wadhwa is a fellow at Rock Center for Corporate Governance at Stanford University, director of Research at Duke University, and distinguished scholar at Singularity and Emory universities. His past appointments include Harvard Law School and University of California Berkeley. This piece, which he wrote for the Washington Post, reflects his own opinion.


Lee H. Beecher, MD
President, Minnesota Physician-Patient Alliance (MPPA)
6600 Excelsior Boulevard, Suite 121
Saint Louis Park, MN 55426-4746
“Empowering patients to make informed health care decisions”

Minutes MPPA meeting 4-10-14: Corrected 4-11-14

Thursday, April 10th, 2014

• SolarteHealth program—Merlin Brown
• May 9 2014 AAPS at Marriot Hotel (MOM) Mpls.—Dave Racer
• Book—Dave Racer.
• Lee Beecher thanks award.
• Meeting places in the future.

1. Introduction of those present: Lee Beecher, President, Mike Ainslie, Don Gehrig, Dave Racer, Hannelore Habrucker, Bob Geist, Doug Smith. John Healy, Rick Morris, Merlin Brown and aide, Mr. Jury Zurich.

2. Minute of 1-16-14 reviewed

3. SolarteHealth program outlined by Merlin Brown MD. A program that would replace 3re party health care payments with a direct pay system combining banking (a special Visa debit card—good anywhere), point of service pricing and payments, and catastrophic coverage benefits. It would eliminate the high overhead involved with 3rd party claims administration and payments. He discussed the origin of the concept, the development of the necessary technology, the target markets, the trial with his own practice, and current fund raising to implement the program. There were many questions and much interest.

4. May 9 2014 AAPS at Marriot Hotel (MOM) Mpls by Dave Racer. Dave discussed at length the particulars of the Workshop program, marketing efforts, and projected program attendance.
4a. Book ideas. Dave discussed putting together a book about direct pay including papers from docs about their experiences, a small direct pay book for patients, website directory for direct pay docs, and consider workshops with CMS credits.

5. Quality measurement discussion by Rick Morris. Rick described his 3 year saga regarding asthma guidelines. The MCM Board sided with his critiques, but leaves the whole apparatus and future of P4P threat unchanged.

6. Dr. Lee Beecher was given a $ 300 gift certificate in thanks for his past role of being at the helm of MPPA and for the member’s gratitude for remaining at the helm of an organization to which he has brought such vigor and fruitful direction. Thanks, Lee! Bob Geist will forward to Lee the gift that resides on his desk. Bob was grateful that no one brought up senior moment problems, since he remembered where it was—i.e., the gift, not his desk.

7. MPPA future meeting place was discussed now that Dr. Beecher is retiring from practice. The members were asked to forward suggestions—send me your ideas.

8. Meeting adjourned at 8 PM—we’ll next meet at the May 9, 2014 AAPS Workshop.

Respectfully submitted,

Bob Geist
Secretary pro tem