One of the most fascinating devices in the science-fiction TV series Star Trek was the Tricorder. This was a futuristic gadget that could instantly collect bodily information and diagnose medical conditions just by holding the appliance close to a patient’s body. At the time, this magical device seemed like an unlikely fantasy because most of us could not conceive how this small handheld contraption could scan an entire body’s organic parts. Today, the Tricorder is a reality.
Fifty years ago, we lived in an analog world where sensors were not part of our day-to-day lives and the digital technologies we take for granted today were beyond the realm of our imaginations. Only a rare visionary such as Gene Roddenberry, Star Trek’s creator, could foresee a world of prolific sensors that could rapidly transmit volumes of data to be analyzed and processed by small devices.
Today, sensors are in our cars, our buildings, and our phones. And it won’t be long before they will be in our bodies as highlighted in the recently published report by the UK’s National Health Service, Preparing the Healthcare Workforce to Deliver the Digital Future. The report is a clarion call for change. And it comes none too soon because the industry that has been disrupted least by the Internet-driven first wave of the digital revolution is likely to become the most digitally transformed arena as the Internet-of-Things ushers in a new and far more disruptive second wave.
A Unique Juncture
The report exhorts that we are at juncture in medical history with the convergence of multiple transformative technologies that will usher in the age of digital medicine: genomics, biosensors, artificial intelligence, and robotics. These emerging technologies will have a major impact on both what healthcare is and how it is delivered as the fusion of these digital applications enables a more holistic approach to both personalized healthcare and population health management.
Digital healthcare technologies will have the potential to empower individuals to be more directly informed about their care, it argues. For example, genomics is likely to provide more accurate diagnosis of genetics-based diseases, allowing individuals to know their likelihood of developing one of these diseases and to take proactive steps to better manage their health. Advances in sensors and wearables will make it possible to bring diagnostics closer to patients, and the proliferation of bodily sensors, in particular, will enable a new generation of medical procedures, such as liquid biopsies that identify circulating tumor DNA in blood and other bodily fluids to better detect and monitor cancer.
Perhaps most promising is the expanding capability of genomics to make corrections to an individual’s DNA that could lead to cures for previously untreatable maladies. This will be possible because genomic-editing and synthetic biology will provide us with the tools to “write” as well as read genomic information.
Role Disruption
While the NHS report provides an excellent picture of how technology will radically innovate the practice of healthcare, its primary focus is to prepare healthcare practitioners for the significant adaptations they will need to make for delivering healthcare in a digitized future.
Until now the major roles in healthcare delivery have been doctors, nurses, and pharmacists, who are generally trained in highly compartmentalized specialties. The report astutely points out that this is likely to change because, as healthcare becomes more data intensive and artificial intelligence becomes more proficient at instantaneously processing large volumes of disparate and complex data, the new digital medicine will require a more cross-functional approach that includes data scientists, computer scientists, engineers, and bioinformaticians. This highlights the new reality that digital medicine is indeed both digital and medicine.
Accordingly, the report asserts that there will be an increasing demand for healthcare practitioners to become digitally literate and that, within twenty years, ninety percent of all jobs in healthcare will require some element of digital skills. In particular, practitioners will need to keep up with advances in artificial intelligence and robotics because these new technologies are likely to change the roles of both clinical and administrative staff over the next two decades. This will include the automation of simple repetitive tasks, improved robot-assisted surgery, and the full automation of most administrative processes.
While the report presciently highlights the certainty of technology-driven role disruption with the addition of new digital specialists and the elimination of most administrative staff via automation, it assumes that the traditional medical roles, especially physicians, will remain relatively constant. Innovations in AI, genomics, and robotics may introduce amazing new tools and treatments, but none of these developments is expected to alter the reality that, in the end, the physician is the final arbiter of intelligence in the complex knowledge-intensive field of healthcare. In other words, whatever technology innovations may come our way, the doctors will remain in charge of dispensing healthcare.
However, while this may be the preference of the physicians who guided the report, is this likely to be the reality? Or is it more likely that the historical role of these high priests of healthcare might also be significantly disrupted by digital transformation? A look inside an industry radically disrupted in the digital revolution’s first wave may provide insight into the answer to these questions.
Changing the Music
In the 1980s and 1990s, music industry executives were ecstatic when a whole generation of consumers replaced their vinyl album collections with superior quality compact discs. And the CD appeared to be the proverbial golden goose that would keep on giving. After nearly a century, the industry appeared to have mastered the challenge of creating the perfect record album. If you were one of the high priests of the music industry in the last decade of the twentieth century, your business fortunes were looking very favorable.
But advances in digital technology often spawn unexpected events, as the music industry soon found out. In 2001, an unknown college student working in his dorm room created the file-sharing platform Napster, and large numbers of music lovers started swapping digital songs over the Internet.
Despite managing to have Napster shut down, the industry completely failed to preserve the dominance of their longstanding business model. Digitization could not be confined to the compact disc and connected consumers meant that the power to distribute music was no longer the province of the high priests of music. Digitization had changed the basic rules for how an entire industry worked.
A Leap in Human Intelligence
In the coming decade, two far-reaching events will mean we are likely to see a similar change in the way that healthcare works. The connection of all humans and things via a common digital network will accelerate both the quantity and quality of healthcare data. Meanwhile, the proliferation of human collective intelligence via sophisticated artificial intelligence (AI) systems will radically transform how intelligence works in the healthcare system.
The traditional healthcare system is designed to leverage the individual intelligence of the physician. Healthcare data and information is typically gathered and processed by individual health specialists whose judgments and opinions steer the course of patient treatments. This is likely to change with the development of AI systems capable of making rapid and accurate diagnoses from the collective intelligence garnered from information gathered by the Internet of Things.
Amir Husain, the author of The Salient Machine: The Coming Age of Artificial Intelligence, makes the point that AI is not just another technology, it is a new form of intelligence. With its vast capacity to store information and its ability to rapidly process and retrieve information at the speed of Google searches, AI doesn’t need to engage in the heuristic short-cuts that are prevalent in all human professions. Medical doctors, like all other professional experts, are prone to construct mental narratives based upon their individual and shared experiences. However, these narratives, while useful most of the time, can often get in the way of accurate diagnoses. A recent study from the Oregon Research Institute found that an algorithm was more effective at diagnosing cancer than a group of doctors and outperformed even the single best doctor.
With its almost limitless data capacity, AI is far more capable of thinking probabilistically and holistically, and is, thus, is able to weigh the relative content of multiple perspectives in a matter of seconds. In other words, the great promise of artificial intelligence is its ability to leverage the power of collective intelligence for better decision-making in healthcare.
This means that AI via the IoT may be able to warn patients of blood clots before impending strokes or heart attacks. Thus, rather than waiting for the presentation of symptoms, the IoT will recognize the weak signals of cellular anomalies, notify both patients and doctors through apps, and even set up doctor appointments. And as the IoT matures, it may learn how to automatically correct the medical malady and notify both patient and doctor of the aborted illness.
Should this happen, the focus of healthcare will be more about prevention and health than about illness and treatment, and the locus of intelligence in the healthcare industry will shift from the individual intelligence of healthcare practitioners to the collective intelligence of AI systems. Like the music industry before it, digitization is likely to radically change the basic rules for how the healthcare industry works.
