Personalized health care and artificial intelligence could improve your life—at the cost your privacy
Andres Rubiano first got the news that his blood pressure was too high in the 1990s, when he was in his late 30s. It didn’t come as a complete surprise—his father had had chronic hypertension at an early age too. His doctor prescribed medication and encouraged him to get more exercise and cut down on the amount of salt in his diet. Rubiano, though, wasn’t very diligent about following this regimen. Each time he returned for a checkup, doctors gave him the same advice and Rubiano disregarded it.
Four years ago, something caused Rubiano to turn himself around. His doctor convinced him to enroll in a pilot project in digital health care. Once a day, Rubiano slipped on an automatic cuff that wirelessly sent blood pressure readings to his smartphone, which in turn relayed the data to a team of clinicians at Ochsner Health System, an academic medical center based in New Orleans. His Apple Watch relayed heart-rate and physical-activity readings. Soon, Rubiano was getting text messages reminding him to take his pills and emails suggesting ways to cut down on salt and boost physical activity. Each month, his doctor’s office called to discuss his readings, tweak his medication dosage and examine new diet and exercise strategies.
The digital prodding paid off. Rubiano now takes his pills, goes to the gym three times a week and eats less salt. “I don’t even like the taste of it anymore,” he says. His blood pressure dropped from 150 over 100 to a reasonable 130 over 78.
Rubiano is an early beneficiary of a new data-driven approach to health care that is starting to take hold in the medical industry. As the fate of the Affordable Care Act plays out in the courts and politicians and patients wring their hands over the rising cost of drugs and treatments, a growing army of researchers, practitioners, entrepreneurs and executives think tech could be a simpler way to fix much of what ails the U.S. health care system. Essentially, they want to do for medicine what Facebook and Google did for social media and internet search. By gathering real-time data on patients and using it to prod, poke and persuade them to do the right thing, they believe that doctors could improve outcomes dramatically for patients with a broad range of chronic diseases and conditions, including heart disease, cancer, diabetes and Alzheimer’s. “We can’t just fix chronic disease; you’ll have it until you die,” says Richard Milani, a cardiologist who serves as chief clinical transformation officer at Ochsner. “We need to surveil you closely and catch you when you’re heading out of bounds.”
There are, however, clear risks. If you think Facebook and Google invaded your privacy, imagine what hackers could do with a minute-to-minute log of your disease symptoms, behaviors, locations and even your appearance and conversations. The key to digital medicine is, after all, the gathering and sharing of copious data about nearly every aspect of a patient’s life. Are hospitals, researchers, Big Pharma, insurers and tech companies worthy stewards of such sensitive data? “If a system can detect signs of cognitive decline in patients’ voices, they don’t want it being used against them in job situations or health insurance,” says Christine Lemke, co-founder of Evidation, a health data company.
If experts can figure out a way to lock down privacy, digital medicine could pay off big time. Its biggest impact is likely to be in chronic care. At present, U.S. health care is designed for crisis-oriented transactional care—you break your arm, the doctor sets it and you go home. That mode works poorly in early detection and treatment, which is what’s needed to keep a patient with heart disease or diabetes from slipping into a medical crisis. The Centers for Disease Control and Prevention reports that 60 percent of the U.S. population has a chronic disease and that 40 percent has at least two.
