As part of the project “Diagnosis Transformation” we met with John Mattison and asked him about his vision regarding the future of healthcare, the most important technology trends and the lessons learned during the transformation process. In this blog we will share part 1 of our conversation: John’s vision about the future of health.
John was appointed Assistant Medical Director and Chief Medical Information Officer (CMIO) of Kaiser Permanente in 1992. Kaiser Permanente is USA’s largest not-for-profit health plan and health care provider, with 43 hospitals and 19.000 doctors. It has been recognized as the national leader for both outpatient and inpatient systems and is a pioneer in prevention and personalised care. For example, Kaiser Permanente conducted 10,5 million patient-doctor visits via email, phone or video tools in the last year.
How would you envision the future of healthcare?
Mattison: To answer this question, I have to start off with a modified quote of William Gibson, namely: ‘’the future is already here, but it is not evenly distributed, (nor evenly converged across all of the technologies and opportunities, and not evenly personalized to the individual)’’. Looking at the technologies that are already available today that are being implemented in isolation is really extraordinary. To provide an example: my neighbour’s two year old daughter had a high fever, a rash and was feeling terrible, so they took her into the emergency room. For two hours they sat there, while everybody else coughed on their daughter with different viruses. Ultimately, they were never seen by a doctor and went home upset. The next day she was even worse, they went back to the emergency room and the exact same thing happened. We are at the point today, that the technologies that are available are not widely distributed and converged.
First of all, the technology exists today to both diagnose which virus is affecting the child and what anti-viral antibiotic would be best to treat the individual. In addition, this knowledge can be uploaded automatically into the personal health cloud of that individual, holding all of their health data including their pharmacogenomics. Decision support tools are available that can tell you the optimal treatment schedule, based on their genomics and metabolic pathways for that anti-viral drug . Furthermore, a physician can get a simple message saying “this patient has this virus demonstrated by this tool, with this antibiotic sensitivity and these pharmacogenomics and we recommend that you prescribe this medication with this dose and dosing interval”. It stages the prescription and all that the doctor has to do is to look at that message and agree. The message is sent to the pharmacy. The pharmacy has already unfiled the patient’s home address when they uploaded the patient from the viral read and the antibiotic susceptibility. They contact the local drone delivery service, puts the dispensers of medication in the drone and the drone delivers it to the desired location. In a full 10-minutes cycle you will have diagnoses, treatment, review by the physician, prescription and delivery.
All of these technologies exist today, and in the case of my neighbour’s baby, will result in far superior and faster care, without having to go into the doctor’s office or emergency room while other people cough on her. In the future, there will be much more self-sufficiency and autonomy of the patient, guided by modern technology and decision support, but with the human review element still incorporated in the process.
How would the interaction between a patient and a doctor look like?
The interaction should be on demand and in real-time. If I want to see my doctor or I want to see any doctor because it is urgent, I should be able to have a video consultation. At Kaiser Permanente, we are already conducting over two thousand video visits each month and we will be doing tens of thousands a month like that next year. The interaction will be more service oriented, but we retain the human relationship. By using video technology, we are able to have face-to-face encounters, allowing us to build and maintain trust. People have trust in those who are treating them, and as a result, they will have lower cortisol and adrenaline levels, which are stress-related factors that interfere with our ability to heal. Therefore, trust is important for people’s confidence in believing they will get better.
Will modern technology be a driver of this transformation?
We are witnessing the exponential growth of many different platforms, in what I call the plecosystem, which is a multi- PLatform ecosystem. There are service platforms like the internet, the smartphone, and open-source learning environments. Likewise, there are many application programming interfaces (API platforms), like Smart-on-FHIR® and other electronic health record vendors, that allow for much more integration of data. In brief, there are multiple platforms and there is an exponential growth of sources of data. Innovations should focus on the leverage of multiple platforms and thereby bringing all the potential data, services and platforms together to help us live healthier, more mindful and resilient lives. It is going back to the wisdom of the ancient tribe where we support each other and have mindfulness and resilience, in addition to practicing healthy habits. From studying the blue zones, we know that mindfulness, resilience and social support structures play a huge role in health, in addition to having healthy habits for eating, sleeping, and exercise. In this, technology will not be a ‘game-changer’, but will support the transformation. A common mistake in healthcare is to believe that technology will drive the change, when in fact the technology must be used to support healthier behaviors, mindfulness and resilience.
How will we be able to use modern technology to restore the ancient wisdoms?
Modern technology will be supporting and amplifying the fundamentals of ancient wisdoms. We need to focus on teaching much better habits of health and resilience early in life, starting with healthy parenting and early childhood experiences. There are a number of ways that technology can help augment those fundamentals in individuals. Innovations such as HeartMath, Muse and Happitech are already focusing on restoring those ancient wisdoms in individuals. It is going to take around two generations before we are really able to shift the needle on how every child has the opportunity to be more mindful and resilient. We need to create generations of people who are much more proficient and confident in their skills, to manage stress and whatever life throws at them. In this way, we can turn around these epidemics and disorders in lifestyle, resulting in for example diabetes and obesity. We need to take technology away from the foreground, put it in the background, and restore human relationships, and basically, human values.