As Science Online draws near, I continue to gear up for the session on 24/7 Health. Another book on the topic, Jody Ranck's Connected Health: How Mobile Phones, Cloud and Big Data Will Reinvent Healthcare addresses the gee-whiz, look-what-we-can-do aspects of the topic but also takes a closer look at the limitations. Smart phones and home computers allow us to tract aspects of our health like never before. Doctors have more tools and access to immediate information. We are approaching a time when sequencing individual genomes will be affordable as well as feasible.
But what do we do with these data?
- A number of twitter colleagues are currently participating in diet and fitness challenges, tracking runs and rides and calories and points. Will they accomplish more than those who have real-life, in-the-flesh work-out buddies?
- Home appliances can now track heart rate and rhythm continuously. If a patient collects these data, how do I use the information? I have no idea at present.
- Say a patient pays to have their genome sequenced. At this point in time, we simply do not know what most of it means, even in relation to known medical conditions or drugs. Sure, there have been some pharmacogenetics studies that produced useful information, but these represent a small portion of one individual's genomic made-up.
The revolution will require Big Data Services on many levels. First, only through the use of such analysis will we learn what the data mean. We cannot interpret one patient's genome until we have studied large populations to know what the results mean. We will need access to more than the gene sequences; accurate information about disorders, drug responses, side effects, and everything else we can consider will be needed to produce the brave new world of individualized medicine that we envision for the future.
As we have seen this week, there are risks involved. Even de-identified genetic data can be identified at some level. As Ranck states the problem:
Finally, multiple streams of patient data will have to be crunched into a usable format. One of the chronic disorders that has led the tracking movement is diabetes. Smart phones allow patients to automatically log blood glucose levels and physical activity; integrated diet logs and insulin tracking can give a complete picture of the factors that influence glycemic control. If I am seeing this patient in the office for a quarterly visit, I really do not wish to manually sift through everything. I need a dashboard that can scan the record and point me to the times when something unexpected happened. The diabetes world is moving toward this endpoint; we are still awaiting these advances for other chronic diseases.
I'm looking forward to a spirited discussion of mobile health on Saturday, February 2, at Science Online. See you there, whether in real life or virtuallly.