Every March in Austin, Texas, the traffic triples and you can never get a restaurant reservation anywhere. Why? Because that’s when more than 70,000 people descend on the “Live-Music Capital of the World” for the annual South by Southwest (SXSW) Music, Film, and Interactive Conference and Festival.
The streets of Austin are filled with techies, musicians, and celebrities mingling with locals for 10 days of presentations, film screenings, and live music. Despite my being a closeted techie—and a music and film lover—like most Austinites, I usually try to avoid the hassle of the convention area downtown at this time. But for some reason, this year SXSW piqued my interest.
Where else can you go to a conference where the keynote speakers are the likes of Malcolm Gladwell, Jessica Alba, Senator Rand Paul, and Snoop Dog? Even the elusive Edward Snowden appeared last year via Skype from an undisclosed location in Russia.
So out of curiosity, I looked at the schedule online and saw that SXSW had devoted a few days of its interactive portion to health-care technology. I was fresh off a year of defending the amount that retina specialists are reimbursed by Medicare, as revealed by the Centers for Medicare & Medicaid Services (CMS) data dump, so I wanted to learn more about what “key opinion leaders” were doing to fix the rising cost of health care through technology.
I saw that venture-capital firms were sending managers and even CEOs to SXSW to mix with start-up entrepreneurs and health-care administrators. Several of the talks listed seemed to address why the health-care system is broken and how technology might fix it. So I picked up my official SXSW badge, changed out of my white coat, put on jeans and a t-shirt, and headed downtown.
Turns out, many of the talks I saw weren’t necessarily devoted to fixing the rising cost of health care, but they highlighted technology’s role in the evolution of health care—with a touch of how to make a ton of money doing it.
The bulk of the health-care conference seemed to revolve around mining data—in this case, patient data. You’ve already seen the business model of “Big Data,” even if you’re not aware of it, by what you do online every day.
If you use Google to search for anything, Google will sell that search engine data to advertisers to market directly to you by your very next mouse click. Facebook mines your “Likes” and “Posts” to market to you on its app. Every credit-card swipe generates information on what you bought, where you bought it, and how much you’re willing to spend—for example, on a new pair of shoes.
Likewise, there is value in health-care data—or more specifically, what a patient sees a provider for (read: ICD-10) and how the provider manages that patient (CPT code).
Health-care data can be used for outcomes analysis, benchmarking, epidemiology, or analyzing safety measures. CMS and other payers, for better or for worse, are already using health-care data to identify outlying utilizers of their pool of money. (Hint: That’s us!)
This health-care data has so much value that companies large and small are striving to figure out how to get it.
Some companies are mining data from insurance claim information and some directly from your electronic health record. Health-care data is so valuable that some start-ups are even writing software to read, analyze, digitize, and aggregate your handwritten charts.
But what I found most interesting at SXSW was discovering the real darling of the entrepreneurial world: the emerging concept of bypassing the medical provider and the health-care system and going directly to the consumer for this data. Introducing the wearables and their downloadable apps.
A market report by IMS Health (Danbury, CT) anticipates this market to balloon to $6 billion by 2016. FitBit (FitBit, Inc, San Francisco, CA) and Apple Watch (Apple, Inc, Cupertino, CA) are 2 of the latest commercially available gizmos that were the toast of Twitter’s #SXSW2015. These wearable devices can track your heart rate, how many steps you take, and the number of calories you burn.
All of this data is beamed directly to the smartphone application you downloaded and—unless you changed your preference settings—sent directly, per user agreement with the company, to their analytics team. There, it may be aggregated, analyzed, and quite possibly, monetized.
Apple recently introduced its Apple ResearchKit. This open-source software framework’s goal is to enable app developers to create programs that allow patients—err, people—to upload directly to Apple any health-care data derived through their iPhone.
So far, ResearchKit’s applications can collect data on cardiovascular risk factors as well as asthma and diabetes control; they can also monitor for worsening signs of Parkinson’s disease. As more apps are created, the ResearchKit’s database will undoubtedly grow.
Several panelists at SXSW predicted that ResearchKit could become the largest longitudinal clinical trial in history. Exaggeration? Just imagine if Apple succeeds in obtaining the medical history of all its users—including conditions, medications, drug history, hospital visits, and surgical procedures—and couples this with real-time, minute-to-minute data on blood pressure, heart rate, pulse oximetry, temperature monitoring, blood glucose level, or any data that can be uploaded to an iPhone (if you can think of it, there’s an app for it).
ResearchKit could potentially obtain limitless patient data on millions of “subjects.” Of note: In 2014, more than 150 million people in the United States had smartphones, and of those, 63 million were iPhones—and those numbers are growing.
If even a fraction of those use Apple ResearchKit, it could dwarf the Framingham Heart study by a factor of 1000.
Maybe that example is a bit extreme, but think of it another way: What if ResearchKit could identify a cohort of its iPhone users who just started a new blood pressure medication and were able to monitor their heart rate and blood pressure every second of every day? That’s some impressive phase-4 data that no pharmaceutical company could ever dream of getting otherwise. That’s valuable.
Why does this matter to the retina doc? In the ophthalmology world, this is just the beginning. Patient-derived data is already out there and will likely continue to grow. Companies like ForeseeHome (Notal Vision, Inc, Chantilly, VA) have developed a home vision-screening device designed to detect early vision changes in patients with macular degeneration. The device immediately notifies the company and, in turn, the physician if there is a new change in vision, prompting them to schedule an appointment.
Sightbook is a downloadable smartphone app created by DigiSight Technologies, Inc (Portola Valley, CA) that measures visual acuity and contrast sensitivity, and administers Amsler grid testing. It also allows the patient to connect with the doctor through its mobile app.
In 2014, Google (Mountain View, CA) and Alcon (Novartis, Basel, Switzerland) partnered to develop a contact “smart lens” with hopes of obtaining continuous glucose measurements in tear film. This is the tip of the iceberg.
Most of us entered the field of retina because we were attracted to its propensity for technological advancement and real-world applications that directly affect the care of our patients. No doubt, wide-field digital fluorescein angiography and high-resolution OCT have improved our ability to diagnose retinal pathology and provide better care.
It seems the retina world is heading toward a new frontier where smartphones, wearable devices, and analyzing patient-derived Big Data will be the new norm. As our patients become increasingly tech-savvy, they will likely expect us to adopt these technologies as part of the future of medicine.
We might be expected to analyze this patient data, either through an email auto-generated by a software company or through a HIPAA-compliant web portal before, during, or between patient visits. This might take an extra few minutes in our already-hurried patient encounter, and to date, there’s no CPT code that reimburses it.
The future of health care is evolving. Are we ready for it?
This article was originally published in Fall 2015 issue of Retina Times, a quarterly publication of the American Society of Retinal Specialists