Date:14 July 2017
The Quantified Self and Connected Health: harnessing Big Data and technology in the quest for cost-effective, decent – and smart – healthcare.
Healthcare isn’t just about ensuring you take your meds on time or managing your self payment gap. On a big scale, it involves keeping communities – even nations – healthy in practical ways. For Africa, that’s a particularly thorny task, given a population projected to double to 2,5 billion by 2050. All the signs indicating that, by the end of this century, 45 per cent of humanity will be African.
Looking at healthcare
Worldwide, rapid urbanisation has resulted in a highly developed private healthcare environment. Sadly, governments struggle to deliver healthcare to the broader populace. How we’ll house and feed everyone will force a radical rethink of healthcare; and, by the way, we’ll be living longer, exposing ourselves to more risk of chronic diseases.
“The thing that should be worrying all of us is, healthy people are the basis of a sound economy,” says Simon Carpenter, chief technology adviser at computer giants SAP. The organisation sees its technology as being the potential key to unlocking a solution to the healthcare conundrum. It’s a solution that revolves around the notion of the connected patient. It starts with the goal of having a completely personalised, digitised patient record that consolidates clinical and administrative data. This provides unprecedented insights and the promise of proactive patient care and precision medication.
SAP & healthcare
SAP’s involvement in healthcare has up to now been largely in managing clinics and hospitals and the patient experience. Its systems are used substantially in organisations such as Netcare, Mediclinic and Life Hospitals. But there’s an opportunity to develop this into something more meaningful across the broader community.
“Every doctor you have ever visited has a paper-based file on you and me,” says Carpenter. “In South Africa today, that’s probably four or five doctors, that have a file on Simon Carpenter, all of them with details of how I’ve been, what medication I have been on, how I have responded to treatment. And none of it joined up.
“At the end of the day, when I next I go to a doctor or if I go to a different doctor, that whole process starts again. We leak insights left, right and centre because our information is not linked. One of the things we are very keen on is using the platforms we have available today to marry this information up so that firstly we can start to understand the patient much better as an individual.
“If we can match up all this data and within the boundaries of privacy and ethics, you can understand how a whole cohort of people is behaving. What the health trends are. Where the epidemics are breaking out. What kind of patterns seem to lead to communicable diseases and the like. The data can be inordinately powerful. But only if we can marry it up. That’s really the crucial essence of what we are trying to get done.”
From a local perspective
South Africa lags a little compared with what we are seeing in the rest of the world. In collaboration with the American Society of Clinical Oncologists, for instance, SAP built a platform called Cancer Links. It allows doctors to collate information from all sorts of cancer patients, not just clinical trial participants. The idea is to identify links between genes, genetic profiles and the phenotypes of an individual person and how they respond to an individual treatment regime.
Of course, less-developed countries face the twin challenges of lack of technology and lack of skills. The good news: technology can help amplify skills. A project in Kenya, aimed at improving prognosis regarding cervical cancer. The project has field workers equipped with easy-to-use mobile devices gathering information. This information is fed to a university hospital in Heidelberg, Germany for diagnosis and treatment advice.
The idea of using data to improve individual health and, as a result, community health. This is tied up with the idea of The Quantified Self. “People are starting to monitor their lifestyles (using wearable devices and the like) and starting to get much more closely involved,” says Carpenter. “That is a trend that will continue and if we get that right, we can have people take greater responsibility for their own health care. Making them more aware of what’s happening within their body and aware of the consequences of their behaviour, we can make them much less of a burden on the healthcare system right at the front end.”
Finding the pattern
As populations age, we can expect to start to see an increase in chronic disease in older patients. “And one of the challenges worldwide is that people are very poor at taking medication as prescribed,” Carpenter says. “When we speak of the connected patient, think of it as something like a social network for medicine. It’s building a set of capabilities that allow doctors and caregivers to be always connected to their patients, monitoring them and if necessary cajoling them to take their drugs at the appropriate time.”
An early product based on the SAP Connected Health platform, seen as an enabler for precision medicine health engagement, is Health Link. Patients can connect via mobile device with their doctors. They can share their daily health data like blood pressure or blood glucose with their doctors. The doctor on the other hand can monitor the status of a patient remotely and can intervene if there is any risk detected.
The rich dataset that emerges from a mobile or a wearable device or a combination of these things helps build understanding of what treatment regimes work and which ones don’t. Future developments could include our medical data being taken up in the equivalent of the block chain, in which we will be able to decide whom we want to share elements of that data with.
“You can bring that all together and understand how a whole cohort behaves. And you can then start to do some interesting stuff like anonymising that data and feeding it back into the pharmaceutical industry, where it supports research into new drug molecules. Get this right and everybody wins.”
Processing the data faster
The ability to process massive amounts of data, swiftly, is already providing medical professionals with more effective and deeper insights. “One of the projects we are looking at is personalised medicine for cancer. This can reduce the time taking for gene analysis from two days to 20 minutes.
“We are starting to find patterns that people didn’t know existed before. You no longer have lung cancer, but one of 11 different types of lung cancer. That in its own right can take huge costs and waste out of the system. Instead of carpet bombing, you can now use a precision munition.”
SAP offers its own employees an industry-first demonstration of the possibilities: COPE, the Corporate Oncology Programme for Employees. A strategic health partner, Molecular Health, provides employees diagnosed with a solid cancer tumour with free access to a molecular genetic tumour analysis and interpretation. This translates DNA sequences into actionable treatment options.
A look to the future
Improved healthcare could feed into agriculture and the whole system that sustains us on this planet, Carpenter says. “If we can figure out better nutrition, which may mean figuring out how to farm better, a lot of the diseases could be curtailed because we are eating better and not getting chronic afflications like diabetes and hypertension.”
There’s evidence of start-ups realising that there is a lot of data out there that has a bearing on people’s health and fitness and there’s a likelihood that we will see the continued growth of telemedicine. Maybe, in the future, primary healthcare will move from rural clinics to mobile devices and a couple of wearables…