Big Data, chronic disease and the future of medicine.

Every day, I make important decisions with my patients.
They are calculated decisions from integrating a lot of information.
Some of that information is subjective, but in modern medicine, a lot of it is objective. The history, the physical exam, blood work, radiology; I integrate all the data to make good sensible decisions. This task becomes more challenging when patients have multiple chronic diseases. Each disease generates countless points of data that need to be considered. Putting all of this together in a 20 minute office visit is very difficult. One way I try to overcome this problem is by scheduling multiple visits and try to peck away at select problems on each visit.

“Team-based” care is also a popular buzz word in medicine. In team based care, multiple people from different disciplines get involved to create comprehensive care plans for each patient. Each team member  collects  more data that is pooled for the team members to make better calculated decisions.
It’s a lot of data collection, but is it enough?
For the chronic disease patient, it isn’t.
Chronic disease persists 24 hours a day, 7 day a week. From genes, to cells to psyche, the damage never stops in the chronic disease state. It’s impossible to catch and fix every bit of damage being done to the mind and body
But instead, we see patients at an arbitrary interval (e.g. 1 or 3 months) and try to identify some basic root causes and address the damage after the fact. It is an exercise in futility. 
But technology will help bridge this gap between the perpetual chronic disease state and physician intervention through the generation of medical “Big Data.” 
An example of this is self-monitoring or self-tracking. We cannot monitor patients 24/7, so patients will utilize technology to watch themselves. Self-monitoring is in its infancy. Blood sugar, blood pressure, heart rate are just the beginning. Technology will evolve to create monitoring mechanisms that cheaply and efficiently collect a tremendous wealth of information from the patient’s home. The data will be better than static information (e.g. a series of blood sugars readings) but dynamic; static data that is automatically trended, analyzed, cross referenced against other monitored variables. In the end, the physician will not receive a series of blood sugar readings. Instead it will be a comprehensive report that tells us what’s happening in the patient from gene to psyche and everything in between. Initially it will be a tremendous volume of information, hence the term “Big Data.” But it will evolve to eventually become concise patient centered “Smart Data.”  
The whole idea of a wired chronic disease patient and 24/7 monitoring may seem like science fiction right now. But I have faith in the world’s innovators out there; to share my vision and one day give me the tools to provide the kind of care and intervention my chronic disease patients deserve.

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