If you watched the Olympics, you no doubt saw GE's Healthymagination ads. One - the "Take a Look" ad - depicts doctors through the ages (ancient China, Renaissance Europe, 19th century American West) struggling to understand what's going on inside a patient's belly. Flash forward to today, when a handheld ultrasound makes it all clear. Without a doubt, it's remarkable to think about the technology that has been created to peer into our bodies and unravel the mysteries of our signs and symptoms.
Nevertheless, I'd like to remake this ad with a twist. Instead of physicians struggling to look into our abdomens, I'd like to depict physicians struggling to peer into the daily lives of their patients to understand what happens when those patients are not in the exam room. To see their homes, their morning routines, lunch breaks, sleepless nights, and their flare-ups of joint pain. We all know our behavior has a major influence on our health and, in turn, that the environment around us helps shape the behavioral choices we make. As Thomas Goetz points out in a recent post here, these small everyday decisions matter. So one would think it's pretty important for our health care providers to understand them and the effects they have on us.
With no disrespect to physicians or their patients, I'd argue that today's physician understands her patient's day-to-day experience only slightly more than the doctor in ancient China (or any other time) understood what was happening inside his young patient's belly. Skilled clinicians gain valuable but fundamentally limited information through their patient interviews. Having just participated in one, I can tell you that my answer to the question of exercise ("I try to work out 3-4 times a week and I walk a fair amount during the day") is a poor representation of my experience. It's aspirational, tainted by recall bias, and lacking in detail.
However, we are now entering an era that will give us the ability to easily share those day-to-day experiences with our health care providers - the equivalent of the handheld ultrasound. Wireless data networks, smartphones, low-cost sensors and minimal software distribution costs have created new opportunities to paint a person's health experience in vivid detail, informing how a clinician sees a patient. Project HealthDesign, a program of the Robert Wood Johnson Foundation's Pioneer Portfolio run by the University of Wisconsin-Madison, just announced a series of grants to explore this future. Five research teams will work with people with a range of chronic health conditions -asthma, depression, Crohn's disease and obesity - to gather data on their diet, sleep, pain, moods, ability to perform day-to-day tasks, and several other factors. The teams will try different ways of analyzing, synthesizing and summarizing the data and they'll try to extract clinically significant information from all the bits and bytes. They'll share the information with the participants and pass information on to clinicians. In short, they will prototype a new approach to health care - one where trends can be spotted before they manifest themselves as problems, one where the effects of new treatment regimens can be readily observed and quickly adapted, one where the connections between behavior and health can be more easily demonstrated.
Is this a good idea? It's not clear. There are many questions around the potential invasiveness of this approach, the practicality of collecting so much data from people and of interjecting this information into the workflow of an already overloaded clinician. And there is even the question of whether any of this information will have any relevant clinical meaning. Project HealthDesign won't answer all of these questions, but will generate insights about them and point out directions for further exploration. But the potential is exciting and it's quite possible that one day, treating a patient without data from her day-to-day experience will seem as quaint as looking at the belly without the aid of a handheld ultrasound.
Stephen J. Downs is Assistant VP Health Group and a member of the Pioneer Portfolio team at the Robert Wood Johnson Foundation.
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