Exclusive: Daniel Kraft talks about rapid changes in data-driven health care

State of Reform will welcome Daniel Kraft, Faculty Chair for Medicine at Singularity University and founder of Exponential Medicine, as our luncheon keynote at the 2016 Washington State of Reform Health Policy conference on Jan. 7.

Dr. Kraft brings more than 20 years of clinical practice experience and biomedical research to his insights on the rapidly changing health care landscape. He is a Stanford and Harvard trained physician-scientist, inventor, and entrepreneur. Recently, he sat down with State of Reform host DJ Wilson to talk about what he sees on the horizon for 2016.

DJ Wilson: What are you keeping your eye on in the health care space—in data, technology, or overall trends?

Daniel Kraft: If we frame our health care system, or systems, they have been designed more as “sick care” systems waiting for folks to end up with acute or chronic disease. So we end up being quite reactive. Also, the information and data that we get in most settings of healthcare is fairly intermittent.

We are entering a new era of very data-rich healthcare in which we have the opportunity to be much more proactive and preventative, increasingly aligning with the policy and reimbursement incentives for value based care.

A new era of connectivity is heading towards the “internet of health care.” A set of technologies, which can capture and create terabytes of data per patient per day, whether that’s genomics or quantified self information or connected homes in which individuals can be monitored in smart and increasingly seamless ways.

What’s coming is the ability to leverage this emerging data with a layer of analytics to machine learning. You could call in A.I. in some forms to make sense of the data because no patient, clinician, or health care administrator wants to see, or is able or sift through, the raw data. They want to understand what is the useful, actionable information—sometimes the needle in the haystack—that can take us to more continuous and proactive personalized prevention, diagnosis and therapy.

In a nutshell, we’re entering an era where we’ve becoming increasingly data-rich, but now we’re struggling with how to make that useful across the spectrum for physician, payer, patient. That’s going to have tremendous implications as we drive towards what is arguably more personalized, information-driven healthcare.

DJ: Where do you see the greatest forces of disruption?

DK: Technology is moving quickly. But sometimes it’s not about the technology per say but about connecting the dots of things that already exist. An often-used example of disruption is Uber which is only a 5 or 6 year old company valued at $50 billion+ and has certainly changed the game for personal transportation. But Uber did not invent the smart phone, GPS, online payments, or online maps on which their platform is built. They just connected dots in a smart way.

There are analogies with health care. In the pre-Uber era the rider/patient doesn’t know where their ‘healthcare ride’ may be coming from, how long a wait, how good the driver/clinician is. The Uberization or ability to connect the dots in healthcare involves more seamless and easy to utilize interfaces, from getting a doctor’s appointment to filling prescriptions, to managing data and therapy in chronic disease. But just like with Uber, there are local regulatory and policy challenges. Disruption has winners (consumers and Uber drivers), and losers (the taxi driver and value of medallions) for example.

So it’s not about fancy future technology; it’s about creating systems and platforms that take some of that friction and make elements of healthcare more seamless, one stop, less fragmented and siloed. I think that’s where much of the disruption will come from—not from the invention of new technologies but by integrating some of these new consumer tools and sensibilities that can be applied across the health care spectrum.

Another area that is more disruptive is low-cost ‘omics. 23andMe has been here for awhile on the consumer side, but we are going to see that data get to low cost, full genomes and other “-omics” including proteome, microbiome, metabalones which can be collected and applied to individual patients and cohorts. The low hanging fruit in this space includes pharmacogenomics—how do your genes impact what drugs you might take and at what doses.

We spend a lot of time and money prescribing medications; in many cases they don’t work well or have side effects that are not good for the individual. We now have the power to obtain pharmacogenomics information from the patient even from a hundred dollar, drop-in-the mail genetic test. The challenge today is that this sort of information doesn’t currently integrate with the workflow and electronic medical records of most clinicians.

So we can have great technologies like low cost genomics, but they are not going to be disruptive or impactful until some of the incentives are set and the workflow is enabled.

DJ: I wonder if the deluge of data and the relatively low-to-adapt higher education of physicians are creating a situation where perhaps the best coordinator of our health care information is not a physician at all. Is the future of care coordination some other patient advocate that is tasked with keeping all of it straight and calling the physician only when necessary? Or will physicians continue to be at the center regardless of how quickly they can adapt to these new tools?

DK: The role of the clinician is going to change in this mix. There may be emerging roles for ancillary folks in helping manage, interpret, coordinate some of the information which can be overwhelming and is not just about presenting the data but how to integrate that into someone’s life.

But I would argue that whether you are a nurse, a clinician, or a pharmacist, we want to be practicing at the top of our license – i.e not just managing colds and counting pills. A significant amount of health care is somewhat rule based and could be—I wouldn’t say replaced—but enhanced or enabled with smart algorithms.

This can lead to an era where some basic elements of prevention, diagnosis and care are enabled and partially managed by an AI “Doctor Siri,” that already knows and integrates the patient’s history, genetics etc, through the patient’s smart phone to help them triage a problem or manage a chronic condition. We are starting to see this emerge with telemedicine platforms and the medical tricorder type platforms which are coming such as the Tricorder Xprize which I helped develop.

We’re going to have tools in the patients’ homes, in their hands, that are going to let them collect data and integrate it. This will help them, at least at the first past pass, figure out, for example whether that abdominal pain really could be an appendicitis that needs to be evaluated in the ER or if it’s much more likely that it could be indigestion from a night out, or a urinary tract infection.

We have the opportunity to leverage the convergence of information technology, algorithms, and platforms like medical tricorders to do some of the more basic-level medicine which is more algorithmic. This may enable clinicians to manage the more challenging cases. In some realms, you don’t have to have an MD to help a patient or a caregiver manage this new world of connected, digital, mobile health. In some cases, this might be the primary care physician who is much more the quarter back who is helping manage and leveraging many of these tools.

 

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