I was intrigued by Elizabeth Holmes’s now-defunct Theranos company early on not because she promised to develop a novel blood testing technology, but by her overarching goal:
‘to redefine the paradigm of diagnosis away from one in which people have to present with a symptom in order to get access to information about their bodies to one in which every person, no matter how much money they have or where they live, has access to actionable health information at the time it matters.’
The most appealing part of the Theranos business model, IMO, was the ability to walk into a Walgreens and have your blood tested with or without a doctor’s prescription. I’m squarely behind efforts to give consumers greater agency over their health: I’ve been part of the content-building team for RadiologyInfo, a leading medical information website, for more than a decade. In just the last five years, visits to the site have increased 400 percent to a record high of 2 million (November 2018).
As much as online health information empowers consumers, Internet-enabled mobile and wearable devices will take us to the next level by offering more personalized health data. Where Theranos failed miserably, other innovators are successfully democratizing medicine through direct-to-consumer health tests, wearable devices and artificial intelligence.
“We are about to see a medical revolution with little mobile devices,” writes Eric Topol, a cardiologist and director of the Scripps Research Translational Institute, in his book “The Patient Will See You Now.” With smartphones in hand, Topol says we’ll no longer be beholden to an impersonal and paternalistic system in which "doctor knows best."
Smartphone as a Pre-Screening Tool
Miniature attachments can turn the smartphone into a stethoscope, a portable ultrasound scanner and in the near future, a miniature laboratory capable of testing blood electrolytes and liver, kidney and thyroid function. And smartwatches are going way beyond counting steps: the new Apple Watch Series 4 introduced last September has an FDA-approved electrocardiogram (ECG) sensor that records and sends a record of your heart rhythm to your smartphone. The difficult-to-diagnose irregular heart rhythm called atrial fibrillation, or A-fib, is one of the leading causes of stroke. Apple’s new ECG sensor is just the first ’pre-screening tool’ for smartphones the company plans to develop.
Wearable Devices Simplify Blood Sugar Monitoring
Another wearable device with the potential to impact both individual lives and healthcare costs is a quarter-sized continuous glucose monitoring(GCM) sensor, designed to help the 1.5 million Americans with Type 1 diabetes monitor their blood sugar. For individuals with diabetes, poor control of blood sugar levels can lead to complications, including nerve damage, eye problems and heart disease. Rather than using a painful and inconvenient finger-stick blood test to track their glucose levels, patients instead fix the GCM sensor to their upper arm and swipe a hand-held scanning device over it to obtain quick readings throughout the day.
Direct-to-Consumer Testing Services
While Theranos ultimately failed to fundamentally change the delivery of healthcare—other startups are gaining a foothold. Companies like Everly Well are now offering common blood tests to assess thyroid function, vitamin D levels and food sensitivities directly to consumers without a doctor’s prescription. Everly Well expects to make $50 million this year selling its tests, which can be purchased online or in drugstores, performed at home with a few drops of blood from the finger and returned by mail for processing in a certified lab. One caveat: Out-of-pocket-fees for the tests mentioned here, which range from $59 to $159, are not covered by insurance.
Consumers clearly want to be both informed and engaged in their healthcare—and they have an appetite for devices and technologies that provide actionable data to help them stay healthy and prevent or manage chronic health conditions. Smartwatch sales are expected to continue climbing from the 43 million units sold last year to more than 89 million in 2022, when the the entire healthcare wearables market is projected to reach $60 billion.
Managing and interpreting the deluge of data these devices will provide—which can produce false-positive other inaccurate results—is another story. An ‘informed’ patient is a double-edged sword for healthcare practitioners who have less and less time to spend with patients. How will physicians and insurers square with the time required for longer conversations with patients?
The New Doctor-Patient Relationship
Providers will need to work to integrate and manage this new flow of personal medical information into their practice while helping patients contextualize the data. Now’s the time for practices to consider expanding education offerings through newsletters, websites and even webinars to help patients not only understand the new and expanding metrics of health produced by wearables, but also how to be better partners with their healthcare providers.
In the near future, digitally empowered patients will not only have symptoms to share with their physician, but potentially a handful of self-administered test results as well. Here’s hoping that together, patients and providers can use personalized health data from wearable and other technologies to more quickly diagnose medical issues, better manage chronic conditions and prevent adverse events.