– by Dr. Irving Loh, MD
There is a sea-change occurring in healthcare, brought about by healthcare technology now accessible by the consumer…I mean patient. The shift is going from physician controlled to patient controlled health data. I am not debating whether or not this is good thing or not…I certainly have reservations. But the change is occurring nonetheless and is something that we all need to recognize. Dr. Google, Wikipedia, Android and iOS tools and apps on smart devices have been giving our patients objective topical data for years, though not necessarily germane information relevant to the patients condition. Symptom checkers, on-line medical help services, patient driven virtual visits are here and getting more prevalent and getting better. But something more fundamental may give this trend a huge boost.
Unless you are absolutely oblivious to things technological, you may have heard about a company in the Silicon Valley called Theranos, which is methodically and intelligently laying the groundwork for disrupting the clinical laboratory testing ecosystem dominated today by Quest and LabCorp. We all order labwork on our patients. Theranos’ play is in the quantity of blood required (microliters via fingersticks), cost (fractions of current prices), and turn-around time (much less than the average 72 hours). Samples are drawn, automatically analyzed by their proprietary microarray technologies, results securely transmitted to a database that is accessible by the patient and the physician. Cost savings to CMS may be in excess of $20 billion annually.
Theranos’ CEO, Elizabeth Holmes, recently pondered a potential paradigm shift in preventive care that may be facilitated by her enterprise. As stated in her July 29 WSJ op-ed (1), multiple barriers exist that impair the ability for laudable preventive care strategies to be as successful as they could be. As a preventive cardiologist for over four decades, I concur with the premise that the key is identifying the index case. The patient that has the marker that signals increased risk of developing a clinical condition that presages premature or avoidable maladies. Those markers may be laboratory, genetic, or other clinical tests that require a prescription order from a provider and pre-authorization from an insurance carrier, or else be paid for by the individual. Authorization and cost are potential barriers that may not be surmountable in the current environment. If the cost of the tests were inexpensive enough to remove the barrier of insurance denial or make the test affordable, then concerned patients AND their physicians may be able identify at-risk patients rather than wait until symptoms of advanced disease arise. Preventive strategies for heart disease, diabetes, cancer and other diseases may then be implemented sooner and to greater health-economic benefit to society, but most importantly, to the benefit of the patient.
If validated tests are affordable and interpretable by the individual, this strategy augurs well for a new era when earliest possible diagnoses are achievable, affording the opportunity for timely and effective interventions. The operative word, however, is interpretable. Having a test result with the normal range provided and even a brief explanation of the test in lay language may not suffice, especially for the hypochondriacs in the patient pool. Consulting with the patient’s healthcare provider remains the key to providing context and deciding the appropriate next steps. Although cynics may regard the op-ed as being self-serving (but as Pope Francis has said, who am I to judge?), I applaud Theranos for providing the technology to potentially make this happen. Disruptive indeed.
1. How to Usher In a New Era of Preventive Health Care: http://on.wsj.com/1IpWzIU
Dr. Irving Kent Loh MD, FACC, FAHA (Epidemiology & Prevention), FCCP, FACP is a board certified internist and sub-specialty board certified cardiac specialist with an emphasis on preventive cardiology. He founded and directs the Ventura Heart Institute, which conducts education, research and preventive cardiovascular programs. Dr. Loh is a former Assistant Professor of Medicine at UCLA School of Medicine. He is Chief Medical Officer and Co-founder of Infermedica, an artificial intelligence company for enhancing clinical decision support for patients and healthcare providers.