What does the future of medicine look like?

Wednesday 28 June, 2017

If you’re wondering what the future of medicine looks like, the right person to ask would be Dr Martin Seneviratne. He may be only 27 years old, but his work and study over the years have made him quite the expert on this question! On Wednesday 15 March 2017, he spoke to the boys at Warrane about the medicine industry and the world of medical software.  

Martin’s focus: medical software                                                                              

Martin grew up and went to school in Sydney, and over the course of his studies gravitated towards the nexus of medicine and technology: medical software.

“My experiences with the health system kept affirming how behind it is from a software perspective,” said Martin. “We still use fax machines, everything is still paper based... It struck me that one of the lowest hanging fruits in medicine is how to use software and data more effectively.”

It astounded Martin that while many other industries (such as aviation and manufacturing) were taking leaps and bounds with the help of technology, medicine was still far behind. So he started working on healthcare apps  – the first being an app called WardConnect, which was rolled out three years ago in Orange Hospital.

Martin said: “It was a checklist tool for hospital wards. We had a custom checklist for the nursing, medical, physio, pharmacy, social work teams, and the app would draw together all of that information from the different cogs within the multi-disciplinary care team into one place. You could see by the bedside a synthesised picture of what was happening with that patient - and then you could assign tasks to each member of that multi-disciplinary team.”

Next was a project called HealthNavigator with the George Institute, which aimed to do community cardiovascular screening using a similar app-based tool. “We gave this tool to community nurses who would take patients through a health questionnaire, and the app would generate tailored risk scores and recommendations about local health services. Trying to increase community health literacy through some very basic technology.”

After finishing medical school, Martin moved on into the hospital system, where he’s been working for the last couple of years. Here again, it has been affirmed to Martin how important software is for the delivery of healthcare, and as such, the next 12-18 months will be a slight detour for him, through the John Monash Scholarship Program.

“I’ve got this amazing opportunity to start a Masters degree in clinical informatics –all about how to use health data more effectively. How do we digitise the health system? How do we build a learning system that knows about you as a patient and can make, for instance, predictions about what the kinds of complications you might face and the optimal therapies for you?”

 The World Economic Forum

In the course of all that, Martin was invited to attend the World Economic Forum in Davos, Switzerland earlier this year. Started in the early 1970s by an economics professor who wanted to create a platform for collaboration between other academics across Europe, the Davos meeting now brings together 3000 leaders from government, academia and industry the world over.

 “The special thing about Davos is that it blends worlds,” said Martin. “You have 50 heads of state and thhe CEOs of most major international corporations in the same room with religious leaders, youth representatives, people from the transgender community, refugee advocates etc. Overall, Davos attempts to give a birds-eye view of all the big trends shaping the world’s economy.”

All this takes place, in the knowledge that someone with the right influence could hear something good, and drastically alter the way that their country or industry does something. But for Martin, it was clear that there was an ever-growing focus on healthcare. “Everyone in the healthcare groups was talking the same language around the future of medicine. And it was a future of digitisation, and automation, and patient empowerment through technology.”

Why has the medical industry fallen behind technologically?

For Martin, this was simple enough to explain. “It’s what I call the innovation paradox, in that medicine is inherently an extremely innovative industry. All through the history of medicine it’s been punctuated by these great stories of innovation,” he said.

“Where I think it falls short is around the adoption of digital technologies,” he continued. “Simply because other industries have been revolutionised by software in a very rapid way; and our modern concept of innovation is quite different from traditional medical innovation, which might have happened in a big pharmaceutical lab, through clinical trials, etc... Modern innovation is where a student in a garage can come up with an idea and get product to market very quickly.”

“That rapid-fire concept of innovation is really difficult to translate into healthcare because (a) clinical workflows are difficult to change; (b) privacy is a big issue; and (c) there is always this huge concern – and a fair concern – around patient safety. It’s very difficult to test things in a fast iterative way in medicine, because patients are potentially at risk. So I think where medicine falls behind in the innovation space is that we haven’t built the right models for rapidly testing new digital health ideas. Creating sandboxes, where you can try something quickly and safely, is part of the key to unlocking some of these technologies.”

So what does the future of medicine look like?

Martin outlined a number of things that should be part of the future of medicine. One of these is record-sharing between hospitals, in order to make looking after patients more efficient. Australia stands to be a world leader in this with the formation of the Australian Digital Health Agency and the roll-out of the MyHealthRecord.

“A fair concern around privacy has been one of the challenges in the uptake of digital tools within medicine,” said Martin. “But I don’t think it’s insurmountable. With the appropriate technical measures in place, with appropriate patient education and opt-out systems, we can safeguard security and start reaping the benefits of unified data.”

 “How can we use all of the data in the health system?” asked Martin. “Imagine if a patient walks into hospital with undifferentiated abdominal pain, we can actually leverage all of the data about that patients and patients like him, and all of the scientific literature that’s being constantly generated, to come up with a more accurate and personalised care plan.”

Will artificial intelligence replace doctors?

One question that came up a few times was about the role of the doctor – will doctors be needed if sophisticated artificial intelligence is implemented?

“The role of the doctor will have to change,” said Martin. “These technologies will not make doctors obsolete, but it will change the cocktail of tasks that physicians do. More than AI replacing doctors, doctors who use AI will replace doctors who do not.”

Martin outlined that broadly speaking, doctors experience three stages in dealing with a patient: gathering data from them; logical processing of that data; then relaying back a diagnosis and treatment options to the patient. He believes that artificial intelligence would be of help in the second step – especially considering that there is psychological research to show that humans can only hold about four pieces of information in their mind when making a single decision, when there are usually volumes of data to take into account for a clinical decision. Here, artificial intelligence would be welcomed. However it couldn’t take the place of the first and last step - where the role of doctors will be bolstered.

“We’ll actually have more time to focus on what is the beautiful human part of medicine,” said Martin, “where you’re talking to a patient, and explaining to them. Where you are their guide, advocate, instructor in a journey through healthcare; rather than just being a brain to logic through data. So I’m excited about the prospect of artificial intelligence - we should look at this positively.”

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