As Joseph Kvedar makes a beeline for the bakery near his office, his phone buzzes. It’s “Sam,” his virtual assistant, reminding him that a cookie won’t help him cut the James Bond-like tuxedo figure that he wants at his daughter’s upcoming wedding. Dr. Kvedar, a vice president at Partners HealthCare in Boston, forgoes the cookie for a walk.
Soon his phone rings again. This time, “Sam” has found a coupon for a local pool on the Internet — does Dr. Kvedar want to take up swimming again? Nevermind that he hasn’t swam in decades, because “Sam” can be compelling. “He” has mined Facebook to learn that several of Dr. Kvedar’s colleagues go to the same pool, so surely he’d like to join them.
“Sam” doesn’t yet exist in the format that Dr. Kvedar presented in his talk “Harnessing the Internet of Healthy Things: How Connected Health Can Advance Rheumatology” on Saturday, the opening lecture of the 2016 ACR/ARHP Annual Meeting in Washington, D.C. But in the world of the Internet of Things, in which everyday objects from toasters to wristbands gather data and share them with the digital cloud, “Sam” looms on the near horizon.
New digital tools don’t just allow for doctors to visit virtually with their patients. “The Internet of Healthy Things,” incidentally also the title of Dr. Kvedar’s 2015 book, is much more ambitious than just that. And it’s not the stuff of science fiction.
“The technology part of this vision is here today,” Dr. Kvedar said. “Advertisers are doing this — why not do it for healthcare?”
The promise, of course, is immense. With gaps between the number of rheumatologists working in the medical field and patients who require their expertise projected to widen, tools that can gather and make sense of enough data points to paint a holistic portrait of an individual’s health profile could literally save lives. Not only could a “Sam” tell a person to avoid cookies, but “he” could help him or her keep track of which pills to take and analyze many different health data points to identify risks.
The individual cogs are in place to make that happen, according to Dr. Kvedar, but they need to do a better job of talking to one another.
“It’s still early, so we have the chance to shape it,” he told a packed auditorium of physicians, researchers and other health care stakeholders. “We really have to seize that opportunity to get in front of what is now a real trend in the industry.”
CreakyJoints, for its part, has harnessed that trend with its own mobile and web-based app, ArthritisPower, a patent-led research registry for arthritis whose aim is to support future research, compare treatments and identify new ones, and perhaps one day find a cure.
In regards to virtual health assistants, there are concerns and kinks that need to be worked out, Dr. Kvedar admitted. A recent AMA digital health study of 1,300 doctors noted that nearly 80 percent worried about liability. “I bet you are too,” he said. “We have to work on that.”
Others, he noted, will worry that digital tools will threaten to replace real doctors. “God, this guy has got technology taking my job away from me,” he said. “It’s not a dystopian future.” Doctors have “very special relationships with our patients, who look to us for guidance,” he added.
Real-life doctors working with virtual assistants like “Sam” can contribute to the Sentinel Effect, wherein patients tend to make healthier choices when they know their behavior is being observed, according to Dr. Kvedar. “They do not want to look like they fell off the wagon,” he said. “That’s a very powerful effect.”
Given the the benefits of “Sam,” when the challenges are mitigated, doctors who don’t embrace what’s coming run the risk of being left behind.
“Don’t be caught by surprise, because you just didn’t think about it,” Dr. Kvedar said. “It is happening.”
By some estimates, there will be 20 billion “smart” objects operating 20 years from now, and all of them will share the data that they collect. “We will know the world in a very different way,” Dr. Kvedar said.
“Sam” will only work, of course, if individuals voluntarily give up their data knowingly. Dr. Kvedar is very comfortable doing that, and given the amount of data millions of people provide regularly to social media platforms and other online tools, it seems likely that many others will feel the same way. And while Dr. Kvedar prefers to have his virtual health assistant function more like a drill sergeant and authoritarian coach, he allows that others might be motivated by a different tone.
“If you find ‘Sam’ too overbearing, fear not, because we will be able to design this sort of program to meet your inspirational and motivational needs,” he said.
“Sam” exists now as a sort of unassembled jigsaw puzzle, according to Dr. Kvedar. “You can only see glimmers of it.” To assemble “him,” programmers will have to do three things:
- normalize the data sources and allow them to tell a unified health story (“All of you are clinicians. The last thing you want is another place to go fish for something.”);
- capture data without friction (“We have to make it easy for [patients], so they do one thing once.”);
- and integrate all of the above.
Though some of the skills that “Sam” will exhibit already exist in Netflix or Amazon algorithms, there will be considerably less margin for error in the realm of health. “We will not get a second chance,” Dr. Kvedar said. “We can’t have goofy recommendations.”
In the end, the chances that “Sam” will actually make a difference may depend on “his” ability to localize. Dr. Kvedar noted that “Sam” didn’t tell him that the cookie might cost him a heart attack, but instead “he” brought up Dr. Kvedar’s daughter’s (theoretical) wedding.
“Personalization is an engagement tool,” he said. “If we get it right, we can help inspire our patients to care better for themselves.”