The Evolution of Healthcare Data Collection: Observations from MC10's Chief Medical Officer Thanks to the advent and implementation of new and constantly developing technologies, healthcare data collection has improved dramatically in the past few decades.
From more than 20 years as an Intensive Care Unit (ICU) Director to serving as a consultant and medical director of several medical product companies, Art Combs, MC10’s Chief Medical Officer, has witnessed firsthand the evolution of the healthcare industry. He has identified five major shifts underlying the change.
1. Invasive and Wired to Noninvasive and Wireless
The early 1960s and ‘70s (or the “Invasive Era” as Dr. Combs calls it) was categorized by new procedures and cutting-edge medical tools. As a physician at the time, Dr. Combs treated some of the first open heart surgery patients, witnessed early cardiac catheterization, personally placed some of the first Swan-Ganz catheters and saw all of the original technologies — the first CT Scanner, the first M-Mode Echo, the first 2D Echo, and the first MRI, not to mention the sequencing of the human genome.
“What I quickly realized in the 1980s (especially with the introduction of pulse oximetry), was that everybody wanted the same information, but they didn’t want to invade the patient to get it,” Dr. Combs recalls. When pulse oximetry was first introduced to the market, “It was a demonstration that you could get a really important piece of information about the patient, in this case oxygen saturation, and you could do it without needles, or catheters, or wires or x-rays,” says Dr. Combs. “That was kind of the death knell of the invasive era. Everything from that point on intended to be either non-invasive or minimally invasive.”
In conjunction with the growing priority of non-invasiveness, wires and tubes were no longer the predominant clinical features that Dr. Combs remembers during his time as an ICU Director. While it was once normal for patients to be connected and constrained by several wires and tubes and devices, clinic environments of today are more wireless in nature “and that is the expectation.”
2. Intermittent, Moment-in-Time Assessment to Longitudinal Acquisition and Time Based Assessment
In the past, the data available to a physician was limited to the information that could be gathered through a patient history, physical exam, and lab tests. “The problem with this method,” comments Dr. Combs, “isn’t the physical or the labs. Those are valuable assessments. The problem is being limited to a snapshot of one tiny moment in time. For example, a cardiogram takes 6 seconds to acquire. There are 86,400 seconds in a day.”
Today’s technology provides the opportunity to examine those other 85,394 seconds to find the problem. “People always want to know if the patient is taking their medicine, and if the medicine is working. In the artificial environment of the doctor’s visit, it’s hard to say,” Dr. Combs notes.
With the help of wearables and novel data capture tools, we can now look at efficacy over time as we observe the patient in their daily life. These healthcare data collection devices provide a much more accurate and complete assessment of compliance and medication efficacy.
3. In-Clinic to In-Home
There’s nothing wrong with the old-fashioned structure of going to the doctor for a visit or a check-up, but “it’s a set of artificial circumstances and a brief moment in time,” according to Dr. Combs. “Some patients get nervous in front of the doctor and their blood pressure is elevated, when at home it’s not. Some patients want to please the doctor and say they are taking their medicine when they are not. There are elements of the clinical circumstance that are artificial and even create artificial medical information.”
The modern day ability to look at a patient’s data within the context of their own natural habitat or home setting provides a level of validity that simply is not attainable in the artificial environment of the doctor’s office.
4. Clinician Interpretation to Clinician Interpretation Supplemented by Data Analytics
In the past, the interpretation of a patient’s health data was limited to one doctor’s assessment during a visit. As Dr. Comb’s puts it, “It was just one person’s thought, based on that one impression, from that one day. There was no opportunity for the doctor to see more data over time, and no opportunity for data analytics to add another dimension.”
This method of analyzing data was narrow and incomplete. The added resource of data analytic capabilities reveals patterns and interpretations of a patient’s well-being that would not be detected by one doctor’s review. “People have a tendency to live their lives in patterns. The opportunity to see these patterns and to examine the big picture, is something that an individual practitioner could never have,” comments Dr. Combs.
5. Internet of Sites and People to Internet of Things
For many years, Dr. Combs says, physicians have had access to the “internet of sites and people. We’ve had access to information, and other expert’s opinions or papers.” Only recently, however, have we gained the benefit of the internet of things. The devices used to treat patients “didn’t give you feedback, or information. They didn’t talk to you,” Dr. Combs recalls. “Now that we have an Internet of Things, we have the opportunity for medical devices to participate by providing useful information for clinical assessment.”
Coming from a place where standards of care were subjective, imprecise, and largely not reproducible, Dr. Combs has witnessed a transition in patient monitoring and healthcare data collection. “We’re moving towards objectifying the subjective, giving precision to the imprecise, and making data reproducible that never was before.”