It's 2025, a Digital Earth where continuous connections are everywhere, yet it's a planet where infectious disease outbreaks can erupt anywhere and spread worldwide in days. To provide a strategic health care firewall against medical crises and bio-terror, the Centers for Disease Control have matured digitally into a global, real-time e-CDC. New medical threats are identified, responded to and contained 24 x 365. As a real-time partner of health services around the world, the e-CDC's digital presence is everywhere. In this continuously connected future, it uses the best specialists to deliver the best medical protection everywhere, instantly, all the time.
Ebola exploded into the headlines because medical health is at the center of the world’s survival and prosperity. Now that Ebola is contained but not defeated, it’s possible to consider how a fully digital medical infrastructure could deal with a global pandemic.
Health challenges from infectious diseases
Ebola is just one of the world’s lethal infectious diseases. With a growing, increasingly mobile and urbanized global population, the number and diversity of infectious disease outbreaks has grown significantly since 1980. In the past 33 years there have been 12,102 outbreaks of 215 human infectious diseases. Those diseases are the second leading cause of death, responsible for about 25% of all deaths.
Experts take threats like Ebola as seriously as the media. TechCast, a virtual global think tank with 130 experts that assess a range of possible futures, estimates a 22% probability that “a new pandemic devastates a major region, destabilizing global society.”
The remarkable reemergence of epidemic diseases has been traced to global transportation and other “anthropogenic” factors that cause a rapid spread of growing numbers of vector-borne diseases. Urbanization increases the risks. Almost half the world’s urban population in developing countries lives in slums, and the number of slum residents is forecast to grow from 1 billion to 2 billion by 2030, condemning billions to crowding, poor sanitation and inadequate access to health care.
A global view clarifies the challenges facing the world’s medical infrastructure: health care pressures will continue in the areas of infectious diseases, unsanitary slum conditions and escalating costs. In addition, bio-terrorism will become a growing threat since its tools and equipment are a normal part of modern development, and bioengineering lab skills are being taught to college students. When pathogens can erupt anywhere and spread worldwide in days, the world’s response time must be reduced to hours and days.
This global view of a new digital medical infrastructure is essential if today’s medical infrastructure turns into a medical scalpel at the world’s throat. Medicine’s increasingly unaffordable costs serve only a fraction of the people who need treatment worldwide. If we recognize that infectious diseases require universal, high quality health care for everyone, and today’s medical infrastructure can't fill those needs. Medicine’s gaps may permit an infectious disease to grow to a mortal threat. As Ebola in West Africa shows, these limitations are a problem for the world, not just a nation.
How could medicine become one of civilization’s core strengths? One of today’s crucial questions is whether medicine will find a global turning point, accelerate its progress and build a skillful and cost effective Digital Medical Infrastructure (DMI). Not just for health care, but as a core capability on a universally healthy and successful planet.
Digital medicine’s first world
By 2025 networks will be an indispensable part of the economy and daily life. In advanced countries, traditional face-to-face medicine is likely to resist wholesale digital transformations. Skilled hands-on professionals will oppose being turned into remote and quick digital processors. Some of the roadblocks will be accreditation, malpractice lawsuits and government regulations. Today’s digital acceleration is likely to prove slower in the increasingly expensive medical sector, no matter how many sectors embrace it. Still, digital medicine is on the rise and within ten years major changes may happen.
At the government level, technology in medicine is focused on e-Health. It includes a complex framework with multiple stakeholders that are defining interoperability between the systems of each country's medical providers, and between different countries. Examples include epSOS (European Patients Smart Open Services) for cross-border interoperability between electronic health record systems in Europe, and HL7 (Health Level Seven International) to develop the ANSI standards for electronic health information that support the clinical practice, delivery and evaluation of health services. These initiatives face the daunting challenges of simultaneously developing interoperability across legal/legislation, clinical medical delivery processes in many different countries, as well as each's many kinds of medical systems and organizations.
On a practical level, current ICT (Information and Communications Technology) systems are expensive investments developed by hundreds of ICT vendors to meet the unique requirements of each health care provider as well as government health services. The range of stakeholder requirements in each legal, clinical, organizational and technical data domain presents serious challenges and delays. Core challenges include data/technical interoperability so both technical and clinical definitions align between different systems.
An exemplary model is the Croatian national E-Health framework. It includes 2,500 general practitioners, 250 pediatric care facilities, 250 women's health clinics, 2,000 dental offices, 120 laboratories, 1,300 pharmacies, 60 hospitals and over 60 ICT vendors that provide software and services. While this kind of advance is significant joining it presents challenges for SMEs in the areas of costs, technical requirements and clinical processes. Both strict technical requirements and complex medical procedures add high costs and difficulties that deter many who may want to participate.
At the personal end of the digital spectrum, an Optimize me movement is developing rapidly as a new connected health domain that is designed for lifestyle technologies that include fitness and health. The first sizable initiatives are new health platforms from Google, Apple, Samsung and others. These support health apps and wearables like Fitbit, jawbone, Apple's watch and others.
In the future these will converge with routine medical analyses of one's own genome, micro-biome and biological activity that is tracked throughout the day. Labs like Nestle's Institute of Health Sciences are researching how to combine personal nutrient analysis with 3D printed food to customize it to fit each person's unique requirements for essential nutrients. Other innovations will focus on quality of life, personal productivity and mental enhancements. Patients will track their data and set their personal goals. Care teams will work with individual users to set measurable goals, analyze their personal data, confirm users know how to respond to their continuous updates, and achieve optimal outcomes.
Both e-Health and Optimize me advances are powerful, but neither provides a global medical infrastructure that fits pandemics. Neither serves the billions of people without resources, those who are excluded from the advanced first-world’s’ medical system.
New challenges, new trails
The recent hysteria over Ebola triggered a re-examination of the ability to respond to major disease threats. Just to deal with Ebola, the Obama administration has asked Congress to approve $6.2 billion in new emergency funds, including $112 million for the Defense Department (through DARPA) to develop new technologies relevant to this type of medical crisis.
On the cost front, it is unaffordable to expand the first world’s technologically advanced medical infrastructure to serve the billions of people who live in slums, Sub-Saharan Africa, India and other under-served populations. For example, only 1% of the global health expenditure is spent on 24% of the global disease burden, which is in Sub-Saharan Africa and comprises 11% of the world's population. The differences from the first world are striking. Sub-Saharan Africa has just two doctors per 10,000 people versus 33 in Europe; 11 nurses and midwives per 10,000 people versus 68 in Europe; and just nine hospital beds per 10,000 people versus 63 in Europe (source: WHO).
NGOs and foundations are similarly limited in their scope and impact. While these contributions are often exceptional and valuable as point solutions to specific problems, they do not change the bigger picture of a world with many medical needs that cannot be met.
A deadly disease knows no boundaries, stops at no borders, and is indifferent to class or political power. A reassessment of traditional advanced medicine, public, private and NGO approaches is forced by the size, severity and cost of these health challenges. After Ebola it is clear that this need is multiplied by the risks of infectious diseases that can be flown swiftly around the world.
What if it were possible to add new tools and capabilities to the CDC, WHO and the medical community so they could be proactive versus reactive, and stay ahead of potential pandemics to prevent outbreaks? What if it were possible to provide new kinds of digital medical infrastructure, services and care at scale where it is missing, and where new kinds of improvements are needed? What if these responsive systems could also defend against bio-terror threats, adding strategic medical defenses where little exists today? There are reasons to consider how to use digital innovation to do humanity the service of paving new trails and adding new options.
A digital reconstruction of medicine offers new opportunities that haven’t been considered before. In transportation, Uber is rebuilding the transportation network. It started with personal trips and is now expanding to carpooling and ride sharing, multiplying its value to everyone who needs transport at ever lower costs. With a similar rate of growth, Airbnb is about to become the world's largest hotelier, surpassing InterContinental Hotels Group and Hilton Worldwide. These and other digital strategies have not created new resources. They have deconstructed existing relationships and reconstructed them in new digital relationships. What would happen if the medical infrastructure were viewed with new eyes, and seen from the perspective of a Digital Earth that is designed to produce universal success by everyone?
Practically speaking, a Digital Earth should be designed as a platform that can address the medical infrastructure's need to control and treat infectious diseases. This platform would utilize an architecture similar to Google, Uber, Airbnb, LinkedIn and other digital platforms: a ‘build once, run everywhere’ strategy deconstructs both medical services and medical resources so they can be accessed over the network as needed, then reconstructed both digitally and physically at each point of need. Over time, this could be scaled to include a growing range of points of need, simultaneously, worldwide.
A global infectious diseases platform
Starting in the 1975 pre-PC world, every decade has produced dramatic advances in how collaboration worked. By 2005, in many companies it had become normal to work in global teams. But now we’re starting to have staggering numbers of transistors processing staggering amounts of real-time data across networks of networks. A real-time Digital Earth is about to begin.
This history and future of collaboration is a perfect illustration of Moore’s Law — the number of transistors on a CPU double every two years — which is an exponential rate of growth. This means many of today’s digital devices are hundreds of times more powerful, connected and capable than they were 10 years ago. The impact is how much the world has changed in 10 years.
A decade from now, the devices in use will be hundreds of times more powerful and better connected than they are today. We are starting exponential growth on top of exponential growth. There has never been a period like this before in history. How much will this change the world in 10 years? In 20 years? One core advance will be to combine multiple advances into new kinds of platforms that accelerate numerous fields beyond anything we have achieved so far.
In medicine, what would a Digital Earth platform look like ? Though it could be conceived as a horizontal, decentralized, network, one has to keep in mind that it also has to provide information and means of action to decision-makers.
Having to deal with potential global pandemics, it should be able not only to detect the very beginning of a crisis, but also to allow appropriate resources in real time to prevent its spread. To do so the platform should be able to redistribute skilled personnel, information, practical and fundamental knowledge, and even medical or pharmaceutical items (such as the formula of a drug, or the 3D plans for a device) in real-time, without regards for the place.
Some attention has to be paid to the physical infrastructure and circuits through which people and practitioners will access drugs. But the main feature, the one that, by 2025, will make a difference, is information. We are not talking of just expanding information systems here. The stake is to digitalize medicine. The platform should be designed so digital technology can deconstruct a domain like medicine down to its digital components, re-assemble it in flexible combinations, then deliver responses in real-time as needed.
Medicine 2025: Immediate, real-time, everywhere to everyone
As we get better at deconstructing / reconstructing a Digital Earth’s technology and capabilities, we will imagine more that’s needed, and a Digital Earth is designed to deliver that. Immediately, in real-time, everywhere, to everyone.
As of today, it is already possible to work on eight crucial features.
Ebola drives today's fears and media attention, but it’s far from a serious global pandemic. In one year, the 2009 Swine Flu (H1N1) pandemic was much more contagious, deadly and expensive. It started in Veracruz, Mexico and by the time it was discovered it was spreading around the world.
In 2009, we had the Internet, Skype calls, new media like Twitter and social media like Facebook, but it took months to discover Swine Flu. In 2025, it is not within months, but hours or days that a digital medical infrastructure should detect a similar flu pandemic — and respond to it effectively at the source, before it spreads.
Ebola mutates like other viruses. In fact, by 2014 there were already four variants of the Ebola virus, with genetic divergences as great as 45 percent.
A new kind of e-CDC, designed to respond to disease threats digitally, would be built as a strategic healthcare firewall, just as PC firewalls are able to detect, identify and deal with computer viruses. Unlike today’s CDC, which operates physically out of Atlanta, Georgia, the e-CDC would be always on, with digital presences everywhere, ready to provide universal threat awareness, analysis and strategic protection from potential health crises.
One of the first world’s most difficult medical problems is coordinating care between different providers and medical institutions. From primary care physicians to specialists to their organizational hand-offs, medical coordination has been described as “poor.” These problems reduce quality of care, patient outcomes and provider satisfaction — while raising costs.
In 2025 new levels of fast and effective medical coordination will have become normal. High-value medical coordination will include first responders like the military, homeland security and 911 emergency services. The e-CDC relies on this to handle the unexpected medical crisis of a new, vaccine-resistant strain of Ebola.
Bio-containment should grow into a medical protocol, run by the e-CDC, activated by an infectious disease or a bio-terror crisis. Medical border security should be digitally added. Digital assessment of the situation could trigger the right response: medical services of course, paramedics, but also police or the military.
A re-conceptualized Digital Medical Infrastructure (DMI) that serves the poor could capitalize on data that shows over 60% of slum dwellers already have mobile phones.
By 2025 Digital Medical Centers (DMC’s) could provide services without medical facilities. Services include medical tests by dispersed MAS Devices, an inexpensive over-the-counter product with sensors to run dozens of medical tests when connected to a tablet or phone. Standardized diagnoses and treatment will be by AI Doc structured medical interviews; phone-based patient monitoring; delivery of generic medicines by drones; and outcomes tracking with continuous improvements in diagnosis, treatments and monitoring.
A 21st Century digital medical infrastructure would be delivered digitally, with tracked results, constant outcome assessment and automated optimizations that add continuous quality improvements. Incidence monitoring of DMC patient diagnoses will trigger infectious disease alerts for rapid treatment of patients and those exposed to them.
At an infrastructure level its goal would be to identify infectious disease outbreaks while raising medical outcomes to first world standards at a fraction of the per patient cost. Though delivered to the poor, given systemic and systematic improvement, this “build once, run everywhere” medical infrastructure might one day match first world outcomes, with universal digital delivery of high quality care.
With continuous digital treatment of patients by medical services, outcomes will be known. The results of different medical caregivers, institutions and processes will be clear. The first-world’s medical systems will evolve responsively and provide quality care at all cost tiers. Low cost will mean high quality with more automated services. High cost will also mean high quality, with more human caregiving. For the first time everyone will receive excellent care, but the delivery methods and styles will match different choices for cost and human services.
Pharmaceutical drugs have difficult regulatory, recall and end-of-life requirements. Instead, consider advancing into a global digital pharmaceutical supply chain. What if the world's inventory of pharmaceutical drugs could be a "mobile strategic stockpile" that maximizes its use and value for curing diseases, eliminating waste/costs, and making drugs one of humanity’s most important real-time global resources? This new digital advance could respond rapidly to the world’s changing disease burdens, providing pharmaceuticals with greater utilization and higher value, while they make the Earth a healthier planet.
When today turns into tomorrow
As Ebola shows, medicine has large gaps in its ability to respond to the growing incidence of infectious diseases, and to growing aptitude for bio-terror. “Medicine 2025” illustrates some options for a digital reconceptualization, reorganization and redelivery of modern medical capabilities.
We are all one in the eyes of a killer virus or bacteria, regardless of whether it comes from a potential pandemic or a bio-terror attack. Now that it can travel by plane around the globe in days, we must find new ways to keep everyone healthy when a lethal infectious disease outbreak begins, or any of us and our children could be at risk.
As the 21st Century’s digital transformation deconstructs and rebuilds industries, medicine has a new opportunity to use these digital advances to serve everyone everywhere, including people who are currently left out.