Looking Back

There are not many things that you can neatly look back on for 15 years and contemplate what to change. This past December at our annual holiday party, I opened comments with: “It has been an amazing 15 years; there is not a day that I would give back…” When reflecting on this comment and thinking about one of the advancements that has happened while we were building Doctor Evidence (DRE) – like the CRISPR technology – I mused that there are actually parts of days that I would like to change.

To put this in context, as a co-founder and CEO of DRE I decided to spend these past 15 years of my life pursuing our mission in order to capture and leverage the knowledge of what drives patient disease and health ailments. Specifically, to capture the learning capital that one gathers when sick, and then use that as a starting point for other patients likewise afflicted; in other words, deep knowledge sharing of care options and outcomes for people in similar situations. This theme can also be precisely applied to drug developers, health authorities (approving and monitoring drug safety), and academics analyzing data on medical interventions.

We at Doctor Evidence have tried to do this by creating integrated data and best methods practices into a unified software platform. We have largely accomplished that task with great satisfaction and benefit to our patrons. In doing so, we have also been part of the struggle to tackle one of healthcare’s biggest challenges: making data digital in a way that can truly enhance and personalize patient health.

Scientific innovations and treatment solutions are being developed at an incredible pace. In contrast, the healthcare information technology market is lagging substantially, with data being held in silos due to proprietary systems (e.g., electronic medical record systems, private registries, claims databases, and other real-world data sources). And now more than ever, we live in a world of connected data, with the ability to perform advanced analytics and data integration with the overall knowledge management system of healthcare. We could peer-review data light speeds faster than current methods, connect individualized data to care options in real-time (including outcome data), transfer data from drug developers to regulators making approval decisions, and collect and match treatment outcome data to patient preferences for care decisions.

On average, 10 years of deep domain knowledge exists for each new drug, multiplied by the hundreds of researchers and developers that have worked on the invention. That blows away Malcolm Gladwells’ 10,000 hours concept. Imagine that we are leaving hundreds of thousands, if not millions of hours of knowledge on the cutting room floor. Arguably, the most valuable thing in healthcare, or any market for that matter, is the learning capital that a professional has in their field. Principally because we are so obsessed with conflict avoidance, we are not connecting critical parts of data in the healthcare ecosystem that could otherwise radically improve the lives of patients. What we really need to focus on in healthcare instead of conflict avoidance, is radical transparency around healthcare knowledge, interests and data.

Looking Ahead

What we need is to create a central database of global health data, with regionalized slices of the data fingertip-accessible. Then, we need to shine a bright light on it such that everyone can comment and focus on enhancing the data. This would of course disrupt the proprietary data sales market, but overall it would expand even that economy by providing a single source of truth around which others can provide services. Imagine a central database where all data is stored, normalized, and used for healthcare decision-making. In an information age, we need to break down walls between proprietary information and create one central source of data. And we have tools to comfort the naysayers, like blockchain. The entire notion of blockchain, itself a fascinating construct to embrace mistrust and deceit originally formed around monetary systems, says we can verify and replicate at any point in the chain, anytime, any scenario; therefore, you can trust it and privacy can be protected based on continuous replication of the chain. But blockchain is only a container; we first need to gather the data for the container and include foundational trusted institutions, like the one principally backed by the Bill and Melinda Gates Foundation: The Institute for Health Metrics and Evaluation (IHME). The IHME maintains the Global Burden of Disease (GBD) database (in its 20^th year) for the World Health Organization (WHO) on all 195 countries in the world. In its 12^th year, the IHME is a great beginning platform for adding additional data sources to create a one-stop trusted source of truth in health data.

Now, given that I did not have a CRISPR-like technology to change some of the last 15 years in healthcare, here are the top 5 things that I would have used it on if I did:

For this CRISPR work, I would focus on fixing the critical parts of the above issues, and in doing so, the whole would be affected by using the same pathway principles that immuno-oncology uses: a critical targeted agent to activate the rest of the ecosystem for correction. By focusing on a targeted set of critical parts of the big issues in healthcare, we can rebalance the equation back to patients and make significant change that will improve the lives of everyone.

As in all endeavors of historical advances in society, knowledge remains the great basis of change. Today more than ever, the “digital age” has given us the ability to leverage and transmit learning capital across an entire society, regardless of social and economic class. We owe it to our loved ones and future generations to share our data and knowledge. If we don’t do this right, future anthropologists will not be studying rock follicles to determine how advanced our culture and tools were, but rather they will be studying digital follicles to see how much we shared and helped each other. Wouldn’t it be nice to live in a world where you would not feel like you were the first person ever to get cancer and struggle to figure out what to do? Wouldn’t it be nice?