The Virtue of Seamless Health Care

Dr. Cole Zanetti describes the future of medical education and training in 2050 and the resource they have in patient

Cole Zanetti, DO, provides a view of a seamless healthcare education system based on competency and empowering patients to manage their chronic diseases.

In 2050, people will manage most of their health care within the convenience of their routine daily activity. Information will be free-flowing; data will be collected from any data stream that is naturally produced by daily living. Examples include purchasing habits through credit or debit card expenses, activity levels of sleep and physical activity, social network data (Facebook, Twitter, text messaging and phone call information), health care data such as claims data, medication compliance, etc. Real-time analytics programs will be customized by personal priority, timing and location. Medical students will learn science and medicine using virtual gaming and augmented reality. This method of learning will allow for greater gains in health outcomes, which will have been redefined through quality-of-life parameters over time. The triple aim between now and 2050 is to transform health education from a focus on quality, cost and population to a new focus on seamlessness, usability and customization. By 2050, doctors will have realized that the greatest resource not being tapped in health care is the patient.

The greatest injustice that exists at the present time is that physicians are not empowering patients with their own information and the learning tools to manage most chronic diseases. The “patient practitioner” movement that we expect to see in 2050 will come to pass when family doctors create patient-training initiatives that provide learning tools and medication kits for patients to manage their chronic diseases at home. The movement will start with non-invasive management of asthma, chronic obstructive pulmonary disease, hypertension and congestive heart failure and then progress to more complex diseases with the advent of home testing and analysis systems. Lab tests will become easily accessible and data analytic systems will be able to provide personalized recommendations.

Optimize Me

Another great change in medicine will arise from the personalized medicine movement. This will ultimately provide access to one’s own genome, microbiome and all biological activity throughout the day. All of this personalized data will be constantly monitored by an ambient intelligence system and will allow for the vast majority of chronic and acute disease issues to be managed at the patient’s own home, at his or her convenience. The system will automatically verify data and will provide patients access to appropriate medications; they will no longer need a physician for every prescription. Doctors in 2050 will help build patient-training modules and help contribute to a communal virtual and augmented reality platform that answers patients’ questions and allows them to learn more about optimizing their health and health-management skills. Patients will work with a care team to establish goals and analyze all their medical data to optimally achieve their desired outcomes. Individuals will get daily updates that compare their progress to that of others, in both their community and in the world, who are striving for the same goal and fit the same demographic. Information could be shared within these groups so that patients with similar situations can network and help each other improve their attributes. Community health assessments will become a source of local and national pride, and may become a major priority in the United States. The transparency of information will drive now-unforeseen creative movements that will allow people of all ages to tackle the most challenging health issues.

Physician Redefined

The physician’s job during this time will be to help create capable patients that are masters of their own health and well-being, aiding patients in the pursuit to optimize personalized attributes that are targeted based on their individual life goals. Medical training during this time will center on helping trainees become the most effective teacher possible. The role of physicians will be to work as part of a team of providers who facilitate information management and learning related to an individual's quality of life goals in the context of health, wellness, and community. Informatics at this time will become a physician's lifeblood. Every patient will be viewed through both a micro and macro lens, using his or her data fingerprint and predictive analytics to help guide clinicians towards optimizing the patient’s care.

Medical school will consist of an integration of simulated and reality-based learning scenarios. There will be no time requirement associated with medical school; at this time the assessment of trainee skills will be completely competency-based. If one is able to prove mastery through dynamic understanding of core concepts of care, a student will pass regardless of the time spent in developing their mastery. In order to develop mastery, the student physician must learn to live a life of health and wellness for him- or herself through this care lens. This pursuit would be essential for doctors to understand the commitment and challenges to maintain health and to provide better care for the rest of the population.

The Evolution of Medical Training

In 2014, a perfect storm is brewing in medical education. The trickle-down impact of innovation is crippling the brick-and-mortar schools’ ability to effectively train doctors for the future. With the advent of a new health care policy, the foundation of medical education is beginning to crack. The areas of quality improvement, systems theory, informatics, learning science and communication have very limited experts, at this time, to fit the traditional model of training. Third- and fourth-year rotation slots are limited due to the increase in class sizes, and at the same time, hospitals and clinics have started charging medical schools to send students for rotations. The combination of these factors has caused tuition to skyrocket and has challenged schools to reassess their approach to education. One of the greatest challenges to be faced is operating within the ocean of medical information that currently exists. Questions of how to change from time-based to competency-based training, to decrease costs and increase innovation are starting to arise.

The generational gap between students and their professors may be revealed in the next few years when medical students, undergraduates, high-school students and many others may be the first to develop a creative answer to this problem. They will begin to create a virtual and augmented reality gaming commons. Initially, the greatest obstacle for implementation of this new form of training may be the organizations that run nationwide licensing exams. The legitimacy of these organizations may be challenged due to their lack of ability to prove that performance on their exams has any correlation to the best patient outcomes. This lack of foresight pinpoints the problem of much of our medical education now – that the medical education industrial complex is aiming at the wrong targets. Without the goal of improving patient outcomes as endpoints for trainees, arguments for continuation of the old training model will begin to crumble. Eventually, a blended curriculum of virtual and augmented reality gaming, along with real world experience, will become mainstay.

The training commons will allow for timely updates to create new innovation scenarios to train doctors for the future of medicine. Experts in key fields will help create gaming challenges for learning for the greater community. This will decrease the traditional need for professors in all areas at each school. Access to this gaming world will be provided 24 hours a day to all health care professionals in training. Soon, this access will trickle down to patients as more training scenarios create digestible learning experiences for all people, not just those in health care.

The gaming world will be able to provide continuity experiences; it will apply real-world data to virtual and augmented reality patients and hone in on the importance of mastering the most common health issues. This will help medical trainees develop the skill of agility when they are confronted with uncommon scenarios. The program will apply real-time evidence-based research through clinical decision support, and will use predictive analytics to demonstrate probable impact. This new method of training will help drastically close the current translational research gap of 17 years from bench to practice. The predictive analytics decision support will be key in providing the impact of high correlation between the virtual/augmented reality gaming training model, and yielding good patient outcomes for trainees.

The training will also provide a consistent curriculum for students nationally. All health care professionals will be trained in fundamental experiences before graduating, and will be deemed competent in such before graduation. The end point of this training will be to create improved patient outcomes in key areas of health and wellness, to be proven over time when compared to the current, outdated system of training. It will also enhance training by empowering patients themselves to improve their own outcomes.

PalpSim- Integrating Haptics with Augmented Reality in a Medical Training Simulation.Image Credit: Real@Real.com

Where We Are Today

This anticipated future of medicine in 2050 is not a stretch of the imagination. In fact, much of this work is already underway. Both the American Association for Colleges of Osteopathic Medicine and the American Association for Medical Colleges, the two medical education training bodies in the United States, are working to address the issues of competency vs. time, increased cost for education, and the educational deficits of their graduates given the new health care climate. In terms of using medical education gaming to address these difficult issues, the game has already begun.

Texas A&M University in Corpus Christi created Pulse!!, a medical education computer-gaming system that allows players to respond to emergency situations and to diagnose and treat patients. The Imperial College of London Medical School has created medical training opportunities in the virtual gaming platform Second Life. The Imperial College’s training platform has already been studied and deemed effective for continued medical education credit. Imperial College also created simulations that provided educational opportunities for the public to learn about preventive health care planning. The College recently created a virtual hospital and clinic that are open to the public. The hospital was based on the London Strategic Health Authority Report, “Health Care for London: a Framework for Action,” which was written as a concept paper for the future of health care delivery. The virtual hospital was created to provide health care providers and the public an opportunity to experience the future before it arrives. The virtual program also allows for opportunities to provide feedback and comment on the experience, creating an opportunity for clinicians and product developers to obtain invaluable information from users.

Andrew Taylor Still University School of Osteopathic Medicine in Arizona is designing a virtual community health center gaming system for medical education and interprofessional training. The University has also been using computer and iPhone gaming applications, along with board games, to facilitate learning. In regards to data analytics and augmented reality, new horizons have begun to emerge. The recent production of IBM’s Watson is demonstrating the impact of predictive analytics mixed with real-time data and evidence-based medicine. The introduction of Google GlassTM is an example of creating an augmented-reality infrastructure for society, and has the potential to bring on a cultural change in how we interact with information. These are a just a few examples of initiatives that are advancing our medical education models toward 2050.

Conclusion

The problems we face today and the ones we will face in the future in medical education are immense. In order to train health care professionals for the future of medicine, to create an educational end point of better patient outcomes, and to create a potential platform to help educate patients to care for themselves, a software update is already underway. The creation of an entertaining and engaging educational platform that allows for our greatest challenges in health care to intersect with our most creative minds will enhance our ability to build a better future. Let this be known as a call to arms. Let us create a future together, and let the gaming begin.

About the Author

Cole A. Zanetti, DO, is a Family Physician and Leadership Preventive Medicine Resident at Dartmouth Hitchcock Medical Center. Dr. Zanetti is a recipient of the American College of Physicians, Primary Care Innovation Award for his proposal on the use of positive deviance as a value based approach to patient engagement. He has worked with the Positive Deviance Initiative on new applications within healthcare, the Dartmouth Center for Health Care Delivery Science on innovative mobile health initiatives in Haiti, was a Robert Wood Johnson Foundation Thought Leader for their symposium on Health and Health Care in 2032, and was selected for a National Library of Medicine scholarship for a biomedical informatics training course. He served as a member of the Blue Ribbon Commission for Transformation of Osteopathic Medical Education and is a member of the medical education game development team for the AT Still University's School of Osteopathic Medical in Arizona. Dr. Zanetti completed his family medicine residency at NH Dartmouth Family Medicine at Concord Hospital. He is currently an MPH candidate at the Dartmouth Institute for Health Policy and Clinical Practice. He received his Osteopathic Medical Degree from the Texas College of Osteopathic Medicine.