Future is here; it's just not evenly distributed

“Future is here; it’s just not evenly distributed,” that's a quote from William Gibson -- one of the great sci-fi authors who coined the term cyberspace. He wrote the book called Neuromancer and invented cyberpunk and steampunk. Gibson is one of my longtime heroes.

2019 I was invited to give a short talk about the future at Quest Analytics’ annual Vision Quest event. Below the video and a summary of the talk.

Diagnose behind the grave

In the summer of 2000, I was in London with my wife, Anu. We were having a great holiday, and we were visiting the British museum and exploring an exhibit about ancient Egyptian art. There was a sarcophagus, and you could press a button to hear stories about the common causes of death at the time of the pharaohs -- 2 000 years ago. Anu pressed a button around the neck area of the sarcophagus, and the story in her earphones told her that one of the common causes of death at the time -- people only lived 39 years old at that time -- was a disease in the neck area. Anu was listening to the story and feeling her neck. Suddenly she turned at me and said, “could you listen to this and touch my neck.” I listened to the story and touched her neck to feel a similar bump described in the audio.  

Anu had a large tumor in the neck. We got back home, and a couple of weeks later, we were at an operating room. Luckily the tumor was a non-malicious one, and the doctors were able to remove it without a problem. At the time, Anu was 22 years old, healthy, athletic, young woman and we had no idea that this incident would lead to a health journey that has taken now 20 years. The operation resulted in thyroid issues, hormonal imbalances, and autoimmune diseases.

Getting pregnant

Fast-tracking ten years ahead. In 2008 we moved to California and started to plan for a family. Quickly we realized that getting pregnant would be difficult. We explored different care options, changed our diet, and overall got very healthy. It took us five years to find out a solution. We saw dozens of doctors, researched the web, read journals, and research papers on the topic. At one point, we even worked with a startup that was like a Doctor House in steroids. They had a team of statisticians, doctors, reporters, and DNA analysts who helped find the correct care.

Finally, after years of work, we got pregnant via IVF. Then on the week of 23, the unthinkable took place. Anu called me at work and said that something was wrong, so I ran home, picked her up and rushed to the hospital. In the hospital, we realized that Anu was in labor. We were hopeful that doctors could stop the process, but there was nothing they could. The baby was born two days before the 24-week cut-off time. With underdeveloped lungs, there was nothing to be done. 

What did we learn in the process?

Losing our first baby was devastating. After a long period of grief, we realized that this was a wake-up call for us. Life is limited. You have to make the most out of it. As a result, we re-prioritized our life to focus on things that make a difference in people’s lives. I doubled down on building BetterDoctor to help other people find the right doctor. Anu left the corporate world and started a Konmari consulting business Joys of Simple, helping people focus on essential by getting rid of their excess possessions. Together we started a small investment fund Do Good Ventures to invest in companies that solve problems that help people live better lives.

I also had three discoveries about the healthcare system.

Data Access

The first major hurdle for our journey was data access. How to find the right research? The right provider and the right treatment at the right time. It was tough, and as described above, we went to extreme measures in our search for answers. A few people would have access to the sort of team of experts that were working with us. We also spent a lot of money and had excellent health insurance to cover most of the bills. Altogether we have probably spent about 2 million dollars in health care in the last ten years. And the majority of this was paid by the health insurance. 

Care decisions

The second hurdle was to find the right doctor. We wanted to find a doctor with a deep understanding of the condition and a willingness to help. We wanted someone who can think outside the box and go beyond the standard care pattern. Someone who is not just reading the manual or going to google search -- but helping you help yourself. It's often difficult to convince a provider to do you the right thing if the treatment doesn’t fit the care manual.

Behavior change

The third hurdle was behavior change. As part of the healing journey, you often have to adopt new behavior even dramatically change your lifestyle and diet. Behavior change is often the hardest part of the process. 

I’ll dig deeper into data access, care decisions, and behavior change below. But let’s first take a look at how the world around us moving from offline to digital.

Digitalization S-curve

S-curve of digitalization describes the industry transformation from offline to online. Where would you think the current healthcare industry is in this digitalization maturation curve? How long do you think it takes healthcare to reach the full maturity stage? 

 The healthcare industry is in an exciting stage. It’s are rapidly moving towards the middle, the disruption phase, where things start to evolve rapidly. Let me put this in perspective, so you better understand what the disruption will mean. 

Automotive

What has taken place in the automotive industry over the last decade? Tesla, Uber, Lyft, and other new companies have completely changed the way we think about transportation and car ownership. Once the automotive industry entirely moves through the digitalization S-curve -- it will have transitioned from people driving in combustion engine cars to self-driving electric vehicles. Science fiction just two decades ago, right?

Banking

Banking is ahead of automotive and has seen a massive transformation over the past two decades. In the US 25,000 bank branches have closed, evaporating hundreds of thousands of bank teller jobs. The concept of money has transitioned from paper bills to electronic transactions -- and is currently further transforming into cryptocurrencies.

Media

Media consumption has wholly transformed from offline to digital. Think about how different your media consumption is from two decades ago. Think about the new companies dominating the media: Facebook, Apple, Spotify, and Netflix. Few of the companies you know a decade ago are significant players today. 

Travel

And finally, travel -- the most digitized industry where everything has changed. It’s even hard to remember the time when you had to visit a travel agent to book your holiday. Do travel agents even exist today? The travel business is entirely online, and some predict that the next chapter of VR will make transformation even more fundamental.

Public sector

Healthcare is not the least digitized industry -- the Public sector is still years behind. They are slowly taking the first baby steps in the right direction.

How long does it take for healthcare to be where travel is today?

One interesting thing about digitization is that the gap between digitized and offline industries is widening exponentially. Even if healthcare is evolving, it’s still not catching up with other sectors further ahead of an S-curve. It will take the healthcare industry about a decade to get where travel is today.

The good thing about having more mature industries is that you don't have to predict the future, but look around and understand what’s happening in other industries today. 

Data Access 2029

Our fundamental problem was finding the right provider and access to the correct data. What's going to happen to healthcare data access over the next decade? Today data is the new oil -- the most valuable resource of our time. Three out of the five most valuable companies -- Google, Amazon, and Facebook -- are data companies. It’s crazy to think that just ten years ago, these companies were in their infancy.

Google has indexed the world’s information in the last 23 years.

To understand the power of data, you just need to look at the evolution of Google. Thirty years ago, you wanted to search for information -- you had to open a book. How many of us still own the Encyclopedia Britannica? Yes, many of us still have the stack of books on our bookshelf. They look kind of - cool. But it’s unlikely that you have opened an encyclopedia in the last five years. 1997, 23 years ago, Google launched with one of the most audacious mission statements -- “index and organize all the world's information and make it readily available to people.” The crazy thing is that in two decades, they've accomplished the mission. Today Google is ubiquitous -- you can talk to Google, and it will answer your questions. People make five billion Google searches every day. It’s hard to imagine how we could live without Google Search and Maps.

Healthcare data interoperability will be a reality in 2029

What about healthcare? One of the significant healthcare initiatives for the last 20 years has been data interoperability. The slow health data evolution from paper to digital to cloud has made interoperability a lousy word. For untrained eyes, not much has happened over the last 20 years, but in reality, we are getting close to the ability to start deploying machine learning to large health data sets in the cloud. I predict that in 2029 healthcare data is finally in the cloud. What will the cloud enable? We’ll be able to finally access and analyze longitudinal medical records and identify care patterns that work across populations. Game-changing stuff, right?

Care Decisions 2029

What’s the connection between an elevator operator and a car and a driver in a car? Elevator operators were prevalent 50 years ago; tens of thousands of people worked every day pressing a button going up and down on an elevator. The elevator operator profession evaporated when somebody invented circuitry that made it possible for anyone to operate an elevator 

What about the cars. Lebron drives his nice Porsche, and in the other image, Lebron is driven by a self-driving car. What will the shift be when we all move from driving a vehicle into becoming a passenger in a self-driving car? There are many people, namely Elon Musk, the CEO of Tesla, who has said that driving a car will be banned in the not distant future. Musk thinks that in about 20 years, driving a car outside designated “driving” zones would be illegal. I think it will take maybe a bit more than 20 years, but it’s an exciting thought. 

2029 every physician has a personal AI assistant

Today, many cities allow cars to be piloted by AI. Why shouldn’t we allow AI to make or help doctors make better care decisions? Above is an image of a company called Augmedix. They have embedded Google Glass into the care flow. The doctor wears Google Glass transmitting video and audio to scribes who take notes, allowing the doctor to focus 100% on the patient instead of sitting behind the computer. The other significant benefit of the real-time documentation is that the system can automatically alarm doctors via Google Glass if they are about to make a mistake. Equally well, the system can show data related to the patient-doctor conversation. Augmedix and similar companies are the first assistants that make the doctor better. I’m confident that in 2029 most doctors will have their own AI assistant that helps them make better decisions. AI will also diagnose and analyze the patients far beyond what a human can do, think analyzing DNA, microbiome, and other biomarkers in real-time in the context of the patient conversation. All this without losing eye contact with the patient. 

Behavior Change 2029

Behavior change is a critical area considering that 80 percent of the diseases are diet and lifestyle-based. Obesity and related metabolic diseases kill a million Americans each year. What can we do to change the behavior? 

Remember all the devices you owned back in 1999. If you wanted to travel and take your technology with you, you had to carry two bags of devices each dedicated to a single action. Today we have smartphones that have evaporated 75 different device categories from cameras to CD players to traditional phones. The 75 doesn’t include books and CDs, and other physical objects that hardly exist today. 

Today, 3 billion people use a smartphone. People check their smartphone on average 80 times a day and spend about 5 hours staring at the small screen. In younger audiences, smartphone consumption surpassed time spent on TV and computer combined. 75% of emails are opened on smartphones. 70% of web browsing takes place on smartphones. Smartphones have completely changed the way how third of the world's population behaves. 

2029 everyone has a health-focused wearable device

Today, hundreds of different wearable devices are focused on helping us understand what’s going on in our bodies. One of the more exciting devices is an Oura ring that tracks your sleep pattern and body temperature and warns you when you have early flu symptoms. Oura was the first device to diagnose COVID infection. 

2029 everyone wears a health-focused, connected wearable device. Some of the more advanced devices will diagnose disease by real-time biomarker analysis. The devices won’t only holistically collect data and diagnose but also effectively coach us to alter our behavior to avoid sickness. I hope Elo Health will be one of the companies making a big difference in 2029.  

The future is here - it’s just not evenly distributed.

By 2029, the healthcare system will look very different than today. Human health has improved, we live a bit longer and we have taken massive strides to improve the three areas discussed above: 1) data access, 2) care decisions, and 3) behavior change. The great thing about evolution is that we don't need to do anything crazy. We just need to look around the other industries, adopt the innovations, and deploy them in healthcare. I like to say, “The future is here it's just not evenly distributed in healthcare”. 

And how did our family healthcare story end? Anu is doing really well and we have two wonderful healthy kids who keep the parents busy.