这篇文章来自 wired.com。原始 url 是: https://www.wired.com/story/the-secret-to-a-high-tech-concierge-medical-office-data/
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根据设计, 旧金山市中心的前方店面办公室感觉更像是一个水疗中心或一个豪华的护肤品, 而不是一个医生办公室。但后一种情况是正确的。尽管阳光透过落地窗照在柔和的墙壁上, 仍有松木表面, 看不到入住台 (迷人的、穿着随意的带有 ipad 的接待员为您提供水), 前进是一项礼宾医疗服务。
保险并不能让你像舌头抑制下喉咙在前进。但每月支付147美元, 作为回报, 你可以通过短信和电话应用 24/进入员工, 更多的时间和医生在一起, 办公室里的小工具比星舰的医务室还要多。在进气时, 你站在传感器前面, 把手伸进孔口;屏幕读出你的身高、体重、体温和血液氧合。在考场里, 你坐在一个定制设计的舒适椅子上, 而医生拿着无线传感器顶着你的胸部, 你的心跳在一个巨大的平板显示器上打开线轴。过去访问的数字图像在你的健康记录的时间线上闪烁。你谈话的关键词从你身体的卡通片中闪过, 在天花板上用离散的麦克风接收 (通过一点自然语言处理和一点人坐在房间里听)。
不过, 前进最有趣的部分是看不见的。作为服务的一部分, 前进从你以前的照顾者处获取你的病历。然后, 它将它们数字化--通常是手工操作, 因为 许多不兼容的数据格式 把你掌握的任何遗传信息都搞乱了医学记录, 从23andme 的粗略基因分型到整个基因组序列。它还能从你的可穿戴技术 (如 fitbit) 中获得数据。总之, 这是一张综合的数字病历。前进只有两个办事处, 在旧金山和洛杉矶, 但即使从来没有成为一个民族品牌, 这种关于数据的想法看起来越来越像未来。
Forward isn’t the only one chasing that future, of course. This week a start-up called Seqster, for example, went online with a sort of data locker that does something similar. It hoovers in electronic medical records from your past physicians (thanks to agreements with 1,000 providers), genome sequences, and an array of commercial wearables. It’ll even build on-the-fly visualizations of test results over time, and let you share that data with family members. And it persists even after your death. “We’ve created this engine where you can aggregate your health data and preserve it and pass it on, creating a multigenerational longitudinal record,” says Ardy Arianpour, the CEO. “And we accidentally solved the problem of interoperability, not just of electronic medical data but for genomic data and fitness/wellness data.”
A visit to Forward is indeed pretty cool. Before they opened their first office, Aoun and his team built out a mock-office from 2-by-4s and foamcore in a warehouse. They brought in actual patients talk to doctors, and then had the doctors meet with engineers about the design of the whole thing. The result is indeed slick; the second office 在洛杉矶"我认为医疗行业为不关心这种经历而感到自豪," 前锋首席执行官阿德里安·奥恩说。如果修复意味着沉溺于一个小剧院, 那么, 当投资者包括阿什顿·库彻和马修·麦康纳时, 你会有什么期待呢？奥恩说, 一个伟大经历的一部分是 "看起来像《星舰迷航记》的高科技和未来主义屏幕"。
这是在为一个更大的目标服务。奥恩说: "在硅谷的世界里, 我习惯了每个人都在关注每一个问题, 不管这些问题有多艰巨, 只是说 ' 没问题, 我得到了这个 '。"这似乎是医疗, 不知什么原因, 我们还没有对这个问题进行那么大的攻击"
If that feels like it perhaps minimizes the efforts of, like, everyone, Aoun admits he doesn’t have outcome measures that show greater success than a traditional practice—yet. The place has only been open for a few months, after all, and he says the team will be looking at how their metrics for care match up with the government’s official Healthcare Effectiveness Data and Information Set. “We need time,” Aoun says. “Our engagement metrics are through the roof.”
No question, Forward (and other concierge-style practices like One Medical or MD2) want to benefit their patients. So, ah, about that: “You get longer visits, greater acceptability of your clinician, and more patient-centered care, quote-unquote,” says Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health and lead author, over a decade ago, of a 论文 on concierge medicine characteristics. “But no one can tell you the outcomes. Take whatever you hear about the outcomes with a grain of salt, because there have not been rigorous studies, let alone randomized studies of patients seen in this setting versus other settings.”
In other words, sure, drop thousands of dollars to dodge lines, have better access to caregivers, and a more pleasant visit to the doctor. Just don’t expect to live longer or healthier as a result.
But surely the addition of all that data from wearable tech must make it easier for doctors to tell you if you’re healthy, or how to get you there, right? Yeah, about that: “By creating a biometric pattern, the theory is that some things will be picked up that otherwise would not,” says Sandro Galea, dean of the Boston University School of Public Health. “What you’re really doing is screening, and in order to screen you have to ask if you’re ready to intervene.” Which is to say, 误报 and false negatives become more of a problem with any kind of preemptive, asymptomatic testing.
What people do know about wearable fitness trackers is that they’re not as accurate as one might hope, and that people tend to stop using them. One review article said that Fitbits and Jawbones tended to undercount energy expenditure and overcount sleep, for example. It’s also worth thinking about whether steps-per-day is the right proxy for overall health. A review from earlier this year found that using wearable activity trackers had no statistically significant impact on body mass index, weight, waist circumference, body fat percentage, or blood pressure.
Maybe the accuracy of the devices will get better, and maybe they’ll begin to be a key to individualized, “precision” medicine, as some people hope. Today, right now, sensors and a sophisticated record tying all your data together may not make you, specifically, healthier. But look to your left and look to your right: It might help those people. Which is to say, integrating your entire personal and medical history—your phenotype—with your activity levels and genotype may have value to society, by allowing for a new kind of population-scale science. “Individual prediction is a totally different kettle of fish than the issue of population predictions,” Galea says. “At the population level, I think these data are very interesting.”
So for example, a pharmaceutical company might be able to discern which gene variants were associated with specific health outcomes in late life, or certain demographic groups. Maybe some activity patterns correlate to illnesses or health decades later. Who knows?
The trick is to get a lot of that data—from many different kinds of people, in an ethical, secure, private way. Forward doesn’t share data, but you can take it all with you. Seqster has a bunch of layers of consent, and expects that pharmaceutical companies and researchers will eventually come asking to look at people’s (anonymized) data. “We want to generate value for users, and then we will connect users to our partners,” Arianpour says. “We never sell your data without you being involved.” If you agree to be contacted, if someone wants your you-stuff as part of a research pool or to train a machine-learning network, they ask and you can decide if you consent. There might even be a little something in it for you. “There will be multiple ways of incentivizing the consumers,” Arianpour says. “Obviously, financially will be one.”
Of course, optimizing your healthcare for the greater good is technically not your problem. If you’re interested in splurging on holistic, Apple-scale healthcare, concierge services like Forward will help you quantify yourself in a soothing environment. You need national-scale systems and standards to figure out the tradeoff between organized, siloed information and messy, aggregated data that has great value, but only if you share it.
As companies like Verily launch massive health care research studies like Project: Baseline, be mindful of what that data will be used for, and who it will benefit.
There are security and privacy issues around every corner, which is why some companies are already promising solutions with buzzwordy technologies like the blockchain.
As more companies and health care providers collect your data, make sure you’re getting the benefits, too.