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Is the End of Search the Beginning of Personalized Prevention?

May 22, 2013


This past week, Google had its annual developers conference, Google I/O.   One of the more provocative talks, called “The End of Search as We Know It,” was by Amit Singhal, who is in charge of search for Google.

The vision, as described by Amit, is that instead of typing words into a box on a website or mobile app, we will have conversations with Google, enabling a much more personalized, refined experience.  The holy grail, of course, is that Google analytics become both predictive and prescriptive, serving you content that is just right for you and anticipates your needs.

It seems there is a race on now to achieve this vision.  One could argue that Amazon, Apple, Facebook, Pandora and others are all in the same mode.  Best I can tell, the promise these companies are floating to advertisers is that their ads will be served up to that focused slice of the population that will find their product relevant in the moment.

If you apply this thinking to healthcare, several controversies/topics come to the fore.

Is Google competing with IBM’s Watson?  Undoubtedly yes.  On the other hand, I’m guessing Google is disenchanted with the consumer health space after the demise of its personal health record (PHR).  And IBM seems to be focused on clinician decision support.  So early in the game, with respect to healthcare anyway, maybe there is not much competition. The path for clinician decision support is clear and the market obvious, whereas the path and market for consumer health decision support are blurry.

To achieve their vision of having a conversation with you at the level of search, Google has to know lots and lots about you.  Some people are spooked by what they track now.  Will there be a way for them to track all of the other necessary data points without running afoul of the privacy lobby (see the exchange between Wally and Catbert below)?

Dilbert

Can we achieve the same vision for consumer health information (i.e., make it highly personalized, motivational, caring, and eerily anticipatory)?

At the Center for Connected Health, we are banking on it.  A big part of our research agenda for the next several years will be in this area.  Current work in type 2 diabetes and cancer pain control represent a start in this area.

Perhaps the most penetrating question is whether there is an economic imperative for personalized prevention that is as compelling as the one for personalized search.  We know the economics of advertising and the ultimate goal of targeting every ad to someone who is a qualified, interested customer – someone who really views the product as a solution to their problem.

I have been thinking about the counterpart in health….it is not as clear to me.  Stated another way, why have we not managed to devote the kind of resources Google is devoting to personalized search to personalized prevention?  For instance, if I can use your genetic analysis to predict your risk for type 2 diabetes and create a uniquely motivating self management program for you, who will find that economically appealing?  You?  The government?  Your employer?  Your health plan?  Your doctor?  It’s not so clear.

Of course we should all want to be healthier, but we all know how that goes. Short-term discipline for long-term reward?  It’s a tough one.  We are not as eager consumers of health information as we are information on clothes, shoes, concerts, etc.

Who else should be interested?  Payers?  Hard to imagine Aetna, United or Wellpoint competing with Google in this area.  Even though they pay for care, they are agents of employers.  I’m guessing HR executives will be more sensitive to the privacy issues than Google is.

It is a quandary.  The pay off of personalized prevention will be breathtaking – you’ll manage your own prevention and your own chronic illnesses largely without the help of a healthcare provider.  This will result in improved health as well as decreased costs.  Who should step up to the plate to build the war chest that will attract the talent from the ‘recommendation engine’ and/or financial industry?

Your thoughts?

18 Comments leave one →
  1. Don Turnblade permalink
    May 22, 2013 7:36 pm

    When the customization gets it wrong, what then? You have the right to appeal bad MIB records, do you have the right to appeal bad personalization records from “Google” or “Online Medicine”?

    Would a request for ideas about quality time with children result in a presumed request for personal sterilization procedures?

  2. May 22, 2013 7:44 pm

    This is emblematic of the anxiety that comes when this topic is raised. My response to the question you raised is no. if we design our algorithms that poorly they’ll never see the light of day

  3. May 22, 2013 8:06 pm

    How about we use the same predictive algorithms to predict people’s stages of behaviour change and serve them stage-specific messages that are more likely to resonate with them.
    For example, a smoker who is looking for information on effect of smoking on health is less likely to respond to a nictoine replacement therapy ad or a cessation website. Instead, they won’t to know more about it before considering quitting(contemplation stage).

    Also, all the data they(Google, Facebook…etc) are gathering can definitely help in predict likelihood of certain conditions. For example, users who searches for fast food location often are more likely to be sedentary and overweight (my assumption) which means they are prime target for public heath interventions.

    Big data has so much potential in Healthcare.

  4. May 22, 2013 8:09 pm

    Great thoughts!

  5. Jim Reid permalink
    May 22, 2013 8:24 pm

    Joe,

    I live for your every post, so in the words of someone on an infomercial somewhere in my past, “Don’t Quit!”

    It’s all about the beneficiary. Twenty years ago I recognized that telemedicine was never going to reach critical mass because it benefited the wrong group. Back then it was as clear as a cloudless sunlit day on Mars that patients benefited from rural – urban telemedicine systems. Many of the programs I was involved in back then proved unequivocally that telemedicine could and did save patients time, money, productivity, inconvenience and real pain. The problem was no one cared. I recognized then that until the real drivers of the healthcare system realized financial benefits, telemedicine had no hope of survival.

    As you well know, after twenty years of grant supported pilots and trials and the associated coming and going of many a telemedicine program, telemedicine is now mainstream. Why? Because with the consistently rising cost of healthcare services it’s finally been demonstrated that the people that are driving the system – public and private payers of all types – accrue real cost savings from today’s sufficiently advanced technologies that 20 years ago were indistinguishable from magic (Thank you, Arthur C. Clarke). It’s the same dynamic that impacts old gold mines (or shale oil deposits) that have been dormant for years until the price of gold or oil rises sufficiently and new technologies make extraction of previously thought to be cost-prohibitively low concentrations of these resources possible. The cost-benefit ratios shift and they are money making propositions again. In my humble (but deadly accurate) opinion, that is what is happening in telehealth today and it’s a splendiferous sight!

    I so admire your ability to take tools and principles from one discipline and apply them to healthcare to yield a new and previously unforeseen advantage or function. Steven Johnson, in Where Good Ideas Come From – The Natural History of Innovation elaborates on this process and calls it “exaptation” which is a term coined by evolutionary biologists. So apply the same principal that foretold today’s ultimate widespread adoption and permanence of telehealth technologies, systems, and services to your question about drivers and adoption of personalized prevention. I would suggest that with this approach one can derive at least half of the answer. When it costs us – the consumers of healthcare services – less to make good choices and adopt healthy lifestyles than it does to consume health care services our priorities will change. Of course that means WE have to be the primary payers into the system. It’s true today that most of us pay a share of our healthcare costs in the form of copays, deductibles, and premiums, but we’re not paying enough today to justify changing our behaviors. This is because there is no direct feedback loop (your often and accurately referenced holy grail for behavior modification) between our good choices and a tangible financial gain. Some employers are starting down this road but they are just beginning and the direct associations are not well enough established for the average employee to recognize, nor are the rewards. When we pay enough of the tab that we can directly associate good lifestyle choices with cost savings (aka pain mitigation) we will start to change our behavior – of this I am certain!

    Of course this approach will only apply for some majority percentage of the population that qualifies to play in feedback loops – those that earn enough to warrant bearing a majority burden of their health care costs. I’m still clueless about how to modify the behaviors of those that don’t. Anyone? Anyone?

    • Kannan Sreehdar permalink
      May 30, 2013 3:06 pm

      Thank you for your post and agree with your comments. However, it is inevitable that WE, as individuals will become more and more responsiuble for our helathcare i.e. pay a greater portion of the helathcare services we consume – simple a macro ecoomic effect of globalization! In that environment, that tangible gain between good choices and financial benefit becomes much more personal.

      On another note, Dr. Kvedar, tries to segment the work that IBM Watson is focused on as opposed to Google and other “search” engines. In my humble opinion, it is only a matter of time before this separation between cklinical decision support and personalized medical information dissipates. It will also provide some strong competition for IBM Watson and other players in the clinical decision support arena.

  6. May 22, 2013 8:48 pm

    Thanks for your kind words and insights!!

  7. May 25, 2013 3:55 am

    The assumption is that such a personalised prevention program will actually be beneficial which requires some evidence. Whilst philosophically it sound like a good idea until we have evidence that it is worth the extra investment required, and it demonstrates real benefit, I would suggest here is lower hanging fruit for us to aim at.

    • May 27, 2013 2:22 pm

      Couldn’t agree more. Evidence is critical to decision making.

  8. May 28, 2013 9:18 pm

    It is a quandary. Thanks for your thought-provoking post, Joseph. I think it’s just human nature. Ever wonder why it is so difficult to get people to quit smoking or lose weight with scarcely 5% succeeding? I think because we handle health as an acute problem — deal with it when it comes up: relief from flu (yet fewer take flu vaccine) or toothache relief (but rare do we floss).

    But when something serious happens, people clamor for 2nd and 3rd opinions, alternative therapies, experimental trials. Then, decision support for people is particularly vital. People are understandably confused and their clinicians (who are not caring for them continuously) are slow to adopt new methods. Which therapy will work for a given individual at a particular time? Well, we can do that well for some drugs today but few physicians do so.

    Unfortunately the genomics field oversold the predictive side; the environmental component is a bigger piece of the puzzle. So there is nothing “average” about any of this. I think we’ll see patterns at a population level, though.

    Privacy concerns take a backseat when one is fighting a grave condition. I think your instincts are correct. People need a way to help them make decisions. Google (and others) can do the data science that unites many key points to provide more personalized guidance than a simple search for data “by the averages.” Maybe it is at that point that people provide more detailed data that can be used to guide them. Then, in time, people will see better results. To borrow from Garrison Keillor, because we’re “all above average!”

    • May 29, 2013 12:43 am

      Thanks for taking the time to write such an articulate response.

  9. May 29, 2013 1:11 pm

    The average primary care visit in the US lasts 15.7 minutes. Most patients will get less than 3 hours of thier PCP’s time in a year. Is it really a surprise that we no longer develop relationships with patients? If we don’t know who they are we don’t know what thier personal challenges are and have no way of providing useful feedback. The fact is that Google likely knows more about your patients than you do. To be an effective advocate we must seek to recreate those relationships that build the trust between us.

    • May 30, 2013 12:29 am

      I agree with the notion that we should have meaningful relationships with our patients. But once established, we can use technology to extend those relationships effectively.

  10. Dena Green permalink
    May 30, 2013 3:04 pm

    Intriguing…I developed a risk reduction interactive computer generated module for adolescents as a student at Teachers College in the late 80’s.

  11. May 30, 2013 3:46 pm

    Joe,
    Regarding your question “why have we not managed to devote the kind of resources Google is devoting to personalized search to personalized prevention?”. The glib answer is that there is no ad revenue in personalized prevention.

    • May 31, 2013 10:34 am

      Indeed, no ad revenue, but possibly other powerful economic incentives. we spend $3 Trillion on healthcare and 50-70% is on chronic illness so there must be a business model in there somewhere……

  12. June 3, 2013 4:43 pm

    Thanks for the excellent analysis and probing questions. As to your closing question about who’ll belly up to the bar to fund what’s needed to bring this to fruition anytime soon, the government’s too preoccupied with trying to implement Obamacare and overcoming the intransigent resistance to it that it won’t be coming to the rescue on this front. And the other player with real “skin in the game” – employers – remains a fragmented market with no centralized impetus or vehicle to do so.

    So Mr. Reid’s telehealth analogy may prove most apt. And another 20 years or more after we have the technology to do it is equally likely to apply here.

    Unless, that is, other countries with less fragmented healthcare systems and more focus on their healthcare bottom lines can take over and do what we in the U.S. are unlikely to do on our own.

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