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How do we view what’s next?

Want to know the future of medicine? Look to the Skies

As a consultant who travels frequently, the recent plane disappearances and crashes have been incredibly disconcerting. I typically deal with fear by learning more about the things I’m afraid of, and this case has been no different. In my quest to learn more about airplane technologies, it became clear that many of the trends impacting the airline industry may foreshadow what is coming in Life Sciences and Healthcare (LSH). While the two industries are seemingly unrelated, a deeper analysis of their recent histories highlights critical similarities, particularly around automation, pricing, and customer segmentation.

  • Technological advancements in aviation and medicine significantly impact the role of pilots, doctors, and researchers. Planes basically fly themselves. Using advanced data analytics and automation, airplane computers are able to analyze inputs like weather, payload, and fuel consumption to determine the best routes and altitudes for the plane. These same automation tools are already impacting LSH. Already, there are machines able to perform tasks traditionally performed by doctors. New machines may assist anesthesiologists, and assist with procedures like colonoscopies, while a team from Berkeley is currently working on improving the Davinci Surgical System so it can perform simple surgical tasks autonomously. Currently, most of these advancements merely augment doctors’ abilities; however, they will eventually position doctors in many subspecialties to spend the majority of a procedure monitoring the computers’ activities and limit their deep involvement to pre- and post-procedure and during emergencies. This is similar to a pilot, who is now mostly involved in the complex tasks during takeoff and landing.

  • Tools like Watson (the computer program that won Jeopardy) are enabling this automation as we are now better able to track, manage, and understand complex data over time through these advanced analytics tools and the decreased cost of storing data. These tools are able to identify things that people may not notice, for example Watson is better at diagnosing cancer than people. Much like the way flight planning software identifies and creates flight plans that avoid bad weather and optimize fuel savings, these tools eventually will be able to identify potentially harmful drug interactions, and eventually they will even be able to discover new drugs. The combination of tools like Watson and initiatives like electronic health records will allow patients to pilot their own care by providing the best route for care (flight plan) that limits the cost (fuel usage) and risks (dangerous weather conditions and turbulence).

  • Regulations and M&A activity have shaped the aviation and medical landscape. In the airline industry, regulatory changes eliminated price floors on routes and shifted the focus from high margins to high volume while M&A activity has allowed airlines to increase margins as of late. Changes to important regulations and record levels of M&A activity are beginning to impact LSH in both what and how doctors are able to charge for care and will potentially impact how much can be charged for drugs and vaccines. The regulatory changes, in conjunction with technological improvements, have dramatically increased price transparency and customer choice in healthcare. In the future, however, the M&A in response to these changes may negatively impact customer choice to some extent.

  • The LSH industry can look to the airlines to see how these changes might impact the future of the industry. In the airline industry, cost transparency through technology has further driven down costs for customers as they can now easily pick and choose routes that effectively balance time and cost. This has resulted in shrinking profits for airlines and all but eliminated the need for professions like travel agents. In LSH, as customers gain choices, outcomes will become extremely important and customer service and marketing costs will increase and become more targeted. Services like ZocDoc will start to look more like Expedia and help patients plan their care based on managing things like length of care (flight time), cost of care (ticket price), and outcomes (quality of service). This may erode profits in LSH in much the same way it has for airlines. In order to respond to these cost pressures, airlines have gotten very creative with loyalty programs and cross industry partnerships (hotel, car rental, and other airline partnerships). There has already been some evidence to suggest this will happen in LSH, with nurses partnering with pharma companies to administer pills and ensure medication is taken. This will likely continue, and possibly deepen, with the addition of wearables (Oscar gives out free misfit wearables and offers discounts based on number of steps) and mobile technologies. Perhaps pharma companies will partner with gyms or even food companies like Whole Foods to further promote healthy lifestyle and improve outcomes.

  • The changing technological and regulatory environment forces industries to segment customers in order to maximize profits. All of these technological, regulatory, and operational changes combined with economic factors have caused the airline industry to take a tiered approach to service. Airlines are dependent on the first class, business class, and economy class structure to create profit margins in a volume-based business. Airlines make more of a profit on first class and business class customers, but they must fill the plane with economy class passengers in order to make a flight worth operating. The same thing might happen sooner than we think in LSH. Currently drugs are made from a one size fits all approach but we are seeing the start of a tiered service: from customized drugs based on individual muscular structure to drugs based on genome sequence. Obama recently dubbed this term precision medicine and requested $215m for this effort. The ability to segment customers in specific ways based on their needs and preferences has allowed airlines to be profitable, but it has also created disparity in services for customers. This service disparity arguably already exists in medicine, but could become even more dangerous for patients if this trend persists.

The lessons from the airline industry have tangible implications for patients and their healthcare. The Air France Flight 447 crash demonstrated the risks associated with automation. Essentially, it allows below average pilots to go undetected until an emergency or random event occurs in which a response cannot be automated. Automation works 99% of the time, but we must worry about the 1%, especially when human lives are on the line. Automation eliminates the repetition of mundane actions that prepare people to operate in an emergency or unfamiliar situation. This will become a risk for doctors. As automation advances and doctors are less involved in the 99% — diagnosing illnesses, prescribing care and minor surgical tasks- it may make it more difficult for them to excel in the 1%- diagnose a new illness, developing new treatment courses, or handling emergencies.

As doctors’ interaction with patients evolves to be more of that of an overseer, how can we ensure that doctors are able to act in extraordinary situations? In aviation, cockpits are now designed to account for the changing role of pilots and co-pilots. The design specifically tries to foster collaboration during trying times. For example, once the autopilot is disengaged, the pilots have a choice of who is in command of the ‘stick’ and if neither takes control, the plane’s computer will take the average of the actions performed by each pilot. While this may not be the optimal arrangement in surgery, as more and more automation comes on line, it is important for medicine to similarly rethink the details of research and patient care to reflect these changes. The importance of innovation cannot be overstated, and advancements in everything from vaccinations to breakthrough virtual care (Microsoft’s Hololens), should be encouraged. However, medicine, like the airline industry, is ultimately a client services business where small mistakes can quickly become catastrophic errors. As such, we must work to make sure every aspect of the medical profession keeps up with innovation and regulation, for advancements are no longer beneficial if they detract from the ultimate goal of improved patient outcomes.

Scott Salandy-Defour