Could the delivery of General Practice (GP) Healthcare take some cues from the Aviation Industry?I have an interest in both and it seems to me that healthcare delivery of the future is going to have a lot in common with the modern aviation industry and perhaps we should start structuring our approach to healthcare to recognise and take advantage of this. You might also argue that physician training could draw upon similar training as pilots in managing information and human factors etc.
The idea that we will all be generating some health related telemetry is a reality. Many of us our doing this already through the use of personal monitoring devices and apps such as "Health" on the iOS platform. Many of us also have access to the internet meaning that we can exchange videos/photos and vital signs quite readily. We also frequently diagnose/misdiagnose ourselves via the common internet search engines. What is absent is any professional input and oversight of this data.
The next logical step is to start associating that telemetry along with some related metrics such as our genetic makeup, lifestyle and occupational inputs along with the more transient inputs (illnesses, diet, accidents, interventions etc) into a profile that is then managed and added to centrally in much the same way as regional air traffic controllers (ATC) take the details of an aircraft, its flight plan and safely transit it through its area of coverage. Analysis of health analytics in the circumstances above would have to be largely automated with the exceptions being dealt with as they present either through artificial intelligence taking actions if the intervention is fairly clear cut or engaging human input if appropriate and necessary to do so. Like health maintenance, a flight plan is a unique, personal thing. Yes it has a lot in common with the flight plans of other aircraft and routes yet it is still unique to a journey. It is also dynamic. A pilot has to adjust for variable conditions, weather, passenger illness etc. I can see humans having the equivalent of a health flight plan where the variables are plugged in and a level of automation oversees the journey automatically through the use of telemetry. What we are currently missing is the ATC component. There are the beginnings of this thinking focused on the delivery of specialist conditions but as a general concept its still does not seem to be on the agenda.The idea of a digital health record is gaining traction for individuals but it is an opportunity lost until we get realtime analysis and intervention based upon information contained within. This maybe something that becomes common to the general public or a service funded by the individual or an employer for its employees. Maybe it requires such levels of computing that it is not practical to apply this to the masses?
Health related technology and research is producing more and more data. The individuals "health flight plan" is a life time journey. Healthcare currently seems to assume that our GP's will somehow continue to manage our health. This is not practical, affordable or deliverable in the current structure. Just as pilots cooperate with ATC and jointly take charge of a largely automated flight, the potential exists for a physician led equivalent of an Air Traffic Control Centre to provide oversight to managing health flight plans for thousands if not millions of people simultaneously. Artificial Intelligence will have to replace the GP personal interventions for the more mundane tasks such as advising on Cholesterol management and the likes and humans will have to accept that the AI has taken this responsibility on. If they wish to engage a human physician this should come at a premium in these more mundane transactions.
Just as AI systems are beating chess grand masters it is logical to assume that an AI GP system can absorb and process a lot more information about an individual in a more timely manner. AI can also benefit from the application of aligning symptoms with favourable outcomes based upon treatments for those patients that have a similar health flight plan and who have already undergone therapy. AI can arguably be more aware and learn much quicker than an individual health practitioner and therefore future physicians may have more of a role maintaining these AI systems than front line healthcare delivery. GP's and other healthcare workers are also more likely to engage with humans via digital means. It can be more efficient and achieve the same outcomes. Physical tasks such as blood screening, vaccinations etc will still need to be done in person but not necessarily by GP's who are the most expensive and valued asset in the delivery cycle. It would be interesting for someone to research the level of confidence/satisfaction the public would have in a AI assisted GP provider vs the traditional provider.
As we learn more about specific conditions and treatments, GP's are expected to know more than is practical about all of the health conditions and will require some form of AI decision support capability. To some degree this is catered for by GP's with differing special interests collaborating in a common practice. Treating physicians will also increasingly become more specialised. Specialisation leads to dilution of availability in geographies and therefore access to these specialists requires two things 1) an appropriate diagnosis and 2) access to the specialist resources which for rare conditions could be based internationally. The future GP service will have to become adept at diagnosing and shepherding patients/clients to the most appropriate treatment resource or scientifically and ethically reaching a decision to move to a palliative response. As a public we should no longer expect all treatments to be available on our doorstep. It is neither practical nor beneficial for a sustainable health service. In these more specific circumstances it is arguably better to bring the patient to the specialist centre for specialist treatment where there is a greater chance of a positive outcome.
In this day and age, I and thousands of others happily, albeit subconsciously, accept that technology has consulted the weather, traffic, passenger and cargo metrics and determined the optimal route to safely and efficiently cross the Atlantic on an aircraft. I accept the aircraft is largely flying itself, constantly adjusted elevators, ailerons, engine management to track a course. It will avoid other aircraft and terrain and the pilot is largely providing oversight and approving what the systems are recommending, I expect the Master Alarm to sound if a fault is detected and the pilot to act in a timely manner to intervene and manage the problem to a successful conclusion. ATC assists in transit through geographies and provides oversight, though increasingly this will become automated as capacity exceeds what humans can safely deal with. They work with the pilots and the aircraft owners to manage issues in realtime as they occur. Airport ATC provide specialist take off and landing instructions. It is no coincidence that air travel is the safest way to travel. The synergies are clear for me between healthcare delivery and delivery of thousands of safe flights each day across the globe. Maybe we need to be a bit more proactive in embracing technology in the healthcare world?
Anthony Dooher
