Track or Treat?

The consumer health revolution is already sending shockwaves through the health sector. Between health apps, monitoring devices, and personal portals, consumers are more engaged in their health than ever before and they’re creating a growing community centered around wellness and preventative care. Consumers are also wanting as much information and control over their own health as possible; a trend that is exemplified by the growing interest in self-ordered tests.

When you look at the size of the consumer healthcare market – $500 billion+ (1) – and the fact that consumers today are tracking everything from exercise, to sleep patterns, to blood pressure and calorie intake, this generation are potentially the most engaged patients in the history of health.

In the US, data shows a staggering 75 percent of adults already own a health and fitness device and of these, some 60 percent plan to purchase other fitness consumer products in the next year – more than four times the number in 2012. Similarly, some 80 percent of patients proactively seek out information regarding their treatment, and are increasingly preferring digital channels as a means of communication (2)

Whilst as healthcare professionals we might dismiss this trend as nothing more than a fascination in the latest devices or a self-indulgence fueled by social media, the reality is the consumer health revolution isn’t happening in a vacuum. It’s set to disrupt the entire health sector, including pathology. In fact luminaries in the field are already advocating the use of social media to advance academic rigor on key topics of interest to their colleagues (3).

What will this consumer-driven era in pathology look like?

In more recent times, the direct connection between pathology and patients has been limited. Referring doctors have predominantly owned that relationship, and as a result have had direct exposure to the behaviors of patients and the expectations of this group. They have also been the arbiters of control over what tests are requested, as well as translating data into lay terms and determining what information is shared with their patient. In essence, the control has been squarely with clinicians.

Given we are now in an era where consumers want to be in control of every aspect of their life, and want as much information as possible to inform their own decision making, gatekeepers will not be tolerated. So if consumers are not given more control, alternative channels will be sourced to enable them to access what they want, when they want it.

This desire will likely to lead to a restructuring of existing relationships and may result in pathology moving closer to the patient. With impatience over access and time delays, we are already seeing a growing trend in patients ordering their own tests, and wanting their own results, without having to physically visit their doctors. Already, 55 percent of millennials have said they would trust a health app in preference to consulting health professionals, signaling a significant change as far as trusted relationships are concerned (4). A recent report states clearly that the “era of direct patient access to test results has arrived”, and that this “major impact on laboratory practice” is going to necessitate development of new ways to “engage directly with patients in a way that will contribute maximally to safe and effective care” (5).

Independent of this shift, pathologists will also be confronted with unprecedented amounts of patient data generated from data rich molecular biology analyses. This will be further supplemented by complementary data fueled by the increased use of health apps, devices and portals. While some of this complementary data may be deemed irrelevant, it will help form a more comprehensive view of the patient which can assist in the speed and accuracy of diagnosis if accessed and interpreted at the right time. As the immediate past president of the European Society of Pathology Han van Krieken said recently, “For a long time, I’ve felt that the era of the general pathologist who knows everything is over… Even areas that used to be fairly simple have become more complicated in the sense that we can gather much more information about our patients and make precise, accurate diagnoses," (6).

Beyond trying to manage and interpret this huge volume of referential information, the insatiable desire for information and personal monitoring will likely translate into an increase in test requests that are focused more on tracking as opposed to treating. Whereas currently tests are ordered when health episodes occur or there is a degradation in a condition, today’s consumer will drive a trend towards wellness tests which is more around monitoring personal health, as opposed to testing related to diagnosis and treatment.

With a growing interest in personal health portals – where individuals can aggregate and track their own health information – there has been an increased desire in gaining accurate insights into their overall health against which they can measure their performance. This will create an entirely new customer base for pathology and will likely also lead to novel test menus offered by organizations and altered reporting paradigms.

As a result, pressure will increase on laboratories to provide immediate access to test results and intelligible personalized reports as soon as the results become available. Furthermore, the new generation of consumers will expect their information to be automatically synchronized with their existing applications and portals, so they have a “one-stop-shop” for all of their health information.

Challenge vs. opportunity

As with any major change, this new era in consumer-driven pathology presents both a challenge and opportunity for laboratories.

Much like the disruption caused by the internet, the true challenge with the consumer health revolution will come from underestimating its impact, or ignoring it completely. Whilst to some it may not appear to be a welcome change, it is a change that is already underway and will become more pervasive as time goes on.

With the growth in self-ordered tests, and development of point-of-care and home monitoring devices, vital signs and a range of substances can now be analyzed by consumers. This has fundamentally changed the dynamics of how consumers engage with healthcare processes and information traditionally controlled by clinicians and pathology. The continued expansion of this trend presents a challenge to pathology to avoid the risk of becoming disconnected from the patient care process.

Conversely, for those who embrace this change and become an early adopter in providing the type of services that meet or exceed consumer expectations, an opportunity exists to drive real change within pathology to not only better position laboratories for this new world of modern health, but to create a point of differentiation and potentially secure a significant portion of this market.

What should be done to prepare?

Modern pathology requires a modern mindset and practices, and there are three main areas which need to be addressed to prepare laboratories for the consumer health revolution:

• Understand your customers – patients versus consumers
  
• Modernize and personalize your systems
  
• Prepare your people.

To truly prepare for this change, laboratories need to first understand the difference between the modern patient and the modern consumer. By understanding the differences between tracking and treating patients – including behaviors, preferences, and expectations – laboratories can design structures, processes and resources that are aligned to support these new expectations and deliver a good service.

To be able to execute against these consumer expectations, modern laboratories will need to ensure their systems are able to support, adapt and potentially predict changes in requirements. This will require an ability to aggregate and interpret large volumes of data, to personalize and automate the results delivery, and to ensure information is shared in a timely manner in a format that is requested and easily understood by consumers themselves. Modern laboratories should also consider how their systems can support integration with other relevant channels such as portals and alerts to mobile devices, without compromising either the quality of the data or its security.

Finally, pathology staff themselves need to be organized and equipped to manage a new customer base, changes in test types and request sources, and processes for receiving, analyzing and reporting results. This might even need to be extended to provide services “whereby laboratory clinicians and scientists are available by telephone or email to discuss test results” (5).

Embrace and modernize

With 75 percent of patients wanting digital health services (7), the Fitbit generation are changing expectations, behaviors and even business models. While it might even be tempting to ignore the wishes of a group who source most of their information from non-traditional sources such as Google or Wikipedia, the reality is that this group could be responsible for driving a disruptive change within healthcare that is both meaningful and sustained.

When you consider that many chronic diseases are preventable by changed behaviors (8), by supporting a generation who are already engaged and informed when it comes to their health, we could not only improve the health outcomes of entire populations, we could also significantly reduce the resource strain on global health systems.

For pathology this presents a huge opportunity. For those that embrace this change, and modernize their laboratories to better support this highly engaged community, they not only have an opportunity to differentiate themselves and access new revenue streams, they can move closer to the patient and help to directly improve health outcomes.