mHealth Monthly Mashup: release 26.0 – the future of mobile health: 2025

Michael Spitz continues his monthly exploration of all things mhealth in his regular mHealth Monthly Mashup series. This month's mashup speculates about the future of mobile health a decade from now...

"Nostalgia often leads to idle speculation," J. Paul Getty allegedly once said, the Pew Research Center taking that truism to heart by celebrating the 25th Anniversary of the Web with a fascinating crowdsourced report forecasting "Digital Life in 2025."

Working in collaboration with Elon University's Imagining the Internet Center, the PRC canvassed over twenty-five hundred multidisciplinary experts who largely agreed on the forecast of complete connectivity, yet differed widely on its implications.

Benign oversight or Big Brother? Indulgent bombast or cyber bullying? Big Data or corporate domination? Transparency or spying? Whether positive, neutral, or negative, all speculation centered around the inevitability and consequences of seamless information ubiquity.

Dovetailing off our own recent speculation on wearable tech, the already clichéd "Internet Of Things" not only characterizes life a decade from now, but places digital and mobile health—and inevitable realization of the Quantified Self—at front and center.

So let's speculate about digital life a decade from now through the lens of digital health, and discover how continuous bio-sensing, real-time feedback, and powerhouse analytics will transform how we view our bodies, our society, and our values in 2025 and beyond...

From future trends to everyday realities

The report divides responses into "More Hopeful" and "Less Hopeful" prognostication categories, a diplomatic way of expressing the full speculative spectrum from bleary-eyed geeky techno-optimism to zombie apocalyptic data-driven doom and gloom.

Despite the divergence in opinion, most respondents nonetheless agreed on several key trends that essentially beckon a world where connectivity becomes simultaneously ubiquitous and invisible, "flowing like electricity" throughout every aspect of life:

• Wiring of the World: The lines now drawn between devices and non-devices, between users and interfaces, will progressively blur as all physical objects becomes devices, and digital interactions become omnipresent and continuous.

• Through the Lookingglass: Boundaries dissolving, as the real world becomes increasingly digitized the digital world will encroach on the analog, "Augmented Reality" and 3D interactive experiences becoming commonplace.

• Digital Disruption: Industries spanning from music to journalism to entertainment have been rendered asunder by digital, a trend that will continue to transform publishing, finance, education, government, and of course healthcare.

From these generalizations the experts then agree to disagree. Importantly for our purposes, a consensus begins to form regarding the both awesome power of digital and mobile health, and looming threats that if left unchecked could be frightening indeed. Let's take a look.

Digital health in 2025: through rose-colored google glasses

Welcome to a world where today's smartphone and tablet apps evolve into biosensor-equipped wearable devices, which in turn morph into the ambient monitoring of our bodies throughout the day and night via any and every conceivable surface or object.

"We may well see wearable devices and/or home and workplace sensors that can help us make ongoing lifestyle changes and provide early detection for disease risks, not just disease," said Aron Roberts, a software developer at University of California, Berkley.

"We may literally be able to adjust both medications and lifestyle changes on a day-by-day basis or even an hour-by-hour basis," he continued. "Thus enormously magnifying the effectiveness of an ever more understaffed medical delivery system."

Our bodies contain trillions of cells taking in and releasing unfathomable amounts of data. Now limited to devices that measure from formal professional settings or relatively crude smartphone or wearable sensors, imagine the possibilities of a fully digitized world:

• Preventing disease? Diet and exercise are inherently quantifiable and measurable, so streams of data can be used to analyze every individual to determine optimal intake, then correlated with calories consumed and burned, input and output, in real time.

• At risk? Whether the concern is stroke or physical injury, the threat internal or external, ubiquitous and continuous sensing can help monitor seniors in hospices for real time emergencies, and even predict events based on patterns of prior behaviors.

• Point of care visit? Today's agony of diagnostics, treatment recommendations, and patient education compressed into 10 minutes vaporizes with Big Data and hyper-customization, enabling docs to do what they do best—make informed decisions.

• Prescribed medication? Dosing can be personalized based on each patient's unique metabolism and body chemistry; administration can be made as seamless as the biometrics used to measure efficacy and tolerability, making compliance automatic.

• Researching new therapies? The Quantified Self will make today's clinical trials seem tragically laughable, as relevant criteria expand into a spectrum of data enabling the identification of increasingly nuanced patient subtypes, down to the unique genome.

And with such multiple, converging revolutions in healthcare personalization, access, and ease, will likely come sweeping changes to infrastructure and services. "We'll start to rethink how we create systems," said Bob Frankston, Internet Pioneer and Tech Innovator.

"...with such multiple, converging revolutions in healthcare personalization, access, and ease, will likely come sweeping changes to infrastructure and services."

"We'll just assume, for example, that a medical monitor will 'just work' wherever we are, and if we show symptoms of a heart attack in the next hour an ambulance will be there to meet us. We'll continue to define new topologies for social relationships, less tied to geography."

Digital health in 2025: the matrix is everywhere

If the world becoming one big and interconnected biosensor sounds appealing, detractors quickly warn of equally threatening dangers ahead. Like Neo in The Matrix, we could all find ourselves falling down the rabbit hole of intractable privacy, security, and control red flags.

"The issues in security and privacy will have been improved in important ways," said Fred Baker, Cisco Systems Fellow. "But will remain threats, primarily because human nature will not have changed, and there is always a percentage of people who seek to harm others."

Technology has always been the great enabler, used for good or ill; but digital in particular ups the ante with both its power and its vulnerability. As Kurt Godel proved, logical systems can never be both consistent and complete, so no computer program is ever completely safe.

Since every code can eventually be cracked, digitalists play a never-ending game of cat and mouse, hackers breaking in only to be coded back out in this endless dance for data control. Industries falter and prop themselves back up, but with healthcare lives are at stake.

The battle between privacy and personalization has therefore been particularly acute in healthcare. On the one hand we all justifiably want our personal information kept private; but on the other we want to live the dream of the Quantified Self as hinted at above.

Unfortunately we can't have it both ways: The better the service, the more the system needs to know about the served. The price we all must pay for convenience, customization, and collaboration is our private information progressively becoming more public.

Extrapolate this rule to the omniscient and omnipresent "Internet of Things" and it becomes obvious that the Big Data risks become as great if not greater than the rewards. Not only can control become centralized and stolen, but the possibility of system-wide crash also looms.

Add malfeasance, and Armageddon is possible. As John Markoff, writer for the New York Times said: "What happens the first time you answer the phone and hear from your mother or a close friend, but it's actually a piece of malware designed to social engineer you?"

"I began as an Internet utopian," he added. "But I have since realized that technical and social forces that have been unleashed by the microprocessor hold out the potential of a very dystopian world that is profoundly inegalitarian. Who said it would get better?"

"The battle between privacy and personalization has therefore been particularly acute in healthcare."

Digital health in 2025: the future is what we make it

Actually I've been saying it would get better—at least from a digital and mobile health point of view—throughout the two years of writing this column for pharmaphorum. To me, and arguably most experts, increased connectivity and measurability are inherently good.

What we do with technology, whether digital communication or nuclear power, should never preclude us from experimentation and, where appropriate, application. Years, sometimes decades need to go by before we even really begin to understand the full implications.

"The impact of the book on society was not fully realized until 100 years after the invention of the press," wrote Jeff Davis, director of the Tow-Knight Center for Entrepreneurial Journalism. "Consider the change brought by only the first 20 years of the Web."

Given these incredible unknowns, and the already proven transformative power of digital for health, we need new models, vocabularies, and experiential sensibilities to even begin to predict what the digital health world and its audiences will be like in 2025 and beyond.

Stowe Boyd, lead research for GigaOM, put it nicely: "We have already entered the post-normal, where the economics of the industrial era have turned inside out, where the complexity of interconnected globalism make it impossible to find low-risk paths forward."

"A new set of principles is needed, and we'd better figure them out," he added. "My bet is that the cure is more Web: a more connected world, but one connected in different ways, for different ends, and not as a way to prop up the mistakes and inequities of the past."

Our kids are texting all day and no longer talking to each other! Social media has drowned genuine human exchange! The government and business have stolen our identities! One day the grid will go down and we'll instantly find ourselves in the Stone Age! #blahblahblah

IMHO young people have never communicated as much as now, social media has brought unprecedented connectivity and transparency to society, and the boundaries of privacy have shifted to the point the complete sharing of medical data is fathomable, and likely inevitable.

As "mobile health" becomes no different than "digital health," and "digital health" becomes its own redundant tautology within a world gone thoroughly digital, we walk along the cusp of realizing the dream of the Quantified Self, ultimately predicting and preventing disease.

Costly? Of course, as quantum leaps in technologies always are. But it'll be inherently worth it, for the same reason humanity has struggled against all odds to overcome entropy and instinct. Yes, the future is uncertain, but that makes it all the more compelling.

"IMHO young people have never communicated as much as now, social media has brought unprecedented connectivity and transparency to society..."

"The Internet is a dangerous place—" said Andrew Chen, associate professor of computer science at Minnesota State University. "It spreads vice easily. The Internet is a powerful place—it enables oppressed peoples to gather together and achieve through a shared voice."

"The Internet is a seductive place—It provides opportunities for people to ignore their lives. The Internet is a chimera—it starts powerful, becomes seductive, then dangerous. The Internet is the fullest expression of human nature—how you see it reflects you more than anything else."

Conclusion and summary

The pundits have weighed-in on how digital will fundamentally impact life in 2025, the jury out on its cumulative effects being more positive or negative. From our vantage point in digital and mobile health, the trajectory couldn't be more exciting—or intimidating.

Regardless where you stand in terms of digital as friend or foe, its benefits to medicine and healthcare are incontestable. From the first herbal tinctures to robotic surgery, from hand drawn anatomical sketches to 3D printing, technology has made life longer and better.

What's fascinating is how digital has also fundamentally impacted communication, enabling real-time collaboration, global connectivity, and an unprecedented level of transparency. Profound openness certainly leads to vulnerability—but so do silence and isolation.

The world of 2025 will likely be an exaggerated version of 2014—the benefits of digital will be even more helpful, and the challenges even more detrimental. But along the way we'll have choices, ones greatly improved by contemplative hindsight, and optimistic foresight.

About the author:

Michael Spitz is VP of Strategy at Klick Health, where he combines his passion for technology with more than 15 years of clinical content expertise to help engineer digital healthcare solutions. Follow @SpitzStrategy on Twitter for his daily – often hourly – updates on all things digital for the ultimate benefit of patients worldwide.

Have you say: What do you think 2025 holds in store for digital and mobile health?