While I was eating sushi, a lion-fish in the room-size aquarium was eyeballing me through the thick glass.  Ironic?  Or,  was I simply exercising poor judgment? I think the fish looked a lot like Phil Specter.

Well, it has happened again. I came up with another new idea, and I thought perhaps I could try it out on you to see if it has legs.

When I run on the treadmill I pass the time by listening to TED talks. To me, the common feature of TED talks is ideas. Ideas about concepts that are in many ways common, but that are presented in a new way.

And that is how today began. The gentleman was speaking about the fact the much of the evolution between people and computers has been directed at shortening the distance between them. During the era of punch cards, people were not even in the same room as the computer.

That changed with the introduction of DOS and the CRT—the green screen—computer monitors. The CRT was physically connected to the computer, albeit by wires, and the distance shortened. And then came the mouse and the personal computer, and the distance between and person and his or her computer shortened to the distance of a mouse click. The most recent change has been that of the touch screen, a distance of .7mm now separates us from our computer.

Today the only commonality of shortening the distance between the individual and the computer, whether typing punch cards, or using a touch screen, is that for someone to interact with the computer they still have to use their hands.

That requirement no longer exists. “Hey, Alexa. Order paper towels.” Look ma’, no hands.

And so I thought about this evolution, and I thought about the theme of my writings to improve access and consumerism. The point I make often in my writing has to do with making it easier for people to access their health system. Making access easier, I reasoned, would improve care, patient acquisition, and patient retention.

And it would.

But this morning I began to question, what if, by applying the same concepts, instead of simply making access to the institution easier, is there a way to make being healthy more equitable? Regardless of social standing. Independent of affluence. Can the consumerism discussion move from just improving care to improving wellness? And could doing so make wellness accessible to more people?

Clearly, those with the most means can afford the best care. Equal care does not exist. And neither does equal health, in part because those with less means are often not as healthy as those who are well off.

I think that is due in part to the fact that neither you or I, and neither the wealthy nor the poor can buy wellness. You cannot hire someone or some organization to manage your health or your wellness. We are all equally disadvantaged when it comes to having the ability to have some one or some organization habitually manage our wellness.

It occurred to me that if wellness were available to everyone, then the disparity between the affluent and the disadvantaged, with regard to needing care, would be lessened because healthy people inherently need less care.

So what if everyone had equal access to wellness? What would that look like?

Instead of: “Ok, Google. What is the cheapest way to fly to Cleveland?” or, “Hi Siri, who was the 13^th president?” or, “Hey Alexa. Order paper towels,” someone could ask, “Ok, Google. Am I healthy today?”

“Am I healthy today?” Today a person could ask this of their 8-Ball, they could use Tarot Cards, or they could hire a psychic. Today those are their best options for managing their wellness.

But the technology exists. OnStar uses a version of it. And artificial intelligence, when applied to that technology gives us Siri and Alexa. “Look ma’, no hands.”

A personal concierge. For paper towels and cheap flights and learning about presidents.

Why not use that same technology to help people manage their wellness? Most of us reading this are probably tracking some aspect related to our health using a smart app or a wearable device. We tracked it yesterday and we will track it tomorrow.

And if I check back six months from now we will still be tracking the same data. And how has your health been during those six months? Did any of those apps or wearable devices tell you to go for a checkup? Of course not. Did anyone trained to evaluate health data evaluate yours? Of course not.

I asked myself, why am I tracking this data?  And I rethought the question to one I felt is more relevant–what do I want to know; what do I need to know? I want to know if I am healthy. Am I healthier today than I was yesterday?

One value of having habitual health data would be seeing how the data did or did not change over time. Routine exams only compare this year’s data to last year’s. Wouldn’t it be better to compare today’s data to last month’s, or to the last ninety days? While knowing your resting pulse is 103 may be helpful, it would be better to know that it climbed steadily from 70 to 103 over the past three months. The same holds true for your blood pressure and other data people are tracking.

And many, many people store that data. Many more would store it if they felt doing so would aid them in their effort to manage their health.

There is more health data that is not being assessed than there is data that is being assessed. This begs the question: If it is worth assessing the data clinicians have, wouldn’t it be worth assessing the data they don’t have?

Why not store that data in the cloud instead of on a phone? And once it is there, why not look at it cognitively, and react to it? Organizations like DoctorOnDemand rely on having someone initiating contact because that person thinks they need to see a doctor. Wouldn’t it be better if instead of having someone with no clinical training saying, “I need to see a doctor,” a clinician said, “I think you need to see a doctor.”

More people have smart devices than have doctors. If all of those people with smart devices had access to an interactive, cognitive healthcare concierge perhaps they would be healthier.  Why not manage wellness through a system of PatientOnDemand?