Transformation of the clinic: Data-driven pre-emption of disease and the politics of health

Healthcare systems in Europe are undergoing a transformation due to high costs of care. Remote measurement technologies (RMTs) such as wearable sensors, mobile apps and data analytics are expected to enable this transformation. To this effect, European funding bodies have announced calls for RMTs that make it possible to conduct data driven pre-emption of episodes of disease to avoid rehospitalisations. We follow the work of a group of investigators of a European research project funded by the European Commission and the Pharmaceutical industry seeking to develop RMTs and also explore ways in which these technologies could work in the clinic. For this reason, they engage in wide consultations with stakeholders such as patients, doctors, healthcare managers and regulators. Through their proposals, which we view as exercises in clinical world-making in action, we study how the hospital and clinical action may be transformed. These exercises raise questions about which actors are included in these proposals and what different roles they are given, which actors reject these technologies and what kind of counterproposals they produce. We show that the introduction of big data analytics and RMTs in the clinic have diverse consequences: they provoke changes to the core business of pharmaceutical industry and imply different understandings of what healthcare and therapy is or should be, requiring a different organisation of the hospital, its link to the home, and a modification of the patient–physician relationship. As we show, the direction of the transformation of the clinic is still highly uncertain.