Digital Healthcare

Dr. Eric Topol: Digital healthcare will put the patient in charge

The renowned physician and digital health pioneer shares his vision for the future of medicine

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Dr. Eric Topol is a digital health pioneer and a visionary. In his presentations and in his book The Creative Destruction of Medicine, he challenges the medical establishment to adopt technologies that will improve efficiency, lower costs and make treatments more accessible and effective. In his upcoming book, The Patient Will See You Now, he describes what he calls medicine's "Gutenberg moment": The printing press liberated knowledge from the control of an elite class; now, digital health technology is poised to do the same for medicine, "democratizing" it in ways that were unimaginable until now.

On November 17, Dr. Topol will give a keynote address at the New York eHealth Collaborative's Digital Health Conference 2014 in New York City.

Recently, I interviewed Dr. Topol about his evolving vision for digital health, his forthcoming book and the topics he will touch upon in his keynote address.

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Eric Topol, MD

Eric J. Topol, MDDr. Eric Topol (@EricTopol) is a world-renowned cardiologist, geneticist, digital health pioneer, and medical innovator. He is Director of the Scripps Translational Science Institute, Professor of Genomics at the Scripps Research Institute, Chief Academic Officer of Scripps Health, and Editor-in-Chief of the online medical resource Medscape.

Voted the Most Influential Physician Executive in the United States in a 2012 poll conducted by Modern Healthcare and named one of GQ's "Rock Stars of Science" in 2009, his research earned him the title "Doctor of the Decade" from the Institute for Scientific Information. Dr. Topol is among the top 10 most cited researchers in medicine – an author or co-author of more than 1,100 peer-reviewed articles. His books include the classic Textbook of Interventional Cardiology, 6th Edition, published by Elsevier. Read more about him on the Elsevier Authors website.

What emerging trends do you see in the digital health arena?

The big trend is the move towards truly democratizing medicine. Since 2600 BC, doctors ruled the roost. Now patients increasingly will be generating their own data — by doing the physical exam through smart phone sensors, for example — and driving their own care. They'll be able to video chat with a doctor at any moment, 24/7, for the same cost as a co-pay to see a doctor in person.

Today, if you have a skin lesion, you can take a picture of it, and a computer algorithm will tell you whether or not you need a biopsy. But imagine this broadly across all aspects of medicine. Think of capturing blood pressure readings with every beat of a watch, and learning immediately whether you have hypertension — or if you have it, whether it's being managed properly, and what causes and what helps it. People being treated for depression or other mood disorders will be able to see whether the lifestyle changes they made are improving their status; people with asthma will be alerted so they can prevent attacks before they happen.

Doctors will still provide treatment, but they won't be doing very much diagnosing or monitoring; that will be done by patients going forward. Algorithms will facilitate those processes or take them over completely, depending on the problem. For example, you might have a condition that normally would require hospitalization. But instead, you'll be able to stay at home because your vital signs can be continuously monitored remotely. If a particular reading causes concern, a notification will immediately be sent to your doctor, who can then intervene. So it's not so much that the doctor's role is less important — it's just different.

Will people still be making regular visits to the doctor's office?

We're going to see a striking decline in physical visits and a major shift to virtual visits. According to a recent survey by Deloitte, one out of six visits to the doctor in the US are projected to be virtual by the end of 2014. That number is likely to be much higher very soon, because we're seeing a proliferation of new companies doing tele-consults. Some are quite large, (for example, American Well and Telehealth) but even small ones are gaining a tremendous amount of traction because they enable you to have a consult immediately by videoconferencing on your phone.

What if people aren't aware something is wrong with them? Sometimes a test the doctor orders for one condition might identify a totally different problem.

That's an unusual situation. There's a lot to say for the wisdom of the body. Most people have the requisite alarm system that tells them if something isn't quite right. If anything, the real problem is that people think there's something wrong when there isn't. While it's true some people aren't seeking care when they ought to be, most people have a pretty low threshold before they seek care. Those who aren't are probably discouraged because getting access is such a painful process. In Boston, for example, you have to wait over six weeks to get a primary care appointment now. Then you might wait an hour after your appointment time, and when you finally see the doctor for seven minutes, he or she is typing on a keyboard and so you don't really see the doctor at all.

This has to change and it will change. The system is horribly broken, and we have new tools and new ways to render care via telemedicine that are remarkably palatable. When patients discover that they can easily connect and get the information they need, that they can generate their data at home and learn about their bodies like never before, that they can have access to the actual content of their lives — this creates a radical shift.

New York eHealth Collaborative's Digital Health Conference 2014

Digital Health Conference 2014

The New York eHealth Collaborative's fourth annual digital health conference will bring together 850 senior-level healthcare professionals to discuss and learn about how healthcare today is being redefined through technology, according to the event organizers.

Dr. Topol will be of the keynote speakers. The other is Dr. Ezekiel J. Emanuel, who will talk about "The Impact of Health IT in Reinventing American Healthcare — Future Visions and its Effects on the Economy."

Dr. Emanuel has also published with Elsevier, including chapters in Goldman's Cecil Medicine, 24th Edition and Critical Care Medicine, 3rd Edition, and articles in various journals, including a recent paper on the Ebola outbreak in The Lancet. He is VP for Global Initiatives & Chair of the Department of Medical Ethics and Health Policy, at the University of Pennsylvania.

In addition, the event will feature experts in consumer health data acquisition and insights, health policy, ethical/privacy issues surrounding the new technologies and what's on the horizon. Elsevier Connect will be covering two sessions: "Science, Sensors and Superpowers — From Sci-Fi to Reality" and "Connected Health — Around the World in 60 Minutes." The former features Dr. Alan Greene and the latter will feature panelists representing eHealth initiatives in Europe, China and the US.

To attend

To participate on social media

Attendees will be live tweeting. Follow @nyehealth and use the hashtag #DHC14.

Won't patients also need to take more responsibility for their health, rather than simply relying on the doctor?

Yes. We're rapidly approaching the end of the paternalistic concept that MD stands for "medical deity." Part of this is fueled by the fact that in the smart phone era, you can have just about anything you want on demand, simply by touching your phone. That is changing expectations for everything we do, and it's challenging the medical community.  In San Diego and several other cities, there are the Pager and Medicast apps that let you pick a doctor and how soon you want him/her to come to your house.

At Scripps, we asked, "Why do a sleep study in the hospital when you can have a person do their own sleep study in the comfort of their own bed for free?" So it's not like an on-off switch; it's a wave of different things that are in the process of changing right now.

Doesn't the health insurance industry need to change as well?

Definitely. That industry has been a real laggard. The change may be fueled by the fact that large employers who pay up to several billion dollars a year to cover healthcare for hundreds of thousands of employees  will demand that employees start using these new, more efficient tools. At that point, much of the responsibility and cost shift to the individual, and that could catalyze a seismic shift in the industry.

How will clinical research will be affected?

Much of the research that's now being done in ambulatory settings can be done so much more efficiently if the medical community would start to accept things like patient-generated data—that is, patients using sensors or doing their own labs through their smart phones, doing remote exams and transmitting them in real time. So many parts of clinical research can be conducted with the consumer in charge, and with social networking, like the model of Patients Like Me.

We've seen this done effectively in the testing of various drugs and at no cost, compared to large, expensive, prospective randomized trials. The use of lithium for amyotrophic lateral sclerosis is one example. We've also had studies of drugs for depression that were done by having  patients self-report  in online health communities.

I'm not saying science and traditional research are obsolete or unnecessary; I'm saying we now have new complementary ways to gather important data. The amount of data generated per individual will expand markedly. Before, we couldn't capture continuous, real-time, granular data for each individual, but we can do it now. So clinical studies can have power with fewer people, because we have more data for each person.

You started out as a cardiologist and are now a guru of digital health. How did that happen?

As a child I was obsessed with mathematics. There really weren't any computers at that point. But I was an early adopter; as a fellow in cardiology at Johns Hopkins in 1982, I was the first person in my group to get one of the original IBM personal computers. So I've been a math and information geek and junkie for just about my entire life.

[pullquote align="right"]"I've been a math and information geek and junkie for just about my entire life."[/pullquote]

I've also always tried to get involved with things that are really exciting, which is why I was drawn into biotech and was actually the first physician to give a patient tPA (tissue plasminogen activator, a treatment for embolic or thrombotic stroke) in 1984. But by the late '90s, with the Internet and the ability to capture digital medical data, I saw a whole new world of medicine coming. Then when I moved to San Diego, the wireless capital of the world, in 2006, I became convinced that this was going to be exponentially bigger than I even surmised in '99. So being in the right place at the right time really helped to catalyze cultivate my interest and passion.

Dr. Topol's upcoming book

In his forthcoming book The Patient Will See You Now: The Future of Medicine is in Your Hands, Dr. Eric Topol fleshes out his vision of "better, cheaper, and more humane health care for all." He notes that doctors label patients as "difficult" when, in fact, it is the healthcare system that is difficult.

"Patients are typically unable to see, let alone keep or contribute to theiroffice visits notes about their condition and their body that they paid for," he writes. The book is as much about empowering the patient as it is about the technologies that will enable that empowerment:

We are embarking on a time when each individual will have all their own medical data and the computing power to process it in the context of their own world. … This will set up a tectonic (or "tech-tonic") power shift, putting the individual at center stage. … What have been dubbed the six most powerful words in the English language — "The doctor will see you now" — will no longer be true.

Drawing on experiences from his own practice — "The first time I had an ECG emailed to me by a patient with the subject line 'I'm in atrial fib, now what do I do?' I knew the world had changed" — and those of others, and positioning them against the backdrop of the technological advances of the past two decades, Dr. Topol makes the case that in the near future, medicine will no longer be ruled by "the edifice complex." Information and expertise will be readily available to all, without having to go to the doctor's office, and new technologies will make it possible to "predict and preempt" many major ills  — all of which ultimately will contribute to the "emancipation" of consumers.

The Patient Will See You Now: The Future of Medicine is in Your Hands (Basic Books) will be available on January 6, 2015.

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Dr. Topol with Stephen Colbert

Dr. Eric J. Topol was a guest on Comedy Central's late-night show The Colbert Report last year, discussing the collaboration of medicine and technology and its future. He even demonstrated life-saving procedures you can do with your smart phone. Using funny-man Stephen Colbert as his guinea pig, Dr. Topol monitored his heart rate with a cardiogram and inspected his eardrum with an iPhone.

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Elsevier Connect Contributor

Marilynn LarkinMarilynn Larkin is an award-winning science writer and editor who develops content for medical, scientific and consumer audiences. She was a contributing editor to The Lancet and its affiliated medical journals for more than 10 years and a regular contributor to the New York Academy of Sciences' publications and Reuters Health's professional newsfeed. She also launched and served as editor for of Caring for the Ages, an official publication of the American Medical Directors Association. Larkin's articles also have appeared in Consumer Reports,Vogue, Woman's Day and many other consumer publications, and she is the author of five consumer health books.

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