Digital medicine puts patients’ health in their hands with doctors’ approval

Imagine hospitals with no regular beds. Visits to doctors’ offices increasingly are replaced by televisits at a time convenient to the patient. Patients will examine themselves with smartphones at their convenience, with the results sent to databases. Machines will interpret the data quickly and accurately. In general, picture a technology-based health care system that is more democratic, humane, and less expensive. Virtual care is the future of medicine as described at Arizona State University by Dr. Eric Topol, cardiologist-scientist-futurist.

Topol spoke at the seventh annual Mark McKenna lecture on March 22 at the Marston Exploration Theater. ASU’s W. P. Carey School of Business sponsored the conference. Topol is far from an ivory-tower thinker. He was the longtime leader of the Cleveland Clinic’s cardiology program, one of the world’s leaders. He is now the director of the Scripps Translational Science Institute in San Diego and chief academic officer of Scripps Health. Topol is helping organize one of the most comprehensive medical studies ever attempted, the Precision Medicine Initiative.

Here, about 1 million Americans are expected to enroll in a study in which for years they will feed data digitally to researchers. The three primary entities involved in the survey are Scripps, the Mayo Clinic, and Vanderbilt University, Topol says. Mayo and ASU announced a partnership in October that is designed to improve patient care. Topol and his team will be responsible for enrolling about 350,000 of the participants. “It’s the most far-reaching medical research program in history,” he says. The study will help shape the future of care, which Topol expects to be more in control of patients and the data they collect.  

Smartphones are the key

Smartphones will be at the center of medicine’s new world, Topol believes. “You can now track any organ, any system in the body with sensors, most of them wearable,” and then show the results on a smartphone, he says. Topol demonstrated an exam of his body through images from his cell phone, everything from internal organs to his left foot. The images were clear, including the organ that has been the focus of much of his life’s work: the heart. A device that works with a smartphone already is available through Amazon and costs less than $100. “You don’t have to know how to read a cardiogram because it’s read for you,” Topol says. “And you can even have it on your watch if you’d like if you like to keep looking at your cardiogram all the time.” Topol has tried this, but admitted, “It doesn’t seem to be all that exciting. “Why would you listen to a person’s heart ever again when you just put this on, and seconds later you see everything … the valves, the strength of the heart muscles, the size of the chambers, and on and on? And secondly, it will track the flow of the blood.”

This device can minimize unnecessary trips to the emergency room for people with heart rhythm concerns, he says. “Most of the time when you feel your heart is fluttering or you’re dizzy, your rhythm is holding up very well.” Another device, which measures blood pressure with the results visible on a watch, has just been approved by the FDA. “I’ve been using it. It works,” Topol says. “This idea that we can change health care with smartphones is really what digital medicine is centered around. The smartphone will be the hub of the future of medicine.”  

Hospitals will look different

Because of the rise of smartphones and wearable technology, “The hospital that exists today is dead in the water,” Topol says. If he were designing a hospital system today, “I would just have an intensive care unit … imaging equipment you can’t get at home, operating rooms, and emergency rooms. And nothing else … no regular beds. Some exams rooms would be available while keeping in mind that medical exams are increasingly done outside of hospitals. More space might be devoted to analyzing data, Topol suggests. “I’m really into this new hospital. It’s a hospital, but it doesn’t have the same stuff. Unfortunately, nobody is doing that yet.” Also, we need to shave emergency room traffic so that only people who truly require it can get the quality care they need, he says.  

Other changes led by tech

The future of health care will be much different in a host of other areas. Regarding patient contact with doctors, “Before you know it, sometime in the next decade there will be more virtual visits, televisits than there will be physical office visits,” Topol says. “That’s because this is so much more efficient. The doctor doesn’t require any other personnel; there’s no other waiting room, no overhead. Doctors who are doing this now actually love it. And their patients love it even more.”  Also, sleep studies in hospitals will be obsolete, says Topol.

Such studies cost around $4,500, with some hospitals charging $10,000 or more. Topol wonders how anybody could sleep in a hospital, knowing the bill that would soon come. Instead, people can test themselves at home with a simple, re-usable ring that contains sensors. People with diabetes already have an alternative to pricking their fingers and drawing blood to measure their glucose levels. You wear a sensor on the abdomen or an arm, Topol says. “I’m not a diabetic, but I’ve used this. It changes what you eat. It helps train people who have diabetes to find out what works to get their glucose under tight control.” Pointing to a recent story in Time magazine, Topol says, even people without diabetes are starting to check their glucose levels on their smartphone. “This could help prevent diabetes in people who are at high risk,” he says.

Also, a test is now available for about $25 where a drop of blood can be analyzed and reveal “every virus you’ve ever been exposed to and when,” Topol says. Another device has just come out that would detect male infertility with the aid of a smartphone “through a sperm sample,” says Topol. “A dedicated chip that costs $5 will be commercially available” that figures out the sperm count within seconds. Current infertility tests are “very expensive and not something done in the comfort of your home. This is a good, positive step.”  Artificial intelligence will have a huge impact as well, with studies showing machines can more accurately interpret data than doctors. For example, AI can better detect the possibility of a person committing suicide than psychologists and psychiatrists. Costs are a crucial factor as well. Topol cited one example where 260 million medical images could be read in one day by a machine for about $1,000. “Tens of millions of dollars vs. $1,000 (while being) and more accurate,” Topol says of AI’s capabilities. “And it doesn’t get tired, doesn’t have a bad day.”  

Roadblocks will delay change

Though change is inevitable, powerful forces are lined up for the status quo, Topol says. Medical schools, including the one Topol founded at the Cleveland Clinic, have shown little interest in pushing along the advances that technology now allows. “That is the real stumbling block,” he says, pointing to older doctors who control the curriculum. “We’ve got a long-in-the-tooth faculty that doesn't want change. And that’s a real problem.

They just want to get through the end of the twilight of their careers.” Also, doctors’ groups sometimes have opposed advances that threaten their pocketbooks, Topol says. “We have a problem with incumbents, with remuneration. We have lots of legacies. Retail (medical) clinics have been taken on by the establishment. A lot of them do good jobs. Any change that changes the control and the money flow is a problem.” Large employers are best suited to force change, even if their motivation is cost savings rather than fighting for what’s best for patients, says Topol. The same goes for insurers, who will work with employers to come up with creative ways to save money. “Companies and insurers, that’s where you’ll start to see the turning point. But it will take a while. It’s unfortunate how long it could take.”  

The secret to change

If Topol could wave a wand and make one substantive change, he would ensure patients could own their medical data instead of hospitals and doctors. Once this happens, positive changes will start to flow in other aspects of the health care system, he says. “That’s the biggest missing link right now. I firmly believe that everybody should have their data. It’s their data. They paid for it. It’s their body. That’s where it should belong.” Only New Hampshire gives legal ownership of medical records to individuals, he says. “In the other states, the data are owned by doctors and hospitals legally. That isn’t right. That’s paternalism. That has to get fixed.” Once patients can generate their data, Topol says, “I believe a consumer-centric health system is inevitable.

The capability now exists for people to feed their data into a “massive planetary knowledge resource for health care.” For example, prospects for people with cancer would improve if the health care system had data for everyone with cancer, their demographics, treatments, outcomes, etc., he says. “That’s an exciting opportunity that each person puts their data into this resource. Most people are happy to do that if the data is de-identified and encrypted.” Such a movement already is starting, as two such resources for cancer are have begun, he says. “If we can get 1.8 billion people on Facebook for social stuff, why can’t we get as many or more for medical stuff to help one another? So, you can pick an individual from this resource and match them (with somebody with the same medical problem.) And you have an excellent matching capability. This is the ability to predict better treatments, better prevention, better everything.

It’s using all these tools that we’ve been talking about.” With all this in mind, “Someday, we’ll be able to predict a heart attack before it happens. Wouldn’t that be exciting?” These changes, Topol believes, will lead to a democratization of health care. The keys are portable data the patients own that can be analyzed relatively inexpensively by increasingly sophisticated machines. Some older people may not feel comfortable with such change, believing “the doctor knows best.” But Topol argues, “That’s going to be passé,” as most people — once exposed to their data through smartphones — are more than happy to take a larger role in their care.” Doctors will still give guidance, “But it will be different.” Patients will be more in charge.

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