From TED talks to the Wall Street Journal to The Colbert Report, cardiologist Eric Topol is the ubiquitous spokesman for medicine’s next wave, where unobtrusive gadgets work with smartphones and sophisticated analytics to continuously monitor signs of health and sickness, alerting both patients and their doctors long before a crisis hits. He first became intrigued by the possibilities of technology in the early 1990s, when he worked with a company that was developing a way to do heart monitoring over the Internet. “I realized that this could be ginormous,” he says. Upon moving to San Diego in 2006, he found himself at the epicenter of wireless medicine, with more than 150 companies in the immediate area that were developing products in the field. One of Topol’s chief research activities is to validate whether these technologies work, and whether they’re better, faster, and cheaper than what’s currently available. “You can’t start using this stuff until you prove, unequivocally, that it’s measuring accurately,” Topol says. One recent study showed that a simple adhesive sensor patch collected more cardiac data, more easily and cheaply, than the Holter monitors that have been standard technology since 1949. As for his own patients, Topol finds himself prescribing apps more often than he prescribes medications. “They take many [blood pressure] readings a day and they know what’s happening in their lives,” he says. “They’re now much more engaged, activated and contextualized.” Below, he talks with HDM about some of the implications of the impending tech revolution.

 

The Topol File

  • Top 10 most-cited researchers in medicine, Institute for Scientific Information
  • Author, The Creative Destruction of Medicine
  • Chair, Cardiovascular Medicine, Cleveland Clinic
  • M.D., University of Rochester
  • B.A., Biomedicine, University of Virginia, Charlottesville

On hospitals

The hospital model won’t work long term. It’s much cheaper to have people in their own home, free of infections and medical errors, with their families around. Most people won’t have to be in the hospital except for the ICU and the OR. Everyone else can be remotely monitored with FDA-approved devices that capture heartbeat, blood pressure, and oxygen level. But because the local hospital is vested with these patients and knows them best, it might become the data repository, and the best way to deal with the tsunami of data with a warm fuzzy compassionate touch. That has to be preserved.

On physicals

Smart phones are delivering any metric you can think of—your blood pressure, glucose, pulse. You can get a sensor for your phone that gives you an EKG, or an attachment that can take a picture inside the ear and show whether your child has an ear infection. You can do an ultrasound exam with a smartphone that’s as good as what comes out of the $350,000 machine in the hospital. The trend will extend to many other things like mood, lung function for asthma—it’s extraordinary how much you can capture. Another category that’s starting to get legs is the ability to do labs through a smartphone, including a finger-stick of blood. That’s not yet commercially available, but it’s going to be as important as the others. There are still going to be doctors and nurses and procedure rooms, but the key is how to deal with the sea of data to make sure those things are being used in the best way.

On integration

We took the Scripps employee base and looked for the “hot-spotters” who consume the most resources—with diabetes, hypertension and arrhythmias--and studied the effect of using apps [to track their conditions]. In order to do that study, the biggest challenge was to get all the apps to talk to each other on one screen, because all of them were siloed developments with no integration. That was just three sensors. My car has 400 sensors that all talk to each other. We have to do better. The big unmet need is not a missing metric, but how to pull all the metrics together and get “moneyball” out of that data.

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