The world is on the verge of a fourth industrial revolution, characterized by artificial intelligence, robots, big data, and deep learning and analytics, but medicine is still stuck at the beginning of the third industrial revolution, which has already brought digital capabilities to billions of people worldwide.
That’s the contention of Eric Topol, MD, director of the Scripps Translational Science Institute and chief academic officer of Scripps Health in La Jolla, Calif., who says that the digital revolution has been occurring since the middle of the last century. Even so, the healthcare industry continues to only minimally leverage information technology.
However, Topol, a practicing cardiologist at Scripps Health and author of The Patient Will See You Now: The Future of Medicine is in Your Hands, sees mobile devices as the technological enabler for the “democratization” of medicine by giving patients control of their own health data, which has historically been the exclusive domain of doctors.
Consumers are “moving from passengers to co-pilots,” challenging the traditional “doctor knows best” mindset among physicians, according to Topol. Previously, medicine has been reluctant to make such changes. “Doctors have thought for years that people can’t handle the truth, and that if they got their data, they would go cuckoo,” he told an audience at this week’s Healthcare Financial Management Association annual conference in Las Vegas.
Nonetheless, with more than 80 percent of U.S. adults owning smartphones, he believes healthcare is on the cusp of a fundamental shift in who controls data. That transfer of control will effectively shift power from physicians to patients, who will play a dramatically more important role in their own care. In the future, consumers armed with mobile phones will gather data from wearable sensors to prevent or better treat health conditions, Topol said, with these devices serving the role of a digital medical assistant or coach.
“They will do most of the routine labs through the smartphone. Some interesting imaging capabilities, and almost all of the physical exam, can be done through attachments to the smartphone,” he said. “You will have your electronic medical records at any moment in time, wherever you are—with all your scans and lab tests graphed—through your phone. You’ll be able to look up your medications and interactions with your genome. And, you’ll be able to summon a doctor anytime, whether it’s through your phone or to your house.”
On-demand medicine is the wave of the future, and physical face-to-face office visits are going to become the minority of physician-patient interactions moving forward, Topol predicted. In fact, he argued that the patient’s bedroom will become the center of remote monitoring, providing continuous tracking of vital signs from the home, as well as virtual consultations via telehealth-enabled smartphones. “The telemedicine revolution has finally arrived, and it’s headed for prime time.”
According to Topol, a professor of genomics, mobile health technology will not only markedly cut healthcare costs but will put personalized medicine in the hands of patients by contextualizing the data they generate in their real world, not just the doctor’s office.
“In a tiny droplet of blood, there’s a lot of information,” Topol observed, which can be tested at home by consumers. “It’s not just blood. It could be sweat, urine, and breath.” There’s going to be pocket DNA sequencers the size of a flash drive that people will use widely, he predicted. “They already exist today.”
Further, consumers today can order a mobile device through Amazon for $69 and perform a cardiogram anytime they want “when they feel that’s something’s not right, when they’re dizzy or when they feel their heart is racing,” he said. An algorithm embedded in the smartphone software updates patients on their heart rhythm, which can “preempt having to go to an emergency room when most of the time (the person’s condition) is normal.”
By wearing a tiny sensor on the arm or abdomen linked to a smartphone, diabetic patients can receive glucose readings every five minutes, according to Topol. In addition, he said an experimental contact lens being developed by Google can painlessly measure glucose levels in tears, replacing the finger sticks that millions of people with diabetes use to draw blood.
Topol looks forward to a not-too-distant future in which diabetics can measure their blood glucose levels on a continuous basis via painless methods and at a fraction of the cost. “Imagine having your glucose on your smartphone or watch for pennies a day—that’s where we’re headed in the next couple of years.”
For people with Parkinson’s disease, Topol revealed that there is a free app that, at any moment in time, quantifies an individual’s tremor, voice, and gait to help determine whether they should take their medication and in what dose.
In addition, ear infections are a common reason for parents to take their children to the pediatrician. However, he said that mothers and fathers can use their smartphones to diagnose their child’s ear infection through the cloud with an algorithm that examines images for the presence of fluid trapped in the middle ear.
Hospital-based sleep studies, which are among the top revenue drivers for many health systems, could also be a thing of the past in Topol’s emerging app economy. He asked: How many people would go to a sleep lab and pay $4,000 for a sleep study when you can take a sensor in a reusable Band-Aid that costs $1 to make and captures almost all of the same data?
When it comes to other advanced sensor technology, Topol said it’s now possible to analyze sweat and physiologic metrics with skin sensors. “The power of being able to do skin sensors that extend beyond the routine chemistries all the way to the environment,” he exclaimed. “For example, exposure to pesticides and even things like nitric oxide which could predict an asthma attack.”
Topol referenced the fact that LifeMap, in partnership the Icahn School of Medicine at Mount Sinai, has developed an asthma app that leverages Apple’s ResearchKit platform to give patients quantitative metrics about air quality, pollen count, and “hot spots” in the community where people are using their inhalers with increased frequency.
“The sensors we see today are only really rudimentary to where the field is headed,” he concluded, “with many more to come.”
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