Topol Talks Technology

At Health IT Outcomes, we’ve made it our mission to provide the healthcare industry with expert guidance on technology system selection, integration, project management, and change management. To help achieve this goal, we speak with industry leaders on everything from EHRs to HIEs to HIM, and then share these conversations with you. We recently traveled to Chicago to attend HIMSS15 where we had the privilege to speak with Dr. Eric Topol, the Chief Academic Officer with Scripps Health, who explained what impact he believes the proliferation and use of mHealth technologies — clinical smartphone attachments and applications, remote sensors, etc. — will have on the transformation of healthcare, as well as the types of health data patients are capturing about themselves today, how he sees this practice increasing in the future, and how this will change the relationship between the patient and their physician, particularly as it relates to ownership of health data.

Health IT Voices: Tell us a bit about you and your role at Scripps Health.

Topol: I’m a cardiologist and I oversee a research Institute at Scripps Health and the Scripps Research Institute called the Scripps Translational Science Institute. In addition to that, I’m really into digital medicine and democratizing medicine which is why I put together the book The Patient Will See You Now.

Health IT Voices: You focus a great deal on the technology surrounding digital medicine such as smartphones. What are some ways smartphones are being leveraged and how is that transforming healthcare?

Topol: Today, with your smartphone, can do your cardiogram. You can examine your child’s eardrum. You can get a diagnosis of any skin rash or lesion. That’s just the beginning of each individual being able to get information that was previously unobtainable, directly through their smartphone. It is moving the routine diagnostic and monitoring functions to the individual. It’s the equivalent, really, of the Gutenberg printing press enabling people to read and get information. But now the consumer — the individual — can get their health information about themselves through their own devices.

But none of these things by themselves get you the answer. They all have algorithms and computer assistance is needed to make the diagnosis or to perform the monitoring with the appropriate filtering and processing of that data. Cloud computing allows immense, powerful algorithm software to basically take raw data and make it useful and accurate. At Scripps, we determine the validity of that data and make sure that it works really well before it’s unleashed.

Health IT Voices: Adoption has not been as rapid as we might expect. Why do you think that is?

Topol: There are many reasons for the lack of adoption, one being this isn’t exactly going over well within the medical community where it is viewed as a loss of control of the paternalistic medical community. Another thing is it’s very new with many of these tools having come out in the last year or two, and a whole lot more in the queue.

We don’t change quickly in medicine. It’s kind of a somewhat sclerotic, even ossified community that doesn’t lend itself well to be agile. It’s not being driven by the medical community, but by consumers. Particularly the younger generation which wants to have all their data and they want to have it now. They are not going to tolerate this waiting a few weeks to get an appointment, then waiting longer to get any data when they are used to having the immediate gratification of getting the answer or the data that they want.

Health IT Voices: How is democratizing medicine going to ultimately do what we all want to do, which is improve patient care?

Topol: Well, democratizing means it’s available to everyone, everywhere. A great example of this? It was published that a smartphone could diagnose cancer in forty minutes for $1.80, and it could be done anywhere in the world. A few weeks ago, it was also published that in Rwanda, you could diagnose HIV or syphilis with complete accuracy for fifty cents. Now, we have things that cost less than a dollar or two, and this is a shakeup, economically, because of the fact that information is flowing directly to the individual.

Health IT Voices: The patient-physician relationship is critical. What impact will this proliferation of technology have on that relationship?

Topol: For the doctor who is already too busy and stretched too thin, there is now a chance to concentrate on simply getting the right treatment for the right person while providing wisdom, experience, and guidance along with communication and compassion.

For the patient, it’s having their data be much more engaged. It doesn’t have that asymmetry it used to have where the doctor gave the orders and all the information was not transparent. It’s a whole different look, but there’s plenty of downside as well.

First, we’ve got a privacy issue. Data is not assured to be private, and if you search something on the web or your phone is hacked, your medications and your conditions can be compromised. Another issue is that this isn’t for everyone, only for those people who want it. Another challenge is that we have to prove the technology. You have to make sure that this is not only accurate, but that it makes medicine better for people and that requires rigorous study.

Health IT Voices: That data security battle is never going to end because, as we progress, people doing the evil are going to progress as well. What are your thoughts?

Topol: There’s a lot of proclamation that privacy is dead. However, this is precious information, and people do not want it out there. The government has not given rightful ownership to the people of their data and as a result, that data is owned by doctors and hospitals. So, despite the fact that the patient paid for services and it’s their data, they don’t even own it. What other sector is there in the world that works like that?

I believe data ownership by the individual is essential so they have it wherever they go. Most people have different providers or they travel and this would allow them to have vital data at their fingertips, wherever there’s a mobile signal — which is basically everywhere.

You don’t want to rely on any particular doctor, hospital, or health system for your data. You should own it, and therefore it’s with you. Just like you are connected to your smartphone, you are connected to your data any time you need it.

Health IT Voices: Where do you see this heading over the next five years?

Topol: By that time, more than 80 percent of adults on the planet will have a smartphone, and that’s a big deal because wherever there’s a mobile signal, there’s a chance for better healthcare. If we see in five years the consumer outpouring of interest and demand, and we see some of the largest employers getting behind this movement, we could have a whole different look.