Eric Topol: We're undergoing a digital revolution in healthcare

The convergence of IT leads to radical innovation and “the most exciting time in medicine,” said Eric Topol, MD, director of the Scripps Translational Science Institute in La Jolla, Calif., and chief academic officer for Scripps Health, speaking during a webinar hosted by the Health Information Management and Systems Society.  This digital revolution with new tools is transforming medicine in virtually every way, he said, a theme carried over from his book, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.

A series of technologies have transformed the future of medicine, Topol said, starting with the cell phone in 1973. There are now more than 6 billion cellphones on the planet. Internet technology, digital devices, genomic sequencing and social networks have enabled us to go from a population level to the individual level with precision and make healthcare far more efficient.

The 2000s introduced mobile devices which have changed our lives, Topol said. That one component of the digital revolution happened in a short period of time. Social networking is another advance that has dramatically altered healthcare. Anyone in the world can find a patient just like them to share information with and learn from. Physicians are not in touch with this movement, however, said Topol. He cited a survey of about 4,000 physicians in which only 11 percent even knew that online health communities exist. There is a “remarkable chasm between traditional medical communities.”

Data are now stored, graphed, archived and relayed to a provider. Most of his patients are hypertensive, Topol said, and he can now get hundreds of blood pressure readings from their devices. “We are more data driven than anyone might have predicted. The average person looks at his or her cellphone 150 times per day. That is potentially a very substantive change” as patients’ vitals can be collected and stored on cellphones.

We’re starting to see new technologies bypass normal physician work, Topol said. For example, high-resolution images of skin lesions can preempt the need for biopsies. Algorithms can give accurate interpretations for lesions, ear infections, eye refraction and more. “All sorts of things are emerging from this mini, powerful computer.”

Even pills can be digitized so that providers can track exactly when it reaches the stomach which can be helpful for monitoring treatments that require high adherence such as tuberculosis, Topol said.

He mentioned a prediction that machines will replace 80 percent of doctors. While that may be farfetched, Topol said he can see a future in which a fraction of office visits are needed and people will compare going to the doctor’s office to going to the video store.

The bottleneck to get to that point is informatics, Topol said, and determining how to extract useful, meaningful data from big datasets. For example, one in 200 people carry a gene with tremendous protective power. People carrying this gene live well into their 90s with no cognitive decline. There is a drug class that mimics this gene, so getting drug simulation to individuals at risk early enough could make a big difference.

Preventing heart attack is something we have not yet been able to do, Topol said. We have the potential to change that by finding out who is in the process of developing a crack in the artery supplying the heart muscle. Clinicians are not good at detecting that today. Stress tests only tell us about narrowing of the arteries. “Once we characterize cells and get their genomic signature, we can simulate your car which has all sorts of sensors.”  A chip the size of 90 microns can be put in the bloodstream and an application can alert via a special ring tone to heart attack. 

Aside from these technological advances, Topol said healthcare must move away from the patriarchal relationship in which physicians look down on patients. He cited a Wall Street Journal article that said 68 percent of physicians will not interact with their patients via email. He called for the American Medical Association to let go as well. “They’re demanding that genomic data not be made available to consumers.” Meanwhile, he cited a National Public Radio survey that found that 81 percent would have their genome sequenced if they could afford it and 73 percent wanted all the information they could get from their genome. That demonstrates “a sense of where the public is going and embracing the era of genomic sequencing. There’s a strong movement toward democratization of medicine.”

The “amazing digital infrastructure, connectivity, ever increasing bandwidth, social network, super computing power, new tools, wireless sensors and information systems are creating super convergence the likes of which we have never seen before,” Topol said. It sets up a participatory, preventive form of medicine for the first time. “The future is bright.”