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Democratizing Medicine: Eric Topol Pushes a Patient-Centered Healthcare

November 17, 2014
by Rajiv Leventhal
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Topol notes that digital health tools can help the patient "come alive"
Eric Topol, M.D.

As the healthcare industry moves into an era of accountable care, new digital tools can help democratize medicine, Eric Topol, M.D., director at the La Jolla, Calif.-based Scripps Translational Science Institute, said in a keynote at the New York eHealth Collaborative's (NYeC) 2014 Digital Health Conference.

In a crowded room full of conference attendees, who at times seemed mesmerized by the examples of how far digital health tools have come, Topol said that these new technologies will allow providers to move to individualized medicine. "You can have multilayers of information about someone,"  he said. "It's almost like a Google Maps for each patient."
Topol outlined eight tools that will democratize healthcare in the future, ranging in areas from sensors to labs to imaging to physical exams to health records to the "Uber doc." Examples of next generation detection include smartwatches that monitor blood pressure every second of the day, or as Topol said, "the ICU on your wrist." Other examples include necklaces for heart failure patients that monitor continuous blood pressure, fluid status, cardiac output, stroke volume, and more. "You're seeing non-invasive ways to track heart failure, which is the number one cause for hospital readmissions," Topol said. "There are physical measures out there for every part of the body, he added. 
Topol continued by talking about the danger that hospital labs and national lab groups are in due to the advent of smartphones, apps, and other devices that produce similar diagnostic results, something that is deeply changing medicine.  He brought up the example of Elizabeth Holmes, who founded Theranos, a Palo Alto, Calif.-based health technology and medical laboratory services company that can get  100 blood tests within minutes with just a droplet of a patient's blood. "This is a game-changer for lab medicine, and if the national lab groups don't keep up, they will have to change," he said. 
Regarding imaging, Topol said that while the stethoscope has long been the icon of medicine, it has become completely irrelevant and is on its way out. Now, even consumers can analyze ultrasounds, he said. "Ultrasound-on-a-chip is making medical imaging so cheap, you have to ask, can anyone do it?" And on smartphone-based portable X-rays, Topol said that "it's a new form of selfies."
Topol then moved on to patient access to their medical records and how transparency of records and services can make a difference. "Ninety percent or more of patients are fed up with their healthcare costs. Transparency is one piece of this," he said. "If a hospital or health system doesnt have all medical records on mobile apps, they're far behind. Everyone should have access to information—it's theirs!" Topol added.  What's more, it takes an average of two weeks to get an appointment with your primary care provider, he noted. "And when you get in the doctor's office, we know what happens. The notion, 'I want what I want when I want it' should apply to medicine. If you can get groceries and your car when you want to, you should be able to get your doctor when you want, too."
To this end, Topol cited a Deloitte report that said one of every six doctor's appointments will be virtual by the end of the year. "Uber doc" is a concept that exemplifies the notion of on-demand medicine with doctor house calls.  Applying specifically to mental healthcare, Topol said that research has suggested people are more comfortable sharing their inner thoughts through devices rather than in person with a therapist. "It's called 'textual healing,' believe it or not," he said. "But virtual visits save a lot of money. On average it is $88 cheaper, as unnecessary tests are performed  after face-to-face visits." 
All of these shifts are leading to an unprecedented amount of pressure on  providers and hospitals, said Topol, who read an article recently on how to survive your hospital stay. "That's a really scary thought," he said. "The smarter patient room is his or her bedroom, as remote monitoring is safer, costs less, and  carries a smaller chance for infections." 
As such, Topol pushed the "doctorless" patient model, where treatment, wisdom, and guidance is provided by the doctors, but in much more partnership with patients than what we have now. "The mantra should be 'nothing about me without me'. You are your data and you need to control and own your data. And there are new tools now that we didn't even hear of four years ago that can help," he said.  "I believe technology can actually enhance the intmacy of the doctor/patient relationship," Topol concluded.  "When we're giving the patient the data in real time that they're entitled to, it puts the doctor and patient on equal footing. The patient has come alive, to a much higher degree."