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Research on the Value of Mobile Health: An Expert at Scripps Looks Forward

January 6, 2014
by Mark Hagland
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Steven Steinhubl, M.D., director of digital medicine at the Scripps Translational Science Institute, shares his perspectives on the current opportunities in mobile health

Steven Steinhubl, M.D. is director of digital medicine at the Scripps Translational Science Institute, and a practicing cardiologist at the integrated Scripps Health system, both in San Diego. Dr. Steinhubl joined the Scripps organization in July 2013, after having served as director of cardiovascular wellness and medicine at the Danville, Pa.-based Geisinger Health.

At the Scripps organization, Steinhubl is helping to lead clinical transformation through the adoption of mobile health technologies and through helping to manage clinical trials of mobile health technology. He will be giving the closing presentation, entitled “Medicine Unplugged: Bringing the Solution to the Problem through Mobile Health,” at the upcoming Health IT Summit to be held January 21-22 in San Diego, sponsored by the Institute for Health Technology Transformation (iHT2). The Institute became a part of Vendome Group, LLC, Healthcare Informatics’ parent company, in December 2013. Steinhubl spoke recently with HCI Editor-in-Chief Mark Hagland about the mobile health-related innovations taking place at the Scripps organization, and their implications for the healthcare more broadly. Below are excerpts from that interview.

At Geisinger, you spent 60 percent of your time as a practicing cardiologist, but now, you’re spending only 10 percent of your time in clinical practice, while devoting the rest of your time to this transformational work. Do you find equal satisfaction in clinical practice and in transformational and technology-related work?

Most people enter medicine because they want to help people, and for many, that is fulfilled through direct patient care. But I’ve also always felt a certain satisfaction in being a clinical researcher for 20 years, and I’ve always felt satisfaction in knowing that what I was doing in research might help many people. And so as satisfying as direct patient care is, developing research trials, especially in digital medicine, is also very satisfying. And I believe we desperately need to change how we deliver medicine.

Steven Steinhubl, M.D.

So what are you and your colleagues doing at Scripps?

Scripps Translational Science Institute sits between Scripps Health and Scripps Research Institute, which conducts basic science research. It’s actually one of the most successful non-university-based research institutes in the world. It does a lot of work on genomics, but also on general science. Now, Scripps Translational Science Institute, which was established seven years ago, initially focused on genomic medicine, but then very quickly, because of the atmosphere in San Diego with QualComm and a large number of science/technology companies, quickly shifted over to work in mobile health.

And within that, what are you and your colleagues working on?

Pretty much everything. With regard to the clinical trials we’re running, one-third are specific to a device requiring clinical data primarily for regulatory purposes; and another two-thirds of trials involve payers looking for technology solutions. One great example of a trial we want to do soon is a continuous blood pressure measurement watch. Right now, we get these little snapshots of blood pressure when you go into the doctor’s office; or more rarely, via monitors. But now we’ll know what happens over periods of time. So a lot of the studies we’re doing are to look at brand-new data that will help us understand our individual differences, and how we respond to different stimuli on a moment-to-moment basis.

How many trials are being facilitated right now at Scripps Translational Science Institute?

Five trials are going on right now, and roughly 15 trials are in some sort of planning stages through July 1. And last July 1, we had no trials running. And then, Scripps Health in and of itself is also focused on digital medicine; so I have a role within the Scripps system, beyond clinical trials, of helping to establish Scripps Health as a leader in the adoption of mobile health technologies.

Tell me a little bit about that.

We have amazing technology in the mobile health world, incredible tools we wouldn’t’ have dreamed of having ten years ago. But we don’t know how to fit those into the practice of medicine, and too often, we try to fit them in incrementally. And that really doesn’t work well, because our systems for the most part are not set up to take full advantage of technologies. And I like the phrase that my former CEO at Geisinger used to use, which was “very perverse financial incentives in healthcare.” For example, the most common diagnosis coming out of a patient visit to a doctor is high blood pressure; but most of those visits could be eliminated if you had the right monitoring technology that could be automatically relayed to EHRs [electronic health records]. And despite the fact that 50 percent of heart attacks and 75 percent of strokes are related to hypertension, we aren’t getting things evaluated and managed in a timely way, in terms of getting patients in at the right time, and making the right interventions.