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Medicine Unplugged

Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks.

Take your electrocardiogram on your smartphone and send it to your doctor. Or to pre-empt the need for a consult, opt for the computer-read version with a rapid text response. Having trouble with your vision? Get the $2 add-on to your smartphone and get your eyes refracted with a text to get your new eyeglasses or contact lenses made. Have a suspicious skin lesion that might be cancer? Just take a picture with your smartphone and you can get a quick text back in minutes with a determination of whether you need to get a biopsy or not. Does your child have an ear infection? Just get the scope attachment to your smartphone and get a 10x magnified high-resolution view of your child’s eardrums and send them for automatic detection of whether antibiotics will be needed. Worried about glaucoma? You can get the contact lens with an embedded chip that continuously measures eye pressure and transmits the data to your phone. These are just a few examples of the innovative smartphone software and hardware — apps and “adds” technology — that have been developed and will soon be available for broad use.

A recent mobile health report by Pricewaterhouse Coopers documented that consumers want these new apps and add-ons for their smartphones — but doctors are not enthusiastic. Why is that? From its inception, the medical profession has been characterized by information asymmetry. Doctors had control of all the data, information and knowledge. Not unlike the high priests before the printing press, the medical profession did all the essential reading. The great inflection of medicine is about to empower consumers to be able to read — not just a one-off measurement (like a blood pressure) but also data for all their relevant physiologic metrics, continuously, on the go. It will provide insights about each individual that we did not have before, such as how blood pressure fluctuates during a stressful event or during sleep. Such data will be graphed on one’s smartphone or tablet, and can be sent to a doctor, caregiver, or even a social network. And this is the precursor to having the key parts of your genome sequence — that which interacts with various prescription medications — maintained on your phone. Your phone, your DNA, your data.

But clearly the reach and impact extends far beyond accessing the individual’s metrics. Being able to diagnose a child’s ear infection remotely will pre-empt the need in many cases to see the pediatrician or go to an emergency room. Having one’s eyes refracted by a smartphone add-on leaves the need for an optometrist wanting. The benign skin lesions that so many people are living with but concerned about could get accurately diagnosed without a dermatologist. Phoning in the electrocardiogram data for someone with palpitations and lightheadedness obviates the need for a cardiology consultation or another emergency room visit. Capturing brain wave data along with oxygen level in the blood, heart and breathing rate with a home sensor would largely eradicate the need for expensive hospital-based sleep studies. If this doesn’t represent the beginnings of the greatest shakeup in medicine, then what does?

Physicians should not be fearful or threatened by the emerging smartphone-centric revolution of health care. The remarkable inefficiency of how medicine is currently practiced, along with its high costs, leaves enormous room for improvement. Rather than waiting an average of one hour for an office visit that lasts about seven minutes with the doctor, who typically spends the time looking at a keyboard rather than the patient, why aren’t we doing many office visits with secure video connects or even Skype and FaceTime? And having real face time. The relevant data on blood pressure, glucose, or whatever relates to the primary concern could be readily transmitted just before or during the visit. With the growing physician shortage that looms ahead, it’s all the more reason to embrace a new form of unplugged medicine. Note to my fellow physicians: It’s time to let go!

Eric Topol is chief academic officer at Scripps Health, a professor of genomics at The Scripps Research Institute and the author of The Creative Destruction of Medicine. This post first appeared at The Huffington Post.

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quick hairstylesDirk DelrealDavid HarlowEric TopolDoctor Mawrdough Recent comment authors
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quick hairstyles
Guest

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Dirk Delreal
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Dirk Delreal

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David Harlow
Guest

@Eric – I hate the overused term, “a perfect storm,” but that’s what we have, creating the environment for the gee-whiz mobile health technologies described in your post. The pressures on office visits and home health visits is rising. Neither fee-for-service rates, which dominate in the former setting, nor case rates, which dominate in the latter, are equal to the task of creating sufficient face time for patients in need with health care providers — who are in shorter supply and higher demand — and office visits are not really needed for the sharing of information in the way you… Read more »

Eric Topol
Guest

Some great comments here from Joe Flower, Michael Ricciardelli and very much appreciated. Regarding John irvine, if you read the PWC report the data support the assertion of marked consumer interest and lack of overall lack of support by physicians. For the cynics who have commented, I have no financial conflicts of interest with any of the technologies mentioned in this article. Cellscope makes the ear diagnostic add/app, Skin Scan and others make the dermatologic dx app, Alive-Cor makes the ECG add/app, EyeNETRA, an MIT spinoff, makes the eye refraction add/app, Sensicor makes the eye pressure contact lens monitoring device.

Doctor Mawrdough
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Doctor Mawrdough

I did not realize that you published infomercials.

Curly Harrison, MD
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Curly Harrison, MD

These devices are one giant backwards leap for humanity, communication, and the soul.

Joe Flower
Guest

People say, “Patients are not ready. Doctors are not ready. The apps are not ready. The law is not ready.” Correct. Nobody is ready, nothing is perfect yet, there are problems to solve. It’s 1910. Ford Model T’s are pouring off the production line, and people are saying, “This’ll never work! Where do you get gas for these things? Who’ll fix them? It’s going to be a legal nightmare! The traffic laws are not up to this. The highways aren’t paved. This will put all the stables and stablemen in town out of work.” It’s 1910, and no one can… Read more »

michael ricciardelli, j.d.
Guest

A law degree is perhaps a blessing and a curse. Although I can see the benefits of portable consumer access eMedicine (for lack of a better term), the legal prospects seem dizzying–perhaps because the law is a slow moving creature and is grounded in such antiquated notions as geography. For example, what effect does skype consults have on state licensing provisions? Where exactly does the consult take place? I’m not being facetious–the law was particularly unprepared for the cybersphere– a quick look at the internet gambling quandry will show that in stark terms. I also, as another reader commented, find… Read more »

Steven Ferguson
Guest

I think Dr. Topol’s point about doing office visits with secure video connections is spot on. Who wouldn’t pay a few bucks to avoid getting into their car, driving across town, waiting for an hour surrounded by sick people when in many cases a video visit will do the trick. Worst case scenario is that you have to go see the doctor anyway.

Rob
Guest

It sounds to me a lot like flying cars (which I am still disappointed about). I agree that this is an inflection point and that patient empowerment is much more likely to drive reform than legislation, but there are definitely some downsides to this. The ear infection detector, for example, will likely lead to a whole lot more diagnosis of ear infections that otherwise went away without treatment. There is lots of evidence that otitis gets better without treatment, even for febrile children. So telling people their kids have ear infections will more likely result in over-treatment than better care.… Read more »

MD as HELL
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MD as HELL

All these apps can only help take care of the well-informed patient. Doctors fear the boat anchor legacy systems being vended under “meaningful use”. They suck!

Patients should really have great fear. They will wait themselves to death.

Fran Stevens, MD
Guest
Fran Stevens, MD

Such hyper enthusiasm for tech devices is indicative of financial conflict.

Dr. Mike
Guest
Dr. Mike

If there is no one identifyable to sue, then the app or service or whatever will never gain traction because it will always be of suspect quality.

If there is someone identifyable to sue, then they will want money for the use of the app or service or whatever. No normal person works for free.

userlogin
Editor

… “A recent mobile health report by Pricewaterhouse Coopers documented that consumers want these new apps and add-ons for their smartphones — but doctors are not enthusiastic. ”

Not sure the evidence entirely supports this, Eric.

I’m hearing that a lot of consumers don’t know quite what to do with this stuff.

It’s a bit like talking about the China market – potentially huge and potentially game changing – but nobody seems to really get it.

The tech savvy docs I talk to actually like this stuff more than consumers do.

John Irvine