The democratization of medicine is as close as the phone in your pocket, says Eric Topol, MD. Healthcare leaders had better be ready for empowered consumers, cost-cutting mobile apps, and genetic sequencing, which promises to be a differentiator.
You're carrying the key to healthcare's salvation in your pocket.
Eric Topol, MD
That was the message from Eric Topol, MD, keynote speaker at last week's HealthLeaders CFO Exchange. In a one-hour tour-de-force session, he made his case for the many virtues of smartphones as constant healthcare companions, patient empowerment, and disruption to the way healthcare has been practiced as far back as ancient Egypt when doctors were also priests.
Topol opened his remarks with photos of taxicab drivers around the world protesting the ride-sharing service Uber en masse. Like many users, Topol loves Uber, particularly UberX, where the driver is more likely not a cabbie. The Uber phone app tells users how many minutes until their ride arrives and "it's a lot cheaper, [the drivers are] friendly, and they want to get the five-star rating," Topol said.
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Healthcare is poised to reach consumers through the same portal as Uber—the smartphone, Topol said. As examples, he mentioned the apps Medicast and Pager, which allow consumers to schedule house calls from among nearby doctors.
Even the Mayo Clinic is getting in on the act, with its Better service. "Basically they've taken their nurse practitioner team, which is very strong, and they've put them on the front lines… with the Mayo doctors in the background," Topol told the assembled CFOs. "[Consumers] pay $50 a month for unlimited access."
Long wait times are one of the drivers behind telehealth. To illustrate the point, Topol displayed wait times to see a primary care doctor in various cities. Boston topped the list at 66 days on average. A recent PriceWaterhouseCoopers report suggests that by the end of this year, one in six visits will be virtual.
What Consumers Want. When They Want It.
There's a tongue-tying acronym for this consumer-driven phenomenon – IWWIWWIWI. "I want what I want when I want it." It started in the fashion world and is disrupting many industries besides healthcare. "Everything else is on demand," Topol said. "Your groceries can be delivered to your door within an hour, and so can your healthcare."
Topol is no stranger to readers of HealthLeaders. He's not just a practicing cardiologist, but also holds prestigious positions at the Scripps Research Institute and Scripps Health, and— vested interest alert— took the role of AT&T's chief medical advisor this year. Two years ago, I reviewed his book, The Creative Destruction of Medicine.
Topol's next book, on the democratization of medicine, is in the works. It should arrive just in time to see the next wave of sensors, health-aware smartphones and, not long after, technology to let smartphones X-ray patients, Topol said.
The lion's share of healthcare data, he believes, will be patient-generated. (I'll believe patients taking their own X-rays when I see it, however.)
As another example of the coming democratization of medicine, Topol cited Theranos. It has technology that can perform tests that labs like Labcorp or Quest perform, but using only "a droplet of blood" at a fraction of the current cost. Walgreens is already starting to install the technology at some of its stores.
Recently-released Medicare data showed that Medicare spent $5 billion in 2012 on labs. "That is going to go through a major shakeup," he said. And Theranos is actually intermediatetechnology. In a few short years, it will be possible to perform these lab tests with—you guessed it—the smartphone.
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Enter Genetic Sequencing
Someone in the audience suggested that common labs could be done this way, but not more complex tests. Topol conceded the point, but suggested, as he has in the past, that medical centers go upscale, particularly into genomic testing, as a hedge against having today's lab testing revenue eroded by Theranos and all that follow it.
"Health systems have not gotten into sequencing, but they should, because it will differentiate, and it's going to be paid for very soon, or is, in many circumstances, by insurance," Topol said.
Another example: With only 13 out of 1,000 patients benefitting from statins, Topol says genetic screening can make a huge difference in reducing side effects and the cost of drugs by not treating patients who cannot benefit from statins.
But statins are loose change compared to high-cost "drugs like [hepatitis drug] Solvaldi and cancer drugs," he said. "They account for some $120 billion today, but they're projected by the end of the decade to be well over $400 billion, because they all have price tags of about $100,000 or more for a course of therapy.
"We can get personal with sequencing and genomics, and we're going to be increasingly using these to get the right drug, and the right dose of that drug, to the right patient and make this much more efficient," he said.
The next day, I did hear a CFO or two grumble that Topol's smartphone-driven world is still not available to all, nor are adequate networks—cellular or otherwise—in place to drive personalized virtual or real care into all areas. Nothing new there. Technology always seems to be unevenly distributed, even in the U.S.
But even if only a fraction of what Topol expects to happen happens, it's still going to be more intriguing and turbulent in healthcare than ever. He practically dared the assembled healthcare systems to take some bolder steps. We will see if any of them take his advice.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.