Digital Health Revolution Long Awaited, Much Misunderstood

First let's dispel one thing about revolutions: no one reading this column who works in healthcare is going to start one, except maybe in your respective capacities as consumers of healthcare. Revolutions come when a critical mass of people—18th-century French serfs or overtaxed colonists—decide there is a better way.

So if anything, the work being done by hospitals, health systems, physicians, and IT companies in creating electronic health records and smart devices is mere road-paving for a new way of practicing medicine that is hopefully not too far off—just in time to save healthcare from collapsing in its own inefficiency.

Eric Topol, MD, cardiologist and chief academic officer at Scripps Health, hopes that his new book, The Creative Destruction of Medicine, will help nudge consumers and a few other constituencies into seeing the true potential of digital health to flip the paradigm, as suggested by the book's subtitle, "How the Digital Revolution Will Create Better Health Care."

"Probably the better term is digital medicine or digitizing human beings," Topol told HealthLeaders in an interview. "We are in a Stone Age of medicine still. In the book I paraphrase a quote from Voltaire that 250 years ago we did not know what we were doing in medicine, and 250 years later we have not made a lot of progress. This is a chance to take medicine to a whole new, precise, participatory era."

There is a misconception, perhaps, that digital healthcare is the realm of "cool gadgets." Topol says the digital shift in healthcare started a few years back with health and fitness wireless devices and apps such as the heart rate monitors in Nike shoes. But cool gadgets are just the start of gathering much more precise data about people and their health. That technology has now moved to devices such as blood pressure monitors that can be worn continuously, or blood glucose monitors.

Imagine the precision if a cardiologist could see a patient's blood pressure tracked over an extended period of time, including during sleep or even at times of stress. "Who stops in the middle of an argument to check their blood pressure?" Topol says.

"I'm not suggesting we are all going to walk around with biosensors continuously," Topol says. "For example, there are more than 1 billion pre-diabetics on the planet, and we have warned them not to become diabetic. We have 400 million of those already. What if they could get their glucose every five minutes just for a week, and learn what are the foods and the lifestyle choices that are putting their pancreas into a high-gear mode we want to avoid? Wouldn't that be a great education for that individual, because each one has his own environment, own nutrition?"

The baseline of innovation in healthcare also has to change, Topol says. Much—if not most—healthcare technology innovation adds to the overall cost. What is needed is "frugal innovation" that bends the cost curve, he says. One promising application is an inexpensive wireless sleep monitor which can provide data on sleep patterns, at a cost of under $100 against a $3,000 overnight stay in a hospital sleep center.

"Now we are talking about the big challenge. Here you have all these great technologies but they are not going to sit well if they have any, any increase in cost," Topol says.

The challenges are immense, especially on the data side. "Each genome you sequence has six billion letters and you have to sequence it 40 times and then you have to interpret it properly," he says. But the day is not far off when you can carry your genomic data on a smart phone, which will have transformative implications for everything from checking drug interactions to predicting disease patterns, he says.

If enough people push for it, and the industry responds, this digital revolution has the capacity to "open windows we have never been able to see through before," Topol says.

"It's getting all this panoramic view of the patient: their biology, their physiology, their anatomy, this high-definition person, which really is transformative."  Even revolutionary.