Eric Topol: Medical technology revolution needs validation to move forward

This is the second in a two-part interview with cardiologist Eric Topol (pictured), a professor of genomics at The Scripps Research Institute in San Diego and author of "The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care." Topol is slated to give the Tuesday, March 5 keynote address at HIMSS13 in New Orleans.

In part one of this exclusive interview, Topol talked about the importance of using digital tools, and gave his take on the progress of genome sequencing. Here, he discusses the future of hospitals, social media and accountability in healthcare.

FierceHealthIT: You've previously talked about how hospitals and office visits won't be as necessary in the future as they are today, a belief also shared by Intel Chief Healthcare Strategist Eric Dishman, who last year at HIMSS predicted that within 10 years, face-to-face visits will be the exception rather than the rule. Do you think such an assessment is ambitious, or can we get to that point in a decade?

Eric Topol: I think that the idea of attrition of the need for regular hospitals should start now. The only reasons to have hospitals in the near term, thanks to the advances of remote monitoring capabilities, will be intensive care units, which are not going to go away, and operating rooms, as well as pre- and post-operation recovery areas. But the remaining monitoring can be done at home, and will be far less expensive. Additionally, there won't be as high of a risk for infections.

Technically we have the capabilities now, but because of the problems that we have with entrenchment, it's going to take a little time before we accept that there's a new model in unplugged medicine. It's going to take longer than it should, and that's unfortunate. One of my favorite quotes is by George Orwell: "The hospital is the antechamber to the tomb." That still applies today, but people haven't accepted Orwell's characterization of the hospital.

FHIT: Have you encountered skepticism of your ideas?

Topol: Yes, there's one pushback that I get--and I should emphasize that I agree with it: Before we embrace these tools, we've got to prove that they work. Not that they measure the blood pressure or glucose levels, but that they change outcomes and that they lower costs. That's a validation step, and what we're doing a lot of at our Scripps Translation Science Institute.

We need a lot of groups all over the world to take that validation challenge on. We can't just accept in a willy-nilly way, just because something is new and wireless that it's some kind of magic. We've got a long history of making serious mistakes and increasing costs with technologies that were never validated. Take, for example, the recent paper [published in the Journal of the American Medical Association] about robotic surgery. That technology was widely used with no data associated with its validation.

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That's why with the Vscan, we conducted a validation study to show that images were just as good as the ones you get in the hospital ultrasound lab, but that for screening, you only need one or two minutes instead of the 45 minute, routine echo study which costs $800. The portable, real stethoscope is free, once you have it in your pocket.

I think that ultimately, this revolution of medicine will not take hold unless each one of the technologies going forward is fully validated. We can't afford to have another false illusion of "this is better" without proof.

FHIT: How vital is social networking is to the future of digitized healthcare?

Topol: I believe that we haven't even scratched the surface of social networking. This is going to be one of the most important parts of the digital infrastructure is to propel the future of medicine.

I say that because we have these online health communities--Patients Like Me, for instance--and there are new ones cropping up almost every week, and they're spreading like wildfire. This is an important way people are sharing information and learning about their conditions from virtual peers.

Moreover, this is a way in which we will establish managed competition. Part of what I'll talk about at HIMSS is that today we talk about shared decision making in medicine. The patient is informed: "What do you want to do? Here are the choices." Now we have "share decision making," where the individual has the data connected to their phone, displayed on their phone--archived and graphed--and they get to decide if they're even going to share it, and who they're going to share it with.

For example, they may share it with their social network--either Google circles or Facebook friends or their PatientsLikeMe subcommunity with people who have the same condition. They may share it with their doctor, or with all of the above.

My point is that this social networking story harnesses the power of managed competition--for instance, I'm with a bunch of people who have high blood pressure and I'm going to compete to have my blood pressure managed exquisitely well. Or, I'm an epilectic, and I'm going to have my brain waves managed well. You name the condition, and you've got a social network  to enhance impact.

I think we haven't even started that yet. We it a little bit in fitness competitions, like with things like FitBit and BodyMedia, I participated in that, and nothing gets the competitive juices flowing more than when you're having each person look at everybody's data. Now that we're getting people armed with their data, we can start to apply these sorts of things to chronic illnesses.

Editor's note: This interview has been edited for length and clarity.



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