Chris McCann, co-founder and CEO of Current Health, sat down with Dr. Eric Topol, founder and director of the Scripps Translational Science Institute, to discuss the biggest opportunities he sees for remote care to impact healthcare delivery and drug discovery models, during COVID-19 and beyond.
Chris McCann: The pandemic has exploded utilization and deployment of remote patient monitoring, digital health and virtual care. What do you think will happen after the direct impact of COVID-19 has dissipated? Will the use of remote monitoring continue?
Eric Topol: When I was working on my book The Creative Destruction of Medicine, I had predicted that telemedicine was going to be an important part of the future of care delivery. What I hadn’t predicted is that it would take a global pandemic to bring that about. When distancing mandates were put in place in March 2020, hospitals began to introduce telemedicine and remote monitoring to a degree and speed that we had never envisioned. During this time, we proved that you can accomplish a lot through virtual visits. I think virtual care will only improve as we’re able to include things like sensor data, labs, and imaging into the virtual visit.
CM: What are the biggest economic benefits that could come from remote care?
ET: The benefits are ginormous, and I don’t use that word too often. The issue here is you’ve got a third of healthcare budgets dedicated to hospitals, mostly to non-ICU patients. In the U.S., we’re at almost 19% of our gross domestic product with healthcare and out of that, a third or more could be preempted with remote monitoring.
What’s more, of the $1.2 trillion dollars we spend on hospitals each year, the number one cost is personnel. However, if we monitored non-acutely ill patients in the comfort of their own homes, we could ensure high-quality delivery of care while allowing better managing personnel resources. Does that mean we’re going to get rid of doctors and nurses? No, but if you look at jobs in the last few years, the biggest jump has been in healthcare personnel, but we need to come up with a better plan than just hiring more people, especially those who are not providing patient care. We have the technology, let’s validate it and find the best way to use it and get the best outcomes from it.
CM: Do you think there are any technological, people or process issues remaining in making telehealth or remote care mainstream?
ET: The technology must become more advanced and it will need to be tailored to meet the patient’s needs before it becomes a mainstream and permanent fixture in our care delivery model. We also need much better AI analytics. Today, we’re looking at one level of data when what we really want to do is integrate everything, so we have the entire history of that patient and every layer of data. We don’t do this right now; we’re just picking a part of the stream.
As we get our arms better around the data and the sensors are further enriched and individualized for specific patients’ needs, I am very confident that we’ll get there. George Orwell once called the hospital “the anti-chamber to the tomb” and that has always stuck with me because it would be great if we could avoid most hospitalizations and I think that we can, more than ever, with the help of digital innovation and remote care technologies.
CM: You touched on the applicability of AI within telemedicine, what do you see are the problems it can solve and what do you see as the barriers to making that happen? Is it simply a matter of getting better data or is there more to it than that?
ET: This is about deep neural networks and inputs. If your inputs are compromised or incomplete, so are your outputs. We have the extraordinary potential to increase the accuracy and speed in which we render patient diagnoses using data. It’s a flood of data that no human being, no matter how confident that person is, could possibly assimilate. So we are going to rely more and more on these deep neural networks and AI algorithms to help us glean actionable insights and improve patient care. It’s exciting but we’re still early in the process.
CM: At Current Health, one thing we have seen a lot this year is an intersection between the decentralization of healthcare delivery and telemedicine but also within clinical research. Do you think we’ll see a continuing change in direct-to-patient recruitment and decentralized clinical research?
ET: I’m excited about some patient autonomy and the offsetting, disintermediating some of the overwhelming workload need for doctors, nurses and coordinators because the clinical trial apparatus is very labor-intensive, expensive and time-consuming. We can get people’s data back to them much faster and more cheaply than ever before. This is not just an advancement in digital medicine but also in citizen science. Most people want their data and want to be empowered and that’s what this plays into, DTP or direct to participants. It’s the most exciting thing to happen in clinical research in a long time. Now, with the power of direct to participants, we can send out a sensor and identify someone's risk through their electronic records at scale, worldwide. The only thing that is holding us back is not thinking big enough.