Wired for Health: An Interview with Dr. Eric Topol

By Shiv Gaglani

In this column we often discuss tech developments and innovations that can affect the way we care for our patients. However, despite the growing presence of tablets and smartphones in the clinic, it remains untested whether mHealth interventions fulfill their promises. In order to rectify this, The Scripps Translational Science Institute recently launched a pioneering study called "Wired for Health" that seeks to determine whether mobile health devices truly improve patient outcomes and reduce costs. We had the opportunity to speak with cardiologist and director of the Institute, Eric Topol, MD, about the study, Google Glass, and medical education.

Can you describe the Wired for Health study that Scripps just announced?

The essential purpose of Wired for Health is to apply solid science to the field of mHealth to determine if these digital technologies improve outcomes while lowering costs and medical resource consumption. We're beginning with a randomized controlled trial to test three devices: the Withings blood pressure monitor, AliveCor heart monitor, and iBGStar blood glucose meter. Wired for Health is the first time multiple medical sensors are being aggregated into a single dashboard, as opposed to the status quo of being interpreted in isolation. This is an important direction for the field if it wants to add value to both patient and provider. We're getting ready to launch a number of such validation studies through our digital medicine program.

How are these studies being funded? For example, has the NIH stepped up?

The NIH has a lot of enthusiasm for mHealth, though I haven't yet seen any significant funding for mHealth studies. The Wired for Health funding comes in part from the Qualcomm Foundation, which awarded us a $3.75 million grant over the course of 3 years. We also have received devices and limited funding from the manufacturers, though they have no influence on the study since we have an assembled an independent team of investigators.

Speaking of Qualcomm, they have clearly been very active in funding medical innovations. They recently announced an interest in Google Glass applications for health care ("Glassomics"). What do you think of Glass for medicine?

While I personally haven't used Glass, I have certainly read some of the reports about how helpful it may be for certain applications. For example, it may be used for recording and documenting operating room procedures. I also assume it may be useful in medical education technology because of its ability capture real-time video and multimedia. You could imagine being able to review and learn from patient encounters and surgical procedures by using Glass.

Earlier in your career you established your career with your genetics research in cardiology. How did you transition into mHealth?

My journey into digital health began back in 1999. I was asked to be an advisor of CardioNet, which was the first dedicated wireless medical company. They were basically trying to transmit heart rhythms over the Internet. I became an advisor and brought along other cardiologists to form a whole clinical advisory group. It was a success at least initially, and for a number of years was really the only technology that allowed real-time collection and transmission via the web of heart rhythms. Now there is a lot more competition in the space from companies such as AliveCor and iRhythm.

Advising CardioNet was an eye-opening experience that let me see how powerful mobile sensors and devices connected to the internet could be in the field of health care. When I moved to San Diego to head up the Scripps Translational Science Institute, I realized that there was no better place to be for someone interested in mHealth. San Diego is the wireless capital of the world and has seen an explosion in the number of dedicated wireless medical companies in recent years.

What are your thoughts on the actual level of adoption of mHealth technologies by clinicians?

In 2009, we created the first dedicated mHealth center called the West Wireless Health Institute because the technologies were just getting off the ground. They still largely belong to early adopters, but I'm confident that at some point unplugged medicine will be so routine that we won't even think of having dedicated centers for mHealth.

In terms of barriers to adoption, one of the biggest is the reimbursement question. Who will pay for the device itself? For the data interpretation? And perhaps some mHealth-based procedures won't warrant reimbursement. For example, though stethoscope use is routine during the physical exam, physicians are not reimbursed each time they use their stethoscopes. Primary care doctors at Allina Health in Minnesota are being taught to do head-to-toe ultrasound exam, so how should/will that be reimbursed? Another barrier to adoption is the need for evidence, which goes back to why we launched the Wired for Health study and have a few other trials in planning. A third factor is lack of awareness and education. There is still a very large number of physicians who do not know about the progress that mHealth is making.

While in Cleveland you helped found the Lerner College of Medicine. What role do you see medical schools taking to make the future generation of clinicians aware of the changing practice?

I think very few medical schools have had the flexibility of changing the curriculum to incorporate the vital components of digital medicine, specifically genomics. Once you have a curriculum in place there's generally a lot of inertia since changes have to go through faculty senate approvals and could take a couple years to actualize. That being said it'll be important for medical students to learn how the field is being turned on its head, whether it's individualized genomics and the microbiome or how wireless medicine will be enabling remote patient visits and changing the clinician-patient relationship. It's also important to note that the gap in awareness to the practicing physicians is even bigger. It will be a necessary challenge to get them up-to-speed on genomics, biosensors, and other practice-changing developments.

Is that why you took up the role as Editor-in-Chief of Medscape?

I had previously served as Editor-in-Chief of two other Medscape sites: the heart.org, which I started in 1999, and a genomic medicine website. Several months ago I was asked to take up the role of Editor-in-Chief of Medscape, and decided that it would be a good opportunity to reach millions of physicians worldwide, as well as allied health care professionals. One of my goals has been to bring more genomics and wireless medicine content onto the Medscape platform so that these providers may benefit from being up-to-date on the latest developments.

As a cardiologist, do you have specific advice to other cardiologists who may or may not be aware of these practice-changing developments?

It'd be great to see more adoption and enthusiasm among cardiologists, reimbursement issues aside. For example, most cardiologists still use the stethoscope, which is really just a stethophone if you think about it. Now that handheld ultrasound with high resolution is available, I haven't used a stethophone to examine the heart of a patient in almost 3 years. Overall, we need to get a bit more imaginative and develop a willingness to adopt future medicine.

Shiv Gaglani is an MD/MBA candidate at the Johns Hopkins School of Medicine and Harvard Business School. He writes about trends in medicine and technology and has had his work published in Medgadget, The Atlantic, and Emergency Physicians Monthly.

Keywords: Microbiota, Medicine, Schools, Medical, Genomics, Blood Pressure Monitors, Multimedia, Awareness, Education, Medical

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