Seth S. Martin, MD, MHS, FACC, joined the Johns Hopkins cardiology faculty in 2015. He is a core faculty member at the Ciccarone Center for the Prevention of Cardiovascular Disease, where he directs the Advanced Lipid Disorders Program and the Digital Health Innovations Lab. He is also an associate professor of medicine at the Welch Center for Prevention, Epidemiology and Clinical Research and an affiliate faculty member at the Malone Center for Engineering in Healthcare.

How and when did you decide to pursue a career in medicine and cardiology?
When I was in college, I took a class as part of my major that explored the history of endocrinology and the discovery of insulin. Once I started learning about diabetes and the innovation that had occurred to treat patients with diabetes, the world of medicine felt tangible, and everything started to connect. I was finding my passion. I also come from a medical family, so this was not a total surprise. In medical school, the core curriculum, as well as cardiology coursework and clinical experiences, helped steer me to cardiology as a training path. During medical school, I tried to keep an open mind and pursue what I was most passionate about – which turned out to be cardiology.

How did you start integrating digital health research as part of your clinical training?
The digital health piece really clicked for me during the cardiology fellowship. I was witnessing this digital revolution around me while training. As a cardiology fellow, I read Eric Topol, MD's book, Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. Meanwhile, I had been working on a big data project called "The Very Large Database of Lipids." Through the project, we identified a problem, which was the underestimation of LDL cholesterol (LDL-C) levels that could lead to undertreatment in patients with cardiovascular disease – in other words, missed opportunities to intensify evidence-based preventive therapy and improve patient outcomes. We went on to create a solution, a new LDL-C equation that was externally validated, recommended by the 2018 AHA/ACC Guideline on the Management of Blood Cholesterol, integrated into clinical practice, adopted by commercial companies, and used at scale around the world. Reflecting on my research, that model – identifying an important problem and then building a solution – has really appealed to me. It is deeply satisfying to be able to go beyond the problem, be part of the solution, and have an impact beyond the published papers.

How do you view mobile health as a domain of digital health?
It would feel funny to talk about digital health without talking about mobile health. Some of the early work has focused on text messages, which the literature shows do work. People seem to pay attention to text messages. For example, on medication adherence or cardiovascular lifestyle, we have seen moderate effects with text messages in early trial data. And we're just starting to see glimpses of the benefits that smartphones and wearable devices can bring. It may not be as simple as creating an app and getting people to download it. Careful thought is required to create an app that could be integrated into clinical care and improve outcomes. Finding the right pairing of products and people is important too. As interest in smartphone and wearable devices grows, we need to be purposeful in guiding these innovative technologies to become equalizers in health across sociodemographic groups.

How can trainees view innovation in the digital health space?
I would really encourage trainees to first think about principles. What is the fundamental clinical problem that you seek to solve? What do patients really need? It starts there, then you can work backwards. When I was first getting into digital health, I may have been too enveloped by the technology itself rather than thinking through the fundamental clinical problem. I have come to appreciate the critical importance of human-centered design. It is also important to understand the landscape of existing solutions and all the stakeholders beyond patients and clinicians. I have been impressed by how many different stakeholders there are in this space beyond patients and clinicians, such as designers, engineers, administrators, payers, business leaders and investors. Engaging stakeholders early can increase the probability of adding value to the health care system and creating a solution that could propel a long-term business model after the grant money runs out. These are things that I did not think about early in my career.

How do you view the pipeline and timeline for commercializing an idea or product from academia?
It is likely becoming more common for start-up companies to be formed out of universities. Early in my training, I was skeptical of interactions with the industry. However, these days I believe industry collaborations are essential to achieving impact on a large scale. We found that when you work with talented engineers and then they graduate from college, they seek to continue the project. Having a start-up company is a natural way for the engineering work to continue and for them to own their work.

How can digital health influence preventive cardiology?
It is difficult to deliver effective preventive care when you only see a patient every few months or once a year. So many things are happening in between. Digital tools will enable us to be much more effective in the way we empower patients to self-manage their risk and help us connect with patients at moments that matter in between scheduled visits. We need to figure out the evidence-based guideline implementation piece and that is the critical question that digital health can help answer. Given our growing toolkit of medications and growing evidence that more intensive treatment is better, but slow progress with real-world adoption, it is increasingly important that we boldly move forward with truly innovative delivery approaches. Enabled by technology, we will see increasingly aggressive secondary prevention, and we will also see earlier aggressive intervention in the primary prevention setting and an increasing interest in primordial prevention to try to prevent risk factors in the first place. Overall, I see prevention taking on a more prominent role in the world of medicine and us becoming better and more aggressive in the way that we deliver prevention. 

This article was written by Samip Sheth, a medical student at Georgetown University in Washington, DC, and chair of the ACC Medical Student Leadership Group.