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Monday, March 3, 2014

"Your smartphone will see you now"

From a Keynote Address by Eric J Topol, MD, courtesy of
Out With the Stethoscope, In With the Smartphone: How Genomics and Digital Advances Will Reshape Practice

...The title of Dr Topol’s talk, “Genomic and Wireless Digital Innovation: Reshaping the Future of Medicine,” failed to capture what was in store—a lively, laughter-filled romp through 4 decades’ worth of flashbacks about old cell phones, floppy disks, hospital room set-ups, and methods for taking blood work and vital signs from patients. It’s all going to change, Dr Topol said, because it must.

Genomics is giving physicians and even patients unprecedented detail about tumors, conditions, and even levels of risk, while technology, through electronic health records and sensors—some inside the body—will allow doctors to care for patients from afar and take measurements in real-world settings. The marriage of the two will result in personalized medicine that benefits patients, Dr Topol said, especially as the price of mapping an individual genome comes down to around $1000.

Today, he said, “We give the same medicine to all patients—the same dose—because we deal with the same statistics and the same clinical trial based on large cohorts. That doesn’t work very well.” Too much sameness results in waste and poor results.

A more personalized approach—a “geographic information system” for the human body—will allow doctors to craft treatment that may change the whole way medicine is practiced, Dr Topol said.  “We can declare that ‘Average is Over,’” invoking the title of a new book by Tyler Cowen.

Patients are demanding change, Dr Topol said. Just as platforms like Facebook allowed young people in Egypt to rise up and overthrow a government that could not justify its practices, so, too, will medicine experience a “health spring.” Patients, fed up with inefficiency, will demand the use of technology not only to reduce medical costs but also to limit intrusions on their time. Patients are no longer willing to wait up to an hour to see a doctor or nurse practitioner for 7 minutes, he said. He cited data that the majority of patients prefer remote visits.

He then went through a string of exciting examples in which sensors promise to not only monitor vital signs but also predict events like cardiac arrests or asthma attacks, offering a window for intervention:

  • Sensors will allow an epileptic to predict a seizure and avoid driving.
  • Wearable sensors could allow blood pressure readings that don’t even require the patient to press “start.” Blood pressure readings are sometimes taken on the forehead.
  • Glucose readings for diabetics are getting better all the time, down to minute-by-minute readings.
  • A cardiac patient who had a monitoring device—and knew how to read it—contacted his doctor with the message, “I’m in atrial fibrillation. Now what do I do?”
  • Studies in sleep centers that cost $3000 to reimburse—and which Dr. Topol said do not provide results similar to sleep at home—could become a thing of the past. Sensors attached to the patient could allow data to be taken while a patient sleeps in his or her own bed.
  • For asthma patients—of special interest at this meeting—sensors will be able to monitor environmental triggers such as pollen, and factors such as chest movement, to ward off an attack.
  • Lab testing could change, as much less blood will be needed to obtain results.
  • Multiple sensors will be developed that interface with the patient’s cell phone, and the doctor’s...
...For all the jokes about “your smartphone will see you now,” Dr Topol said it is true that there is a place for personal, mobile technology, and a place for the trained physician, but the roles will be redefined. “The doctor is not being squeezed out,” he said. 

That said, “We are going to have a lot of computer-assisted medicine.”
Yeah. I'll probably have to pull in some of my thoughts pertaining to the Weeds' "Medicine in Denial" in the context of Dr. Topol's observations.

REC Blog post link
REC Blog post link
One continuing concern I have is that of widespread genetic counseling availability and competency. has an excellent series examining the myriad difficult issues.

The case for health IT internships
How do we prepare students, and give them the tools and experience they need to succeed?

The recent federal mandates for healthcare information technology have increased demand on the field, boosting the need for educated and knowledgeable staff for health IT projects. But with the emergence and recent popularity of graduate education in healthcare informatics, we are seeing an influx of students entering these programs who do not have clinical or information technology backgrounds.

These individuals have a great desire to work in informatics and recognize the enormous impact the field can have on healthcare, but they lack the hands-on experience that many employers seek. Some of these students have even reported challenges getting hired after obtaining their master’s degree, for lack of ‘experience.’

Given this, how do we prepare these individuals and give them the tools and experience they need to succeed?...
Click the title. Interesting article. What' the joke? "Experience" is that which you get just immediately after you really needed it.


Remember the days when we actually had to know stuff? Or spend a lot of time finding out?

More to come...

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