Best practices and innovations in e-health

[This review was originally published in Essays in September 2012] 

If you haven’t yet read this game-changing book, grab your tablet and download it now. This is the most important healthcare book since Clayton Christensen’s Innovator’s Prescription.

The words creative destruction may sound negative, but don’t judge this book by the title. Eric J. Topol, MD, outlines the positive ways in whichindividualized medicine – using the genome and digital technologies to understand each person at the biologic level to determine appropriate therapies and prevention – will disrupt today’s population-based approach to treating illness. Topol points out many present-day examples of the digital revolution in science that is redirecting medicine towards a truly individualized patient experience.

Dr. Topol is one of a handful of people who could title a book The Creative Destruction of Medicine. Topol is a prominent American cardiologist and geneticist and the Gary and Mary West Endowed Chair of Innovative Medicine, and Professor of Translational Genomics at Scripps Research Institute. He is a well-known digital medicine aficionado and frequent speaker who delights audiences globally with his health science and technology show-and-tell featuring the latest digital health technologies. (Note: Topol will be speaking September 26 at The Economic Club at MaRs Discovery District, and keynoting the OHA’s HealthAchieve November 6 at the Metro Convention Centre.)

Setting the Stage The book starts by focusing on the powerful mini computers in our pockets – always connected with massive storage and processing capability. Constant connectivity, collaboration, and customized consumption is driving our data-driven culture and changing us all in ways that we may not yet recognize.

Chapter two provides background on the orientation of medicine today and its focus on evidence generated through large-scale randomized controlled trials and expert ‘guidelines. Through a number of case study examples Topol identifies core issues with the current state and calls for more evidence based on individuals, not just populations. Chapter three introduces narrative examples of consumer empowerment (many include elements of DIY medicine), and how information is pushed to consumers and pulled out by them.

Capturing the Data The second part of the book is organized in five chapters which systematically outline the ways that data is being captured in modern medicine:

• Physiology: Wireless Sensors capture data such as blood glucose, blood pressure, and sleep quality and connect to networks that enable remote monitoring and data sharing that will provide the foundation for virtual office visits.
• Biology: Sequencing the Genome presents a detailed look at the human genome and application of genomics to the digital revolution in health. After a lengthy background introduction to the general topic, cancer genomics are highlighted along with the controversial topic of personal consumer genomics. Topol believes that we may be closer than we know to “routine molecular biologic digitization of humankind”.
• Anatomy: From Imaging to Printing Organs introduces anatomical digitalization now made possible by pocket-sized high resolution ultrasound units that will replace the stethoscope and new technologies for imaging the brain, heart, and cancer. This chapter really pushes current thinking about modern medicine with a discussion about digitizing and printing human organs.
• Electronic health records (EHRs) and Health Information Technology are covered in chapter 7 where Topol outlines the patient safety issues and reports that gave rise to the call for better (or more complete) health records. In principle, EHRs provide the ability to captures, store, exchange, access, and analyze medical information from anywhere in the world. While privacy and security of data in EHRs, integration of records, clinician adoption and use, and evidence of benefits are continue to be debated, the world is pressing forward with digitization of health records.
• The Convergence of Human Data Capture is the closing chapter of this section in which Topol combines his main themes of combining genomic data with sensor-based real-time capture of physiological data to provide a portrait of the digital human via convergence of human data capture. He highlights a few of the myriad combinations of digital medical convergence such as wireless sensors plus genomics for managing heart disease, cancer, type 1 diabetes, and asthma. For example:  in those identified as having genetic susceptibility for heart attack,  implantable microsensors could flag the presence of biomarkers that precede a heart attack and allow for early intervention – much like the service engine warning light in our vehicles.

The Impact of Homo Digitus

Topol takes a closer look at new models for delivery of care and information in Chapter 9. He highlights telemedicine featuring bidirectional video links between patient and provider as an effective mode of communication. Topol postulates that the need for in-person visits and emergency room visits will be reduced over time as biologic and physiologic data are available within the EHR. However, he cautions that it may take years before there are an adequate number of “digital native” physicians to completely drive the new system forward and that consumers must lead the charge in the interim.

Topol takes a similar look at the life science industry and the recent consolidation that has been taken place.  He calls for new tools and new modes, introducing the concept of wikimedicine – mass collaboration and interaction across key stakeholder groups – and calling for use of genomic data to reboot clinical trials.

Topol closes the book by putting his ideas together to lay out the series of convergences toward digitizing human beings. He summarizes how we will arrive at a point where the science of individuality is the core driver of medical practice. This includes a section on the overhaul of conventional infrastructure which focuses on hospitals and clinics. In his final thoughts, Topol concludes that no aspect of medicine or health as we know it will be spared from the creative destruction ahead. Radical transformation is dead ahead.

The Future is Now

This is truly a great book that will change how you think about medicine, healthcare, and your own health. Topol succeeds in his goal  to provide “not simply a techno-tour” of the latest devices and technologies utilized in healthcare. Ultimately, he sets out the foundational elements of the creative destruction of medicine and how these elements are coming together. Genomics will increasingly provide base information and evidence on individual root cause of susceptibility for a condition, and mobile biosensors already provide a window into our organ function and physiological processes. The result is a new capability for systematic and evidence-based approach for each individual and customized prevention, diagnosis, treatment, and disease-management.

While this ability to bring forth digital doctoring may sound futuristic and revolutionary, in fact, much of the foundation is already here. In Canada, for example, those with chronic conditions such as diabetes, hypertension, or heart disease regularly use small medical devices to collect and digitize this physiological data. In some cases, this may be exchanged over network to share with providers, peers, and family caregivers. As policy is put in place to allow for reimbursement for virtual visits, we will witness the explosive growth of digital doctoring (aka creative destruction) that Topol outlines in his book.

Throughout the book, Topol inspires a new thinking about the digitization of human beings and the impact on the practice for medicine. Importantly, he calls for all of us to action as consumers of healthcare. Participatory action by informed consumers with access to their data is a key element of the creative destruction.

So fire up your digital biosensors, get your genomic data mapped and get ready for your next virtual visit with a completely individualized prescription.

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