Smartphones and genomics are revolutionizing healthcare.
Twice in the last two years, Dr. Eric Topol, a prominent San Diego cardiologist, used a small sensoring device that fits over an iPhone to determine that a passenger was having a heart attack on a commercial aircraft.
Made by Oklahoma City-based AliveCor, the case is built with two sensors connected to an app. Topol put the sensors on the passenger’s chest and the device works like an electrocardiogram that he could read in real-time on his phone.
An emergency landing took place for the first incident. For the second emergency, Topol was able to calm and stabilize that patient and the plane landed about 90 minutes later.
The combination of ubiquitous smartphones and mobile devices, combined with the emerging science of genomic sequencing, is making a loud impact on medicine and healthcare.
For instance, smartphones now can accurately monitor many of our vital signs, reducing the cost for an office visit. Rather than asking whether medical data can be gathered with the smartphone, the question many doctors are asking is whether the technology will help deliver better medical care?
In his book, The Creative Destruction of Medicine: How the Digital Revolution will Create Better Healthcare, Topol discusses how genetic testing, along with digital devices like smartphones, might improve and personalize health care. He is director of the Scripps Translational Science Institute in La Jolla, Calif., and the newly appointed editor-in-chief of Medscape, an online platform of 30 medical specialty areas offering news, perspectives, clinical point-of-care tools and continuing medical education.
He has been a vocal and constant proponent of individualized medicine, calling on physicians and patients alike to replace outmoded diagnostic tests and one-size-fits-all treatments with digital/mobile technologies and medical genomics, an emerging discipline that uses genomic information (DNA sequencing and genetic mapping) about an individual as part of their clinical care.
“We practice medicine on a population level, doing everything the same for every patient whether it’s screening or pharmacological treatments,” says Topol, who is Jewish. “We aren’t individualizing care, which is where medicine can make a major difference because of the available technology.”
Topol is convinced that using mobile technologies will allow patients to be better informed and will empower them to assume more responsibility for their own health.
Smartphones And OB/GYN
“I use many phone apps in my practice,” says Dr. Ethan Goldstein, M.D., an obstetrician and gynecologist at DMC Huron Valley-Sinai Hospital and director of the hospital’s GYN Robotics and Minimally Invasive Surgery Program. “For instance, I love having a drug prescription app at my fingertips that lists all the side effects of a drug before I recommend a prescription for a patient. I frequently reference a medical protocol app that describes the ever-changing guidelines published by the Centers for Disease Control (CDC).
“I also use an app to calculate a patient’s Body Mass Index (BMI), which helps me educate patients about weight management,” Goldstein says. “Another useful app calculates a patient’s FRAX Score, a tool that helps clinicians assess the need to treat patients with osteopenia [low bone density] and reduce their risk of hip fracture.”
Goldstein often draws pictures for patients so they have a better understanding of a disease process or surgery.
“I use these amazing iPad apps for demonstrating anatomy, a specific medical condition or surgical procedures,” Goldstein says. “Often it’s the app that helps patients truly comprehend the information.”
Besides the clinical apps, Goldstein uses his smartphone to read journal articles.
“There are apps that summarize the latest medical updates in my field and others that allow me to communicate privately with other doctors around the country on difficult diagnoses and new therapies. Healthcare is advancing by leaps and bounds, and these apps help me stay current.”
Goldstein, a member of the DMC Medical Group in Commerce Township and Bloomfield Hills, has been using Electronic Medical Records (EMR) for three years.
“I can use my smartphone to securely access patient information,” he says. “This connection improves the quality and consistency of patient care when I’m on call and not physically in the office. Additionally, having mobile access to my office schedule enables me to find times in my schedule for a patient if she needs to be seen.”
Goldstein hopes that using smartphone apps will motivate patients to become more informed and proactive in their own healthcare.
“I advise my patients to sign up for the free MyFitnessPal mobile app so they can log their caloric count and exercise efforts wherever and whenever,” Goldstein says. “I often have patients use apps to track their menstrual cycle or to remind them to take medications. Huron Valley-Sinai Hospital has a fantastic maternity app for the iPhone that allows patients to keep track of their appointments, follow their pregnancy, and it provides tons of useful information for expectant mothers.
“Looking ahead, I can see using the smartphone so that physicians can video conference patients to review the results of their screening tests. With 30 million newly insured patients to care for under Obamacare, our healthcare system will be severely strained, which means doctors need to think outside the box to find ways to provide quality and efficient healthcare.
“The smartphone or computer may be how we communicate normal results, while preserving office visits for those patients with problems. It takes time to establish credibility for using this type of technology in this way, but we can all expect a paradigm shift in medicine.
“I’m a technology and gadget guy, so the medical uses of smartphone apps are natural for me,” he says. “Smartphones and apps have enhanced my ability to practice obstetrics and gynecology. Yet, I don’t want medicine to become impersonal. While diagnosis and treatment should be evidence-based and data-driven, clinical examinations and patient feedback are equally important. Utilizing technology, I will continually encourage patients to take ownership of their own healthcare, while educating and guiding them to make the best choices.”
Liz Suminski of Waterford, who is seven months pregnant, uses a DMC pregnancy app on a regular bases. “It tells me how big my baby is, what I should be doing that particular week and sends me short articles on nutrition and how to stay active,” she says. “Although Dr. Goldstein uses his cellphone to give me my tests results, it’s more comforting to know that I can be in constant contact with him whether he’s in the office or not.”
Smartphones And Diabetes
Smartphones now serve as glucometers for diabetic patients and can serve as cardiograms for heart patients. Patients don’t have to use finger sticks and intermittent glucose readings when they buy the app in the Apple Store to get continuous checks on their diabetes and wear sensors that track their activity.
“Diabetic patients routinely use technological devices, including insulin pumps and devices that continuously monitor blood sugar levels,” says Dr. Lowell Schmeltz, M.D., chief of endocrinology at DMC Huron Valley-Sinai Hospital.
“For example, many patients use the Web-based system called CareLink to help them take in information from their diabetes management tools, including insulin pumps, continuous glucose monitors and blood glucose meters. The software organizes their logbooks into easy-to-read charts, graphs and tables. These reports help patients and their healthcare provider discover any trends and other information from the data that can lead to improved therapy management for greater control of their diabetes.
“I can login to their CareLink account, analyze their data and make adjustments to their insulin regimen without the patient coming to the office. I don’t get compensated at all for helping patients electronically, but it is the right thing for patient care. I hope one day that insurance companies and Medicare will recognize this as a payable item.”
“It’s awesome,” says Janet Kelly of Farmington Hills, Schmeltz’s patient for five years. “I’ve been a diabetic for 44 years and never had a doctor use emails like this. There’s no other way to do this. I’m on a pump and I wear sensors and he receives the data thru CareLink. I email him a little note about how I feel and what’s going on in my life. He then emails me instructions within a day — two at most.”
Another smartphone attachment is the iBGStar, a glucose monitor for diabetics that plugs into an iPhone. A test strip is put into the device and a drop of blood is applied from a tiny pinprick. The glucose level appears on a small display and is stored by an app on the iPhone, allowing for long-term monitoring with an option to email it to a healthcare provider. It was cleared by the FDA in December 2011.
MobiSante, based in Redmond, Wash., has devised a smartphone-based ultrasound system that also was granted FDA clearance in early 2011. A handheld ultrasonic probe plugs into a smartphone, which generates and displays an image.
“Many doctors build up brick walls preventing direct patient communication,” Schmeltz says. “I believe technology can break down that barrier and bring doctors and patients together, leading to better health outcomes. For instance, insurance usually covers the cost of patients’ quarterly visits to my office for analyzing data and adjusting treatment. Between visits, when patients use the various technologies, they can have adjustments made to optimize their care. Most of my patients love this approach.”
A phone can be a useful medical device even without any additional hardware or software. Some medical practices already send text messages to patients’ mobile phones, reminding them to take their medicine, renew their prescriptions or visit a doctor. Combined with medical downloadable apps, a built-in camera and video recorder, more advanced smartphones can be used as sensors to measure or track heart and respiration rates. Add hardware in the form of sensors that plug into the phone or connect to it wirelessly, and a phone can become an even more powerful tool for monitoring and diagnosis.
Smartphones And Wellness
“I use an iPhone and an iPad in my practice,” says Dr. Michael Seidman, director of the Division of Otological/Neurotologic Surgery and medical director of wellness at Henry Ford West Bloomfield. “At the lower end of the technology, I use email on my smartphone to receive photos of a wound for an out-of-state patient or someone who can’t make it to their post-op visit for one reason or another. Associates may share a picture of an ear or other head and neck issue, and then I can see the issue in real time.”
“I’m helping to establish an ears, nose and throat surgical (ENT) hospital in Bangladesh, India, with other physicians throughout the world,” Seidman says. “We need to use telemedicine to take pictures to see the problems in a remote village. There are scopes that can go into the ear and hook up to the smartphone and then, provided there is wireless or broadband, the image and info can be sent across the planet for review. I use the iPhone to take video clips of a patient and send them to a hospital or physician for consultation.
“I may take my phone or iPad in the room when I’m with patients so that I can quickly reference a medication or health concern,” Seidman says. “Patients are familiar about adding health apps to their smartphones, especially when the topic concerns weight loss or tracking their daily exercise. Insurance companies may accept the data from smartphones when the focus is on weight loss.
“I’m a firm believer that patients need to be engaged in their healthcare and be the CEO of their bodies,” he says. “God gave us one body and it’s our responsibility to take care of it. If smartphone apps can help patients change their behavior and improve their lifestyle by monitoring their heart or tracking their weight loss, it’s a win-win for everyone.”
At what point will the Food and Drug Administration (FDA) want to review a health app before it is released is a common topic of discussion among physicians using technology with patients.
Currently, there is only draft guidance from the FDA regarding requirements for the review of medical apps. To date, the FDA does not regulate smartphones, tablets and most mobile health applications. A review is deemed necessary only for mobile-health apps used in conjunction with already-regulated medical devices, or those that would transform a mobile device, such as a smartphone or tablet, into a regulated medical device.
A second area for discussion is that not everyone is excited about patients taking charge of their own healthcare. Historically, healthcare is a very paternalistic and conservative industry, and many physicians may not want patients to become independent and too empowered. Topol points out, however, that as medicine becomes more of an information science, patient engagement will lead to better healthcare and lower costs.
“These days, I’m prescribing a lot more apps than I am medications,” Topol says.
Indeed, the number and sophistication of health apps is growing and many are available at little or no cost. Seldom does a health app cost more than $10 dollars. Topol points to a growing number of apps and devices, none of which he is paid for using or endorsing, that are capable of measuring vital signs and then transmitting that data to smartphones. Whether it’s your heart rate or your sleep habits, Topol believes we should track our own conditions through our phones and use that data to see patterns and warning signs of illness.
Topol speaks of a future where human beings are digitized through sensors in the bloodstream. “By having a sensor in the blood, we can pick up all sorts of things — whether it’s cells coming off an artery lining [indicating heart attack], the first cancer cell getting in the bloodstream, the immune system revving up for asthma or diabetes, or you name it. All these things will be detected by sensors in the blood, which will then talk to the phone.”
And when one of these warning signs is picked up by the sensor, a special ring will be sent to your cell phone. Like an engine warning light on your car’s dashboard, this ring will indicate that trouble is brewing in a certain area of the body. Ideally, this would prevent life-threatening incidents, like heart attack.
He argues that in the near future, everyone should have his or her DNA sequenced, which would reveal what diseases or conditions an individual is prone to, and also what types of drugs will or will not be effective for that particular individual. Topol is in full support of DNA sequencing, but there is some controversy regarding how effective DNA sequencing is when it comes to predicting illness.
A few years ago, it cost Steve Jobs $100,000 to sequence his DNA; today you can do it for less than $5,000, with information available in a couple of weeks. Topol expects the cost of a genome sequence to drop below $1,000 in the next three to five years, and there’s a distinct possibility for the $100 genome.
Topol further predicts that finding a cure to ailments, from cancer to heart disease, depends on sharing our medical information. He insists that if we were serious about the war on cancer, people who had the disease would get their tumor genome sequenced, record treatment techniques and outcomes, and then make it all public knowledge.
“If we started to bring all this information together, the acceleration of knowledge and the transformation of what we could do for the future of disease would be extraordinary.”
DMC Health For Life Apps
For the sixth consecutive year, Detroit Medical Center (DMC) has been named to the nation’s “Most Wired” list in the July 2012 issue of Hospitals & Health Networks magazine and as one of the Top 25 Connected Healthcare Facilities in Health Imaging & IT Magazine. DMC lists several health-related apps on its website (www.dmc.org/apps):
• Child Medical Guide answers questions on everything from animal bites to earaches.
• Run with DMC, a training companion with a running log to record your run details and keep you injury free.
• DMC Pedometer to keep track of your steps toward a healthy lifestyle.
• ER Wait Time to show the current ER wait times and a map showing you how to get to the DMC from any location.
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