Tag Archives: eric topol

Practicing Medicine in the Digital Age: Challenges & Opportunities of the Virtual Encounter

The digital age of medicine is upon us.  This past week at the opening Plenary session at the Annual Heart Rhythm Society Meetings, we heard Dr Eric Topol and others tell us that we must embrace social networking in order to engage patients and improve care.  The Affordable Care Act has now changed the landscape of medical practice in the US–we must do more to focus on preventative care and work harder to curtail costs.  More patients are insured and a primary care shortage is upon us (according to data from the AAFP).  In fact, it is estimated that we must create an additional 65 training spots in primary care every year for the next 10 years in order to keep up with the demand–this is assuming that the AAFP estimate of a 25% growth in workforce will be needed to meet the growing pool of insured Americans.  In addition, preventative services will require frequent follow up, patient engagement and support services.

Patients are more connected than ever–most patients now go to the internet to prepare for office visits and come armed with lots of information.  Office visits are already now dominated by keyboards and EMRs–it only seems logical that the next step will be virtual access for physicians and patients.  With growing primary care shortages and an increasing pool of patients needed access to care, telemedicine is likely to play a much larger role in the future.  The concept of telemedicine is not new–remote areas and hospitals have been utilizing telemedicine consults in order to provide specialist support for primary care physicians with limited access.

This week, the Wall Street Journal’s Belinda Beck reported on the growing telemedicine business–doctors seeing patients via computer portals from nearly anywhere in the world.  Several web based companies are now regularly hosting virtual doctor visits online where physicians and patients interact via phone and internet.  Patients describe symptoms and discuss issues with their virtual doctor and are then prescribed therapy–all for a cost of only 40-50 dollars.  Most visits are completed within 15 minutes and no travel is required for either doctor or patient.  Advocates argue that for simple straightforward problems telemedicine visits are much more cost effective and also provide high quality efficient patient care.  Critics have voiced concerns over the quality of care, lack of doctor-patient relationship and the over-prescription of antibiotics.  Some argue that when a virtual visit occurs, diagnosis is made more difficult due to a lack of physical exam.  In addition, data obtained by the Wall Street Journal from Rand, indicate that virtual visits are more likely to result in the prescription of an antibiotic.

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(Graphic from JAMA Internal Medicine and Published in the WSJ)

As you may expect, guidelines from regulatory agencies and medical boards are currently in the works.  Virtual physicians will be held to the same standards as in person office visits and continuity of care is being encouraged by allowing patients to choose their virtual doctor rather than have the provider randomly assigned.  In addition, the Federation of State Medical Boards is now recommending that all virtual doctors are licensed in the state in which the patient that is treated resides.  However, this particular requirement for licensing does not really make good sense if the objective of telemedicine is to provide care to those with limited access to physicians.  Virtual medicine has the potential to meet significant primary care needs in remote, rural and underserved communities and may be an alternative to in person treatment of simple, straightforward medical problems.

As we continue to reform the US healthcare system, many challenges must be met and overcome.  Providing affordable, high quality, efficient care to a growing number of insured Americans is a significant task.  With the advent of digital medicine and advancements in mobile technologies, it is now possible to provide care to patients who may otherwise remain unserved.  Wearable sensors, mobile devices that can obtain real time electrocardiograms and other technologies in development make it possible to receive diagnostic data from remote locations.   In order to be successful, we must embrace change and utilize the digital tools that are now available to provide care to those who so badly need it.
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(Image source: Screen grab via YouTube TED talk by Dr Eric Topol)

Genomics at your fingertips: DNA Sequencing in the Primary Care Office

Personalized medicine is on the horizon. Social media, wireless devices, mobile smartphones and emerging medical technologies have allowed us to track our own health indicators and monitor our bodies like never before. Genomics allows us to better understand why certain people are more susceptible to certain diseases and why disease may be more aggressive in particular individuals. Combining the power of data with the power of genomics will revolutionize the way in which we care for patients in the future–most likely this will occur in my lifetime.

Imagine a day in which you are given a prescription that is specifically made to target disease in YOUR body based on YOUR own genetic characteristics. The future of medicine is in genomics. Diseases that have been long thought incurable or untreatable may very well be cured and successfully treated through matching DNA and therapies. In the past genetic sequencing has been a tool of the research center and has been cost prohibitive for most–nearly $250,000 dollars per genome. Now, technology has improved significantly and sequencing is around $6000 dollars and is expected to drop even further.

This week in the New York Times, author Anne Eisenberg describes a new company that is marketing genomic sequencing machinery (cleverly called Knome)–currently these are being sold to academic and private research laboratories at about $125,000 dollars each. However, in the not so distant future, I can imagine a world in which a primary care physician has a sequencer like the Knome on-site and is able to analyze your DNA when you come into the practice as a new patient. Your personal physician can then utilize the information for choosing your therapies for years to come. If you move or transfer care to another provider, your genome sequencing would transfer with you–just like your medical records do now. I would also expect that ultimately we would have an encrypted national database of our personal genomes so that when you are travelling and need medical care, a provider in an Emergency Department in another part of the country can (with your permission of course) access your genome data when prescribing therapy.

Certainly, genomics has much promise. We are just beginning to see the potential that targeted therapies can have on treating particular forms of certain cancers. As our knowledge of genomics increases and the availability of DNA sequencing becomes more mainstream the archaic data driven population approaches to treatment of disease are likely to be abandoned for more efficient, more effective and more directed, patient specific approaches. The transition to the genomic based practice of medicine will not be without difficulty. As we approach a time when patient-specific genetic information will be commonplace, we must prepare for the inevitable administrative responsibilities and controversy that are sure to arrive at the same time. Protecting individual privacy (and you think HIPAA is bad now) and avoiding discrimination for “genetic predisposition” to particular disease come to mind as potential hot button issues. However, the potential impact on our ability to practice medicine is infinite. As Dr Eric Topol clearly articulates in his book The Creative Destruction of Medicine, doctors will be able to combine data obtained from personal technology with powerful genome sequencing tools to provide the BEST medical care where drug effects are predicted and diseases are treated with certainty as opposed to a trial and error approach. Ultimately, the digital revolution will improve healthcare and allow for new technology and tools such as genome sequencing to be quickly incorporated into everyday practice.

So, one day in the not so distant future, I expect all of us will know our own genetic sequences. A visit to the doctor will likely include a look in your ears, a look in your throat, a stethoscope on your chest AND a quick glance at your DNA….

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