Instead of treating all patients with the same condition the same way, physicians should start taking advantage of new technology tools, such as genomic sequencing, to tailor their approaches to individual differences, he told attendees at the annual meeting of the Healthcare Information Management and Systems Society (HIMSS) in New Orleans.
In a wide-ranging keynote speech, Topol outlined his vision of a personalized, patient-centered style of medicine in which physicians play a much less important role and patients play a more important one than they do today. In this scenario, consumers will employ a rapidly proliferating array of mobile health apps and body sensors to diagnose and treat the majority of their own ailments.
To begin with, he noted, consumers will start wearing or using sensors to measure not only their activity, but also changes in their vital signs and bodily functions. Some devices will track brain waves while you sleep. Current devices that can be clipped to a finger, he pointed out, can already measure heart rate and blood oxygen levels and transmit the data to a smartphone. Consumers can use these tools rather than going to a sleep lab in a hospital, he said.
[ Want to learn about healthcare CIOs' top priorities? See HIMSS: Hospitals Making Progress On Meaningful Use. ]
Topol displayed an "ICU monitor" that resembled a Dick Tracy wristwatch. It can register vital signs such as blood pressure, heart rate and oxygen saturation and display them on a smartphone. In the future, he said, there will also be at-home devices that will show whether a child has an ear infection. Other devices will be able to analyze speech to diagnose Parkinson's disease or analyze a person's breath to measure their lung function or diagnose lung cancer.
All of this -- combined with consumers' increased access to their health records, self-education via the Web and social networking communities -- will help correct the imbalance in information that now exists between physicians and patients, Topol said. At some point, he said, patients will be able to perform most medical tasks themselves, without physician help. Hospitals will exist only for intensive care, while most sick patients will be monitored remotely at home.
Topol views genomic medicine as a game changer because of its potential to personalize patient care. Noting that a person's entire genome can be sequenced in a few hours for a few thousand dollars, he predicted that eventually most patients will have their genomes sequenced so they can be properly cared for if they get sick.
The genomic revolution, he noted, has already led to a major shift in how scientists are approaching cancer treatment. In one type of malignant melanoma, he said, patients have had an 85% response rate to treatment when it was tailored to them. In contrast, he noted, only 30% of patients with rheumatoid arthritis respond to three drugs for that condition that together cost $30 billion a year.
At the cutting edge of research, organizations like Scripps are trying to combine genomic data with personal sensors that can be imbedded in individuals. A sensor half the size of a grain of sand, which Scripps is co-developing with Caltech, could be placed in a person's body and prevent sudden cardiac death by detecting cracks in arteries, he said. When one appeared, it would make a cellphone ring.
These kinds of technologies, he said, will someday change the doctor-patient relationship. While that relationship is now based on asymmetry of information, that will change when patients have access to information on their own DNA. A recent survey, he noted, showed that 81% of patients would like to have their genome sequenced. The American Medical Association, he said, has said this should be performed under the guidance of a healthcare professional. Topol disagrees because this information -- like medical records -- belongs to the individual.
There are signs that doctors are starting to change their attitudes about information sharing, he said. For example, he referred to a recent study of medical note sharing with patients. Many physicians opposed this to begin with, but after they started sharing their notes with patients they changed their minds. The Blue Button technology, which allows consumers to easily download their medical records, is another step in the right direction, he said.
Topol also mentioned the big data trend, noting the enormous increase in the amount of healthcare data as healthcare has become digitized in the past few years. Supercomputers such as IBM Watson, he said, will be required to "pick out the signal from the noise."