With his 2016 bestseller, The Patient Will See You Now, Dr. Eric Topol earned critical acclaim and gained widespread popularity for his bold vision of the future.
In the book, Topol described a healthcare system in which technology empowers patients to own their medical information, access it digitally and understand how it affects their health. With that information, Topol believes people will take it upon themselves to demand far more transparency, convenience and control than exists in healthcare today.
Topol, who’s also a cardiologist, a professor of molecular medicine and an oft-cited researcher, is today’s leading physician voice on the power of information technology to improve medical outcomes. Thanks in large part to his radical ideas on digital health and the democratization of medicine, he has recruited an army of converts (with 144K Twitter followers and counting).
It was with these credentials in mind that Topol seemed an ideal candidate for the highly coveted (and totally fictitious) role of “Leader of American Healthcare,” an opportunity afforded to guests of the hit-new podcast Fixing Healthcare. In November, Topol joined the show to share (and defend) his plan for solving some of the healthcare industry’s greatest challenges. Like all previous guests, Topol was asked to provide a road map to achieve the following improvements:
1. Increase life expectancy in the U.S. to at least the middle of the pack among the wealthiest nations
2. Increase the quality of U.S. patient outcomes by 20%
3. Decrease the cost of U.S. healthcare by 20%
4. Improve patient service and convenience by 20%
5. Improve professional satisfaction for clinicians by 20%
Given his almost encyclopedic knowledge of, and passion for, technology in healthcare, we expected Topol to begin by expounding the virtues of genomic medicine, artificial intelligence and the many great sci-tech advancements of our time.
Instead, the man famous for touting tech-based solutions caught us by surprise with this opening salvo, a down-to-earth assessment of two fundamental problems in American healthcare today.
“The United States is the only country that does not provide healthcare to all of its citizens,” Topol told us. “That needs to be fixed. We can’t address these critical metrics unless we provide healthcare equitably among all U.S. citizens. That’s step number one. Along with that, we do so much for so many people that is unnecessary—the waste. At least a third of the $3.6 trillion a year in the U.S. that is spent (on healthcare) is wasteful, unnecessary and harmful.”
As out-of-character as his emphasis on coverage and wastefulness might have seemed to listeners, they make total sense in the context of Topol’s image of the future. He’s both a visionary and a realist.
Without coverage, patients can’t access medical care. And without medical care, even the most sophisticated medical technologies prove useless. Regarding waste, until American healthcare sheds its unnecessary practices, care-delivery costs will continue to soar, insurance prices will rise as access erodes, and clinical outcomes will suffer. There’s not a “killer app” on the market that can undo the damage unnecessary care inflicts on our nation’s finances and health.
Next, Topol sought to address a root cause of waste in healthcare.
“We have, increasingly, the problems of data-flooding and lack of time. Doctors have to look at not only the data, but interact with patients, which is most important,” Topol said. “The reason clinicians went into medicine is because they wanted to care for their fellow human beings. The reason why today we have a burnout rate in excess of 50% in this country … is because doctors can’t take care of patients. They’re squeezed so much by administrators. We have far too many administrators who are making far too many requests for productivity among clinicians. The result has been not just disenchantment: The doctor who suffers from burnout has twice the rate of medical error. We know there are more than 12 million serious medical errors in the United States every year and that number is not going down, but rather is increasing as the rate of burnout increases. So, we need to make life better for clinicians and for patients.”
According to Topol, one way to make life better is to bestow upon doctors the gift of time. He notes that with the average patient visit lasting seven minutes, doctors can’t properly diagnose, treat or (better yet) prevent problems. The solution?
“The gift of time can be achieved by using analytics.”
At this point, like streams, Topol’s vision came together to form a powerful river of thought. Building on the foundation of coverage for all, he presented to us a broad range of technology applications to eliminate waste and allow physicians to exit today’s care-delivery treadmill.
For example, deep learning and artificial intelligence can help doctors diagnose medical problems more easily and accurately than doctors at present. Expanded patient monitoring through wearable devices and sensors can allow physicians to shift the setting of care delivery from hospitals to people’s homes. Genomics offer the potential to improve clinical outcomes in powerful and personal ways. Helping people understand their personal healthcare risks can motivate them to obtain the preventive services recommended. In the area of cancer, DNA analysis of both the cancer itself and the patient could revolutionize oncological treatments.
But, again, none of this can happen without more affordable, cost-effective healthcare—a theme Topol hammered home at the end of his opening remarks.
Providing “healthcare for all” and “stopping all the unnecessary, wasteful, and harmful care” are to Topol gateways through which American medicine must pass in order to create the kind of healthcare system he proposes—one that relies on technology and genomic medicine to achieve superior outcomes more efficiently.
Two areas of his plan merit further exploration. Information technology will doubtless revolutionize medicine. The question is: How soon? Topol didn’t provide a firm number, but spoke often (and perhaps too optimistically) of major changes coming “in the years ahead.” And yet, he offered a very conservative estimate of technology’s impact on healthcare employment. He was careful throughout not to suggest that human jobs will be displaced by machines. Rather, he portrays the clinical roles of man and technology as complimentary, especially when it comes to the use of “pattern recognition” software available now in the fields of dermatology, radiology, pathology and ophthalmology.
“Humans get distracted, they get tired and they also don’t have the magnification potential or the ability to assimilate data. But I don’t ever see the point where humans, doctors, clinicians are not required because often we’re talking about critical decisions … Someone has to sign off before a patient is treated or diagnosed. I believe that’s where a doctor’s going to come into play.”
That might seem true for now, but there’s no denying machines are surpassing people’s abilities to diagnose certain medical problems and recommend treatments. In the not-too-distant past, laboratory studies were done by hand. Multiple clinicians had to sign off on the results. Now, machines perform these tasks with only a single, accountable pathologist needed to sign off on the machine’s calibration. Deep learning can’t solve every clinical problem, of course, but it’s already generating more accurate diagnoses and treatment plans for some of the most common ones—and at a lower cost. Therefore, even as the U.S. population ages, we’ll need fewer physicians tomorrow than today.
After all, why make a dermatology appointment if your rash can be properly addressed through a digital picture and a machine-generated diagnosis? Why have an ophthalmologist perform your visual refraction if a smartphone app can accomplish the same task and ship glasses to your house at a fraction of the price? As patients get more and more comfortable with the convenience and affordability that technology enables in healthcare, we will see many of medicine’s longstanding approaches go the way of camera film and brick-and-mortar video stores.
What’s unique about the Fixing Healthcare podcast is that no guest’s plan goes undisputed. Following Topol’s initial presentation, we probed his solutions, dissected his strategy, and posed serious questions about its implementation. We were impressed with Topol’s gutsy and candid responses to more than a dozen difficult queries, which can be heard on iTunes or fixinghealthcarepodcast.com. Five of the most challenging questions Topol answered were:
• What are your thoughts about national specialty societies, knowing that many continue to advocate for wasteful or unnecessary procedures?
• Physicians are smart, they’re scientists, so why do they continue to do things that add no value?
• How do you see hospital consolidation and closure progressing, given that every community resists closing a local facility?
• Electronic health records frustrate and slow physicians down, so why have we made such little progress toward a 21st-century solution?
• How would you recommend that we use data analytics to measure individual physician performance, particularly in the areas of quality and service?
Fixing Healthcare is a part of the New Books Network (NBN) and a co-production of Dr. Robert Pearl and Jeremy Corr. Join the conversation or refer a potential candidate for “Leader of American Healthcare” by following the show on Twitter @fixingHCpodcast, liking the show on Facebook or visiting the LinkedIn page.