High-Tech
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Smartphones and genomics are revolutionizing healthcare.
By Ruthan Brodsky
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wice in the last two years,
Dr. Eric Topol, a promi-
nent San Diego cardiolo-
gist, used a small sensoring
device that fits over an
iPhone to determine that
a passenger was having a
heart attack on a commer-
cial 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 health-
care.
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 De-
struction of Medicine: How the
Digital Revolution will Create Better
Healthcare, Topol discusses how
genetic testing, along with digital
devices like smartphones, might im-
prove and personalize health care. He
is director of the Scripps Translation-
al Science Institute in La Jolla, Calif,
and the newly appointed editor-in-
44 May 2013
I RrD TIMM
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 con-
stant proponent of individualized
medicine, calling on physicians and
patients alike to replace outmoded
diagnostic tests and one-size-fits-all
treatments with digital/mobile tech-
nologies and medical genomics, an
emerging discipline that uses genom-
ic information (DNA sequencing and
genetic mapping) about an individual
as part of their clinical care.
"We practice medicine on a popula-
tion level, doing everything the same
for every patient whether it's screen-
ing 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 mo-
bile technologies will allow patients
to be better informed and will em-
power them to assume more respon-
sibility for their own health.
SMARTPHONES AND OB/GYN
"I use many phone apps in my prac-
tice," 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 fre-
quently 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," Gold-
stein says. "Another useful app calcu-
lates 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 un-
derstanding of a disease process or
surgery.
"I use these amazing iPad apps for
demonstrating anatomy, a specific
medical condition or surgical proce-
dures," Goldstein says. "Often it's the
app that helps patients truly compre-
hend 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 com-
municate privately with other doctors
around the country on difficult diag-
noses 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 Town-
ship 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 pa-
tient 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 smart-
phone 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 pa-
tients to keep track of their appoint-
ments, 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 se-
verely 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 smart-
phone apps are natural for me,"
he says. "Smartphones and apps
have enhanced my ability to prac-
tice obstetrics and gynecology. Yet,
I don't want medicine to become
impersonal. While diagnosis and
treatment should be evidence-based
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