Ambulatory care is now at the forefront of national and local initiatives to redesign how health care is financed and delivered. However, an even bigger change-the emergence of the digital revolution-is about to fundamentally alter the context, structure, and process of ambulatory care. "The Creative Destruction of Medicine" offers both a searing diagnosis of contemporary medicine and a visionary prescription for what lies ahead.
The book is a tour de force that challenges our imagination to think big and act boldly. Dr Topol presents a wealth of information and scientific evidence to buttress his argument that we are entering a new era of individualized medicine and consumer empowerment. Through 11 chapters, he paints a sweeping view of how and why health care is being propelled into a new age through digital medical innovation. The book is organized into 3 parts, and each of the 11 chapters present a vigorous defense for change:
Setting the Foundation
* The Digital Landscape: Cultivating a Data-Driven, Participatory Culture
* The Orientation of Medicine Today: Population Versus Individual
* To What Extent Are Consumers Empowered? Clicks and Tricks
Capturing the Data
* Physiology: Wireless Sensors
* Biology: Sequencing the Genome
* Anatomy: From Imaging to Printing Organs
* Electronic Health Records and Health Information Technology
* The Convergence of Human Data Capture
The Impact of Homo Digitus
* Doctors With Plasticity?
* Rebooting the Life Science Industry
* Homo Digitus and the Individual
There is no turning back despite the medical community's profound resistance to change, particularly wireless technologies. Central to this view is the fact that it is now possible to digitize human functions. Smartphones can measure moment-to-moment blood pressure, alert your physician to an asthma attack, continuously monitor heart rhythm and blood glucose levels, track moods, and even monitor brain waves while asleep-all the things that make us tick. Anything and anyone can now have a sensor with the capacity to gather and transmit data about the real world.
The author believes that the "Internet of Things," a world of interconnected and sensor-laden devices, will revolutionize medicine. He sees this new horizon as "being able to image any part of the body and do a 3-dimensional reconstruction, eventually leading to the capability of printing an organ." Yet, many of these digital innovations, large and small, go unused because of the gridlock of the medical community and a calcified regulatory environment.
Similarly, human genome sequencing has opened a new door in medical discovery. The author believes that sequencing will become a routine procedure and the backbone of a patient's medical history. It will determine both testing and treatment options, paving the way for more precise and individualized care. It is a future oriented toward prevention, early detection, and cure, not necessarily traditional treatment models of clinical care. The author is optimistic that the cost of genomic sequencing early in life can be cost-effective over the long term because "it preempts extensive and expensive medical evaluations, not to mention totally ineffective treatments."
Dr Topol describes this phenomenon as the "Age of Convergence," whereby an unprecedented superconvergence of digital, mobile, cloud computing, genetic, and life science are being marshaled to simultaneously improve the quality and cost of care. He cautions that if we keep practicing medicine, as we do today, health care will become an unbearable financial burden. It is the race between health care innovation and resistance to change that will dramatically shape the delivery of care in the 21st century.
One of the book's unifying themes is the democratization of medicine and data. Consumers, empowered by digital devices and "anytime, anywhere" data, are called to lead the charge toward personal health and measuring outcomes of specific groups with a shared condition. Dr Topol dismisses the notion that patient data, including sequencing information, should remain in the sole province of providers. Patients own their data, and this has profound implications for the management and potential monetization of information associated with electronic medical records, clinical trials, and medical research. To emphasize this point, the first chapter focuses on developing a data-driven participatory culture.
With access to more in-depth information on medical conditions and scientific articles, consumers now have a far greater capacity to understand their treatment choices and clinical protocols used by physicians. There is a clear trend emerging as "the convergence of medical information proceeds, and the lines become blurred between the medical community, patient online communities, and the broad base of consumers."
Dr Topol dismisses evidence-based medicine because its focus is on what is good for a large population rather than a particular patient. Furthermore, when care is shaped by guidelines indexed to a general population ("mass medicalization") rather than an individual, it diminishes quality care because many screening tests and treatments are applied to the wrong individuals.
The use of experts to make clinical recommendations or guidelines has become the standard for care, although such recommendations are often based on opinion ("eminence-based medicine") with a paucity of facts. With the accumulation of more meaningful information on individuals through digital medicine and genomic sequencing, it is hoped that clinicians can override their current dependence on broad-scale guidelines.
Traditional medicine is seen as wastefully imprecise, whereas the digital revolution presents a more promising and effective treatment paradigm-one geared to hyperpersonalization and individual empowerment. At the same time, the author cautions about the possibility of treating digital information (data deluge) instead of the individual.
The author posits that the convergence and harmonization of digital medical tools and infrastructure will serve as the means to a radical disruption of health care. It is a challenging thesis that calls into question fundamental assumptions about how medicine is practiced today, the changing role of patients as consumers, and the adoption of powerful new technologies in our everyday lives-all of which are redefining what is possible and desirable in medicine today.
Moreover, the democratization of medicine through access to innovative technologies will usher in more precise diagnosis and treatment choices for providers and patients. Waste could be vastly diminished, and both medical and medication errors would be significantly reduced. The key to this reality shift lies in a commitment to an individual-centric approach to medicine and patient care, which is enabled by the digital revolution.
Dr Topol concludes that "the convergence of the digital world and medicine is inevitable, setting the stage for a radical disruption we need." It is indeed a revolution, and ambulatory care redesign is at the heart of this transformation.
-Peter Boland, PhD
President
Boland Healthcare
Berkeley, California