As an Air Force veteran (1988-2002), interventional cardiologist, global medicine vice president for Medicines Company and director of cardiovascular wellness at the Geisinger Health System, Steven Steinhubl, MD, has seen and done a lot. Now he's taking on a new challenge: the first-ever director of the Digital Medicine program at Scripps Health.
Steinhubl will lead the San Diego-based health system's efforts to evaluate mobile health devices and apps and will be working closely with the Scripps Translational Science Institute, a National Institutes of Health-supported collaboration of several public and private organizations. That mission was bolstered last year by a $3.75 million grant from the Qualcomm Foundation to support the development of breakthrough digital technologies.
"Right now there is a lot of excitement surrounding mobile technology, but not a single mHealth app has been rigorously studied," Steinhubl said in a July 9 press release announcing his appointment. "Our challenge is discriminating the hype from what will actually help patients and benefit the healthcare system."
He'll be joining forces often with STSI Director Eric Topol, with whom he's worked for close to two decades.
"Throughout Dr. Steinhubl's distinguished career, across the board in academics and the life science industry, he has displayed innovative and pioneering work, along with an ability to find synergy among different technologies," Topol said in the press release. "Those are among the many reasons we recruited him."
Steinhubl recently sat down to answer a few questions passed on by e-mail from mHealthNews.com.
1. In your new role with STSI, what criteria will you use in evaluating new mHealth technologies?
"Our primary criteria for evaluating mHealth technologies will be based on their potential to impact patient care in a positive and meaningful way. Everything else flows from that over-arching mandate: The simpler and the greater cost savings, the better, but it has to have the potential to lead to a measurable and real improvement in individuals’ wellness. Scripps Health is committed to digital technology designed around the patient to add value to their care and to fit into their schedules and lives."
2. How can mHealth be used to empower patients? How does this change the traditional doctor-patient relationship? What does this mean for the physician?
"mHealth has the potential to radically alter the current routine care of patients, which in many ways has remained unchanged for centuries: When you don’t feel well you see a doctor, or if you have a chronic medical condition frequent, intermittent visits to the doctor’s office are required to track your progress or the impact of therapeutic interventions. mHealth has the potential to provide the tools necessary for patients to take charge of their own health. Chronic conditions like diabetes, hypertension, heart failure, asthma, COPD, depression and many others can potentially be continuously tracked with automated, actionable feedback to the patient and, when necessary, their provider.
For acute conditions, there are devices that measure all pertinent vital signs, check for urine infections, evaluate for anemia, image the ear drum for ear infections or diagnosis your heart rhythm. There are even wireless thermometers with crowd-sourced information. These are just some of the tools that can inform patients of their health that in the past would require an office or even emergency room visit.
This will obviously change the doctor-patient relationship, but I believe very much for the good. As recalcitrant to change as physicians have historically been, it is clear that the vast majority of physicians are unsatisfied with the way they currently practice medicine. Surveys show that nearly two-thirds would not encourage young people to join the medical profession, and the same proportion would retire today if they could financially. A significant percentage of this discontent is centered on the loss of a meaningful doctor-patient relationship. mHealth will improve that by allowing physicians to be what they were trained to be – diagnosticians and educators, and not managers of algorithmic medicine."
3. Is the healthcare industry taking the necessary steps to protect personal health information stored on mHealth devices? If not, what needs to be done?
"The guaranteed protection of personal health information is critical to mHealth achieving its full potential. I believe that both healthcare and mobile health providers recognize this as their highest priority. Nonetheless, security issues are mentioned by healthcare systems, providers and patients as one of their chief concerns around mHealth. While these concerns are legitimate and should not be minimized, it is important to recognize that the banking industry is way ahead of healthcare in terms of the secure wireless transmission of extremely sensitive personal data. If we can be comfortable with depositing checks and otherwise accessing and modifying our bank accounts with mobile devices we should feel the same with our personal health information, but there is more work to do."
4. How can mHealth devices and apps be used to create savings within the healthcare system?
"In the current U.S. healthcare environment, with its perversely incentivized financial model, any modifications that decrease physician visits, procedures and hospitalizations are unlikely to gain the kind of traction necessary to have a substantial impact on healthcare costs. But as this model changes, and the healthcare system is more appropriately incentivized to keep patients well and out of hospitals and doctors’ offices, mHealth devices are going to be a key component to accomplishing this.
For example, nearly one quarter of Medicare beneficiaries have five or more chronic medical conditions and on average visit 13 different physicians a year. This cohort accounts for 68 percent of Medicare spending. However, some of the most common chronic conditions – diabetes, hypertension, depression and arthritis, for example – can all be tracked at home with mobile technologies and real-time feedback to the patient and the provider in a way that is likely to be more effective than how patients are currently managed while preventing, if not eliminating, the need for office visits.
A second way that mHealth can decrease costs is by refining phenotypes such that patients receive more individualized and appropriate therapies. mHealth can do this by providing data that we currently don’t have, such as continuous beat-to-beat blood pressure fluctuations, or continuous glucose monitoring with blood glucose levels every 5 minutes rather than several times a day or less. These novel data streams will allow for more targeted and individualized therapies."
5. To what extent should the healthcare industry be regulating health and wellness apps?
"It is critically important that any device or app designed to diagnose or treat a medical condition be held to the standard of being proven effective and safe. The medical field is replete with examples of 'sure-thing' interventions that were eventually proven to be either ineffective or even harmful. Recognizing the limitations that regulation brings with it, I believe it is absolutely necessary. A century ago there was no regulation of pharmaceuticals. Some marketed agents turned out to be extremely effective, like aspirin, whereas others extremely dangerous, such as the purported non-addictive cough suppressant (called) Heroin. Not all great mHealth devices and apps will be effective, and some will almost definitely be proven to be harmful."
6. What, in your opinion, are the most common mistakes made by a physician or small practice in launching an mHealth platform?
"I worry about two common mistakes. The first is allowing ourselves to be persuaded by the hype and not demanding evidence before incorporating mHealth technologies in our practice. There is a tremendous lack of clinical evidence supporting the vast majority of mHealth technologies. We can’t let our enthusiasm overwhelm our commitment to providing expert medical advice to our patients, which includes when recommending an mHealth technology.
A second potential mistake is assuming that all patients will feel equally empowered by what mHealth technologies have the potential to bring them. There are some patients who will clearly be empowered by the ability to continuously monitor their various health parameters. But there are others who may be more likely to not benefit at all from so much information, and instead just feel additional stress and anxiety. Just like no one medication is best for every patient with a specific problem; the same will be true from mHealth devices and apps."
7. Do you see any current mHealth trends that will ultimately fail? Why?
"I think it is too early to say what will and won’t be successful. One trend I’d like to see start failing is the ability for 'snake oil,' or clearly bogus, medical apps to be easily available for download."
8. One of the more intriguing niches in mHealth is the development of games and the use of gaming technology. Where do you see these technologies fitting into the healthcare delivery landscape, and do they come with any drawbacks?
"The use of gaming technology will be especially important in wellness and fitness technologies, especially those focused on the critical issue of the obesity epidemic. Incentivizing individuals to be more active and eat better – when they already know they need to do these things but aren’t – is an incredibly important challenge. Gamifying wellness in order to motivate users to remain chronically engaged seems very promising."
9. Name a couple of the more intriguing or unusual mHealth apps or devices that you've seen or heard about lately. What's on the horizon?
"I’m especially intrigued by the technologies available for eye health, primarily because of their potential impact on quality of life. Mobile devices that allow for automated visual acuity exam and others that provide for a detailed fundoscopic exam can bring state-of-the-art eye care to anywhere in the world and help tens of millions of people.
For future capabilities, I’m especially fascinated by some of the breath analysis-based technologies. If these pan out, they could allow for the non-invasive diagnosis of infections, cancers and numerous solid organ diseases."
