Steven Steinhubl, MD, was named the first-ever director of the Digital Medicine Program at the San Diego-based Scripps Translational Science Institute in early 2013 and is a practicing cardiologist in the Scripps Health System. An Air Force veteran, having served in Alaska and Texas, he's also the former director of cardiovascular health for the Geisinger Health System and has published more than 400 abstracts, peer-reviewed manuscripts and book chapters.
Q. What's the one promise of mHealth that will drive the most adoption over the coming year?
A. The greatest promise of mHealth is its ability to provide improved and much more personalized care. But in order to drive adoption, strong clinical evidence is needed to support this capability. The wide range of devices and wearable sensors offer incredible possibilities but patients, providers and healthcare payers require proof of their benefit.
Q. What mHealth technology will become ubiquitous in the next 5 years? Why?
A. Wearable sensors that continuously monitor stress and anxiety levels could play a huge role in the future in improving the quality of life of a large portion of the population. Anxiety disorders are the most common mental illness in the U.S. But stress and anxiety, especially when chronic, can be poorly recognized, by both the individual experiencing them as well as healthcare providers attempting to help treat them.
Several wearable and smartphone-based monitors have been developed and are in early-stage testing to evaluate how effectively they identify individual-specific stress responses. Not only will this technology allow for people to recognize when they are experiencing unhealthy stress, but most importantly it will enable them to recognize what works best for them in preventing or controlling that response.
Q. What's the most cutting-edge application you're seeing now? What other innovations might we see in the near future?
A. Every time we breathe, the air in our lungs mixes with the constituents of our blood. The ability to identify and measure part-per-billion level concentrations of various volatile organic compound disease biomarkers entering our exhaled breath from our blood offers a remarkable opportunity to completely change the way we diagnose a multitude of diseases such as cancers, infections and more. Dogs, with their much more finely tuned sense of smell than ours, have already proven that multiple conditions can be diagnosed through smell. Early work with handheld breath analyzers is attempting to duplicate this capability as “digital noses.” This is truly remarkable technology.
Hypertension is the single greatest risk factor contributor to morbidity and mortality worldwide. Multiple new technologies that measure blood pressure with a blood pressure cuff can dramatically improve the diagnosis and treatment of high blood pressure. Also, non-invasive continuous glucose sensors can play an extremely important role in not only helping individuals with diabetes better manage themselves but also allow individuals without diabetes to better understand how food choice affects them, hopefully leading to healthier dietary decisions.
Q. What mHealth tool or trend will likely die out or fail?
A. Pure activity trackers are a growing fad, but I believe just a fad that will gradually die out when people find that after the novelty wears off, that they don’t really lead to increased activity in the majority of individuals.
However, since improving activity plays a critical role in overall health maintenance, there will be a growing need for devices that track activity along with multiple other measures of well-being such as sleep and stress, along with possibly blood pressure and glucose. The combination of these multiple sensor parameters, when enabled through personalized data analytics to give individual feedback on how one affects the other, can provide personalized and actionable information to allow people to make better lifestyle choices for them.
Q. What mHealth tool or trend has surprised you the most, either with its success or its failure?
A. The most promising — and a little surprising — trend I’ve noticed is the growing recognition by technology developers and consumers alike of the importance of obtaining real-world, compelling evidence in order to drive change. Early in what has been referred to as the mHealth hype cycle, there seemed to be a more prominent belief among technology developers that healthcare providers and consumers would self-initiate the uptake and expansion of the many great ideas that were being offered. Most developers didn’t recognize at that time that change in healthcare is a very, very challenging proposition — no matter how badly it is needed. Today, more and more developers are talking to us about their recognition of the importance of going beyond pilot studies and really proving the clinical worth of their technology.
Q. What's your biggest fear about mHealth? Why?
A. That fee-for-service will continue as the dominant payment system in healthcare. It is a broken and perversely incentivized payment system that is bad for patients, healthcare providers and the economy. In a fee-for-service environment there is no incentive to study or fully incorporate mHealth technologies.
Q. Who's going to push mHealth "to the next level" — consumers, providers or some other party?
A. Consumer-oriented companies moving into healthcare will likely be the major force behind moving mHealth to the next level. These “disruptive” providers will be focused on user convenience as well as improved outcomes, the sweet spot of mHealth.
Q. What are you working on now?
A. We have well over a dozen very exciting studies and clinical trials in some phase of development or currently ongoing. Our hope is that when complete, they will demonstrate improved outcomes, greater satisfaction for consumers and providers and overall substantially lower costs and will therefore help drive change. Our trials cover the entire gamut — heart failure, stress, visual impairment, atrial fibrillation, PTSD, wellness, sleep apnea and chronic disease management. But we are just starting to scratch the surface. There is much more work to do.
