The Star Trek universe is a fairly optimistic vision of the future. It’s what we would like it to be – an adventure fueled by advanced technology. In the world of Star Trek technology makes life better and causes few problems.
One of the most iconic examples of Star Trek technology is the medical tricorder. What doctor has not fantasized about walking up to a sick patient, waving a handheld device over them, and then having access to all the medical information you could possibly want. No needle sticks for blood tests, no invasive tests, scary MRI machines, and no wait. The information is available instantly.
It’s clear that we are heading in that direction as technology progresses, but how close are we?
The Smartphone in Medicine
Many people in developed nations today are walking around with supercomputers in their pocket – their smartphone. Technological advances are often strange – the ones we anticipate seem to never come, but then life-changing technology creeps up on us.
Carrying around a fairly powerful computer with a graphical interface and both wireless and 4G communication is certainly a game-changer. I already cannot image living without my smartphone. I still remember the days of getting paged and then having to find a payphone somewhere if I was away from home.
Technology, however, is frustratingly slow to penetrate the practice of medicine. This is probably because practicing medicine is complex and standards of care require incredible due diligence and testing. Still, the lag is frustrating and, more important, costly.
The low-hanging fruit has already been picked. There are smartphone apps that are essentially reference material for physicians. Epocrates, for example, is a drug reference. Doctors can quickly check for side effects, drug interactions, or proper dosing when prescribing a drug. This is handy, but when I’m in my office I can get all this information online.
Medical apps are starting to take off, but there is tremendously more potential here than is being fulfilled at present.
A recent interview with Eric Topol, a cardiologist who has been developing smartphone-based portable monitoring devices, shows some of this unmet potential. The smartphone can not only run apps to provide information, but can be a portable computer that operates attachable medical scanners. He demonstrates a portable EKG, a portable ultrasound, and a wireless glucose monitor.
These devices are currently poor replacements for their standard counterparts. The EKG app, for example, uses 2 leads instead of the standard 12 leads. The quality of the ultrasound picture is not as good as a full ultrasound machine.
The potential benefits of such portable devices is that they allow for doctors to quickly and cheaply, in their office, get diagnostic information that they would otherwise not have or would have to specifically order. This can improve the quality of the medical interaction. It can also save money, if a quick and cheap procedure can replace a more expensive one.
Perhaps the biggest benefit at this point is in remote areas or developing nations, where advanced diagnostic technology is rare or not available. Portable versions of these diagnostic tests are far better than nothing.
On the downside, it’s possible that accepting quick lower grade information instead of more expensive and cumbersome but higher grade information may be counterproductive. Perhaps that 2 lead EKG will miss an abnormality that would have been seen on a 12 lead EKG.
For each such device these questions need to be specifically studied – the sensitivity and specificity of the portable test, and the impact of having such technology in the office.
As portable technology improves, however, this will become less and less of an issue.
The Tricorder X-Prize
The X-Prize is a technology competition that offers a monetary award for the first team to achieve a specific technology goal. There are now X-Prizes for many such goals, including the Qualcomm Tricorder X-Prize. Here is the vision of the winning device:
As envisioned for this competition, the device will be a tool capable of capturing key health metrics and diagnosing a set of 15 diseases. Metrics for health could include such elements as blood pressure, respiratory rate, and temperature. Ultimately, this tool will collect large volumes of data from ongoing measurement of health states through a combination of wireless sensors, imaging technologies, and portable, non-invasive laboratory replacements.
I like that they are keeping the parameters open enough to allow for creative innovation. The prize is 10 million dollars, which sounds like a lot but winners typically spend at least that developing the target technology. The X-Prize, and similar contests, have proven to be an effective way to jump-start a specific technology. I am anxious to see what emerges from this one.
Technology in the Office
My medical career happens to have begun right at the beginning of the web and portable device revolution. I just caught the tail end of practicing medicine with minimal computers. When I was a student computers were used only for looking up lab tests. Everything else was done by hand. My first pager was analog – I had to make out the fuzzy voice coming out of the small speaker.
Today I sit in front of a computer, strategically placed so that I am still facing the patient with the computer off to the side. Everything I do, other than my direct interaction with the patient, is on the computer.
There is still a certain level of discomfort with technology in the office, but it is rapidly fading. At first there were some complaints, and some of my colleagues were concerned about the impact of using a computer during the office visit. I have had patients complain to me about other doctors who do online searchers during the visit, as if this implies a lack of knowledge on their part.
My approach has always been – I will adapt, and my patients will adapt. Adapt or fall behind.
The systems we have in place are far from perfect. In fact I think they are clunky and in desperate need of a major upgrade. But despite that, they are amazingly powerful. I have incredible amounts of information at my fingertips, both about my patients, and medical knowledge.
Patients are getting comfortable with the computer as an office fixture, and are appreciating what the technology can do to facilitate their care. Patients routinely, for example, walk into my office with an MRI scan on a CD, and we can look at it together.
I also think that many patients are starting to understand that no physician can have all medical knowledge in their head. There is simply too much. We still need to have a robust fund of knowledge, even just to think clinically. But we cannot and should not rely only on memorization for important information. I use Google and PubMed every day to supplement my memory, or update my knowledge about an uncommon disease I have not treated in a while.
I am also open about it with my patients – “Let me see if there is anything recently reported about that.” If they ask if one of their drugs can cause a specific side effect, I simply check to see if it has been reported, and then give them the information and help them put it into context.
In other words, I encourage my patient to see the act of looking up information as a positive part of the visit, not a negative part. And they seem to get it. People are becoming more comfortable with computer technology in general.
The future of medicine that we appear to be heading for is one in which we have greater and greater access to information – medical knowledge and diagnostic information. Patients are also becoming increasingly involved in their own healthcare as portable devices and apps give them the ability to monitor their health and report this information to their physician.
Patients are also gaining greater access to their own health information. The most popular medical record systems allow for patients to access their own records and lab tests from home.
I am not going to argue that technology will be a panacea. The current healthcare system has many problems that technology alone won’t solve. This kind of technology, however, can vastly help.
Cheap portable tests may displace more expensive tests when they are not needed. Increased access to information can improve the quality of care. Increased medical information for doctors at the point of patient care can improve their practice of medicine. Increased monitoring of patients can prevent bad outcomes. All of these things can potentially reduce the cost of healthcare.
While the advances are amazing, I still find them frustratingly slow, and their implementation lacking. This is an area that deserves, in my opinion, dedicated resources for development and implementation.
I want my tricorder.