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Will Your Smartphone Become a Tricorder?

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.

Conclusion
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.

Posted in: Science and Medicine

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10 thoughts on “Will Your Smartphone Become a Tricorder?

  1. I want my tricorder.

    I want it to command and control an army of nanorobots going around the body, destroying cancer cells, reporting vital signs and sending me pictures.

    Hey, we are working on it: http://science.nbcnews.com/_news/2013/03/21/17405032-dna-origami-the-shape-of-things-to-come?lite

    It’s not totally science-fiction anymore, more of a question how long it will take to get there.

  2. Chris_G says:

    I don’t find it uneasy if my doctor will take time and look up certain information online. In fact I appreciate that he would at least find the answers for me instead of saying directly “no, it can’t be done.” I agree that doctors have a lot in their minds and they are human. The too tend to forget sometimes. It’s great that they have smart phones nowadays. It’s easier for everyone now, not just for the doctors.

  3. mho says:

    “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.”

    This why the critical thinking skills that the sciencebasedmedicine writers expound on are so important. We’re becoming more comfortable, so much so that we think googling = research, but many of us [patients] lack skepticism and the wariness to sort through all the misinformation.

    Thanks, SBM-ers

  4. nickmPT says:

    I agree that technological advances are a great boon to health care, however I have a concern when clinicians are increasingly subjected to entering in all those check boxes and superfluous information due to mandates/defensive medicine/etc at the expense of actually hearing and making sense of the information the patient is giving. That is not really a knock on physicians as they are doing what they have to survive.

    I think that is what patients are complaining about when they go to see the physician and they see them for 4-5 min and almost the entire visit is spent with the doc staring at the computer screen. I see less of a problem with as you said looking up recent information/clarifications/side effects for the patient.

  5. Documenting the patient visit in real time is also a huge advantage, as it results in a far more accurate note – compared to documenting later and having to remember all the details.

    During a visit I use the computer to:
    - look up test results and previous notes, including notes from consultants
    - view diagnostic imaging
    - document the visit
    - order lab tests and other studies
    - prescribe medications
    - look up needed information

    This all happens in real time as I am meeting with the patient. The EMR system we are using is a bit clunky. I wish it were better. But it’s not a huge drag on my patient time, it’s just annoying. Most of my computer time is interacting with patient information and is useful, not merely administrative.

  6. elburto says:

    What Chris_G said.

    Also, as someone who’s lucky enough to have two rare conditions that GPs may have heard mentioned once or twice in med school, new research findings from (in one case) the sole research agency are not something that they’ll ever be aware of. Being able to give my doc (current one is amazing) a PMID, and have him scan through it while I’m there, is amazing. For the other uncommon condition* I can keep an eye on the latest NICE best practice guidelines, so that tweaks can be made if I’m not feeling the effects of the current regimen.

    Professional orgs and charities/advocacies representing specific illnesses are a great help in this regard.

    They can direct patients/carers to legitimate sources of advice and info, and instill an awareness that doctors are human and cannot possibly keep up with every new advance.
    In my former pre-bedliving existence, one of the pieces of advice I was trained to give was:

    “You live with [condition] every day, but your GP doesn’t, and you obviously can’t see your [specialist] every time you have a query. Learn all you can about your health problem. [resource] is a great source of info and advice, and will help you to take a more active role in your care”.

    We had lists of officially recommended and vetted support groups, charities and patient info sites to recommend, and while the first contact with some patients saw an annoyed, confused person with a diagnosis they didn’t quite understand, further contact was with someone who felt empowered, supported, and better able to cope. All thanks to the internet and social networking groups.

    If you’ve got a condition that only affects say, four in a million, then the internet is a world changer, a total revolution.

    Medical/health apps for patients are a rapidly growing area, and it’s driven entirely by people who want them. There are simple things like medication reminders, to disease/event specific symptom trackers that can provide a clear picture of what’s happening when, as well as detecting patterns. No longer are people reliant on the will and wallet of research agencies and software designers. The smartphone revolution opens up software design to virtually anyone.

    It’s a very exciting age to live in.

    *The condition is fairly common, but the presentation isn’t. This means that existing treatments are essentially tailored to benefit patients who are almost diametrically opposite to me.

  7. kojote says:

    Don’t miss Peter Jansens Tricorder: tricorderproject.org Open Source Tricorder and Peter was at Scanadu

  8. BillyJoe7 says:

    I’ve told this story before but it may be new to some…

    My daughter’s smartphone had an app that monitors and records pulse rate. We discovered a few things with this simple device. I and my two daughters have pulse rates of around the 40 bpm, my wife and our two sons have pulse rates hovering around the 90 mark. If this is a genetic effect, it is obviously linked neither to the X or Y chromosome. And my younger daughter also had paired beats. A later ECG demonstrated pulses bigeminus and subsequent electrophysiological studies identified the focus of the abnormal beats which was successfully zapped by an electrode passed up into the heart via an artery in the groin. She thought it was normal to hear your heart beating when you are trying to go to sleep!

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