The Doctor Will See You Always
Wireless technologies are about to transform health care—and not a moment too soon
By Joseph M. Smith
Imagine a world in which your medicine cabinet notices that you are due for a prescription refill and calls it in. A sensor implanted under your skin detects a fluid buildup in your lungs and alerts your doctor, who decides your heart medication needs an adjustment and contacts the pharmacist to change your dosage. Meanwhile, sensors in your toilet confirm that your body has adjusted well to your other medications but sees indications that you may be a borderline diabetic. Your doctor, given these readings and your family medical history, suggests that you change your diet. Noting that fact, your bathroom scale asks you to punch in a weightloss goal and starts giving you a regular progress update. Your medical checkup isn’t an annual event—it happens every day, simply as you go about your daily life. If such ambient monitoring and intervention strikes you as a little creepy, think of it this way: It could avert a heart attack, stroke, or other medical crisis. It could keep you out of the hospital and save money for both you and the health care system. Part of the savings would come from radical changes in the management of chronic diseases, which in the United States eats up 75 percent of health care spending, or about US $1.9 trillion each year.
A trial program by the U.S. Department of Veterans Affairs offered an early look at what systemic change could mean. In 2003, the VA began using simple messaging devices and occasional videoconferences to let chronically ill veterans stay in touch with nurses and other health care professionals. Under this program, one of the largest of its kind in the world, 71 000 veterans are now receiving daily monitoring for such conditions as diabetes, heart disease, and posttraumatic stress disorder. The VA’s program involves veterans who typically have multiple chronic illnesses that could easily land them in the emergency room unless complications are caught early.
The results have been striking. A December 2008 VA study of this program concluded that it had reduced hospital admissions by 19 percent and reduced days spent in hospitals or other health care facilities by 25 percent. At $1600 per patient per year, the telehealth program costs vastly less than visiting nurses ($13,121) or nursing home care ($77,745).
As successful as it has been, the VA’s system is very simple telemedicine, in many cases using dialup telephone connections and basic devices. Add today’s ubiquitous wireless connectivity and new mobile health monitoring devices, and the benefits will be far greater. Wireless glucose monitors are already on the market from companies like Medtronic and DexCom, and the latest ones may soon be paired with insulin infusion pumps so they can automatically adjust insulin dosages in response to changes in the patient’s glucose level.
The MiniMed Paradigm Real-Time Revel System from Medtronic is the first to combine an insulin pump with regular monitoring of glucose levels for diabetes management.
People with congestive heart failure may soon benefit from a wireless monitor being developed by CardioMEMS. This tracking method detects fluid buildup in the patient’s lungs, a common complication that often leads to hospitalization. The device can detect a problem even before the patient notices major symptoms; the doctor can then adjust the patient’s medication to reduce fluid levels.
Diabetes and heart disease are only the first of many conditions whose treatment will be improved by such monitoring tools. Down the road we’ll likely see similar approaches to blunt the progress of chronic kidney disease and prevent hospitalizations for chronic obstructive pulmonary disease, emphysema, and pneumonia, among other ailments.
But you’re reasonably healthy, you say, just a tad overweight and a bit too sedentary. Consider the $159 WiFi Body Scale, introduced two years ago by the French company Withings. Or take a look at Panasonic’s wireless-enabled blood pressure monitor, also introduced two years ago. This $199 consumer device has a portable wireless display that saves up to 90 of an individual’s readings, which makes it easy to take to your next doctor’s visit.
(Above) Withings’s WiFi Body Scale uploads weight and body-mass information to a website. Users can then track trends and print graphs to share with nutritionists or doctors.
These two devices may not seem revolutionary; after all, they’re just standard products updated with telecommunications capabilities and Web interfaces. But they signal a sea change in health care. They enable physiological data, the basic vital signs collected routinely at the beginning of just about every visit to a doctor’s office, to be easily and automatically recorded and monitored over time.
These are just a few of the kinds of medical conditions and physical data that today can be monitored by sensors and wireless communications. Increasingly, people are turning to technology to gain a more complete picture of their overall health.
For example, for the many people who have trouble getting a good night’s rest—50 million in the United States alone—there are now a number of sleeping-aid devices either on the market or awaiting approval by the U.S. Food and Drug Administration or regulatory agencies in other countries. BiancaMed’s bedside sleep monitor is one of the most promising. About the size of an alarm clock, the SleepMinder uses motion sensors to measure your sleep quality, respiration, and any incidents of sleep apnea without having to make contact with your body. A simpler device intended for consumer use is the Zeo Personal Sleep Coach, which is already available for $159. If you suffer from irregular heartbeats or know somebody who does, a recently announced product from AliveCor may help. The company’s $100 case for the iPhone 4 enables the iPhone to run electrocardiograms (ECGs).
The Zeo Personal Sleep Coach communicates wirelessly with a headband to monitor sleep cycles. the system scores each night of sleep and lets you look at detailed information online.
Meanwhile, researchers at Georgia Tech have developed an iPhone app that assesses the tremors associated with Parkinson’s disease, potentially allowing doctors to better treat patients. Even Ford is getting into the wireless health care action. In May 2011, the company announced that it is developing in-car health tracking as part of its Sync system.
This iphone application may enable people with Parkinson’s disease to better understand symptoms. the iTREM is being used in a clinical study at Emory University.
The United States isn’t the only country whose crippling health care costs and aging population are pushing the development of alternatives to traditional health care delivery; the same holds true in much of Europe and Japan. Conversely, in developing countries, where cellphones are as prevalent as almost anywhere else in the world, the United Nations Foundation and scores of nongovernmental organizations have been implementing mobile health (mHealth) programs, successfully reaching people who have little access to health care, with a focus on things like phoned-in pill reminders for diseases such as tuberculosis, letting people know via text where they can find confidential HIV/AIDS testing, and using communications networks to track disease outbreaks and epidemics.
It’s not a big leap, then, to imagine augmenting such technology in a few years with a smart medicine cabinet, capable of tracking medications, warning about potential interactions, reordering prescriptions, and checking expiration dates. It could also interact with other devices, like the calendar on your smartphone (to remind you that you have an upcoming trip, so you’d better stock up on your prescriptions) or your refrigerator (to remind you not to drink grapefruit juice because you’re taking Lipitor). The benefits could be huge. The New England Healthcare Institute estimates that the cost of drug-related complications, including failure to take medications as directed, is as much as $290 billion annually—or 12 percent of total health care expenditures in the United States.
In the future, wireless technology integrated into medications will be able to confirm that the patient has ingested the medicine. Proteus Biomedical, based in California, has developed digestible computer chips with built-in wireless transmitters.
Of course, these devices don’t work alone: Somewhere the data need to be interpreted, as in the VA’s telehealth program, by medical professionals. Eventually, though, as health sensors become commonplace in people’s homes and in the community, the onslaught of data will quickly overwhelm clinicians, so we will have to create smart systems that automatically interpret and act on the data they gather. People are also worried about privacy. They may fear that a device could be hacked or that data could be misused by employers or insurance companies.
While all these technologies have exciting potential, the wireless revolution in health care does have a few obstacles in its path. There are regulatory hurdles, for starters. You should be able to make your health care information at least as secure as your checking account.
We also need interoperability standards. At present, health care is a kind of Tower of Babel, with separate devices and databases containing bits and pieces of information about us but no single system accessible by patients, doctors, and caregivers that provides a complete and comprehensive picture of an individual’s health. Recent reforms in health care reimbursement policies made in U.S. legislation should help overcome these hurdles.
The main thing that will drive adoption of these integrated wireless systems is the data that validate their costeffectiveness; that will require studies and trials that go far beyond what the VA has done to date. But I am convinced that we will get there. Eventually, we’ll tie together today’s trends—the expansion of tools for wirelessly monitoring and diagnosing disease, the increasing ability to remotely manage drugs and medical devices, and the growing understanding about how genetics affects susceptibilities to disease—with smart systems that learn as well as respond. And we will have a revolution in health care that changes society as dramatically as the Industrial Revolution once did.
Click here to read the entire article, which appeared in the October 2011 issue of the IEEE Spectrum magazine.
