1. Smartphone as Tricorder
The tricorder featured in the television show Star Trek had the magical ability to diagnose almost any ailment in human or alien. Today's smartphone is starting to fulfill that amazing diagnostic role:
"With the smartphone revolution, an increasingly powerful new set of tools—from attachments that can diagnose an ear infection or track heart rhythms to an app that can monitor mental health—can reduce our use of doctors, cut costs, speed up the pace of care and give more power to patients.... Smartphones already can be used to take blood-pressure readings or even do an electrocardiogram."Dr. Topol raises some concerns about the "medical smartphone" including privacy, lack of human touch, and most importantly, accuracy:
"All of this raises serious issues about hacking and personal privacy that haven’t yet been addressed—and the accuracy of all of these tools needs to be tested. People are also right to worry that the patient-doctor relationship could be eroded, diminishing the human touch in medicine....He outlines a typical diagnostic scenario for the smartphone which is likely to happen in the next few years:
Before these tools enter widespread use, they must all be validated through clinical trials and shown to not only preserve health but to do so while lowering costs."
"Let’s say you have a rash that you need examined. Today, you can snap a picture of it with your smartphone and download an app to process the image. Within minutes, a dedicated computer algorithm can text you your diagnosis. That message could include next steps, such as recommending a topical ointment or a visit to a dermatologist for further assessment."2. Smartphone as Doctor's Assistant
Another important use-case for the smartphone is to serve as an "aid" to a doctor or to more official medical care. For example, a smartphone app can remind patients to take their medicine and refill their prescriptions. There are even more ambitious proposals for the smartphone and its attachments to serve not only as an aid, but in certain instances as a low-cost alternative to aspects of visiting a doctor such as the Physical Exam:
"Smartphone selfies are all the rage, but smartphone physical exams are just taking off. The ability to make a definitive DIY diagnosis of an ear infection with a phone is just the first step. Apps are now being developed to handle all aspects of the eye, the throat and oral cavity, and the lungs and heart."Perhaps, the most valuable medical information about your health comes from the Lab Tests ordered by a doctor. Even some of these these can eventually be replaced by smartphone attachments:
"It isn’t just hospitals’ rooms that are on their way out; so are their labs. Smartphone attachments will soon enable you to perform an array of routine lab tests via your phone. Blood electrolytes; liver, kidney and thyroid function; analysis of breath, sweat and urine—all can be checked with small fluid samples in little labs that plug directly into smartphones. And you can do your own routine labs at a fraction of the current cost."Finally, the fabled Doctor Visit itself in certain cases can be replicated by a video call via your smartphone:
"Now, at any time of day or night, you can demand and get a secure video consultation with a doctor via smartphone at the same cost (about $30-$40) as the typical copay charge through employer health plans. This may seem exotic now, but several large consulting firms—including Deloitte and PricewaterhouseCoopers—have forecast that virtual physician visits (replacing physical office visits) will soon become the norm."3. Medical Wearables
Smartphones and smartphone attachments offer amazing health monitoring functionality, but wearables (e.g. wristbands, earpods, glasses, etc.) introduce a potentially new dimension. In the beginning, the wearable focus was on fitness trackers, and more recently there has been a lot of excitement over heart rate monitors including one on the soon-to-be-released Apple Watch. But this represents only the tip of the iceberg:
"Even bigger changes are in the works. Using wearable wireless sensors, you can use your smartphone to generate your own medical data, including measuring your blood-oxygen and glucose levels, blood pressure and heart rhythm."There are even more exotic exciting possibilities to come:
"Other wearable sensor tools now being developed include necklaces that can monitor your heart function and check the amount of fluid in your lungs, contact lenses that can track your glucose levels or your eye pressure (to help manage glaucoma), and head bands that can capture your brain waves. Someday, socks and shoes might analyze the human gait to, for instance, tell a Parkinson’s patient whether his or her medications are working or tell a caregiver whether an elderly family member is unsteady and at risk of falling."Finally, one of the crowning jewels of any hospital is the Intensive Care Unit (ICU) in which very sophisticated (and expensive) technology monitor the vital signs of very sick patients helping them to stay alive. This challenging task may eventually be replaced in part (and under specific circumstances) by the combination of the smartphone and wearables making it possible to build a "virtual" ICU in one's own home:
"Such wristwatch sensors could do enormous good. By having the equivalent of intensive care unit monitoring on your wrist, hospital rooms—those $4,500-a-night risk zones for serious infections and other complications—can be replaced by our bedrooms. As a result, except for ICUs, operating rooms and emergency rooms, hospitals of the future are likely to be roomless data surveillance centers for remote patient monitoring."4. Analyzing Medical "Big Data"
More continuous monitoring of health by smartphones and wearables will produce a deluge of data. This "Big Data" has the potential to transform medicine if properly shared and analyzed into a more accurate understanding of human health both at the individual and population level:
"When that flood of data is properly assembled, integrated and analyzed, it will offer huge new potential at two levels—the individual and the population as a whole. Once all our relevant data are tracked and machine-processed to spot the complex trends and interactions that no one could detect alone, we’ll be able to pre-empt many illnesses.Finally the analysis of this Big Data can be used to construct medical "expert systems" that can provide meaningful medical advice and recommendations to patients:
Take asthma attacks. A teenager who’s prone to wheezing in gym class could get comprehensive data on environmental exposures such as air quality and pollen count, along with data on physical activity, oxygen concentration in the blood, vital signs and chest motion; their lung function can be assessed through their smartphone microphone, and their nitric-oxide levels can be sampled via their breath. Then that information could be combined with the data from every other tracked asthma patient—and trigger a warning, delivered by text or voice message on the teenager’s phone, that an attack is imminent and tell the teenager which inhaler would prevent it.
The same type of procedure could prevent heart failure, seizures, severe depression and autoimmune disease attacks. It could save countless lives."
"As more medical data is generated by patients and processed by computers, much of medicine’s diagnostic and monitoring aspects will shift away from physicians like me. The “doctorless” patient will remain in charge, turning to doctors chiefly for treatment, guidance, wisdom, experience, empathy and the human touch. These doctors won’t write orders; they’ll offer advice."All of this sounds like Science Fiction, but The Future is coming and the smartphone combined with attachments and wearables will be the perfect tool to realize this future. They can help to diagnose health issues, serve to complement the typical tasks of a doctor, gather a range of physiological information, and then even provide data and recommendations to optimize medical treatments.
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