This TedMed blog post by Stacy Lu has announced that Shiv Gaglani, a MedGadget Editor and John Hopkins Medical Student, and ‘a team of current and future physicians” will take to the stage of TedMed 2013 with the debut of “The SmartPhone Physical” a “first of it’s kind demo” of a “well-patient checkup using only smartphone-based devices“.
Of course this isn’t a first of a kind at all – Eric Topol MD has already demoed something very similar on Prime Time US TV shows (eg. CNBC and the Colbert Report) and we were providing similar smartphone based physical checkups for delegates at mHealth events all the way back to the Mobile Healthcare Industry Summit in 2009 – and I took it beyond demo when I used such tech a few years ago to diagnose a delegate who was unaware that they were suffering a MI at a Mobile Industry event (following speedy admission to Hospital and some treatment there was thankfully a very good recovery!).
None of that of course takes away from the cool profile that the Smartphone Physical website has made of an array of mHealth sensors:
> “Body analysis using an iHealth Scale“:
> “Blood pressure reading using a Withings BP Monitor“:
> “Oxygen saturation/pulse measured simultaneously with blood pressure, using an Masimo iSpO2 placed on the left ring finger“:
> “Visual acuity via an EyeNetra phone case”
> “Optic disc visualization using a Welch Allyn iExaminer case attached to a PanOptic Ophthalmoscope“:
> “Ear canal visualization with a CellScope phone case“:
> “Lung function using a SpiroSmart Spirometer app to conduct a respirometer test”
> “Heart electrophysiology using the AliveCor Heart Monitor”
> “Body sounds: A digital stethoscope from ThinkLabs auscultates and amplifies the sounds of a patients lungs (posterior chest) or heart (A, P, T, M areas on the anterior chest)”
> “Carotid artery visualization using a Mobisante probe”
What would I include in a Smartphone Physical?
Shiv Gaglani has done a great job bringing together 10 devices so I thought it might be interesting to think of another 10 that could be included:
> Interactive Patient History Taking Questionnaire
It astounds me that a medical student in 2013 hasn’t put a clinically validated interactive Patient history taking questionnaire into the mix as most medical schools have been hammering the importance of listening to what Patients tell you into their students even since Sir William Osler fathered modern medicine more than a hundred years ago (as a Founding Professor at John Hopkins).
> Video Content
I could imagine that a rich Mobile Video Library with animations and clinical experts explaining how to use the mHealth devices would prove very helpful:
> Mobilized EHR
No Patient should be without anytime anywhere access to their important up to date health information eg. like Microsoft offer with their HealthVault service:
> Making sense of a POC Test
How about using the camera to take make a video of the Patient walking or doing a test or a photo of a PoC test eg. an Urinalysis strip:
> Colour Blindness
A basic gallery app could help determine if the Patient is colour blind:
> Alcohol/Drug Test
> Neurological Test
Using it’s pupil tracking tech the latest range topping Samsung Octo-core Galaxy S4 could use it’s pupil tracking tech to document a complex neurological test:
> Diabetes
Blood Glucose levels would be an interesting additional data point to add eg. the Mobile Connected FDA Cleared Glucometer from Telcare:
> Sleep
Everyone who’s attending TedMed 2013 will have a Smartphone so I see no reason to think of the physical check up as a single event especially when long term measures can provide so many useful insights eg. Sleep by X Motion (the world’s best selling iOS mHealth app):
> Video Consulting with remote Doctors
It’s obvious that unconnected care experiences can present major challenges. Remote registered Doctors with not only access to the data that’s being captured but also an understanding of how it’s being captured and a view of the Patients Medical History could really help Patients and Providers as they seek to derive value from the Smartphone Physical:
**** UPDATE 28th July 2014 UPDATE ****
I’ve recently been trialling the FLirOne – an Infrared Camera attachment for the iPhone – from FLIR and will be reporting soon (link to be added) on some of the interesting applications we’ve found for this new sensory capacity in medicine. Within 24 hrs of having it on my phone I’d already identified where £,000’s of heating costs are being lost in Healthcare facilities (which is also important as it impacts on Patient comfort levels) but the potential for this to augment the diagnostic abilities of Doctors will be very interesting – while thermography is already commonplace amongst top flight equine veterinarians (monitoring for foot balance/problems/treatments/arousal/etc) I can imagine it will have huge potential for finding difficult veins, treatment and monitoring of sores, musculoskeletal pain, etc.
**** UPDATE 18th August 2014 UPDATE ****
Nothing on the market yet but it’s easy to imagine some applications for an UV Camera in areas of dermatology or on the forward facing camera of a tablet for teaching young people how to properly apply sun protection:
What would you like to see added to the Smartphone Physical?
Sounds like a great technology leap, however recent evidence suggests that the value of the well checkup is very limited.
http://online.wsj.com/article/SB10000872396390443624204578060682331138100.html
So automating a low value healthcare intervention may not deliver any significant results. there is a very real danger that all it will do is generate more false positives which will blow out healthcare costs rather than decrease them.
It is another example of technology led health innovation not being grounded on good quality evidence based care.
Hi George,
Thanks for making these important points.
As you know I agree that it’s critical that we don’t let healthcare industry innovation be led by those who have fallen for the
fallacy of technology that can.
A few points I think worth also considering:
> I wouldn’t place too much confidence in this particular WSJ news story because the research only really suggests the value of “paying” for un/poorly documented well Patient checkups is limited. Is anyone really surprised about that?
Also for most people who have expendable finances the idea of concluding that testing their baby/child/partner/parent for XYZ is cost ineffective because it’s not linked to a statistical difference in terms of morbidity/mortally is also not really getting close to appreciating the real problem of health checks as they are conducted today.
Undocumented healthcare checks aren’t best practice in 2013 and we really shouldn’t be inferring this finding will be the same for larger scale population wide health screening.
Patients who are concerned enough today to be paying for such health screening are a group that is affluent and aware enough of their health needs, however access to interactive Patient History Taking tools via the internet and mobile web means healthcare provider organisations are now looking at a disruptive opportunity that can reach a much wider population and so it’s important to appreciate that there are now very different rules at play (for more on this check out Alan Moores’ read/write book: No Straight Lines – making sense of a non linear world).
As these sensory technologies become ever more integrated into the mobile phones that Patients have in their pockets and look at every few minutes (eg. 8 of the 11 I’ve suggested here are already possible just using a Smartphone without any accessory) this will become increasingly evident.
> Efforts like this TedMed event are helpful in generating wider awareness of the opportunity but as we both know a lot of the challenges will only become obvious when you actually start using these Smartphone connected diagnostic sensors with Patients (eg. read here about our experiences using the Alivecor ECG device back in 2011 and you will appreciate that we’ve been using cheap smartphone based medical device accessories for years and have had incredible success diagnosing heart problems that Patients were completely unaware of and as a result we’ve made considerable reductions in these Patients and their families being impacted by the devastating consequences of strokes).
> “there is a very real danger that all it will do is generate more false positives which will blow out healthcare costs rather than decrease them“.
This was one of the things I was pointing to when I mentioned that “It’s obvious that unconnected care experiences can present major challenges” however even worse than blowing out costs I can see it causing harm to patients because it could lead to them undergoing unnecessary interventions or being prescribed medications they don’t need.
I can also imagine that cheap diagnostic testing devices could also increase false negatives (Patients being told not to worry about something because the test didn’t pick it up) that would further distance Patients from Healthcare Professionals who can help them while undermining trust in mHealth. This is one of the reasons you will never see me advocating for a mHealth sensor that isn’t combined with a documented care experience.
Thanks David for the detailed and informative response.
It is important to understand the cost effectiveness of procedures we perform, including check ups. If the Smart Phone Physical can perform the function at a significantly lower cost then it is quite possible that the cost effectiveness calculations will be overturned and benefit demonstrated.
The fact that it is properly documented is very important.
I hope the people promoting it at TedMed are as sensible as you in pointing out its need to be implemented as part of a evidence based care experience. My fear is that it is ammunition for people like Vinod Khosla who will say it just demonstrates that we don’t need doctors to deliver healthcare.
Hi George, thank you for your great points. We just wrapped up the Smartphone Physical at TEDMED and had an outstanding response. We made it clear to those we screened that this was not a panacea and that it had the potential to backfire if not based on evidence (improved care, lower costs, etc). At their current form, these devices are certainly not replacements of clinicians but rather may augment their role, further transitioning them from data collector to data interpreter.
Hi David and colleagues at 3G Doctor, thanks for covering The Smartphone Physical and for the compliments on the site and collection of the devices. Great ideas regarding what else we could add; in particular I like the neurological test that may be enabled through eye-tracking.
I wanted to give you some insight into how we came up with the list. The number one constraint was time; we had to decide which devices in aggregate could be used to screen hundreds of TEDMED participants in under 10 minutes each (to our knowledge, the scale of this undertaking is what makes it first of its kind. Eric Topol had a great segment on Colbert, though unfortunately only had time to use the AliveCor and CellScope). Given the time constraint, we were limited to 10 devices that are either already commercialized or will soon be. Another criterion was whether the devices would potentially turn up in a clinician’s office or exam room. I’m a big fan of Zeo (r.i.p) and other sleep monitors, but those would not be useful during a <15 minute encounter with a patient.
We also considered a number of apps, including ones that analyze skin conditions, color blindness, and even scoliosis (ScolioTrack), but with the exception of the SpiroSmart decided to stay mainly with devices. I reached out to a few companies developing some of the apps/devices (e.g. an iOS-compatible breathalyzer developer; temperature sensor; glucometer, whose use in routine physicals may lead to many false positives) you mentioned, but for various reasons they were unable to participate. This was the case with an EHR, which I agree should certainly be a part of any physical to allow for accurate recording of the patient-clinician encounter. Eventually most of these devices will hopefully insert their data into the patient's file – that's one way in which they would be more than cool gadgets and actually useful in the medical setting.
Will you be at TEDMED? It would be excellent to meet up and do a mind-meld given our similar interests.
Hi Shiv,
Thanks for sharing the background on what you’re looking to achieve.
Perhaps sending delegates a SMS with a bit.ly link to a YouTube video that explains what you’re doing would help you with recruitment at the event? It could also open up the potential for the apps like Sleep X to add value (as Patients could start to use them now and bring this data with them to the checkup).
“I reached out to a few companies developing some of the apps/devices you mentioned, but for various reasons they were unable to participate”
That’s a shame. I’ve shared the work you’re doing with the +3900 member mHealth group on Linkedin and will keep you posted and update this post with anything that group suggests that you might also like to consider.
“This was the case with an EHR, which I agree should certainly be a part of any physical to allow for accurate recording of the patient-clinician encounter”
I’ll send you an introduction to the HealthVault team at Microsoft as I think they could really help you make this important development.
“Will you be at TEDMED?”
Unfortunately not but I will be watching developments there and looking forward to the conversations you will no doubt start. Perhaps you’d like to also host your Smartphone Physical at the mHealth Symposium I’m organising in Dublin?
One last thing – Break a leg!