Eighteenth-century French philosopher Voltaire – amongst his many other pithy and lasting axioms – notably wrote: “God gave us the gift of life; it is up to us to give ourselves the gift of living well.” Almost 300 years later, his observation seems more salient and timely than ever. In the 21st century, we find ourselves in an era of technology unimaginable by Voltaire – one that empowers individuals to live better than ever, with tools no longer limited to the intellectual or aristocratic elite.
Accordingly, this month we thought it would be refreshing to take a break from looking back at the trials and tribulation caused by Meaningful Use in 2014, and look forward to the advantages and challenges promised by the consumer-focused health care technology market of 2015 and beyond. After all, we need only walk into the local Wal-Mart to be confronted with devices aimed at improving everything from sleep to diabetes, and our patients are clearly starting to take notice. Much more disruptive than the Internet revolution of the past 20 years, emerging technology promises not only to educate, but also diagnose, leading to an entirely different definition of “informed patients.” Like it or not, this is the new generation of “connected health,” and it is poised to reshape health care delivery in the very near future. We’ll review some of the recent innovations here.
Dr. Neil Skolnik and Dr. Chris Notte
‘Steps’ to achieve better health
While you might be challenged to recall the introduction of the mechanical pedometer by Thomas Jefferson in the 1700s, you no doubt recall the digital pedometer revolution of the 1990s. Seemingly overnight, these small belt-worn novelties began showing up on waistbands everywhere, easily confused for small pagers. Initially, the goal of owning a pedometer was simple: get to 10,000 steps a day to achieve better health. But the pedometers of today are far from simple. Now, they are worn on the wrist, or embedded in our phones, and track everything from calories burned to hours and quality of sleep. What’s more, they are integrated with health and wellness smartphone apps and often form the center of diet and fitness plans.
It’s hard to argue with the value of devices such as Fitbits and FuelBands as they encourage our patients (and even ourselves) to engage in more healthful and active lifestyles, but these are really just the beginning of the connected movement. Things really become interesting for physicians when patients choose to advance to the next level of technology and move from wellness tracking to disease management and diagnosis.
Beyond the Fitbit: Personal diagnostic technology
All of us encourage patients to monitor their blood pressures and blood glucose levels at home, as this can provide multiple data points crucial for proper management and medication dosing. But patients are no longer limited to just taking measurements and recording them on a paper log. Like the modern pedometers described above, BP cuffs and glucometers can now fully integrate with smartphone apps, leading to a whole new world of data integration. What’s more, the software can help patients self-manage their conditions, make recommendations on lifestyle modifications, and even suggest treatment options.
But personal medical gadgets are not just limited to upgraded versions of time-honored devices. Advancement in sensor and cloud-based technologies have paved the way for entirely new categories of diagnostic equipment. One such device, the S+ by ResMed (a respected respiratory equipment manufacturer), is a small box that sits on a bedside table. It is billed as “the first non-contact sleep sensor,” and ResMed claims it will “track and better understand your sleeping patterns, and then create personalized feedback and suggestions to help improve your sleep.” Not surprisingly, the S+ integrates with your smartphone, and even includes multiple sensors, smart alarms, and other tools to improve your sleep experience.
Another device currently in clinical trials is the Scanadu Scout, described by creators as a “medical tricorder” (an intentional reference to Star Trek). Integrating a thermometer, blood pressure sensor, pulsometer, pulse oximeter, and 2-lead EKG into a device about half the size of a hockey puck, the Scout collects and communicates data to a smartphone via Bluetooth. This could make it easier than ever for patients to compile cardiovascular data to share with their physicians, especially as a growing number of ambulatory EMRs offer the ability to submit these readings directly into the medical record through a web portal.
On a final note, we would be remiss if we didn’t mention the growing range of home blood-testing kits that offer everything from hemoglobin A1C measurements to complete genome sequencing. All of these innovations signal a shift away from the idea of the medical home being the physician’s office, while keeping the patient squarely at the center of care delivery.