Tony Seupaul, MD, chair of the Department of Emergency Medicine at University of Arkansas for Medical Sciences, uses a wearable electronic device, a FitBit, that measures not just physical activity, but the amount of REM sleep he gets each night.
“For me as a physician who works shifts, sleep is important because the sleep cycle can be disrupted,” Seupaul said. “That is a nice way to track and see what kind of sleep I’m getting. It will tell you if you are restless in the night. Wearable motion sensors like FitBits are relatively inexpensive for the technology they provide. It is a fair amount of data on your wrist. For the first time, we really have technology that is affordable, portable and readily available for a lot of people to take advantage of.”
Wearable medical technology is being deployed in Arkansas to save lives. At the Walker Heart Institute Cardiovascular Clinic in Fayetteville, a “life vest” is used as an alternative to an implantable defibrillator.
“Patients can live their lives while wearing the LifeVest Defibrillator knowing that if life threatening dysrhythmia occurs, their life will be preserved,” said Boris V. Bogomilov, MD, director of electrophysiology. “We have at least one example of a patient life being saved. It is a very useful device to provide a safety net for patients.”
The potential uses for wearable technology go far beyond the LifeVest. In fact, wearable medical technology will result in drastic changes.
“It will be akin to what happened in 1439 when Gutenberg invented the mobile type printing press,” said Bruce Murphy, MD, PhD, president/CEO, Arkansas Heart Hospital. “At that time, the only people who could read were high priests. In only 120 years, Shakespeare was writing the best English the world will ever see.
“This is medicine’s Gutenberg moment. We are now unleashing the high priest learning to masses by allowing easy access to diagnosis. It is being called the democratization of medicine. That is the future of the medicine when people take charge of their own problems. We will still need doctors. Doctors will be there to confirm the diagnosis and deliver the therapy. But patients will come in and say, ‘I have a strep throat,’ and will know that is true because an app let them test their saliva.”
Murphy said access to diagnostic capabilities will empower people. Patients won’t be writing prescription themselves, but will probably know the drug of choice to treat their condition.
“The collision of simultaneous megatrends will drastically, radically and almost instantaneously change medicine,” Murphy said. “That collision has to do with the advent of what I would call digital biology: the integration of artificial intelligence and data collection to guide health. It is the future of medicine.”
There has been much discussion about the future of medicine being population management or disease management that has led to the efforts to ration healthcare by segregating patients into a medical home or an accountable care organization.
“We don’t believe that is the future of medicine,” Murphy said. “We believe the future is individualized medicine. Within a very short period of time, patients will be in charge of healthcare through wearables to monitor their heart rate, EEG, and blood pressure. Artificial intelligence will allow them to make decisions about their healthcare, sometimes in conjunction with a physician. This will lead to the price of medicine going dramatically going down, which we believe will be real turning point.”
These devices aren’t just a science fiction fantasy; wearables are here now. For example, there is a smart phone app that can allow a parent to take a photo of a child’s ear and be able to tell if the child has otitis media. There are dermatological apps that can look at a skin lesion and report whether it is a skin lesion, rubella, rubeola, an allergy or melanoma.
“There are wearable t-shirts in other parts of the world available now to give you continuous Bluetooth data on your heart rate, blood pressure, and oxygen saturation,” he said. “Someone on a farm hill in Wisconsin can have vital signs monitored continuously by healthcare providers states away. That is available now.”
Murphy said the eruption of digital biology has been very elegantly put into two books by Eric J. Topel, The Patient Will See You Now and The Creative Destruction of Medicine.
“Those two books show this is reality of the future, and that future has already been realized in other places, although not necessarily in Little Rock,” Murphy said. “I think it is a great thing.”
However, he predicts physicians will hate it.
“Now there is a great paternalism in medicine,” Murphy said. “I’m the doctor. I’m in charge. The worst patient a doctor wants to see is one who has info they have kept on themselves. Really, I have to look at that? I’m the doctor. You have to embrace the fact that the role of the physician is dramatically changing. The importance of the physician in a diagnostic process is greatly diminishing. Considering that the average time to get an appointment with a doctor is 21 days and the average office wait time for a patient before seeing a doctor is two hours, patients will like it better.”
The wearables will be used for more than just diagnosis and monitoring. Like the FitBit, they can be a coach for a patient. Wearable continuous EEG monitors can be used for patients with mental problems such as depression and anxiety.
Some of the work to develop the next generation wearable medical technology is being done in Arkansas. The Center for Nano-, Bio-, and Info-Technology Sensors and Systems at the University of Arkansas is working on a $9 million National Science Foundation grant that includes research and development of wireless biosensors for human physiological monitoring. Researchers at the center have already developed and tested two similar but slightly different biosensors that can measure important physiological signs. Integrated into “smart” fabrics – garments with wireless technology – these sensors will monitor a patient’s respiration rate and body temperature in real time and thus provide point-of-care diagnostics to healthcare professionals and greater freedom for patients.
