The Doctor is in… Your Device – by Harry Glorikian

I recently wrote a piece for the USA Today Magazine and wanted to share it with you.

“STAR TREK” was ahead of its time in many ways, and not just because the sci-fi franchise portrayed a future several centuries after the series first aired in the 1960s. The cult classic TV show/films foresaw what life might be like in the 23rd century, when humankind would be hurtling on spaceships through unknown universes. Much of the show was fantasy, of course, but the series has been heralded for foreshadowing the future with un- canny accuracy. Dozens of articles have appeared on the topic, even one in the venerable Scientific American. Many tech writers have credited the show with anticipating and even inspiring the advent of myriad of modern technologies, including iPads, flat-screen TVs, Bluetooth headsets, Google Glass, sliding doors, and chatbots like Siri that can answer our questions and complete tasks.

Perhaps no technology imagined by “Star Trek” has enticed more international interest than the medical tricorder. The device, which resembled a clunky transistor radio on the original show, included a small, detachable scanner that Dr. McCoy, Spock, or other Enterprise crew member could use to instantly diagnose the health of a human or Vulcan. The magical medical tricorder then pushed the patient’s clinical information to a master databank, allowing intergalactic doctors to learn more about all life to help further hone the technology. As I am about to explain, we are not as far off from this scenario as you might think.

Since the tricorder’s first appearance, the device has inspired endless intrigue, spurring both techies and Trekkies to try to re-create the tool for real life use. The technology needed to devise a modern-day tricorder, however, has long lagged behind the enthusiasm to do so. In 2014, telecom giant Qualcomm hoped to speed the science along, launching a global competition called the Qualcomm Tricorder XPRIZE and offering $10,000,000 to anyone who could create a tricorder that diagnosed 13 different medical conditions and monitored five vital signs, all independent of a physician. Qual- comm’s intent was to give people control over their own health care—a theme of patient empowerment that you will see associated with many AI-enabled medical machines.

Eight international teams were selected to show off their prototype tricorders and compete for the grand prize. Although none were completely successful in meeting the competition’s demands, several came close, and the XPRIZE Foundation awarded more than $3,- 000,000 to the top-scoring two teams and an additional $100,000 “Bold Epic Innovator” award to a third, donating more than $5,000,- 000 of the remaining original purse to ongoing efforts in consumer testing and adaption of tricorders for hospital use in developing nations. Since the conclusion of the Tricorder XPRIZE competition, the teams have met with varied success in moving their technologies from prototype to consumer-ready.

The “Bold Epic Innovator” team from Canada is arguably one of the most successful. Cloud DX had its beginnings in the after- math of a devastating 2010 earthquake in Haiti. Physician Sonny Kohli was volunteer- ing and realized quickly the need for a small, portable device that could help doctors diagnose patients. Just a few years later, back in Ontario, Kohli joined forces with others who later would become the Cloud DX team. Cloud DX’s tricorder, named Vitaliti, continuously monitored multiple vital signs, including blood pressure, heart rate, blood oxygen saturation, and temperature.

Cloud DX today has made significant strides in tackling the problem of monitoring and diagnosing patients, inside and outside of the hospital. Its Connected Health Kit can do a lot of what its tricorder could do: monitor blood pressure, temperature, weight, glucose, and blood oxygen levels. For doctors looking to keep an eye on patients who are discharged from the hospital, or in settings where hospital care is difficult to come by, the Connected Health Kit addresses many concerns. Devices like this one are an integral part of the future of health care.

Tools like tricorders may seem like science fiction, and it is true that we are not (yet) able to wave a tiny device over the length of some- one’s body and one second later know absolutely everything about their health condition, but Cloud DX and companies like it are showing us that science fiction is well on its way to becoming reality.

Mobile health is not new. The practice of us- ing personal mobile devices like smartphones with wearable sensors like watches to track and even diagnose medical conditions has been around for more than a decade. The Withings company launched its connected body scale in June 2009 and its blood pressure monitor (connected to the iPhone) in 2011, for example, while Apple made its foray into tracking personal fitness and health when it teamed up with Nike in 2006 with the Nike+iPod Sports Kit.

What is new, however, is the breadth of to- day’s technology. AI has advanced so rapidly that smartphone apps and their connected sensors now can accomplish feats previously inconceivable just a handful of years ago. Using only a smartphone, you now can prevent health emergencies, diagnose clinical disorders, and even treat conditions without prescription drugs.

AI is not the only technology driving the breakneck explosion of mobile medicine either. AI-enabled software is only as good as the data it relies on to make medical predictions. Today, software companies have more data than ever before, thanks to millions of users worldwide who have been tracking their heart rate, steps, sleep, and other biometrics, knowingly or not, for years. This ever-expanding databank allows software manufacturers to hone the accuracy of their existing apps while creating new software and sensors that can monitor, diagnose, and treat people in other amazing new ways.

Another factor fueling the transformation of smartphone medicine is hardware, which has become more sophisticated in recent years. This upgrade has given our phones the ability to process and store more data in a smaller space, making it as powerful as some super- computers. Today’s smartphone even outshines the supercomputer found on the spaceship Orion, launched by NASA in 2014 to prepare for man’s first crewed mission to Mars.

As our smartphones get smarter—and our out-of-pocket health care costs continue to rise—the world of medical apps has exploded. Today, there are more than 350,000 health care apps, and the mobile health market is expected to approach $290,000,000,000 in revenue by 2025. It is a fascinating contradiction: while the costs of technology continue to drop (does anyone remember how expensive the first personal computers were?), health care costs keep rising.

It is not really surprising that there is a lot of interest, especially from big tech and the business world, in using the power of technology to tackle one of health care’s biggest challenges—cost. I believe that is one of the reasons we have seen so many tech companies enter the health care and life sciences industries; their outsider point of view is not unlike the one I had looking in at the telecom industry and imagining how GPS could be used in a whole new way. The industry is revolutionizing not only how we look at medicine, but also the power we hold in our hands to take care of our own health.

Think about it for a moment. If you could own an app that could diagnose you with the same accuracy as your primary care provider, you would have the virtual equivalent of an on- call physician with you at all times who could help streamline your care in real life. Earache? Let the AI-enabled app, maybe combined with access to a telehealth provider, distinguish be- tween something that needs an office visit in the next day or two, a simple prescription with advice to follow up in a week, or a recommendation to head to the emergency room or ur- gent care right away. Without the cost or chaos of an unnecessary office or urgent visit, you would be able to consult this virtual physician regularly without waiting to get seriously sick to realize something was wrong with you—or if you should just take an over-the-counter pain reliever and rest for the day.

Similarly, if your phone and a few connect- ed sensors could monitor your blood pressure, cholesterol, and other basic biomarkers around the clock, you would know within seconds if something was irregular rather than waiting to reach the same conclusion after developing symptoms.

How many of us head to the dermatologist every year for a head-to-toe exam to look for signs of skin cancer? What if your phone also could scan your skin for signs of cancer or other ailments without the yearly trip, and in the comfort of your own home, and then transmit the scan to the dermatologist’s office, where it could be looked over? If things look good, you might get a letter in your electronic health record saying you are good for another six months or a year. If the dermatologist sees something concerning, you might get a phone call instead, asking you to schedule an appointment for a follow-up in office. The setup also could be ideal for parents who are worried about a rash on their child. They would have the ability to know what was wrong, probably in less time and at a lower cost than it takes to get an accurate diagnosis today.

In short, smartphones are democratizing medicine in ways we never have seen be- fore—an idea first touted by the eminent cardiologist Dr. Eric Topol in his 2014 book, The Patient Will See You Now. Since then, more of us own smartphones. Nearly 4,000,000,000 worldwide, including 81% of U.S. adults, possess this portable supercomputer. Now, anyone who has a smartphone or smartwatch potentially can access quality health care, no matter how old he or she is or whether living in a big city with access to excellent hospitals and specialists or in a rural area without many medical facilities or qualified physicians. We still will need trained doctors, of course, and there is some level of infrastructure necessary to get health care systems ready to receive data from our phones and digital devices, but the smartphone has become medicine’s great equalizer, making it easier for everyone to obtain top medical attention, regardless of their nationality, ethnicity, age, income level, insurance coverage, or other factors that tradition- ally have limited quality health care.

Today, you can find a smartphone app for nearly every medical condition or outcome. Apps abound to monitor heart rate, blood pressure, blood sugar, cholesterol, fertility, sleep, and even brain-wave activity. Some apps can diagnose or offer medical guidance; others share your information with a physician or other health care provider. There are apps that mimic medical equipment, turning your smartphone into a digital stethoscope, blood- pressure cuff, thermometer, spirometer, and even ultrasound. You can use your phone to access your electronic health records or connect instantly with a physician via video or text. Your phone can help you find and enroll in a clinical trial or help you shop around for the best price on prescription drugs. With the help of a smartphone and some sensors, you can find out if your child has an ear infection or learn how to walk again after a devastating spinal-cord injury.

In addition to offering innovative ways to let you take control your health, what these apps all have in common is that they are powered by AI and big data. Simply put, AI comes into the picture in two ways. First, your health data is detected and compiled through the intelligent features of your devices in ways previously not possible, such as heart rate, blood pressure, sleep restlessness, temperature, etc. Second, these smartphone apps can build extremely large data sets across the entire population that uses that app (big data) as well as pulling in outside data from other studies or research related to the same health metrics.

This is where AI comes in. When you put these two types of information together and use sophisticated algorithms to identify patterns and see correlations, you can make sense of what’s going on with large groups of people, and how health or metrics among populations are changing. You also can tell users how their patterns compare to those of others, how their own pat- tern might change day to day—or, in the case of a crisis, diagnose an emergency, but making those connections between individuals and populations only becomes possible with advanced AI tools and software trained to “learn” about patterns and compare them to known health care standards.

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USA TODAY # SEPTEMBER 2022