2014-08-26

Consumer grade health monitoring equipment.

Right now a somewhat new category of health/medical equipment is beginning to emerge.  These devices are not your traditional medical devices, with their bureaucratic, long-winded approval processes that guarantee that whatever comes out the other side is ten times expensive and several years behind the technological status quo.  These devices are for everyday use of consumers to have some idea of how their health is doing.

When I talk about measurement devices to track your health, you probably think of glucose meters and blood pressure measurement cuffs.  Expensive stuff that needs to be carefully calibrated, tested, rated and approved.  Well, those are critical and very nice to have.  But there are lots of other parameters that you can look at and analyze to gain useful information.

For instance body weight.  For people with certain medical conditions, keeping a close eye on developments in their body weight is critical.  And this is much harder than you would think using old-fashioned bathroom scales.  Since your weight will vary throughout the day and even between days, trends can be hard to spot if you do this by eye and by memory.  But if you store the measurements and you have software that can smooth out the rather noisy data, you will be able to spot trends much easier.  For instance I can easily spot a 200 gram gain or loss over a week using my internet-connected bathroom scales with data visualization software -- I seriously doubt that even if you record your weight carefully with pen and paper you'll spot that change unless you do a bit of work.

And that's an important point.  If you want people to measure something related to their health, you have to automate it and preferably, not have it interfere with their lives.

Taking a weight measurement with a WiFi-connected bathroom scale takes zero effort.  You just step on the thing for a few seconds while you are brushing your teeth and you are done.  If you brush your teeth 2-3 times per day, that's 3 datapoints right there.  (Compare to one datapoint at your doctor's office during the yearly checkup.  An almost worthless measurement).

Taking a BP reading, on the other hand, is a pain in the neck.  The traditional way to measure BP is with a cuff -- a device called a sphygmamanometer.   The measurement procedure calls for sitting down, putting the cuff on, and performing a series of measurements.  To the greatest degree possible you have to try to eliminate sources of error and to make the measurement the same way every time in order to produce data points that can be compared reasonably well.  This takes real effort.   So you won't get people to gather lots of BP data points every day.  This is a parameter in dire need of a proper measurement technology.

What will be an important focus is how we can instrument ourselves and our surroundings in order to measure health-related parameters without effort.  And there are a lot of opportunities. Just take your bed.  You can monitor movement to determine how well you sleep.  It should be possible to pick out your pulse either by sound, or by making sheets out of fabrics that can utilize contact with your skin and make use of conductive materials embedded in the sheets.  If you have enough leads, proper signal processing and some software to figure out how the sensor grid is aligning with your body, there is no reason you wouldn't be able to produce many hours of EKG-data every night. Meaning that not only will you know more about your heart than was previously possible -- it is going to be possible to detect heart problems much, much, earlier than before.
Ditto for breathing.  Combine audio analysis with the minute movements of your bed as you breathe and it should be possible to detect a number of anomalies.

Recently I built a prototype for monitoring body temperature while in bed.  My theory was that it should be possible to automatically detect if someone is running a fever.  Without having to get up and use a traditional thermometer every now and then.  The sensors are just embedded in your bed (no pun intended) and you log the measurement values over the network.  It took me just a few afternoons to build and even after the first full night of testing it was obvious that non-intrusive fever detection is feasible.  I'm still working on it, but I've already reached the cost goal:  you can do it for under $100 in materials cost.  And that is for a WiFi-enabled device with a big, bright LED display.

So to sum up:  here are some of my beliefs around consumer health monitoring:

  1. We have to develop cheap, automated technologies for health monitoring to free up the time of medical personnel so they can spend less time on menial measurement tasks which they are not very good at anyway since they are humans -- and humans are terrible at observing and recording physical phenomena.
  2. It has to be non-intrusive.  If it takes effort, users won't stick to it.  The goal has to be to hide these measurement devices in everyday objects and to opportunistically gather data whenever data is available.
  3. New high quality sensors available for very little money combined with cheap connectivity and high capacity computing means that observations that would have been pretty hard to come by a few years ago are now easily attainable.
  4. Privacy and security will be a huge problem.  On one hand you want to keep this data private. On the other hand, you want it to be easily available to you and your healthcare professionals.
  5. Regulatory bodies and traditional makers of medical technologies are slow and incremental -- meaning that there will be an unresolved tension here for years.  Ultimately this means that public healthcare organizations will forego incredible cost savings opportunities because they lack the kind of people needed to figure out how to expedite this.

(When I say that humans are terrible at measuring things, I mostly base this on papers I've read that quantify the error rates of defined measurement tasks where the accuracy of the measurement devices are known.  For instance for a given urine collection device used in many hospitals the theoretical accuracy would lead you to believe that errors would typically be in the 2-5% range.  The observed error is as high as 25%+.   Measuring well is hard.  Leave it to the machines if you can.

Of course, I am beating myself up over being really bad at referencing these papers when I discuss things or when I write.  This leads to misremembering the precise figures as well as not being able to provide helpful references for people who wish to understand these things.  I'll try to get better at this. Sorry.  Of course, it also doesn't help that some of these papers are behind paywalls -- which is just the disgracefully obsolete way scientific publishing works)

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