Cell phones and tiny sensors help quickly alert you to health trends
At any given moment, it is likely that someone in the United States is suffering from an asthma attack. About 25 million Americans are sick with this life-threatening disease, and every year about half of them lose control of the disease. Some of them will rush to the emergency room and others will quickly find their inhaler to take fast-acting drugs that are able to relax the constricted airways within minutes. But it is difficult to calculate which patients are at high risk of having such an attack because the statistics needed to identify these trends are based on the recollection of the patients themselves who report their attacks days or weeks after they happened.
This state of affairs may change in some US cities thanks to new technology. In Louisville, Kentucky, in some areas of California and in Washington state, patients with shortness of breath use inhalers equipped with a small sensor that wirelessly transmits location data and frequency of use. This data is sent via a secure server to patients' cell phones and to doctors' web interfaces, and provides an immediate report on the patient's condition. The data is also stored for future reference.
The inhalers and data monitoring system, together called Asthmapolis, which were approved for use by the US Food and Drug Administration (FDA) in July 2012, are just one example of a developing strategy that is part of a new trend that has yet to gain a catchy name. This trend holds great promise because it combines the documentation and supervision of public health accepted in medicine for a long time, and the technologies of data mining and cell phones. Together, these tools produce in-depth and updated reports that can both help patients and medical researchers and improve public health and environmental protection.
"When you think about the forces that will shape medicine in the next 20 and 30 years, three prominent trends emerge: a significant aging of the population, a large increase in the rate of chronic diseases, and a shortage of caregivers," says Steven DeMello, head of the health services division at the Institute for Utilization Research in information technologies for the benefit of the public" of the University of California at Berkeley. DeMello says that the diagnosis and supervision through mobile phones can moderate the impact of demographic trends by identifying health crisis situations early, by enabling remote treatment, and by making available to patients information that helps them curb the disease they suffer from.
in one breath
The Asthmapolis system developed following the dissatisfaction of one of its founders, David Van Sickle, with government asthma data. This frustration increased after he received a doctorate and served as an epidemiologist in the American Centers for Disease Control and Prevention (CDC). "Despite everything we know about shortness and its treatment, most patients, as individuals, still suffer from uncontrolled outbreaks of the disease," he says. "The doctors who treat them cannot make 'corrections' because the patients do not report their bad condition, and in the end they are at a higher risk of going to the emergency room, being hospitalized, losing school days and work days - and all of this is under the radar of public health."
Van Sickle realized that patients already carried devices that could be used to objectively report their condition: their inhalers. Most patients with shortness of breath take slow-acting medications daily to permanently control the disease. Repeated use of an inhaler indicates an emergency situation in the making. In 2006, Van Sickle and several partners began to develop a wireless sensor, which today is being tested in all kinds of conditions. In Louisville, for example, researchers use it to identify local environmental factors that trigger short-circuit attacks; In Sacramento, the focus is on effective treatment and follow-up after a seizure.
The project in Louisville is financed by the local authority. Ted Smith, who is in charge of innovations at the city of Louisville, hopes to deploy at least 500 sensors and compile an annual picture of the disease's impact on the population and the role that Louisville's notorious air pollution plays in making it worse. The project in Sacramento is located in the medical centers of Woodland Healthcare and Mercy Medical Group, organizations affiliated with the healthcare provider Dignity Health. The goal is to check if reporting symptoms to doctors, in real time, benefits the patients. Michael Patmas, the chief physician at Woodland, says the project may benefit other patients as well. First, many of the asthma patients in the area are farmers whose work outside, in the dust, causes attacks. Better management of their health can prevent their arrival in emergency rooms and reduce their burden. Second, comparing the aggregated data coming from the inhaler sensors against the weather reports in the area, can allow the hospitals to warn against expected risk factors through text messages, for example. "If it's dry and hot and the wind is blowing in a certain direction, we can send a warning: 'The weather conditions are bad today,'" says Patmes.
Follow trends
Technological developments such as Asthmapolis reflect the merging of two trends that are both new in themselves: remote monitoring of patients and the collection of observations from modern sources.
Information mine: The red pins on the Asthmapolis screen in the picture mark the places where the patient used the inhaler. In the orange areas other patients used their inhalers.
The remote monitoring monitors patients with chronic diseases such as heart failure for example, which may erupt and become a medical emergency. The patients have devices in their homes or on their bodies that transmit wirelessly or electronically an alert to the care providers when changes are registered that could indicate danger. The "Elderly Health Administration" (VHA) of the USA has been experimenting with such remote monitoring for more than ten years. The devices connected to the monitoring system are diverse: from sugar meters for diabetics to home scales - as changes in body weight can indicate the worsening of heart failure. In addition to the VHA trials, there were also trials in which they connected an electrocardiogram (EKG) to a home phone to detect early signs of a heart attack, trials in daily drug dispensing kits that report whether or not they are used, trials in cellular applications that allow diabetics to report what ate and how much insulin they took, and experiments with Bluetooth-connected peak-flow meters that allow short-term patients to diagnose the onset of narrowing of their airways.
Since most of these technologies are new, there aren't many comprehensive studies examining them yet. The few studies that have been done so far show that the patients feel that they have better control over their disease and are more satisfied with the treatment in general. It is possible that this technology will prove its full medical value only when larger groups of patients use the various sensors.
Most of the information collected in remote monitoring is sent from a patient to a doctor or a team of caregivers, so it focuses on treating that single patient. In the second trend that led to the invention of Asthmapolis, the flow of information is from many to many: that is, the information comes from many sources and is accessible to many users, starting with public health services and ending with individuals in the general population.
Until today, disease control data arose from the world of medicine and public health and remained there. Doctors provided the data and it flowed through the pipes of the health services and was published by government bodies. The first version of this new method of surveillance, based on crowdsourcing, was probably ProMED-mail (acronym: "Emerging Disease Monitoring Program") - an electronic mailing list managed by academics on a voluntary basis, which began operating in 1994 and today is listed as 60,000 are written. ProMED-mail has many and varied writers and it receives data from official sources, such as government authorities, and from unofficial sources such as news reports. The second generation of this map is the HealthMap founded in 2006 by a group from Boston Children's Hospital. This system combines active contributions from readers, as ProMED-mail also does, with patient, automatic processing of data from government sources, from news reports, and from texts on social networks on the Internet, and produces from all this data, in real time, maps that mark disease outbreaks around the world.
Both of these projects have shown that they can identify important developments faster than the usual monitoring methods. In February 2003, ProMED-mail issued a query that broke the walls of silence that the People's Republic of China had placed around the burgeoning SARS epidemic. And in April 2009, HealthMap's online data mining tool discovered reports of a respiratory illness in newspapers in Mexico a few weeks before the CDC announced the first case of the H1N1 flu pandemic.
Meanwhile, other developers are working on a new generation of mobile devices that will collect medical data. San Francisco-based FitBit, for example, makes a range of wearable sensors that transmit information about sleep and physical activity to a mobile app and online computer interfaces. The Scout, which the Scandu company from Moffett Field, California, announced its launch at the end of 2012, has been compared to a medical tricoder from "Star Trek", for the fact that it is a manual tool that measures pulse, body temperature and blood oxygen level at the same time. The challenge facing these new devices, much like the one facing the first mailing lists and remote monitoring systems, is convincing people to use them. In this respect, DeMello says, the latest toys have a certain advantage. "The idea is that you have a core of monitoring technology wrapped in a shell of a product, and if possible nicely designed and compact, wrapped in a shell of a service," he says. "All of these are needed for the method to be successful."
But beautiful design costs money. FitBit's cheapest device, called the Zip, costs $59.95, and Scando says consumers will pay "less than $150" for the Scout. And if in advance only a small part of the public manages to purchase the devices for themselves, then the great promise inherent in them: provision of in-depth health data for large groups of the population - may not be fulfilled.
on the notebook
Marin M'Kenna (McKenna) is a journalist and blogger who has written two books on public health. She writes about infectious diseases and health issues and food policy in the world.
