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Thursday Apr 10, 2014

New Gadgets Show Promise for Future of Medicine

As a physician with a technological bent, I'm constantly looking for new gadgets to add to my arsenal and enhance my practice. From hand-held, two-lead, smartphone-based electrocardiography machines to USB otoscopes, I have played with and used a number of tools in practice that hold the potential to change medicine, especially primary care, as we know it.

Even our patients, especially those who have grown up with computers, now electronically document multiple aspects of health and wellness in a movement referred to as the "quantified life." From calories counted to miles run, from photographs of each day to recordings of blood sugar and blood pressure, technology allows patients to document and analyze every moment of their lives. Physicians are getting on board, and the recent surge in interest about telemedicine has pushed hand-held and wearable medical technology into the spotlight.

Google Glass, which I'm wearing here, is one tool that makes it easy to document visual findings from a physician's perspective.

I enjoy being on the cutting edge. To that end, a few weeks ago, I was lucky enough to be selected for the Google Glass Explorer Program. Although not yet "ready for prime time," as they say, the device serves a few useful purposes. Much like smartphone cameras, Glass makes it easy to document visual findings from the physician's perspective (with patient permission and a signed release form, of course). I also can capture audio notes and search for information from multiple sources.

I haven't used Glass for telemedicine yet, but hosting a Google Hangout with Glass could easily offer an opportunity to broadcast audio and video of standardized (or actual) patient encounters, give students a new perspective on patient interviews and physical exams or provide a distant subspecialist with a personal view of patients in a remote clinic. A surgeon in India recently used Glass to broadcast a live orthopedic surgery. Several surgeons here in the States have written about using Glass to visualize imaging studies or patient vitals while performing surgery. It's an amazing gadget, and we are just beginning to see the potential for head-mounted displays and augmented reality realized.

Telemedicine tech encompasses a lot more than screens and cameras, though. Several companies make USB versions of tools that are common in the primary care arsenal, including stethoscopes, otoscopes, electrocardiography machines that attach to a cellphone, even ultrasound machines the size of a smartphone. While dismissed by some as frivolous gimmicks, the move toward using remote sensing technologies continues to evolve as a viable medical option, especially in underserved areas of the United States and abroad.

The entire patient encounter can even be conducted by a layperson with limited training and broadcast to a physician half a world away or just across town. Much of the tech hinges on high-speed broadband Internet, so there are some limitations, but transmitting either live or recorded information for later review could allow physicians to help more patients in more places. A patient could come to a clinic; give a history with video conference software; be examined using a digital otoscope, ophthalmoscope, stethoscope and visual inspection performed by a trained worker; and receive a two-lead electrocardiogram using a device attached to a cellphone, and the physician on the other end of the link could determine whether telediagnosis was appropriate or whether the patient should be referred to a hospital or clinic, all from several hundred or thousands of miles away.

Personally, I've been working on a plan to use the technology in a rural/underserved area to provide triage and care in a free clinic, even when I can't be there in person. Although still relatively expensive, the technology continues to improve and costs continue to trend down, making this an increasingly viable option. The quality of the signal, from pictures and video of the tympanic membrane to recorded heart sounds, is more than usable, even over cellular or low-speed broadband (1-2 megabits per second) connections and can be transmitted to mobile devices, laptops or desktop computers. Proof of concept is one thing, and I'm excited about the potential, but once the project is fully underway, I plan to post a follow-up with more details.

Therein lies the problem with many of these technologies: They are new. Untested. Untried. Critics often call these gadgets a solution looking for a problem. Maybe they're right about some of them, but each and every one of these gadgets can be viewed as a step in the right direction. I don't know whether anyone told René Laennec he was crazy when he rolled up a piece of paper and placed it on a patient's chest, but his invention of the stethoscope moved us from immediate auscultation (an ear on the chest) to the ability to hear with striking clarity the motions of fluids inside the heart, lungs and abdomen. Inventions and technology have entwined with medicine ever since and continue to provide new ways of caring for the sick.

Although technology can never completely replace laying a human hand of comfort on the shoulder of a suffering patient, it can offer new methods of recording patient encounters and extending skilled health care to those in remote or underserved areas. From cellphones to cameras to augmented reality, we're entering a new phase in the practice of medicine, and, as new-to-practice physicians, we'll be leading the charge.

Sound off in the comments below about any novel tech or new gadgets you're using that help make your practice better, both for you and your patients, and feel free to contact me @DrTolbert on Twitter.

Gerry Tolbert, M.D., is a board-certified family physician who practices in northern Kentucky. A lifelong technophile, his interests include the intersection of medicine and technology. You can follow him on Twitter @DrTolbert.

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