Move over Bones - Maybe we don't need that Tricorder just yet!

A call to Entrepreneurs: Help tele-medicine reinvent the house call.

We have all heard about the Qualcomm $10,000,000 Tricorder XPrize contest. Here's a description taken from the site describing the contest:

The Prize: Empowering Personal Healthcare

The Qualcomm Tricorder XPRIZE is a $10 million global competition to stimulate innovation and integration of precision diagnostic technologies, helping consumers make their own reliable health diagnoses anywhere, anytime.

The dire need for improvements in personal health and healthcare in the U.S. has captured the attention of government, industry, and private citizens for years. But a viable solution has evaded the most technologically advanced, educated and prosperous nations on the globe. Integrated diagnostic technology--once available on a consumer mobile device that is easy to use--will allow individuals to incorporate health knowledge and decision-making into their daily lives.

Advances in fields such as artificial intelligence, wireless sensing, imaging diagnostics, lab-on-a-chip, and molecular biology will enable better choices in when, where, and how individuals receive care, thus making healthcare more convenient, affordable, and accessible. The winner will be the team with the technology that most accurately diagnoses a set of diseases independent of a healthcare professional or facility, and that provides the best consumer user experience with its device.

The Device Itself

As envisioned for this competition, the device will be a tool capable of capturing key health metrics and diagnosing a set of 12 diseases. Metrics for health could include such elements as blood pressure, respiratory rate, and temperature. Ultimately, this tool will collect large volumes of data from ongoing measurement of health states through a combination of wireless sensors, imaging technologies, and portable, non-invasive laboratory replacements.

The devices are expected to accurately diagnose 13 health conditions (12 diseases and the absence of conditions) – 10 required core conditions and a choice of three elective conditions – in addition to capturing five real-time health vital signs, independent of a health care worker or facility, and in a way that provides a compelling consumer experience.

Required Core Health Conditions (10): Anemia, Atrial Fibrillation (AFib), Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Leukocytosis, Pneumonia, Otitis Media, Sleep Apnea, Urinary Tract Infection, Absence of condition.

Elective Health Conditions (Choice of 3): Cholesterol Screen, Food-borne Illness, HIV Screen, Hypertension, Hypothyroidism/Hyperthyroidism, Melanoma, Mononucleosis, Pertussis (Whooping Cough), Shingles, Strep Throat.

Required Health Vital Signs (5): Blood Pressure, Heart Rate, Oxygen Saturation, Respiratory Rate, Temperature.

Certainly this is a noble pursuit, and I believe potentially doable. However I think perhaps the XPrize’s goal of a creating a small “Star Trek  tricorder” , while it certainly would be a wonderful tool, is only one way to “enable better choices in when, where, and how individuals receive care, thus making healthcare more convenient, affordable, and accessible.”

I believe there are steps we could take right now, with existing technology to accomplish that particular goal, but it will take entrepreneurs with a practical vision to move healthcare forward, and a desire to help improve the lives of the millions who do not have access to healthcare, to make that happen.

Let’s take a look at the “when, where, and how” part of the above statement

First: When (and why) do we go to the go to a family medicine physician? Usually we go when:

1.      We are sick.

2.      We are being examined to keep us well.

And of course another part of the “when” we go is. When we are able to make the trip, which is part of the problem the XPrize folks are trying to solve.

Second: Where do we go? Well this one is pretty simple: usually the doctor’s office or similar medical facility.

Third: How do we receive our care at these visits? What does the doctor do at most of these visits? Well in most cases the doctor, and more often the nurse, will:

1.      Take our temperature

2.      Take our blood pressure

3.      Measure our heart rate.

4.      Listen to our breathing.

5.      Ask us some questions about our general health.

6.      Perhaps have us give a blood, urine, tissue, or some other sample for analysis.

Based on the data gathered from the exam, the physician will generally prescribe something, or refer us to a specialist. Staying with the “How” part of this: How does the physician come to the conclusion regarding what to do? By using the data gathered from the exam to decide on a treatment.

Now it would be truly wonderful to have a device that we could simply wave around to tell us that we have a cold or strep throat, along with whether we simply need rest or an antibiotic.  However, we are not there yet. The main problems are:

1. Making a device small enough to take all of those readings accurately and which does not rely on physical sample from the patient.

2.  Making a device that can accurately determine a diagnosis and treatment from that data without a physician.

Starting with point one, there are quite a few small commercially available devices that alreadycan gather much of the information a physician would. We can easily determine our own blood pressure, heart rate, blood sugar, and temperature without ever setting foot in a doctor’s office.There are electronic stethoscopes that could be used to transfer the data elsewhere. Regarding some of the other things a physician might do during a typical exam, a webcam would certainly allow a physician to see the patient and ask questions and, depending on the resolution of the camera, perhaps allow more complex examinations with the assistance of the patient. Using this type of technology, much of the typical physician’s exam can be done remotely.

Of course there is the issue of blood, tissue, or other samples that may be needed. For something like a simple Strep test, these could be done by the patient and mailed in or dropped off. Depending on what other kind of sample is needed, the same principle may also be possible to apply. Blood does present some challenges depending on the sample size needed. Obviously simple sugar tests can be done at home, but test requiring larger samples may require having blood drawn.

If we move point two and take this a step further: assuming the physician is not readily available,  a patient could follow a standard set of guidelines to do a self-examination and send the data to their physician for interpretation. Algorithms can be devised that would analyze the data gathered and use it to determine probable diagnoses. I do not propose basing treatment on these diagnoses, but rather a using this as a tool to assist the physician in prescribing treatment.

Everything I am describing could be done today. I don’t pretend that it would eliminate the need for patients to travel to their doctor entirely, but I am confident that the great majority of the visits that fall under family medicine appointments could be handled this way. This would allow physicians to see patients who perhaps would never even be able to make it to their office. Many physicians could even schedule “remote clinic” days, reducing the need to additional staff, as reducing the associated costs. It is not hard to believe this type of treatment paradigm would make “healthcare more convenient, affordable, and accessible.”

Under the Affordable Care Act the government has become much more open to the idea of paying for telemedicine treatment ,so this is not simply an experiment with no possibility for reimbursement. What we have not seen is a concerted effort to make this happen.

We need forward thinking entrepreneurs who are willing to invest in the development of better hardware and software to make this something the medical community does not have to do themselves. As someone who has worked in the clinical and business end of medicine I know that, as a group, medical people do not like to change how they do things.

I know there are other companies who are just now moving into the tele-medicine business, but I have yet to see one which has put together a comprehensive service to really that will convince the healthcare industry it is their best interest to adopt it. There are hundreds of possibilities for investment that can spring from this:

1.Unlike the Tricorder, I believe it would be possible, right now, to make a single device which would provide the data it now takes multiple devices to provide. It would also give consumers a chance to receive a rudimentary exam and results without even stepping foot in the doctor’s office. Putting control over their health in their hands.

2. In cases where patient do need to have blood drawn or perhaps a more involved exam it would allow the possibility for allied health personnel to travel to the patients home rather than a physician making house calls. Using a model similar to other home health services, I can envision a company which exists to provide services like this to multiple physicians thereby using economies of scale to make it financially feasible.

I believe there are even more complex treatments that could be carried out using this model, including services like physical therapy and my own field, prosthetics and orthotics.  With the advent of Accountable Care Organizations’s the question is not whether a model like this will come to be, but when.

So I lay down the challenge to those entrepreneurs among you who want to better the world in addition to making money. This can be done but it will require resources. Where I a billionaire (or even a millionaire) I would be doing this right now. We can give people all over the world access to care they could not receive before – and we can do it quickly. It does not require anything more advanced than the technology we already possess – and the will to get it done.

Owner of Logan Healthcare Consulting, Patrick Logan's professional experience covers broad spectrum: executive, clinician, consultant, manufacturer, manager, educator, marketer, lecturer, athlete, motivational speaker, and even an actor. He has over 25 years of leadership experience in the healthcare field at all levels including budgeting, administration, and project management. He is a recognized expert on the healthcare market, with specialization in the integration of ancillary care models into hospital systems, facility design, and the development of best practices for national, regional and local organizations. He can be contacted through LinkedIn. He also wants everyone to know that he loves Star Trek and really does like the XPrize Tricorder contest (but wants to do something NOW).