Telemedicine is a fifty-year old concept with an avalanche of new providers, devices, and applications. It began with manned space flight, when both the astronauts’ space suits and reentry capsules were “wired” to monitor vital signs and environmental conditions; and almost simultaneously, engineers at DARPA began what became the internet. With the “big data” projects of molecular medicine during the 1990s, computational medical science went online.
Today, a Google search for “telemedicine sites” returns 1.1 million entries. Some of these include teledermatology (using a cell phone to spot melanomas); telestroke assessment for rural clinics; teleradiology for faster evaluations of medical images; teledieting; telepsychiatry; telerehabilitation; electronic intensive care monitoring; tele-medication-adherence; and tele-emergency services for ships and remote scientific stations.
Wearable, implantable and ingestible devices allow wireless, distance monitoring. The catch word for wearable things is “smart”—as in smart slippers that track the location of Alzheimer or dementia patients; smart eyeglasses that put a sensor at the temples to detect stroke; smart pill bottle caps that remind people to take their medicine; smart hospital gowns that monitor patients’ mobility and fall risk; smartphone apps that analyze eyes in selfie images for anemia; smart bedmats with motion sensors to detect REM sleep periods when blood pressure falls to its lowest level in 24 hours or when a newborn stops breathing at night; and a smart menstrual cup with wireless reporting for infections. One of Apple’s next products may be the “iRing”—a finger-worn device with multiple biometric sensors and a microphone for taking voice commands.
In 2001, an Israeli company, Given Imaging, won FDA approval for the first camera in pill form. Users swallow it, allowing a tiny wireless camera to transmit pictures of the gastrointestinal tract as it moved from the esophagus to bowel, looking for bleeding sites, abnormal veins, polyps, and inflammation. Other ingestible camera pills are capable of taking biopsies and delivering drugs when an external magnet triggers their actions.
Among many implantable devices with (or working toward) wireless monitoring are three that illustrate a range of uses: implantable blood pressure monitors, implantable brain-computer interfaces, and implantable tumor sensors. From the first experimental blood pressure monitor in 2007—implanted in the wrist—two types have evolved: one, a cuff type surgically implanted around an artery, and two, an inner artery design that is catheter inserted. Both can give continuous BP measurements. Two years ago, the Braingate neural implant allowed a paralyzed woman with “locked in syndrome” to think a robotic arm through movements giving her a drink of coffee, and since then the company has been working on a wireless model. And MIT engineers have developed an implantable tumor sensor that measures pH and dissolved oxygen—two indicators for whether or not chemotherapy is working. It is inserted through a needle and wirelessly beams chemical data outside the body.
All of these innovations and hundreds more illustrate how communications can make healthcare more effective, efficient and equitable.