Something Not Unlike Research

eHealth technology enhances active self care, but is not a substitute for it

post by Bill Gardner

Here is a cool new eHealth technology: a bone cast with wireless telemetry of muscular activity. It is

threaded with electromyographic (EMG) sensors that track muscle activity around a fracture site. Created by Pedro Nakazato Andrade, a recent graduate of the Copenhagen Institute of Interaction Design, the cast can relay data wirelessly to physicians and physical therapists. It shows how much mobility a patient has in an affected area and how physical therapy and daily activity are affecting the area, allowing clinicians to adjust treatment accordingly.

The key thing this device does is measure "how physical therapy and daily activity are affecting the area." It is not, itself, a device with therapeutic activity. More to the point, it does nothing if you are not doing your physical therapy -- which is most of us. eHealth will fundamentally change health care only in the context of interventions that successfully engage patients in self-care. 

I've overstated the point somewhat. My motivation to adhere to my physical therapy regimin will likely increase if that I know (or at least believe) that that regimin will work. So if the smart cast makes therapy more effective, I'll be more likely to do it.

The problem is that eHealth technology is often presented as if it were a pill: you put it on and you get better. Rather, you put it on, and your self-care becomes more effective. And getting patients to effectively and consistently care for themselves is the hardest problem in chronic care. 

Jimmy Connors was once asked, what are the most effective exercises to improve your tennis?Connors: "The ones that you will actually do."

Are people ready for Personal Health Records?

post by Bill Gardner

A Personal Health Records (PHR) is a record of your medical and health data that you access and maintain yourself. In theory, PHRs should empower patients to better understand and manage their health care. Google Health, however, was unable to build up a sufficient user base to make it viable even for a very well funded and patient company. This may be one reason why:

This week, I talked with Dan Russell, a search anthropologist at Google, about the time he spends with random people studying how they search for stuff. One statistic blew my mind. 90 percent of people in their studies don't know how to use CTRL/Command + F to find a word in a document or web page! I probably use that trick 20 times per day and yet the vast majority of people don't use it at all. "90 percent of the US Internet population does not know that. This is on a sample size of thousands..." 

It may be some time before PHRs can make a significant contribution to population health.

 

Epidermal electronics, cyborgs, and eHealth

post by Bill Gardner

How do we become healthier? One way is to change our health behavior. Another is to reengineer ourselves as healthier organisms. One idea on these lines is that we could carry electronics that monitor our physiology and behavior in ways that would permit us to better control our health.

Early examples of this are already here. I have a congenital arrhythmia that is managed by an implanted pacemaker. The device also provides telemetry -- albeit through a very primitive interface -- that allows my electrophysiologist to monitor my heart. I have been having some cardiological problems recently, and we were able to determine that I am no longer able to tolerate as much caffeine as I habitually consume.

Implanting devices, however, is far from optimal. It's expensive and mildly risky to put them in or upgrade them. So here, from Science, is a technology for realizing electronic devices as thin, flexible fabrics that stick to your skin like a tattoo:

We report classes of electronic systems that achieve thicknesses, effective elastic moduli, bending stiffnesses, and areal mass densities matched to the epidermis. Unlike traditional wafer-based technologies, laminating such devices onto the skin leads to conformal contact and adequate adhesion based on van der Waals interactions alone, in a manner that is mechanically invisible to the user. We describe systems incorporating electrophysiological, temperature, and strain sensors, as well as transistors, light-emitting diodes, photodetectors, radio frequency inductors, capacitors, oscillators, and rectifying diodes. Solar cells and wireless coils provide options for power supply. We used this type of technology to measure electrical activity produced by the heart, brain, and skeletal muscles and show that the resulting data contain sufficient information for an unusual type of computer game controller.

In effect, you will be able to wear an electronic device as a thin film sticking to your skin. Remember that the remaining iterations of Moore's law imply that extremely powerful computers will be available at very small scales in the next decade. You won't want a tiny CPU next to your skin, because it will generate a LOT of heat, and it would need a power source more continuous than a solar cell. Nevertheless, all this suggests that if we wish, we will be able to have computers and telemetry with us with minimal encumbrance all the time (The suggestion about "an unusual type of computer game controller" is also quite a turn-on.)

Donna Harraway said,

We are all chimeras, theorized and fabricated hybrids of machine and organism; in short, we are cyborgs.

I certainly am one. There are large questions here, on which I invite comment. First, as I discussed here, technologies like are likely to increase health inequalities. Second, how many useful health applications are there for wearable electronics, other than issues like mine? What do you want to measure about yourself, and how would it benefit you?

Update: Hilarious mistake -- I originally titled this epidural electronics, but of course I meant epidermal!