WBBA Event Recap – April 10, 2013
by Martin Suchorolski, PhD
Ideas and technology presented at the recent WBBA conference on Mobile Health (mHealth) promise to have an impact on healthcare locally and globally with technology described as “coming out of Sci-Fi”.
Dr. Paul Yager, Chair of Bioengineering at University of Washington (UW) and event co-organizer, started the conference off by describing how the healthcare system is in the process of changing more and more to electronic formats, but is not quite there yet. Smart phones combined with cloud-based electronic medical records, he foresees, will become patient’s input and output devices for many diagnostic purposes and have the potential to transform the flow of medical information into the hands of the consumer. With these devices, diagnostics that can be acted upon immediately for therapy (termed “theranostics”) and integrated information agents able to interpret data would enhance the patient experience. Dr. Yager highlighted several problems that are currently being faced by mHealth including financial, regulatory, technical, rapid phone platform evolution, and resistance to change by the current medical system, but he seemed hopeful that not too far down the road this technology would emerge.
Jigish Avalani, Executive VP of Global Marketing and Alliances from Apperture, predicted that, muchlike technology transformed the way communications from payphones to mobile, access to healthcare would be transformed, reducing wait times in the process. As an example, he mentioned two services are already changing this interaction: Zocdoc, enabling patients to find doctors with available appointment times in their vicinity, and Teladoc, for accessing doctors over the phone 24-hours a day. Through investigating personal and non-personal interactions within the health care system, different decision points were highlighted that could be acted upon to transform health care.
Bill Reid, Vice President of Product Development and Chief Security Officer at Numera, then described a “tele-health” device designed to remotely monitor falls by patients, even outside of their homes. The Numera Libris captures location data using GPS, descent info using an accelerometer, and sounds made during a fall event. This information is then transmitted to a cloud-based system, the data processed and sent to the call center. With an increasing coverage area of cellular service across the US, Numera hopes that by providing convenience and ease of use of a mobile device they will provide services to a market with many people at risk for falls not protected by such a service today.
Dr. Abraham Flaxman, Assistant Professor of Global Health at the UW, next presented how mobile devices can produce better estimates of the global burden of disease. Global burden, described as years of life lost plus years of life lived with disability, is a useful measure for policy makers and researchers and important to estimate effectively. In his talk, Dr. Flaxman described methods to compensate for inaccurate reports of death and disability, including collecting verbal autopsies via smartphones in a uniform format to be processed by machine-learning algorithms to better predict actual levels of global burden. The use of technology resulted in faster interviews, analysis, workers more satisfied with the overall collection process, and the ability to achieve (with the use of machine-learning algorithms) greater accuracy than physician-certified validation.
Following a panel question and answer session, Dr. Gaetano Borriello, Professor at UW Department of Computer Science Engineering, took the podium and presented a poignant case for developing mobile diagnostics for global health, by describing the shortage of physicians in some countries equivalent to “20 doctors in the city of Seattle”. Conditions for diagnostic tests in many countries are very challenging, with lack of refrigeration, and problems with timing test duration sometimes affecting test results. Dr. Borriello described several inventions (also credited to Dr. Dean Stevens from Dr. Yager’s group and Nicola Dell from UW CSE) using smart phone technology as an imaging and computing platform to solve these problems: cell-phone based imaging, “ratiometric” image correction of test-strips for low-light conditions, “time-sensitive” tests which are more accurately read (developed by Yager lab), optimizing data analysis code to run on smart-phone devices, and ways to create touch-free imaging platforms to avoid device contamination. Future technologies may include adding microscopy and co-designing disposables to accompany the phone.
Dr. Yager ended the lecture series by describing the next-generation of lateral flow tests, which he termed Microfluidics 2.0, which he described as “programming in paper”. Existing lateral flow tests rely on paper-based assays; they soak up liquid (and patient samples) to activate signals (typically from immunoassays) to produce tests that are inexpensive to fabricate (less than $1/test), do not rely on electricity, and are simple to run. Two projects were presented: the first was to develop an amplified immunoassay for influenza subtypes and the second was to develop isothermal nucleic acid amplification tests for MRSA and influenza subtypes. Remarkably, Dr. Yager’s team, which includes several corporate subcontractors, has shown that they are able to amplify DNA using Epoch Biosciences chemical systems, PATH’s Phase-Change Material (PCM) technology and GE’s modified paper materials to create an inexpensive system that allows them to conduct the amplification in a paper matrix with approximately the same sensitivity as in conventional tubes (with no electrical power). Combined with smart phone cameras to perform imaging, diagnostics such as these hold the promise of affordable point-of-care access to diagnostics for patients globally.
The event concluded with a question and answer period, with topics ranging from cancer detection, patient privacy, standards at many levels, and evaluation of international marketplaces.