Star Trek is still having an impact, decades after Gene Roddenberry first got it on the air. It has become a standard for comparison when evaluating different visions of the future. The latest area where Star Trek may have given us a model to emulate is in the field of health care: the medical tricorder.
The concept is simple: a hand held device equipped with sensors that can measure a wide range of health indicators (pulse, blood pressure, temperature, etc. etc.) combined with software and enough computing power to interpret the readings and give a quick and accurate diagnosis of a life-form's state of health. Imagine what a device like this could do for health care, if widely available and adapted for use by anyone, not just a Dr. McCoy.
By 2015, you might not have to imagine it any more; you might be able to hold one in your hand. More below the Orange Omnilepticon.
Each year, the XPRIZE Foundation gathers thought leaders from around the world, for a 3-day summit called Visioneering, to debate and brainstorm solutions to the world’s “Grand Challenges” through incentivized prize competitions. During one session in 2010 The Artificial Intelligence (AI) Physician and Lab-on-a-Chip prizes were conceived. Immediately it became clear these two concepts complemented each other and should be combined into one prize with a new and unique focus on consumer needs rather than a device for clinicians and doctors.To emphasize, this is being envisioned as a disruptive technology - because it is intended to reshape the way health care is provided. It's aimed at consumers - NOT doctors, as is stated above. If it can be realized, it will be a game changer.
It was envisioned that this hand-held consumer device would allow individuals to access the state of their own health anytime, anywhere, and potentially revolutionize how people could interact with the healthcare system. Contributing to both prize development and the architecture of prize design was Dr. Daniel Kraft, a Stanford- and Harvard-trained physician-scientist with over 20 years of experience in clinical practice, biomedical research and innovation.
Anyone who has ever had a child become sick late in the evening, or over a weekend knows what it's like to wait to contact a doctor during normal office hours. Anyone who has begun to feel not quite well, but unsure what's going wrong knows what it's like to wait for a diagnosis. Anyone who has had to wait for test results to come back knows how nerve-wracking that can be. Anyone who has had a doctor misdiagnose an illness, or take forever identifying an effective treatment knows how frustrating and potentially life-threatening that can be.
The tricorder is intended to address those situations by providing a quick and accurate diagnosis of 16 different conditions - as well as ruling them out. How it will do it, and exactly what will be on the list is why this is a contest - it's about pushing the technology. Some of the conditions that have been suggested for targeting are things like: ear infections, blood pressure, anemia, diabetes, heart attack. The full guidelines are here (pdf). Here's a summary:
The winner(s) of the $10M Qualcomm Tricorder X PRIZE will be the best‐performing solution in its ability to assess a set of 16 distinct conditions and five (5) vital signs in a pool of people within three days, while providing a strong consumer experience in the areas of usability, understandability, engaging and desirable presentation of information, and ability of the solution to willingly invoke action on the part of the user. In addition, the winning solutions must:In short, it looks like they want to have enough 'smarts in the box' to function without needing to uplink to more powerful processing power/databases or a human diagnostician - but data can be stored and transmitted to make that possible, since it's obviously a good thing to be able to do if needed.
• Meet minimum scores for both consumer experience and health condition assessment
• Continuously monitor five vital signs over the course of the consumer testing period and log this data to the cloud
• Have a maximum mass of no more than 5 pounds for the entire solution provided by the team to the consumer
This assessment and monitoring, as well as the interpretation and interaction of the solution must be performed solely in the hands of a consumer, independently of a healthcare worker or facility. Use of telemedicine or simply sending a person’s health data directly to a healthcare worker is not acceptable. This requirement is intended to put the means for health awareness, metrics, and initial steps of care first in the hands of the person to whom the health belongs.
The rationale for developing the medical tricorder is pretty convincing. Again, a selection from the pdf file:
Unfortunately, the cost of healthcare is not the only problem the U.S. faces. There is strong evidence that despite having access to some of the best modern medicine, the care being delivered is prone to delay and inadequacies in the eyes of the most important party: consumers. Consider these common situations faced by many people seeking medical attention:
• It takes 21 days on average to obtain a doctor’s appointment (4)
• Three out of four people have difficulty making appointments or receiving after‐
hours care without visiting an emergency room (5)
• Only 57 percent of people report that their doctor listened, explained, showed
respect, or spent enough time with them (6)
In addition to affordability and access hurdles, when individuals finally do obtain care, only 55 percent receive the recommended screening, diagnosis, or treatment. (7)
Change is long overdue but it needs to be directed at the heart of the problem; peripheral improvement within the system has been unsuccessful. Funding has been poured into this problem; healthcare reform has been a priority for decades across presidential administrations. Yet not only is the system hemorrhaging the increasing resources that we are putting into it, but there are also many signs, some previously noted, that it is fit for change so radical it would be classified as “disruption.” Some researchers, stakeholders and others are fighting to change the existing paradigm, but displacing such a swollen, self‐serving system is no easy task.
4 Merritt Hawkins & Associates, 2009 Survey of Physician Appointment Wait Times
5 The Commonwealth Fund, A Call for Change: The 2011 Commonwealth Fund Survey the U.S. Health System
6 The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008.
7 Elizabeth A. McGlynn, Ph.D., et al., “The Quality of Health Care Delivered to Adults in the United States, The New England Journal of Medicine, June 26, 2003.
This Is Not Going To Be Easy, But...
There are a lot of hurdles to clear here. It's not enough for the device to detect health problems within the range it is supposed to cover. It has to minimize both false positives and perhaps more important, false negatives. And, of course, it should be able to inform the user when it can't make a diagnosis, but it is detecting conditions that need further testing.
Is it going to be possible to design sensors that will be reliable, rugged, and easy to use? Will there be consumables that need to be replaced? Can they be designed to work in the hands of people with no medical training? Is it going to be possible to make them non-invasive?
The question of legal liability if the device fails in some way is rather a hurdle as well. Cost is another question; what price point will allow enough people to buy one of these to sell enough to make them economically viable? Will they covered by health insurance? The medical profession is going to be highly skeptical if not outright hostile to this idea. What will it take to get them to buy in to the concept?
The record of health care delivery as described above certainly suggests a medical tricorder that works as intended has a huge opportunity to improve things. It's easy to envision someone with a chronic illness could benefit greatly if they could take regular scans at home to allow their physician to monitor their health - especially with software smart enough to pick up warning signs from long term trends. Watson showed what happens when you put massive computing power together with parsing algorithms and a vast database. It's already being turned to medical uses. Kevin Drum over at Mother Jones has a thought-provoking article arguing that we are very close to the point where robots will be able to fill many jobs now being carried out by humans - and it's going to happen sooner rather than later.
There are already a number of teams working on the competition, who are investing serious time and resources. The potential is huge - and applicable in ways beyond a hand held device. For example, Dr. McCoy's Sick Bay had a bed with a lot of scanners built into it that were non-invasive and wireless. The sensors and software being developed for the tricorder could certainly be used in that way. Consider also the research that could be done using the information in a standard format gathered by thousands or millions of people getting scanned on a regular basis. Anonymized and monitored over a long baseline, it could revolutionize medicine.
The X Prize foundation hopes to announce a winning finalist team by June 2015. There is still time to register; entry fees will be going up so don't delay if you think you've got a shot at this.