Managed Care - February 2009 - (Page 30) itoring stations or networks and, of course, with medical professionals. They can give warnings, they can provide advice, they can tell you it’s time you get yourself to your doctor, or they can help prevent an unnecessary doctor visit. And if you do need to go, they can help your doctor figure out what is wrong with you more quickly. This is not rocket science, either. Some of this is already available today. A toilet that monitors the chemical composition of your urine and feces looking for metabolic or other problems has been available as a consumer item in Japan for a number of years. Intel and other technology companies such as Honeywell have been working on building “smart” homes using today’s technologies to allow these “smart” tools to be linked with a variety of sensors built into the home itself to allow the monitoring of elderly individuals. Intel has extended this to include things such as motion detectors, pressure sensors in furniture, cameras, transmitters embedded in common household items, and sensors in carpeting, walls, and even clothing. All these tools • Computer glasses that can help a person remember things and people through a tiny infront-of-the-eye display; • Skin mapping that can monitor a person who is prone to develop melanoma; and • A smart bandage that can tell if a wound has gotten infected. All of this will introduce new challenges regarding privacy, security, and the meaning of the concept of “personal space” — issues that are well beyond the scope of these discussions. But they will happen and they are happening, and what may currently be still thought of as science fiction may be available to you in the not-too-distant future as something that is intended not to take your place or do something for you to make your life easier, but to make your life better by helping to keep you healthier and more active. DM will embrace these technologies and incorporate them into the day-today activities of a program and a patient. The current and ongoing blending of DM with wellness Physicians are never going to have the time to spend going through volumes and volumes of data, so it is going to be up to the computers themselves to integrate, correlate, and analyze. can communicate with each other and through a network to allow a picture of an elderly person’s activities to be built and monitored for changes in routine that may indicate someone getting in trouble. The Defense Advanced Research Projects Agency (DARPA)3 has developed a T-shirt that a patient can wear that allows nonintrusive remote monitoring of vital signs. The nonintrusive part is the key, as it is the ability of these smart devices to do their work without being obvious and without interfering with the day-to-day activities of people that will allow the widespread usage and acceptance of these devices. What else might be coming? According to Carol Lewis, author of Emerging Trends in Medical Device Technology: Home is Where the Heart Monitor Is,4 the list includes such things as a toothbrush that can sense, evaluate and monitor the bacteria present in your mouth, diagnose an infection, and maybe even determine not only when but which antibiotic is needed. Other products that Lewis says already are on the drawing board: and other less traditional spaces will likely accelerate some of this. Some of this technology, in the form of hardware, already exists. Some will need to be developed, and all will continue to be refined, improved and miniaturized, and made faster and less expensive. But the factor that ultimately determines when these tools will become available and commonplace is likely not the hardware but the software. Creating the various sensors and devices to measure a whole variety of parameters is much further ahead than creating the systems needed to take all of that data in; analyze it; find the right patterns within it to show or predict problems; and then make the output concise and usable in a form that provides information to a patient or health care provider that can be acted upon. Some of this is technical and has to do with systems, processors, and software capable of integrating ever-larger amounts and types of data. But a lot of it is also clinical and will require a very deep understanding of human disease and human behav- 30 MANAGED CARE / FEBRUARY 2009
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.