David Kerr: 2012, technology and all that

David KerrJanuary is the month that heralds the end of procrastination. The New Year is traditionally the time that individuals and organisations look ahead and plan for the future. Among the usual resolutions to do more, eat less, and be more productive, there is also the ubiquitous past-time of predicting the near future. For healthcare the future seems to be focused increasingly on the development and application of technology with a blurring of the distinction between consumer electronics and medical devices.

In their review of more than 1600 posts during 2011 focusing on technological innovations in medicine, Medgadget highlighted various technologies that will make a difference not just to individuals but also the way medicine is practiced. These include lab-on-a-chip technologies for HIV and Syphilis testing, robots that could replace theatre scrub nurses, brain-controlled prosthetic arms, in-car health management, and further evidence that the iPad is now a must-have medical technology given the huge number of medical apps available. Elsewhere, the next year is predicted to see the creation of artificial intelligence systems located in a computer “cloud” that any healthcare provider can access to help with interpretation of lab data or review of radiological images. There is also the potential to use apps to diagnose rashes or to assess a mole, thereby perhaps reducing the demand for dermatologists. You can now order your personal genomic sequence online at a fraction of the cost compared to a few years ago. Given the advances in wireless sensing, artificial intelligence, and the lab-on-a-chip, there is the opportunity to take self-diagnostics to a completely different level. There is even a prize (worth $10 million) for the inventor of the first functional “tricorder” for non-invasive sensing and analysing human data and making an instant diagnosis—first used by Dr Bones McCoy in the 1970’s series Star Trek.

In my own area of diabetes, the next year will bring increasing use of established technologies such as insulin pump therapy but with significant user preferences to use the smaller “patch” devices, a drive to have continuous glucose monitoring devices approved for use by the NHS, and a renaissance in self-monitoring of blood glucose using a more structured approach perhaps incorporating some of the methods used by the computer gaming industries to encourage testing. More patient education will be available online and web portals will be created to smooth the process of care between primary and secondary care providers and patients. The focus will be on outcomes that matter to people living with diabetes such as risk of severe hypoglycaemia rather than surrogate measures such as HbA1c levels or average glucose level.

The other prediction for 2012 is that social networking will have an even more prominent place in medical practice especially in the public health space with the potential to change behaviour more effectively and with less financial costs than traditional approaches. Communication between patients, their peers, and healthcare providers will be less hierarchical and the new social media could be also a hugely powerful driver for change in the area of new drug and device development as well as running clinical trials. Trail participants would be able to provide immediate feedback on a new drug, support training in the use of a new medical device, and importantly capture adverse events in “real-time.”

The caveat of all of this is to make sure that the technology innovators engage with clinicians so that the devices and technologies will actually be used by the target population. In my own speciality, many people with diabetes are from backgrounds where using a smart-phone or computer tablet to help with their healthcare is not a top priority even if they have the numeracy and literacy skills to use them and can afford the cost.

David Kerr wears many hats, sometimes at the same time – Diabetologist, editor of Diabetes Digest, researcher, and founder of VoyageMD.com, a free service for travellers with diabetes. He has received consultancy fees and honorariums for participating in advisory boards for Medtronic, Roche, Lifescan, and Abbott Diabetes Care. He also holds a small amount of stock in CellNovo (a new insulin pump company) and Axon Telehealth.