Bench Press

We’ve commented before about the ability of telemedicine solutions to bring cutting edge technology and quality of care to emerging economies. One example is some of the recent work that the Camera Culture Group from MIT’s Media Lab has done by building a clever optometry solution into an accessory and an application for Android-powered smartphones (HT: Engadget).

The concept is very cool. Many optometrists today use autorefractors, machines which scans the images formed on the back of a patient’s retina to get a rough, but automated, measure on the quality of your vision. Optometrists will then use phoropters to get to a precise enough measure of your eyes as to be able to prescribe lenses for contacts/glasses.

The problem with this approach is that autorefractors and phoropters are too expensive and too time consuming for widespread use in many places around the world. The NETRA solution that the Camera Culture Group came up with was to build an accessory and an application which force a user to make a pair of lines overlap using controls on the phone. Doing this repeatedly lets the application do a calculation similar to what is done by an autorefractor to calculate the quality of the user’s vision in a process which is much faster (several minutes) and cheaper than a standard eye exam (more details in the video and images below)

The project website shows a very compelling table which compares the relative prices and accuracies of optometry solutions in existence today.

It’ll be interesting to see where this technology can go once displays similar to Apple’s Retina Display become cheaper and more prevalent. This example definitely shows the power of telemedicine approaches and is hopefully a harbinger for more equally compelling and innovative solutions for the needs of scientists and doctors around the world.

(Images and video from NETRA website)

With smartphones becoming more sophisticated and more popular, its only natural that there are a growing number of attempts to use them as a platform for scientific inquiry (pocket ultrasound, microscopy, and astronomy for example). This is especially useful in developing countries, where a relative lack of high-end computers and fixed broadband access make smartphones a very suitable alternative to the more expensive, bulkier solutions that are used in the developed world.

It should come as little surprise, then, that doctors in India are helping to pioneer a new “telemedicine” tool using the camera and processing capabilities of Apple’s popular iPhone to do remote diagnosis of Retinopathy of Prematurity (RoP), a condition which is more likely to afflict infants born underweight. While curable, RoP needs to be treated within days of detecting it as to prevent permanent damage to a child’s eyes, something which the iPhone’s camera, mobile broadband, and robustness of software and security platform allows pediatric eye surgeons to diagnose from remote locations, hundreds or even thousands of miles away.

But, the potential of smartphones to function as a tool for tele-medicine can probably go far beyond this. At least, that’s what i2i TeleSolutions, an Indian-based startup, is betting on. They provided part of the software solution for the RoP diagnosis tool, and are aiming to provide software and services to enable further telemedicine technology – mainly:

• Security – It is important that sensitive medical information is transmitted securely in a way such that only the appropriate medical professionals see the information.
• Data compression – As fast as 3G and the new LTE networks are (and will be), network coverage and data transfer rates will continue to be a limiting factor on the adoption of telemedicine. As such, a true telemedicine solution will require lossless compression techniques.
• IT support – Medical organizations are not especially well-suited for building sophisticated IT capabilities, nor do medical professionals necessarily have the time to learn an arcane user interface. For that reason, telemedicine solutions should aim to provide web-based access methods (in addition to any non-web based methods they may choose to push) to access and react to data.

i2i provides further details on the scope of their platform on their web page, but I think it represents a strong start for a solution. Going forward, I’d like to see them (and any competitors that emerge) provide support for:

• Additional types of data – i2i’s focus seems to be primarily on images, but the full range of capabilities on smartphones is massive – GPS, accelerometer, magnetometer, and even microscopy and other medical attachments – and I would hate to think that tele-medicine would be limited only to its imaging capability
• Deployment on more phones – The iPhone is unique in the maturity of the platform, but it would be nice to see similar applications on other operating systems like Android, Symbian, and Windows Mobile.
• Interactivity – The i2i platform appears to be very unidirectional: (1) take a picture, (2) send it to a remote surgeon. I think the true promise of telemedicine is something which allows for a greater level of flexibility and interactivity on both ends (to refine the view, or make a suggestion on some other place to scan, etc).
• Ability to tack on analytics – There is a significant amount of medical data that needs to be analyzed/processed before it can be acted upon. Building some sort of open protocol or extendability (a la Firefox or Salesforce or LinkedIn/Facebook model) would do a great deal towards enhancing the potential of a telemedicine platform

Anyone else have any other ideas?