From on the skin to under it, a diagnostics revolution looms

15 Jun 2016

Diagnosis is restricted by the information medical professionals can access but, with the growth in smart data-collecting devices, the ties are loosening.

Research Week

Wearables are the Tamogatchis of the 2010s, as Fitbits, Apple Watches and countless uninspired in-betweens abound. Each device may look, at best, subtly different, yet the overbearing conformity is only natural when such limited technology is being shared around.

Future Human

Pedometers, heart-rate monitors and sleep-pattern surveyors represent the banal holy trinity that dominates this industry. Yet when you peer into the world of actual approved and beneficial smart medical devices, you realise there’s an awful lot more under the hood, and diagnostics – perhaps even treatment – is on the cusp of a revolution.

Smart medtech

Today’s wearables will seem dated quite soon, perhaps. Photo via Shutterstock

The examples are everywhere. A few years back, in the UK, the NHS trialled a smart stethoscope that revealed minute readings from kidney stone treatment, with something similar recently approved in the US.

Elsewhere, a new device called NeuroLife has helped a quadriplegic man regain hand function. This device reads brain signals and connects to a sleeve on his arm, which stimulates the muscles that control his hand.

Medtronic has a fascinating ‘continuous glucose monitoring’ product that, through the use of a tiny sensor under the skin and a patch above, does exactly what you would expect.

The sensor connects to a transmitter that sends the information to a monitoring and display device. This can notify people when their glucose is approaching worrying levels.

The same company has a MiniMed device that connects to insulin pumps and, through an app, keeps users up-to-date on critical measurements for better management of diabetes.

Smart medtech

Diabetes is sort of a front-runner in terms of smart medtech. There are even smart socks from Siren Care that inform users of the early signs of diabetic foot ulcers. ‘Thermistors’ less than one-third of a millimetre long are embedded in the yarn to measure temperature and can prompt alerts to doctors and patients, when needs be.

Remote monitoring and analysis

Considering we spend far more time outside of hospitals than in, this growing trend toward treating people outside of a four-walled medical institution makes sense. Now, there are also more accurate, real-time readings possible through the use of sensors and apps, providing both patients and doctors with valuable information with which to make better decisions.

For example, a common diagnostic tool doctors use for people with cardiac issues is a six-minute walk test, basically measuring how far a person walks and how they handle it, among other factors. Of course, a few minutes on a treadmill can only reveal so much and it could be far more valuable to have more comprehensive stress-test data acquired over a longer period of time – say, a week. With current, and future, sensor capabilities, this is entirely possible.

Even basic smart devices should be able to perform better than a six-minute test – via Shutterstock

Even basic smart devices could provide more data than a six-minute test. Photo via Shutterstock

The great medtech divide

Surprisingly, it’s areas such as this basic tracking that make those fad wrist wearables a little more progressive than you may first realise. “The Apple Watch actually does have some interesting features. The pulse oximeter on the back will give you your saturated oxygen and heart rate,” explained Garret Coady, managing director of BlueBridge Technologies.

What is keeping Apple, Samsung or other tech companies from putting these technologies into medical-grade equipment? Time, money and mounds of paperwork.

‘If it costs €10,000 to get an everyday wearable tracker to market, it would be €400,000 to turn that into a trusted medical device’

Coady suggests that if it costs €10,000 to get an everyday, run-of-the-mill wearable tracker to market, it would be €400,000 to turn that into a therapy-deploying, secure, trusted medical device.

“You have to be able to rely on it,” said Coady, of the data retrieved from these devices. “That’s what smart medtech is: creating products that are consistent in what they do, and the measurements and readings can be acted upon. That takes time.”

An app like Angry Birds can be released on a Friday and, if there are glitches to iron out, someone can fix it over the weekend and update the app by Monday. Nobody dies.

“The repercussions of getting it wrong [in medtech] are too big,” said Coady. “You have to do due diligence. Track everything.”

With medical devices, what’s called “post-market surveillance” is needed, relentlessly. “You need someone online all the time, monitoring forums, articles, emails, everything, in case any issues arise,” said Coady.

“[It’s] kind of like what you hear in the drug world – they’re never finished, the danger is always there. A lot of monitoring for adverse events is needed by the company. It’s incumbent on them to respond to it once they see [anything].”

‘The repercussions of getting it wrong in medtech are too big. You have to do due diligence. Track everything’

The money trail indicates that this hurdle can be overcome, as investors are taking on medtech, biosensors and bioinformatics in greater numbers now than ever before.

Medtech’s future is shrinking

From a medical practitioner’s perspective, the devices in existence right now offer dramatic improvements, with evidence of greater diagnosis accuracy from better tools. But, in future, these devices will look like small fry.

Inspirefest speaker Lisa Helen, from the Tyndall National Institute in Cork, is working on a sensor to help anaesthetists guide needles to where they need to go, making their way to a chosen destination without any damaging nicks here and there.

“We are taking a needle that is already being used in the clinic and putting a small sensor on the tip of it,” she said. “That sensor is there to identify the tissue type that the needle is touching in the body, so we can identify exactly where the needle is and what it is touching.”

On a more futuristic scale, nano-engineers in California have utilised 3D-printing technology to manufacture fish-shaped microrobots – dubbed microfish – that may one day be used in detoxification, targeted drug delivery, or even surgery. There are actually a growing number of people looking at how miniature robotics can help surgeons in multiple-use cases.

Investment figures in medtech companies and sensors, via Deloitte

Investment figures in medtech companies and sensors (click to view full-size). Image via Deloitte


They say beauty is only skin deep, and, in a few years, so too may diagnostics be, as a growing number of tattoo-like tools are being researched. Look at ‘electronic skin’ (e-skin), a subject on which papers are released every few weeks celebrating another obstacle overcome.

Last October, scientists developed a ‘skin-inspired organic digital mechanoreceptor’ that could give people with prosthetic limbs a type of feeling. In a report published in Science, Zhenan Bao and 16 colleagues described an approach using pressure-sensitive foils and printed ring oscillators.

“The sensor successfully converted pressure into a digital response in a pressure range comparable to that found in a human grip,” the research said.

Then, in April this year, University of Tokyo researchers developed a breakthrough OLED biosensor-driven display that could be placed on a person’s skin. The display measures just two micrometres in thickness and, in theory, could show data on blood oxygen levels, pressure or temperature, if and when the wearer needs its.

Investment in bioinformatics, via Deloitte

Investment in bioinformatics. Image via Deloitte

Electronic skin problems

A problem with e-skins, though, is malleability. Should engineers ever aspire to have patches ‘tattooed’ over regular skin, particularly over joints, it would need to be flexible – a problem that may have just been solved by Zhenqiang ‘Jack’ Ma (not to be confused with the Alibaba magnate).

Creating what he calls the world’s fastest stretchable, wearable, integrated circuits, Ma’s serpentine-like circuit design allows for vast improvements in both flexibility and connection capabilities.

“My background is in microwaves, for many years. I worked for industry, too. When I looked into this problem, I realised we needed to solve it,” he told after the paper was published.

Ma claims his e-skin can handle frequencies up to 80GHz, with more research to be published soon.

“Interference was such a big problem, but the way we laid out the circuit means that it no longer affects anything,” he said. “It can mean diagnosis, in the future, could really be obtained through these types of ‘wearables’.”

Ma’s discovery was such that, on the day of its publication, health companies inundated him with follow-up questions, one of which I, too, was curious about. That is, if a patient wears this form of e-skin over their chest, and they also have a pacemaker, will signals cross and create potentially lethal problems?

“No, no, no,” Ma assured me. “Mayo Clinic was just onto me about that very thing, because it’s exactly what they would encounter. But from our tests, we showed no interference. Because the frequency is so high, we can use just one wire to transmit multiple data flows.”

Fabricated in interlocking segments like a 3-D puzzle, the new integrated circuits could be used in wearable electronics that adhere to the skin like temporary tattoos. Because the circuits increase wireless speed, these systems could allow health care staff to monitor patients remotely, without the use of cables and cords, via Yei Hwan Jung and Juhwan Lee/University of Wisconsin-Madison

Fabricated in interlocking segments like a 3D puzzle, new integrated circuits could be used in wearable electronics that adhere to the skin like temporary tattoos. Because the circuits increase wireless speed, these systems could allow healthcare staff to monitor patients remotely, without the use of cables and cords. Photo via Yei Hwan Jung and Juhwan Lee/University of Wisconsin-Madison

Look back to look forward

It can take today’s medical professionals weeks of meetings, discussions and tests to diagnose a patient, but technology advances such as those outlined above have prompted visions of a Star Trek-style future for healthcare. In this utopian world, our doctors would be equipped with Dr Leonard McCoy’s Tricorder, a simple handheld device that could diagnose illnesses immediately.

“We can imagine a future in which anyone can use a high-tech, all-in-one medical device to diagnose, monitor and treat disease,” reads a recent Deloitte report, which pulls out references even older than Star Trek for its future hopes.

“We might even go so far as to envision an updated version of the ‘Florence Nightingale days’ [..] one person could handle all of a patient’s care.” Of course, that person would be armed with immense amounts of processed information.

Deloitte argues that there are five building blocks for exponential technological progress: processing power, data storage, network connectivity, miniaturised hardware and advanced software. Indeed, devices are getting smaller at a rate of 5.6 per linear dimension per decade, bandwidth capabilities are skyrocketing, and processors and storage are only going one way.

The continued development of these five building blocks magnifies exponential advancement capabilities, according to Deloitte. As digital technology and wireless networks increase mobile device capabilities, this movement reaches a crescendo.

Smart medtech

Advancing technologies have dramatically reduced overhead issues for developers of new medical technologies. Image via Deloitte

“When technologies merge into open platforms and ecosystems, the investment becomes lower and lead time shorter, since people and technologies can rapidly build on previous waves of development,” Deloitte claims.

And so, the leap from fiction to reality is predicted on the back of remarkable advances in technology, using big data in faster, more innovative ways than medical professionals could ever have managed in the past.

Take, for example, Watson, the IBM supercomputer, which has a reported cancer diagnosis rate of 90pc. By way of comparison, humans successfully diagnose around 50pc of patients.

A Tricorder is probably too far-fetched to be a serious possibility. (The device could also cure illnesses in a second or two. Let’s be real.) But the drive towards devices that harness colossal amounts of personal, local and even global data to better diagnose will, inevitably, lead to better treatments. And it’s a natural assumption that one day this information will become more available to both medical practitioners and patients, be that through wristbands, socks or their own skin.

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Main scan image via Shutterstock

Gordon Hunt was a journalist with Silicon Republic