IEEE Technology and Society Magazine - December 2015 - 37
2020, as computers downsize,
their increasing ubiquity among
the population will extend lifetimes, enhance intellect, and assist
in adapting to our environments.
The consequences of wearable
and in-the-body technology are far
reaching, and perhaps aside from
potential liability and distributive
justice issues, matters of autonomy,
which relate directly to privacy, will
become a foremost concern to the
legal community.
micron size levels, we can virtually decouple from the traditional
doctor-patient model for diagnosis.3
As in-the-body and wearable
processors become commonplace
within the next decade, reactive
medical practices will evolve into
predictive, preventive, personalized, and participatory medicine, or
what has been popularly coined "P4"
medicine, where devices send physiological data into the cloud so that
"examinations" can proceed in real
time. Expert systems, not doctors,
will analyze and determine wellness
and disease, and tweak personalized electronic prescriptions for
treatment and anatomical enhancement. Information gathered directly
from patients will be used to update
charts automatically, and may also
be used to alert health officials, such
as the U.S. National Center for Disease Control, of impending pandemics or the potential transmission of
diseases, such as Ebola and AIDS,
and capable of identifying the individuals that pose the public health risk.
By 2020, The Internet of Things
[3], largely RFID, will connect 100
billion identifiable objects to the
Internet [4], [5], many of which will
be implanted RFID-like devices, yet
a significant proportion will be in
the form of in-the-body application
specific processors.4 And, beyond
Overview of Available
Technology
Systems of med ic a l dev ice s,
diagnostic and therapeutic, that
interoperate in the single-person
environment can be divided into
three categories: 1) wearable and
embedded computer/transmitters,
sensors, electrodes, stimulators,
actuators, and pumps that deliver therapy and make and transmit measurements; 2) network
architecture, including telecommunications that interconnect the
devices, both within the body and
to the outer world; and 3) mechanisms to program and re-program
applications using interoperability architectures. Combined, these
systems will allow for sharing of
information throughout networks
both wired and wireless. Diagnostic/therapeutic devices will be
tailored to a range of specialized
clinical situations, home care,
hospitals, the battlefield, portable applications and doctor visits.
Apple Computer's HealthKit (app
installed on iPhone 6) and the
Samsung Digital Health Platform
are but a two examples of smartphone technology that have health
and fitness apps to collect physiological data. The data inform
the user of wellness; help combat
medical disease such as diabetes; and potentially send the data
directly to hospitals, insurance
3
Today's silicon-based microprocessors use
22-nm transistor technology, assembled as sixcore hyper-threaded chips running at roughly
3.3 GHz. Since each core executes two threads,
the theoretical processing speed is 40 billion flops. Before 2020, silicon chips will use
between 5 and 11 nm technology incorporating
fifty cores allowing 100 simultaneous hyperthreads to execute 330 billion flops. Although a
general purpose microprocessor may measure
90 mm2 and contain several billion transistors,
application specific processors (ASICs) can be
constructed employing fractions of the number
of transistor and remain computationally powerful while reaching down into the sub-micron
(smaller than blood cells) range for special processes.
4
Products range from relatively simple devices
containing medical history that are injected
under the skin, to more complex devices connected to the brain [6], [7].
december 2015
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IEEE Technology and Society Magazine
companies, and doctors, which
can update, in real-time, an individual's medical record.5
The latest embedded medical
gear often connects through Bluetooth or other technology to both
local and remote computers, 6
including smartphones, such as
Apple's iPhone 6, special phone
equipment,7 and local general purpose Internet modems that transmit medical data to central sites,
where a patient's condition is analyzed.8 We see the emergence of
sensors and stimulators telecommunicating with varying degrees of
sophistication: a) to monitor the
wellness of otherwise symptom
free individuals, who desire to
have their health monitored; b) to
track the occurrence of illnesses
extant within a population; c) to
diagnose, for example the onset of
a heart attack; d) to diagnose the
state of the electronic device, e.g.,
the functioning of the battery life
for a pacemaker or a prosthetic; e)
to adjust an anatomical process,
e.g., to alleviate pain, depression
5
By way of example, Samsung's commercial
partners for digital health currently include:
Nike, Aetna, Cigna, Cleveland Clinic, dacadoo,
Edamam, Humana, Fitbug, Lark, Merck, Preventice, Skimble, and WellDoc. Samsung's research
partners include UCSF, imec, Bloom Technologies, EarlySense, Elfi Tech, Stanford University,
LifeBeam, Sensifree, and SleepRate.
6
Presently in-the-body medical devices, such as
the pacemaker, maintain a bi-directional radio
communication with a remote albeit local computer in the Medical Implant Communication
Service frequency band between 401 MHz and
406 MHz. The maximum power transmission is
25 μW, providing a range of a couple of meters.
The maximum bandwidth is 300 kHz, which
limits these devices to low bit-rates compared
with WiFi or Bluetooth.
7
The CareLink® Network for pacemakers allows
patients to have their devices checked remotely
by telephone connection rather than what had
previously required a doctor's office visit: a full
parameter summary, battery voltage and longevity, lead impedance and trends, automatic
capture thresholds, episodes, percent pacing,
histograms, real-time and magnet egms, stored
egms, arrhythmia summary with mode switch
duration [8].
8
See [9], reporting on a system that detects an
arrhythmia and informs the patient's condition
by automatically sending an alerting SMS to the
mobile phone of the doctor and caretaker.
37
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