Nahum Kovalski

I’m there and I’m here, at the same time

Remote medicine is on its way, and it's going to get a big boost from sensor technology
The Fitbit bracelet sensor records vital signs and exercise information (Photo credit: Courtesy)
The Fitbit bracelet sensor records vital signs and exercise information (Photo credit: Courtesy)

The term “remote presence” has become a catchword that is being used by innovators in the healthcare market. It refers to both physician and patient geared technologies that allow for the remote medical assessment of a patient. The endpoint of these technologies is to eliminate the significance of distance between the physician and patient.

Remote presence (RP) can be a solution for geographically distant communities. It has been well discussed, in the press and professional medical literature, that there are huge segments of the world’s population that are too far away from any medical care. The significance of this is that people suffer and even die due to the lack of even basic medical assistance. With a successful RP solution, even today, a great deal of these remote population groups can benefit from some degree of medical care. For example, even a simple series of SMSs can be used to describe a condition to a remote healthcare professional. And in turn, this healthcare professional can SMS back with helpful suggestions.

There is no question that the Internet and the growing availability of smart phones, even in the developing world, have created the infrastructure for worldwide RP. 10 years ago, connectivity of this degree was a dream. Today, one can design web-based solutions that can collect critical information from patients and on-site health technicians, and then have a remote physician offer help based on this information and other sources of data. For example, a remote physician  informed of a patient with bloody diarrhea could make a likely diagnosis of a certain type of infection based on a series of questions that the patient answers, and the knowledge that there is presently an epidemic that causes such a symptom. The power of even this basic a solution is tremendous.

Many people, even in the United States, do not have ready access to a physician. And this can happen even in the middle of New York City. An elderly patient who has no assistance, may simply be incapable of navigating stairs or an elevator to make it across town to their physician. You may wonder how such individuals refill their prescriptions. The answer is that far too many don’t. So across the world, there is a desperate need for  this new RP  model of delivering healthcare.

Because many people use their cell phones and tablets as their communication hubs, there has been a tremendous investment in the field of mobile health or mHealth. mHealth refers to any health-related technology that is accessible via a mobile environment. Far more important than the strict definition, is the fact that mHealth is a key means for providing RP. Whether through SMS, email, specially created apps, the Internet or any other function available via a mobile device, the key is that the patient can gain access to medical care without having to physically visit the physician.

Developers realized that cell phones alone cannot collect all the information desired.  This realization is part of the reason for the literal explosion of interest and investment in the field of sensors. The idea is simple: sensors that can read pulse, blood pressure, temperature and in the future many many more health parameters, and then send this information to an online medical record. This medical record might be entirely housed in an application on the user’s phone. Or, the medical record could be sitting on a remote computer, as part of a cloud-based system.

For now, we will define cloud computing as a group of computers sitting “somewhere” that host many different kinds of applications and data. This “cloud” of computers makes it possible for others to access functionality and data that was put there by others. So a patient saves information to the cloud and a doctor can read this information from the cloud.

Back to sensors. Of late, smart watches are being touted as a readily available and easily  wearable mechanism for housing sensors and sending the information on. Not surprisingly, smart watches are part of a collection of technologies called “wearable tech”. Google glasses is a well-known wearable that can connect a user to a physician, pharmacy or general sources of medical information. In the near future, sensors embedded in our clothes, bodies and environments will feed a constant stream of information to our online medical records and other online data stores [which may be used for enhancing our shopping, for example].

For RP, the information collected from sensors will be critical to remote diagnoses. Let us now imagine a doctor sitting in a given location surrounded by computers that constantly display information about patients. An alert pops up that a patient has a very low blood pressure. The doctor clicks a button and is immediately connected by video and voice to the patient. The doctor begins to ask the patient a series of questions while reviewing other collected data, such as the person’s pulse and even ECG. Within moments, the doctor diagnoses a myocardial infarction – a heart attack. Another click of a button and the ambulance is on its way. In the meantime, the doctor continues to speak to the patient all while reviewing further information, such as the patient’s list of medications.

This technology already exists but it does not make it possible to evaluate many medical conditions. Imagine now that the patient is complaining of leg pain. Leg pain could be due to a problem with the patient’s back or could be related to poor blood flow in the leg itself. Future sensors will be able to assess blood flow throughout our body and the status of our muscles. So in the future, the remote doctor will know that the patient has normal blood flow in the leg, but also has a muscle spasm in the lower back. Abdominal pain  is also a very difficult complaint to assess remotely. But again, in the future, there will be sensors that can collect sufficient information so as to rule out any critical disease from the abdomen or elsewhere.

One problem that arises from this whole scenario is the reverse of our situation today. Whereas today, we have insufficient information on a remote patient, as more more sensors are created and used, we will be swamped with so much information that it will be impossible to track it all and to spot abnormalities [like the low blood pressure in the story above].

Over the course of the lifetime of a  person born a couple of decades from now, the amount of information collected about the person’s health will be staggering and truly hard to conceive. There is already a market for housing large amounts of personal information and analyzing it to find critical patterns, whether the information is health-related or not. In the future, technologies will be constantly analyzing the data they collect about us. Part of this analysis will allow computers to predict future medical problems. In this brave new world of medicine, remote presence might not even be necessary, as computers will make the diagnosis on their own and plan treatment on their own.

Now the interesting question is, if patients will have access to all of this, why should they need to go to the doctor in the first place? As I have noted in earlier blog posts, I cannot even predict what the role of physicians will be when computers and sensors can do all that I have described above.

I would like to add a quick note to the readers of this blog. Please feel free to comment and offer feedback on my posts. More so, if you would like me to discuss a certain medical technology topic (not answer medical consultations), then indicate as such in the comments section and I will do my best to respond as quickly as possible

Thanks for listening


About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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