The most recent IEEE-PULSE publication dedicates several articles to the new generation of hospitals. The technologies behind these new billion dollar hospitals run the spectrum of science and engineering. But are the hospitals intelligent or are they rather enablers for better care? The use of “intelligent devices” needs to be carefully constructed. These devices are not restricted to the hospital of the future. They will become a part of the patient’s life at home.

Imagine the transition that has taken place over the last twenty years; when cell phones were not allowed, to now, when cell phones are not only encouraged but a necessary component of the distributed patient data system. You will use your cell phone QR app to open the gate of the parking structure and simultaneously register for your visit. From that point on the hospital tracking system remembers where you parked and if you made it in reasonable time from the garage to your appointment. Your data files of diagnostic images and lab tests are brought to the immediately accessible data storage. Your photo is recalled and the image recognition software of the waiting area alerts the front desk to your arrival.

You can be greeted as a familiar person, not with the greeting, “last name please”. Any outstanding issues from you last visit can be reviewed prior to your wait in the lounge. Of course you are most likely wearing a digital watchband that transmits your vitals to the attending physician’s iPad and the hospital EMR (Electronic Medical Record).

However much of the very useful diagnostic information is collected outside the hospital. The information on your digital watchband offers much more than your immediate vitals. It contains home information since your last visit. A record of the regularity in which you took your medications will be recorded. This will all be automated as well, without the patient’s interaction. Nano sized transmitters, which are safe to ingest, document when the patient took their medicine. If the patient did not take their medicine in a timely fashion the watch will upload this alert to the care facility.

It can be argued that the best laboratory for the measure of a patient’s well being is the home bathroom. Blood, saliva, stool and urine are all available each day. It only requires a creative non-intrusive way to acquire these samples; Saliva from the toothbrush mini lab, blood from a man’s shaver, or tiny pricks from new blood monitors that work with only a drop of blood. Bathroom wipes placed in a plastic zip lock bag and dropped into a small home lab center could record massive amounts of information.

Just what information is useful and how much is over done? Patients today are already having genome maps to identify their areas of risk. The tests can be very patient specific based on the genome risk factors. This information may also be specific for the medications that are prescribed. The use of statins, for example, requires regular tests for liver function. Such test data is easily acquired in the home and preset alert levels can quickly identify aberrant measurements.

Sleep quality is already measured in today’s wrist devices and synchronized with the patient’s computer devices. There is no reason this data could not be used for patients suffering from sleep apnea. For the elderly, this “activity monitor” along with heart rate could alert care facilities and care givers to contact the person by calling the individual on their wrist device.

This all sounds intriguing and everyone probably agrees, doable. Small APP companies have already developed, and many people are using, the “devices” mentioned. This area will continue to grow rapidly especially as the baby boomers start to rely on these devices. It would be great to say there is nothing but roses in the future. However, there are some very risky thorns that could be exposed by companies unfamiliar with the fail safe nature expected of these devices. To date most companies are relying on the thought that these devices do not enable any processes without the physician or another persons intervention. Is this really the case? As the devices get smarter and the physicians and caregivers rely more heavily on these devices, we may be riding a treacherous slope. We need to think very carefully about how we regulate these devices without inhibiting their life saving implementation. The US is already over regulating drugs and devices with much of the development now taking place outside the US.

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