Technologies such as Asthmapolis represent the confluence of two trends that are themselves new: the remote monitoring of patients and the collection of surveillance data from untraditional sources.
Remote monitoring tracks patients with chronic conditions, such as congestive heart failure, that might flare up into emergencies. Patients keep devices in their homes or on their person that wirelessly or electronically alert health care workers to worrying changes. The Veterans Health Administration (vha) has been experimenting with remote monitoring for over a decade. The linked devices range from glucose meters for diabetics to bathroom scales because weight changes can indicate worsening congestive heart failure. Trials outside the vha have included electrocardiographs hooked up to a home phone line to check for early signs of heart failure; daily medication dispensers that wirelessly communicate whether they have been opened; smartphone apps through which diabetics can report what they have eaten and how much insulin they have self-administered; and Bluetooth-enabled peak-flow meters, which asthma patients can use to detect whether their airways are becoming constricted.
Because most of these technologies are new, only a few comprehensive studies have been done. So far they report big increases in patients' sense of control over their illness and overall satisfaction with their care. The technology may not prove its full worth for improving health care until sensors are used by larger groups of patients.
Most of the data gathered during remote monitoring travels from one patient to that person's doctor or team, thus targeting that single person's care. In the other trend that has helped birth Asthmapolis and similar projects, the information flow is from the many to the many—that is, extracted from multiple sources of data to benefit multiple users, who can range from public health authorities to members of the general public.
Traditionally, disease-surveillance data arise from, and stay within, medicine and public health: they originate from physicians, flow through health departments and are published by government agencies. The earliest iteration of this new, crowdsourced style of surveillance was probably ProMED-mail (Program for Monitoring Emerging Diseases), an electronic mailing list run by academic volunteers that began in 1994 and now reaches about 60,000 subscribers. ProMED-mail takes contributions from a wide array of correspondents and accepts data from official sources such as governments and from unofficial ones such as news reports. A second generation of the same concept is HealthMap, founded in 2006 by a team at Boston Children's Hospital. It combines the active contributions of readers—ProMED-mail's bread and butter—with passive, automatic-intelligence processing of government data, news reports and social-media chatter in order to produce real-time maps of disease outbreaks around the world.
Both projects have demonstrated that they can identify important developments more quickly than traditional surveillance. In February 2003 ProMED-mail relayed a query that broke through the wall of silence that the People's Republic of China had constructed around the burgeoning SARS epidemic. And in April 2009 HealthMap's Web-scraping tools spotted respiratory illness reports in Mexican newspapers a couple of weeks before the CDC announced the first cases in the H1N1 flu pandemic.
Meanwhile others are working on a generation of portable devices that gather health data. Fitbit in San Francisco, for example, makes a family of wearable sensors that communicate information about sleep and exercise to a mobile app and Web dashboard. The Scout, announced in late 2012 by Scanadu in Moffett Field, Calif., has been likened to the “medical tricorder” from Star Trek because the handheld device simultaneously measures pulse, temperature and blood oxygen. The challenge for these new devices, as with the earliest remote monitors and e-mail lists, will be persuading people to use them. There, DeMello says, the latest toys have an edge. “The idea is, you have a core monitoring technology, wrapped in a product—preferably a lovely little piece of design—wrapped in a service,” he says. “You need all of those to be successful.”