Thinking Inside the Box
Enterprising researchers design award-winning diagnostic device to make health care access universal
Could a portable toolbox transform health care in rural China? For Chung-Kang “CK” Peng, Ph.D., a statistical physicist at BIDMC, the idea is not so far-fetched. For the past five years, Peng and his international, multidisciplinary team have worked on building just such a contraption as part of the $10 million Qualcomm Tricorder XPRIZE, which challenged contestants to design and construct a compact, wireless, and user-friendly clinical diagnostics device for the lay consumer. Incorporating Peng’s expertise in non-linear dynamics and complex systems, their novel prototype could hold the key for bringing basic health care to parts of the world that currently have none. “In China, there are about 800 million people who don’t have health care because they live in rural areas and don’t have access to large hospitals,” says Peng. “Imagine if we have a system that can diagnose 50 or 100 diseases and we put one of these systems in one million villages, then we serve a really huge population.”
Encouraging technological development to solve the world’s most pressing problems for the benefit of humanity is the mission of the non-profit XPRIZE. The foundation’s Tricorder challenge takes its name from the futuristic handheld device made famous on the 1960s television series Star Trek, which could diagnose any malady with one swipe over a patient’s body. While the contest’s parameters weren’t quite so ambitious, its intent was clear—to boldly go where no health care tool has gone before. Starting in 2012, nearly 300 participating teams were charged with designing a portable unit weighing less than five pounds that allows the user to effortlessly and accurately monitor five vital signs and diagnose 13 health conditions independent of a health care worker or facility. In 2015, seven teams were selected to build models of their designs, and by December 2016, the competition was narrowed down to two finalists, one of which was Peng’s Taiwan-based Dynamical Biomarkers Group (DBG).
They forced us to push the boundaries a bit.
Andrew Ahn, M.D.
Getting to the finals was no mean feat. “They didn’t make it too easy for us,” laughs Andrew Ahn, M.D., a BIDMC hospitalist, who acts as DBG’s lead medical advisor. “They forced us to push the boundaries a bit.” For one, the competition's designers were clever in their selection of diseases, requiring the teams to address a range of diverse conditions that can’t be diagnosed with a single technology; some, like atrial fibrillation, require signal monitoring, others, such as ear infections, need imaging, and still others, like anemia, entail blood testing. With the call for more technologies, however, the five-pound weight limit becomes a heavier burden to bear, and creativity becomes the name of the game. For example, DBG adapted the microphone of their unit’s built-in smart phone to analyze a person's exhalation, creating a "spirometer" for measuring lung function to diagnose emphysema. They also applied different lenses to its camera for imaging ear infections and melanoma. In addition, the team members relied on Peng’s expertise in developing algorithms to analyze information over time to make their invention both intelligent enough to make relatively accurate diagnoses and sufficiently user-friendly to do so simply and efficiently—a mere 90 minutes by a untrained, non-medical consumer in the last stage of the contest. “We work with what’s in front of us,” says Peng. “We always think this way.”
While ultimately no team successfully met the full requirements to claim the Tricorder Challenge’s $10 million grand prize, DBG took home a $1 million second-place award for its strong performance. However, they had always considered the competition as just a starting point for their efforts. “This is the first generation, which was just to compete, to show the feasibility of our principle,” stresses Peng. “But we want to have a second generation that can actually be used in the field.
It’s not meaningful to win the award if you can’t use what you’ve built.” From the beginning, the team members agreed that any prize money they earned would feed back into developing and testing their toolbox. Already they are exploring ways to incorporate diagnostics for more conditions into their unit and are in discussions with governments in Asia and Africa to potentially run trials of their system in locations with minimal health care access. And while the latter is an agenda close to the heart of this international team, their ultimate goal is to improve health technologies for all patients in need, be it across the globe or around the corner.
Unfortunately, $1 million doesn’t go as far as it used to when transforming health care as we know it. That’s why Peng and his colleagues’ efforts have relied on philanthropy, which will continue to be instrumental in moving their work forward. In addition to the smartphone manufacturing company HTC, which sponsored the design and building of the DBG’s XPRIZE prototype, the team has received support from a variety of donors who have been inspired by the innovative nature of its research. “The reason why we appeal to these donors is that we agitate the system. We figure out how we can actually move health care into that next stage,” says Peng. “And you probably notice that a lot of our money comes from Taiwan and China because I believe those will be the places where you can implement these technologies and start this evolution first.” A health subsidiary of a large Chinese energy company, Ovation Health Institute has invested $500,000 to support the team’s cross-disciplinary research and to explore the integration of traditional Chinese medicine concepts and practices into their toolbox. Largan Health Technology, the health division of a major supplier of camera lenses for smartphones and digital cameras, made a $600,000 gift to support their cross-disciplinary work, as well as make the interface with this type of technology more user-friendly. And the Delta Environmental & Educational Foundation in Taiwan has donated almost $350,000 to sustain the group’s innovative training program, which brings students from China and Taiwan in diverse specialties ranging from engineering to physics to medicine to study in Peng’s lab for a year.
Peng and Ahn believe that this type of intuitive philanthropy and the comprehensive research and teaching environment of an academic medical center will be critical to bringing their dreams to fruition. Of course, they are dreaming big—from applying machine learning techniques so that doctors can train computers to become increasingly better diagnosticians, to incorporating social, environmental, and behavioral factors that influence health into their algorithms, to improving their analysis of vital signs continuously over time to get more accurate assessments. They are even in talks with a company that makes drones to determine the feasibility of delivering medications to isolated areas by these unmanned mini-aircrafts once a diagnosis via their toolbox is made. “It’s not that we are trying to supplant the doctor’s role, we are trying to supplement it,” says Ahn, noting that much of their work has equal applicability to patients in the U.S. as routine care increasingly leaves the hospital setting. “This technology lends itself to putting big data into context and hopefully empowering the patient and the community in the process so that they can become proactive in their own care.”