Visualization by Sonali Patel
Objectives: Technology-enabled non-invasive diagnostic screening using smartphones and other point-of-care medical devices was evaluated in conjunction with conventional routine health screenings for the primary care screening of patients.
Design: Dental conditions, cardiac ECG arrhythmias, tympanic membrane disorders, blood oxygenation levels, optic nerve disorders and neurological fitness were evaluated using FDA-approved advanced smartphone powered technologies. Routine health screenings were also conducted. A novel remote web platform was developed to allow expert physicians to examine TES data and compare efficacy with routine health screenings.
Setting: The study was conducted at a primary care centre during the 2015 Kumbh Mela in Maharashtra, India.
Participants: 494 consenting 18–90 years old adults attending the 2015 Kumbh Mela were tested.
Results: TES and routine health screenings identified unique clinical conditions in distinct patients. Intraoral fluorescent imaging classified 63.3% of the population with dental caries and periodontal diseases. An association between poor oral health and cardiovascular illnesses was also identified. Tympanic membrane imaging detected eardrum abnormalities in 13.0% of the population, several with a medical history of hearing difficulties. Gait and coordination issues were discovered in eight subjects and one subject had arrhythmia. Cross-correlations were observed between low oxygen saturation and low body mass index (BMI) with smokers (p=0.0087 and p=0.0122, respectively), and high BMI was associated with elevated blood pressure in middle-aged subjects.
Conclusion: TES synergistically identified clinically significant abnormalities in several subjects who otherwise presented as normal in routine health screenings. Physicians validated TES findings and used routine health screening data and medical history responses for comprehensive diagnoses for at-risk patients. TES identified high prevalence of oral diseases, hypertension, obesity and ophthalmic conditions among the middle-aged and elderly Indian population, calling for public health interventions.
Why is this work important?
Providing good healthcare in low- and middle-income countries (LMIC) paradoxically requires expensive equipment for health monitoring and assessment which may not be easily available because of resource limitations. There is high variation in degrees of healthcare access in LMIC, but such access is important because cardiovascular diseases, preventable blindness, oral cancer and treatable neurological conditions constitute more than half of the disease burden in LMIC. Comprehensive TES may allow for more patients to be screened for more conditions in resource-limited settings, improving their access to primary healthcare. A lack of consensus exists about the usefulness of TES in augmenting primary health screenings in LMIC.
What has been done before?
Devices that allow TES have typically been evaluated in isolated silos, concentrating on individual devices or specific anatomical sites. They have additionally not been comprehensively evaluated alongside routine health screenings.
What are our contributions?
This is one of the first studies to investigate using multiple TES to augment routine health examinations. To facilitate this large-scale study, we developed and successfully used web examination platforms that enabled multiple physicians to diagnose health conditions remotely. We identified patients who would not have received the care they need in the absence of TES, and link TES to primary health outcomes.
This study led to significant insights about strategies to develop technologies at MIT that are ready for deployment for effective and scalable primary care in the real world.
What technology-enabled examinations were performed?
Single-lead ECG: AliveCor Mobile ECG
Blood oxygen saturation: Contec Medical Systems 50-DL Pulse Oximeter
Oral imaging: ACTEON Soprocare
Retinal scan: D-EYE direct ophthalmoscopy adapter attached to iPhone5s camera
Tympanic membrane imaging: CellScope Oto with iPhone5 LEDs and camera
Neurological examinations: Microsoft Kinect
What are the next steps?
We are actively working on automated diagnoses, analyses of disease co-occurrence, and patient risk stratification.
Future studies that build on our technology-enabled screening process can evaluate the process for larger numbers of patients. A future longitudinal study may allow for additional insights into time-varying conditions.
The screening process combines routine health examinations and numerous technology-enabled exams.
