Smartphone becomes doctor’s digital assistant

Engineers are working with doctors to develop wearable digital health technologies that can prevent and treat diseases at home, helping healthcare services reduce outpatient visits and readmissions.

We live longer. At the same time, the number of elderly people with a wide combination of chronic diseases is increasing, and recruiting nurses and doctors is becoming more difficult. This creates a high demand for new healthcare technologies.

“It’s a bit crazy actually. Currently, we’re seeing a double pressure with elderly people suffering from type 2 diabetes, cardiovascular disease, dementia, and Alzheimer’s. In addition, the need for mental health services has virtually exploded—something that was not anticipated to this extent. More people than ever are experiencing mental health problems, and this is happening at a time when we’re short of healthcare professionals across the board,” says Jakob E. Bardram, DTU Professor and Head of Section in Digital Health Technology.

Developing health technology

To cope with the pressure on hospitals, the trend is to treat patients at home rather than as outpatients in hospitals. It’s about making early diagnoses and preventing disease instead of treating diseases. Today, DTU engages in a number of strategic partnerships companies and the healthcare sector to design and develop digital health technologies. Here, researchers use wearable technologies such as smartphones as platforms to monitor sleep, heart rhythms, and mental disorders, among other things.

Common to the projects is that the researchers collect and analyse data that makes it possible to monitor patients at home over a long period of time. This gives doctors a better and more detailed understanding of how patients are feeling while enabling faster diagnostics and treatment.

Smartphone finds disease

“DTU works closely with doctors and nurses to develop new types of health technologies and explore how they can be used in clinical research and treatment. And digitalization will play an important part! Instead of the doctor only seeing a snapshot of the patient for an outpatient treatment, we can use smartphones to monitor patients over time. Smartphones are a great tool for developing personalized digital monitoring solutions. Everyone has one and they’re easy to use,” says Jakob E. Bardram.

An example of such health technology is the Neuropathy Tracker app developed for smartphones by DTU and neurologists from Zealand University Hospital in Roskilde. Now, the first version of the app has been tested on patients to see if it can detect symptoms and early signs of neuritis.
The challenge for patients suffering from neuritis is that their nervous system can degenerate if they suffer from type 2 diabetes or have undergone chemotherapy. If the disease is not treated in time, numbness can occur in the fingertips, feet, and legs.

Traditionally, neurologists use vibrations from a tuning fork to detect early signs of nerve impairment. But with the Neuropathy Tracker, doctors can ask patients to use their smartphone as an examination tool, where patients enter whether they feel the vibration in their legs by vibrating the phone from their big toe up the leg. They then record if they feel pain from a needle prick on the skin up the leg.

App a difference-maker for the hospital

An ongoing validation study will now show whether the researchers have developed a clinically applicable tool that can prove that the app is reliable and provides trustworthy data.

“In a validation study like this, you typically ask patients to repeat the study on themselves twice to make sure they get the same result. And it has actually surprised us that the patients’ own examinations are excellent. Even better, or at least as good as if a professional had performed the same examination,” says Martin Ballegaard, Senior Consultant and Clinical Associate Professor at Zealand University Hospital in Roskilde.

He believes that an app like Neuropathy Tracker makes a big difference for the hospital, both in terms of optimizing resources and making it easier for patients who don’t necessarily have to physically attend:

“We have a great need to develop solutions that can help us prioritize our work. In the future, healthcare will be under more pressure, with fewer staff to treat more patients. That’s why we’re increasingly making use of this type of measurement. At some point, of course, we need to see the patients to make sure they don’t have another disease, for example. However, if the patient follows a treatment in the outpatient clinic, maybe they don’t have to visit the hospital physically every time. This can help us prioritize the patients who most need to be examined quickly in the hospital.”

Wearable health technologies growing

The Neuropathy Tracker is just one of several new wearable health technologies emerging. The development of digital technologies is moving fast. Today, healthcare and the healthcare industry are looking for more engineers with skills in developing and designing new digital health solutions that can be used to diagnose, prevent, alleviate, or treat diseases. From mobile apps to cloud-based solutions that can analyse large data volumes using AI.

To accommodate this demand, in 2022 DTU created a new specialization in digital health, expanding student admission by a third to a total of 120 students.
In addition, DTU and the Capital Region of Denmark have established Denmark’s first Technical University Hospital of Greater Copenhagen (TUH). The vision is to create better and more health services for the benefit of the individual patient, the overall healthcare system, and society in general. This is done by pooling the academic and professional competences of DTU and the hospitals, and create a setting for the collaboration between engineers and healthcare staff, where they can meet and create new ideas and solutions on the hospital premises.

Collecting data on a large scale

Developing new digital health technologies requires many disciplines. To detect, assess, and diagnose diseases in patients’ homes, DTU researchers use a wide range of wearable sensors that measure heart rate, heart rhythm (ECG), blood sugar, blood pressure, weight, and oxygen saturation, among other things. Researchers can link the data to patient behavioural data from the smartphone such as mobility, activity, social activity, steps, sleep, and speech. Patients can also contribute by entering data on things like medication intake, depression, pain, diet, well-being, and stress.

In terms of research, DTU works both with collecting data on a large scale and analysing it. The ability to collect large amounts of data about an individual patient’s disease and compare it with information from millions of other patients opens up completely new possibilities. Combined with advanced algorithms, the data can predict disease progression and make accurate diagnoses, says Jakob E. Bardram:

“If you ask what’s happening in healthcare technology in the next 10 years, it’s about developing and scaling data analytics. The biggest challenge will be to gather, process, and analyse data across patients and diseases in a unified platform, so doctors and nurses can use it effectively. Creating such platforms is an altogether different task, involving the use of AI and the design of intuitive overview screens for patients, relatives, and clinical staff—and that’s what we focus on.”

Two cases using smartphone as platform:

• Stroke rehabilitation
  Recovering from a stroke traditionally requires many hospital visits. But with the help of new technologies, DTU is developing an app to help patients rehabilitate at home. This is done using a wearable exoskeleton that is controlled via signals from the brain. It can help the patient rehabilitate the arm, for example. Researchers are working to make rehabilitation more exciting by combining it with gamification.
  
  Using a headset, patients can pretend to sweep virtual dirt off the floor with a physical broom in hand. By imagining a physical activity like sweeping, patients’ motor nerves are stimulated, allowing them to faster regain their mobility and agility. This kind of active patient involvement—combined with direct physical feedback—brings motivation and satisfaction and creates an opportunity to improve the rehabilitation process.
   
• Heart problems caught early
  Researchers and doctors from DTU and Bispebjerg and Frederiksberg Hospital want to gain a better understanding of how heart disease develops over time. In one study, data such as heart rate, sleep, stress, and pulse are collected using a heart rate sensor and an app installed on the patient’s smartphone.
  
  The data will be used to develop mathematical algorithms to detect heart problems at an early stage and start preventive treatment. The technology is also being developed in close collaboration with an innovative Danish start-up, where the technological solutions will be incorporated into their products.