“I have a vision of an automated quantitative neurological examination, done by yourself with the help of devices and apps with no input from a neurologist to mess up the metrics. My colleagues tell me I am mad; they tell me repeatedly that there is very little chance of a machine taking over what took us the better part of 15 years to learn how to do. They are wrong. It all depends on why you want to automate the neurological examination. For diagnosis or monitoring? I need the automated neuro exam to be able to measure the impact of MS on your neurological system so that we can document and assess relapses and disease progression. We could potentially use the automated neurological examination as an outcome measure in clinical trials. The sky’s the limit in terms of what we can do with modern technology, the questions is whether or not neurologists and the community are prepared to concede that technology is better at doing things than we are? Why shouldn’t a computer algorithm look at, analyse and interpret retinal images taken with a smart phone? Why shouldn’t an algorithm assess upper limb and hand function? Why shouldn’t a device detect unsteadiness of gait and predict and help prevent falls? We are entering an era of technological evolution that is happening at such a fast pace that some of us in the medical profession are simply being left behind. I think we need to embrace technology and adapt; by using technology we will become better neurologists. The time saved will allow us more time to communicate with our patients.”
“I wonder if our new online web-EDSS calculator will be viewed in the future as a disruptive technology? In reality it gives you a surrogate measure of the physician EDSS. Wouldn’t it be amazing if the web-EDSS, or some future version of it, replaced the physician EDSS? I wonder if we could use it to detect and document relapses? Is this the beginning of a brave new world?”
“Are any of you interested in getting involved in designing and validated the DIY neurological examination?”
Jeremy Greene. HISTORY OF MEDICINE: Do-It-Yourself Medical Devices — Technology and Empowerment in American Health Care. N Engl J Med 2016; 374:305-308.
….. Yet “do-it-yourself” is rarely defined, and novelty claims in this arena require a decidedly short-sighted view of history. An examination of past and current DIY medical technologies suggests that over time, different approaches to these devices have been linked to different concepts of empowerment, with very different implications for benefit, cost, and risk for consumers…..
….. On the one hand, there are some deep continuities between today’s disruptive DIY medical technologies and those that came before. One proposed application of DIY health care, for example, is the digitally mediated remote physical exam, illustrated by CliniCloud, a thermometer–stethoscope accessory and smartphone app that can send a 15-second recording of a child’s breathing to a physician’s office for an assessment of whether a cough requires a clinic visit or just reassurance….