Abstract
Smartphone-based telehealth holds the promise of shifting healthcare from the clinic to the home, but the inability for clinicians to conduct remote palpation, or touching, a key component of the physical exam, remains a major limitation. This is exemplified in the assessment of acute abdominal pain, in which a physician’s palpation determines if a patient’s pain is life-threatening requiring emergency intervention/surgery or due to some less-urgent cause. In a step towards virtual physical examinations, we developed and report for the first time a “touch-capable” mHealth technology that enables a patient’s own hands to serve as remote surrogates for the physician’s in the screening of acute abdominal pain. Leveraging only a smartphone with its native accelerometers, our system guides a patient through an exact probing motion that precisely matches the palpation motion set by the physician. An integrated feedback algorithm, with 95% sensitivity and specificity, enabled 81% of tested patients to match a physician abdominal palpation curve with <20% error after 6 attempts. Overall, this work addresses a key issue in telehealth that will vastly improve its capabilities and adoption worldwide.
Highlights
Enabling patients to receive a medical diagnosis and treatment when geographically separated from a physician has been a long-standing goal of healthcare, as exemplified by telemedicine and the direct-to-consumer telemedicine industry
For patients complaining of acute abdominal pain, a physician will first suspect that a patient has appendicitis and will seek evidence indicating otherwise, by using a physical examination and palpations
If remote palpations are needed, the physician calibrates the system by performing a self-palpation using their own smartphone (Fig. 1b)
Summary
Enabling patients to receive a medical diagnosis and treatment when geographically separated from a physician has been a long-standing goal of healthcare, as exemplified by telemedicine and the direct-to-consumer telemedicine industry. Telemedicine enables patients to receive medical advice from the comfort of their home, which is especially helpful those living in a medically underserved community Such communities are common in both developed and resource poor settings, for example 20% of Americans[4] live in a medically underserved area as defined by too few and/or geographically distant clinics. Modern medicine relies on medical encounters that primarily consists of two components: a patient history and physical examination[15] During such an exam, a physician: inspects, feels (palpates), taps (percussion), and listens (auscultation) to the patient. We enable remote interactions with a new technique that trains a patient’s own hands to palpate and act as a surrogate for a physician Since this technique leverages the innate ability of modern smartphones to track movement, no additional hardware or devices other than a smartphone are needed
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