March 20, 2010
Mini Laboratory For MD Offices
Why make a second visit to your doctor to discuss test results when the tests can be completed during your first visit?
In a joint project, researchers from seven Fraunhofer institutes have developed a modular platform for in vitro diagnosis which enables various types of bioanalysis – of blood and saliva for example – to be conducted in the doctor’s surgery. Thanks to its modular design our IVD platform is so flexible that it can be used for all possible bioanalytical tasks, states Dr. Eva Ehrentreich-Förster from the Fraunhofer Institute for Biomedical Engineering (IBMT) in Potsdam-Golm.
The core element of the mini-laboratory is a disposable cartridge made of plastic which can be fitted with various types of sensor. For an analysis the doctor fills the cartridge with reagents – binding agents which indicate the presence of certain substances such as antigens in the specimen material. Various tests or assays are available for different types of analysis. To perform an assay, the doctor only has to place the relevant substances in the cartridge and the test then takes place automatically. »We have optimized the assays so that up to 500 assay reactions can be conducted in parallel in a single analysis step, explains Dr. Ehrentreich-Förster. Even in the case of complex analyses the doctor obtains a result within about 30 minutes. A new module on the reverse side of the cartridge also makes it possible to analyze the specimen material at DNA level.
Of course one logical future step is to make miniature test labs so cheap and easy to use that you can do your own testing at home. Beyond that comes embeddable devices that will monitor your blood chemistry from within your body. Then your cell phone will query the embedded sensor devices, pass up the results to a medical diagnostic server somewhere on the web, and then pass back down to you the news that you need to stop at a drug store to pick up a drug that is waiting for you.
Even without home medical testing it should become possible to avoid going to a doctor's office. Just as some drug stores have automated blood pressure testing devices they could also have miniature automated medical testing labs. The test results could be used by expert system software to recommend over-the-counter treatments or refer you to a doctor's office if the test results suggest a prescription-only drug is needed as a treatment.
It seems like most of the population is sufficiently scientifically illiterate and undisciplined in following medical directions that they might need a medical professional to hold their hand through the process, even when it's not strictly necessary.
A couple of thoughts:
Tests in doctor's offices are big profit centers - doctors work very hard to transfer tests (labs, x-rays, etc) from hospitals to their offices, where they can mark them up dramatically. Unfortunately, their quality assurance isn't nearly as good.
Why the heck do most tests require prescriptions??
If we are going to put a lid on health care costs, we need to automate medicine as much as possible. These types of advances are good news, and as a desirable side effect, they help reduce human error by reducing human input.
Heck, I haven't figured out why I have to go back to the doctor's office to get the test results even now; Didn't they invent the mail some time ago, and phones a bit after that?
Yes, I also think we shouldn't need to see a doctor in order to get tests done. Ideally: You create an account on some web server for all your medical records. You go some place and request tests. When completed those tests automatically get added to your web server account medical test history. You let doctors into your account as appropriate.
Yes, automation is absolutely essential. Automation has got to include fewer human interactions. So going to a pharmacy and sitting down at a machine, selecting some tests, and then hitting a button so that the machine sucks blood out of you could avoid all human interactions up to that point.
Your web server medical history account could even know what tests you need and at what interval. You could get an automated text message on your smart phone with repeated reminders until you go get some test. Then the web server gets notified of the test results and it automatically knows to stop pestering you about it. Maybe then it starts pestering you about getting some drug. Or it gives you a daily reminder to take the drug.
I look at what financial services web sites are evolving into and think this has got to happen for medical services too. I rarely interact with human bank workers. That's the way it should be with medicine.
You could do it very simply: create microfluidcs test by engraving paths and strucures through UV Masks and ozone engraving in plastic cd-rom disaks... Deposit reactants with a press and glue the discs and you have a microfluidic laboratoy. Near the center two orifices for blood and urine with a plastic or paper cap. Insert it into a cdrom like reader. It spins the fluids go that go and react through centrifugue force. positive results are read by making certain binary tracks like a spiral cdrom track chemically readable...
A laser would just read the results. A laser could also heat certain parts os the disc, etc...
Thousands of tests could be made like that in an instant and cheap... An universal software could read and make diagnostics and with the internet...
One practical problem: testing today is geared towards insurance. Tests are typically marked up 20x (I kid you not!), and then discounted 80-90% by insurance.
Without insurance, you'd have to negotiate a discount. Of course, if tests were freed from prescription protection, competition might solve that very, very quickly...
Automated testing will be cheaper and could be done with mass market price competition if it was done in drug stores.
Insurance: We need higher deductibles and health savings accounts so that people spend their own money and become more price sensitive.