The era of the Internet of Medical Things (IOMT) can be best summarized into five broad categories of relevancy for the practicing emergency physician.

First, there are devices that an emergency physician uses directly with patients. An example of this would be a digital stethoscope that augments sounds and creates new data sets that can be analyzed in real time.

The second category of IOMT devices is that which we as emergency physicians will be called on to interpret by our patients. A good example of this would be a connected inhaler that gives the emergency physician significantly more information about the patient’s recent use and exacerbation patterns.

Devices that enhance communication within the emergency department or hospital are a third broad category of devices that allows for more efficient and new forms of communication. Patient-monitoring technology is another broad category of devices that will connect the emergency physician to patients in new and exciting ways. Imagine pre-hospital ECG readings but for a whole host of new applications.

The final broad category is more on the fringe: the overlay of robots and deep learning and computer vision tools to help with diagnosis and treatment. Robots are now involved in surgery and the delivery of medication and supplies throughout hospitals. Drones are being tested for delivery of medication and blood to remote locations that can’t be accessed by ground transport. And entrepreneurs are looking to leverage deep learning to assist with radiology imaging, dermatology, and ophthalmology.

Devices for Direct Patient Care

The Digital Stethoscope. Auscultation using a stethoscope has been a hallmark of the physical exam for much longer than anyone who is alive and reading this article. Small advances in technology have improved portability through size reduction and increased volume emitted by the device. Now, we are seeing a revolution in design and function. New digital systems are augmenting traditional stethoscopes, and there are now smartphone cases that can act as conduits for auscultation. These devices can capture sound and represent it as an amplified digital signal or display the data in completely new user experiences. Imagine devices that not only augment and refine the sound experience but also tell you, “Hey, there is an s3 heart sound.” In this example, you can imagine patients using the device at home and texting their primary care provider or telling an emergency physician upon arrival that the device detected an s3.

As an example, CliniCloud’s digital stethoscope not only gives you information on the heart sounds but also heart rate and respiratory rate. This device retains sound information at lossless 44.1 kHz audio, stores it locally on the device, as well as backs it up on a HIPPA-compliant cloud platform so that your information, as well as that of family members, is retrievable and also sharable. The smartphone app allows you to follow trends, share the data with health care providers, and gives tips on data acquisition and interpretation of data. Also very compelling, this device can be used with telemedicine services like Doctor on Demand, giving more information to the clinician on the other end of the video call. The CliniCloud, with stethoscope, thermometer, and case, is priced at $150.

At $499, Thinklabs’ device can capture the data and display it in a format for teaching and rhythm strip tracings, showing vital information such as an s4 heart sound. This digital file can be shared, stored, and even imported into an electronic medical record. There is an app feature that allows for importing into mobile SMS apps such as WhatsApp, allowing the operator to share for expert interpretation or a second opinion.

The Digital Otoscope. There are a few different iterations of this, but the most prominent example is CellScope’s smartphone attachment. As is the case for a number of new medical devices, the CellScope Oto leverages the core technology present in the smartphone to deliver very clear images of the tympanic membrane. Providers can acquire and interpret these images at the bedside already through direct visualization. But now, they can compare these to images taken by the family from home using the same device. This also provides the opportunity to leverage telemedicine by sending images to subspecialists in those rare cases where immediate consultation is required.

This technology also gives a few new advantages not previously available. One, it allows images to be stored in the electronic medical record to confidently document physical exam findings instead of just descriptions of what is being seen. Additionally, the images can follow the patient back to the primary care clinic so that provider can monitor any changes that may have occurred in the interim period. The CellScope is priced at $79.

The Digital Ophthalmoscope. The fundoscopic examination is a challenging part of the physical examination. Operator skill, the patient’s pupillary anatomy, and lack of mydriatic agents all become less important when a digital ophthalmoscope is used. There are stand-alone devices that produce more complete digital images or hybrids that can be used in conjunction with a smartphone. It is worth noting here that one of the challenges manufacturers have when dealing with smartphone-based attachments is the sometimes impossibility of keeping up with ever-changing form factors in smartphone design.

These devices improve view of the retina, and similar to other digital otoscopes, having these images allows physicians to employ teleconsults more effectively and document in the medical record more accurately. To be discussed in more detail later, deep learning and computer vision will be able to help identify disease processes such as diabetic retinopathy. Thus, expert-level guidance will eventually be embedded in devices such as this. The iExaminer PanOptic from Welch Allyn is more than $500 with an iPhone adapter.

Mobile Ultrasound. Perhaps one of the most developed areas of IOMT, the first handheld ultrasound system connected to an off-the-shelf smartphone was FDA cleared back in 2011 when Mobisante (no longer being sold) brought this product to market. Now, there are options from many companies, including GE and Philips. These connected devices bring new form factors and, with that, new possibility use cases. Plus, since the devices are essentially portable computers, operators can leverage the connectivity for education and teleradiology. As these systems evolve and become more ubiquitous, various types of monitoring systems will likely be layered on top of the ultrasound system, acting as an interface hub for other forms of IOMT. GE’s Vscan retails for more then $8,000, while the Philips Lumify has a $199 per month subscription.

Dr. Younggren is currently the chief medical officer at Cue and serves as the medical advisor for Shift Labs and Blumio. He is also medical mentor for the Highway1 hardware accelerator. He is a practicing emergency physician and serves as the medical director for emergency preparedness and urgent care at Evergreen Health in Kirkland, Washington. Previously, he served as chief medical officer at Mobisante and Shift Labs.