Photo courtesy of Cloud DXSaving lives, Star Trek style: Cloud DX wearable closes in on Tricorder X-Prize Phil Froklage May 5, 2016 Columns, View from the ‘Loo We were talking about how there aren’t enough doctors when Dr. Sonny Kohli ran out of time for me. I was interviewing him about his company, Cloud DX, a finalist in the Qualcomm Tricorder X-Prize. One of many X-Prizes, the Tricorder prize offers $10 million for a device capable of diagnosing illness in a patient without any help from a human being. As we spoke, Kohli was driving through the Southern Ontario countryside to Mohawk College in Hamilton, to speak at a conference on the future of virtual care. Kohli was telling me about the preciousness and fragility of medical knowledge. An airstrike against a Syrian hospital had just killed one of the last pediatricians in Aleppo, which underscored the need for technological solutions to our medical challenges. Doctors are simply too scarce, the need for them too great. But, as can happen in rural Ontario, Kohli drove through a dead zone and our connection dropped. When he called back, his voice had changed. All apologies, he told me we needed to talk another day. The hospital had called. A patient needed his help. With no technology to turn to, Dr. Kohli was turning around. *** For Kohli, it started in Haiti. He was volunteering there after the 2010 earthquake, at a hospital called Project Medishare. Founded by two philanthropic physicians in 1994, Medishare was a tent hospital in the years leading up to the quake. After treating 30,000 victims on kitchen tables, Medishare moved into a permanent structure – a half-functional community hospital ravaged by earthquake damage. Its medical staff lacked basic diagnostic equipment. They didn’t have a working EKG machine. Kohli knew an EKG was non-negotiable, and teamed up with a pair of engineering students who had accompanied him – Mike Battaglia and Sean Murphy – to jerry-rig an EKG from a broken unit, a few meters of wire and some duct tape. Kohli was working in Haiti’s most advanced hospital at the time. All the others had been destroyed by the quake. “I just kept thinking, ‘Why do we need to MacGyver a broken EKG machine?’” says Kohli. “‘Why don’t I have a smartphone-connected EKG? This is 2010, this should be possible. And it should be affordable enough that we can deploy it in a place like Haiti, India, Africa, or remote parts of Canada.’” The thought wouldn’t leave him alone. When he got home, he and the engineers teamed up to make the world’s first smartphone-connected EKG, small and cheap enough for the developing world. They called it Triomi. Their success attracted the attention of serial entrepreneur Robert Kaul, an executive who specialized in bringing Canadian technologies to the U.S. Kaul cold-called Kohli to talk about his smartphone EKG, and ask if he’d ever heard of something called the Qualcomm Tricorder X-Prize. *** It’s impossible to overstate just how hard it is to build a Star Trek tricorder. “Star Trek shit” is startup shorthand for technology so exotic and powerful it seems to bend or break the laws of physics. The X-Prize is asking companies to make a device ripped straight from the show. Originally, there were 312 teams. That number dwindled to 29, then nine. Two teams have dropped since then, and now only seven remain. “What (the X-Prize) realized with the seven remaining teams – and that number may dwindle even further – is that it’s very difficult to put everything the X-Prize wants together,” says Kohli. “They’re asking for the sun, the moon and the stars. It makes it very exciting, but the challenge is, they realized, harder than they thought.” As a result, X-Prize has extended its deadline, with tricorders for the remaining teams due this summer. They will be graded, then tested throughout the fall at the University of California, San Diego. Winners will be announced in January. For a chance to win the $10 million, the device must diagnose 10 “core conditions” reliably: anemia, urinary tract infection (lower), diabetes, atrial fibrillation, sleep apnea (obstructive), chronic obstructive pulmonary disease (COPD), pneumonia, otitis (ear infection), and leukocytosis. The final condition is “absence of core conditions,” meaning the device must reliably know when a patient has none of the above – a taller order than it sounds. These core conditions can already be detected and monitored with existing technology, so the X-Prize is making teams cover all of them. A winning tricorder must also diagnose and monitor three elective conditions from a possible 10: pertussis (whooping cough), hypertension, mononucleosis, hypothyroidism/hyperthyroidism, food-borne illness, shingles, melanoma, strep throat, or a cholesterol or HIV screen. From a technological standpoint, these conditions are way tougher than the core set. As the X-Prize guidelines dryly put it, diagnosing any of the elective conditions “may require entirely new technologies or very significant miniaturization pushes.” Then there are the vital signs. Five of them: blood pressure, electrocardiography (heart rate/variability), body temperature, respiratory rate and oxygen saturation. A winning tricorder has to monitor all of them at a hospital grade. “It also has to do it in real time, unlike a hospital monitor which are spot-checks for the most part,” says Kohli. “So, it depends on the vital sign, but every second or every minute type thing. All that data has to be logged in the cloud correctly as well, so not only does it have to be acquired from the patient in real time for 24 straight hours; it needs to be logged in the cloud correctly to ensure it’s all there. We’re talking raw data as well, so not just a ‘120 over 80,’ but the actual pulse waves for us, or the ECG trace.” It’s a big data play, which is part of the vision of the Tricorder X-Prize. The rules demand teams log data “to a cloud whenever and wherever connectivity is available or minimally at least every 12 hours.” The goal is to use these untold reams of new data to learn even more about the impact different conditions have on the body. Diagnosing 13 conditions and monitoring five vital signs in real time is a lot to manage, but that isn’t even the hard part. The consumer also has to like the experience of using the tricorder without any help from a doctor. “Fifty per cent of the marks are weighted towards what the consumer felt when they were interacting with your tricorder, and remember that there can’t be any healthcare people around, just the consumer and the tricorder,” says Kohli. “If the consumer marks your tricorder poorly because they didn’t like the experience, you’ll lose.” *** Cloud DX’s solution, Vitaliti, comes in three parts – an homage to the original tricorder. The first piece is a wearable device draped around the user’s neck like a mantle that constantly monitors EKG, heart rate, oxygen saturation, respiration, core body temperature, blood pressure, movement, steps and posture. The second piece is a hand-held. It has a spirometer, a small device with a tube you blow into that analyzes your breath. It can tell you on the spot if you have asthma or COPD, a common smoking and pollution-related illness. The handheld also features an otoscope, the tool doctors stick in your ear. CloudDX has crafted one that takes a photo and analyzes the image to tell the patient whether or not they have an infection. It also has a microphone to analyze the audio of the patient’s coughs. The third piece is a bay station: a desktop unit that analyzes urine, blood, and saliva. There’s no comfortable way to get blood from a person, and consumer experience is huge in the X-Prize, so Vitaliti takes as little as possible. “We tried to make that experience very seamless, taking very minimal amounts of blood, and exchanging blood for saliva wherever we can. That is very novel technology. We’re going to be able to diagnose HIV just from saliva, which is incredibly exciting for us. We can only imagine the implications that will have in the Third World, even the First World.” Crafting technology this powerful that is still easy to use was an effort that required collaborations all over Waterloo Region and Toronto. Vitaliti’s headquarters is on Victoria Street South in Kitchener, Ontario, but much of the design happened in Toronto. “All three pieces have a very similar design language, thanks to Cortex, which is an industrial design firm who partnered with us and worked very closely with us in Toronto,” says Kohli. “We also worked with Pivot, which is a user experience company, who helped us create the app, so that the when the user interacts with the tricorder they feel like they’re interacting with a doctor.” *** When Dr. Kohli was called back to the hospital mid-conversation, I was about to ask him if he thought of his tricorder as a replacement for doctors. The vision for the Tricorder X-Prize is unequivocal: It hopes to inspire devices that “address the[…] challenge of transforming healthcare by turning the ‘art’ of medicine into a science” and “inspire a future where consumers demand the tools to assess and manage their health independent of a hospital or doctor’s office.” They want to be in the business of doctor replacement. Kohli is a physician himself. I doubt he sees Vitaliti, or any of the other solutions diagnosing 13 conditions and monitoring five vital signs, as a replacement for a doctor. But after getting called away eight minutes into our first interview, Kohli tried three more times, unsuccessfully, to answer my question about if he was inventing his replacement. Each appointment we made had to be rescheduled when duty called. As a full-time physician, Kohli is just too busy to worry about if his device will replace him. Right now, it seems like he’s hoping for all the technological help he can get. Top photo: Dr. Sonny Kohli with Cloud DX’s Vitaliti diagnostic technology. View from the ‘Loo looks at the issues, people and events that shape Waterloo Region’s technology sector.