Digital biomarkers: The future of healthcare

• Healthcare data and services are often siloed, unstructured, and difficult to access, leading to inefficiency and waste in the industry
• The vast majority of our time we spend living our lives is outside of traditional medical settings, providing a larger window for observing the signs of disease
• Hardware advancements in smartphone cameras have the potential to be used for measuring and remote monitoring to detect disease earlier

Globally and annually, trillions of dollars and data are wasted in the traditional healthcare industry.¹

The total time we spend in a traditional medical setting getting checked for a potential disease accounts for only a tiny fraction of the total time we spend living in our life settings.  And, according to a recent survey in the US, over half of primary care physicians spend less than 16 minutes with a patient per consultation.²  This leads to data that is far too often siloed, unstructured, and intermittently generated, hindering its ability to be used efficiently within our healthcare system.

The vast majority of the time we spend living our lives is outside the traditional medical setting – in the life setting – a place that provides access to a significantly larger window to observe the signs of disease.  However, thus far, there have been a lack of solutions to measure these signs.

Moreover, the traditional medical setting continues to rely on costly and invasive approaches that are also inaccessible to everyday consumers without a physician’s involvement.  This often creates a barrier to accessibility, affordability, and convenience, by requiring a physical intermediary (such as blood or tissue) to be measured to map or “mark” a disease (known as biomarkers).

There is a better way.  And you look at it every day.

Our healthcare system uses biomarkers to measure our health. Today, these biomarkers are overwhelmingly molecular (blood) in nature. In fact, according to the Centers for Disease Control and Prevention (CDC), 70% of medical decision-making about our health is based on lab test results.³  At my company, BioTrillion, we believe digital biomarkers will one day overtake physical biomarkers in healthcare.

Digital biomarkers offer a host of advantages to measure our health over molecular biomarkers that are confined to clinical settings, including improved precision, speed, and affordability (better, faster, and cheaper).^4,5

Our current healthcare system still lacks in terms of digital biomarker development, and we believe that healthcare innovators have only begun to scratch the surface of dimensions when it comes to identifying more of them.

Currently, the “milli-scale” – the size at which we can technically see, but usually do not perceive, has a disproportionate number of biomarkers that focus on the spatial dimension rather than the temporal (time) one.  We’ve all heard in science or sci-fi books and movies of the concepts of space and time. They are fundamental dimensions that govern the world around us, including how we see, perceive, and measure. Technically, if one tries hard enough, one can estimate spatial features (millimeters) at the milli-scale with their eyes.

However,  temporal changes (milliseconds) that occur at the milli-scale are nearly impossible to gauge with mere human senses. This is why most medical biomarkers, which have evolved in the field of medicine for several centuries, are disproportionately oriented around the spatial dimension.  There were no time sensors or stopwatches to measure the temporal milli-scale.  When you think about it – blood protein concentrations, cell counts, cell size, tumor size, weight, and height – are all forms of spatial measures.

We are only at the tip of the iceberg with the discovery of novel temporal biomarkers such as heart rate or electrocardiogram (ECG) – as they would have been impossible to measure a mere century ago. Nonetheless, within this unique domain of the seen yet-not-perceived, there is a wealth of valuable health insights that remain “hidden” in the temporal dimension.

In healthcare, the eyes and face contain classic examples of the milli-scale’s potential at the temporal level, but where there remains a lack of health innovation.  For example, consider the human eye.  There is temporal information, such as the milliseconds of time it takes for a pupil to constrict when stimulated by light, which can provide insights into one’s neurologic function. Poker players have figured out the value of information hidden at the temporal scale. By watching others’ eyes, players can gain insight into their opponents’ strategies and next moves.

However, for most of us, these often overlooked temporal changes occurring at the milli-scale are too difficult to measure with human senses – but not with machine sensors.  There exists tremendous potential to innovate new digital health technologies that can measure and produce insights from the features that live in the world of milliseconds.

This is particularly true in recent years, considering the rapid pace of hardware advancements we all enjoy in our smartphone cameras, with annually improving resolutions and frame rates.  It is in this area of healthcare that our technology, BioEngine4D,⁶ is focused – to digitally detect developing diseases.

Anatomy refers to the structure of parts that form the human body; this can be thought of spatially.  Physiology refers to the function of those parts; this can be thought of temporally. Using the cardiovascular system as an example, anatomy focuses on the structure of the heart – chambers, arteries, veins, and valves. In contrast, physiology focuses on the process of the heart pumping blood, such as heart rate.

According to Harvard Health, “when it comes to your heart rate, it’s a bit like the speed of your car. What you want is not too fast, not too slow, and not too erratic… And unless something unusual is going  on, you’re likely to be unaware of what your heart is doing.”⁷ Today, millions and soon-to-be billions of people will be able to measure their heart rates using smart devices and wearable technology. Artificial intelligence (AI) can process and analyze millions of retrospectively measured heart rate data points across a large population to determine specific changes in heart rate patterns that “mark” most accurately to a cardiovascular abnormality – making it a digital biomarker.

Many developing diseases express signs in a dynamic pattern of progression that can be better detected through continuous monitoring, using more subtle and frequent physiologic measures. Specifically, your eyes and face emit more feature-rich information about your health than any other visible anatomic area on your entire body. The types of optical digital biomarkers we have yet to develop are abundant in variety and hold the promise of being biomarkable to a vast array of diseases. They will enable a world in which signs of diseases can be detected before ever stepping into a physician’s office  – from the mere smartphone we look at every day.

Large companies in the tech industry are beginning to rapidly innovate in this space, especially given their expertise in AI.  For instance, Apple partnered with Stanford Medicine to develop the Apple Heart Study, which uses the Apple Watch to study irregular heart rhythms of participants who can easily contribute to large-scale real world evidence generation by simply downloading an app.⁸

Verily, a subsidiary of Google created the Study Watch to be used as part of a program that uses a proprietary smartwatch to measure various physiological and contextual behavioral data through its wearable sensors. Furthermore, it’s intended to bring us one step closer to understanding health and diseases, and a future of proactive healthcare.^9-11 Have the answers to many health problems been staring us in the face all along?  At my company, BioTrillion,¹² as part of our digital biomarker development, we are creating a mobile digital biomarker technology platform called BioEngine4D to digitally detect developing diseases from a single 10-second “Healthy Selfie” that can be taken from the smartphone owned by 3 billion people globally. The future of healthcare is closer than we think, and it may be just a quick “Healthy Selfie” away.