Biosensors help practitioners collect patient data remotely

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When David Borkholder closes his eyes and dreams big, he envisions a time when a vast array of health-related information is collected, measured and analyzed simply because someone sat on their home toilet.

Borkholder, professor of microsystems engineering at Rochester Institute of Technology, is researching the effectiveness of a sensor system his team designed and integrated into a seat that looks no different than those found at local home improvement stores. It started when the college approached Google, which had expressed an interest in advancing in-home cardiac monitoring, and proposed the idea. Google provided the initial funding.

The goal is to measure the homeowner’s blood pressure, heart rate and arterial oxygen saturation. One benefit of the device is the person whose health is being measured isn’t required to do anything out of the ordinary. Simply sitting on the seat allows doctors to gather and analyze reliable data. All that is required is skin contact and body weight pressing on the sensors; both occur each time a person sits in the bathroom. The seat has Bluetooth connectivity and the information it collects is sent to a cloud database.

“If you look historically at the way we practice medicine, it really is episodic, infrequent encounters with the patient,” Borkholder says. “Whether that is via a lab test you do, or a visit to the doctor, there is a limited and intermittent flow of information. When you start thinking about what in-home monitoring and wearable technology can do for us, I think it can fundamentally change how we approach health care.”

Obtaining accurate results from at-home testing is challenging because of compliance issues among patients and variations in the quality of available equipment. Those using this seat receive daily electrocardiogram, ballistocardiogram and photoplethysmogram testing at home while doing nothing more than answering the call of nature. Information collected includes the activity of the heart muscle, the force with which the heart beats and a measure of oxygen levels, similar to what is recorded when a doctor places an oxygen sensor on one’s finger at the office or emergency room.

“It really gives the opportunity for picking up on trends that would be hard to see during normal visits,” Borkholder says.

The consistent data collection over time can show potential trends that might predict deteriorating health conditions. “Our focus in working with Google was trying to develop a system to help heart-failure patients and reduce readmissions,” Borkholder says. “There is a significant likelihood of these patients being readmitted in a relatively short time period, within several months, to the hospital.”

In the future, Borkholder sees his sci-fi toilet seat benefiting those who have undergone chemotherapy, too. Sometimes, that treatment can weaken the heart muscle, so patients often have an echocardiogram every three months. “Can we detect deteriorating cardiac conditions for cancer patients using this device?” he says, considering the possibilities. “Could we pick up those changes in a far less costly manner and as much as three months earlier at home?”

Both Nick Conn, Ph.D. candidate in RIT’s microsystems engineering program, and Karl Schwarz M.D., director of University of Rochester Medical Center’s echocardiography lab, helped create the futuristic toilet seat that fuels these dreams.

“Dr. Schwarz brought a critical clinical perspective to the early stage design,” Borkholder says. “He is an important part of the team and was involved from the earliest conceptual stages. That medical perspective is really critical to engage early on in the process. The collaborations are fun and you always learn so much working with folks from other disciplines.”

Schwarz also helped develop software to translate the information gathered into key data for physicians. They can use it to tailor treatments more quickly and easily for patients.

“On ‘Star Trek,’ whenever someone on the crew became ill, they would lie down on an examination table in the sickbay and an overhead monitor would immediately begin displaying health information,” Schwarz says. “The ‘Star Trek’ patient didn’t have to do anything special to start the monitors. The simple act of lying down on the exam table was enough. The ‘Star Trek’ physician also didn’t have to do anything. Having a patient on the table was sufficient to start the flow of diagnostic data. That’s what we’re doing here with the toilet seat. We all use the bathroom throughout the day, and with each use, our device collects cardiac data, interprets your cardiac health and streams the data securely and instantaneously to your physician.”

Benjamin Miller, Ph.D., who oversees a lab dedicated to molecular recognition and biosensing at the University of Rochester Medical Center, was intrigued when he heard about the inventive toilet seat. “That’s a pretty interesting example,” he says. “One of the neat features of this field is that you learn that people are looking for applications of these biosensors everywhere.”

Miller has been working with the idea of biosensors for nearly two decades. He became interested in them through the Center for Future Health, which was located at the University of Rochester Medical Center.

“It was really kind of ahead of its time in looking at developing new technology that would be applicable to home health in a variety of ways,” he says. “How could we incorporate technology into everyday home appliances and elements of the house, everything from your bathroom mirror to the cutting board to the refrigerator that would report back on health? We came up with some interesting ideas, but we also realized that for us to drive these to the home, we needed to come up with ways to alter how medical diagnostics are done.”

Miller believes biosensors will one day replace many medical diagnostics used today. For example, consider what happens when a doctor prescribes a test to determine if a man has prostate cancer. “Right now, you go to the clinic and have blood drawn and someone runs the test and you get the test back in a few days,” Miller says. “In the future, I think three things will happen. The clinic will have a new way of doing it with a much smaller sample, more accurately and cheaper.

“Second, eventually the doctor will be able to do that right in the office with a hand-held device that is not much bigger than a phone,” he explains. “Third, what will happen down the line is, integrating some of this new technology, a doctor will have a handheld test that will not only look at PSA levels to determine one’s prostate health, but it will look at protein and genetic markers that will more accurately tell if a patient has prostate cancer.”

This local research has the potential to alter the future of medicine. In the years ahead, instead of booking an annual physical and being asked, “How are you feeling?” doctors might be armed with mountains of medical data collected unobtrusively from the patient.

Borkholder is excited by the prospect. “We will then discover key opportunities to improve the quality of health care, intervene on behalf of patients earlier in the process, and reduce the overall cost of health care,” he says.

Travis Anderson is a Rochester-area freelance writer.

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