Internet of Body: The Next Big Thing for Medical
During SMTA International, I sat down for an interview with Titu Botos, Ph.D., the VP of engineering at NeuronicWorks. We discuss the next big thing to come after the Internet of Things (IoT), which Titu believes is the Internet of Body (IoB). IoB could include implantables and ingestible medical devices to monitor your body better. Overall, it’s a great time for medical electronics.
Nolan Johnson: I’m here with Titu Botos from NeuronicWorks in North York, Canada. Where is North York?
Titu Botos: It’s about 14–20 kilometers away from downtown Toronto.
Johnson: Let’s start with a quick overview of what NeuronicWorks does for its customers.
Botos: We’re an engineering house and a design shop. We take an idea and bring it to life. When a customer comes to us, they leave functional products as well as blueprints for manufacturing; we call that the “cookbook.” Although we strive to help them after that for the manufacturing itself, they are fit to go anywhere they want to. In other words, our business model is that when everything is said and done, they have the intellectual property (IP); they can do with the IP whatever and wherever they please. That’s our business model.
Johnson: And they can go from an idea or a concept all the way through the engineering methodologies for all of the pieces to a finished product, or they can manufacture where they want.
Botos: Yes. We have in-house design for PCB electronics, firmware—which is low-level software—and high-level software from the cloud. We complement these three main skills with industrial, graphical, and mechanical design. On the other side, we have apps, the Internet, and the cloud. All of that comes under one roof, and we are able to serve the customer fully. We call those “full-house” projects.
Johnson: What are some of the industries that you serve with these design services?
Botos: We started 10 years ago from an industrial control background surrounding any type of motors—valves, pressure, temperature, etc. We do not use a programmable logic controller (PLC), but we can design a PLC and do the electronics and the firmware for a controller to make it work. After starting this way, we expanded into a few automotive projects, and medical more recently, which means another set of troubles and challenges.
Besides these three main paths, we are very interested in wearables, which you might call our fourth industry. I believe it’s the next big thing to come because on the industrial side right now—even automotive and medical—we ride the IoT wave where everything gets connected. Every node brings data into the cloud. We have a collection of information that we can peruse, digest, and make a decision based on.
This is the current trend, and I hope we can still ride that wave for a while. However, it will die down, like anything else, because everything has a beginning and an end. After IoT goes down, I hope IoB will come up and propel us forward further. IoB is a similar concept to IoT, but right now, we have a sensor attached to the body of the person, which will be the new wave. First, it was the PC, and then it was cellular, dot com, etc. Now it’s IoT. What’s the next trend? We think it will be IoB.
Johnson: Do you have customers coming to you with IoT projects at this point?
Botos: IoT is the thing now, and it’s huge. We have project after project going into the cloud right now. There are two types of customers: startups that want to make the next little gadget that collects some data, and then other types of enterprises and businesses that have been established for years that do pumps or controls, but were never in or reported to the cloud before.
There is a shift in the business. Customers try to change their positioning so that they charge for the service as much as possible. For example, for reading temperature or pressure, they may even think to give a sensor, including the transducer, electronics, Bluetooth, or Wi-Fi. All of those options can be used for free and guaranteed to work for five years, but every time anyone accesses your pressure, you come to our cloud or web portal and are charged 0.00 something. With IoT, everything is connected to the cloud. It’s a huge amount of data that can be used afterward to find trends and convey messages to see what happens.
Johnson: How do you see IoB and medical merging in the future?
Botos: They are very closely related because they all touch the body. IoB and medical sense what happened to the body—primary signals. They pull up signals and send what happens to the body, such as heart rate.
For me, IoB is beyond wearables like the Fitbit. All due respect for Fitbit—there is nothing wrong with them—but there are many other medical devices right now that get attached to your wrist or placed in your ear that can tell you things besides the heartbeat. Some wearables can even tell you about your stress level. Right now, my stress level might be off the chart, but it’s going there because by analyzing the signals the body puts out, you are able to infer quite a few things.
I believe the two niche markets that will go first into IoB are kids and seniors—the two extremes. For example, I’d be very happy to see what my mom is doing right now. She’s back home in Romania. Yes, I talk to her every second or third day, but it would be interesting to know, “Did she fall? What is her heart rate? How is her well-being?” If you can characterize that in a word, it would be the signals. I believe seniors might want to take it because, for example, I tried to convince her to have such a device to see what happens.
The second one is the kids. I like to know what my monkeys are doing and if they are fine. The problem with this thing is that it opens a new era of privacy. It’s a new meaning because you can be hacked. Two weeks ago, there was a Bloomberg Businessweek magazine story with what happened to Apple and Amazon, and that’s another story. Now we are overwhelmed because somebody can find these things out about you. If not for bad reasons—for lack of better words—then for life insurance. You have your whole life in a data center somewhere.
There is still time until this becomes a reality. I’m still concerned about my privacy. I’m not doing anything special or wrong, but I’m still concerned. If I look at my daughters, they don’t care; they post everything everywhere—it doesn’t matter. With this approach, if you give it to kids first, they will grow up and, as adults, will say, “Sure. I’d like to know what happened to my heartbeat in the last 24 hours.” It’s another approach.
Johnson: Not only do we have the possibility of invasiveness around data privacy, but IoB starts to touch on a number of different ways of connecting to the body.
Botos: IoB would become successful the moment you forget you have that attachment. Today, it’s still bulky. You still have to put it on, pull it off at night, and eventually charge it. That is still a threshold that many people have to go above or surpass to accept the technology.
The moment it touched your skin, like a sticker, you could forget about it. You could have it there for weeks, months, or even more, and you wouldn’t have to do anything. You could shower and maybe even swim. That will be a true application for IoB.
Johnson: Do you see IoB moving into implantables?
Botos: Yes. It’s already there.
Johnson: I could easily see a pacemaker doing something like that or an implantable blood sugar monitor.
Botos: Yes. The other class I was talking about besides patches is implantables. I saw it last year at the Wearable Technologies Conference in San Francisco where you could have a glass-based encapsulated pill if you want. It’s a near field communication (NFC) tag that you put under your skin, and from that moment, you can start paying with your hand. You can identify yourself to a tag or a door: “Yes, I am Titu. Here I am.” That’s a completely different class. It has a higher class in the medical industry because it has to survive inside your body and should have as little of an effect on your body as possible. The first implant I saw was encapsulated in medical-grade sterile glass.
The other class of IoB devices would be the ingestible ones. You swallow it as a pill, and it has two purposes. First, it’s sensor-based as in it goes, stays in your body for about 24 hours or so, and it collects data as it travels through your digestive tract. You have a receiver on your body somewhere very close because the energy is low like a patch. It transmits that, and when it goes out, it’s basically disposable.
The other scope for this digestible would be to deliver drugs to the right place. Yes, invasively entering the bloodstream is one way—the old way; for example, with something like insulin, we cannot have it as a pill. There have been hundreds of trials where they try to convert insulin into a pill so you can take a pill instead of taking a shot every time you need it. It’s much easier to swallow, but it’s proven that the digestive tract is breaking the insulin into pieces, so that is not the drug anymore.
The point is to have a vehicle that will deliver that insulin intact, so it can do what it was meant to do. That would help, but recognize that it’s a third class. We hope blind people will start to see one day. We have a project in our labs, but it’s still far away from taking somebody from the street and having them regain their vision the next day—that day is still very, very far off.
Johnson: What are some of your customers’ biggest challenges regarding FDA approvals? Do you have any advice for design teams looking at starting to do a medical device around this technology?
Botos: Go with a team that has been doing that for a while because there are a few hoops you have to jump through that can be costly if you don’t know how to approach them.
Johnson: Give me an example.
Botos: All the specifications, for instance. I’m hard-pressed to give all the details for a test now, but to satisfy something for the Federal Communications Commission (FCC) and industrial control is one thing. To do medical—something that touches the body or goes in the body of a patient—is a totally different ballgame. Choose the right horse, so to speak. You need time, money, and patience because it doesn’t happen by applying today and getting an approval the next month. No—it’s months and months of pushing, providing data, doing tests, and answering questions because this is the part where we come in again because we can shield the customer for most of it.
A medical device is not developed in three days either—you need months to do that. By the end of working with the customer, we know the product inside as well as the customer if not even better, if I dare say. We want to be able to answer questions when the officers come. We can let the customer know what we did so they don’t have to bother with, “Give me all the details this component has. What are the materials?” We have all that prepared. In the end, the specification stays with the customers. We are there for support and to make life a bit easier while going through that process.
Johnson: When you’re developing a medical device for a customer, how soon are you bringing the FDA into the process on the design?
Botos: That’s a great question. After a few projects, we have a little experience, and we don’t have to bring it in as soon as the system design. However, as soon as we start to choose components and technology, then you should have somebody on your side looking over your shoulder and guiding you through the process. It would be a pity to arrive six months or a year and a half later to discover that the device will work but it’s a nightmare to get it certified.
Johnson: When you’re starting to make the design and component selections, is that when you’re also starting to talk to the FDA?
Botos: When we do the system design and choose the technology that you think you are going to employ in a project, that’s the best time because that’s the moment you choose your future.
Johnson: There’s also been a lot of discussion about supply chain issues with some long lead times for components, especially passives. Is your team facing challenges coming up with the right kinds of parts?
Botos: Yes. Oddly enough, there is a Chinese saying that goes something like this: “May you live interesting times.” This is what we are doing right now. It started in 2001–2002 when manufacturing jobs left North America and went offshore; it became a big challenge. Then, design jobs are going somewhere far; that’s another level of challenges. Now, jobs are coming back for multiple reasons: getting lost in translation, and a shortage of components.
You have to prove to your customer that you understand them, are on the same page, and are speaking the same language, for lack of a better word. By that, I don’t mean English, but you understand fully what they mean. When they say green, it’s green, and when it’s yellow, it’s yellow. I feel that’s very important.
Prove to them that you can control the source of the components you choose. You know exactly where they’re coming from and the quality and you can provide those components. The big challenge that we have seen in the last year or so is with automotive electronics because cars are crazy right now. Five or 10 years ago, you had around 40 processors in a car. Today, I don’t even know; there are so many. As I said, IoT is coming. Even now, portable toilets have sensors. Sensors and electronics are everywhere.
The huge demand on the components is a strain on manufacturers. The big picture is the manufacturers want to speak with Apple, Amazon, IBM, and other big guys. When startup customers come to talk to us, one of the advantages we bring to the table is that we know where to talk, how to get the components, and we give them a view and bill of materials (BOM). This shows we did our homework and the component is available and in the right point on its lifecycle.
To answer your question, it’s very important to make sure that after a year and a half of development, you have a BOM that can be replicated again for the next 15 years. There are customers—especially medical and even industrial and automotive—who are fine with developing a new version eventually (a better product), but they’re not okay with redesigning the product next year because a component is obsolete. That’s an entirely different thing.
We face the challenge of making sure that you know that the component is coming; industrial is one level of quality, automotive is another, and environmental is even more stressful. Medical is one step above that. You have to make sure the component is correct, has the right materials inside, and can last for 15 years. If I design it well in that environment, it will last 10–15 years. That’s a requirement.
Then, do we have that component? Can we make sure the component will be available for manufacturing? We are moving as a company into thousands of pieces with continuous growth, and our projects now are manufactured in hundreds of thousands of pieces. For that, the supply chain has to be very well established.
I appreciate our connections with Avnet, Arrow, and Fisher Electronics. Those are the guys who are helping us. They can vet the BOM we propose and say, “Yes, this is the thing you can use today and in five years,” and provide all of the components.
Johnson: Fantastic. This has been helpful. Is there anything else that we should talk about before we wrap it up?
Botos: Everything is very interesting and becoming increasingly challenging. There are still projects where you have to drive an LED on and off or blink it or dim it, but most of it is going very small. As I said, IoB has to be very small to be successful—that’s the bottom line. The pairing of IoB and IoT with artificial intelligence is another thing entirely. What is a human anymore? That’s a good question to ask at one point. One problem is we have less time for each other, but we try to do more things. A doctor can reach 1,000 or 10,000 patients, but an engineer of a product can touch millions. This is a great job.
Johnson: Thank you for your time, Titu. I really appreciate it.
Botos: Thank you very much. It was my pleasure.
This article was originally published in the November 2018 issue of Design007 Magazine.