Sameer Berry, a gastroenterologist-in-training Sameer Berry

Sameer Berry is currently a third-year resident physician at Cedars-Sinai Medical Center in Los Angeles. As a gastroenterologist-in-training, here's an innovation I could use: A "smart" toilet. What do I mean by that? Well, I'm not referring to those comfort-focused toilets with warm-water washing, air drying, and heated seats have been ubiquitous in Japan (and at Google's headquarters) for years. And I'm not talking about the hygiene-focused toilets that made recent news when Bill Gates announced a $200 million investment in toilet design to convert human waste into useable fertilizer and clean water. Although the latter is useful and needed, as the the improved sanitation could reduce infant deaths by 50,000 and save billions of dollars annually. The smart toilet I'm referring to is a health-tracking toilet. In my gastroenterology fellowship, I will treat diseases of the gut. I'd love to see the next generation of medical-technologists designing hardware with features to monitor and diagnose gastrointestinal disease. It's a hard problem for all sorts of reasons, but both doctors and patients could benefit if we figure out a way to stop flushing away some of our most vital health information.

The need for a "smart toilet"

Doctors realize that our patients will spend 99 percent of their time outside of our office. Yet most of the data we use to make decisions about their care is collected irregularly in clinics or hospitals. In my view, understanding the status of a patient's day-to-day health outside of the clinic is key to having a holistic assessment of well-being and therefore delivering better care. We've seen a lot of wearable devices emerge in the past decade. And the most recent crop of them are attempting to bridge this data gap by sharing medical information with physicians that goes beyond steps and calories. One example is AliveCor, which can record a medical-grade electrocardiogram (EKG) from a patient's smartphone to help detect abnormal heart rhythms. These medical technologies are aiming to get a better sense of people's health outside of the 0.1 percent of the patient's life spent in our office. But so far, we don't have an equivalent technology for the human gut. I see a big opportunity to apply these innovations in areas where patients feel a lot of stigma -- and bowel habits is a big one. It's also arguably among the most impactful and actionable data. Patients of all ages and socioeconomic classes experience gastrointestinal symptoms, and we are well aware of the diet's impact on our overall health. Yet, aside from a few recently-available technologies to analyze the gut's micro-biome, there are few -- if any -- devices to continuously monitor and share information on our gut health. The obvious solution is an upgrade to the toilet, which has not been significantly improved upon for hundreds of years. Lots of companies have tried to create a health-tracking toilet, but most have failed to deliver on their goals because they offer gimmicky monitoring or lack evidence that their data can accurately track health outcomes. Toilet manufacturing giants Toto and Matsushita made a step in the right direction when they released WiFi-connected toilets that measure body mass index, biochemical makeup (sugar, protein), flow rate, and temperature of urine. Inui Health (formerly known as Scanadu) announced FDA approval for its smartphone-connected urine analysis which can detect bladder infections, pre- and gestational diabetes, and kidney disease, all in the comfort of one's home. None of these have been incorporated into a single toilet, leaving a wide open opportunity for entrepreneurs.

Capturing important data

One of the major roadblocks for wearables is a drop-off in engagement. It quickly becomes cumbersome for people to charge a device, log data, and remember to carry a wearable around all day. But toilets are used every day and conveniently allow for passive and continuous monitoring of personal health data. For physicians, even basic data on stool and urine would be very valuable in the hospital setting. Doctors ask patients questions about their bowel movements and other details (consistency, color, blood, and so on). We currently rely a lot on anecdotal information from patients or nurses, which seems bizarre in a world where other data is objectively collected with technology. Making matters more complicated, patients frequently can't remember whether they had a bowel movement. But the number of times a patient uses the toilet each day is also clinically important when assessing whether they're getting any better from a gut health perspective. Elderly patients with dementia frequently go days without a bowel movement, putting them at risk for intestinal perforation and severe infection. Most hospitals use a device connected to the urinary catheter for real-time objective measurement for urine volume and temperature, but nothing similar exists for their stool. Besides urine and stool analysis, the potential uses of smart toilet analysis are almost limitless. They are the ideal place to capture metrics for daily measurement like blood pressure, body fat, and weight without adding work for the patient. And I see a lot of potential in measuring hormone fluctuation with menstrual cycles for family planning, or skin-sensing electrocardiograms. Alphabet has even filed patents in 2015 for pressure-sensing toilet seats to measure blood pressure. I also see patients using a "smart toilet" to take better control of their own health and well-being, including their diet, if one were made available. And studies have found that they're getting more comfortable with the idea. A survey from the research firm Accenture reported that nine out of ten people are willing to share wearable health data with their physician. And consumer adoption of wearable health technology is increasing exponentially, and has nearly doubled in the last two years from 21 percent in 2016 to 33 percent this year. The vast majority of patients surveyed in the study felt that wearable health devices improved the understanding of their condition, their quality of care and it helped them communicate with their physician. But I do have one note of caution. As with any health device with remote-monitoring, there is a risk of triggering false alarms or over-diagnoses which could lead to unnecessary workups and increased costs. The answer to that conundrum is prospective research studies to validate the technology and prove that its use helps patients and physicians achieve the health outcomes they find important.