You Are Becoming Digital Evidence: Medical Ingestibles, Insertables, and Embeddables

It can be challenging to schedule regular lab work or checkups. The doctor's availability, location of labs, costs, and the general whirlwind of life all contribute to this complexity. Personal health is one of the most important aspects of our lives, and in a perfect world, it would always be a top priority. Unfortunately, sometimes your to-do list fills up and the most important tests, like blood pressure readings, don't get done.

Technology is solving the problem of needing to actively keep tabs on your health data. Recent advances in broadband-enabled sensor technology offer more convenient, less costly, and less invasive solutions for collecting health-related information. In the healthcare industry, the devices revolutionizing how medicine is practiced are commonly referred to as medical wearables, ingestibles, and embeddables.

These new medical devices also collect patient data, often generating much more data than what has been available in the past using traditional methods of collection. It is difficult to estimate the value of data in the healthcare industry. Real-time biometric data about a patient can be the difference between life and death, and the ability to collect tremendous amounts of data over a long period of time, with millions of potential subjects for study, is a researcher's dream.

While data from medical wearables, ingestibles, and embeddables is often shared with a patient's healthcare providers, digital forensics professionals have also been able to access this data, which is then used in investigations and litigation.

Wearable Medical Devices

Wearables include watches, rings, and patches that people wear to monitor their health, track exercise, and even stay safe. These innovative devices gather data through skin contact and transmit information wirelessly to smartphone applications and remote diagnostic facilities, giving wearers a non-invasive way to better understand their bodies and how they are feeling.

Wearable technology devices are often low-commitment items that demonstrate how one's body reacts to external stimuli, tracking track activity, sleep, and heart rate. They can also provide information on vital health indicators, such as heart rate, blood pressure, and blood glucose levels.

Because wearable technology sends a large volume of data back to a user's phone, computer, or another device, that data may become available during a forensic examination of that device and be used as part of an investigation.

Case Example: Wearable Device Reveals Cause of Distracted Driving

One recent instance of wearable data being used during a legal case was when a truck driver was in a serious accident with another vehicle. The plaintiff's theory was that the truck driver had been distracted by their cell phone at the time of the accident, resulting in the crash.

A forensic examination of the driver's cell phone showed that there was an Apple Watch connected to the phone. During the examination process, the biometric data from the Apple Watch revealed that the driver had experienced a serious incident of atrial fibrillation, or rapid and irregular heartbeat, at the time of the accident.

The conclusion from the Apple Watch data was that the crash didn't happen because the truck driver's eyes had landed on a recent message containing a hilarious meme, but rather because the truck driver had suffered a stroke while driving.¹

Ingestible Medical Devices

Ingestibles put a sensor inside the user's body that allows for the monitoring of internal processes. An example of an ingestible sensor is the "Smart Pill," which uses wireless technology to help monitor internal reactions to medication.

Other ingestible sensors use RFID to track drug levels in a patient's body and alert physicians when optimal dosing is achieved. These sensors can also use wireless technology to send information about medication levels from the stomach to the doctor's office or hospital where the patient may be staying.²

Another recent ingestible trend is the "capsule endoscopy," where the patient swallows a miniature pill-shaped camera that travels the length of the digestive tract and transmits images along the way. This new diagnostic tool could eventually replace traditional colonoscopies or endoscopies.³

Ingestible technology data related to medication use could become an important source of data in certain court cases.

Case Example: Incompetent Due to Non-Compliance

A defendant is accused of a crime. The defendant admits to the crime, but the defense's theory of the case is that their mental illness was the primary factor in his commission of the felony. An examination of the defendant's cell phone reveals an application that monitors the patient's compliance in taking their medication. This examination reveals that the defendant was non-compliant, failing to take his medication for days leading up to the incident.

If the scenario above sounds far-fetched, it is not. The FDA has already approved a drug called Abilify MyCite, which is an aripiprazole tablet with a sensor, used to treat schizophrenia and manic and mixed episodes for patients with bipolar I disorder. After the pill is ingested, its digital ingestion tracking system sends a signal to a patch and then to an app, which allows the data to be shared with the patient's care team.⁴ It is certainly possible that data from pills with tracking sensors could be recovered by a digital forensics expert and used in trials or litigation in the future.

Embeddable Medical Devices

Miniature devices that are inserted under the skin or deeper into the body are called embeddables. One commonly known device that can be embedded is a heart pacemaker.

In the future, embeddables may be so small that doctors would be able to inject them into our bodies. Further advancements in embeddable technology open the door for promising applications like helping diabetes patients monitor their blood sugar levels reliably and automatically without needing to draw blood.

As with ingestibles and wearables, data from embeddable medical devices can be recovered through digital forensic techniques and used as evidence in legal matters.

Case Example: Fire, Fraud, and a Pacemaker

The case of Ross Compton shows how valuable data from embeddables can be during litigation. Though Compton claimed that a fire woke him up in the middle of the night, the incident was investigated as a potential case of arson.

Law enforcement got a search warrant for Mr. Compton's pacemaker data. A cardiologist reviewed the data and gave the opinion that, "It is highly improbable Mr. Compton would have been able to collect, pack, and remove the number of items from the house, exit his bedroom window, and carry numerous large and heavy items to the front of his residence during the short period of time he has indicated, due to his medical conditions."

Because the data from his pacemaker revealed that he may have known about the fire before it happened, which gave him enough time to remove valuable items from his house, Mr. Compton was convicted of arson, with the alleged motive being insurance fraud.⁵

Conclusion

Medical devices, whether worn by a patient or ingested or inserted into the patient's body, are becoming more prevalent as technology improves. These devices generate data that is collected and stored via applications on cell phones, computers, and in the cloud. This information can then be shared with the health practitioners, the patient's family, and the patients themselves in real or near real-time.

The primary reasons many use these devices include patient compliance and risk management. However, it is important to remember that data from these devices can be recovered by digital forensics professionals and used as evidence in investigations and litigation.

Sources:

1. Heart Health Notifications on Your Apple Watch (Apple Support)
2. Edible RFID Microchip Monitors if Patients Taking Medication (rfidworld.ca)
3. Capsule Endoscopy (Mayo Clinic)
4. FDA Approves 'Smart' Pill That Tracks Adherence (pharmacytimes.com)
5. A man's pacemaker data will be used against him in court (slate.com)