IT in Healthcare

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Information technology (IT) in the healthcare industry is improving the care received by patients and the efficiency of nurses and doctors. These changes are being made through software improvements, increased connectivity (through the internet of things), and more devices to monitor patients inside and outside of the hospitals. Beyond simply helping the patients, nurses, and doctors, technology is changing the way that medical students are practicing and implementing what they are learning.


Contents

History

Through extensive research of the history of IT in the healthcare industry[1][2], we have identified three distinct waves of change due to information technology (IT)[3].

The first wave began in the 1950s and brought automation to simple systems within hospitals. It also brought the aggregation of data and allowed for statistical analysis of such data. In the 1970's different core processes were integrated together through IT. This enabled an easier business to business management and inter-connectivity throughout hospitals. Around 2010, the third wave started to be implemented in the healthcare industry, creating a full digitization of the enterprise. This is leading the healthcare industry to place more emphasis on the patients and clients rather than operations.

Personal Healthcare Technology

With the third wave of technological advancements impacting the healthcare industry, we are seeing more patients gain access to their test results and personal health information outside of the doctor's office. This is making some patients turn into consumers of their own health, as they are acquiring preventative devices, keeping track of their daily activities, and staying better connected with their doctors. These technological advancements are helping patients outside of the hospital stay healthier, be more aware, and become more informed about their personal health.

Wearables and Devices

Wearables and devices such as Fitbit and at home blood pressure monitors make up a large part of how individuals are monitoring their own health. With these devices becoming more affordable due to technological improvements, we are starting to see more patients becoming consumers of their own health on a day to day level. Furthermore, the number of devices related to personal health are emerging for consumers to buy on a rapid basis. These devices are also starting to become more targeted to individuals with specific conditions and are either trying to prevent their condition or respond to unusual events that are related to their condition. Below are a few wearables/devices that are currently in the market or making their way to market for consumers.

iBeat Cellular Pulse Monitor

IBeat is a watch that constantly checks the wearer's pulse strength, heart rate, and velocity of blood flow through 12 wrist facing sensors that are in the watch's band.[4] The watch will detect if the wearer is going into cardiac arrest and will notify a third party call centre that is monitoring the signal if they are in danger. The call centre will then notify emergency responders of the wearer's location and all other relevant information that the watch has detected.While the watch has not received FDA approval, it has gained significant interest from insurance companies as well as those with serious heart conditions. Some insurance companies are even looking to help cover the cost of the watch for its users. The watch itself costs $249 and has monthly charges of $20 that would cover the monitoring and GPS location tracking. The watch bridges the gap between functionality and utility as it keeps users constantly monitored while being discreetly hidden as a watch. One of the major issues facing this wearable is that the customer needs to be wearing the watch at all times to know that they are being monitored. To help combat this, the watch itself can last for up to four days per one charge and has a small battery pack that can charge the watch while it is being worn.

A Closed System Artificial Pancreas for Type 1 Diabetics

Artifical Pancreas

The artificial pancreas is a device that is designed for those with type 1 diabetes, which is a disease where the pancreas does not produce insulin. Type 1 diabetes affects 700,000 Americans and is normally developed around the age of 14 but can be diagnosed up until the age of 40. [5] Pictured to the left, is a fully closed artificial pancreas system. The body uses insulin to control levels of glucose that are in the bloodstream and for those with type 1 diabetes, they need to monitor their blood sugar levels throughout the day. In the event that their blood sugar levels are too low, they need to consume some sugar, or their blood sugar levels are too high, they must inject insulin. The artificial pancreas is a closed system that takes the need to self-monitor glucose levels out of the picture. The device uses the continuous glucose sensor to monitor the glucose levels and then sends the information to the insulin pump that will determine the appropriate amount of insulin to inject in the same way a healthy pancreas would. In the event that glucose levels are low, the monitor can send notifications to you or your caretaker's phone telling you to consume something with sugar. The device helps wearer's experience less time in hyperglycaemic or hypoglycemic episodes (overly high, or low levels of blood glucose levels) by constantly monitoring the wearer's levels and responding with the appropriate course of action. [6]

Portable Gluten and Peanut Sensors

The company producing the portable gluten sensor and peanut sensor is Nima.[7] Their device takes a small piece of your food and analyzes it through a chemical reaction done within a single use disposable capsule. It takes three minutes for the device to register if the food that you are about to eat has gluten or peanuts in it.The device is allergen-specific, meaning it will not detect for both gluten and peanuts but rather one or the other and a second test would be needed to check for the other allergen as it requires a different chemical reaction. This device is beneficial for those with peanut allergies and/or celiac disease, which is an intolerance to gluten that causes them to get a very upset stomach and feel sick. The device that analyzes the results costs $289 and the single-use capsules that check the food costs $5. Nima has also produced an app that allows users to upload the results from the food they tested at restaurants or from packaged food to better help others with celiac disease or peanut allergies avoid foods that could cause an allergic reaction.[8]

E-Health

E-Health makes use of information and communication technologies to help govern and control the information gathered by hospitals and healthcare providers.[9] British Columbia (B.C.) is currently in the process of developing an E-Health platform that will make lab results, diagnostic scans, electronic histories, and electronic prescriptions available online to be accessed by doctors and patients.[9] E-Health will make it easier for patients to get their test results and prescriptions filled without needing to visit a doctor's office for a five-minute check-up or visit an office that is in a different town altogether. Another benefit of an E-Health platform is that it digitalizes a patients medical history and can provide that information to any general practitioner, doctor or specialist that is granted access to the information. This allows a new doctor to be briefly informed of any serious conditions, reduces the need for guesswork and provides the doctor with any current medication that you are consuming. With E-Health systems gradually being implemented into the healthcare industry, there a number of concerns involving potential data breaches, inability to access the systems, or the patient's ability to understand the information. To combat this E-Health B.C. is working to create a secure system, with effective processes in the event of the system crashing.[9] Also, they are trying have all doctors use language that is not jargon, or full of abbreviations. With a system that is easily understood by doctors across the province, it will allow for patients to receive the best possible care by a doctor that well informed on the patient. In the future, another potential implication of an E-Health system could be the sharing of information from at home wearables and devices such as Fitbits. Although this is not currently being discussed by doctors and health care providers, the information collected by these devices will help provide a doctor with a holistic understanding of the patient's daily activities and reduce lying from patients who are embarrassed by their lack of exercise. This also leads way to data mining and using remotely collected information as a way to predict or detection conditions in patients before they come into a doctor's office complaining of some pain.

Telehealth

Telehealth Explained

Telehealth is the movement of receiving healthcare and medical advice via various forms of online communication without needing to see a general practitioner or doctor face to face. Telehealth is keeping patients at home longer, reducing re-admittance rates, and decreasing wait times. A potential implication of how telehealth can change the way that the healthcare industry sees patients is to use it as a screening process to determine the urgency of which a patient needs to see a doctor and then scheduling an appointment time that they should come into the doctor's office. To the right, there is a video that describes how one company is viewing the implications of telehealth. Telehealth is broken into four main aspects that will change the standard doctor, patient relationship.[1]

Live Video

Patients with minor health concerns could soon be video conference calling a doctor for a consultative or a diagnostic appointment.[1] On the call, the patient would describe their ailments or conditions much like a regular appointment and the doctor could recommend treatment such as prescription or inform them of what they have. Of course, without the physical interaction, it would require doctors to operate cautiously and ask the patient to seek physical medical attention if they are unsure. Other implications of live video conference calls with a doctor are follow up appointments. With specialists sometimes being far away or in another city video calls provide patients the opportunity to have a routine check-up from their house, which benefits the elderly, those with mobility issues, or those without access to a vehicle. Below you will find a video that is demonstrating how a live video connection to a specialist is able to save lives in a hospital setting.

Telehealth in a Real World Setting

Store and Forward

Store and forward is an approach to healthcare that is beneficial when a general practitioner (GP) isn't informed enough to provide a full diagnosis. An example of this is a GP being asked if the patient's mole looks cancerous. The GP would submit a photo to a dermatologist, who would inspect the photo and then inform the GP if more testing should be conducted or if the mole is perfectly fine. Currently, we are seeing a service like this being performed in Brazil called Doctor Consulta[1]. The service targets those with low income who cannot afford to see a specialist and charges flat fees for consultations. The doctor on sight will push the case forward to the corresponding specialist who is able to further recommend proper treatment for the patient. This form of consultation is faster than getting a recommendation to see a specialist. However, it can be less accurate than in person consultation and again requires doctors to operate with caution. With improvements in technology, we are seeing computers that are able to identify various forms of skin cancer, which could ultimately replace the need for a specialist in the store and forward model.

Remote Monitoring

The process of remote monitoring is recording medical and health data at home and in your everyday life that you can share with your doctor for a deeper analysis.[2] Currently, this is done with a device the hospital will give you to track a specific feature, such as heart rate. However, with the increase of wearables and personal devices (talked about above) such as the artificial pancreas, iBeat cellular pulse watch, at home blood pressure monitors and Fitbits, there is an abundance of data related to the user's personal health. This could provide healthcare professionals with more accurate information about one's daily health. A Fitbit alone tracks the number of steps walked, the number of stairs climbed, pulse, the velocity of blood flow and even sleeping patterns of the wearer, which is all information that a doctor isn't able to accurately track. By having devices like this monitor and upload the information to eHealth accounts or a platform that the doctors can view remotely, patients could receive more specialized treatment or even help doctors predict conditions such as a heart condition. Remote monitoring can also help patients stay healthier longer and in their homes for a longer time. Thus reducing wait times and readmission rates.

Mobile Health (mHealth)

With the rise of personal devices like cell phones constantly keeping us connected to the world around us, the health industry is looking at the potential implications of sending text messages or other alerts through these mediums.[2] The messages can inform the public about general health warnings such as air quality advisories, or outbreaks of a disease. This will help the general public be more informed of potential hazards around them and can even inform them of steps to stay healthy. Another implication of mHealth is to send notifications to individual patients or specific groups of patients. For example, a reminder text about an upcoming appointment or a notification that is sent to the elderly and parents of newborn children who are more at risk of attracting the common cold. Currently, we are seeing a system similar to this being implemented in Canada where the government is able to send a mass text to the public informing them of a natural disaster or other emergency notifications. Issues surrounding a system like this in healthcare involve determining who is in charge of sending the notifications, how citizens would opt in (or out) of the service, and how the information is specialized and tailored to individuals. MHealth is not limited to simply receiving text notifications, but can also be downloading apps on your phone that provide you with reminders or track your conditions or sleeping patterns.

Institutional Uses of Technology

In today's wave of technological advancements in the healthcare industry, IT advancements have focused on 3 core aspects[3]: (1) Making Health Records Accessible, (2) Streamlining Critical Processes, and (3) Collecting Accurate Data.

(1) By using IT to collect patient records, the healthcare sector stays more organized, leading to significantly fewer errors in bookkeeping as well as cost savings through minimizing physical storage space of records. The digitization of health records will also support the cross functionalities discussed above in regards to E-Health. This a necessity to ensure that IT in the health industry continues to advance in a technology-driven area through focusing on convenience and simplicity towards both doctor and patient. [3]

(2) The development of IT has currently supported the streamlining of critical processes within the industry. Being able to use technology has allowed professionals to focus on patient care rather than focusing on the operational and administrative work. [3]

(3) Being able to collect accurate data from patients is a vital part of paving the way for the future of health. Through careful analysis of AI and machine learning, clean and concise data is important to fuel the advancement of the industry. The current IT advancements have supported this initiative by allowing patients to input and store their data electronically, reducing the amount of human error experienced. Through this method of data collection, dirty data is limited and IT can properly use data to be analyzed. [4]

All 3 points above have focused on Wave 2 of the history of IT in the Healthcare sector. Currently, the healthcare sector is making the transition from Wave 2 to Wave 3 of the technological movement. Through new technologies, the healthcare sector can see new improvements to patient care[5] , as well as support professionals in making more well-informed decisions.

IBM Watson Health

IBM Watson Logo

The main driver for the new wave of IT in healthcare focuses around the idea of being able to not only analyze data but also make it available for both the patient and doctor in an accessible manner. Pioneering these pieces of criteria, IBM Watson Health allows for healthcare facilities to be able to use data to optimize performance, engage patients, enable healthcare, and reduce costs[6]. By using IBM Watson Health, healthcare professionals and researchers compile and understand the collected data in meaningful ways in order to make more informed decisions about patient care.

The basis of IBM Watson Health is that it brings together medical data into a centralized area on the cloud. It then combines traditional analytics and cognitive thinking in order to learn and refine its analysis, turning that data into knowledge[6]. It is able to do all of this while engaging the patient to be an integral part of the doctor-patient relationship as the patient must be responsible in doing their part to upload data through using personal healthcare items as listed above.

IBM Watson Health's effect on a healthcare facility has only returned with positive responses. It not only benefits the doctor-patient relationship by creating an environment where they need to communicate with each other electronically, but it also supports the facility in saving costs, accurately reporting and billing, and organizes patient records into one unified platform. IBM Watson Health supports each area of a healthcare institution by creating and sorting the appropriate pieces of information that doctors will need to complete their tasks. All in all, it supports the drive of pushing the healthcare industry into a more data-driven society.


How IBM Watson Health is Used

How IBM Watson Health Is Used

An example of using IBM Watson Health can be seen most clearly through a doctor-patient relationship.

Suppose a patient named Aaron has a doctor named Dr. Green. Their doctor-patient relationship is developing as Aaron has just moved from a different part of the country. As Aaron's previous doctor did not use IBM Watson Health, his patient records were not easily transferred to Dr. Green, resulting in Aaron having to go through numerous test for Dr. Green to compile new patient information on him. As this process takes time, effort, and money, IBM Watson Health seeks to eliminate this hassle by storing client information securely in the cloud. This form of storage allows both doctor and patients to have access to their information conveniently.

Continuing the doctor-patient relationship with Aaron and Dr. Green, Aaron's health is able to be consistently monitored by IBM Watson Health, alerting Dr. Green if any abnormalities arise. By pairing a patient's healthcare wearable device, such as a Fitbit, IBM Watson Health is able to send the collected data to the doctor and allow the doctor to do remote monitoring of the patient. Remote monitoring makes the overall experience for both parties easier as the patient needs to have fewer doctor office visits while the doctor is able to have fewer patients to see while still being able to service them through IBM Watson Health.

IBM Watson Health is also able to gather data from other patients around the world as well in order to make recommendations based on past experiences. For example, if Aaron has allergies to certain medication and lives a particular lifestyle, IBM Watson Health is able to match data with previous patients in order to find the optimal medication plan for Aaron that will not only ensure that he is not allergic to the medication, but also ensure that he is able to continue living the lifestyle he is currently. This is especially important for medical breakthrough in niche specializations since those medical findings may not be widely published. Through uploading the treatments to specific specialized cases of illnesses onto IBM Watson Health, patients no longer have to wait months on end for a specialist. Instead, the specialist is able to post their findings onto IBM Watson Health are share their findings to all other doctors utilizing IBM Watson Health[1].

This give an take process from patient and doctor allows for IBM Watson Health to by dynamic in its recommendation as data is always changing and focused on ensuring patients are being treated with the best care and doctors are receiving the right pieces of information to make better-informed decisions.

Use For Globalization

IBM Watson Health can be used as a way to communicate globally about health trends and issues around the world. By uploading information to the cloud database, users of IBM Watson Health are able to access information effortlessly through their electronic devices as they have unique log-ins. Wherever a patient goes, they are able to always have their medical records with them. For example, when Aaron moved to a different part of the country, if his previous and new doctor both utilized IBM Watson Health, then his medical records can all be moved to his doctor without having to do any new testing as the most recent information would be available for the new doctor to view. Looking forward into the future, IBM Watson Health can bridge together countries and allow for a universally understood healthcare system through their platform.

As immigration and travel bring people of all types of ethnicities to different parts of the world, IBM Watson Health helps connect patients to the doctors in areas around the world where they may not be experienced with different body types. If a patient who is traveling from South Korea needs medical attention while they are in Denmark, Danish doctors can use IBM Watson Health to not only receive the patient information, but also recommendations on how to treat the patient if norms are different around the world. Not only will IBM Watson Health help with recommending solutions to help the client, it will also help standardize practices since IBM Watson Health collects data worldwide without any bias. By doing this, doctors can see the best practices made around the world and make more informed decisions as to what they should recommend to their patients.

AHMC Healthcare's Use of IBM Watson Health

Success Stories

AHMC Healthcare & Hospital[1] implemented IBM Watson Health and was able to change their 0% compliance rate to hitting 100%. IBM Watson Health helped to identify the deficiencies in their system and provide meaningful recommendations on how to allocate resources in order to properly combat the problems. They are now able to streamline their processes as less time is used to do tedious tasks as the AI does it for them.

Doctors and patients are also feeling more comfortable after using IBM Watson Health as a doctor's recommendation can easily be cross-checked with an unbiased AI to find the right results[2]. It helps with training doctors to make informed decisions as they can be easily matched up against IBM Watson Health to see if the data collected by the doctor and the data collected by the AI follow the same direction towards a certain recommendation. Patients feel more comfortable because they are able to see the options they have for treatment once IBM Watson Health analyzes their symptoms and data points, giving them the peace of mind to choose which recommendations they are comfortable to continue forward with.

Microsoft Azure & Patient Monitoring

Patient monitoring has been a large issue that has been looming over the healthcare industry as of late because of the amount of time it takes a doctor to see a patient while in the hospital. It clogs The use of Microsoft Azure recently has allowed healthcare professionals to be mobile around the healthcare facilities while still being able to monitor their patients[3]. Being able to do this will help with the streamlining of critical care as the data collected by Azure will be able to alert professionals as to which patients need priority care.

How Microsoft Azure supports Ochsner

Ochsner Health Systems

Ochsner Health Systems in Louisiana has been one of the first healthcare facilities in the world to successfully implement this technology into daily practice [1]. Being able to monitor vitals of patients and have the data stored within a cloud computing system has allowed them to aggregate their data to predict trends and potential dangers that may be faced with a patient.

They are able to use Microsoft Azure so successfully in patient monitoring because of their capabilities to do a full implementation for all patients within a floor. By doing this, they are able to use the AI to learn and predict all possible adverse events due to the current patient circumstances. What this means is that they are able to move patients around the facility to ensure that the patients are receiving the right care at the right time. For example, they were able to eliminate cardiac arrests outside of the ICU by 44% because of the early notification system that certain vitals of a patient will lead to more complicated symptoms very soon[2]. As minutes can be a matter of life and death in the medical industry, Azure was able to, on average, notify healthcare professionals of adverse symptoms of patients 4 hours earlier than if AI was not there to support them. This allows the patient to be moved to other areas within the facility to receive care from specialized equipment or professionals before it is too late.

Predictions with AI in Healthcare

AI is approaching an area where it is able to predict many factors of a patient, supporting healthcare professionals in ensuring that they are able to prepare for what is in the future. Being able to predict the future outcomes of patients supports healthcare professionals as they are able to work based around the needs of patients and take preventative measures against adverse events of patients if possible.

With Microsoft Azure's help, data is analyzed and processed to help patients

Microsoft Azure

Microsoft Azure is able to aggregate hospital data from around the world compare it to a patient's data and predict future illnesses and life expediencies, all based upon the patient's lifestyle through machine learning[3],. The real power of AI here is in helping the patient understand what the outcomes of their lifestyles will lead to. Currently, doctors and patients may have troubles communicating information across to each other effectively, leaving gaps of information in places that may be vital. Through predictive AI, there will be clear and concise data points for both doctor and patient to use in order to change lifestyles for the better[4],.

Google is now helping to predict deaths in hospitals

Google

Recently, Google has started to be implemented throughout healthcare facilities around the world for its predictive powers. It focuses and learns with past information and is able to give healthcare facilities information about whether a patient will pass away within 24 hours of being admitted[5], and is now starting to predict if a patient will need re-admittance in the future.

Being able to predict if a patient will pass away within 24 hours of admittance helps healthcare facilities by giving them a chance to be able to plan ahead and make better use of resources. By admitting higher-risk patients in one area and lower risk patients in another, healthcare facilities can create hot and cold spots of high turnover areas to be able to better re-stock rooms for different purposes.

Risks of Institutional Use of IT

Although IT adds convenience and functionality to the healthcare sector, it poses many risks as well[6].

Protection of Confidential and Personal Data

One of the main risks associated with moving data onto the cloud is the risk of confidential and personal data not being secured[6]. According to a KPMG study, "eight in 10 healthcare organizations were compromised by cyber-attacks" [7]. Patients hold their data very close to them as it is private and personal to their lives. Therefore, the risk of this information being leaked can seriously damage a patient's reputation in their daily lives. IBM Watson Health combats this by de-personalizing information before it is sent to the cloud to be aggregated with other data [8]. This means that a patient's personal information is stripped from their data as it is processed by IBM Watson Health. By adding this level of security to their database, patient records are safer and patients can have a peace of mind knowing their information is not at risk of going public.

Dirty Data Impacting AI Analysis and Predictions

With an abundance of information flowing into databases that the AI uses to analyze and create predictions from, this data needs to be clean and error-free. If the input is consistently dirty, then the output will have errors and be ineffective to both patient and doctor[6].

This risk is especially important as both patient and doctor rely heavily on analysis, recommendations, and predictions of AI. If the output information is incorrect, it may seriously affect the health outcomes of the patient as they may not be getting the most compatible treatment they can be getting.

Difficult Transition Times Between Technologies

As upgrading a healthcare facility to house high-tech equipment is put a large burden on the financial department; therefore, the risk of not being able to upgrade to the new technology poses a threat for a facility to move into the third wave of IT in healthcare. However, as facilities do transition into the new wave of technology, there may be a gap between if the new equipment is able to perform to its potential, leaving out information that can be collected or leaving certain patients out from receiving better service from the technology [7].

Blackout Periods from Internet Being Unavailable

With the AI and other IT in the healthcare industry so reliant on being able to use the internet to access the cloud for data, a lack of internet would cause a blackout period of information, leaving both patient and doctor in the dark[9]. Contrasting to information storage methods used today of having paper files in filing cabinets, those do not rely on having electronic access to them and can be accessed at any time. The convenience of electronic records ends,and becomes a liability when the internet is not available and no physical sources of data can be found. As AI and IT in healthcare mature and become more refined, private offline databases that store patient information will be necessary to ensure that all aspects of a healthcare facility can be run smoothly at the optimal quality at all hours.

IT in Medical Research

The North American healthcare system is currently facing three main issues: a shortage of medical staff, long and ineffective development cycles for pharmaceutical drugs and medical techniques, and ethical concerns regarding various medical practices. Many researchers and technologists are teaming up to develop technologies or new practices to solve these problems.

Shortage of Medical Staff

US Physician Shortage Trend 2008- 2025

As you can see from the chart on the right, the deficit in the number of physicians in the United States is growing exponentially every year, and there are no signs of slowing down.[10] In countries where medical care is privatized, shortage of doctors could lead to higher medical cost, making such service inaccessible to lower-income patients. In countries where medical care provided by the government, patients may be facing long wait times and thus compromise their health further.

This problem is also prevalent in Canada. In fact, in BC, there is only 1 doctor per 323 patients.[11] This left 700,000 people in B.C. alone without a family doctor that they can seek regular medical advice from.[12] Furthermore, while the enrolment numbers of medical school have increased in the past years, a growing number of medical students are not matched with a place for their residency after graduation.[13] Some people point to the hospital’s reluctance to take in more residents due to the high cost of training these interns. [13] Regardless of the reason, the reluctance to train new doctors is only going to worsen the shortage of doctors. Many researchers and technologist have begun exploring creative solutions to train doctors more efficiently and effectively.


In addition to the shortage of staff, it is becoming increasingly difficult for medical students to keep up with learning the material. According to a peer-reviewed medical journal published by the American Clinical and Climatological Association, “In 2020 [the doubling time of medical knowledge] is projected to be 0.2 years—just 73 days. Students who began medical school in autumn of 2010 will experience approximately three doublings in knowledge by the time they complete the minimum length of training (7 years) needed to practice medicine."[14] What this means is that while your doctor is trying to manage his time among more than 400 patients, he must still try to keep up with the new medical information.


CNN detected Melanomas

Deep Learning Convolutional Neural Network Application in Dermatology

Researchers in Germany, the United States of America, and France trained a Convolutional Neural Network (CNN) to identify skin cancer by showing it 129,450 clinical images of malignant melanomas (the most lethal form of skin cancer), as well as benign moles (or nevi).[1] To test the CNN's accuracy, 58 board-certified dermatologists from 17 countries took part in the study. The results showed that when the background medical information was not given, the convolutional neural network was actually able to predict the right diagnosis more frequently than board-certified dermatologists on average.[2] However, when the dermatologists were given the patient's medical history, they still performed similar or better than the CNN. While this technology cannot fully replace doctors as they still serve as an important piece of the puzzle that offers clinical knowledge and medical advice to patients. This technology can potentially help dermatologists speed up each patient’s visit once it passes various clinical trials. Alternatively, the CNN can be used by patients to conduct preliminary tests before booking a dermatologist appointment. By reducing the number of unnecessary patient visits and allow the doctors to focus on urgent cases, the convolutional neural network could potentially help reduce the shortage of doctors by reducing the demand.


IBM Eye of Watson

Eyes of Watson Application in Radiology

The Eyes of Watson technology was first introduced at the annual conference of the Radiological Society of North America.[1] Researchers fed the supercomputer large amounts of imaging and text in electronic health records. Through using deep learning to identify patterns and perform clinical inference with a priori clinical knowledge, the computer was able to present the radiologist with its assessment of the imaging, the process that it took to achieve that assessment, as well as assemble relevant medical information for the radiologist to make the final diagnosis. [1] The shortage of medical staff is common in the radiology department as well. In fact, a single radiologist working in the emergency room would have to examine as much as 200 cases a day. Depending on the case, the radiologist can be looking at as many as 3000 images per study for cases such as the lower body CT angiography. [2]


If the technology is approved for actual clinical use, the goal is to improve how radiologists receive, prioritize and validate data. Furthermore, the report generated by Eyes of Watson can potentially have real impact effect on the cost and length of stay of patients. Ultimately, Eyes of Watson will make radiologists more efficient and effective in making diagnoses. It will drastically decrease the number of images that radiologists have to read every day. Moreover, it will assist the radiologists in prioritizing the more urgent cases over others. Lastly, as the machine is equipped with a priori medical knowledge and access to the internet, it will be able to provide the radiologists with relevant and up-to-date medical information along with diagnosis recommendation. [3] Furthermore, similar to the CNN, this technology could be used to train students in medical school. By allowing the doctors, or radiologists, to focus on more urgent cases as well as creating more efficient and effective ways for students to learn, it could potentially alleviate the physician shortage.


Usage of Artificial Reality in Medical Training

Augmented and Virtual Reality in Medical Training

With the advancements in hardware and software in both augmented and virtual realities, many companies are exploring applications of their technologies in fields outside of entertainment.

Microsoft HoloLens has partnered Case Western Reserve University to deliver educational material to their medical students. Through using HoloLens, students are able to learn about human anatomy on a whole new level. The HoloLens allows students to view and interact with the study materials in real 3D. [1] The students can adjust the angle of the organs, change the level of detail, and see live movements of the organ.

Furthermore, virtual reality can be used to allow junior surgeons to practice specific procedures without putting patients at risk.[2] Not only can this potentially increase the efficiency and effectiveness of medical training through allowing students to practice in settings close to real life, it could also save the hospitals a lot of money in medical insurance on each intern and resident. In both instances, the issue of the shortage of medical staff can be improved by training more doctors at a faster speed.

Phases of Pharmaceutical Drug Development

Slow Development Cycles of Pharmaceutical Drugs and Medical Practices

Long preparation period not only applies to medical staff but also to all pharmaceutical drugs and other medical practices. Long development process with low chance of developing a succesful drug consumes a lot of resources and capital. As you can see on the right, a typical pharmaceutical drug has to go through various cell-based or animal trials, before the stages of the human trial.[3] This significantly elongates the speed at which science can provide medical care to patients in need. Furthermore, it costs the pharmaceutical companies a great amount of money and resources at each stage.[3] And in most cases, pharmaceutical companies use this reason to justify their high drug pricing for the patients in need.

Many tech companies have heavily invested in the healthcare industries in order to create technologies that can help speed up the development processes.

Microsoft Azure Cloud Computing x Medical Research

Microsoft has made significant investments in healthcare technology. Another application of the Microsoft Azure is to have a platform in which cross-discipline researchers can have run fast analysis on the data they have collected in a secure and privacy compliant manner.[4] This is particularly important because regardless of the type of drug or medical procedure that is being developed, they must go through stages of trials to collect data that demonstrates their effectiveness before it can gain FDA approval. There are many reasons why Microsoft Azure is the industry-leading cloud computing software used by medical researchers. As medical information and data are highly sensitive, Microsoft Azure has built security and compliance standards into its development methodology; and thus, it is recognized as the most trusted cloud computing platform by government agencies[5]. Moreover, being an open-source platform, Microsoft Azure allows companies and researchers to build their own unique application to help their niche research. [4]

Microsoft Health Bot Project

In addition to the data management and processing platform, Microsoft also developed a Health Bot that enables its healthcare partners to easily create intelligent and compliant healthcare virtual assistants and chatbots.[5] With the built-in artificial intelligence, the program is equipped with language understanding models, credible symptom checker protocols provided by Microsoft’s partner Health Navigator, Bing Knowledge, and is able to learn from the previous interactions and allow it to become more effective and efficient. [6] Furthermore, it is HIPAA (Health Insurance Portability and Accountability Act) compliant, which makes it desirable to health service providers. Lastly, the extensible feature enables a variety of healthcare service providers to author their own scenarios, connect to their own databases of patients' medical records, conduct handoff of patients from-and-to other partners, and control the baseline configuration to tailor to their client demographics. [7].

Health Navigator, a leading provider of telehealth and e-health service in the United States, used the Health Bot to create an online triage engine that its clients can access. The triage engine will collect information such as the client's chief medical concern, age, gender, symptom severity and duration, and known medical history in a chatbot format; subsequently, the triage engine will calculate a triage score and recommend the appropriate level of care to the client. [7]. This will allow the clients to receive professional answers to questions such as "Do I need to see a doctor?" or "How serious might this be?". If implemented widely, the technology has a potential to reduce unnecessary clinic or hospital visits. Not only will this save time and effort for the patients that do not require medical attention, it can also free up the physicians to tend to those we need medical attention.

Try a demo of the triage engine here: https://www.microsoft.com/en-us/research/project/health-bot/.

Premera Blue Cross, a health insurance provider in the United States, have used this Health Bot Project to allow its clients to easily look up their insurance coverage. Through conversing with the bot, clients can now efficiently obtain answers to whether their insurance plan covers certain pharmaceutical drugs or medical procedures without having to sift through their long and complicated benefit plans. [8]

Aurora Health Care is a not-for-profit healthcare provider that operates 15 hospitals, more than 150 clinics and 70 pharmacies in 30 different communities in the United States.[9] With so many different levels of healthcare services under its wings, Aurora built a bot using Microsoft's Health Bot Project to allow its patients to find the right level of care. Aurora's bot can significantly increase the efficiency of medical service providers by directing the patients to the appropriate level of medical care.

Ethical Concerns Associated with Medical Research

In order for medicine to progress, humans have been using various animals for testing, especially for pharmaceutical development. In fact in Canada alone, over 4 million animals are used for research testing in 2016.[10] And this number is drastically increasing every year. For many years, there have been animal activist groups that protest against the inhumane treatment of animals.

Not only are we sacrificing innocent animal lives, the current process often fails to predict human responses because traditional animal models often do not accurately mimic human pathophysiology, hence the need for phase 1-4 trials to test on different patients. Clinical studies take years to complete and testing a single compound can cost more than $2 billion.[11]   Furthermore, the Data published by FDAReview.org, a project of the nonpartisan Independent Institute, indicates that "only about 1 in 10 drugs that enter clinical trials ultimately win Food and Drug Administration approval". [12]  


Some researchers have set out to revolutionize the drug development process with technology.


Organ on a Chip

Organ on a Chip

What if there are better ways to research the effectiveness of pharmaceutical drugs or medical procedures? Some researchers from Harvard have come up with a solution that does exactly that. Researchers from the Wyss Institute of Harvard designed microchips that are lined with specific human cells in the hollow channel.[1]  The chips can then mimic the microenvironment of that organ.[2] If this technology gains FDA approval, it could revolutionize the entire drug development process. Instead of testing the response on animals, researchers will be able to see the actual effects of the compound on human cells without causing harm to anyone. For instance, you can line the chips with lung cells to test a particular drug used for lung cancer. The coolest part is you can connect these chips to form the actual interactions that happen between different organs in a human’s body. [3] In the future, researchers even hypothesize the possibility of testing the drugs on the specific patients' cells to prescribe a personalized combination of compounds at the appropriate dosage.[3] With this technology, pharmaceutical drug developments can potentially become more efficient and effective. This reduction in resources needed can potentially be reflected in lower medical costs, and thus more accessibility to the patients in need.

3D Bioprinting of Organs and Tissues

While 3D printing has been prevalent in some medical specialties now such as customizable prosthetics. [4] The era of bio-printing is still being researched and tested. Researchers hypothesize that by printing organs with 3D Printers using stem cells, they will be able to print at the basic structure of the tissue or organ in need, place in the patient’s body, and allow the organ to naturally grow inside the patient’s body and eventually replace the dying organ.[5] This will drastically reduce the need for organ transplants and allow patients with organ failures to receive a replacement in a faster and safer manner. So far, the most promising application of this technology is bio-printing skins for burnt victims.[6] This technology will create infinitely more resources for doctors to treat patients. Instead of waiting months or years for an organ that may not even be suitable for your body, the doctors will be able to simply print one with your own cells. If this technology is developed and approved for usage, it could revolutionalize the organ transplant processes. Furthermore, it could potentially reduce the need for buying and selling of organs on the black markets in underdeveloped countries.

Authors

Gini Kuo Dynamic Tang Cole Williamson
Beedie School of Business
Simon Fraser University
Burnaby, BC, Canada
Beedie School of Business
Simon Fraser University
Burnaby, BC, Canada
Beedie School of Business
Simon Fraser University
Burnaby, BC, Canada
ginik@sfu.ca dynamict@sfu.ca crwillia@sfu.ca

References


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