Emerging Technologies in Health Care

1. Emerging Technologies in Health Care Based on extensive research, using the Web, to discover potential and live applications of Emerging Technologies in the Field of Healthcare

2. Blockchain in Health Care Need, Use Cases, Challenges and Future Trends

3. https://health.techjini.com/blog/infographic-applications-of-blockchain-in-healthcare/https://health.techjini.com/blog/infographic-applications-of-blockchain-in-healthcare/

4. Applications of Blockchain in Healthcare https://health.techjini.com/blog/infographic-applications-of-blockchain-in-healthcare/

5. How will Blockchain Help Healthcare-1 • Imagine you meet with a heart-attack in a location away from home, where your physician maintains your health records in his system. How will the emergency doctors in the new location be able to learn of what your past case history was • Even in the event of your physician being part of a large hospital your health records at best could be available only to the doctors of the hospital. • But when you require care elsewhere, the same problem surfaces. As strange as it sounds, even doctors in other hospitals and emergency departments using the same EHR system usually can't see your data without undergoing several time-consuming steps. There simply is no convenient way for you to "hand over" your records to other doctors who might be caring for you. • The other problem is that most of these electronic health record management systems are not interoperable. That is, other EHR systems cannot ordinarily interface with the EHR being used in your hospital. • “The structure and processes now governing EHR systems were created to benefit their manufacturers and purchasers, not patients like you. EHR vendors could easily open up their software, connect their systems (making them "comprehensive") and therefore make it easy for all your care providers to access your records. But they won't do so voluntarily.”

6. How will Blockchain Help Healthcare-2 • To avoid medical errors and improve quality outcomes, all the physicians we see should have access to our medical information, provided that information is kept private and secure. • Blockchain technology can facilitate these requirements • Blockchain data points are protected at the individual patient level with a numeric public key, and/or a more complex privacy key. Therefore, if someone were to hack into an EHR system powered by blockchain technology, they wouldn't be able to ascertain whose data it was or manipulate the information as they can today. Similarly, a physician with access to your medical record couldn't look at another patient's record within the same health system or hospital without his or her permission. Based on Dr. Robert Pearl’s article in Forbes

7. Attempts at Ensuring EHR Interoperability Without Blockchain • A valiant attempt is being made by many of the HIS manufacturers to called CommonWell Alliance (https://www.commonwellalliance.org) to ensure that Electronic Health Records from one system can be read by other participating members system. • This attempt is basically to prepare to face legislation which may make it mandatory for output of HIS to be interoperable. • The FHIR (Fast Healthcare Interoperability Resources) Specification, introduced by Health Level Seven (HL7), is a standard for exchanging healthcare information electronically. It has been around from some time but its adoption has been slow due to frequent changes in the standards.

8. Health Information Exchange (HIE) versus Blockchain (Deloitte’s Viewpoint)

9. Use Cases of Blockchain in Healthcare • Gem – This startup is working with the Centre for Disease Control to put disease outbreak data onto a blockchain which it says will increase the effectiveness of disaster relief and response. • SimplyVital Health – Has two health-related blockchain products in development, ConnectingCare which tracks the progress of patients after they leave the hospital, and Health Nexus, which aims to provide decentralized blockchain patient records. • MedRec – An MIT project involving blockchain electronic medical records designed to manage authentication, confidentiality and data sharing. An excellent article on the benefits of Blockchain to maintain Electronic Health Records (EHRs) can be found here https://www.forbes.com/sites/robertpearl/2018/04/10/blockchain-bitcoin-ehr/#77d83ae179e7 Another article “The Global ‘Blockchain in Healthcare’ Report: the 2019 ultimate guide for every executive” is worth a read https://healthcareweekly.com/blockchain-in-healthcare-guide/

10. CHALLENGES OF DEVELOPING THE BLOCKCHAIN FOR HEALTHCARE • “Like every technology, blockchain has limitations and is not suited for application to all scenarios,” IBM says. “It is not well suited for high performance (millisecond) transactions involving just one participant with no business network involved, or for replicated database replacement. It is not useful as a transaction-processing replacement and is unsuitable for low-value, high-volume transactions.”

11. Apps to Monitor Patient health • Streams from Deep Minds (acquired by Google) is perhaps the most versatile of the applications introduced in the field. • Streams lets doctors and nurses use a mobile phone to see information about their patients that they need to make decisions about care and treatment.  It puts test results and vital signs observations in the palm of their hands, and alerts them with a breaking news-style warning if a patient’s condition is getting worse. It also makes communication between different clinicians easy, so everyone has the most up to date information all the time. • You can read more about Streams and how it works here.

12. How a blood-test is conducted without and with Streams

13. Streams: Securing Patient Data

14. AI and Healthcare-1 • IBMs Watson, when it was challenged to glean meaningful insights from the genetic data of tumour cells, a task that took human experts about 160 hours to review and provide treatment recommendations based on their findings. Watson took just ten minutes to deliver the same kind of actionable advice. • Researchers at the John Radcliffe Hospital in Oxford, UK developed a diagnostics algorithm system that’s more accurate than doctors at diagnosing heart disease at least 80 percent of the time. The doctors then went on to treat the people and caregiver to support them. • Another example where non-human decision-making supports doctors is Harvard University researchers smart microscope that can detect potentially lethal blood infections and identify the responsible bacteria with a 95% accuracy rate.

15. Watson Health Cloud • IBM’s Watson is a phenomenon and its impact on healthcare can best be understood by watching this video Here is another video about how Watson’s assessment in the field of oncology concords with the assessment of experts

16. AI and Healthcare-2 • Cancer is another critical area where thinking machines can be used to optimise and improve care as their Japanese researchers reported that a new AI-aided endoscopic system can reveal signs of potentially cancerous growths in the colon with 94% sensitivity, 79% specificity, and 86% accuracy – all of which is better than current human ability. • The evidence of AI use in supporting doctors was published in 2017 in the Journal of the American Medical Association where it was found that deep learning algorithms were able better diagnose metastatic breast cancer than human radiologists were when under time pressure, such as in an emergency room. • See the next slide on Amazon Comprehend Cloud to learn more about deep learning

17. Enter Amazon Comprehend Medical • Amazon Comprehend Medical is a natural language processing service that makes it easy to use machine learning to extract relevant medical information from unstructured text. Using Amazon Comprehend Medical, you can quickly and accurately gather information, such as medical condition, medication, dosage, strength, and frequency from a variety of sources like doctors’ notes, clinical trial reports, and patient health records. • Amazon Comprehend Medical uses advanced machine learning models to accurately and quickly identify medical information, such as medical conditions and medications, and determines their relationship to each other, for instance, medicine dosage and strength. • You can use the extracted medical information and their relationships to build applications for use cases like clinical decision support, revenue cycle management (medical coding), and clinical trial management.

18. Amazon Comprehend Medical: How it works

19. Health Chatbots • “…digital personal assistant or a chatbot could help physicians, nurses, patients or their families. Better organization of patient pathways, medication management, help in emergency situations or with first aid, offering a solution for simpler medical issues:”. The Medical Futurist • BUOY Health, is among the leading health chatbots. Developed by a team of doctors and computer scientists through the Harvard Innovation Laboratory, the company’s algorithm was trained on clinical data from 18,000 medical papers to mirror the literature referenced by physicians. Examples of data include 5 million patients and approximately 1,700 conditions. You can check your symptoms online or browse in the vast database of Buoy Health to figure out what might be wrong with your health. • Your.MD is another prominent Health Chatbot. Try it out here

20. BUOY Health Demo

21. Virtual Reality

22. What is IOT • The Internet of Things (IoT) is a convergence of smart devices that generate data through sensors to create new information and knowledge to boost human intelligence, efficacy and productivity to enhance the quality of life. IoT is defined as “Intelligent interactivity between human and things to exchange information and knowledge for new value creation”. • It is a complex yet complete solution encompassing three main technology components namely connected things with embedded sensors, connectivity and infrastructure, and most importantly analytics and applications. See figure to the right Courtesy: Malaysia National Internet of Things (IoT) Strategic Roadmap

23. Global IOT Implementations GLOBAL IOT IMPLEMENTATIONS Courtesy: Malaysia National Internet of Things (IoT) Strategic Roadmap

24. Understanding IOT in Healthcare

26. IOT In Health Care

27. IOT Use Cases in Healthcare

28. IOT Use Cases in Healthcare - 2 Closed-loop (automated) insulin delivery: One of the most fascinating areas in IoT medicine is the open-source initiative OpenAPS, which stands for Open Artificial Pancreas System. OpenAPS is a type of closed-loop insulin delivery system, which differs from a CGM in that as well as gauging the amount of glucose in a patient’s bloodstream, it also delivers insulin – thus “closing the loop”. The automatic delivery of insulin also allows diabetics to sleep through the night without the danger of their blood sugar dropping (also known as night-time hypoglycaemia).

29. IOT Use Cases in Healthcare - 3 Bioflux from Biotricity, is a high-precision, single-unit mobile cardiac telemetry (MCT) device that provides real-time monitoring and transmission of ambulatory patients’ ECG information. Together with their proprietary software, highly customizable reports, and 24/7 monitoring center, the Bioflux system is a complete solution for remote cardiac monitoring that merges seamlessly with physicians’ existing platforms and workflows.

30. IOT Use Cases in Healthcare - 4 Cerner, has developed the St. John’s Sepsis Agent. Sepsis affects as many as 18 million people worldwide each year. It’s been estimated that between 28 and 50 percent of these people die—far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined. The St. John’s Sepsis Agent, an electronic warning system, monitors patient’s symptoms in key areas. Data is sent to a central hub in the cloud where evidence-based algorithms can effectively predict which patients are at risk. Health care professionals can then intervene, resulting in a 20 to 30 percent better chance of survival

31. The Advantage the Middle East Has Over the West in Healthcare Technology Adoption • “Many of the technological innovations are currently invented in western countries, but their healthcare systems have become ossified monstrosities and sadly do not embrace these magnificent home-grown technological inventions. • “The Western countries are stuck in legacy concentrate which leaves an opportunity for the Middle East to overtake them”. Brian De Francisca • Overseas observers have “seen a very positive approach to AI from leaders in the healthcare industry in the Middle East! There is a lot of interest across the board to identify and use suitable AI solutions in hospitals. There is an active participation in conferences to learn more about the possibilities of AI, and a huge interest in solutions to be implemented to make a good patient experience real.”Dr Angelika Eksteen, Director, AI Directions

32. Conclusion • Each of the important technological innovations such as AI, Blockchain, IOT, Shared Cloud Storage are valuable in their own right. But when used in concert, complementing each other, their benefits far outweigh the sum of their parts. • The Gulf, especially Saudi Arabia, with the necessary critical mass, not overwhelmed by legacy systems and many terra-bytes of patient records, nor at the mercy of a few technology providers who control all the electronic health data, and led by a young and forward-looking Crown Prince, can overtake even advanced countries in adopting emerging technologies in healthcare. • Despite the hype, the use of Emerging Technologies, like any other technology, should be measured by the ROI it generates. Starting small is the way forward.