Blog Series: #IoT in Healthcare by Dave Brown (@QiiQHealthcare)


The opportunity #IoT in Healthcare is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities that present themselves to the Startups, Healthcare IT organisations are tremendous.

We asked experts what they thought about the current trends and focus areas that the IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.  

Presenting the insights shared by Dave Brown (@QiiQHealthcare) on #IoT in Healthcare.

Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:

Dave Brown: Great user-centered design; cheaper sensors; integration-friendly cloud services (including ML and AI).

Q2: Is an IoT based system going to be a utility or a service?:
Dave Brown: The UI -where the rubber meets the road- is a service. The software behind it is also a service. I can see some of the hardware elements and networking tech’y being a utility.

Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:
Dave Brown: More public exposure of performance metrics will incentivize QI and therefore innovation. Free-market competition (between innovators) will drive down costs. With this accelerated change, risk will rise – this can’t be avoided. However, reliability and data security standards will stabilise risk.

Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:
Dave Brown: Not sure.  But to my previous answer – system reliability and security standards will help confidence levels for healthcare providers who are frightened of change.

Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
Dave Brown: Start with the big picture in mind; begin with small, measured implementations, and look for IMPACT.  Advance quickly as success metrics show up.

Q6: What are the aspects of Connected Care for the Patient Care Continuum
Dave Brown: Healthy Living, Prevention, Diagnosis, Treatment & Home Care. THIS DOES NOT HAPPEN WITHOUT PROGRESSIVE APPROACHES TO INTEGRATION. The future = API’s.

Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
Dave Brown: One simple picture: a FitBit user shares their data with their provider network; always-on data analysis (that also taps the user’s genomic data) triggers alerts when bad signs arise; then an automatic clinical response launches to address the issue before it becomes a serious problem. This process is AI-driven.

Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
Dave Brown: BIG question – hard to predict – creative and informed entrepreneurs will come up with many. I think these IoT solutions emerge from a vibrant startup community. Governments assist merely by creating incentives for the birth&growth of well-run startups, including spurring investment. They can also help round up healthcare executives and tech entrepreneurs to thoughtfully examine REAL problems and viable solutions (to save entrepreneurs from building solutions that no-one will buy and deploy).

Q9: How can private hospitals justify the RoI’s of Smart Hospital Components? :
Dave Brown: Similar answer as Q2a: start small and measure measure measure.

Q10: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.:
Dave Brown: Not sure.  How ’bout: “Smart API’s”

Q11. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?:
Dave Brown: It’ll take more than 5 years for a real transformation to occur. But as I’ve already written, more good data (genomic + real-time consumer sensors) with strong AI will increase proactive community interventions, thus reducing the demand on urgent care.

Q12. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?:
Dave Brown: We ARE a startup, committed to helping redesign workflow in urgent care.  We need to partner with companies contributing to acute care IT. We eventually need to integrate with community-care solutions to further improve the patient experience in moving from community care to acute care.

You can contact QiiQ Healthcare via their website: http://QiiQHealthcare.com
You can reach Dave via Twitter: @DaveBrutusBrown

References

  1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
  2. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
  3. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7

Stay tuned to the #IoT in Healthcare Blog series Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:

http://blog.hcitexpert.com/search/label/IoT%20in%20Healthcare

Author
Dave Brown

Co-Founder at QiiQ Healthcare, designer/engineer – perceptive, meticulous, smart and sensible
leader/entrepreneur – social, tenacious, visionary and realistic

With age, I’ve become a “big picture” guy, but I can and will roll up the sleeves….

I’ve led small and medium-sized user-facing technology projects: starting with strategy, and flowing right down to the detailed tactical level. I get the P&L picture, and am very comfortable driving execution.

Blog Series: #IoT in Healthcare by Srinivas Prasad M.R. @prsdsrnvs


The opportunity in #healthcare IoT is estimated to be $2.5 trillion by 2025. How are we embracing this change?

During the #PhilipsChat, on the 10th April 2017, we asked questions related to the current trends and focus areas that the Healthcare IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.
A great discussion ensued that has spawned this blog series. Presenting the insights shared by M. R. Srinivas Prasad (@prsdsrnvs) on #IoT in Healthcare #PhilipsChat. (http://en.wikipedia.org/wiki/M._R._Srinivasaprasad)


Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:
M. R. Srinivas Prasad: In the emerging markets the IOT devices that would play an important role in extending care to the homes and community, would be those that can enable remote monitoring of cardiac patients, COPD patients and pregnancy monitoring in the rural community. These devices could be devices like Connect diagnostic ECG, Low cost but reliable wearables to monitor basic vital signs and breathing patterns and connected intelligent fetal dopplers to help monitor the child during birth helped by midwives

Q2: Is an IoT based system going to be a utility or a service?:
M. R. Srinivas Prasad: This will be a mix of both. It can (also) be an Outcome-based pricing model which is a variant implementation of the Service Model.

Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:
M. R. Srinivas Prasad: Need to adhere to Continua standard for these devices for open connectivity but in the near term I see that cost will prevail over the interoperability standard if regulatory bodies don’t ensure conformance from the start.

Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:
M. R. Srinivas Prasad: A change in the mindset of going from paper to paperless is needed. Then there is a need to educate hospitals “Software is not free”. In addition, enabling IoT will need reliable telecom networks, work with the ecosystem to set up datacenters. Maturity & innovation around commercial business models will be a need Supporting infrastructure like connected ambulances, trained paramedics & and efficient transportation system will help.

Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
M. R. Srinivas Prasad: Postoperative care can be shifted to the patient’s home. This can help free up beds in the hospital which can help in increase revenue to the hospital from a new patient. Hospital-acquired infections can be reduced and finally, in bringing down the cost of care, the benefit that can be extended to the patient.

Q6: What are the aspects of Connected Care for the Patient Care Continuum?
M. R. Srinivas Prasad: From Philips Healthcare point of view Connected care for the Patient Care Continuum comprises of Healthy Living, Prevention, Diagnosis, Treatment and Homecare. Here’s a video that explains these aspects https://www.youtube.com/watch?v=Xe-KxiiIyNI

Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
M. R. Srinivas Prasad: (elaborated on each of the aspects of Connected Care for the Patient Care Continuum)
#HealthyLiving There are many in the market but it is important to choose the right one like the ones which are accurate e.g. Philips watch. Eating healthy food but tasty from an Indian cuisine context means fried food. Philips air fryer helps air fry tasty healthy food.

#Prevention Breathing Fresh & clean air is important for us to avoid pulmonary complications in countries like ours where pollution levels are high. #Philips Air Purifier helps address this issue

#Diagnosis Early diagnosis is critical to increase survival rate and reduce the cost of treatment. Use of AI in helping clinicians early diagnosis and also managing a larger population base can help solve the India challenges. Either for aiding in detection of infectious diseases like TB or identifying lesions from brain and breast scans.

#Treatment Minimally invasive devices are the key here . Low dose interventional X-ray systems or mobile surgery systems . Radiation planning systems which aid accurate and the right dose planning.

#HomeCare Monitoring of post cardiac patients and COPD patients at home. Philips Home Co business in india extends care into the home. This reduces cost of care and also helps the hospital to manage more new patients. Monitoring compliance to medication is another key aspect when extending care to home.

Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
M. R. Srinivas Prasad: Government should step in with policies that support in “giving the last mile connectivity” to decentralize healthcare (and) help in the convergence of Mobile technology, Consumer engagement and Payment reforms.
Additionally, Population management to understand disease profiling, to understand the spread of infectious diseases like malaria, typhoid etc. Smart ambulances. Garbage clearing monitoring. Air quality monitoring device across the city. Adequate availability of AED ‘s and accessible and connected. These are all related to health care.

Q9. How can private hospitals justify the RoI’s of Smart Hospital Components?
M. R. Srinivas Prasad: Demanding solutions from healthcare companies. Looking at OPEx models where the capex requirement is low. Productivity improvement from workflow efficiencies. Productivity gains or clinicians from using AI and smart tools. Better clinical decisions and patient re-admissions which will be enhance patient stickiness and also enhance the brand which will drive more patients to the hospital.

Q10. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?M. R. Srinivas Prasad: A seamless experience which helps the hospital in its business, helps the clinicians make better decisions, helps patients by reducing their healthcare costs and the insurance providers become more efficient and manage their premiums better. A win win for all. Example from the onset of chest pain to early diagnosis, to emergency care, seamless patient data flow into the hospital EMR’s. Flow or patient context and information right through the various departments in the hospital including radiology, cardiology, critical care and also seamless extension of this care into home or the community post discharge and post operative care on remote care settings. A seamless experience in a distributed care environment

Q11. What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas? M. R. Srinivas Prasad: Advanced AI models to aid early diagnosis of chronic diseases – Cardiac, COPD, Oncology and Mother and Child space. Smart IOT devices to support Monitoring of patients under various clinical conditions post discharge. Pregnancy monitoring and post natal care. Solutions in the healthcare informatics space and connect care solutions to help extend care into the community and homes

To one other question from Mr. NS Ramnath (@rmnth): On a scale of 1 to 10, where do you think the sensors in wearables in the market today stand?
M. R. Srinivas Prasad: It’s in a very nascent stage but with a huge potential and key to help solve our healthcare challenges.

Mr. M.R. Srinivas Prasad, signed-off from the chat by urging the participants, “let’s define the future of healthcare for a better India and a better world. Technology is key! Cheers

References

  1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
  2. #IoT and #AI: Potent combo redefining healthcare by M. R Srinivas Prasad @prsdsrnvs on Livemint http://www.livemint.com/Opinion/iuOHAO5UCn1qzH2q5JwJvL/IoT-and-artificial-intelligence-Potent-combO-redefining-hea.html
  3. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
  4. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7
Author
M. R. Srinivas Prasad

CEO, Philips Innovation Campus, India

Blog Series: #IoT in Healthcare by Dr. Vikram @drvikram

The opportunity in #healthcare IoT is estimated to be $2.5 trillion by 2025. How are we embracing this change? The Types of Opportunities that present themselves to the Startups, Healthcare IT and Healthcare organisations are tremendous


During the #PhilipsChat, on the 10th April 2017, we asked the experts what they thought about the current trends and focus areas that the IT Industry, Medical Device Manufacturers, Hospitals and Startups will need to keep in view in the near and short-term while making their organisation ready for the Digital Transformation that can be and will be enabled by #IoT in Healthcare.

A great discussion ensued and that has spawned this blog series. Presenting the insights shared by Dr Vikram Venkateswaran (@drvikram) on #IoT in Healthcare #PhilipsChat.

Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?:
Dr Vikram Venkateswaran:
In my opinion, the immediate benefits are in areas where other industries have made progress: cheaper rates for Sensors, Increased security at device and sensor level. Additionally, an Increased integration of sensors and devices with EMR allowing for proactive interventions and remote monitoring for Chronic diseases.
Another aspect is Managing inventory and tagging assets are key for more hospitals, and i think that is an immediate benefit that will accrue.
To the question of, Do you think India will benefit from cheaper portable diagnostic devices or remote treatment a better stead ? asked by Divye Marwah; I would say, both patients and the hospitals will benefit.
Sukesh Kumar: Do you think #AI will help in taking healthcare to the next level?
Dr Vikram Venkateswaran: Its already happening in certain specialties like Oncology
Q2: Is an IoT based system going to be a utility or a service?
Dr Vikram Venkateswaran: Tricky one but I would say a service, with elements of a utility.

Ms. Manishree Bhattachar (@ManishreeBhatt1), Analyst with NASSCOM, “Do you think EHR implementation is a requisite, to go for a full bloom service+utility models for IoT devices?”

Dr Vikram Venkateswaran: I think so personally, without the full view of patient history, proactive intervention; depends on the care priorities for the Hospital.

Q3. Do you see any device, connected via any protocol and with any cloud; as the future, if yes how will that be achieved? Standards?:

Dr Vikram Venkateswaran: That is one of the biggest challenges today, EMR integration with IoT devices for example Wearables, remote pacemakers, Bionic Limbs, lenses with ability to monitor sugar levels and Blood Pressure.

Q4: In India (or your country), what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare?:

Dr Vikram Venkateswaran: Network connectivity and availability of LE sensors is the key, Most healthcare systems are still on paper records, Patient education is the key as well, massive change in perception is required.

Q5. How can hospitals leverage #IoT based solutions for service delivery and patient care? :
Dr Vikram Venkateswaran: Health Checks, remote health monitoring as a service, pro active intervention as a service

Q6: What are the aspects of Connected Care for the Patient Care Continuum?
Dr Vikram Venkateswaran: Interoperability and adherence of standards, increased communication, Change in perception of patients and hospitals

Q7. Please share usecases for Connected Care for: Healthy Living, Prevention, Diagnosis, Treatment, Homecare:
Dr Vikram Venkateswaran: Remote monitoring of cardiac pacemakers,  monitoring of blood glucose, Sweat analysis for athletes, Sleep monitoring for patients and athletes

Q8: What are the Healthcare based Smart City components? How can Local, State and National Government’s make #IoT solutions in healthcare economically viable?:
Dr Vikram Venkateswaran: Disease Surveillance, Leveraging weather data to predict disease patterns, Population health management

Q9: How can private hospitals justify the RoI’s of Smart Hospital Components? :
Dr Vikram Venkateswaran: Hospitals can prioritise understanding disease patterns

Q10: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.:
Dr Vikram Venkateswaran: Smart Care, Home Healthcare, Remote Health Monitoring, Home Health, Connected care, Connected Health

Q11. Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?:
Dr Vikram Venkateswaran: Hospitals to focus on critical care, emergencies and palliative care. Regular check ups and follow ups to be conducted leveraging IoT

Q12. Finally: What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?:
Dr Vikram Venkateswaran: Disease Surveillance, Home Healthcare

References

  1. Here is the original Blog Post announcing the #PhilipsChat Tweetchat : http://blog.hcitexpert.com/2017/04/philipschat-on-iot-in-healthcare.html
  2. #IoT and #AI: Potent combo redefining healthcare by M. R Srinivas Prasad @prsdsrnvs on Livemint http://www.livemint.com/Opinion/iuOHAO5UCn1qzH2q5JwJvL/IoT-and-artificial-intelligence-Potent-combO-redefining-hea.html
  3. Join the #Philipschat on Twitter #IoT in #Healthcare on Monday 10th April 2017, 3 PM – Health Care in India http://healthcare-in-india.net/healthcare-technology/join-the-philipschat-on-twitter-iot-in-healthcare-on-monday-10th-april-2017-3-pm/
  4. Curated list of Tweets from the #PhilipsChat: https://twitter.com/i/moments/852242427008233473
  5. Review the #PhilipsChat Transcript & analytics via @symplur here >> http://hcsm.io/2loNiv7
  6. #IoT & #AI – A potent combination redefining healthcare event by @PhilipsBlore moderated by @drvikram https://youtu.be/6cpeICKV9Fw

Stay tuned to the #IoT in Healthcare Blog Series Bookmark this link to follow on the insights being shared by the experts on the HCITExpert Blog:


Team @HCITExperts [Updated: 29th May 2016]
Author

[tab]
[content title=”About Dr. Vikram Venkateswaran”]

Dr. Vikram Venkateswaran

Dr Vikram Venkateswaran is a healthcare thought leader who writes and speaks about the emerging healthcare models in India and the role technology plays in them.
Connect with me

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#PhilipsChat on #IoT in Healthcare with @prsdsrnvs and @drvikram

87% of healthcare organizations will have adopted Internet of Things technology


Internet of Things (IoT) in Healthcare, or Internet of Medical Things (IoMT) are seeing an increasing adoption rate in Healthcare Organisations. In a recent study the following statistics were part of the report: [1]

1. 60% of healthcare organizations have already introduced IoT into their infrastructure 

2. In just two years, 87% of healthcare organizations will have adopted Internet of Things technology.

3. The most common area where IoT is being utilized is for patient monitoring and maintenance. 73% of surveyed healthcare executives said they used IoT in this area, while 42% said this was the main use for IoT

4. 64% of respondents said they use IoT for patient monitors, 56% use IoT for energy meters, and 33% use IoT for imaging devices.

5. 80% of healthcare executives said IoT has improved innovation

6. 76% said visibility across their organization has improved, while 73% said they have enjoyed cost savings following the introduction of IoT.

7. 57% of respondents believe workflow productivity will improve as a result of the adoption of IoT, resulting in considerable cost savings

8. 36% believe IoT will create new business models, while 27% said the use of IoT technology would improve collaboration with colleagues and patients.

And here is an #Infographic: IoT in Healthcare: Types of Opportunities, I think it will be apt to share the same with you at this time to review the market opportunity. 

The study however also highlighted the disadvantages to introducing IoT. Such as security risks, with healthcare organisations facing many cases of breaches in the past year. 


The report pointed out, 89% of healthcare organizations that have adopted IoT said they have suffered a security breach as a result, while 49% said malware was an issue.

Coming to the Tweetchat!! I am honored to be considered for hosting the tweetchat with Mr. Srinivas Prasad, CEO, Philips Innovation Campus, in India and Dr. Vikram, Founder and Editor of Healthcare India.

//platform.twitter.com/widgets.js



Mr. Srinivas Prasad (@prsdsrnvs), has over 3 decades of experience with various Technology companies. Prior to his current assignment, Prasad was Vice President-IT at FMR India, a leading US Multinational in Bangalore. He has also established and served as General Manager for the Software Architecture Division of Sony in India.

Earlier in his career Prasad worked for Alcatel Business Systems in France and Indian Telephone Industries in various capacities, leading teams in developing telecom products for the Indian and Global markets. Before his current role as CEO-PIC, he headed the Healthcare division at PIC as Sr. Director.

Prasad has an outstanding academic record and holds a Bachelor of Engineering degree in Electronics and Communication and a Masters in Business Administration.

Having a unique distinction of being a Hindu Hitachi Scholar, he has published papers at the Telecom IEEE conferences. Prasad has worked in Japan and France earlier in his career. He has been part of several national committees in India including the CII taskforce to drive Broadband adoption in India.

An ardent cricket enthusiast he has played for Karnataka state, South Zone and represented the Country earlier in his career. Read more about Prasad and his achievements at http://en.wikipedia.org/wiki/M._R._Srinivasaprasad.


Dr. Vikram Venkateswaran
(@drvikram)
Dr. Vikram Venkateswaran is a healthcare management thinker, speaker and author. He is also the founding editor of Healthcare India. He started his career as a dental surgeon running a chain of dental clinics in New Delhi. He has an MBA from IMT Ghaziabad and has worked with healthcare systems in India, US and Europe.

On April 10th, 2017 between 3 – 4pm IST, I would like to welcome all experts to share their thoughts and insights with Mr. Srinivas Prasad and Dr. Vikram  on how to leverage IoT in Healthcare.

Agenda for #PhilipsChat : #IoT for Healthcare

Q1: In the near term (1-3 years), What are the top 3 innovations in IoT that can benefit healthcare?

Q2: Is an IoT based system going to be a utility or a service?

Q3. Do you see any device, connected via any protocol and with any cloud as the future, if yes how will that be achieved? Standards?

Q4: In India, what are the Digital Infrastructure requirements for enabling IoT based Innovations in Healthcare? 

Q5. How can hospitals leverage IoT based solutions for service delivery and patient care? 

Q6: What are the aspects of Connected Care for the Patient Care Continuum (tell us about one solution each that can benefit consumers)

> Healthy Living
> Prevention
> Diagnosis
> Treatment
> Homecare


Q7: What are the Healthcare based Smart City components? How can Local, State and Indian Government’s make IoT solutions in healthcare economically viable?

Q8: How can private hospitals justify the RoI’s of Smart Hospital Components? 

Q9: Give us a Buzzword we are going to be hearing regarding IoT based innovations in Healthcare.

CT: (Closing Thoughts) Tell us a 5 Year view of IoT in Healthcare and what would a Patient Experience in a Smart Hospital?

Signoff: And everyone’s favourite question of the Tweetchat, What areas of IoT based innovations are you looking to partner with Startups for? Can you give us two areas?

To participate, just log onto your twitter account on mobile, web or tablet on 10th April Between 3-4pm, as mentioned earlier and tweet with the hashtag: #PhilipsChat 

Transcript of the #PhilipsChat

References

  1. 87pc Healthcare Organisations to Adopt Internet of Things Technology by 2019
  1. #Infographic: IoT in Healthcare, Types of Opportunities http://blog.hcitexpert.com/2016/05/infographic-iot-in-healthcare-opportunities.html
  2. The Current Status of 8 Future Technologies on Healthcare by @msharmas http://blog.hcitexpert.com/2016/09/the-current-status-of-8-future-technologies.html


Author

[tab]
[content title=”About Manish Sharma” icon=”fa-heart”]

Manish Sharma

Founder HCITExpert.com, Digital Health Entrepreneur

Connect with me via any of my Social Media Channels

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Understanding the Medical Diagnosis processes, to build an AI based solution by @msharmas


Human Intelligence

is The ability to adapt one’s behavior to fit new circumstances.

In Psychology, human intelligence is not regarded as a single ability or cognitive process but rather as an “array” of separate components. Research in building AI systems has focused on the following components of intelligence: [1]

  • learning,
  • reasoning,
  • problem-solving,
  • perception, and
  • Language-understanding

These components of human intelligence are also utilized during diagnosing a patient and defining the treatment plan and protocol for the patient.

The process of Medical Diagnosis


The process of how a Doctor goes about her diagnoses of a patient, is the ability of a Doctor to adapt to varying presenting illnesses of her patients.

  • Identify the Chief complaint of a patient
  • Gather information about the history of present illness
  • List the possible diagnosis & record the differential diagnosis for a patient
  • And then perform relevant diagnostic tests to determine the most likely causes for the presenting complaints

The Doctor initiates the process of identifying the most likely cause of the patient’s presenting illness and then based on the results of the diagnostic tests, proceeds to confirm a diagnosis and then proceed towards defining a treatment plan for enabling the patient to recover from the disease.
 

In the above simple process defined for a medical diagnosis, the Doctor (based on her training) makes use of all the “components of intelligence” to arrive at the most likely treatment plan for a patient. The process obviously gets more involved and complex depending on the type and nature of diagnosis.

Medical Diagnosis or Medical Algorithms?


From the above “very simple example” it’s clear that the doctor uses her learning and reasoning to proceed towards the best possible treatment pathway for the patient. And this can be treated as a series of Questions that help the doctor arrive at the “confirmed diagnosis” for the patient.
 

The process of Medical Diagnosis can then be treated as an Algorithm that helps the doctor arrive at a conclusion based on the presented facts.
 

Dictionary defines an “Algorithm” as, a process or set of rules to be followed in calculations or other problem-solving operations
 

The doctor in the above scenario has being processing via a set of rules and calculations and problem-solving operations to arrive at the confirmed diagnosis.
 

The doctor goes through a perception analysis to determine what specifically is presented based on the patient’s illness and then determines based on, not only the diagnostic test results, but also based on other parameters of a patient’s active and confirmed diagnosis.
 

Medical Diagnosis work in clinical practice generally has four models: [4]

  • Pattern Recognition, wherein the doctor recognizes the current patient’s problem based on her past experiences with other patients, e.g., Down’s syndrome.
  • Hypothetico-deductive, wherein the doctor performs a certain battery of tests to test a hypothesis, a tentative diagnosis
  • the Algorithm Strategy: the algorithm strategy has been used in Healthcare and has been represented using Medical Logic Modules [5], Arden Syntax for Medical Logic Systems [6] and Clinical Pathways [7] and finally the
  • Complete History Strategy has been defined to be the identification of Diagnosis by possibility. Evidence based medicine is then used to come to a conclusion of the final diagnosis. [8]

The training process to arrive at a Medical Diagnosis has been used in the past to the development of expert systems or Clinical Decision Support Systems (CDSS). Early medical AI systems have tried to replicate the clinical training of a doctor into meaningful implementations of AI in healthcare.

Usecase for Artificial Intelligence in Healthcare


Understanding the process and workflow in healthcare is going to be important in implementing solutions that are “aware” and intelligent. And the systems that need to be developed for Healthcare need to be able to assist the clinicians with systems that are more close to the clinicians natural daily workflow.


Consider the current scenario of a physician meeting with a patient in a clinic setting, with the current systems in place the “Patient Visit” workflow generally involves the doctor having to divide her time between talking to the patient, examining the patient and recording the findings on an EHR (electronic health records) system. Most such visits can last from 5 minutes to an hour depending on the specialty (for instance, general medicine to mental health). Additional complexity is added to the workflow based on the patient diagnosis.
 

There have been many studies that have recorded the doctor’s reasons for resistance to enter the visit data into a system [9]. A time and motion study of a patient – doctor interaction can be revealing in an EHR vs a non-EHR setting. While EHRs have shown their ability to reduce potential errors (as has been well documented in the report, to err is human) the additional steps of transcribing the visit data into an EHR is generally seen by the doctors as being a disruption in their natural visit or encounter workflow.
 

On the other hand, take into consideration a study of the workflow of a pathology department such as biochemistry or hematology, where the technology implementation is relatively easily accomplished. The pathology departments main “Entity”(from a systems perspective) to be processed is the patient sample and the level of automation required to process the various tests that need to be performed on the sample is quite well defined by its degrees of freedom, the test ordered by the doctor. Similarly the entity in a radiology department is the image that is the outcome of a radiology exam.
 

In radiology department for instance, an AI-based solution can enable operations at scale for enabling reading of radiology images from rural areas, where in the images get uploaded by the medical assistant or radiographer at the remote location. The AI systems now have the ability to read and report the images with increasing accuracy, but we still have some way to go before we achieve a greater deal of accuracy.
 

On the other hand, the “Entity” in a patient doctor interaction in a visit, the patient, has many more touch points within the patient care continuum and the level of complexity of this interaction needs to be dealt with in a completely different approach. While the processing in a pathology or radiology department is based on the sample or an exam, which is a snapshot at particular point in time, the treatment of a patient constantly needs to be monitored and presents more data points on an ongoing basis.
 

An AI-based solution to help a physician therefore needs to be applying for instance, the four models of medical diagnosis to a patient visit before we can call a patient visit as an intelligent or aware encounter.
 

If a doctor divides her time between listening to the patient regarding her present illness, and simultaneously recording the information on a computer system, there has been a disruption in the doctor’s natural workflow of focusing on the patient, of listening to her present illness, asking questions about onset, etc. and reviewing the results of the investigations and radiology reports. The doctor is trained to handle all these data points and process the information from the perspective of the four aspects of the medical diagnosis training of the physicians.




Here is an interesting story you would like to review showcasing a doctors 35-hr shift in Delhi, India. By the way the story lends itself to creating some really interesting “Intelligent Digital Assistants” for the doctors.   It also presents to experts developing AI based solutions for Healthcare, a fantastic time and motion study of a Doctors’ shift and the touch points to where the technology can be integrated into the Doctors “workflow”
  
Current systems do not allow that, they tend to focus on implementing a strategy of recording by exception, by recording only the exceptions and all the other aspects being marked as normal, for instance. While such aspects have been proposed and devised by working with the physicians, still they are workarounds to do what the technology of today allows or allowed in the past. 

These are re-creations of paper based systems that have been translated to an electronic health recording system.
 

The Patient – Physician interaction needs to be revamped, in the current information technology systems by enabling the various components of human intelligence we have highlighted earlier:

  • learning,
  • reasoning,
  • problem-solving,
  • perception, and
  • Language-understanding

Ideal scenario for a Patient – Physician interaction would be the implementation of a solution that “records” all of the conversation during a visit and automatically creates the Visit note, by understanding the Chief complaint, presenting illness, history of the patient, procedures ordered, medications prescribed, follow-ups or referrals ordered, et al. Purely based on the conversations between the doctor and the patient.
 

Such a scenario requires the implementation and collaboration between various components of the Artificial Intelligent ecosystem. And that will be the true and useful implementation of AI for the Patient and Physician interaction, enabled by Artificial General Intelligence capabilities.
 

The change needs to be implemented by not only incorporating the changes to the core algorithms, but it also involves incorporating changes to the UI and UX design changes. AI based solutions will force a change in the way current systems have been designed.

Its important to explain the way the physician thinks while interacting with the patient. 

It’s been of late seen technology solutions to be hindering the doctor patient visit process. And hence it my endeavor to try to present the case that AI while hyped to be replacing doctors, is not yet ready for the prime time. There are areas of immense potential, radiology image processing for instance but then that’s from a process improvement perspective. And not doctor patient interaction perspective. 

For years now, technology in healthcare has been trying to take the paperless approach and has tried to “replace” paper while forgetting that there is a more important component of enabling workflow in the Patient Care Continuum. 

And it’s because of this reason, I argue that whilst it’s great for the technology hype cycle to see AI as the deliverer, we need to remind ourselves once again, that it’s not about going paperless, but ensuring the 15 min that a patient gets of the doctor’s time, are well spent with the conversation being patient focused and the technology receding to the background and generating the relevant care records.

In other areas of healthcare too it is about process improvement.

And add to that the fact that in most implementations in healthcare, clinical documentation is either cumbersome or non existent, the hype cycle of AI needs to consider these issues. From my understanding since the underlying data is fragmented, not standardized and not interoperable in majority of the instances; I took a shorter term view of the AI implementation in the systems in this article.

Current Status of Artificial Intelligence in Healthcare

There has been data explosion in Healthcare not only from the perspective of the patient care continuum, but also from the point of view of the resource management and scheduling, inventory and purchase management, insurance, financial management, etc.
 

While most of the current focus has been on building AI-based solutions that are in the patient care continuum, there are definitely many more areas within a healthcare organization that will benefit from the implementation of intelligent systems.
 

Just the other day, I attended a conference around AI and the panelists were mentioning the following uses of AI

  • ecommerce recommendations
  • learning for students based on concepts in school
  • autonomous cars
  • AI based treatments plans for cancer patients
  • intelligent assistants, chatbots
  • Teaching computers to see; etc.

And while they all highlighted areas of advancement in AI tech, they are yet to reach the ability to currently create a system that converts a doctor patient conversation to actionable events that can spawn workflows that needs to be instantiated based on the ever changing patient condition.

In the near-term, I see there will be specialized implementations of AI that will enable the brute power of technology to present the best case scenario for a particular patient condition, but an AI Physician is still a work in progress. This has been shown to be a success with the advent of cancer care solutions using IBM Watson. 

The AI systems are being implemented in various scenarios in healthcare and you could consider them to being “trained” and being presented with a great amount of data and studies. As more data is presented to these AI systems, their level of accuracy will only improve and provide benefits in-terms of scale and reach thereby reducing the time to diagnosis and time to treatment for patients having affordability and accessibility issues in healthcare.

Artificial Intelligence has already started making its way into healthcare, with 90+ AI startups getting funding to deliver solutions like;
  • helping the oncologist define the best treatment plan specific to each patient
  • a virtual nursing assistants, to follow-up with patients post discharge
  • drug discovery platforms, for new therapies
  • Medical Imaging and diagnostics
  • The use of AI in diagnosing diseases, patient education and reducing hospital costs
  • You can also find a great discussion on machine learning, wherein how machine learning could replace/ augment doctors via the health standards podcast with Fred Trotter.

Some of the other areas where AI is being implemented in Healthcare. Microsoft, Apple, IBM and other major players are all looking to AI help in curing people. And they are forming a group that creates the standard of ethics for the development of AI.

AI in healthcare also has a potential to be leveraged to be implemented in the following aspects of Healthcare Industry: 

  • Billing and Insurance Workflow, Insurance reconciliations and provider workflows can be enhanced by enabling total automation of the processes by enabling handling of the insurance claims by AI based Insurance agents. The exceptions and outliers can be escalated for manual interventions and closures.
  • Improving customer experience in healthcare by providing a 360 degree engagement, the SMAC based solutions will use the power of integrating the data streams from multiple sources to help deliver a better service to the patients.
  • Inventory and Supply chain processes can benefit from AI driven optimization by incorporating e-commerce driven innovations that allow for a democratization of product to vendor mix by searching and delivering the best cost options to the procurement department. Thereby bringing the costs down. Logistics improvements delivered in other industries need to come to healthcare to allow for the reduction in the cost of procurement of drugs, devices and durables. AI will help organizations in identifying variable costs and help them understand how to handle scenarios that will present themselves in an ongoing basis.
  • AI enabled resource management and scheduling will allow for identifying areas that need to be staffed with more resources and when additional resources need to be hired to meet with the increasing demands or provide elastic resource management based on ever changing operational demands. Booking appointments with doctors, will become a job taken up by Bots or AI assistants, enabling the nursing and administrative staff to focus more on delivering care and enhanced service experience for the patients.
  • AI-based people management systems will help hospitals in recruitment, retention and performance management of their employees. By presenting an analytics driven approach to people management, systems will be able to help employees to be trained to take up newer roles and responsibilities.

So by when will AI really take over Doctors?
 
It’s clear from the image above, that estimates of how much processing power is needed to emulate a human brain at various levels (from Ray Kurzweil, and Anders Sandberg and Nick Bostrom), “along with the fastest supercomputer from TOP500 mapped by year. Note the logarithmic scale and exponential trendline, which assumes the computational capacity doubles every 1.1 years” [10]. Kurzweil believes that mind uploading will be possible at neural simulation, while the Sandberg, Bostrom report is less certain about where consciousness arises

Based on the above point of view, an interesting question to ask today:
If a Doctor goes through 7+ years of training to become a specialist, how many days will it take for an AI based Physician?

The answer perhaps lies in the following statements

Chief scientist and AI guru Andrew Ng of Chinese search giant Baidu Inc. once put it, “worrying about takeover by some kind of intelligent, autonomous, evil AI is about as rational as worrying about overpopulation on Mars.” [11], [12].

And,

What is it that makes us human? It’s not something that you can program. You can’t put it into a chip. It’s’ the strength of the human heart. The difference between us and machines.
– Terminator Salvation, 2009

References
[1]: AlanTuring.net What is AI?
[3]: Improving Diagnosis in Health Care | The National Academies Press https://www.nap.edu/catalog/21794/improving-diagnosis-in-health-care
[4]: The diagnostic process in general practice: has it a two-phase structure? http://fampra.oxfordjournals.org/content/18/3/243.full
[5]: Managing Medical Logic Modules.
[6]: HL7 Standards Product Brief – Arden Syntax v2.9 (Health Level Seven Arden Syntax for Medical Logic Systems, Version 2.9) http://www.hl7.org/implement/standards/product_brief.cfm?product_id=290
[7]: Clinical Pathways via Open Clinical, knowledge management for medical care http://www.openclinical.org/clinicalpathways.html
[8]: Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology. Boston: Little, Brown and Co., 1991; 3–18.
[9]: Barriers for Adopting Electronic Health Records (EHRs) by Physicians https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766548/
[10]: Artificial General Intelligence,
[11]: AI guru Ng: Fearing a rise of killer robots is like worrying about overpopulation on Mars
[12]: The Artificially Intelligent Doctor Will Hear You Now
[13]: Why we are still light years away from full artificial intelligence | https://techcrunch.com/2016/12/14/why-we-are-still-light-years-away-from-full-artificial-intelligence/
[14]: AI In Healthcare Heatmap: From Diagnostics To Drug Discovery Startups, The Category Heats Up

[15]: Doctor’s 35-hr shift on 8 bananas, a toilet in nearby cafe
http://indianexpress.com/article/india/india-others/doctors-35-hr-shift-on-8-bananas-a-toilet-in-nearby-cafe/ 
[16]: Gigerenzer’s simple rules by NS Ramnath on Founding Fuel 
http://www.foundingfuel.com/article/gigerenzers-simple-rules/
[17]: A.I. VERSUS M.D: What happens when diagnosis is automated? By Siddhartha Mukherjee
http://www.newyorker.com/magazine/2017/04/03/ai-versus-md

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Manish Sharma

Founder HCITExpert.com, Digital Health Entrepreneur

Connect with me via any of my Social Media Channels

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