Category: Clinical reality

What does 5G and the IoT mean for health tech?

Published on by Dr Alice Byram

What is 5G?

Like many acronyms, they are demystified once you know what they stand for. 5G simply means the fifth generation of wireless technology. In simple terms, it means speeding up the data due to bigger channels, more responsive technology due to the lower latency or less lag, and the ability to connect a lot more devices at once. Within 5G, these qualities can differ depending on the channels used. For example, the speed itself may be slower if the frequency being used is lower and similar to that used in previous technology, such as old TV frequencies or current 4G. It may be all that is available if the physical infrastructure for the new frequencies is not available.

Where can I find it being used in health?

Decreased latency leads to less “lag” and, therefore, a more real-time experience. Whilst a delay during a videocall is annoying, it is generally not life-threatening. Transfer that to an operating theatre and the ability to operate remotely does depend on real-time transfer of what is happening, and vice versa, the ability to react and stop unexpected bleeding or coordinated efforts between various surgeons.

Similarly, the ability to connect more devices at once is of great importance in ever more connected health care settings. Physicians are forever being asked to adopt the latest wireless monitoring and sensors to create a more seamless experience for the patient. However, if you are still in a system that uses fax or in a department where the internet connection is flaky, the real game-changer for day to day use will be the ability to connect all the devices at once with confidence. In telemedicine, this translates into the ability to not only be seeing and communicating with the patient but also monitoring and receiving real-time data about their physical status. Many experts in the digital health space see these qualities as the gateway to 4P medicine, which is a digital version of what clinicians have been doing for years. 4P stands for predictive, preventative, personalised and participatory.

Another bugbear of out of hours care or just seeing a patient who does not usually attend your hospital or surgery is the inability to see their previous images. Imaging studies are notoriously complicated to transfer between systems and the ability for either the patient themselves or another health professional to send over quickly in a compatible format MRI or CT scans. It may surprise you to know that as a clinician in the NHS, I could not access the recent CT head scan of a patient done at a hospital only 25km away. Or maybe it’s no surprise, and you just shake your head as an inevitable reality. But we need to demand from our clinical workspace the same fast internet and communication we get from our Netflix subscription!

What is the IoT?

IoT simply stands for the Internet Of Things. In other words, “objects with computing devices in them that can connect to each other and exchange data using the internet”. In healthcare, this translates into sensors and technology linked to the patient rather than the clinical setting giving a real picture of what is going on in a person’s life and health. From distance monitoring which is set to alarm the clinician when certain parameters are reached, to active ongoing monitoring that transforms the patient’s home into a virtual hospital, the IoT with 5G gives clinicians more confidence to extend already existing hospital at-home projects. Well established in older and more frail patients, hospital at home with CGA (Comprehensive Geriatric Assessment) has already been shown to decrease hospital admissions with similar long-term outcomes and greater patient satisfaction.1 Distance monitoring will open this option up also because the carers and patients themselves will feel more supported and empowered. In France, where cancer patients wishing to stay at home are limited by the clinician not feeling with that confidence, a better solution may be found with real-time monitoring.2

Of course, no one person is just a patient or a disease, but rather a combination of roles, identities and functions. Where the IOT comes into its own is bringing all of this to the clinician, the information from all sources, including non-medical aspects such as travel, air contamination, favourite activities, brings clinicians closer to the original definition of being a doctor. When you would have known your patients, their families and everything else going on in their lives. This lack of continuity and depth brings many clinicians to burnout, and 5G and the IOT should be seen as facilitating a return to that holistic vision of a person or patient who comes to see them. Only then can the clinician use their knowledge base and experience to personalise the treatments and solutions they offer fully. Digital health augments a clinician’s practice. Those who argue that doctors will become irrelevant have clearly not sat in on patient clinics and surgeries, going through the options available based on local resources, the latest advances and patient preference. In medicine there is never one right treatment, and the art remains in the ability to pull it all together, making use of all the information and resources available.

1.        Shepperd, S. et al. Is Comprehensive Geriatric Assessment Admission Avoidance Hospital at Home an Alternative to Hospital Admission for Older Persons? : A Randomized Trial. Annals of internal medicine 174, 889–898 (2021).

2.        Margier, J., Gafni, A. & Moumjid, N. Cancer care at home or in local health centres versus in hospital: Public policy goals and patients’ preferences in the Rhône-Alps region in France. Health policy (Amsterdam, Netherlands) 125, 213–220 (2021).

Straight from the horse’s mouth – or where to go for verified information about #coronavirus or any other medical topics.

Published on by Dr Alice Byram

If you work in #digitalhealth it is important that you deal only in facts and validated information to retain credibility.

Over the past years, months and days, we’ve all been exposed to #fakenews in one form or another. Some of it is obvious and maybe even funny. Other fake news maybe less obvious, especially if it comes through a friend or colleague. #coronavirus has led to many fast circulating examples of misinformation so here is a quick guide to how to make sure you have up to date validated information and a list of specific #COVID19 resources.

We often don’t know where to go in the middle of so much available information. Newspapers often get their information second hand and report , as is their function, on ever changing situations early on. Blog posts can look surprisingly well referenced but if you go into the references maybe citing animal studies or non peer-reviewed articles. Did you know that many journals now ask authors to pay for their article to be published, knowing they have a willing market in researchers needing to publish a certain amount of articles a year?

Other sources of potentially biased information due to having vested interests are patient information webpages which appear at the top of google. Often pharmaceutical companies or pressure groups have invested a lot of money in making sure that their page appears first when you type in their name. It may take a while to find out who is behind the page – a red flag in itself.

So where should you look?

The best sources are official, have an obligation to be updated regularly and have been reviewed by someone other than the author. Looking at the site where the information is hosted is one of the first steps.

  1. .ac.uk – university sites in the UK
  2. .gov – official government sites
  3. .nhs.uk – the National Health Service in the United Kingdom
    1. NHS Patient Info
    2. NHS Specialist Info
  4. .org – if combined with it being the national college of a medical speciality, it should be a reliable if not always very easy to use source of specific medical information
  5. .edu – a educational institution which may be a university hospital with information for healthcare professionals and patients.

Clinical guidelines and updates are often published by national societies but there are also a few other places to look:

FDA: The U.S Food and Drug Administration website has a lot of regulatory information but also updates on current events such as donating plasma if you have recovered from COVID-19. Use the search option to find information about your topic of interest.

NICE : The National Institute for Health and Clinical Excellence is a UK based organisation on which clinical protocols are based. if you want to check what is the is the latest guidance on a specific health issue, including coronavirus, then this is a good place to start. Don’t be put off by the sometimes dense text, there is always a summary option available.

For research papers you can look at PubMed where almost all research papers are collated, with links out to the originals and links to other articles citing the information provided in your chosen article. You can specify how recent you want the article to be and whether you are interested in just humans or also animals. Using the “review” filter means that you will get an article looking at all the research on a particular topic. This can be very useful for the general public or non-specialists. You can also set up alerts so that you receive an email every time someone publishes something in your field of interest.

If you do receive a whatsapp or facebook message purporting to come from Stamford University for example, copy and paste the first line into google and you will quickly find out if it is a scam or not. Even videos with an MD explaining something may not be validated information. Always fact check anything you receive.

Specific COVID-19 or #coronavirus resources.

In view of the fast changing events it really is best to go straight to the horse’s mouth, or the specific #COVID-19 pages of the ones informing the experts and the general public:

  1. World Health Organisation
  2. British Medical Journal – Best Practise
  3. John Hopkins Coronavirus Dashboard.
  4. KnowledgeShare compilation of articles and guidelines coming out.

If you want to hear it from those on the ground.

Front-line health workers whether doctors, nursed or paramedics have taken to podcasts as the way of reflecting on their experiences and how it fits in with the evidence. They are ahead of the official guidelines especially in fast-changing situations such as the current coronavirus pandemic.

EMCrit – USA based emergency physician and guests.

The Good GP – Australian Family Medicine Doctors talk about their experiences and latest updates.

Emergency Medicine College explains how to deal with COVID19 for non-EM doctors.

Pondermed – talks about the reality for radiographers amongst other COVID-19 topics.

Paramedic podcasts – prehospital health workers are the first people on the scene and have a unique view on what actually works and is really going on.

aaron-blanco-tejedor-VBe9zj-JHBs-unsplash

Lost USB? Hacked? What to do in the case of a data protection breach?

Published on by Dr Alice Byram

Despite all the best will in the world and processes in places, data breaches can happen. It can be as simple as a lost USB with patient information or a more sustained hacking attempt which affects only your clinic or you as part of a wider organisation which has been maliciously attacked.

Informing the supervisory body.

The most important point is that you have 72h to inform the supervisory body as soon as you are aware of the breach as per Article 33. If you don’t do this within 72h, you must give reasons as to why this wasn’t done. The information you will need to provide is:

  • Nature of the breach:
    • Categories of data subjects
    • Numbers of data subjects.
    • Numbers and categories of data records affected.
  • Data protection officer contact details as well as those of other people who may be able to give relevant information.
  • Explain the potential consequences of this breach.
  • Explain what you have done so far and what you plan to do to mitigate the effects of the breach.

Informing the patient.

Once you have informed the supervisory authority, you need to notify the person whose data has been breached (data subject) in clear and plain language. As per Article 34, you do not need to inform the patient if:

  1. The data was encrypted or used other methods to ensure that it is unintelligible to persons not authorised to access it.
  2. The data controller has taken extra measures to ensure the risks of the data breach are not likely to materialise.
  3. It would involve a disproportionate effort. Public communication would be the alternative in this case.

If the supervisory authority feels that this is a high-risk situation and you have not informed your patient/data subject, they make take on the task of informing patients about the data breach and its potential consequences.

natanael-melchor-43LwvC-eQPM-unsplash

Why you need to clinically validate your #healthtech.

Published on by Dr Alice Byram

Quoted failure rates of #healthtech start-ups are almost as hysterical as the millions said start-ups are said to be receiving. Numbers vary vastly from 44% to 70%. The actual numbers don’t really matter (unless you are one of the investors or workers losing out), the real issue of how to avoid this happening in the first place in #digitalhealth. #Healthtech projects which have clinicians behind them do well both in the private and public sector; they have inbuilt clinical validation from the start. This is why you too should think about doing it. 

So that the #healthtech actually works.

It may seem an obvious point, but many digital health “solutions” fail because they are not in fact a solution. They are a product which is developed by non-healthcare professionals to answer a perceived need. Innovative technology is showcased brilliantly at industry events but then is either rejected or fails when it comes to the medical profession.

Bias in medicine is a dangerous thing, and as clinicians, we are continually being put in our places by patients who don’t conform to expectations. There has been much talk about Babylon’s diagnosing a woman as having anxiety instead of a heart attack, pointed out incidentally on #medtwitter. However, this is just one of many examples of bias which can mean that your non-clinically validate #healthtech not only doesn’t work but also becomes a liability. And as with Babylon, word spreads fast in the medical community. How many #healthtech developers are employing data scientists to look at potentially dangerous biases in their algorithms?

So that doctors support your #healthtech.

Lack of clinical take-up leads to a lot of “doctors will just have to get used to changing their practise whether they like it or not” comments, implying that they are stuck in their ways. This overlooks the fact that doctors, by definition, are lifelong learners, adapting their clinical practice on a daily basis. Every patient you see is a risk-balance assessment of what works best for that patient based on current evidence but also your own professional opinion. Healthcare professionals are your toughest critics because they are the ones who see the #clinicalreality and the aspects which you don’t. No man is an island and no patient is just one disease.

When you diagnose a patient, you do so not just by looking at a set of tests and variables such as heart rate, but by speaking and looking at the patient. The questions often seem random to a layperson, but sometimes the examination is even superfluous. I know I’m not the only person who has gone back into a cubicle to put a stethoscope on for the patient’s benefit as I’d already understood what was going on by the time we’d finished talking. Just how many #digitalhealth people realise that by the time you are ordering the tests, you are often just confirming the diagnosis. When you “treat” a patient, you do so not just following a protocol but based on many other factors.

However, there are many frustrations which we know technology could help with; having access to all the correct patient information, reducing the decision burden by incorporating protocols. So speak to your target clinicians. Now. Often. In their clinical setting. What they will tell you is that they will enthusiastically take on validated and evidence-based #healthtech which answers their needs. In fact, they will probably be able to tell you what you need to do to make your #digitalhealth technology work. Sometimes they have already done it themselves, and you can work with them.

So that patients go to their doctors asking for your #digitalhealth solutions.

And if you speak to the doctors, and nurses, and healthcare assistants, and receptionists, and porters, don’t stop there. Patients, especially chronic patients, have a very clear idea as to what works, what doesn’t work and which of their #digitalhealth needs aren’t being met. There is a whole #wearenotwaiting movement where type 1 diabetes patients have been going faster than the industry at developing openAPS or open artificial pancreas systems and glucose monitoring. After many years of being treated as dangerous mavericks, they are now being incorporated into paediatric diabetes care in major NHS hospitals. Even the fact that they are not FDA approved has not put off parents and doctors using them. That is what “disruptive” in #healthtech really means. Meanwhile, Medtronic and others who provide the “official” solutions, have recognised the fact that it makes more sense to employ directly the #wearenotwaiting developers rather than play catch-up.

Even patients who are not digitally savvy will be quick to tell you why they will or won’t use an app or technology. And often these are for very different reasons to the doctors. Maybe it is because they are more affected by the short-term side effects of a medication whose dose needs to be changed than targets- and they have to be able to access that information quickly. It may be that your amazing frailty support system doesn’t recognise the fact that being part of the #silvereconomy doesn’t mean being bedbound, and that they too want to go places in the world with no internet connection. Patients are whole persons whose disease lives with them once they leave the consulting room, and any treatment, digital or traditional, needs to take that into account.

So that you can expand into the community.

It is fair to say that in an era of influencers, traditional advertising is being rethought to reflect the age-old concept that you are more likely to follow the recommendation of someone you trust that the manufacturer. Doctors, suspicious as they are (!), prefer to hear about new medications and developments in medicine from other doctors. Pharmaceutical companies have long recognised this fact and this is another advantage of clinically validating your product. You speak the language of your target users, and once clinicians are prepared to listen, it can be a useful two-way conversation and is the way you get your #digitalhealth product to a clinical setting.

Patients too ask friends and family for advice. The reason that the instruction to only take medication which has been prescribed for you is precisely because people still take their family member’s medications for something which may or may not be a similar disease. Once you have patients with a vested interest, then others will follow. The way to do that is to listen, speak to and answer their needs.

It’s an exciting time to be in medicine, both as a professional and a patient or carer. It is in everyone’s interest in making sure that the progress in #healthtech works first time round….and keeps on working and being relevant.