CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.
Dr Pankaj Gupta
Partner, Taurus Glocal Consulting
09 Dec 2015
A VISIONARY SAW THE NEW ERA
Steve Jobs said: “I
think the biggest
innovations of the 21st
century will be at the
intersection of biology
and technology. A new
era is beginning”..
STAR TREK THOUGHT ABOUT IT FIRST ?!
Star Trek Communicator
Tablets! Injectable Nano Particles!
Tricorder Diagnostic DeviceStar Trek Glass! Bionics!
Sensor in the equipment monitor
usage, throw Alert/Reminders
o Book Fault when ping to the
modality doesn’t get response
o Book Maintenance when due
o Bulb near expiry in X-Ray
o Equipment nearing end of life
o Radiation levels
o Appropriate Service Request
gets logged automatically
SENSORS IN BIO-MEDICAL MAINTENANCE
o RFID tag or Bar codes on Lab
o Auto Analyzer
o Auto Reporting
o CRM – Email to patient, Alert for
o EMR - Feed to EMR, Alert for
o CPOE – Drug to Lab Alert
o Reminder for follow-up lab tests
for chronic diseases
Computerized Physician Order Entry [CPOE] system looks over the shoulder of the Doctor
and raises alerts and reminders when clinical protocols are not adhered: Drug-Drug
interactions, Drug-Lab issues, Drug overdose, Double prescriptions etc.
Bar Code Medication Administration [BCMA] system scans the bar code on the drug to
ensure right drug, right patient, right formulation, right dose, right time, to reduce
medication errors across continuum of care
*Source: Bates et al JAMA 1995; 274:29-34.
PATIENT SAFETY AND QUALITY OF CARE
BIONICS, ROBOTIC SURGERY, GOOGLE GLASS
o First Bionics Olympics to be in
o Google Glass takes inputs from
voice, touch, eye ball movements
o Devices will soon take the EEG
o Output will soon be visible on the
air – monitors become obsolete
o Plastic, Cardiac, GI surgeons are
using robotics for surgery. Patient
doesn’t have to be in the same
room or same facility or
WEARABLES, INGESTIBLE, IMPLANTABLE
o Implantable e.g. intelligent cardiac
pacemaker can alert rhythm changes
o Wearable sensors in NICU keep tab on
identity and vitals
o Biomarker measuring Contact lenses
e.g. Google glucose contact lenses
o Tablets with Ingestible sensors help
o Tablets with Bar codes and RFID ink
help identify counterfeit
o HIS/EMR/PHR can take appropriate
Actions as per Alerts/ Reminders
SMART CITIES - EMERGENCY RESPONSE
o Air, Water, Sewer sample sensors
alert for disease outbreaks
o Past data analysis provides Disease
patterns, Accident patterns
o Traffic sensors give early alert of
o Car, smart phone or wearable device
alert about any Medical Emergency
o Automatic Redirect Ambulance
nearest to the Accident site or Medical
o Devices shake hands and establish
Identity of the Patient
o Paramedics Smart PDA pulls out
o Start Paramedic care – Golden Hour
o Keep Hospital ready as per patient’s
medical history, diagnosis, drugs,
o Hospital Air and Surface sample
sensors monitor infection load –
throw alert when overload
o Sensors in drapes, linen alert
o Building management system
senses body vitals and adjusts
AC and Lights accordingly
o Smart beds can ping the Doctors
Mobile App and provide vital
information to the doctor on
Telemedicine is a Bundle of existing
technology and business applications:
o Video: Video chat, F2F Webconference e.g.
Skype, High resolution Videoconference,
Sharing Endoscopy video film, USG
o Image: DICOM format e.g. X-Ray, CT,
Patient’s pictures e.g. JPG/GIF format
o Voice: VOIP Phone to Phone, Computer to
Phone, Computer to Computer
o Text: Chat Sessions, Electronic Medical
Records, Messenger Apps e.g. WhatsApp
o Business Applications: Primary Care,
Second Opinion, Remote Monitoring etc.
TELEHEALTH AND REMOTE CARE
DE-IDENTIFY BEFORE DATA ANALYTICS
HCIOT PLATFORMS HAVE YET TO EMERGE
StarTrek: Knowledge Bank
Avatar: Tree of Life or the Neural
Network of Eywa
Animal brains linked to create Star Trek-
style ‘Superbrain’ – The Financial
Express, Thursday, Nov 26, 2015: In
ground-breaking Star Trek-style
experiments, scientists have
successfully linked the brains of
multiple rats and monkeys, creating a
‘brainet’ that allowed them to co-
operate and learn as a
interfaces (BMIs)…allow subjects to
use their brain signals to directly
control the movements of artificial
devices, such as robotic arms,
exoskeletons or virtual avatars.
SMALL DATA ^ = BIG DATA PLATFORM
IOT PLATFORM LEADERS
Apple: Powerful platforms HomeKit, HealthKit, ResearchKit are combined with
Health App and "things" e.g. iPhone, Apple Watch and iPad. Partnerships with
UC San Francisco, Massachusetts General and Stanford in the areas of
diabetes, asthma, Parkinson's disease, and breast cancer.
Google: Acquisition of Nest, Home Hub maker Revolv. Create an OS platform
akin to Android known as Brillo. Communication protocols known as Weave.
Conjunction with the Google Cloud for Big Data. Partnerships with Novartis,
Johnson & Johnson (NYSE:JNJ), DexCom (NASDAQ:DXCM) and LabQuest
that leverage Google's intellectual property.
Samsung: Android ecosystem player. Own OS - Tizen called "OS of Everything".
Analogous to GE (NYSE:GE) Healthcare, Samsung offers an extensive line
of healthcare products ranging from CT scanners to diagnostic tools.
SECOND LINE CHALLENGERS
Qualcomm: AllJoyn IoT framework. Open, secure and universal framework. Enable
interoperability among nearby devices, products and applications across
platforms and operating systems. Qualcomm Life (QL) - mobilizing healthcare
to improve lives and advance the capabilities of medical devices. QL includes a
venture capital arm and recently acquired Capsule Technologie and its
SmartLinx Medical Device Information System capabilities.
Amazon: Amazon Web Services (AWS) IoT designed to "easily and securely
connect devices to the cloud and reliably scale to billions of devices and
trillions of messages". Partnership with Philips Healthcare whereby the
HealthSuite digital platform will utilize AWS IoT capabilities. What seems to be
little known about Amazon is the quiet acquisition of a company called
2lemetry. 2lemetry developed a very interesting IoT platform known as the
ThingFabric™ which offers quite a comprehensive set of capabilities.
o Heavy Challenge: Dell acquired
EMC/VMWare. Special focus on
Healthcare, Education and Public.
o Big Iron: IBM, GE, Oracle, SAP,
o EMR Biggies: Cerner, Allscripts,
o Carriers: Varizon, Comcast, AT&T
o Device Players: Medtronic, Phillips,
BD, St. Jude, Stryker. JnJ, Varian
Whole different animal. Needs a complete rethink!
o New players who are IoT specialists
are emerging, offering very focused
HCIoT features and services
o Solid Pedigree: ProMed Network AG
is a new IoT platform from
Switzerland and Germany funded by
the Seiler family of Lasik laser fame
o Smaller Iron: Stanley/Black&Decker,
o Wild card: Flextronics, PTC,
o Chip Guys: Analogue devices, Intel,
o Device Contenders: Aethon, Under
Armour, Ekso Bionics, ReWalk,
BioTelemetry, iRhythm, Proteus,
Glooko, DexCom, Kit Check
Continua Alliance: describes itself as "the only
organization convening global technology
industry standards to develop end-to-end,
plug-and-play connectivity for personal
connected health. Continua is dedicated to
the development of design guidelines and
test tools to expedite the deployment of
personal connected health devices and
CommonWell Health Alliance: describes its
mission as follows: "We are creating and
executing a vendorneutral platform that
breaks down the technological and process
barriers that currently inhibit effective health
data exchange. Health data should be
available to individuals and providers
regardless of where care occurs".
CommonWell Alliance includes Cerner
(NASDAQ:CERN), McKesson (NYSE:MCK),
Allscripts (NASDAQ:MDRX) and
Athenahealth (NASDAQ:ATHN), Social
Security Administration, CVS Caremark
(NYSE:CVS), Varian Medical Systems
(NYSE:VAR), and RelayHealth.
CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.
ODDS AND ENDS
o Computing/network infrastructure can deal
with security But privacy is a policy matter.
Anonymizing of databases helps but it isn’t
fool-proof. In general, people are the
weakest security and privacy link
o HIPAA has been there for a while but more
is needed for HCIoT.
o Medicare Telehealth Parity Act of 2015 has
been introduced in US Congress
o Drug Supply Chain Security Act (DSCSA),
which outlines the procedures to identify
and trace key prescription drugs as they
traverse the supply chain in the USA.
o FDA's Unique Device Identifier regulations
that require medical devices to embed UDIs
in "machine readable form" another obvious
driver for HCIoT apps
o Prepare the IT infrastructure for
Transaction load of IoT as it increases the
transaction load multiple times
o Wi-fi in wards for doctors to take notes and
give orders thru tablets?
o Single site design difficult to change to
o Cloud, or hosted data center? If In-house –
Plan for BCP and DR?
o Carriers e.g. Reliance Jio, Qualcomm,
Varizon, Comcast, AT&T building HCIoT
Platforms - able to connect any Network –
3G, 4G, CDMA, GSM, Li-Fi, ISP, MPLS.
o New players who are IoT specialists will
emerge, likely offering very focused HCIoT
features and services e.g. privately held
SigFox touts a healthcare vertical.
HIPAA TITLE II
Title II: Preventing Health Care Fraud and Abuse;
Administrative Simplification; Medical Liability
o Data Privacy
o Transactions and Code Sets
o Data Security
o Unique Identifiers
o Protected Health Information (PHI)
o Right to keep personal information from
o Hospital staff, in-house and outsourced IT
staff may be authorized to see data and
may disclose it inappropriately
o Protect sensitive information – Gender of
unborn and MTP are sensitive info
o Positive results for sensitive Lab tests – HIV,
Hepatitis B etc.
o Public health research - Anonymised data
o Don’t want data of one landing up on another’s
desk – Registry for People Identity, Facility
Identity to be fool proof
o Dr Parminder Singh = Dr P Singh !
o Dr Paramjit Singh = Dr P Singh ?
TRANSACTIONS AND CODE SETS
o Syntax and Semantic integration challenge –
codify diagnosis, procedures and order sets
o Data Analytics challenge - standard
terminology for clinical notes
o Diabetes with MI discharged with B-
o Diabetes with Coronary Atherosclerosis
discharged with B-blocker
o Type-II Diabetes with CHF discharged
o HCIoT is fraught with network and data
security concerns. A former US VP feared the
worst and got the Wi-Fi switched off for his
o US FDA and Congress is also waking up to
the new IoT paradigm!
o Network security
o Data centre,
o IT Support Teams, Outsourcing
o Data Security - Encryption
o Public/Private keys
NETWORK AND DATA SECURITY
o Hacking sophisticated medical devices. Change
calibrations of lab, bedside and ICU equipment.
Backdoor entry to critical Healthcare IT systems.
Hacking Remotely operated surgical robots.
o Authentication - are you who you say you are?
o Passwords, Biometrics (finger print, retinal
o Authority - do you have a need to know?
o User U in role R who satisfies constraint C has
o Ms Ann working as Nurse in ED has r/w/x
permissions; whereas she doesn’t have those
o Ensure only authenticated users to perform
authorized activities on authorized data
o Audit - record of who actually got into what
o Record of every entry, correction, change, over
HEALTH INFORMATION EXCHANGE
IoT integration between multiple systems
o Meta data based integration
o Physician Registry - Dr Om Prakash Singh
in ENT vs Dr OP Singh in Otolaryngology?
o Patient Registry
o Disease Registry
o Document Registry
Business as Usual
Short Term Gains Long Term Success
QUOTE FROM MOTHER OF NURSING
“The effect on sickness of beautiful objects, on variety of objects and
especially brilliancy of colours, is hardly to be appreciated. Such
cravings are usually called the “fancies” of patients but these “fancies”
are the most valuable indication of that which is necessary for their
recovery. People say that the effect is only on the mind. It is no such
thing. The effect is on the body too. Little as we know about the way in
which we are affected by form and colour and light, we do know this:
that they have an actual and physical effect. Variety of form and
brilliance of colour in the objects presented to patients are an actual
means of recovery”
- Florence Nightingale
Dr Pankaj Gupta
Partner, Taurus Glocal Consulting