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Iotslam healthcare 2015v2

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Healthcare iot – welcome to the future

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Iotslam healthcare 2015v2

  1. 1. CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION. Contact: Dr Pankaj Gupta Partner, Taurus Glocal Consulting Dr_pankajgupta@yahoo.com drgupta@taurusglocal.com Website: www.taurusglocal.com Blog: http://www.healthcareitstrategy.blogspot.com/ LinkedIn: http://www.linkedin.com/in/drpankajgupta 09 Dec 2015
  2. 2. 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”..
  3. 3. STAR TREK THOUGHT ABOUT IT FIRST ?! Star Trek Communicator Tablets! Injectable Nano Particles! Tricorder Diagnostic DeviceStar Trek Glass! Bionics!
  4. 4. 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
  5. 5. o RFID tag or Bar codes on Lab samples o Auto Analyzer o Auto Reporting o CRM – Email to patient, Alert for abnormal values o EMR - Feed to EMR, Alert for abnormal values o CPOE – Drug to Lab Alert o Reminder for follow-up lab tests for chronic diseases LABORATORY AUTOMATION C P O E
  6. 6. 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. 56% PATIENT SAFETY AND QUALITY OF CARE
  7. 7. BIONICS, ROBOTIC SURGERY, GOOGLE GLASS o First Bionics Olympics to be in Switzerland 2016 o Google Glass takes inputs from voice, touch, eye ball movements o Devices will soon take the EEG inputs directly 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 geography!
  8. 8. 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 drug compliance o Tablets with Bar codes and RFID ink help identify counterfeit o HIS/EMR/PHR can take appropriate Actions as per Alerts/ Reminders
  9. 9. 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 accidents o Car, smart phone or wearable device alert about any Medical Emergency o Automatic Redirect Ambulance nearest to the Accident site or Medical Emergency o Devices shake hands and establish Identity of the Patient o Paramedics Smart PDA pulls out Medical record o Start Paramedic care – Golden Hour o Keep Hospital ready as per patient’s medical history, diagnosis, drugs, allergies etc.
  10. 10. o Hospital Air and Surface sample sensors monitor infection load – throw alert when overload happens o Sensors in drapes, linen alert when soiled 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 rounds SMART HOSPITALS
  11. 11. SMART PHONES AND WEARABLES
  12. 12. 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. 12 TELEHEALTH AND REMOTE CARE
  13. 13. DemographicsDiagnosisSymptomsSigns Clinical EMR Radiology Devices Laboratory Analysers Physicians Department Insurance Hospital Pharmacy BCMA DE-IDENTIFY BEFORE DATA ANALYTICS
  14. 14. 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 superbrain…Brain-machine 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.
  15. 15. Hospital Pharmacy Telemedicine Patient Lab/ Rad Payers Ambulance SMALL DATA ^ = BIG DATA PLATFORM Standardized Syntax, Semantics, Registries, Meta Data Universal Translators, Connectors, Interfaces, Analytics
  16. 16. 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.
  17. 17. 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.
  18. 18. TRADITIONAL PLAYERS o Heavy Challenge: Dell acquired EMC/VMWare. Special focus on Healthcare, Education and Public. o Big Iron: IBM, GE, Oracle, SAP, Salesforce o EMR Biggies: Cerner, Allscripts, Epic o Carriers: Varizon, Comcast, AT&T o Device Players: Medtronic, Phillips, BD, St. Jude, Stryker. JnJ, Varian Whole different animal. Needs a complete rethink!
  19. 19. 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, HP/Aruba o Wild card: Flextronics, PTC, McKesson, Zebra o Chip Guys: Analogue devices, Intel, ARM o Device Contenders: Aethon, Under Armour, Ekso Bionics, ReWalk, BioTelemetry, iRhythm, Proteus, Glooko, DexCom, Kit Check NEW PLAYERS
  20. 20. BIG PICTURE 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 systems". 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.
  21. 21. CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.
  22. 22. 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
  23. 23. HCIOT INFRASTRUCTURE 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 multi-site later 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.
  24. 24. HIPAA TITLE II Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform o Data Privacy o Transactions and Code Sets o Data Security o Unique Identifiers
  25. 25. DATA PRIVACY o Protected Health Information (PHI) o Right to keep personal information from outside world 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 compromised 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 ?
  26. 26. 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- blocker o Diabetes with Coronary Atherosclerosis discharged with B-blocker o Type-II Diabetes with CHF discharged with Metoprolol
  27. 27. 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 pacemaker. o US FDA and Congress is also waking up to the new IoT paradigm! o Network security o Firewalls, o Data centre, o IT Support Teams, Outsourcing o Data Security - Encryption o Public/Private keys NETWORK AND DATA SECURITY
  28. 28. 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 scan), smartcards o Authority - do you have a need to know? o User U in role R who satisfies constraint C has permission P o Ms Ann working as Nurse in ED has r/w/x permissions; whereas she doesn’t have those permissions offduty 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 ride etc PHYSICAL SECURITY
  29. 29. 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
  30. 30. Transformative Leadership Next Practices Process Innovation Incremental Improvements Existing Operational ModelsObsolete Resilience Business as Usual Short Term Gains Long Term Success
  31. 31. 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 Contact: Dr Pankaj Gupta Partner, Taurus Glocal Consulting Dr_pankajgupta@yahoo.com drgupta@taurusglocal.com Website: www.taurusglocal.com Blog: http://www.healthcareitstrategy.blogspot.com/ LinkedIn: http://www.linkedin.com/in/drpankajgupta

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