iOS 13.6 Update Apple has added a new category for symptoms in the Health app, including symptoms logged from Cycle Tracking and ECGAbility to log new symptoms, like fever, chills, sore throat or coughing, and share them with third-party apps. The latest update to the health app settings now include symptoms associated with various illnesses such as body and muscle aches, coughing, coughing, appetite changes, dizziness, fainting, headache, nausea, and more. All the new symptoms listed in the app come with a description and allow entry options based on the symptom in question, with options to add details like Severe, Moderate, Mild, Present, or Not Present for an associated symptom. Sources: https://support.apple.com/en-euro/HT210393 Sources: https://appleinsider.com/articles/20/06/09/ios-136-adds-symptoms-to-health-unattended-ios-update-download-toggle Sources: https://www.myhealthyapple.com/apples-health-app-adds-new-symptoms-in-ios-13-6/

RWANDA: COVID-19 RESPONSE In some places in the world right now, getting tested for COVID-19 remains difficult or nearly impossible. In Rwanda, you might just get tested randomly as you're going down the street. "So whenever someone is driving a vehicle, bicycle, motorcycle or even walking, everyone is asked if you wish to get tested," says Sabin Nsanzimana, director general of the Rwanda Biomedical Center, which is the arm of the ministry of health that's in charge of tackling COVID-19. Health officials in personal protective equipment administer the test. Nsanzimana says the testing is voluntary, although some others say refusal is frowned upon. The sample collection — from a swab up the nose — and filling out the contact information paperwork takes about five minutes. "All these samples are sent that day to the lab," Nsanzimana says. "We have a big lab here in Kigali. We have also six other labs in the other provinces." Despite being classified by the World Bank as a low-income country, and despite its limited resources, Rwanda has vowed to identify every coronavirus case. Anyone who tests positive is immediately quarantined at a dedicated COVID-19 clinic. Any contacts of that case who are deemed at high risk are also quarantined, either at a clinic or at home, until they can be tested. Nsanzimana says health workers call or visit every potential contact of someone who tests positive. "We really believe that doing so is important to make sure we detect and trace where the virus could be," he says. TRACK AND TRACE Comprehensive contact tracing is a task that has overwhelmed countries with far more resources than Rwanda. Rwanda's per capita income is roughly $2,000 per year. Yet all testing and treatment for the virus is provided for free. It costs the government between $50 and $100 to run a single coronavirus test, Nsanzimana says. In order to test thousands a day, Rwanda has started using a process called "pool testing." Material from 20-25 nasal swabs are all put into one vial and run through the machine. This allows them to test far more samples at once. If they get a positive result, then all the swabs that went into that initial vial are tested individually to pinpoint the person who's infected. Nsanzimana says Rwanda's experience dealing with other infectious disease outbreaks is helping it now during the pandemic. The country is using systems and equipment it already had in place to address HIV. "The main machines we are using for COVID testing are the HIV machines that were (already) there," he says. "We are using the same structure, same people, same infrastructure and laboratory diagnostics, but applying it to COVID testing." Since recording its first case in mid-March, the country of 12 million has recorded just over 1,500 cases. Ohio has a similar size population and has recently been reporting roughly 1,200 cases a day. BIG DATA & ANALYSIS "Rwanda did a few things that are quite smart," says Sema Sgaier, the head of the Surgo Foundation, which has just launched a new data tool to analyze trends around COVID-19 across Africa. "One is they responded really early. They put some of the most stringent lockdowns in place compared to every other African country. In fact, we've been monitoring physical distancing data across the continent and Rwanda fares, I think, second; they've physical distanced the second most across Africa" — a conclusion based on mobile phone movement data. South Africa is No. 1. Rwanda mobilized community health care workers and police and college students to work as contact tracers. It set up national and regional command posts to track cases. It's even using human-size robots in the COVID-19 clinics to take patients' temperatures and deliver supplies. Tolbert Nyenswah, who ran the Liberian ministry of health's response to Ebola in 2014, gives Rwanda high marks for how it has been handling COVID-19, even if at times it's heavy-handed. "Rwanda, from all indications, is a success story for Africa," Nyenswah says. The strong leadership from President Paul Kagame, which Nyenswah says can even be authoritarian, has been effective during this crisis. Kagame demands accountability from his health ministry. Whether the people trust or fear the government, Rwandans listen to their government and have been following the orders regarding masks, washing hands and staying home. Nyenswah worries that the worst is yet to come in Africa with this pandemic. "No country is out of the woods yet," he says. However, he adds that Rwanda is an example to other low-income countries that even with limited resources, this virus can be contained. "So what needs to be done is to follow the (prevention and containment) measures. Political leadership is very, very crucial. Rwanda should continue what it is doing now. And other countries should emulate Rwanda. Source: https://www.npr.org/sections/goatsandsoda/2020/07/15/889802561/a-covid-19-success-story-in-rwanda-free-testing-robot-caregivers RWANDA: THE DIGITAL HEALTH PIONEER PART 1 Read Part 1 here - https://www.healthcare.digital/single-post/2017/11/03/Rwanda-The-Digital-Health-Pioneer Introduction to Rwanda Rwanda has made remarkable socioeconomic progress in the past decade with real GDP growth averaging 8.2% annually. This has translated into improvements in the health situation. Major health reforms took place, including the health insurance improvement, which aims to guarantee access for all to health care; and experience from Rwanda has shown that it is possible to achieve universal health coverage in a country with 90% of its population in the informal sector. Life expectancy has doubled during the 20 years following the devastating 1994 genocide against the Tutsi, as a result of increase in the number of health facilities, improvement in immunization coverage, good access to safe drinking water, and improved housing. All targets related to the three health-MDGs were met, with a notable success in reduction of child mortality and considerable improvements in maternal health. "Rwanda’s eHealth Strategic Plan for 2016–2020 is the key driver to economic growth and to improving the lives of people. Digital health improves service delivery and clinical outcomes, and we know that cannot happen if we don’t look at the data." Dr. Patrick Ndimubanzi, Honorable Minister of State, Public Health and Primary Health Care, Rwanda Digital Health Innovation in Rwanda ... https://www.healthcare.digital/single-post/2017/11/03/Rwanda-The-Digital-Health-Pioneer

As lockdown shifts to downturn, we have seen how many companies have adapted to new low-touch, socially-distant norms. Cafes and restaurants have developed thriving street-food and delivery businesses, cinemas and theatres have become drive-in experiences, students study online together, contactless payment has finally replaced cash. In sport, Norway created the “Impossible Games” with athletes from Europe and Africa competing synchronously by video-link in different locations. In business, Apple hosted its annual developer conference (WWDC20) virtually, with impressive online keynotes, animations and interactions, shared by more people than ever. London Fashion Week did likewise. Fundamentally, we are seeing a rapid shift to what I call “liquid” business models. In chemistry, you will remember, a “liquid” state exists between a solid and a gas – between a structured and unstructured state. In the business world, between a physical and digital world. “Liquid” means that we can fuse together the best of physical and digital formats, devices and channels, and also give consumers much more choice in how it is constructed. Liquid businesses are more accessible and agile, responsive and personal. These “liquid” attributes permeate both the inside and outside of business – shaping the new ways in which we work – how we communicate, collaborate and learn – and the new ways in which we compete – sell, create, manufacture, and support customers. “Liquid” is a much better word than hybrid, or multi/omni-channel, or physigital, as I’ve even heard the combination of digital and physical called. (Plus, I haven’t heard “liquid” applied to business, or business models, before, so I’m claiming it right here!) The pandemic has seen rapid adoption of new technologies, and more significantly a shift to “digital me” with elevated Maslow-style human needs of belonging and connectedness. New formats emerge, responding to the new consumer, fusing the best of digital and physical: Liquid Health… the fluid combination of digital technologies like Babylon Health and Good Doctor, providing smartphone consultations, AI-enabled diagnostics, robotic surgery, together with empathetic care. Liquid Work… the fluid combination of more distributed yet collaborative working from anywhere, more flexible jobs and employment, more diverse and talented teams, creative people augmented by tech.​ Liquid Production… the fluid combination of made remotely and on demand, embracing 3D printing to print what we like as we need it, the shift from fragile slow supply chains to dynamic personal ecosystems. Liquid Retail… the fluid combination of digital consumers, with physical delivery – dark kitchens of Deliveroo delivering restaurant meals to our home, luxury brands selling direct, from Tiffany & Co. diamonds to Amazon’s Common Threads. Liquid Mobility … the fluid combination of multi-modal transport, as we shift to electric and autonomous cars, we shift from ownership to subscription, enabling a choice of transport modes, as we become more local. Liquid Learning… the fluid combination of distance and physical learning experiences, for children to executives, lifelong learning becoming the norm with flexible qualifications, topped up over time, relevant and applied. Babylon and Liquid Health Babylon Health … Ali Parsa’s “liquid healthcare” app uses AI to diagnose your problem, leading to a smartphone consultation, connected to a network of pharmacies, and specialist doctors and hospitals if needed. Babylon, based in London, now employs over 750 doctors, scientists, engineers and data analysts. They offer a subscription-based service to individuals wanting faster, on-demand health advice. A deal with the UK’s NHS to create a version of Babylon’s service called “GP at Hand” has dramatically scaled-up the service, with similar partnerships internationally. For the NHS it creates a fast, more personal service to patients, directly on your smartphone, and relieves the pressure on physical resources. Parsa sees Babylon as “the biggest doctor’s brain in the world”, and loves to show how his AI-based analytics can more effectively diagnose patients’ needs than a real person. His real ambition is to create personal and predictive healthcare, using a range of wearable sensors that can monitor individual health, and take action before it’s ever needed. Source: https://www.thegeniusworks.com/2020/07/liquid-business-models-the-fusion-of-digital-and-physical-concepts-devices-channels-from-babylon-health-to-singularity-sushi/

The healthcare industry is rife with runaway costs and unrivaled bureaucracy, with established companies either unwilling or unable to fix their most fundamental problems. Amazon's entry into this market will no doubt pressure traditional players to shake things up. Amazon is a company that scans business landscapes with a mercenary's eye. The healthcare sector appeared in its crosshairs several years ago, and its early ventures have already forced traditional companies into action. For example, Amazon acquired PillPack, an online pharmacy service, in June 2018 for $753 million. No doubt this acquisition influenced the $69 billion CVS-Aetna merger a few months later, followed quickly by Cigna's acquisition of Express Scripts for $67 billion. And there are frequent rumors of potential mergers between large corporations and healthcare companies. One persistent rumor has Walmart acquiring Humana Inc., the country's fourth largest health insurer, which Aetna tried to bag in 2015. There is serious money in play in the healthcare industry. Global healthcare spending totals nearly $8 trillion a year, according to figures from Forrester and CNBC. For comparison, global retail spending totals $2.4 trillion annually. In 2018, private sector employers in the U.S. spent nearly $700 billion on healthcare for employees. Per capita cost of healthcare in the U.S. in 2018 was $10,224, which is 28% higher than any other nation. Amazon healthcare initiatives The healthcare industry lacks Amazon's logistical expertise, said Jeffrey Becker, a senior healthcare strategy analyst at Forrester Research. "The leadership behind Amazon's healthcare effort is equally put off by over-complications, having been described as 'incredibly allergic to market inefficiency,'" he said. "This is a team we expect to tackle the most complex healthcare problems head on with simple solutions and a relentless pursuit of process improvement." With its expertise in cost cutting and reengineering for greater efficiency, Amazon has embarked on multiple healthcare initiatives. A central part of that strategy is Haven Healthcare, a joint venture Amazon formed in January 2018 with Berkshire Hathaway and JPMorgan Chase, which was intended to drive down insurance costs for the three companies' 1.2 million employees. Haven is a nonprofit with the main objective to work directly with big healthcare providers, for example, Fresenius, Catholic Health Initiatives, or Cedars-Sinai, for better coverage and pricing. Haven bypasses health insurance companies to reduce premiums, deductibles and other costs. Other companies, such as Walmart, use this strategy of buying healthcare direct from providers instead of insurers. To achieve the desired savings, a company must have legions of employees, Amazon counts 840,000 on its payroll, that are also well distributed geographically. Amazon's healthcare forays in 2019 alone include: It introduced Amazon Care, a telemedicine app for its own employees. Care provides video consults and dispatches medical professionals as needed to an employee for tests, shots and in-person procedures. It bought Health Navigator, an online provider for symptom checking and triage tools for routing patients appropriately. It joined forces with healthcare companies via AWS, its cloud computing business, to create HIPAA-compliant conversational interfaces to support virtual clinics. It launched Amazon Comprehend Medical, which detects useful information in unstructured clinical text, such as physician's notes, discharge summaries, test results and case notes. With Haven as the centerpiece, Amazon's various healthcare offerings could be repackaged into some kind of healthcare-as-a-service option. Healthcare must embrace technology Healthcare companies must overcome technology resistance, said Elizabeth Mitchell, CEO of the Pacific Business Group on Health (PBGH), a consortium that includes Boeing, Safeway, Walmart and Wells Fargo, among others. "Healthcare is about 30 years behind any other industry with regard to effectively using technology," she said, adding that too many proprietary products make real integration impossible. Electronic medical records are an example of this, Mitchell explained -- billions are spent on incompatible systems that work poorly, if at all. "It's amazing to me how little effective technology has been leveraged," she added. Mitchell said she witnessed such dynamics firsthand as a former executive at Blue Shield of California, a health plan provider. "I know there's awareness of this, but there hasn't been much movement." Signs of change Forrester's Becker said he sees change afoot. Humana recently signed a seven-year partnership with Microsoft's Azure for cloud services, artificial intelligence capabilities and collaboration technologies. Humana also partnered with Doctor On Demand for virtual primary care physician services that triage and route patients more efficiently to the correct services. UnitedHealth Group, the nation's largest health insurance company, built the United Nerve Center, which combines IoT technology with disease-specific programs for tracking and other functions. The United Nerve Center issues real-time streaming data for UnitedHealthcare's chronically ill patients and allows its providers to spot deterioration in the early stages. These moves by Humana and UnitedHealth Group are more advanced than Amazon's healthcare initiatives at the moment, according to Becker. So far, Haven has kept a low profile, except for shuffling executives; COO Jack Stoddard left the company after less than a year and Atul Gawande relinquished his CEO title in May 2020 but is still chairman of Haven's board. In the midst of a global pandemic, Becker would like to see Haven use the opportunity to showcase its expertise and innovation while the nation's attention focuses on healthcare. Amazon's influence in healthcare goes beyond technology Becker points to another nontechnology phenomenon in healthcare driven in part by Amazon's entrance: Insurance companies, known as "payors" in the insurance industry, buying medical provider groups. The CVS-Aetna merger, for example, now has 1,700 digital clinics. These clinics are typically operated by provider groups as the first point of contact for someone who needs medical attention. Handled properly, being that first point of contact can save an employee and their employer money. It's also a way for companies to "own" a customer -- in this case, a lot of customers. "United [Healthcare] is the largest employer of providers in America because [it's] gone on a buying spree," Becker said. "The payors are aggressive about vertical integration and using a merger and acquisition strategy to own the first point of contact with that brick and mortar healthcare market." Payors are also buying primary and urgent care centers but not hospitals, which are less cost effective, he added. Whether Amazon can transform healthcare with its technology and logistics expertise is still an open question. But there's not much debate over whether the company is up to the task. Haven faces some big obstacles as it tries to work directly with providers and re-create all the administrative systems and processes that insurers typically handle. But Amazon shows time and again it's willing to play the long game. "Companies look to maximize revenue and that's what markets do, but it's often at odds with good patient care," PBGH's Mitchell said. It's a health imperative to have patient, drug interaction and other information shared effectively. "This is not a technology problem, this is a business problem," she said. Source: https://searchaws.techtarget.com/feature/Amazon-healthcare-initiatives-wake-up-an-industry-slow-to-change

I believe Apple has a 2 year vision to make the iPhone a 'One-Stop Shop' for medical information, records and data ... so expect an Apple electronic health record in 2020. Apple have been actively involved in the Argonaut Project for the last 18 months deepening their knowledge and technical expertise of Health IT, electronic medical records and personal health records. What is the Argonaut Project? The Argonaut Project is an initiative dedicated to accelerating the development and adoption of HL7's Fast Healthcare Interoperability Resources. FHIR is a standards framework featuring a RESTful API designed to enable the exchange of health care information between applications and systems. The FHIR framework is designed to allow implementation of health care standards across all systems, devices and applications, regardless of the variability caused by diverse health care processes. The Argonaut Project comprises both health care IT industry provider organizations and electronic health records vendors, including Mayo Clinic, Intermountain Healthcare, Partners HealthCare, Epic Systems and Athenahealth. Argonaut Project participants are working together to modernize nationwide health care interoperability through the increased adoption and development of the HL7 FHIR framework and API. Enabling nationwide health care interoperability is an extremely difficult goal to achieve as there are hundreds of EHR systems available today and thousands of EHR system implementations. Apple and the Argonaut Project According to multiple sources and industry rumours, Apple has a "secretive team" operating within its health unit currently communicating with developers, hospitals, insurers and interoperability specialists about storing clinical data on the new iPhone 8. In theory, with all of their medical and patient data at their fingertips, iPhone users can access a much broader view of their health, learn from insights and share as much or as little information as they wish with doctors and healthcare professionals. Apple has been hiring developers familiar with protocols dictating the transfer of electronic health records and has talked with several health IT industry groups, including "The Argonaut Project," which promotes the adoption of open standards for health information, and "The Carin Alliance," a group aiming to give patients more control over their medical data. A centralized way to store all of a person's health data would allow the medical community to overcome existing barriers that prevent the transfer of patient information between medical providers. Hospitals and doctors offices often don't have a simple way to transfer patient information, and online medical portals are sometimes difficult to use with little info available to patients, Apple already allows iPhone users to record medical data and health information gathered by the Apple Watch and other connected devices in the built-in Health app, and it has delved into health research with CareKit and ResearchKit, but based on these rumors, the company's goal is to expand its health efforts far further in the future. Patent US 9723997 B1 : Electronic device that computes health data Further evidence of Apple's potential to launch an electronic health record can be seen in its recent US patent filing 9723997 B1 for an "electronic device that computes health data". INTRODUCTION An electronic device includes a camera, an ambient light sensor, and a proximity sensor. The electronic device uses one or more of the camera and the proximity sensor to emit light into a body part of a user touching a surface of the electronic device and one or more of the camera, the ambient light sensor, and the proximity sensor to receive at least part of the emitted light reflected by the body part of the user. The electronic device computes health data of the user based upon sensor data regarding the received light. In some implementations, the electronic device may also include one or more electrical contacts that contact one or more body parts of the user. In such implementations, the health data may be further computed based on the an electrical measurement obtained using the electrical contacts. SUMMARY The present disclosure discloses systems, apparatuses, and methods related to an electric device that computes health data. An electronic device may include a camera, an ambient light sensor, and a proximity sensor. The electronic device may use one or more of the camera and the proximity sensor to emit light into a body part of a user touching a surface of the electronic device and one or more of the camera, the ambient light sensor, and the proximity sensor to receive at least part of the emitted light reflected by the body part of the user. The electronic device may compute health data of the user based upon sensor data regarding the received light. In some implementations, the electronic device may also include one or more electrical contacts that contact one or more body parts of the user. In such implementations, the health data may be further computed based on the an electrical measurement obtained using the electrical contacts. In some implementations, the electronic device may utilize the camera to determine the user's body part is misaligned with the camera, the ambient light sensor, and the proximity sensor for purposes of detecting the information about the body part of the user. In such implementations, the electronic device may provide guidance to correct the misalignment. In various embodiments, a mobile personal computing device may include a camera, an ambient light sensor, a proximity sensor, and a processing unit communicably coupled to the camera, the ambient light sensor, and the proximity sensor. The processing unit may be configured to: use at least one of camera and a proximity sensor to emit light into a body part of a user touching a surface of the mobile personal computing device; use at least one of the camera, an ambient light sensor, or the proximity sensor to receive at least part of the emitted light reflected by the body part of the user and generate sensor data; and computing health data of the user, utilizing the processing unit, using at least the sensor data regarding the received light. In some embodiments, a method for using a mobile personal computing device to obtain health data may include: using at least one of camera and a proximity sensor to emit light into a body part of a user touching a surface of the device; using at least one of the camera, an ambient light sensor, or the proximity sensor to receive at least part of the emitted light reflected by the body part of the user and generate sensor data; and computing health data of the user, utilizing the processing unit, using at least the sensor data regarding the received light. In one or more embodiments, a method for guiding use of a mobile personal computing device to obtain health data may include: detecting, utilizing a camera, a profile of a body part of a user contacting the camera; determining, using the profile, if the body part is misaligned with a combination of the camera, an ambient light sensor, and a proximity sensor for purposes of obtaining health data for the user; and providing guidance to correct the misalignment. In various embodiments, a computer program product including a non-transitory storage medium may include a first set of instructions, stored in the non-transitory storage medium, executable by at least one processing unit to use at least one of a camera and a proximity sensor to emit light into a body part of a user touching a surface of a mobile personal computing device; a second set of instructions, stored in the non-transitory storage medium, executable by the least one processing unit to use at least one of the camera, an ambient light sensor, or the proximity sensor to receive at least part of the emitted light reflected by the body part of the user and generate sensor data; and a third set of instructions, stored in the non-transitory storage medium, executable by the least one processing unit to compute health data of the user using at least the sensor data regarding the received light. It is to be understood that both the foregoing general description and the following detailed description are for purposes of example and explanation and do not necessarily limit the present disclosure. The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate subject matter of the disclosure. Together, the descriptions and the drawings serve to explain the principles of the disclosure. From OS developers to health providers CB Insights reportedly recently that Apple were not the only Tech company interested in the mobile and electronic health record market, their analyst stated ... "Apple and Google are competing to capture users’ health and wellness data via connected devices. Google is looking to create a suite of alternative wearable devices and sensors for harnessing real-time health diagnostics. Google is mainly interested in creating novel forms of noninvasive sensors for identifying when a user of a wearable is injured or at risk. These wearables include electronic skin adhesives that collect diagnostic information, and more. Apple’s health innovations primarily rely on the existing sensors, camera, and computing power already in Apple products such as the iPhone, Apple Watch and even AirPods. Using the iPhone or Apple Watch, collected wellness data can be stored and shared with physicians and caretakers. Similarly, Apple has designs for enabling a patient to initiate a telemedicine session for treatment using a mobile device. Apple’s focus on wellness and lifestyle management, combined with the AirPods and the AI assistant Siri, could mean that Apple will explore the coaching and fitness space to proactively keep people healthy." https://www.cbinsights.com/research/innovation-patents-apple-google-amazon-facebook-expert-intelligence/

Genetic Testing sites like 23andMe are rapidly emerging as the new Social Networks. Over the last 10 years, millions of people across the world have submitted their DNA for testing and eagerly waited the results, including me back in May 2016. How are genetic testing sites becoming the new Social Networks? People are completing their DNA testing, receiving their results and then opting in to receive contacts from others with a similar genetic profile to them. This process of being contacted by people based on their DNA profile instead of location and shared interests is a fuelling a new wave of social network activity. The big benefit appears to be discovering relatives or distant family members based on a highly relevant profile and scientific match. This new activity could unlock a new use case for Facebook, particularly for older users in the 65+ bracket, not only could people keep in touch with their children and grandchildren by using the world's largest social network, they could also "search" for older or newly discovered family members of the same age. Instagram and WhatsApp are highly appealing to younger users and real assets for Facebook, could 23andMe be the jewel in the Facebook crown for the older user base? Why now, what is so unique and interesting about genetic testing? Genetic testing appears to have hit an inflection point, growth in the last 2 years has increased 300% from around 4M to 12M. In addition to the growth in this core service, a number of peripheral companies and consumer services have emerged, particularly focused on the data produced and analysis to create personalised insights. "Genealogy services use DNA to tell people what continents their ancestors are from and to locate family members, including distant cousins.The type of readout used, called a genotype, consists of around a million measurements of a person’s genome, performed using an inexpensive DNA chip." "Both Ancestry.com and 23andMe allow customers to download the data files.The sheer number of people who have the data could spur growth in websites that offer to reanalyze it. Companies including Habit and Promethease take the files and provide a breakdown of people’s diet or health risks, frequently with little oversight from regulators." "Consumer gene-testing companies have struggled for years to convince buyers that DNA tests have much value. Genealogy testing is, so far, the one killer app that has emerged to capture wide interest." Size of the global direct-to-consumer (DTC) genetic testing market from 2014 to 2022 If Facebook did acquire 23andMe, what would be the benefits of the deal beyond the data? DNA based Advertising – imagine targeting people based not only on their likes, interests, age, location etc.. but also their genetic profile? Their DNA, pre-determined and pre programmed would unlock a new advertising format. Very appealing to advertisers looking to go beyond hyper-local, hyper-targeted, programmatic and retargeted solutions. Advantage over Google – with a new layer of targeting by genetic profile, Facebook’s advertising platform would gain a competitive advantage over Google. Instead of trying to compete on reach, scale and quantity, Facebook could compete with a first mover advantage combined with technology, design and mobile products. Silicon Valley Talent – the 23andMe workforce of about 450 employees is roughly a 50/50 split between men and women and over 50% of its leadership roles (heads of research, regulatory, privacy, comms, ops, and more) are filled by women. This is rare in many companies, but even more so in its home base of Silicon Valley. Sales and Distribution – 23andMe kits are already available to order on Amazon, one of the world’s largest sales and distribution channels, now imagine them also being available to order on Facebook? How quickly could the order numbers scale from 10 million to 20 to 50 million? Following Spotify and MusicalDNA – Facebook would be following in the slipstream created by Spotify a few months ago, “Ancestry.com and Spotify have joined forces in a campaign that marries science, technology and creativity to deliver personalized experiences and new findings for consumers. Specifically, people can now create personalized playlists based on their DNA." Sources : https://www.nytimes.com/2018/06/16/style/23-and-me-ancestry-dna.html https://thestack.com/security/2015/09/16/ancestry-com-dna-advertising/ https://www.technologyreview.com/s/610233/2017-was-the-year-consumer-dna-testing-blew-up/ https://www.thedrum.com/news/2018/09/21/spotify-and-ancestry-invite-people-create-custom-playlists-based-their-dna https://www.statista.com/statistics/792022/global-direct-to-consumer-genetic-testing-market-size/

Introduction to Rwanda Rwanda has made remarkable socioeconomic progress in the past decade with real GDP growth averaging 8.2% annually. This has translated into improvements in the health situation. Major health reforms took place, including the health insurance improvement, which aims to guarantee access for all to health care; and experience from Rwanda has shown that it is possible to achieve universal health coverage in a country with 90% of its population in the informal sector. Life expectancy has doubled during the 20 years following the devastating 1994 genocide against the Tutsi, as a result of increase in the number of health facilities, improvement in immunization coverage, good access to safe drinking water, and improved housing. All targets related to the three health-MDGs were met, with a notable success in reduction of child mortality and considerable improvements in maternal health. "Rwanda’s eHealth Strategic Plan for 2016–2020 is the key driver to economic growth and to improving the lives of people. Digital health improves service delivery and clinical outcomes, and we know that cannot happen if we don’t look at the data." Dr. Patrick Ndimubanzi, Honorable Minister of State, Public Health and Primary Health Care, Rwanda Digital Health Innovation in Rwanda Let's explore 5 examples of Digital Health innovation in Rwanda ranging from artificial intelligence and machine learning to blood delivery by drones and telemedicine. 1) Jembi - Rwanda Health Information Exchange (RHIE) The RHIE project comprises of an international project team and is funded by the IDRC, Rockefeller Foundation, PEPFAR and the HIPPP initiative. The international project team has designed an enterprise architecture based solution at country level, and seeks to further strengthen eHealth and health information systems within Rwanda. The first phase is focused on the maternal healthcare domain, and the main objectives are to: Complete an Implementation Science/Research Project to present the impact of a Health Information Exchange (HIE) on the maternal healthcare delivery system in Rwanda. Develop a pilot implementation of the Health Information Exchange (HIE) in Rwanda that is focused on the maternal health care system in Rwanda. Expand the understanding of HIE in Rwanda within the health delivery system and the technical community. The project includes identifying and defining high level architecture for the health domain in Rwanda, identification of appropriate standards, functional requirements and interoperability profiles across multiple business, and foundational domains. https://www.jembi.org/project/rwanda-health-enterprise-architecture-rhea/ 2) ZipLine - Blood Delivery by Drones More than two billion people lack adequate access to essential medical products, such as blood and vaccines, due to challenging terrain and gaps in infrastructure. Zipline improves access to these supplies by flying over impassable mountains and washed-out roads, delivering directly to remote clinics. We centralize supply and provide on-demand deliveries, completely reducing waste and stock-outs. Zipline provides a seamless delivery system at an affordable price, obsessing over every detail, so you can focus on patient health. 2.9 million children under age five die every year. And up to 150,000 pregnancy-related deaths could be avoided each year if mothers had reliable access to safe blood. Through a partnership with the Government of Rwanda, Zipline will deliver all blood products for twenty hospitals and health centers starting this summer, improving access to healthcare for millions of Rwandans. Learn more at flyzipline.com Follow us on Twitter @zipline 3) Babyl Rwanda - Artificial Intelligence and Machine Learning Babyl Rwanda is a digital healthcare provider, registered in Rwanda but with its headquarters in London. Its objective is to put an accessible and affordable health service into the hands of everyone on earth by combining the ever growing computing power of machines with the best medical expertise of humans to create a comprehensive, immediate and personalized health service and make it universally available. Babyl uses a combination of artificial intelligence and machine learning with live doctors and nurses to provide medical consultations to anyone with a mobile device. In the developed world where the penetration of smart phones is much higher, this is done through an app. A patient will download the app and privately go through a triage, or seek medical advise on the app and get a diagnosis. They can then go to a pharmacy or lab for more tests or request to speak to a doctor. In Rwanda where the mobile telephone penetration is over 75%, with the majority of the population using feature phones, we have developed a USSD version. Anyone may dial *811#, and register for the platform using their National ID - which is attached to their sim card. Your ID is verified with NIDA in a second and feedback provided. This is an important step because patient information is very sensitive, so we need to be sure we are treating the right person. The patient may then book an appointment, after which they will receive an SMS confirmation of the appointment and get a call from the consulting doctor at the time of the appointment. The doctor will either diagnose the patient and send them a prescription or if further tests need to be done, send them to one of our partner labs for lab work and ultimately give a patient a diagnosis. 4) IntraHealth International - Integrated Health Service Delivery For over 20 years, we’ve collaborated with the government of Rwanda and local partners to meet the country’s need for high-quality health care services by training health workers and strengthening the systems that support them. We’ve helped the country establish decentralized health services that involve communities in defining and ensuring quality, bringing high-quality services closer to communities who need them, including services for family planning, HIV/AIDS, pediatric care, nutrition education, gender-based violence, and more. We’ve also helped Rwanda centralize data on its health workforce so it can analyze health worker information alongside service delivery and medical record data to improve services and referrals for clients. IntraHealth provided technical assistance for significant scale-up of family planning services, training hundreds of health workers and bringing long- acting reversible contraception to the health center level. We served as one of USAID’s key HIV prevention, care, and treatment clinical partners from 2005-2012, creating an innovative strategy to invite male partners of women in antenatal care to be tested for HIV, achieving high rates of participation (>90%). IntraHealth is supporting Rwanda’s efforts to centralize health workforce data so it can analyze health worker information alongside service delivery and medical record data to improve services and referrals for clients. https://www.intrahealth.org/sites/ihweb/files/attachment-files/countrybriefrwandaapr2017.pdf 5) TeleMedicine - Rwanda Military Hospital In an enclosed room at Rwanda Military Hospital in Kanombe, students listen attentively to instructions from a video interaction. This is part of their medical training, a session that allows them to interface with senior health professionals from top countries around the world. However, this practice is not entirely limited to teaching future doctors. On the opposite side of this hospital building, medics gather in a conference room to discuss sophisticated cases with other doctors from different hospitals who have more knowledge on the issues. This is telemedicine; a trend of offering medical services that started as early as 2011 at Rwanda Military Hospital. The aim of this new approach was to improve student training and consequently medical service delivery through regular consultation of experts on advanced medical cases. "Everyone is involved nowadays; it is part of the medical practice. Medical students follow the training in real time but the technology applies even in medical procedures. You could be having a patient here in Rwanda but get guidance from other countries," says Dr Pacifique Mugenzi, the head of research and education at Rwanda Military Hospital. Dr Mugenzi, who is also a trained oncologist, adds that at least once a week, doctors at the hospital meet to discuss complicated cases with other doctors, eventually deriving useful solutions. "We have discussed surgical cases, gynaecological cases and I recall a liver case where we deliberated about its management. Many issues are involved in these discussions but most of them revolve around surgery," adds Dr Mugenzi. Telemedicine provides a base to collaborate with hospitals all over the world and Rwanda Military Hospital has been working with institutions such as the Mercy Hospital in Oklahoma, USA. The recently signed memorandum of understanding between Rwanda and South Korea will improve the quality of telemedicine offered at Rwanda Military Hospital and other referral hospitals within the country. Also, this arrangement is expected to improve hospital information system (HIS) and provision of ICT-based medical services. "Much as the pact is still in early stages, Korea is far more advanced in the field of telemedicine. For example, they may have health centres without all the facilities but use the technology to treat people from another centre with the necessary facilities. During the visit of their delegation, they made assessments on the infrastructure at the hospital. We performed exchanges using telemedicine between RMH and Bushenge to exhibit whether the systems would support the project," Dr Mugenzi explains. The Future - What's Next? Rwanda is poised to play a central role in the African Alliance of Digital Health Networks ahead of its formal 2018 launch. In order to achieve strong and sustainable digital health systems, the African Alliance advocates for in-country leadership, technical capacity and digital innovation to be fostered across the continent. By investing in the development of human resources, the African Alliance will help governments develop the cadres of technology experts and tech-savvy leaders needed to support digital health policies. The African Alliance will also seek to develop a health workforce that is able to use digital health systems effectively in day to day practice, as well as for training, mentoring and performance management. Conclusion Digital innovations have already transformed the way humans interact and communicate. In Africa, the use of digital technology continues to grow rapidly, with roughly 170 million internet users and more and more people joining the internet via computers and mobile devices. Digital health encompasses technologies that enable better collection and sharing of information, improved quality and reach of health service delivery, and better decision-making by governments, health workers, and individuals. It has a critical role to play in achieving Universal Health Coverage and the health-related Sustainable Development Goals. African government leaders play a vital role in developing national digital health systems. Strong governance and leadership is foundational to developing, costing, and implementing a national digital health strategy. Government leadership is also indispensable in responding to the ongoing challenges of fragmentation in digital health investments, limited data exchange capacity within and between countries, and the absence of legislation and policies that promote digital health systems. Lets continue the discussion, tweet @lloygdprice :)

Messaging apps are the future of digital health technology in the UK. Looking forward 2 years, 5 years, 10 years, secure communication between doctors, patients, clinicians and nurses is going to be an essential utility and productivity tool, potentially unrivalled by any other technology in terms of impact and widespread adoption. Today though, demand is outstripping supply and healthcare staff are turning to WhatsApp to fulfil their requirements. It is widely acknowledged that WhatsApp is being used across the majority of NHS hospitals. A recent British Medical Journal study of 2,107 doctors across 5 hospital sites revealed 98.9% of doctors and nurses own a smartphone, and critically around 35% of them use web-based messaging apps to discuss patient care and send clinical information on a regular basis. The BMJ study concluded "we have demonstrated much higher smartphone ownership among doctors and nurses, who perceive these devices to be useful when performing their clinical duties. Large numbers of staff are sending patient related clinical information using smartphone messaging modalities. Care must be taken by doctors and nurses to ensure that no identifiable patient data is transmitted in this way, and healthcare organisations must develop strategies and policies to support the safe and secure use of these technologies by front-line staff." "The findings from this study demonstrate that smartphones have become increasingly popular among healthcare professionals who perceive them to be an excellent tool in supporting healthcare delivery. The results provide strong evidence that healthcare organisations need to develop policies to support the safe and secure use of digital technologies in the workplace and that strategies are needed to secure further innovations in digital health." Healthcare messaging apps in the UK today So if this is such a large market opportunity and everyone is using WhatsApp, what could fill the demand in the UK? There are lots of messaging products available in the UK for healthcare professionals to use, all with varying amounts of traction and use, however one clear market leader is yet to emerge leaving potential for more entrants into the market from within healthcare and also from other industries. Let's look at the 6 main products available in the UK today - 1) Cupris - http://www.cupris.com Cupris was founded by Jules Hamann, a Consultant ENT Surgeon, and Paul Thomas, an award-winning designer and entrepreneur, to develop medical devices that exploit smartphone technology to improve healthcare communication. Jules felt that a significant proportion of the patients he saw in clinic could be cared for without coming to see him in person. We believe that smartphone technology can enable examinations to take place closer to the patient's home and away from over-crowded hospitals. Jules, Paul and Mike believe that providing equal access to healthcare for everyone is an essential step in the future of healthcare and want to enable patients to be treated wherever they are, no matter how remote. 2) MedicBleep - https://www.medicbleep.com Medic Bleep has been developed as a simple and secure solution to the communication challenges that healthcare professionals and wider team in the NHS face while going about their everyday work. This means that if you work in the NHS, Medic Bleep can make your life easier by cutting down on wasted communication time. We’ve made Medic Bleep super easy to use and available on 3 key platforms – web, iOS, and Android – so you can choose what works for you. If you spend the majority of your time at a desk, we suggest you go for our web version (which works in any browser). If you’re on your feet all day or constantly moving between locations then our iOS (iPhone) or Android mobile/tablet apps give you the flexibility to read and respond to messages on the move. 3) MedCrowd - https://www.medcrowd.com medDigital was selected to join the first cohort of the DigitalHealth.London Accelerator - a world-class programme that supports SMEs to develop digital health innovations for the NHS. Through this program, medDigital developed medCrowd, a compliant messenger for health and care teams to work together more effectively and give the best care. Health and care teams are using non-compliant messaging technologies, such as WhatsApp and Facebook Groups, to share confidential health and care information on a daily basis, despite clear guidance from NHS Digital and other professional bodies that only compliant technologies must be used. Therefore, we developed medCrowd to protect confidential health and care information to the right standards. Health and care teams can now join medCrowd and work together compliantly across different organisations all over the world. 4) Hospify - https://www.hospify.com Founded by two surgeons and a technology journalist, Hospify's mission is to give healthcare workers and patients throughout the UK and Europe a very low cost, reliable, industry-wide, legislatively compliant and data secure text and picture messaging app that they can use as an alternative to the frustrating plethora of partial, local channels that they currently have to rely on. 5) Forward - http://forwardapp.co.uk Forward seeks to make bleeps, switchboards and paper handover lists a thing of the past, freeing up doctors to do the things that really matter. Forward is as secure as your NHS email account and is designed to protect both your patients and you. Forward uses end-to-end encryption and stores all data off device in a secure UK hosted cloud in line with NHS Information Governance. Forward users must have access to an approved NHS domain email address. On registering with Forward, a secure activation link will be sent to that address. This unique activation link will expire after 48 hours. 6) CareFlow Connect - www.careflowconnect.com Founded by two surgeons in 2007, Careflow Connect Ltd was acquired last year by System C Healthcare Ltd, one of the UK’s largest suppliers of health and social care software. Originally based on the principle that secure, mobile, social-media-like technology could improve team working and patient care, Careflow™ is now used by doctors, nurses and other healthcare professionals across NHS Acute, Community and Primary Care and is currently contracted across 18 NHS Trusts and counting. Available via web, native iOS and Android, it provides secure messaging, patient identified care-coordination, alerting & escalations, smart patient lists, ward-round management, handover, task management and patient referrals. Healthcare messaging apps in the US Technology innovation tends to start in the US, so what's going on stateside? Is everyone using WhatsApp? No is the short answer, more than 70+ secure text messaging products exist in the market today as a result of the american healthcare ecosystem fully embracing the need to improve communication between patients, doctors, clinicians, surgeons, nurses and staff. In the last 3 to 5 years, the development of secure messaging technology has rapidly expanded from a simple real-time communication tool designed to simply secure PHI, to a platform facilitating advanced clinical communication processes and improved patient outcomes. This rapid expansion has negated the need for WhatsApp, however it is safe to say WhatsApp is being used by healthcare professionals in the US, just on a smaller scale. A direct result of 70+ secure text messaging solutions being available is competition, innovation and the need to diversify. More and more companies are now focusing their attention to large scale enterprise platforms and building combination mobile/desktop solutions that underpin the entire communications structure for healthcare systems and hospitals. Let's look at a few of the market leading products - PingMD - a secure messaging app for doctors allowing medical health experts to connect with other professionals as well as their patients. Patients usually download the application only when their doctors are using it or recommend it to them. PingMD is HIPAA compliant and allows you to connect with your physicians the same way you might communicate with a friend or colleague via text messaging, image sharing and so forth. TigerText - provides secure, real-time mobile messaging for the enterprise, empowering organizations to work more securely. TigerText's encrypted messaging platform keeps communications safe, improves workflows, and complies with industry regulations. TigerText´s secure healthcare text messaging apps have been implemented in more than 5,000 medical facilities and we currently process more than 150 million secure text messages every day. The implementation of TigerText´s secure app for texting in healthcare at the Houston Fertility Institute resulted in the organization create a reliable system for securely recording patients´ notes. Scheduling accuracy improved by 20% and an 80% reduction in phone tag was recorded. QliqSOFT - provides a real-time, HIPAA and HITECH compliant, secure text messaging for healthcare organizations that connects doctors, nurses, and other members of the healthcare team to facilitate patient care. What about closer to home, are the Dutch one step ahead of the UK? Dr Michiel van de Sande, oncological orthopaedic surgeon at Leiden University Medical Center (LUMC) in the Netherlands believes Holland are ahead of the UK when it comes to messaging apps in healthcare and points to the fact that over 30% of Dutch doctors have collectively embraced one solution, Siilo https://www.siilo.com which has catapulted them ahead of the competition as the market leading product. Joost Bruggeman, MD PhD, Co-founder Siilo believes ""Healthcare is in transition. Care is increasingly delivered closer to the home of patients, specialists super-specialize, and locum positions are on the rise. This makes healthcare professionals increasingly mobile and puts pressure on our interrelationships. Siilo helps medical teams to connect and work together." Ok so why did Siilo become the market leader? Why again like the US are doctors not using WhatsApp on such a large scale? No-one really knows for sure, Bruggeman has a theory it is because Siilo understood medicine is mobile , always has been and always will be. From pagers to palm pilots, text messages to mobile apps, healthcare professionals have always frequently communicated to each other in order to share knowledge, ask opinions and access information. He believes "Knowledge is the result of hard work: it involves cognitive and analytic processes after appropriately weighing and collecting information, and in medicine, it is also heavily mixed with professional experience. So first, we were blessed with instantly accessing information. But now, instant messaging has given us the possibility to instantly access knowledge. Thus, your instant messenger has become a new kind of Personal Digital Assistant." What about further afield, what has been the experience in Australia? Australia were in a similar position to the UK a few years ago, due to demand from doctors, nurses and healthcare staff, combined with the use of WhatsApp, a number of secure messaging solutions evolved and were released onto the market. However this evolution of new messaging solutions has not had the same effect as in the US, in fact a lot of healthcare professionals believe the current situation they find themselves in is not a particularly positive one. Jeremy Knibbs for example commented recently in his article Digital Upheaval Asks Demanding Questions Of Austalia’s Health Sector that .. "Digital transformation has been slow to arrive to the healthcare sector because the sector is inordinately complex, fraught with risk and regulation and the economics of supply and demand, especially around the services of doctors, has retarded the normal rapid equalisation of informational power that digital brings to the consumer, in this case, the patient. It is true that the various software and secure messaging vendors, along with the major healthcare data players, like the large pathology providers, have failed largely in Australia to organise well enough to make communication of vital healthcare data efficient and secure. Much of the problem has been a lack of co-operation between competing parties." Conclusion The real benefits of secure messaging go way beyond communication, they are about connecting teams and reducing hierarchies to create efficient working environments. Based on the huge potential of secure messaging, I believe what is needed in the UK is one solution endorsed by government healthcare organisations which has learnt from both the US and Europe in terms of product features, security, UX. UI, auditing, encryption etc... and then applied to meet the needs of local markets in England, Northern Ireland, Scotland and Wales. This could be part of the national IT infrastructure, for example NHS Digital in England could release their own product or co-develop one in partnership with an existing digital healthcare company. Alternatively, the Welsh NHS Board for example could hold a Hackathon or open innovation day and ask four or five digital health companies to present their ideas on the best messaging product for the Welsh market and then commission the development of one solution. Without this approach, more and more solutions will come onto the market, potentially confusing users with different login/registration/authentication/identification processes and ultimately make interoperability and the sharing of data harder and harder as solutions effectively compete for the end user and have little motivation to work together. Messaging could be a repeat of primary care practice management software ... Let's continue the debate, tweet @lloydgprice to start a conversation.

Health tracking equipment is advancing at a significant rate with many items available that are designed to easily and efficiently fit into our busy lifestyles. Bellabeat have now introduced the ‘LEAF’ taking health-tracking design to a whole new level. This health tracker is specifically designed for women and helps to monitor activity, sleep, stress levels and even the menstrual cycle. The latest in health app technology, the LEAF has a beautiful and sleek jewellery-like design making it stand out from other health trackers of it’s kind, such as the Fitbit. It is designed to be worn on a shirt collar or hem and, with accessories, can also be worn on the wrist or neck. Its stainless steel leaf design gives the impression of an elegant brooch when worn on the collar/hem and its wooden back houses the activity tracker and battery neatly. The LEAF has various functions to monitor your health. As it does not have an in-built display, it relies on the LEAF app on your smartphone to help you set goals in various areas such as fitness and stress levels. The LEAF tracks your movements and uses a unique vibrate alarm to let you know when you should increase activity or slow down. It monitors your sleep patterns to help you make necessary changes ensuring you get the best amount and quality of sleep that you can. One unique feature focuses on breathing and encourages users to spend up to 15 minutes a day on specific breathing exercises to help alleviate stress. Another exclusive feature that makes the LEAF specific to women is it’s ability to help women understand their monthly cycles. Users can view their ovulation and period days easily whilst being able to see how other areas of their health affects this. All of the LEAF’s applications are designed to come together and help to create a well-balanced lifestyle in mind and body. These advances in health tracking are helping us to manage our health more efficiently. By keeping such a close eye on our health we are better in tune and informed about our health, which in turn can help our healthcare practitioners – making it a lot easier to inform our GPs when it is needed. Before embarking on any new healthcare regime it is best to get a check up with a GP.

Since Facebook’s acquisition of Oculus VR in March, many of us have been wondering what the future holds for the world of virtual reality. Will the technology be quietly relegated to the realm of gamers, software developers and tech enthusiasts or could Oculus Rift and its competitors soon begin to penetrate our everyday lives? The applications for the sci-fi-esque device are perhaps broader than what television portrayals of virtual reality have led us to believe. For example, Oculus Rift could have huge implications in the field of healthcare. In a post on Facebook, Mark Zuckerberg explained his vision for Oculus Rift goes beyond fun and games; “But this is just the start. After games, we’re going to make Oculus a platform for many other experiences. Imagine enjoying a courtside seat at a game, studying in a classroom of students and teachers all over the world or consulting with a doctor face-to-face — just by putting on goggles in your home.” Since the transition from desktop computers to mobile devices, Zuckerberg sees virtual reality as the next phase. While some may be concerned about the negative impact of Oculus Rift on our health, proponents of the device claim the uptake of virtual reality could offer significant benefits to our wellbeing, improve access to healthcare and even raise standards of care. 1. Mental Health The immersive element of Oculus Rift makes it a perfect tool to alter perceptions in the long term. Virtual Reality is already in use by the US military as a way to treat Post Traumatic Stress Disorder. Researcher Albert Rizzo of the University of California’s Institute for Creative Technologies developed ‘Virtual Iraq’ in 2005 to help soldiers recover from their ordeals, with promising results. Since then, virtual reality technology has progressed rapidly and has also become much more affordable. In an interview with online tech magazine, The Verge, Rizzo has said that virtual reality therapy or VRT through Oculus Rift could revolutionise the way we approach mental health problems. “This has the capacity to turn virtual reality [therapy] into a mass market treatment…I’m sure anyone doing this kind of clinical work will agree with me.” In addition to PTSD, VRT could find its way into treatment plans for autism, addiction, depression, anxiety disorders, eating disorders, phobias and personality disorders. Virtual Reality will allow patients to immerse themselves in a variety of situations in order to overcome their problems in a controlled environment, which they can reflect on afterwards with a mental health professional. Founder of PsyTech LLC, Farnando Tarnogol has been working on the Anxiety Management Virtual Reality Platform. Tarnogol has said “Anxiety disorders and phobias are a real problem that affects one in 60 people in the US. Studies have proved that virtual reality therapy can be as effective as in-vivo exposure – being exposed to real heights, for instance – or imaginary exposure.” Oculus Rift could help people overcome a fear of heights, allowing acrophobics to remove themselves immediately from the situation if they feel too uncomfortable. While virtual reality has been shown to help treat mental health issues, the device could just as easily create them. Video games have long been blamed for increasingly violent behaviour in schools, for example. Overly graphic games could even be traumatic themselves, in which case, will the prescribed cure be more virtual reality? Then again, the aim of some VT software may be to make people feel somewhat traumatised, for example when raising awareness of human rights issues or imploring criminals to understand the psychological impact of their actions. The potential uses for VRT could become very disturbing indeed, perhaps reminiscent of the ‘Ludovico technique’ in the film A Clockwork Orange. 2. Communication and Education Currently, the closest most of us have come to face-to-face communication in the virtual world is via video calling services such as Skype. Oculus Rift, however, promises to make interacting with our peers feel as realistic as if we were there in the flesh. One of the examples Mark Zuckerberg used to show the diverse applications of Oculus Rift was sitting in the doctor’s chair, having a conversation. Virtual reality headsets could become the ultimate Telehealth device by providing patients the same level of support as attending a doctor’s appointment in person and therefore easing the burden on heath services. Similarly, Oculus Rift could make for easier communication between medical professionals and allow students to virtually attend lectures and seminars, ask questions and feel completely immersed without any distractions. A medical student will be able to see an operation performed and experience first hand the high-pressure environment of an operating theatre. Virtual Reality headsets could also transform the lives of the elderly, people with limited mobility and those who are unable to experience the world in the way they would like. For example, someone usually confined to their home would be able to virtually visit friends around the world, forgetting for a moment they are still sat in their own living room. 3. Physical Health There are numerous physical health concerns surrounding virtual reality, many of them dependent on how advanced the technology is, what the virtual reality scenario is and acclimatisation to the device. For example, a fast paced shooting game that is poorly configured and played for five hours straight by a virtual reality virgin is likely to make the player feel more than a little queasy. One thing is for certain, if virtual reality is to make a successful transition to the mass market, it probably shouldn’t be seen as a sure-fire way to induce vomiting. Oculus Rift still has some way to go in this respect. So far, many pioneers of Oculus Rift have reported headaches and nausea after using the device. Quick, spinning movements and head jerks seem to have a particularly adverse affect on the user. Feelings of disorientation could last for hours or even days after a gaming session and pose a significant risk to everyday activities such as driving. While wearing Oculus Rift, the visual signals received are often at odds with other signals. For example, the user may see and hear they are accelerating or turning, but not actually feel it. The body eventually adjusts to this so when driving in reality the movements seem very exaggerated. Eventually, users may be able to flip easily between reality and virtual reality but it is easy to see how unpleasant side effects of excessive use could result in a serious accident. Another key concern involves Oculus Rift’s affect on our eyesight. The evidence suggests, however, that looking through the device is actually better for us than looking at a screen on a computer or mobile device. Our eyes have evolved to look off to the horizon, so activities that involve staring at something as close proximity may result in eyestrain. With Oculus Rift, the eyes are not converging at all and the user sees things at a distance, in a more natural way. The Occulus VR Knowledge Base states “The Oculus Rift causes very little eye strain, particularly compared to other standard displays or headmounts. Normally, when you take a break from using a monitor or TV, the idea is to give your eyes a chance to focus and converge on a distant plane. This is a natural position of rest for your eyes. With the Oculus Rift, your eyes are actually focused and converged in the distance at all times. It’s a pretty neat optical feature.”

A British start-up developing virtual reality and artificial intelligence technology for doctors has been snapped up by a US medical devices giant. Digital Surgery, which was known for its surgical training apps and kitting out doctors with VR headsets, has been acquired by New York-listed Medtronic in a deal that represents a substantial exit for Britain's burgeoning medical technology start-up scene. Medtronic and Digital Surgery declined to comment on the value of the deal, but sources said it was in excess of $300m (£229m). Founded in 2013 by former surgeons Dr Jean Nehme and Dr Andre Chow, Digital Surgery first made waves developing an app for helping train surgeons with a database of common procedures. It has also developed virtual reality software to train doctors as well as artificial intelligence tools for surgeons in the operating theatre. As well as attracting interest from the US medical giant, The Telegraph understands that SoftBank, the Japanese investing giant that has backed dozens of tech start-ups through its Vision Fund, came close to an investment in Digital Surgery. No deal was agreed. SoftBank, which has become notorious for its quick-fire investing in start-ups across the world, has recently pulled back from several deals after submitting term sheets. It came close to investing $150m in US healthcare start-up Honor, and also pulled out of a deal with software company Seismic. SoftBank has reined in its investing style after several big bets from its first Vision Fund, including WeWork, turned sour. Medtronic, a US-listed medical technology giant that employs over 86,000 people, is set to fold Digital Surgery into its existing portfolio of robotic surgery technologies. Dr Nehme said: “We have always believed in computational power and data as two central drivers of consistency and quality in surgery. Computational power has impacted our lives in so many ways, and within surgery it is almost absent. By joining forces with Medtronic, we will finally apply computing and AI to surgery on a meaningful scale with a goal of helping more patients in more places benefit from consistently high-quality surgical care.” In 2017, The Telegraph revealed it had secured £15m from 8VC, a West Coast fund whose partners had previously been an early backer of Oculus Rift. Other investors included London's Balderton Capital. The start-up was previously recognised in the Telegraph's Tech4Good awards. According to the start-up's last Companies House statement, between them Dr Nehme and Dr Chow owned around 20pc of shares in Digital Surgery, with those shares now worth millions of pounds. SoftBank declined to comment. Source : https://www.telegraph.co.uk/technology/2020/02/13/virtual-reality-surgery-start-up-digital-surgery-snapped-us/

What is Synchronous Telemedicine? The Office of the National Coordinator for Health Information Technology (ONC) defines synchronous telemedicine as "live video-conferencing," which is a "two-way audiovisual link between a patient and a care provider." The U.S. Department of Veterans Affairs (VA) states, "Synchronous telemedicine requires the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place." The American Telemedicine Association (ATA) defines synchronous telemedicine as follows: "Interactive video connections that transmit information in both directions during the same time period." The University of Miami (UM) Miller School of Medicine states, "Real-time telehealth sessions are live and interactive, and frequently use video-conferencing technologies. Often, special telehealth-enabled instruments, such as a video otoscope or an electronic stethoscope, are operated by a nurse or technician at the consulting provider's direction to remotely perform a physical examination." What is Asynchronous Telemedicine? ONC defines asynchronous telemedicine as "store-and-forward video-conferencing," which is the "transmission of a recorded health history to a health practitioner, usually a specialist." VA states, "Asynchronous telemedicine involves acquiring medical data, then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline." ATA defines asynchronous telemedicine as follows: "Term describing store-and-forward transmission of medical images and/or data because the data transfer takes place over a period of time, and typically in separate time frames. The transmission typically does not take place simultaneously." UM states, "In store-and-forward telehealth, data are captured locally, then temporarily stored for transfer at a later time, either via a secure web server, encrypted e-mail, specially-designed store-and-forward software, or electronic health record. The consulting provider then reviews the stored data and makes diagnosis, treatment, and planning recommendations that are electronically transferred or faxed back to the referring provider." Benefits of Synchronous Telemedicine An article in Healthcare Informatics Research (HIR) states, "The major advantage of a synchronous approach is the efficiencies gained by having the opportunity to refine details pertinent to the care episode during the session, by seeking additional information or data, and in many cases providing a clinical decision or advice within the session." An mHealth Intelligence article notes, "Real-time telehealth provides timely care, especially in emergencies or urgent situations, and maintains the concept of the doctor-patient relationship by enabling a face-to-face analysis and treatment. The doctor is able to see the patient, conduct, and examination and engage in conversation, much as he or she would in an office visit." A study published in the American Journal of Emergency Medicine concludes, "Synchronous audio-video telemedicine consults resulted in short-term cost savings by diverting patients from more expensive care settings." An American Psychiatric Association report on synchronous video-conferencing in psychiatry found that, based on a review of more than 30 adequately powered randomized controlled trials, "… treatment intervention outcomes using synchronous video-conferencing was comparable to in-person care outcomes. With the exception of one study, the review found no statistical difference in clinical outcomes for pharmacotherapy or psychotherapy delivered by synchronous video-conferencing treatment and in-person treatment." Finally, an article in The Online Journal of Issues in Nursing includes the following sentiments: "Synchronous visits enable assessment, diagnosis, and treatment in hospital or clinic settings, and facilitate nurse-to patient-education." "Critical access hospitals with limited resources can benefit from prompt, synchronous consultation by a neurologist, in the event a stroke is clinically suspected, and timely treatment with thrombolysis is critical." "Synchronous telehealth models improve convenience, access, and efficiency of care by offering walk-in telehealth services." Benefits of Asynchronous Telemedicine The HIR article previously referenced states that asynchronous systems "… decouple the components of the interaction so that they can occur at different times at the convenience of the participating parties. This model still allows for multiple component interactions to occur, but the effect of the time separation may add overhead of required refreshing of the episode context during this process. An efficiency gain may nevertheless be obtained in asynchronous services when the telemedicine task does not require to-and-from interactions, and especially when it does not rely on direct interaction with the patient throughout." The Center for Connected Health Policy (CCHP) shares several asynchronous telemedicine benefits, including the following: "Patients can get timely specialty care without needing to travel beyond the location of their primary care providers." "Wait times for specialty care are lessened, especially in areas with shortages of medical specialists." "The store-and-forward process can overcome language and cultural barriers." A study published in the Journal of General Internal Medicine that compared blood pressure control and healthcare use between patients who received "virtual visits" structured as asynchronous online interactions and typical hypertension care concludes, "Among patients with reasonably well-controlled hypertension, virtual visit participation was associated with equivalent blood pressure control and reduced in-office primary care utilization." Finally, the previously cited mHealth Intelligence article notes, "… proponents of store-and-forward technology say the platform is ideal for evidence-based care in which providers are able to gather all the information on a patient, analyze that data, match it to evidence-based care and make a diagnosis. While perhaps not suitable for emergency care, it gives providers the leeway to add clinical decision support to the process and eliminates the sometimes-inconvenient requirement of having both patient and doctor available at the same time." Synchronous Telemedicine Applications While our discussion up to this point has touched on various synchronous telemedicine applications, CCHP provides several examples of other ways organizations can leverage synchronous telemedicine, including the following: "Video conferencing connects emergency providers with medical specialists who otherwise would not be available for consults." "Primary care providers can consult with medical specialists who are not available locally." "Medical specialists can examine patients in remote locations when distance is a barrier, as is the case when patients live in rural and underserved urban areas. This includes situations where the physician needs to directly observe the patient." "Language translators can provide video interpretation services to multiple locations, a cost-effective expansion of these programs." A study published in the Journal of Medical Internet Research on synchronous telehealth services for patients with cardiovascular diseases notes that such services include "… instant transmission of blood pressure, pulse rate, electrocardiography, oximetry, and glucometry for analysis; mutual telephone communication and health promotion; and continuous analytical and decision-making support." A recent FierceHealthcare article notes that real-time video conferencing is leading to a resurgence of "house calls," albeit virtual ones. As a final application example, synchronous telemedicine is helping improve medication management. As a U.S. Pharmacist article states, "Essentially, telepharmacy leverages technology to allow one pharmacist to provide supervision and review prescriptions at multiple locations. Patients pick up medications from a nearby licensed location staffed by pharmacy technicians and have access to the same counseling with a pharmacist at the remote location as they would at the home pharmacy, only it is done via a screen rather than in person." Asynchronous Telemedicine Applications CCHP also provides the following examples of how organizations can use asynchronous telemedicine: "In radiology, physicians at small rural hospitals can forward X-rays or MRIs to specialists at major medical centers for review." "In dermatology, primary care providers can take digital photos of their patients' skin conditions and forward the images to dermatologists for review and determination of treatment if needed." "In ophthalmology, eye screenings for diabetic retinopathy, a disease that is a major cause of blindness among individuals with diabetes, can be captured digitally by retinal cameras and transmitted to a specialist for review." A Urology Times article notes, "In our specialty, a relevant example might involve receiving a computed tomography image or a photo of a genital lesion for expert opinion. Obtaining CME hours via a downloadable course is another example of asynchronous telehealth services." Finally, an article in The Lancet Oncology states, "Store-and-forward communication is practical in fields that require imaging. As an example, the nonprofit organization ORBIS links clinicians in developing countries with mentors in developed countries to improve the diagnosis and management of ocular diseases, including cancer." Source : https://blog.cureatr.com/two-forms-telemedicine-synchronous-vs-asynchronous