Pfizer The year 2018, barely under way, has already dealt a series of disheartening blows to the quest for an Alzheimer’s cure. Within the first three weeks, pharmaceutical giant Pfizer Inc. abandoned the costly and frustrating field of dementia drug development, and two promising treatments stumbled in patient trials. Alzheimer’s support groups are putting on a brave face, but the collective disappointment is palpable as the global cost of caring for some 50 million dementia sufferers is set to reach $1 trillion this year. “It’s very fair to say that progress is slow,” David Reynolds, chief scientific officer at the charity Alzheimer’s Research UK. “Companies have put a lot of time, effort and money in over the last 25 years, and there haven’t been any new medicines launched in this area for 16 years now.” Long Term Experts say it takes 12 to 15 years, on average, and more than $2 billion to develop a single drug. According to the Alzforum website, which gathers data on candidate drugs, fewer than 300 have made it to phase two trials of drug efficiency. Only five have ever been approved to treat symptoms such as memory loss associated with Alzheimer’s, first identified more than 100 years ago. With a clinical trial failure rate of over 99 percent, there is still no licensed drug that slows the condition’s progression, or cures it. Today, about 100 candidate dementia drugs are enrolled in trials, compared to over 1,000 for cancer, according to Reynolds. One reason is that “pharmaceutical companies ultimately are companies. They are beholden to their investors,” he said. “A return on investment is really: How much time and money do you put into getting a new medicine versus how much money can you make once you’ve actually got it? In this area, success has been very difficult to come by.” The stakes are high According to the World Health Organization (WHO), some 10 million people per year are diagnosed with dementia, with Alzheimer’s disease accounting for about two-thirds of cases. By 2030, the number of sufferers is projected to reach 82 million globally, and by 2050 some 152 million. The medical, patient-care and economic costs are enormous. A heavy burden falls on family members, the majority of care providers worldwide. Many have to give up their jobs. Alzheimer’s affects mainly older people — about 1 in 4 over 85 years old is a sufferer. And numbers have soared as life spans have lengthened thanks to medical advances in other fields. With cardiovascular disease and cancer the biggest killers in the 1960s and ’70s, that is where most of the research money went. “In dementia, that investment wasn’t there. So the amount of knowledge … about the disease is at a much, much earlier stage, and arguably the brain is a much more complicated organ” than the heart, said Reynolds. To this day, scientists don’t know exactly what causes Alzheimer’s, leaving drug developers stumped. On Jan. 6, Pfizer announced an end to its “discovery and early development efforts” for Alzheimer’s and Parkinson’s dementia drugs. H. Lundbeck AS Two days later, Danish company H. Lundbeck AS reported its idalopirdine compound did not “decrease cognitive loss” in patients, and on Jan. 12, biotech firm Axovant Sciences Ltd. announced the end of the road for its offering, intepirdine. Experts say every failure of a drug reveals something new about Alzheimer’s disease, which is thought to be associated with a buildup of protein plaques and tangles in the brain. One important recent realization was that an effective treatment may have to begin long before symptoms appear as protein buildup likely starts decades before disease sets in. This, in itself, presents a research challenge. When they are in middle age and symptom-free, “How do you find these patients?” asked French neurology professor Bruno Dubois. “How long do you treat them?” Drugs in development today are targeting several tracks. Some use antibodies to mop up proteins in circulation, or enzymes to inhibit their production. Another experimental approach is vaccination: training the body to produce its own antibodies to attack disease-causing proteins. “We are not moving backward,” insisted Reynolds. Yet he was “by no means certain” that a goal set by the Group of Eight in 2013 to develop a cure or treatment for dementia by 2025 can be met. “Even knowing the obstacles, we have never been as optimistic as we are today,” added James Hendrix, a director at the U.S.-based Alzheimer’s Association, one of several nonprofit research funders. “We will not slow down in our fight against this terrible disease,” he vowed. “We are steadfastly committed to both advocating for further increased federal funding for Alzheimer’s and dementia research, and increasing our own level of research funding to get us to where we ultimately need to be — a world without Alzheimer’s disease.” Source : https://www.japantimes.co.jp/news/2018/01/25/world/science-health-world/rocky-start-alzheimers-drug-research-2018/#.Wmzs8SOcYkg

1) The LOHAS bed Sweet, sweet sunshine was the inspiration behind this innovative, hybrid hospital bed/wheelchair design by Lirong Yang. Just a bit of sun can go a long way to make paralyzed individuals feel unconfined to their beds. The problem is that it currently takes 3 nurses to transition the patient from bed to wheelchair. The LOHAS bed, however, only requires one. Utilizing a unique folding design, the assistant or nurse can safely and easily transition the patient without any real lifting. The bed can be folded and transformed into a wheelchair in a matter of minutes without disturbing the individual. The result is more privacy, more independence, and more sunshine to enjoy! Designer: Lirong Yang 2) Dosnoventa bicycle Unimpressed by the sterile vibe of existing wheelchair models, designers Hoyoung Youn, Sungyub Lee, and Jiyoon Han looked to Barcelona’s Dosnoventa bicycle brand as inspiration for their Infinito mobility concept. The design first tackles the stigma wheelchair users face with an entirely new aesthetic and form. With a sporty silhouette and large go-anywhere wheels, the new look is more rover-like than wheelchair. Fun, vibrant color details mimic that of Dosnoventa fixie collection. The new design also enhances mobility thanks to its scissor-inspired structure. It sports an innovative adjustable seat-height feature for better ergonomics. It also has two distinct riding positions: one that is ideal for cruising and manoeuvering and the other for putting the user at eye level with standing individuals. This in combination with a safety features like 6-point buckling and a gyroscopic stabilizer give users the confidence and independence they so desire. Designers: Hoyoung Youn, Sungyub Lee & Jiyoon Han 3) OH hearing aid This thoughtful design by Julia Marina Cunha forces us to examine our attitudes about hearing disabilities. For years, hearing aid designs have gotten “better” by blending in with the human body. However, this masking of the device also perpetuates the concept that hearing loss or disability is something to be ashamed of. Designed with this in mind, OH is at once a hearing aid and a fashion accessory. It allows the user to customize the product by changing the external ring’s range of textures and colors. It can also be used as an earring or attached hearing pin. However it’s worn or in whatever style, it’s aim is to diminish the stigma associated with assistive technology and enhance the user’s self confidence. Designer: Julia Marina Cunha 4) DolPhin Smart Mini Infrared Thermometer Thermometers have taken a giant leap in design with the popularity of Withings Thermo last year. Ever since then, thermometers have come leaps and bounds in their abilities, aesthetics and especially sizes – however none of them have been as compact as the DolPhin Smart Mini Infrared Thermometer. This smart thermometer is the embodiment of portability and compact design being just 5cm long and weighing a total of only 13g. The thermometer simply plugs into one’s smartphone audio jack (sorry everyone who owns the new wave of jack-less smartphones). Thankfully, due to the noninvasive, non-contact nature of this thermometer, it can be used again and again while staying safe and sanitized. With the thermometer comes a helpful app to read and store the temperatures being taken. Not only this, the accompany app has useful searching capabilities for nearby facilities such as; neighboring hospital, internal treatment, university hospital, otolaryngology, health center, pharmacy or the emergency room. This little guy is perfect for a vast range of applications and taking up only 5cm in your pocket; it’s safe to say it’s an easy decision bringing this with you in your travel/medical kit everywhere and anywhere because you never know when you just might need it. Designer: DolPhin 5) Clevu wearable tech As someone who’s been a lifelong sufferer of deteriorating vision, I can testify that no mix of glasses and corrective lenses is enough to get it right all the time. Simply put, there will always be instances where your vision could be better throughout the day. Designed with this in mind, Clevu (a clever combination of the words clear and view) is a wearable system that can not only work as traditional reading glasses but is capable of enhancing a variety of other sight situations. Enjoying the outdoors? There’s a setting for that. Watching TV? There’s a setting for that too. Using a digital lens overlay system with parts integrated into the compact frame, users can toggle between preset and customized settings to enhance contrast and even make the most minute adjustments in focus. Ideal for aging individuals with varying degenerative eye problems, Clevu not only adapts to the user’s unique needs but simultaneously inspires their sense of independence. Designer: Hyosub An 6) Cloudandco Smart Cane Design for so many people is such a visual medium, one must ask oneself… If you remove sight from the design experience, does it still remain a good product? I find designing for the visually impaired quite an interesting domain, because they experience products in a way we don’t, or more importantly, cant. Try doing whatever it is you’re doing right now (eating a meal, perhaps) with your eyes closed. It’s a completely different experience that most people may not be comfortable with. The Cloudandco Smart Cane by Brandon and Max takes on the challenge of designing a product with an experience that is far from visual. The ergonomic smart cane comes as just a joystick handle with an automatic telescoping stick that shoots out when switched on. However, the walking stick doesn’t stop there. It connects to an app on the smartphone, actually guiding the user to destinations they set. The Smart Cane can give off vibration and audio feedback, guiding its user to their destination. Users can toggle through destinations using a button on the top. There’s even a braille panel on the back that can communicate with the user. The Smart Cane takes its non-visual experience further by allowing the users to charge it wirelessly. Instead of having them fiddle with ports and cables, the Smart Cane can just be placed on its charging pad and it automatically gets charged for when it’s required next! Designers: Brandon Cooke & Max Dahl 7) Handihaler Why do medical products look the way they do? That’s a question I’ve asked so many times on this website, it’s beginning to become my catchphrase. Look at the GIF above. The first couple of products you see look instinctively medical. Why so? My theory is that because in an attempt to not overpower the function, less attention was paid on form. This makes medical products look functionally reliable. In short, the more functional it looks, the more functional it must be. However, designers are working to change that now. Medical products should be functional without looking ugly under the ruse of functionality. You can have a medical product that looks incredibly stylish and yet does a remarkable job of saving lives. So look at the GIF above. Look at it some more. The inhalers transform from functional to fabulous, breaking all norms of medical product design, a trend we’re beginning to see a lot these days. Simple and desirable, these black and white inhalers don’t just break the stigma of carrying an inhaler, they also look striking enough that you’d instantly spot it on the shelves (helping the brand reach customers). They embody a characteristic not often used with medical products. Iconic. The black and white body helps create a contrast while cutting the visual bulk of the product. The white part of the product lies on top and doesn’t interact with the user’s hands much, while the bottom is mainly used for gripping, and comes molded in a matte black rubbery material for easy and comfortable gripping. The three inhalers, although different in design, look like a part of the same visual family, and do a remarkable job of making medical products desirable and instantly iconic. Designers: Craig McGarrell, Dawn Tang and Agata Guz (Team Consulting) 8) Epipi Time is of the essence when it comes to treating anaphylaxis, so it only makes sense that the standard EpiPen would be as simple to use as, say, a fire extinguisher. Only… they’re not! All that archaic imagery and fine print only make things more complicated. This new design, called Epipi, really makes things as simple as unscrew, press, and go! The rigid casing protects the device even when its being juggled around in a purse or backpack. In the event that it must be used, its color combination and construction intuitively tell the user what to do. Just twist to arm it, hold against the skin, and press the button to release. A clear window into the medication reservoir will indicate that the contents have been emptied which enhances the confidence of the user that they performed the function correctly. Designer: Harry Moorman 9) The Hue inhaler Style that saves lives seems so apt a title for this post too (it was used for a post done earlier this week). I feel it’s important that medical products that are more commercial than industrial should be given style makeovers, so they don’t become isolating elements, but rather elements that boost the confidence and healing capabilities of the people using them. We’ve seen wonderful work done in the prosthetic department as well as for casts that heal fractured bones. The Hue Inhaler is a step in that direction, bringing incredible CMF detailing to the otherwise mundane asthma inhaler. The Hue is completely 3D printed (note the transition from mottled color to transparent) and comes with a dazzling set of color combinations that are bound to break the monotony of medical product design. There’s even a woven paracord for easy access, or clipping/strapping to your bag/pants. With roughly 300 million people in this world suffering from asthma and almost 250,000 deaths per year, the Hue Inhaler’s crusade to destroy stigma around inhalers may just save more than a fair share of lives. Designer: Tim Zarki 10) One Drop Diabetes system Oftentimes, in the process of designing a product that saves lives, we forget one rather crucial part of the healing process. The product must make users feel better, not just through function, but also emotionally, and psychologically. While most medical devices aim to perform functionally, only some try to look fashionable, less intimidating, or break stigmas through good design. A collaboration between Pensa and Jeff Dachis (the former co-founder of Razorfish), One Drop is a completely exhaustive diabetes fighting system that could easily be a part of any diabetic’s EDC kit. Designed with a homogeneous language that binds the three products together into a beautifully chrome kit that anyone would be proud to carry, the One Drop brilliantly bridges the wide chasm between medicine and fashion, empowering people and motivating them into keeping their health in check! Designers: Pensa & Jeff Dachis Source : https://www.yankodesign.com/2017/12/28/2017s-top-medical-designs-the-future-of-healthcare/

Introduction to Google's 'Project Soli' Soli is a new sensing technology that uses miniature radar to detect touchless gesture interactions. Soli sensor technology works by emitting electromagnetic waves in a broad beam. Objects within the beam scatter this energy, reflecting some portion back towards the radar antenna. Properties of the reflected signal, such as energy, time delay, and frequency shift capture rich information about the object’s characteristics and dynamics, including size, shape, orientation, material, distance, and velocity. Soli tracks and recognizes dynamic gestures expressed by fine motions of the fingers and hand. In order to accomplish this with a single chip sensor, we developed a novel radar sensing paradigm with tailored hardware, software, and algorithms. Unlike traditional radar sensors, Soli does not require large bandwidth and high spatial resolution; in fact, Soli’s spatial resolution is coarser than the scale of most fine finger gestures. Instead, our fundamental sensing principles rely on motion resolution by extracting subtle changes in the received signal over time. By processing these temporal signal variations, Soli can distinguish complex finger movements and deforming hand shapes within its field. Soli Gesture Recognition and Hardware The Soli software architecture consists of a generalized gesture recognition pipeline which is hardware agnostic and can work with different types of radar. The pipeline implements several stages of signal abstraction: from the raw radar data to signal transformations, core and abstract machine learning features, detection and tracking, gesture probabilities, and finally UI tools to interpret gesture controls. The Soli SDK enables developers to easily access and build upon our gesture recognition pipeline. The Soli libraries extract real-time signals from radar hardware, outputting signal transformations, high precision position and motion data, and gesture labels and parameters at frame rates from 100 to 10,000 frames per second. The Soli sensor is a fully integrated, low-power radar operating in the 60-GHz ISM band. In our journey toward this form factor, we rapidly iterated through several hardware prototypes, beginning with a large bench-top unit built from off-the-shelf components -- including multiple cooling fans. Over the course of 10 months, we redesigned and rebuilt the entire radar system into a single solid-state component that can be easily integrated into small, mobile consumer devices and produced at scale. The custom-built Soli chip greatly reduces radar system design complexity and power consumption compared to our initial prototypes. We developed two modulation architectures: a Frequency Modulated Continuous Wave (FMCW) radar and a Direct-Sequence Spread Spectrum (DSSS) radar. Both chips integrate the entire radar system into the package, including multiple beamforming antennas that enable 3D tracking and imaging with no moving parts. What can Google's 'Project Soli' do for Healthcare? In March 2015, Google’s Advanced Technology and Projects group (ATAP) announced Project Soli, which uses radar technology to create a touch free interface using hand gestures. While much of the hype has been around the implications for consumer wearables, Project Soli may also drive change in how clinicians and patients interact with technology. Using radar rather than cameras, Project Soli appears to stand out from other gesture-based technology by providing extremely high granularity and fast response times. The release video demonstrates its ability to quickly recognize sub-millimeter motions such as a finger flick or small hand rotation, as well as an extremely small form-factor chip which can be embedded behind certain surfaces. The implications for healthcare are very exciting: the ability to easily and intuitively control electronic information through gestures could radically change how we access information in hospital settings. Eliminating Input Devices The explosion of electronic information use in healthcare has resulted in a similar expansion of the quantity of computers, tablets and dashboards used in the hospital environment, and it is not unusual to have thousands of such devices in a medium-sized acute care hospital (300-500 beds). This poses a very real challenge for infection control professionals, as many of the surfaces are used constantly, but can suffer damage from the strong chemicals used to clean them. Despite the best infection control procedures, these surfaces often become a breeding ground for two of Canada’s most common hospital-acquired infections (HAIs): methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile bacteria. Incorporating Project Soli-type chips would allow users to control devices without touching them, reducing the risk of spreading infections. This could mean that not only would there be fewer germs present, but also that surfaces could be constructed with more durable materials if they do not have to recognize touch inputs. Streamlining Surgery Gesture recognition has the potential to streamline surgical procedures and provide better information to surgeons as they are operating, by allowing them to manipulate CT and MRI images without touching anything outside the sterile field. In this context, Project Soli does not represent a disruptive change, but rather an incremental improvement on technology already being pioneered in some hospitals. A Kinect-based gesture recognition system named GestSure has been developed in Toronto and was first demonstrated at Sunnybrook Hospital in 2011, and Microsoft has worked with hospitals in London, England to develop a similar Kinect-based technology that meets this need. However the increased responsiveness and granularity of Project Soli’s device may make gesture-recognition in ORs more intuitive and easy to use – which is important when driving adoption by clinicians. Finding a Place in Healthcare Project Soli is still in the very early development stages, which means it will likely be several years before it is available commercially – and even reaching that stage will be dependent on how it is adopted by application developers and hardware manufacturers – but the possibilities for healthcare are immense.... Source : http://atap.google.com/soli/ Source : https://www.linkedin.com/pulse/what-googles-project-soli-means-healthcare-kim-osborne-p-eng-/ Kim Osborne Kim is a professional engineer specializing in Information Technology strategic planning and technical design on a range of healthcare & commercial projects throughout Canada. She excels at supporting projects from initiation through to implementation, and works closely with users and stakeholders to translate workflow needs and challenges into functional requirements and technical planning documentation. Her coordinated and knowledgeable approach to developing effective stakeholder engagement ensures that recommendations and project deliverables are feasible, and tailored to the unique needs of each client. Kim has applied her technical and business skills drive the success of a range of IT, security and AV design projects from visioning to construction, and works closely with other consultants to ensure a coordinated approach to planning. Her experience includes technology strategic planning for multiple hospital clients across Canada, network design and output specifications for large hospital redevelopment projects, work on large P3 construction projects and construction and commissioning support for technology systems implementation. Her extensive industry knowledge and real-world experience provides valuable strategic guidance throughout the IMIT visioning and planning stages, ensuring that solutions are value-driven, forward-thinking and can be realistically implemented. https://www.linkedin.com/in/kosborne/

NHS healthcare professionals who are directing analytics projects and programmes, as well as IT managers in the NHS, cannot help but be engaged in arguments over how far it is desirable to use software algorithms in work previously carried out by people. Such decision-support software is also deployed in sectors other than healthcare, but its merits and demerits are more sensitive in that sector. In February 2015, the British Medical Association (BMA) complained that England’s 111 telephone advice service, which was launched in March 2013 and relies mainly on staff using decision-support software, was referring too many callers to GPs and to hospital accident and emergency departments. The service uses NHS Pathways as its decision-support software, which is also used by English ambulance services to assess 999 callers. The NHS system is managed by the Health and Social Care Information Centre. The BMA said a comparison of October 2014 with a year previouslyshowed that 111 referred 186% more callers to GPs and 192% more to A&E. The 111 service replaced NHS Direct, a national helpline that had made greater use of clinical staff, and used a system procured from AXA Assistance in 2000. Charlotte Jones, the BMA’s GP lead on unscheduled care, says the reliance on algorithms is part of the problem. “Computer-based algorithms, by their very nature, have to be relatively risk-averse and take the safest option,” she says. “However, they are not always applicable to the clinical setting or, if they are, they don’t allow for subtleties in symptoms, and symptoms don’t always fall neatly into boxes. “So the computer algorithms that call handlers have to follow don’t allow handlers to move away from them when common sense or your own individual knowledge calls for it.” Janette Turner is senior research fellow at the University of Sheffield and director of the medical care research unit at the university's School of Health and Related Research. She agrees that any kind of phone service is limited by the fact that it cannot diagnose. “You need a clinician face-to-face to make a diagnosis, to look at people and do tests,” she says. “This is about assessing the level of urgency and the level of care. The question is how well algorithms can assess, compared with clinically trained staff.” Turner and her colleagues assessed pilots of NHS 111 for the Department of Health in 2012. There are problems in comparing 111 with NHS Direct, because the previous service did not handle out-of-hours calls to GP surgeries. “People who called NHS Direct were calling because they weren’t sure what they should do,” she says, whereas many 111 callers have already decided that they want to see a GP. According to NHS England data, 29% of 111 call time was provided by clinically trained staff in December 2014. “It is true that a far bigger proportion of 111 calls are handled by non-clinical staff,” says Turner. But 111 tends to put callers through to its clinical staff on the same call or have them ring back in a matter of minutes, whereas NHS Direct often took several hours to do this – and the old service also had a reputation of being over-cautious. “It wasn’t known as NHS Redirect by the ambulance service for nothing,” says Turner. However, the Sheffield research on the 111 pilots did show that it resulted in a 3% increase in ambulance call-outs – enough to make a significant impact – although it did not find a significant impact on visits to A&E departments. Turner agrees with the BMA's Jones that any algorithm-based system is likely to err on the side of caution – partly because those designing the systems will be wary of taking risks, and partly because they lack the information available to someone in the same room as a patient. But Turner thinks it makes sense to use algorithm-based systems to assess callers initially, because some will want basic advice and others will have straightforward problems. She points out that ambulance services have used non-clinically trained staff equipped with decision-support software for two decades – the same NHS Pathways system used by 111 – although they only have to decide what level of urgency to attach to a call. The question is not whether to use such software, but what proportion of the work needs to involve clinically trained staff. What we need to do is ensure that any software used, while having to be safe, is also appropriate for patients, and not leading to potentially unnecessary harm with additional inappropriate extra tests. Jones argues that the English 111 service needs to increase that proportion – and notes that it is doing so. “The call handlers in 111 are given 12 weeks' training and they are not clinical staff,” she says. “There are clinical staff in some of the centres to help them, and that is increasing. Indeed, they are looking at putting GPs and more nurses in to support the decision-making of the individual call handlers when they feel the computer software needs to be overridden. “What we need to do is ensure that any software used, while having to be safe, is also appropriate for patients, and not leading to potentially unnecessary harm with additional inappropriate extra tests, causing anxiety or inappropriately reassuring people. “That is where the tension comes in. That clinical judgement, clinical knowledge and experience that develops over a long period of time means you can use that experience for managing individuals.” The belief that software should support, rather than replace, clinically trained staff is shared by Mateja Jamnik, a senior lecturer at the Computer Laboratory at the University of Cambridge and an expert in artificial intelligence. She says that, as clinical decision-support systems improve, they are likely to need less input from non-clinically trained staff, such as call handlers. “However, the expert knowledge provided by clinical staff that the callers may be referred to will, as far as I can see, remain a crucial part of the service,” she adds. “But these clinicians will be supported collaboratively by expert systems.” Replacing clinicians with algorithms completely would be fraught with technical and ethical issues, says Jamnik. “For example, who takes the responsibility for a wrong or harmful decision by a computer program? While we have significant evidence that, in some cases, software can be more reliable than humans to make crucial decisions, I think that, for the foreseeable future, these systems will be designed for and used in collaboration with, and support of, clinicians. “They will make the role of clinicians much more efficient, and allow them, in addition, to consider new dimensions coming from biomedicine that we were never able to use before.” Jamnik says using software to support clinicians has already produced some significant case studies of improvements in patient safety. For example, a study in a Boston emergency department, which introduced a decision-support system to help clinicians prescribe a particular drug or course of treatment, saw errors decline by 55%. In the UK, University Hospitals Birmingham NHS Foundation Trust has reduced error rates in prescribing through its Prescribing Information and Communications System (PICS), which uses the trust’s agreed procedures and policies to advise staff. I see the future in the hands of human experts, but heavily supported and helped with expert systems that are becoming more accurate all the time. For example, if a clinician orders a high level of a certain drug, PICS can query this. The user can override the software, but that override action is recorded. Such events are recorded to monitor how staff work, but also to adjust policies and train new doctors. The trust has licensed the software to other parts of the NHS. “I see the future in the hands of human experts, but heavily supported and helped with expert systems that are becoming more accurate all the time,” says Jamnik, particularly given progress in analysing data on patients with several medical conditions, as well as work on personalised medicines. “Clinicians cannot, in such complex patient cases, reliably take all the relevant facets into consideration,” she says. “Sometimes, electronic health records and clinical evidence need to be combined, and computers can effectively address this using statistical and machine learning techniques.” Software can also avoid errors that people are prone to making, such as overestimating the likelihood of events that happen more frequently, she says. “A decision-support system is less biased and therefore provides valid help to a human expert.” The University of Sheffield’s Turner says there is also potential for NHS staff in the community to use clinical decision-support systems to help them do more. Some 80%-90% of 999 calls are not life-threatening emergencies, she says, and the paramedics dealing with such call-outs could set up more appropriate treatment as part of their visit. “To enable them to do that, there is probably scope for hand-held devices with support software on them,” Turner says. For example, for older people who have suffered a less serious fall, the best treatment is for them to be visited by a specialist falls team that can help them make changes that allow them to stay in their own home. This is a better option than taking the patient to A&E, where they could face a long wait and risk infections – and it is also cheaper. While some workers have, and will, find their jobs replaced by IT, it looks more likely that skilled healthcare professionals will see software support them to become more accurate and efficient. Given that the ageing UK population and more expensive treatments are increasing demand for NHS services more quickly than economic growth can support – which is true of most developed countries – it looks more likely that the medics of the future will be cyborgs rather than robots. Source : http://www.computerweekly.com/feature/NHS-111-shows-how-medical-diagnosis-can-be-computerised

The health system in Sweden is founded on the principles of equal access and regional autonomy. Sweden recently updated its national eHealth vision, which now states that, by 2020, all residents aged 16 or over should have access to all health-related information documented in county-funded health and dental care. So, how are we doing so far? I have had full access to my electronic health record (EHR) online since 2012, when Uppsala became the first region in Sweden to make EHRs accessible to patients. I’ve continued to use the patient-accessible EHR (PAEHR) “Journalen” ever since. As a health informatics researcher and a member of the DOME research consortium, I also have a special interest in how the PAEHR is designed and used. The responsibility for healthcare provision in Sweden is shared between the central government, county councils and municipalities, with the county councils the principal providers. Private care providers also operate throughout Sweden, but they are publicly funded and an integrated part of the national healthcare system. This decentralized organization of healthcare also means that each county council (or private care provider) has the choice over which EHR system it uses. This means that throughout Sweden, many different EHR systems are in use and interoperability between them has traditionally been low. So how is it possible that as a Swedish citizen I can access all my EHR data in one place? Two things enable this; a national patient portal and a national health information exchange platform. Although the county councils are autonomous and can prioritize which eHealth services to focus on, the decision was made at a national level that patients should only have one way to reach healthcare. A national patient portal, ‘1177.se’ is available for anyone seeking healthcare or health-related information in Sweden. The patient portal actually consists of three parts: 1177 on the phone – a telephone advice service 1177.se on the web – a public service website where citizens can access and search for information about illnesses, symptoms and treatments, as well as finding out about healthcare in their particular region 1177.se personal e-services – after authentication (using a nationally approved BankID), individuals gain access to personalized e-services. Citizens can add their primary care centers or hospital units and send secure messages to them. It is through this portal that Swedes can access their EHR. Sweden has approximately 10 million inhabitants, 41% (about 4.1 million) of whom had created their own account to use personal e-services on the 1177.se portal by June 2017. Through this national patient portal citizens can reach the PAEHR and, in June 2017, the total number of unique users of this e-service had reached 1.3 million. But although the 1177 patient portal is national, there are still several different EHR systems in use across Sweden. So how can the patient view all their EHR data in one e-service, so it looks as if it’s all from one EHR? Well, Sweden has chosen to implement a national Health Information Exchange (HIE) platform to facilitate the communication between different health information systems and eHealth services. The national HIE platform enables a single point of connectivity for client applications, making all Swedish EHRs appear as a national, virtual EHR. The PAEHR is one of the e-services using the national HIE platform, making the information gathered from possibly many EHR systems appear as one continuous record to the patient accessing it. However, we have a long way to go. Despite the national HIE platform and the intention to provide patients with a complete overview of their health-related data, the view remains fragmented depending on where, when and why a patient seeks treatment, as there are important differences in how much information each care provider allows citizens access to. This is closely related to the difficulty of agreeing on a national regulatory framework for patients’ direct access to their health information. Another challenge has been resistance from healthcare professionals. Both within Sweden and internationally, healthcare professionals have raised concerns about how these changes might affect their workload. Some think that more of their time could be taken up explaining the contents of the EHR and dealing with increased questions from patients. There’s also a feeling that EHRs could make conflicts with patients, misunderstandings, and misinterpretations more likely, leading to those in care being unnecessarily worried more often. However, these professional concerns are often alleviated after the e-service has been in place for some time, and healthcare professionals who use the e-service themselves are less worried. Despite the identified challenges, preliminary results of a national patient survey among PAEHR users in Sweden indicate that the overwhelming majority of patients who have accessed the PAEHR are positive about it. Almost 90% of respondents completely agreed and 8% partly agreed with the statement “Having access to ‘Journalen’ is good for me”. With such a staggering vote of confidence from the actual users of the e-service, it does seem that Sweden is doing a lot right. However, we need to continue learning about how to best implement and use such solutions both within and outside of the country. In the recently started research project PACESS (patient-centered assessment of patients’ online access to electronic health records) Swedish academics have begun evaluating the current implementation and use of PAEHR through in-depth qualitative case studies in different regions. The goal is to achieve a better understanding of how roles, relationships, and organizational structures are affected. In addition, we will work together with patients and healthcare professionals to co-design future eHealth services based on the PAEHR to improve communication, collaboration, and co-creation of the EHR. We hope that this research will help move progress forward not only in Sweden but for all patients regardless of illness or country of residence. Source : https://www.futurehealthindex.com/2017/10/30/access-electronic-health-records/

Strategy Guided by their passion to improve people’s lives, Philips has been a leader in building and shaping markets with meaningful innovations for the last 125 years. With the world facing the challenge of tackling climate change and energy constraints, as well as providing effective and affordable healthcare to a growing global population, Philips see compelling opportunities in the health technology and lighting markets. Determined to win in both, Philips recently separated out their Lighting activities as a stand-alone company. This created more focus, giving Lighting the opportunity to grow and capture the vast opportunities in energy-efficient, digital lighting products, systems and services. Philips then enhanced their efforts to expand their core business to address the opportunities available in the health technology market outlined as 4 main themes - a) Global resource constraints on health systems are driving a shift to value-based healthcare to reduce cost, increase access and improve outcomes. b) Aging populations across the globe and the rise of chronic conditions are driving a shift of care to lower-cost settings and the home. c) More and more people are looking for new ways to proactively monitor and manage their health. d) The digitalisation of healthcare is shifting value from devices to software and services. Five years ago Philips believed these challenges could only be met through new, more integrated forms of care delivery across the health continuum, with a shift away from today’s focus on acute care and late-stage interventions. The convergence of Philips’ consumer technologies that facilitate healthy living, medical technologies that help clinicians to deliver better diagnosis and treatment, and cloud-based technologies that enable data sharing and analysis were identified as the key enablers of more effective, lower-cost integrated health solutions. Philips built their strategy around their core strengths of professional healthcare and consumer health and well-being. Focus Philips focused on 5 priority areas to expand their integrated solutions capabilities - 1) Personal health 2) Definitive diagnosis, 3) Minimally invasive guided therapy 4) Population health management 5) Connected care delivery Within 4 broad specialties - 1) Cardiology 2) Oncology 3) Respiratory care 4) Fertility, pregnancy and parenting In the last 5 years the company have successfully teamed up with hospital and health systems to understand their needs, provide integrated solutions, and engage in multi-year cooperation to drive improvements in terms of patient outcomes, quality of care delivery and cost productivity. Looking forward into the next 5 years, Philips will drive the benefits of scale further in their current businesses while delivering additional growth from continuing investments in innovation. They will also invest in their Philips HealthSuite digital platform to establish themselves as a leading cloud solution to connect consumers, patients and providers. Transformation, Mergers & Acquisitions “Philips has made a very massive transformation over the last five years and we have pivoted to be a focused health company,” Chief Executive Officer Frans van Houten said in an interview on Bloomberg TV recently. “we are not distracted by other performing businesses in other sectors.” Philips has made a series of acquisitions in recent months that have focused the 126-year-old Dutch company on health technologies including software and services. In the process, the company has moved away from its historic roots in manufacturing light bulbs, TVs and CD players. Is the Strategy working? What are the latest results? https://www.philips.com/static/qr/2017/q3/philips-third-quarter-results-2017-presentation.pdf Philips had a “particularly strong Q3 17,” in China, both at the consumer and hospital businesses, the CEO said, adding that he expects growth at private hospitals to offset any risk of governments giving preference to domestic suppliers. Sales of toothbrushes are also increasing. “The penetration of oral care of electric toothbrushes in China is still below 4 percent,” he said. “If you compare that to Western Europe or the United States where it is about 30 percent, it just underlines what positive journey is possible in the years ahead.” The Dutch company kept its outlook to raise profitability to the average industry standard for health care-equipment peers, including GE and Siemens AG, over the next three to four years. Even though organic revenue growth has not topped 4 percent since the beginning of this year, Philips kept its outlook for a 4 to 6 percent revenue growth in 2017.

Time magazine published its annual Best Inventions of the year list yesterday after considering hundreds of inventions from around the world. Let's look at the 4 Healthcare focused inventions that made the 2017 list - 1) eSight 3 - Glasses That Give Sight to the Blind eSight 3 is an engineering breakthrough that allows the legally blind to actually see. eSight houses a high-speed, high-definition camera that captures everything the user is looking at. eSight’s algorithms enhance the video feed and display it on two, OLED screens in front of the user's eyes. Full color video images are clearly seen by the eSight user with unprecedented visual clarity and virtually no lag. With eSight’s patented Bioptic Tilt capability, users can adjust the device to the precise position that, for them, presents the best view of the video while maximizing side peripheral vision. This ensures a user’s balance and prevents nausea – common problems with other immersive technologies. https://www.esighteyewear.com/technology 2) Forward - Clinics That Redefine Preventive Care A New Kind of Health Membership, Augmented with Technology. Forward is a full-stack company: doctors, designers and engineers work together to build their own software and hardware, including our own electronic health records system. This allows us to innovate faster and prevents us from being held back by legacy systems. We're constantly improving by adding new services and capabilities that are only possible because we rebuilt the entire system from scratch. Healthcare has a scaling problem: because it's a labor-based business, it's hard to keep costs low. We're building hardware and software to help our care team take care of more people than they could without technology. Our ambition is for Forward to be affordable to everyone. We started Forward to deliver better health to people at a lower cost. But if we had to do this by working within the existing healthcare system, we wouldn’t even know where to begin. How do you unwind everyone’s broken incentives, retrofit ancient software, and convince a bunch of people to change a system in which they benefit from the status quo? We felt it would make more sense to instead start from scratch and to build things the right way from the start. We made three major decisions about how to build Forward from scratch: We built it as a health membership instead of a transactional doctor’s office, allowing us to be proactive and preventative instead of reactive We built it as a full-stack company that combines software, hardware, and the actual doctors practicing medicine all under one roof We built it as a product for actual people, not insurance companies https://goforward.com 3) Willow Pump - A Portable, Wearable Breast Pump Willow is unique because everything works inside the Pump and inside your bra—with no external tubes, cords, or dangling bottles to hold you back. First, you align Willow with your breast, wait for the Pump to initiate latch, and then secure it inside your bra. Once latched, Willow senses let-down and automatically switches to expression phase based on your individual milk production. Your milk flows into the disposable, spill-proof Milk Bag tucked securely inside the Pump. And the best part is you can move freely while you pump and track your milk progress in real time on the Willow App. When you’re done pumping, simply open Willow and remove the Milk Bag (which doesn’t leak, thanks to our innovative one-way valve). Then pour it right into a bottle or store it in the fridge or freezer for later. As Willow works inside your bra, the Willow App displays what is happening. See things such as milk volume, pumping time and past pumping sessions. Compatible with iPhone 5 or newer. The Willow App is only available for iOS (iPhone 5 or newer, iOS 10.2 or later). We plan to offer an Android app in the future. https://www.willowpump.com 4) Bempu - Wristbands That Help Babies Get a Better Start Bempu Health is a public health organization funded by the Gates Foundation, Grand Challenges Canada, USAID's Saving Lives at Birth, and others. We received our first grant from the Gates Foundation in November 2014 after spending a year in the field meeting with more than 100 pediatricians and neonatologists around India to learn more about the true problems in newborn health care. We worked with doctors to brainstorm solutions, then built + tested prototypes, and now we are distributing our health tech. innovations. Our first innovation is the Bempu Hypothermia Monitoring Device – a novel neonatal hypothermia monitoring bracelet. Our device is built to serve areas where temperature monitoring is often overlooked due to understaffed hospitals and unaware or uneducated parents. The device alerts in the event of neonatal hypothermia through an intuitive audio-visual alarm, which promotes corrective actions like Kangaroo Mother Care (skin-to-skin contact) and swaddling, as well as positive health-seeking behaviors. We are a team of passionate and skilled health advocates working together to build technologies that will drastically improve global health. We are currently a team of 15 with expertise in biomedical and mechanical engineering, product design, medical electronics engineering, marketing & operations management, and public health. As of Summer 2016, our BEMPU Bracelet has protected 1000+ babies in approximately 150 centers across India! http://www.bempu.com TIME’s 25 Best Inventions of 2017 Source : http://time.com/5023212/best-inventions-of-2017/

The internet, Apps and AI have affected many aspects of our lives. Shopping, entertainment, communicating with social groups, booking travel, and banking are dramatically different experienced for my teenage children than they were for me. In spite of the many conferences, blogs, and £Billions of private equity funding, ‘Digital’ has had by comparison relatively limited effect to date on how we as citizens obtain healthcare, and how doctors and clinicians deliver healthcare. There are many reasons why healthcare may be a slow adopter including clinical governance, legacy systems, and vested interests. Babylon’s recent launch of their GP App, and NHS England’s announcement of £45M to digitise GP surgeries, have dramatically increased the public awareness of digital health, and we may be at a tipping point. Over the past eight years, I have spent significant time working in pathology. This is a heterogenous discipline which includes highly automated blood science laboratories processing up to 20,000 samples per day, many low volume sub specialist tests, and some areas which remain highly manual, such as histology, where samples are manually cut, processed into paraffin blocks, sliced thinly onto glass slides (sometimes with stains to detect cellular abnormalities), and interpreted under a microscope by a consultant, who may then attend MDT meetings in person to discuss the results. The NHS has 200 consultant vacancies out of c2200 posts, and new training posts have not been filled for several years. District General Hospitals in remote areas in particular have struggled to fill posts. Histology reporting is often on the critical path to achieving cancer access times, and the NHS is spending c£60M per annum on backlog services and additional payments to consultants. Whilst the process has made developments over the years, most 2017 histology labs would be recognisable to colleagues who retired 30 years ago. This may be about to change. A number of companies have been developing digital histology solutions for several years, but until recently the business cases didn’t stack up: scanners were slow and expensive, a single slide can be a 500MB file even with compression (c 100 MRI scans), and digital reading was slower than a microscope. Within the past twelve months, technology seems to have broken through, although many histopathology consultants remain reluctant to switch from microscopes. I was recently invited to visit one of the early large scale adopters of digital histology. Not in the UK – I flew three hours to Bucharest to visit Synevo, the diagnostics division of Medicover. Many of my generation in the UK still associate the old Soviet nations with Trabants and crumbling concrete communist blocks. Romania has invested massively in technology infrastructure (my hotel broadband was 4x faster than any London hotel) and education. The Synevo lab was a futuristic building, with well designed process flows, and better than most I have seen in Western Europe. Dr Stoicea, the lead histologist spent two hours talking passionately about quality, digital histology their investment in the Philips system, the journey to implement it, and his plans for future development. Whilst some histologists see digital technology as a threat, it clearly could be used to improve outcomes and turnaround times: Digital slides can be sent anywhere. Histologists can sub-specialise, which should result in greater accuracy of reporting. Slides can be sent to where capacity is waiting. Why employ histopathology consultants? An Uber type system would allow the next available sub-specialist anywhere in the world to report. Many slides are negative, but still need reporting. Many positive slides are stained, and the proportion of slides taking the stain are manually counted. Philips and others are developing AI systems which will look at slides and cells and undertake interpretation. Some manual checking will probably be mandated for several years after these systems are developed, but they should reduce time per slide by guiding consultants to anomalous cells, and doing routine counting. BD’s focal point technology already offers this in gynaecological cytology. Quality control can be improved.The system can track what the consultant looked at, potentially prompt them if they missed something, and allow them to annotate and send to other global experts for a second opinion. Slides can be reported anywhere.Staff who would otherwise take career breaks could report from home. MDT meetings can be virtual, again with a global histology expert attending for the part of the meeting where he is needed. There are very substantial discrepancies between the salaries of histologists around the world – probably ranging from £30K to >£300K within Europe. The efficiency of histologists in terms of comparable cases reported also varies by a factor of 3-4 between the least efficient public sector services and the most efficient private ones. The correlation between efficiency and salary is also far from perfect. It is difficult to see how this economic disparity can be sustained, once slides can move around the globe at a click. If China were to train 10,000 English speaking histology consultants, they could dominate then world in reporting, as they have done in manufacturing, and as they seem intent upon doing in genetic testing, based upon their investment in genetic sequencing labs. Hugh Risebrow CEO, Latchmore Associates http://www.latchmoreassociates.co.uk Founded in 2003, Latchmore Associates supports public, private and third sector health and social care organisations, with particular expertise in the following areas: • Supporting overseas/ new entrants to the UK market • NHS private patients, commercialisation and revenue generation • Public/private partnerships from market sounding through to procurement and implementation • Pathology partnerships/ consolidation • Bid and transaction negotiation support • Interim management

Several tech founders are trying to break into the NHS. How will their smartphone-powered ideas get on in an institution sceptical of change, underpinned by a notorious tangle of IT and bureaucracy? A near-sacred institution, the NHS has spent little time out of the public psyche since its inception in 1948. Today, far from being a celebrated feat of public welfare, each day brings a barrage of stories of closing hospital A&Es, cuts in funding, huge debts and an ageing population. Faced by a heavy funding deficit, demands vastly different to when the service was conceived, and shifts in politics and ideology, many believe the NHS is itself strapped to a life support machine. Yet several enterprising individuals see something quite different in the NHS: a massive client with a £116bn annual budget, and the platform from which to unleash smartphone-powered medical products and services that could spread all over the world. The barriers are high, but if they can be overcome, there’s potential for the NHS to spawn an entire economy in the way that modern-day Silicon Valley sprawled out of Intel, or London’s creative economy was accelerated by the BBC. In the last couple of years, millions of pounds from VCs and angel investors have been pouring into early stage British ‘medtech’ companies that are already, or have the potential to, sell into the NHS. Around 211 UK-based medical related companies have raised a combined £883m in the last five years, according to research firm Beauhurst. The NHS is, after all, a platform and client like no other in the world. It is unique in its size, scope and reputation, making it the ideal place to launch a health startup and prove a product’s effectiveness. Time travelling If successful, these startups could also achieve something which lavishly paid management consultants and IT firms have failed to do: modernise the NHS, propelling it into the digital age to transform how it operates and provides care, saving billions of pounds along the way. To the startup world, the state of healthcare provision in 2016, and especially within the NHS, is like time-travelling back to the 1980s; a tangle of paperwork and IT systems that should be consigned to museums combined with an unnecessary level of bureaucracy. It’s an especially striking contrast at a time when enormous leaps have been made in less vital services, from how current accounts are used through to ordering a burger. But there are already signs of startups at the gates of the NHS. It’s not quite an all-out digital revolution yet, but pilot schemes with smartphones and smartwatches where patients can book appointments, be reminded to take their medication and have their progress tracked by a doctor without visiting a hospital are going on across the NHS. A smaller number of forward-looking trusts have already invested in such startup-created technology. Accelerator programmes and startup initiatives meanwhile are getting rubber stamped by powerful figures within the NHS. Faster, cheaper, easier The cheerleaders for the digital transformation of the NHS are quick to illustrate the potential, with utopian descriptions of the future of UK healthcare. A multitude of unsynchronised IT systems and paper files could be replaced with a seamless platform that allows X-rays, medical records, medication, and the vitals of any patient to be available to a doctor at the tap of a tablet screen; no shuffling through papers or post, no lost emails; everything made faster, cheaper, easier and more accurate. Not only would such services make life better for staff and patients, and even save lives, but the cost savings through boosted efficiency could help ensure the NHS’s longevity for many decades. VC clamour Early success stories have built confidence. Patients Know Best, a platform that stores digital medical records for care givers, while maintaining patient privacy, has been taken up by 200 sites across the NHS. Another, Zesty, enables patient and referral bookings to be made through a smartphone. It had focused on private healthcare and dentists, until an NHS sexual health clinic approached founder James Balmain. It’s now used by 30 clinics across London and three large hospitals are set to add the service, ditching call centres and appointments sent by post. Zesty’s main competitor, Dr Doctor, is used by six trusts, reaching four million patients. Co-founder Tom Whicher says the app is saving each of the trusts over £1m a year by reducing missed and rescheduled appointments, as well as postal costs. Patients Know Best and Zesty are two of many firms to have benefited from the VC clamour around medtech. Patients Know Best passed through Seedcamp and has since raised £6m, while Zesty has raised over £7m. Another is Network Locum, a platform used to find roaming doctors, which raised £5.3m in summer 2016. NHS accelerator The NHS is changing too. After a period of seeming institutional resistance to change and innovation, the NHS is, on the surface, awash with schemes to embrace whizzy new startup ideas. Funds from various NHS digital schemes have been flowing for the last five years. A snappily named set of ‘Academic Health Science Networks’ were created across the country in 2013, with the sole focus of adopting innovation in the NHS. So-called ‘vanguard’ hospitals have been given the freedom to spend money on trying out the services startups are coming up with. There’s even an NHS tech accelerator and a new, faster way for hospitals to be reimbursed for spending on new technology (read more: How to get hospitals interested in tech). Enthusiastic noises The NHS has appointed a clinical director of innovation, Tony Young, an energetic doctor who’s launched four startups. ‘If there’s a place in the planet where you can innovate at scale in healthcare, the NHS is it. The size means we can do things no one else can do,’ he passionately tells Courier. Similarly enthusiastic noises are being made by Mahiben Maruthappu, who set up the NHS’s accelerator programme in 2015. He says: ‘Two thirds of the UK population have smartphones, yet only a fraction use them to interact with the NHS. We need to use this as people already have them, so the NHS doesn’t have to pay.’ Advocates like Young and Maruthappu are certainly leading the charge. Pressure to find ways to save money is also a powerful motivation behind adopting new tech. The government reckons tech can greatly contribute to a planned £22bn in savings by 2021, and has earmarked £4bn for making the NHS paperless by 2020. Hospitals in the red Melissa Morris worked as a management consultant on healthcare projects before launching Network Locum and sees a new willingness in hospitals to talk to startups. ‘Before, there was more of an option to stay in their comfort zone, but now that all the hospitals are in the red, they’re so indebted, they have no choice. It’s desperate times calling for desperate measures,’ she says. But this debt, amounting to £2.45bn across the country’s trusts, along with the government’s consistent statements that no more money will be given to the NHS, is as much a barrier as it is an opportunity. It means there’s little extra funding or resources for overworked staff to try things out, let alone fail. Alluding to the problem, Young says: ‘There’s a real passion and desire [in the NHS]. But a lot of it comes down to the fact that the NHS is given a set amount of money from the elected government, then the leadership has the difficult [task] of deciding how that pot of money is spent.’ Saving money is something startups working with the NHS are acutely aware of. Founders talk of having to provide a saving within a year or risk being dropped from contracts. ‘You have to show the savings you can make right from the start. [When writing a proposal] we clearly show what the savings can be in year one, in year two,’ says Zesty founder Balmain. Bruce Hellman, founder of patient monitoring app uMotif, adds that he actually helps trusts identify where money can be found to fund the use of the app’s service. The NHS badge The power of the NHS stamp around the world is a key attraction for startups. Ivana Schnur, co-founder of Silicon Valley-based AI nursing app Sensly, has placed a large amount of her focus on the NHS, asserting that it’s ‘the best system in the world to prove a product’. After successful deployments in the NHS, Patients Know Best has launched in 19 other countries. ‘The UK is a lot better than it gets credit for,’ says founder Mohammad Al-Ubaydli. ‘Intros from the NHS go across the world, and if you’ve been marked as a secure platform by the NHS, it makes things a lot easier abroad.’ For AliveCor, a US company that makes hand-held, patient-operated electrocardiograms, selling into the NHS has actually boosted sales back home, triggering meetings with large hospital operators in the US that were previously reluctant to see the product. ‘The big providers had been a tough nut, but since going back to them and saying the NHS loves it and it’s saving money, it’s opened doors,’ says Francis White, who heads up AliveCor’s UK business. Beyond the obvious places for startups to expand (such as the Gulf, Australia and the US), developing countries – where healthcare is of low quality, but smartphone use high – are also increasingly attractive to these startups. Globally, the digital healthcare market is expected to reach £162bn by 2020. Loosely structured There is, however, a big caveat to all the positivity. The barriers to breaking through with a healthcare startup, especially into the NHS, are manifold, and often so onerous many have been scared off. With no standard road map for selling into hospitals, every startup talks of the stultifying effects of navigating the labyrinthine arteries of the NHS. It’s complicated by the fact that far from being one organisation, the NHS is a decentralised collection of over 200 trusts, akin to individual businesses that decide what services they buy, and from whom. This loosely structured nature means that just because a business has sold into one trust, it doesn’t follow that any other trust will be interested. With most startups devoid of a massive sales force shuttling the length of the M1, progress is slow going. ‘You have to find a champion in a hospital, a human that appreciates what you’re doing and can see the benefit and go from there,’ comments Rich Khatib, co-founder of Medopad, which produces a series of connected health apps. ‘There are so many hurdles to jump through that, as a small startup team, it’s too difficult to target more than one at a time.’ Culture clash Bruce Hellman of uMotif adds: ‘The NHS is very difficult to sell into, and it takes longer than it should.’ More recently, Hellman has begun to place greater focus on selling data analysing software to pharma and research companies, noting that the NHS is ‘hard going’. A recurring issue faced by those who have tried to get a business off the ground in the NHS is a clash of culture between startups and hospital workers, as well as a reluctance to adapt. It’s an issue identified by those from outside the medical profession and so called ‘doctorpreneurs’ alike. ‘Healthcare is built to minimise risk, while entrepreneurs have an inherent risk-taking nature,’ says one doctor. Maxims from the startup world such as ‘fail fast, fail often’ are anathema in an industry where failure simply isn’t possible. But Tony Young is now keen to instil an attitude of learning from failure in the NHS. To help change attitudes – as well as make the NHS a place where new innovations are developed – he’s signed up 100 doctors to a new entrepreneurial programme. The problem with a funky app But changing culture in a disjointed organisation the size of the NHS is never going to be easy. And while the size is appealing to investors, and to startups at the ‘big vision’ stage, it presents extensive challenges with adoption. There are 150,000 doctors, over 300,000 nurses, 150,000 scientists and technical staff, plus 18,000 ambulance workers, 25,000 midwives and 30,000 managers: the NHS is the fifth biggest employer in the world with more staff than India’s railways and almost as many as McDonald’s globally. Mahiben Maruthappu, who works part-time as an A&E doctor, along with advising the NHS on innovation and running his own health startup, sympathises with the inertia among NHS staff towards new technology. ‘The NHS is under such pressure and people are used to working in a certain way, [so that] with everything else going on, innovation has become a nice-to-have rather than a must-have,’ he says. ‘When I’ve got 40 patients waiting, a funky app is not the first thing I’m going to be thinking about, unless it’s shown that it can make things easier, which is what we must now do.’ It’s a point that further highlights the barrier that a lack of funds and resources presents to innovation. One NHS employee commented that using new software on old machines that constantly crash leads many to quickly lose faith in technology, as it means things can actually be slowed down in comparison to using good old paper; off-putting when staff in their department are allocated just 12 minutes per patient. Spend smartly Lord Darzi is widely credited with starting the process of opening up the NHS to innovation after releasing a report into the future of the service in 2008. Now taking a back seat, having resigned his role as an under secretary in the Department of Health in 2009, he argues that there is enough money in the NHS; but more of the budget needs to be spent on new ways of doing things. ‘The NHS doesn’t need more money, it needs to spend it better,’ he tells Courier. ‘Commissioners need more power to drive innovation. More outdated services can be decommissioned, getting rid of what doesn’t work, rather than the new service needing to be adopted on top of the old as an extra cost.’ Some have found the NHS to be simply an unsuitable client for a startup. After taking the decision to move the headquarters of Big Health (the company that makes mindfulness app Sleepio) to the US in 2015, co-founder Peter Hames told Bloomberg: ‘We assessed [the NHS] and it was just not feasible. We could waste years with no impact.’ Looking overseas It’s a sentiment shared by former NHS doctor Jamie Wilson. After being unsuccessful in finding a market for a previous digital health startup, he launched home carer hiring platform Home Touch, which explicitly avoids selling to the NHS by going direct to users which receive council grants for care. ‘I know of people for whom it’s taken six or seven years to sell into the NHS,’ he says. ‘I just don’t have that amount of time to persuade people in the NHS to purchase the product.’ Mike Casey, the founder of Futurenova, has decided to focus on exporting his tablet cases, which are designed for hospital use and made in Manchester. He is winning customers in the US and Germany, where thanks to the corporate environment, products can be simply bought online with a business credit card, unlike the complex trail of purchase orders and approvals needed in NHS hospitals. Despite Sensly’s Ivana Schnur’s enthusiasm for the NHS as a place to prove a product works, she cautions that the commercial case ‘is a little bit more complicated’. Getting noticed But despite such challenges, there has undoubtedly been progress, and startups such as Network Locum and Dr Doctor are examples of companies which have won big contracts. ‘It’s become more sophisticated over the last five to 10 years. Before 2003 there was no way of getting your product in front of the top level,’ says NHS veteran Peter Young. He created his first patented medical device 20 years ago, and as a long-term proponent of reform to enable innovation, has had varying success in having his inventions adopted. There are also now numerous schemes for those inside and outside the NHS to get an idea or product noticed, including MedCity, an organisation created by London’s Academic Health Science Centres and the Mayor of London, that helps startups set up trials within hospitals. MedCity’s CEO Sarah Haywood argues that, with world-leading NHS hospitals connected to some of the best universities in the world, and London’s already excellent medical research and existing tech scene, the capital is ripe to become the world’s medtech centre. Indeed, if these startups can successfully marry technical innovation, outstanding product execution and savvy negotiation of the NHS system, as well as get politicians, hospital managers and doctors on side, this wave of innovators could well be at the vanguard of a glut of new products that could transform healthcare around the world. And it’s not beyond fantasy to believe that, just as the idea of universal healthcare at the point of access was revolutionary when it was introduced in the UK in 1948, innovation in the British health service could well be pioneering and radical once again some 70 years later. This story is taken from Courier Dec 2016/Jan 2017.

The use of robots can help transform the way our healthcare system is managed, says Stephen Sutcliffe, director of Finance and Accounting at NHS Shared Business Services. In his speech at the Health and Care Innovation Expo in Manchester earlier this year, the health secretary Jeremy Hunt outlined the digital standards he expects to see in place for all NHS patients by the end of 2018. And he is right. In today’s world, where it’s the norm for many of us to be functioning online, both at work and at home, why shouldn’t we have the option to use the same modern technology to access our medical record, book an appointment, or get a repeat prescription online? But away from the more headline grabbing digital initiatives that will undoubtedly benefit frontline patient care, there is also a – perhaps less glamorous, but no less crucial – transformational journey taking place in the NHS back office. For those of us concerned with optimising NHS business functions in light of the ongoing pressures facing our hospitals and other healthcare providers, the importance of embracing new technology cannot be overstated. The recent annual report from the Care Quality Commission (CQC), for instance, found the NHS is operating at ‘full stretch’ with ‘unprecedented pressure on the system’. It is against this backdrop that the need to introduce the most up-to-date technology to further modernise traditional NHS business processes – and to channel the subsequent staff time and financial savings into other areas – can be seen more clearly than ever. Whilst automation has already started to replace many paper-based manual processes, helping forward-thinking NHS organisations save money and make better use of their workforce, the introduction of Robotic Process Automation (RPA) promises even greater opportunities for wide-scale efficiencies. RPA is the latest in processing technology, utilising the most recent desktop and device automation technologies and applying innovative RPA solutions to carry out repetitive data entry and processing tasks. Any process that has traditionally relied on labour-intensive manual interventions, will begin to see greater consistency, better controls and improved quality. Because guess what? Robots don’t make mistakes, robots can work around the clock and robots do the same thing over and over again without getting bored. So employing robots to carry out the simple and mundane frees up humans to do what you want people to be doing – thinking, questioning and adding value. It is inevitable, of course, that with any new technology comes a certain level of resistance. But RPA should not be feared. Indeed, in many aspects of everyday life it’s already working successfully all around us. And with the efficiency improvements that hospitals and other parts of the NHS need to meet, this technology will become increasingly important to back office processing. At NHS SBS, for example, we provide finance and accounting services to almost 70 NHS provider trusts and all of the country’s NHS commissioning organisations. On this scale, the benefits of introducing RPA across some of our 500 plus prospective financial processes are obvious. Transformation is a term that is used a lot in relation to healthcare. But, in this instance, it perfectly describes how RPA – which by definition will become ever more sophisticated over time – will ensure that resources in the NHS back office are better deployed for years to come. Stephen Sutcliffe Director of finance and accounting at NHS Shared Business Services https://www.sbs.nhs.uk NHS Shared Business Services is a unique joint venture between the Department of Health and Sopra Steria. We're proud to be the only company which is part of the NHS family, with over 30% of the market using one or more of our products. Our mission is to deliver £1 billion savings back to the NHS by 2020. We've already delivered audited savings of over £400 million to our NHS clients. As an industry innovator, we use data, intelligence and technology to revolutionise NHS back office functions and support services to maximise performance. Source : https://www.sbs.nhs.uk/blogs-robots-will-transform

Technology plays a big part in all of our day to day lives, whether it is at home or at work. Innovative developments such as virtual reality can often make our lives easier, improve processes and health and safety. Walter Greenleaf, PhD Expert on The Medical Applications of Virtual Reality Technology has said “Although entertainment, social connection and gaming will drive the initial adoption of Virtual Reality technology, the deepest and most significant market for VR will be in clinical care and in improving health and wellness”. According to Bloomberg, some of the world’s biggest tech companies have invested over $4 Billion in virtual reality since 2010 and the healthcare industry plays a big part in these investments. Virtual reality headsets make you feel like you’re actually in the room, the doctor’s office or anywhere you want to be, making it a great tool in facilitating patient care. VR is also an amazing tool that can aid in education and training in the healthcare industry, providing more realistic experiences. Proximie is a great example that uses augmented reality technology to bring cutting edge, collaborative, visualisation tools to the operating room. Proximie enables clinicians to virtually scrub into clinical setting, in real time, increasing access to high quality surgical care, improving patient outcomes, reducing costs and delivering a highly engaging training experience. VR has the power to transform the healthcare industry. Here’s how: 1) Real time hands-on experience in medical education In 2016, Dr Shafi Ahmed performed an operation to remove cancerous tissue from a patient’s bowel, live streamed in VR with the hope that it will make the healthcare industry fairer and boost training. Additionally, allowing medical students, trainee surgeons and curious members of the public to involve themselves in the procedure in real time via the Medical Realities website. This enables medical students to acquire knowledge and understanding about the human body. Students can perform ‘hands on’ procedures but in a safe and controlled setting where they are able to make mistakes and learn from them without any risk to a patient, then applying the skills learnt to a real life case. 2) Improved patient education From learning about diagnoses and medications to understanding tests and procedures, VR enables patients to learn about what is involved in the clinical trial and conveys it as an interactive experience which decreases distraction and offers visualisations that can promote better understanding about their conditions. 3) Helps patients manage stress VR technology helps patients manage stress by giving them easy to understand information and help them feel more in control and comfortable. OnComfort is a start-up that is using virtual reality to aid patients diagnosed with cancer. They have created five VR apps to reduce patients stress, anxiety and need for pain medication. These have been tested by doctors on more than 1,500 patients in the U.S. and Europe and have produced positive results. Breast cancer patients who used OnComfort’s VR apps saw 50% reduction in anxiety, 80% reduction in the use of pain medication and a 40% decrease in overall pain. 4) More detailed medical imaging Through EchoPixel’s True 3D system, VR has the ability to provide 3D forms of CT scan and MRI images to physicians which enhances the understanding of patient structures and diseases. This in turn enables doctor’s to produce better outcomes for patients, in less time. 5) Faster rehabilitation Stroke and Brain injury victims can use immersive virtual reality therapy created by MindMazeto to regain motor and cognitive function faster than physical therapy. The virtual exercises and real time feedback are made to feel like games, helping to motivate patients to practice activities every day, as well as assisting physiotherapists in making decisions whether the person is ready to carry out tasks. VR and AR is an exciting space in Health Tech. It’s early days and funding is still a challenge for these innovations. The technology is developing so rapidly, AR and VR offers a significant opportunity to disrupt the status quo. The technology is becoming more economically feasible and there is little doubt that is does assist healthcare providers to deliver and patients to receive the best possible care.

The year is 2027. Dorothy visits her GP about panic attacks she's been getting at work. Before prescribing any treatment, the doctor looks at her genetic history for markers that could affect her response to certain drugs. The GP is looking in particular for CYP2C19 polymorphism, which would mean Dorothy can't metabolise a group of medicines (SSRIs); and at the same time, she examines her patient's sequenced DNA to see if she carries the genetic mutation responsible for panic disorder. Dorothy is a heavy drinker and her doctor sees that she carries a risk gene for alcohol dependence. She considers a drug that could modulate the gene. Dorothy leaves with a smartwatch to log her daily life for the next week: her quality of sleep, diet, exercise, stress, mood and activity. In the room next door, Fred is talking to a specialist about his Parkinson's symptoms. He was prescribed a drug recently for the subtype of Parkinson's he has and, for the first time, there were no side effects. In the past, Fred and the specialist used trial and error to find the right medication. But ever since computers have been able to process exabytes of data, scientists have found patterns and trends that allow them to treat Parkinson's with greater efficiency. Better still, through using an app on his phone, Fred has realised that taking his medicine at night affected his sleep; so he's started taking it at lunchtime instead. Valerie has a migraine again. Like many young people these days, she had her DNA sequenced for her 18th birthday and discovered that she's one of the 7 per cent of Europeans who can't convert codeine into morphine. She inherited her response to the drug from her mother. Valerie knows to mention this to her doctor who prescribes her a non codeine-based painkiller. The doctor also considers what impact Valerie's gut flora and microbiome might have on medication. At its simplest, precision medicine is ultra-tailored healthcare. When President Obama announced the Precision Medicine Initiative in 2015, he put it this way: "delivering the right treatments, at the right time, every time, to the right person." Precision medicine, also known as personalised medicine, is being heralded as the next major breakthrough in healthcare. In Britain, the NHS is "on a journey towards embedding a personalised medicine approach into mainstream healthcare." While medical care has always been tailored to the individual to an extent, the degree to which it can be personalised today is unprecedented because of new technology. Equipment that would have been the stuff of science fiction 20 years ago is now available in many universities. Three key advancements combine to make medicine more precise: patient-generated data through smartphones and wearable tech, genomic medicine and computer science. First, patients can quickly and easily log their daily symptoms with apps on their phones or wearable technology to understand their illnesses better. Detailed records also aid doctors in the way they treat patients and provide data for research. Second, technology is allowing us to sequence DNA at a faster rate and a cheaper cost than ever before; and scientists are understanding the genetic markers of disease at a significant rate. Estimates suggest the cost of sequencing the very first genome could have been as high as $1bn. By 2016, the cost had dropped below $1,500. The process now takes hours rather than weeks. Third, in the age of big data, computers are allowing scientists to analyse vast amounts of data with greater precision than ever before. Machine-learning algorithms accelerate analysis of data sets which result in rapid discoveries. Precision medicine is charged by a need to address the sheer variety of people's reactions to things going wrong in their bodies. From neurological disorders to strokes, cancer to depression, infections to alcoholism, each patient is unique; so ultimately the treatment should be unique, too. Parkinson's is one of the first diseases precision medicine is being applied to. It's a heterogeneous disease, which means there is a lot of variability in how patients progress. In its early stages, the disease can manifest itself with symptoms very different from the tremors most associated with it. Patients may have motion-related issues with walking, posture or movement of the fingers; but they may also experience cognitive and memory problems, depression or lose their sense of smell. Because the early signs are so varied, it is difficult to predict the progression in individual patients. Dr Duygu Tosun-Turgut of the University of California won the 2016 data challenge set by the Michael J Fox Foundation for Parkinson's research. Her aim was to discover whether the progression rate of Parkinson's disease could be predicted. If doctors could predict the speed of a patient's decline, it could affect both treatment and prognosis. It would also assist with clinical trials, as it is better to recruit patients in swift rather than slow decline. In these patients, changes and improvements – and therefore efficacy of treatment – are demonstrated more dramatically. To define the progression rate, Dr Tosun and her team looked at all the clinical data available, captured from multiple patient visits to clinics. This included, for example, the results of memory tests, the total number of times patients could sit down and stand up over a 30-second period or changes in sleeping habits and sense of smell. Dr Tosun then looked for a pattern using data-driven machine-learning algorithms. Two groups were identified. One was slow progressing and the other was fast progressing. The next step was to find out if there were any baseline assessments that could be used to predict the rate of progression. At this point they looked at genetic makeup, fluid biomarkers, imaging MRI data and other factors. "The body is a whole, everything is so connected. There might be something dominant but it affects other systems in the body. It's the same in the brain," says Dr Tosun. She discovered that if patients arrived with more motor-related symptoms on their first visit, they would decline faster. She also identified a brain region with degenerated white matter fibres. She found that the more degenerated the structures were in these regions, the faster the patient declined. Data was collected from people with a family history of Parkinson's or those who exhibited early signs to see if the same measure could be used to detect the disease before the symptoms started appearing. The goal would be to intervene before the disease started to progress. "It's very difficult to reverse neurodegeneration," says Dr Tosun. "If [a patient is] progressing fast, or if they have the markers telling us they're going to progress fast, you need to progress faster." Now Dr Tosun has turned her focus on the earliest mechanisms that trigger neurodegeneration. If it is known what triggers the disease, there may be precautions people can take to avoid developing Parkinson's. "It can be diet, supplements, physical activity or cognitive activity," she says. "It's very important to understand everything about that patient," says Dr Tosun. "Not just their symptoms: their environment, their background, the state of their brain and body. The more we learn about the patient, the more the we can model the disease and treatment better." With advancements in computer science, algorithms and hardware, scientists like Dr Tosun are at the point where they can look at all the data at one time to better understand disease, health, prognosis and treatment. Finding patterns will help answer different questions. The vast capacity of big data is crucial. Dr Beckie Port, senior research communications officer at Parkinson's UK, says, "The more people you put in your experiments, the more you can iron out some of the complexities and start to see trends, It's going to be a mammoth mission to start teasing out individual factors that could be used for personalised medicine, but it's not impossible." Personal technology – wearable tech such as fitbits and smartphone apps – is another important element in precision medicine. It is already being used in the field of Parkinson's. uMotif is a 'patient data capture platform' that allows patients with long-term conditions to track their symptoms using an app. A patient inputs information about symptoms every day, including non-motor symptoms. How did you sleep? What's your mood like today? How about stress levels? What did you eat? How's your pain? Do you have nausea? With this information, researchers and clinical teams can understand the disease better; and patients can have more useful conversations with their clinicians. The patient becomes an active participant rather than a spectator. "How you feel your Parkinson's is a very important thing in quality of life and good treatments," says uMotif's co-founder and chief executive Bruce Hellman. The data capture for a major study into Parkinson's is just finishing. Over 4,221 people tracked their health for 100 days and donated the data to academic research. Already, the feedback suggests the technology is having a positive effect on individual lives. Since using the app, Mick, a Parkinson's patient, reports feeling more assured in talking about his condition with a neurologist because he has a record of what's been happening and how he's felt. "It teaches you, 'Don't beat yourself up because you can't do what you used to do, look at what you are doing'," he says. Through plotting her feelings each day, Sam now realises that she was managing her life with Parkinson's better that she thought. She'd been getting anxiety attacks in the morning and it suddenly dawned on her that changing taking her medication from the evening to the morning might help ease the attacks. It worked. "I'm in control of my health," she says. "One of the problems people have," says Dr Port, "is that when they go to the doctor's they may be having a very good or bad day but it might not reflect what they're like on an everyday basis, That snapshot the specialist sees could influence [the patient's] drugs for the next six months." "People with Parkinson's often only visit a doctor twice a year," says Hellman, "so knowing more about their health will help them to bridge the gap between health visits and better understand their symptoms. Health is done to you at the moment but in the future it should be done with you." The 100,000 Genomes Project is planning to sequence 100,000 genomes from around 70,000 people. The largest national sequencing project of its kind in the world, it aims to create a new genomic medicine service here in the UK. At the time of writing, the 20,429 genomes that have so far been sequenced are split 50/50 between cancer and rare diseases. It covers a large geographical area: England already has 13 genomic medicine centres covering 85 NHS trusts. "Genomic medicine is right at the vanguard of personalised medicine," says Tom Fowler, deputy chief scientist and director of public health at Genomics England. He points out the role it can play in treating rare diseases, where unmet diagnostic needs are of paramount importance. "For people with a lifetime of wondering why they or their child is affected, the benefit [of genomic medicine] is being able to answer that question. It also can improve existing or potential treatment and help with making reproduction choices." Thanks to genomoic medicine, numerous diagnoses have been possible. The gene mutation causing four-year-old Jessica's rare disease was identified by researchers after her parents spent years not knowing what was wrong. Jessica's treatment is simply a special diet that enhances glucose production in the brain. After a month on the regime, Jessica's parents "noticed a big improvement in her speech, energy levels and general steadiness," according to consultant Maria Bitner-Glindzicz of Great Ormond Street hospital. "Overall, she is better and brighter in herself and her parents don't worry about her having fits on a daily basis as they used to." The project anticipates a 25 per cent diagnostic rate in rare diseases but Fowler says the remaining 75 per cent don't just get put aside, the data goes into research environments where it will be worked on: "It's the start, not the end, of the journey." A small group of Parkinson's patients is included in the 100,000 Genomes project because early onset Parkinson's is considered rare and it's more likely to contain a genetic factor. It is estimated that around 5 per cent of Parkinson's cases have a genetic link; but Dr Port thinks the role of genetics in the disease is probably a lot larger. The challenge now is how to move this kind of healthcare into the mainstream as part of routine healthcare. Fowler hopes that will happen in the next five years. In 2015, in partnership with Health Education England, nine universities introduced master's degrees in Genomic Medicine. "A legacy of upskilling staff so they understand information will make the long-lasting difference," says Fowler. "If we build an infrastructure and workforce that can cope with genomic medicine, as new discoveries happen we've got the ability to adapt and take them on board." Genetic testing can already reveal the potential for future illness and allow for proactive and preventative decisions. When Angelina Jolie, for example, discovered she carried BRCA1, the genetic marker for breast cancer that her late mother carried, she had a double mastectomy. People with a BRCA1 mutation have a 65 per cent chance of developing breast cancer, according to the National Cancer Institute. At the moment the number of people who've had their genes sequenced is fractional but it could become more commonplace. Will everyone have genetic testing eventually? "At the current time it's difficult to see how that would step out into the mainstream," says Fowler. "There may well be a time where that is the case and we move towards it." The NHS wouldn't be expected to pay for that, he adds. People are already paying to have their genes tested. Companies like 23andMe of gene testing home-kit services, which offer the possibility of finding out if you have a genetic variant that could put you at risk for certain traits or conditions. They range from serious conditions (cancer, Alzheimer's) to traits (caffeine metabolism, alcohol flush reaction, coriander aversion and sensitivity to the sound of chewing). Critics of precision medicine say that the word 'precision' is an unrealistic, inflated, hyperbolic term. They caution that there are many things happening in the human body, as well as genetics. In the journal Clinical Pharmacology & Therapeutics, Canadian doctor Dan Roden wrote, "Patients are more than collections of genomes and gene-environment interactions; they are individuals influenced by experience, culture, education, upbringing, and innumerable other factors." Still, there have already been some major success stories in genomic medicine. Most recently, DNA sequencing has led to a 'miracle' drug that treats spinal muscular atrophy (SMA), the most common genetic cause of death in childhood. The drug has recently been approved by the FDA. Combined with patient-generated data and computer-powered analysis of big data, precision medicine seems like an obvious next step. It will take time and cost money but once the task of digitising healthcare is finished, it promises a slicker, more efficient system with better diagnosis and treatment. "You can't assume everyone has average Alzheimer's, Parkinson's, or depression. They have their own properties," says Dr Tosun. "Precision Medicine is the solution, it's something we need to do." Source : https://thelongandshort.org/life-death/precision-medicine