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Smart Health Technology


The next step in healthcare technology

Published: 2018
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Summary


Keep it simple! Ease of use determines whether users accept the solution. Then admit that the solution itself is far from simple. Health IT is a complex domain to succeed in.
Steffen Lerche

There are big expectations for the potential of Smart Health Technologies to support healthcare. This type of technology is still in its infancy, but Smart Health Technologies are expected to be commonplace in the future. However, further research and development is needed, e.g. to ensure the accuracy of data.

There are many opportunities for companies to develop Smart Health Technology solutions that will support the healthcare sector, e.g. within telemedicine and early detection. However, there are also definite barriers, e.g. the infrastructure and competencies needed to incorporate Smart Health Technologies in daily operations. Advice for companies includes ensuring data security and using global open standards, and much more.

Short Definition


Looking for technologies which can provide a short feedback loop and give us an understanding of the impacts of our lifestyle and behaviours and other long term aspects will be interesting in the next 10 years.
Kevin Dean

The term ‘Smart Health Technology’ combines the term ‘Smart Technology’ with health, i.e. smart technologies used for health purposes. Smart Health Technologies is capable of recording health information from increasingly advanced sensors, storing and computing this information automatically and deliver either personalised advice or automated actions from the collected data. As such, Smart Health Technologies are at least in part physical, and can include the means to interact and engage with data by way of e.g. Virtual or Augmented Reality as well as other forms of data representation.

Smart Technology is an umbrella term covering all forms of technologies which have

  1. Physical sensors with which to register data from its surroundings
  2. Computational capacity with which to store and analyse the data
  3. The means to deliver either actionable advice tailored to the end-user or automated actions, based on the data input.

Smart Health Technology adheres to the above definition, with the clause that it is used with the purpose of, or within the domain of health.

What are Smart Health Technologies?


the expectations for biotech and AI are enormous. It is however essential that this potential is demonstrated in a reliable fashion.
KORA, Højgaard & Kjellberg

Smart Health Technologies are believed to cause drastic changes over a short period of time as well as provide an opportunity of incorporating both health data from private citizens through wearable technologies and smart health data from within the hospitals. This latter aspect will give rise to intelligent operations and maintenance. Hal Wolf argues that not only wearables, but also sensors and robotics will be available for remote monitoring by 2025.

According to Niall McDonagh, Smart Health Technologies cover a variety of solution types. In hospitals they can be e.g.:

  • Sensors
  • Medicine dispensation
  • Smart pills
  • Smart surgeries
  • Holographic devices/simulation

Beyond the hospital sphere they can be e.g.:

  • Wearables
  • Early registration devices
  • Remote technologies (McDonagh, 2017)McDonagh, N. (2017, November 28). Niall McDonagh. Interview performed by Health Innovation Centre of Southern Denmark

While Data Analytics enable IT-systems to deliver tailored advice based on advanced analysis, the analysis will only ever be as good as the collected data. With recent advances in the development of health technology, we are seeing pervasive technology within healthcare which empowers citizens, patients and healthcare personnel as well as the operations of the healthcare system in general. Smart Health Technologies are able to obtain and engage with various kinds of data related to personal health and wellbeing.

The trend of recording especially personal health information has been steadily growing for several years with the notion of the Quantified Self. This movement has seen a steep increase in recent years as the rising abilities of IT and decreasing costs has made a wide variety of Health Technology available at an ever lower cost. The current state of Smart Health Technologies is advanced but still in its relative infancy. It will combine and grow alongside Data Analytics.

CASE:

Care-o-bot 3 – A robot at home

The care-o-bot 3 from Fraunhofer IPA is a robot which takes care of service related tasks in peoples home. The care-o-bot is in early stage of development, but the vision is that the robot in time should be able to bring the owner different things, help them come out of bed, helping with training.

“Care-O-Bot 3 is already able to independently move around the home while it performs simple service tasks. In Patient@home, these properties are continuously expanded through the project’s research and innovation performance and the robot will therefore continuously be able to engage in scenarios of increasing complexity” (Care-O-Bot, 2012)Care-O-Bot. (2012). Care-O-Bot 3 as a Test Platform and Inspiration. Retrieved from http://www.en.patientathome.dk/projects/care-o-bot-3-as-a-test-platform-and-inspiration.aspx.

Why are Smart Health Technologies Relevant?

Smart Health Technologies are influenced by the megatrends of democratisation, increased health focus and the paradigm shift in patient groups, while the trends of acceleration and digitalisation enable Smart Health Technology solutions, along with Data Analytics.

In relation to the burning platform created by the demographic change, the advances of technology have already been adopted to assist in providing care and wellbeing for persons in need for several decades. The demographic change is expected to be a driver for the development of Smart Health Technologies. The types of Smart Health solutions will depend on the needs presented by this change.

The true relevance of Smart Health Technologies also depends on the future capabilities of the technologies. Kevin Dean gives an example:

“If every time you smoked a cigarette your fingernails turned black and a black spot appeared on your forehead, indicating how much damage you were doing to your lungs, heart and circulatory system and to your DNA, then we might change our behaviour. Looking for technologies which can provide a short feedback loop and give us an understanding of the impacts of our lifestyle and behaviours and other long term aspects will be interesting in the next 10 years” (Dean, 2018)Dean, K. (2018, January 4). Kevin Dean. Interview performed by Health Innovation Centre of Southern Denmark.

CASE:

SENS motion® - IOT plaster

“SENS Innovation ApS was founded in 2014 with the aim of revolutionising the way our healthcare system uses daily physical activity in the treatment and prevention of a number of diseases. SENS motion® is a tool for health professionals to efficiently follow up and motivate larger patient groups and provide support for especially physically weak patients. The SENS motion® technology uses small and flexible disposable smart patches. The system has been developed with doctors, patients and health trainers to fit the rehabilitation process both at home and within a hospital setting.  The SENS motion® smart-patch platform had to be significantly matured to be usable within the area of home rehabilitation. This product development process have been driven by the user inputs gained from Patient@home” (Sens Motion, 2012)Sens Motion. (2012). Efficient home rehabilitation tool SENS motion®. Retrieved from http://www.en.patientathome.dk/projects/efficient-home-rehabilitation-tool-sens-motion%c2%ae.aspx.

How are Smart Health Technologies used?

The use of sensors in self-monitoring has long been the cornerstone of the notion of Quantified Self. The combination of recording personal health and the possibilities within Data Analytics enable Smart Health Technologies to provide engaging and personalised output. In the future, machine learning may enable Smart Health solutions to provide users with predictive recommendations based on their lifestyle recorded through different data sources.

Smart Health Technologies make both real time and historic health data available to the citizens and healthcare personnel. The reliability of the collected data, however, is often discussed. Smart Health Technologies are still in their infancy and the reliability of the data is still not high enough for healthcare providers or end-users to rely on the precision and accuracy of the data. Jonas Moll sees a great future for Smart Health Technology data when the reliability is better:

Once this gets fixed and we have done some clinical trials to show that one kind of wearable device actually delivers trustworthy data I think this will be integrated into our electronic health records and become part of the decision-support that clinicians draw diagnostic information from(Moll, 2018)Moll, J. (2018, January 2). Jonas Moll. Interview performed by Health Innovation Centre of Southern Denmark.

More advanced solutions will be developed in the near future, as the advances in mobile data-sharing rise with the advances of 5G data transfer. This will enable data transfer rates faster than 1Gbps, allowing for virtually instantaneously responses to citizens (DNV GL, 2017)DNV GL. (2017). Technology Outlook 2025. Retrieved from https://to2025.dnvgl.com/p: . .

Smart Health Technologies in the Danish Healthcare Sector


The state of Smart Health Technology is experimentation, and only advanced users are really using it.
Jonas Moll

According to the Danish Institute for Local and Regional Government Research, previously KORA now VIVE, “the expectations for biotech and AI are enormous. It is however essential that this potential is demonstrated in a reliable fashion” (KORA, Højgaard & Kjellberg, 2017)KORA. , Højgaard, B. & Kjellberg, J. (2017). Fem megatrends der udfordrer fremtidens sundhedsvæsen. Retrieved from https://www.kora.dk/aktuelt/nyheder/2017/fem-megatrends-vil-forandre-fremtidens-sundhedsvaesen/p: . . However, it is important to remember that “it is a common trend to underestimate the time of implementation for megatrends, and undervalue the value in the long term” (KORA et al., 2017, p. 53)(KORA, Højgaard & Kjellberg, 2017)KORA. , Højgaard, B. & Kjellberg, J. (2017). Fem megatrends der udfordrer fremtidens sundhedsvæsen. Retrieved from https://www.kora.dk/aktuelt/nyheder/2017/fem-megatrends-vil-forandre-fremtidens-sundhedsvaesen/p: . . This applies to Smart Health Technology as well.

The expectations for the potential of Smart Health technologies are high but there is still a way to go before the full potential is realised. Jonas Moll argues that:

“Wearable devices such as smart watches are still pretty immature still. I think that when they become less annoying to wear we will be integrating those data points in our healthcare system” (Moll, 2018)Moll, J. (2018, January 2). Jonas Moll. Interview performed by Health Innovation Centre of Southern Denmark.


In a number of cases, patients will soon be able to carry out diagnostics using CDS, and receive advice and guidance regarding treatment.
Steffen Lerche

The present state of Smart Health Technologies is characterised by an enormous promise of future abilities, but for now the examples are few. While we see mostly smartphone apps and a few stand-alone products today, the prevalence of Smart Health Technology in health is still limited. The current ability to analyse and provide actionable advice to users based on their health data is still limited. Jonas Moll explains:

“The state of Smart Health Technology is experimentation, and only advanced users are really using it. For now it is very unreliable and sometimes does not work. In essence you cannot trust the data coming out of Smart Health Technology today. Once this gets fixed and we have done some clinical trials to show that one kind of wearable device actually delivers trustworthy data I think this will be integrated into our electronic health records and become part of the decision support that clinicians draw diagnostic information from” (Moll, 2018)Moll, J. (2018, January 2). Jonas Moll. Interview performed by Health Innovation Centre of Southern Denmark.

Smart Health Technologies and their ability to analyse and provide actionable results still need to be developed further before the true potential can be realised. Steffen Lerche believes that like Healthcare personnel have their clinical decision support systems, patients will soon have their own decision support systems too:

“Healthcare professionals use clinical decision support (CDS) systems to proactively react to indications for a given diagnosis and actively search for further information to qualify the diagnosis in question in order to ensure that best practice recommendations are taken into account for treatment. In a number of cases, patients will soon be able to carry out diagnostics using CDS, and receive advice and guidance regarding treatment(Lerche, 2017)Lerche, S. (2017, November 28). Steffen Lerche. Interview performed by Health Innovation Centre of Southern Denmark.


We’ll see sensors in individual devices as well as for remote monitoring, and while these will not be fully distributed they will be commonplace
Hal Wolf

Further Research and Development

Among our interviewed experts there is an agreement that Smart Health Technologies will increase and become pervasive in the near future. For example, Hal Wolf argues that Smart Health Technologies will be commonplace in 2025:

“Attention is being focused on wearables but I believe that the use of sensors and robotics will start cracking through in the next seven years. We’ll see sensors in individual devices as well as for remote monitoring, and while these will not be fully distributed they will be commonplace (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.

Our experts also agree that making claims about what specific technologies will be worth focusing on is speculative, and that the best practice is to adhere to industry standards. New technologies will emerge in accordance with purposes or needs. As with the development and adaptation of smartphones, it is likely that we will see a rapid deployment of a singular good Smart Health Technology-related idea.


If we start offering advice to people, especially about their medical and health status, we need to really focus on the reliability and dependability of the sensors providing the data.
Kevin Dean

Sensor technology is expected to be perfected in the near future. This will enable Smart Health Technologies to incorporate precision technologies and internet connection in wearable devices. This means significant opportunities for monitoring and treatment. It will take time and require several steps of research and development, not least to ensure adequate precision for use. Kevin Dean explains:

“If we start offering advice to people, especially about their medical and health status, we need to really focus on the reliability and dependability of the sensors providing the data. There is a real challenge in making sure that those sensors are working, calibrated and accurate and that’s actually a whole other dataset that needs to accounted for” (Dean, 2018)Dean, K. (2018, January 4). Kevin Dean. Interview performed by Health Innovation Centre of Southern Denmark.

Challenges for Smart Health Technologies

On the one hand the challenges for Smart Health Technologies are related to the technical capabilities of the technologies, e.g. whether adequate precision and data security can be ensured. This will be necessary to ensure that Smart Health Technologies can be incorporated in healthcare. On the other hand incorporating Smart Health Technologies in healthcare will affect the healthcare personnel and the way that they work. A cultural change is in the cards.


I think a lot of things will happen in five years … and we have to educate the people, our employees, much more in thinking differently. Making a cultural change.
Peder Jest

The introduction of Smart Health Technologies will no doubt foster a change in the healthcare system. Not only will the healthcare sector need to adopt a new way of managing citizens with illnesses and special needs, the healthcare personnel will also need to be more agile in relation to integrating and working with new technological devices. For example, the advances in especially Smart Health Technologies is expected to speed up the process of using telemedicine to monitor and treat patients remotely. Peder Jest underlines:

“I think a lot of things will happen in five years. And a lot of new expectations in the next generations will show up and we have to educate the people, our employees, much more in thinking differently. Making a cultural change” k(Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

In general more healthcare will take place in the homes of the citizens or in their local environment. Telemedicine is often used to the benefit of chronically ill patients today, however in the future, treatment in the local environment of the citizens will expand to other patient types. This means that the healthcare personnel will be delivering healthcare in a different way. Peder Jest explains:

“A lot of patients will be treated at home or at institutions, care homes for example, together with the GPs and the municipalities in contact with the hospitals and the physicians, nurses at the hospitals, but at a distance” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

Peder Jest argues that for providing healthcare in the local environment, Smart Health Technologies will have a significant role, and the healthcare personnel will need to learn how to work differently (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

Opportunies and Barriers


 the case is that the global market was approaching 10 billion US Dollars in 2017 and that it would double by 2020. I mention these numbers purely to make the point, that this sector is already large and that it is growing rapidly
Niall McDonagh

The expectations for Smart Health Technologies are significant when it comes to reach, effect and time. Niall McDonagh underlines this expectation:

“One report I saw in Smart Health Technology, in the case is that the global market was approaching 10 billion US. Dollars in 2017 and that it would double by 2020. I mention these numbers purely to make the point, that this sector is already large and that it is growing rapidly(McDonagh, 2017)McDonagh, N. (2017, November 28). Niall McDonagh. Interview performed by Health Innovation Centre of Southern Denmark.

Kevin Dean argues that the pervasive technologies which we see today will become even more so in the coming years, and that familiar technologies such as the smart phone or smart watch will be developed further to include more detailed and reliable health technology sensors and abilities (Dean, 2018)Dean, K. (2018, January 4). Kevin Dean. Interview performed by Health Innovation Centre of Southern Denmark.

The opportunities for companies developing Smart Health Technology solutions are expected to be significant, particularly when it comes to:

  • Digitalisation and the general positive attitude towards technology in new generations
  • Supporting the healthcare sector in caring for the growing proportion of elderly and chronically ill patients
  • Supporting the healthcare sector in caring for citizens in or close to their own home through tele-solutions
  • Early detection and intervention
  • Intelligent operations and maintenance

There are, however also some barriers for Smart Health Technology solutions to overcome:

  • The healthcare sector’s readiness to adopt Smart Health Technologies and integrate them into their daily operations
  • The healthcare personnel’s existing competencies for using Smart Health Technologies
  • The readiness of the infrastructure to integrate Smart Health Technologies and data

Considerations for companies

When developing solutions for healthcare, particularly solutions that handle personal data, the following aspects will be relevant to consider.

In May 2018 the General Data Protection Directive from EU (GDPR) will enter into force in the EU (European Council, 2016)European Council. (2016). The General Data Protection Regulation. Retrieved from http://www.consilium.europa.eu/da/policies/data-protection-reform/data-protection-regulation/. The purpose of the directive is to strengthen citizens’ fundamental rights when it comes to data, privacy and digitalisation – but also to simplify rules for companies and thereby facilitate growth. Some of the more noteworthy changes enforced by the directive are the possibilities of issuing fines amounting to up to 4% of a company’s annual turnover.

In order to adhere to the GDPR, companies may look at the Guidelines for Cybersecurity (ISO 27032).

The regulation regarding data subject consent has been further strengthened and clarified. Consent must be explicit and the citizen must be clearly informed of the precise and defined purpose of data collection. Furthermore the citizen has the right to revoke consent. If consent is revoked the data must be deleted and proof that it has taken place presented to the citizen. This will affect all companies handling data pertaining to the citizen’s health.

Data portability is a new topic introduced by the GDPR. With GDPR the citizen will have the right to data portability. This means that if you collect personal data the citizen has the right to receive the personal data concerning him or her in a structured, commonly used and machine-readable format. They also have the right to transmit those data to another organisation that collects data about the citizen. The purpose of this obligation is to limit the number of times citizens have to answer questions about the same subject matter, e.g. age, height, gender etc.

This is particularly interesting from a healthcare perspective because data might be required to be shared across different organisations in the healthcare sector to a much greater extent than they are today. This might also prove a new business opportunity for companies, since there may be a whole new market emerging for solutions to support data portability, e.g. by providing system integration or sharing information between different IT systems.

In addition to the more general GDPR directive, an updated directive on Medical Devices will enter into force in the spring of 2020 and 2022. The two directives (EU) 2017/745 “MDR” & EU 2017/746 “IVDR” –   (European Parliament & European Council, 2017a)European Parliament. & European Council. (2017a). (EU) 2017/745. Retrieved from http://data.europa.eu/eli/reg/2017/745/oj/eng and (European Parliament & European Council, 2017b)European Parliament. & European Council. (2017b). (EU) 2017/746. Retrieved from http://data.europa.eu/eli/reg/2017/746/oj/eng heavily regulate what is defined as medical devices, and how such devices can be tested and used within the boundaries of the EU. This is central for especially Data Analytics and Smart Health Technologies. ‘Medical purpose’ is defined as any type of diagnosis, prevention, monitoring or treatment or alleviation of disease or disability. The vast majority of devices which collect health information are likely to be considered medical devices, even if they do not process or analyse the data. Companies operating within the domain of health should proactively investigate compliance with these regulations and adjust development processes accordingly.

Bringing technology into the sphere of healthcare services brings with it relevant ethical considerations. The Health Innovation Centre of Southern Denmark has developed two videos that illustrate the expectations and challenges that may arise when new technology meets the healthcare sector. The videos focus on the perspectives of the patients at home and the clinicians working across sectors, respectively. Companies may consider these ethical aspects in their development process.

 

Advice for Companies

Companies developing Smart Health Solutions for the Danish Healthcare Sector of 2025 should particularly consider the following:

With access to easily understood information citizens are empowered to take charge of their own health. While this is not a necessity, it is an ability with which great results have been seen earlier. The key point is a clear and transparent link between action and data which help to illustrate and thus either create or shorten the feedback loop between action and consequence. Deloitte suggest incorporating gamification to ensure the motivation and engagement of citizens:

“Gamified applications have significant, positive effects on health by developing resilience and patient empowerment while activating optimistic emotions … Gamification has the ability to activate patients, make them accountable for their health choices, and turn them into consumers (Deloitte, 2016)Deloitte. (2016). Boosting patient empowerment and motivational pull. Retrieved from https://www2.deloitte.com/de/de/pages/strategy/articles/boosting-patient-empowerment-and-motivational-pull.htmlp: . .

Steffen Lerche advises companies to:

“Keep it simple! Ease of use determines whether users accept the solution. Then admit that the solution itself is far from simple. Health IT is a complex domain to succeed in (Lerche, 2017)Lerche, S. (2017, November 28). Steffen Lerche. Interview performed by Health Innovation Centre of Southern Denmark.

know the various standards that regulate the domain and comply with the standards related to health services.
Steffen Lerche

With several companies offering Smart Health Technologies to both private and institutional use, there is a need to use both Global Open Standards and a platform which incorporates data into one coherent view. There are markets for solutions that record specific data, analyse data or offer a platform for aggregating data from several Smart Health Technology providers.

Due to the sensitive nature of the data collected, there is a need to ensure long-term access and quality of data. Combined with other factors, such as Global Reach, companies should use and adhere to Global Open Standards as well as allow integration of competing products onto platforms and exportation of data. Using globally recognised Open Standards will allow companies to offer services globally and reduce the cost of services. In addition, this will ensure that citizens and hospitals using Smart Health Technology services are ensured access to their data in the event of companies going out of business. It will also ease migration from older systems to new.

Steffen Lerche advises companies to:

“know the various standards that regulate the domain and comply with the standards related to health services. Create an overview of applicable legislation and become familiar with the details. And last, but not least, make sure you enter into the right alliances. Otherwise, you might develop the world’s smartest solution, but it may be doomed to fail” (Lerche, 2017)Lerche, S. (2017, November 28). Steffen Lerche. Interview performed by Health Innovation Centre of Southern Denmark.

Erik Jylling underlines the need to integrated solutions into existing systems:

“We have to have the ability to assess that the solutions are also in favour of being integrated in the system” (Jylling, 2017)Jylling, E. (2017, December 13). Erik Jylling. Interview performed by Health Innovation Southern Denmark.

When entrusted with the personal information of citizens, there is an expectation to keep this information secure and encrypted. When the information is personal health information there is an added critical element to keeping this information safe due to the sensitivity of the information. Jonas Moll explains:

“we have so many examples of data leaks and that is a huge barrier going forward” (Moll, 2018)Moll, J. (2018, January 2). Jonas Moll. Interview performed by Health Innovation Centre of Southern Denmark.

Values and Risks of Smart Health Technologies

Smart Health Technologes may add value for the citizens, healthcare personnel, healthcare sector and society as a whole in relation to:

  • Early detection and intervention
  • Personalised treatment
  • Improved healthcare processes or patient journeys

However there are also potential risks to consider:

  • The need for cultural and organisational change
  • Opposition to continuous monitoring
  • Safety and security of personal information

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