29 August 17 The Business Times
- Dr Loke Wai Chiong, healthcare sector leader, Deloitte South-east Asia;
- Linus Tham, group chief information officer, Parkway Pantai;
- Dr Tan Teck Jack, chairman & medical director, North-east Medical Group;
- William Chew, managing director, myHealth Sentinel (mHS);
- Adjunct associate professor Gamaliel Tan, chief medical informatics officer and head, Department of Orthopaedics, JurongHealth Campus.
Moderator: Amit Roy Choudhury
THE use of increasingly powerful biosensors to monitor health has the potential to revolutionise the healthcare industry. To know more, The Business Times bought together a group of healthcare specialists for a roundtable to explore the ramifications.
Excerpts from the discussion:
Amit Roy Choudhury: Biosensors are a key to providing remote healthcare, including patient monitoring outside the hospitals. This has the potential of revolutionising healthcare in Singapore and elsewhere. Can you share some of the transformational applications that are happening or are about to happen in the use of biosensors to provide world-class healthcare outside of super-speciality hospitals?
Dr Loke Wai Chiong: Broadly defined, biosensors are detecting devices which can sense certain physical or chemical parameters in the human body, and then transmit the information in the form of data to an aggregation or analytic engine, and the subsequent analysis ultimately generates insights leading to some action either by the patient or by the care provider (or increasingly by an automated treatment delivery system). The rapid advance in technology in the various steps - to sense, communicate, analyse and feedback into action - has transformed how healthcare is provided from, say, as recent as 10 years ago.
Linus Tham: These sensors offer immense potential and opportunities for Parkway Pantai, whose healthcare institutions see international patients from across all over Asia and the Middle East. The ability to remotely monitor patients' health status allows doctors to better prepare them before surgery, while they are still in their home country. For example, some biomedical readings could indicate that the patient may not be ready for a given procedure, or highlight areas that may require special attention when they arrive at the hospital. In the same way, post-surgery care can be augmented by data from biosensors to better monitor a patient's recovery at home after discharge.
Dr Tan Tech Jack: As a medical doctor in primary care, I am truly excited about the many recent technological advancements that can be applied to Singapore's ageing population. The North-east Medical Group is currently partnering two local startup companies. One allows remote monitoring of heart rate and blood pressure of patients, and the other, a mobile app with local flavour (pardon the pun!) that monitors individual dietary intake and offers personalised advice. Another technology we are looking at is non-invasive glucose monitoring devices that no longer require painful finger-pricks. These electronic clip sensors allow continuous measurement of blood glucose levels which could then be transmitted to our cloud monitoring services. Our medical group has always been keen to adopt technologies that provide quality, responsive and personalised care.
William Chew: As a Singapore-based medtech company, we at mHS provide digital health platforms that enable healthcare providers such as hospitals and community-based GPs (general practitioners) to remotely monitor, aggregate, track and analyse patients' vital signs. Products are evolving from user-operated, discrete, medical-grade devices that provide "snapshots" of single parameters, such as BP (blood pressure), BG (blood glucose), into multi-functional wearables, with miniaturised biosensors embedded within skin-like organic-polymer patches, "smart" clothing and even contact lenses. The really exciting pay-off for healthcare will be when all of this data is combined with data analytics/AI (artificial intelligence), to derive "personalised and actionable insights" for each individual patient.
Gamaliel Tan: Medical sensors are used to measure physiological parameters such as pulse rate, blood pressure, temperature and oxygen saturation levels. With miniaturisation, medical sensors are now wearable. Together with the ubiquitous use of smartphones and cloud technology, this allows for remote monitoring of patients with chronic disease. Better control of chronic disease and avoidance of costly admissions to the hospital are the potential beneficial outcomes of this.
Amit: The use of automation and biosensors can address the issue of manpower shortage in the healthcare sector, particularly in Singapore. The different health clusters here are experimenting with technology in this respect. Can you share some of the advances that you see happening or are about to soon happen?
Linus: Hospitals in Singapore have been using sensors such as temperature sensors in general wards for some time now. However, these technologies still require the setting up of some infrastructure within the hospital facilities. Also, devices in use so far tend to be uni-function in nature. This curtails their extensive use in a general ward setting, where most patients would prefer not to have multiple sensors attached to them. However, multi-function sensors are becoming available in the market. These innovations will help make remote monitoring a comfortable experience for patients, while helping to reduce the workload of healthcare professionals in the hospitals.
Jack: Automation is a need, primarily driven by manpower shortage and a quest for productivity. I predict a widespread deployment of biosensors, followed by intense rationalisation. Moreover, the plethora of biosensors and IT platforms have lagged in terms of adopting health IT standards. I see consolidation and convergence of these standards happening soon.
Current medical technology has its strength in learning specific tasks from data depositories, complex image processing and doing repetitive tasks quickly and consistently. These advancements can potentially automate certain functions of pathologists, radiologists and eye surgeons in pattern recognition. However, we are nowhere near replacing the human mind in performing high-value medical tasks such as disease diagnosis and devising a personalised management plan. Huge breakthrough advances in AI for areas such as natural language processing and contextural awareness would be required.
William: Simply "injecting technologies" piecemeal into the legacy healthcare model would have very limited impact in terms of easing the "shortage" of doctors and nurses. For example, patient-generated data from activity trackers and mobile apps tends to be ignored by most doctors today due to concerns about the data quality and the lack of clinically validated tools to analyse and make use of this new torrent of data. Hundreds of companies, including tech titans Microsoft, Apple, Samsung, Google have all tried to launch different "tech-centric", consumer-facing devices and apps, in an effort to "fix" healthcare, but with little success. Therefore, a consensus realisation has emerged that technology needs to serve the larger "transformation" of the healthcare model, the goal of which is to create a "continuum of care" in which all the different care providers in the healthcare ecosystem are "interconnected" and work together based on a shared, single view of the patient. For technology providers, this translates into empowering, not "disrupting", clinicians to care for larger numbers of patients without any compromise in the quality of care.
Gamaliel: I would prefer to use IT to make each care episode safer and more productive. This means arming the care provider with the right information at the right time and empowering all patients and care providers with the information to make the right choices. One way to do this is via telemedicine. Patients and carers will need a set of biosensors and a smart device with Internet connection to upload vitals back to the hospital servers. A nurse can then monitor them and patients may skip an appointment if their markers are within normal range. This saves both the patients and the doctors an unnecessary trip. There are other hospitals which provide tele-rehab, tele-eye, tele-stroke and various other tele-programmes that save patients from travelling to the acute hospital. These programmes rely on a nurse or allied healthcare provider being the point of contact in the polyclinic or patient's home while the specialist is in the hospital taking the tele-consult.
Wai Chiong: When discussions turn to IT, AI and automation, people start to ponder what the "Future of Work" will look like in Healthcare. Deloitte recently announced a partnership with the Economic Development Board to launch a Future of Work Centre of Excellence, and it will specifically address how cognitive technologies, robotics and hyper-connectivity can and will augment human skills and lead to the reinvention of many jobs including those of doctors, nurses and other health professionals. This is a trend we cannot ignore nor hide from, and healthcare leaders and policymakers need to make their preparation for the future today.
Amit: Are medical practitioners seeing patients who are more aware of their health status, thanks to home use devices such as blood sugar and pressure monitors and other such devices? How has it affected the treatment and management of chronic diseases? Do you see a stage where medical-grade off-the-shelf health-monitoring devices such as fitness trackers would be available for use? How would this impact the healthcare industry?
Linus: Devices are becoming more pervasive and increasingly accurate. My view is that they are quite ready, especially when we are applying them to otherwise well patients living at home, and there is no absolute need for the same medical-grade precision required in our hospitals. These developments herald an era of "hospitals without walls", where patients are supported 24/7 by an ecosystem of systems and devices inside and outside the hospital. Such a facility will automatically receive data uplinked from its patients' remote monitoring devices and have IT systems in place to monitor what is "normal" for them. Clinicians are alerted to abnormal readings and prompted to reach out and check in on the patient through tele-consultation sessions. Drugs are prescribed and delivered via courier when necessary. In some cases, they may even be able to prevent an illness or medical emergency before it even occurs. Such "hospitals without walls" would be able to provide quality, cost-effective care to a larger number of patients, without adding further strain to limited healthcare manpower resources. Another hurdle is for regulators and payors in the markets to recognise the value of such end-to-end care, as opposed to paying only for each episodic visit.
Jack: Yes, patients are definitely more aware of their conditions now due to proliferation of such devices. Instead of episodic readings taken at each doctor's consult, the added closed-loop feedback to patients encourages better self-management and provides doctors with better tools for decision making. There are two issues associated with increased availability of health-monitoring devices. First, many fitness trackers are not medical grade, and it may be some time before we see medical off-the-shelf products that comply with established standards. Secondly, immense amounts of data may confuse the patients and doctors, not necessarily resulting in better health decisions. The healthcare professional must not fall into the trap of being over-reliant on data and algorithms, sacrificing judgment and human touch.
Gamaliel: I believe empowering patients with their health data will help them to manage their own disease better. There are off-the-shelf glucometers and weighing machines that can help diabetic, heart failure and renal failure patients monitor their conditions closely with their remote-care team. Patients on anti-coagulant therapy (warfarin) can also invest or rent a PT/INR machine to monitor their therapeutic levels. Fitness trackers with motion trackers can potentially monitor elderly patients in their homes. If they are not moving for a prolonged period, it could mean they have fallen or be injured. An alert can be sent to their loved one or healthcare provider to call or investigate.
Amit: Biosensors, fitness trackers and other such devices are a part of the general disruption that technologies such as cloud computing, mobile, IoT (Internet of Things) and Big Data are bringing about. From the healthcare perspective the disruption has the potential of being transformational. Where do you see the future developments progressing in terms of the quality of healthcare that can be provided?
Linus: In the last 20-30 years, healthcare has witnessed a paradigm shift from reactive care - trying to heal something that has broken or do catch-up with the next big disease - to preventive care. Today we are at the cusp of the next revolution in healthcare. Existing technologies, such as biosensors, fitness trackers, cloud computing, mobile apps, big data and IoT would significantly improve the quality of care across the care continuum. In the next 20 years, we will see the shift towards predictive healthcare: How we can predict medical problems and make provisions for our health way in advance, with the intelligent and innovative use of consumer technologies in healthcare settings. We are not that distant from a future where we can monitor the functions of our bodies and plan for treatment without even visiting the hospital. It is possible that in the future, you will find the disease, before the disease finds you.
Jack: In the future, I see better coordination and communication between doctor, the care team and patients, through secure sharing of data and its analyses. Care plans become patient-centred, or even be patient-driven, for example, using a nutrition mobile app to improve dietary compliance and achieve caloric control. This ultimately transforms healthcare professional roles, shifting away from traditional power roles of an authoritarian who monopolises information, to focus on more complex roles of medical decision making.
Gamaliel: As biosensors become more advanced, they can be used to augment human function. Retinal implants that can give semblance of sight to patients with macular degeneration are already a reality. Commercial players such as Apple, Google and Alibaba are already making inroads into lifestyle trackers. With products such as Alexa and Siri embedded into their smart devices, it's not inconceivable they can monitor our vitals and alert us if thing are going awry and can even offer to schedule a check-up sooner than later.
Wai Chiong: The potential for benefit is huge, with 24/7 self-monitoring and remote automated care delivery becoming a reality faster than we can imagine. But with the hyper-connectivity of nearly all things medical, will also come the new risks of cybersecurity, hacking and ransomware, as recent high-profile incidents have highlighted. New skills and capabilities in cyber-vigilance, security, and resilience will be crucial in this new age.