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As originally asked by Kelly O’Rear.

How will they affect patient care? How will they affect security and privacy in the healthcare setting?

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Mike Plishka
Partner in Creative Thinking, Innovation and Design
Sensor technology is already becoming advanced enough to allow certain types of monitoring in real-time. Blood chemistry sensors are a different story but they’re in the works. Creative use of sensors and non-invasive (into patient’s lifestyle) are key. As I touched upon in this blog entry ([http://zenstorming.wordpress.com/2012/10/26/dieter-rams-design-innovation-healthcare/|leo://plh/http%3A*3*3zenstorming%2Ewordpress%2Ecom*32012*310*326*3dieter-rams-design-innovation-healthcare*3/yNCP?_t=tracking_disc] ) for the patient, it’s not necessarily about being healthy per se, it’s about doing what she wants to do, when she wants to do it (i.e. Quality of Life)

In my opinion, the ultimate platforms of the future, when they solicit patient interaction, will be less healthcare oriented and more ‘gamish’ in their feel-the person won’t use it as a healthcare app at all, but to do something else.

Regarding healthcare apps, for better or worse, the FDA is hard at work trying to figure out how to deal with these little monsters 😉

Emad Baba
We provide and develop sophisticated healthcare solution
I think every human will have a special software and he has to make update time to time to stay healthy 🙂

John Strupat
President, JST Limited
@Kelly. Here is a healthcare example that doesn’t specifically use mobile devices, but could be template for many other diagnostic apps that could disrupt current medical practice:

[http://www.ted.com/talks/lang/en/max_little_a_test_for_parkinson_s_with_a_phone_call.html|leo://plh/http%3A*3*3www%2Eted%2Ecom*3talks*3lang*3en*3max_little_a_test_for_parkinson_s_with_a_phone_call%2Ehtml/dZK-?_t=tracking_disc]

You ask about improving healthcare.

One answer will come from looking closely at who would benefit from success of this technique and who would be threatened.

John Strupat
President, JST Limited
If you include reliability as part of security, as in ‘data security’, then you just need to match that up with business risk.
100% reliability = 0 business risk
Anything less, who knows?

As an example on the fringe of healthcare, who pays out when your elderly parent’s wireless call button doesn’t “work” so help does not arrive in time?

Extend that scenario to the many proposed apps that would stream biophysical data for monitoring, diagnosis, etc.

The FDA may decide that the benefits outweigh the risks and allow you to market the device, but that will not protect you in a product liability case.

Zeljko Roncevic
M.D., Ph.D. Pediatric Cardiologist, Professor of Pediatrics
If we are talking about health care: 2. treatment outcomes 3. cost-benefit 3. satisfaction of patients and health care professionals 5. pediatric healthcare. Children are 1/4 of US population and they are the future of the nation.

Kelly O’Rear
Medical Software Consultant
I agree security is a major concern when it comes to improving healthcare. What are the other big concerns?

John Strupat
President, JST Limited
Kelly, I don’t see that development money really is an issue at all. Investors will always take chances where there is potential for a good rate of return.

However, must agree with Bruce that the payment side of this kind of technology is a real problem. Many entrenched medical groups are against any reduction of their control and power. Some may call that politics but it is where the dinos roam free.

However, the power of the physician and the hospital to control this may be changing with the HMOs. insurance companies and even Governments who are looking for ways to keep people healthy and out of hospital care. Note that I did not say “patients”!

Earlier responses highlight a huge potential market to wirelessly monitor data from people, ideally using expert systems that need no human intervention to analyze it.

What it is going to take to make this happen is a fundamental shift in the expectations for health care that is not hospital centered or physician centered.
Particularly in the US, you will not be able to take advantage of new high tech but low cost wireless technologies if your first response to a problem is to call 1-866-sue-them.
Not sure that this thinking is even possible in the US?

I expect to see these technologies used in Asia first and spread from there but may never make it to the US.

Zeljko Roncevic
M.D., Ph.D. Pediatric Cardiologist, Professor of Pediatrics
Bruce you are right it comes down to money, If eye to eye talking with patient and physical examination are “dinosaur medicine” we’ll have problem with dehumanization of medicine. I’m not against technology and I use a lot of modern technologies but please can you give me definition of “dinosaur medicine” ?

Bruce Grayson
Strategic Business Development – Enterprise and Mobile Software – Clinical Applications and Medical Devices
In my experience it comes down to money. It is very expensive to make products in our regulated environment. Products that are manufactured need to make significant profits to cover the costs, there must be someone willing to pay those significant product prices.
Other industries leverage cost reductions from similar or adjacent sectors to steal ideas and competitive advantages. We will see that in IT, mobile, and parts that use other components that become mass produced.
Now the payment side of the equation needs to have arguments made to show intervention by the device will reduce the costs of healthcare for a certain intended use.
We don’t need an electronic stethoscope if the dinosaur brand will work just fine.
That is why we still have graphite pencils and paper clips. They do the job, cost effectively.

Zeljko Roncevic
M.D., Ph.D. Pediatric Cardiologist, Professor of Pediatrics
It’s not political and I don’t care about politics and politicians. It’s about your question how they affect security of the patients. It’s about control of thousands of softwares with intention for use as medical devices in humans. Are you sure that some of them are not potentially danger for patients (improper use, poor quality, avoiding medical help in risky and poor interpreted situations by non-professionals…) ? Intention is how to improve control.

Kelly O’Rear
Medical Software Consultant
Stripping this discussion down to the basic question, what is it going to take to get the healthcare sector out of ‘dinosaur times’? (Not trying to turn this into a political discussion!)

Zeljko Roncevic
M.D., Ph.D. Pediatric Cardiologist, Professor of Pediatrics
It’s clear that the new generation of cell phones will play a much bigger role in Health industry than now. Mobile phones have a good potential in telemedicine, preventive care, fast control of patients with chronical diseases, better communication with patients and health providers. Everything is nice on the first sight but there is a lot of legal and ethical problems as I wrote in my comment to “The death of the stethoscope” article on LinkedIn. There is a danger of populistic approach to health care. The concept that everybody can do everything is danger because it introduce amateurism in an expert zone. What about evidence based use of costumer-oriented devices? What FDA thinks about this kind of devices or it will be uncontrolled field with potential fatalities ? Who will be responsible?

John Strupat
President, JST Limited
@Shannon – Well, there is that old joke about putting all the medical product liability lawyers in a big boat and then….

I see a clash of the cowboy culture of software developers from the consumer world (think cell phone apps) vs. the anal, fussy types who write tedious software development protocols where life is on the line (think nuclear power plants, aircraft, military systems).
Three factors that illustrate the wide gulf between them:

1. Requirement for a formal software development procedure that demands treating medical software as either a stand-alone medical product or as an integral part of a medical device. Endless V&V and stress testing. Obvious legal implications for any software involved in the diagnosis or treatment of a patient, including drug delivery, as in product recalls and other expensive fun. FDA is involved in this, of course.

2. The need to use an operating system qualified to an international standard for appropriate use in a medical device.

3. Formal risk analysis and hazard analysis of the implications for all imaginable software/hardware combo defects, especially with wireless communication, of signal loss, dropout, hardware reset, etc.

What does 30 seconds of signal loss mean to a wireless system transferring ECG signals to a monitoring station? I’m thinking it depends on exactly what is supposed to happen when the ECG signal stops, but that point of view may be different with the patient, the health care provider, the company involved in the system, and the legal folks who await the appearance of new technologies and new problems to resolve in court.

Likely some other medical sector issues involve turf wars between various health providers, concerns about confidentiality of data, ownership of a patient’s data and storage retrieval of same, plus who is going to pay, etc..

Issues with biophysical sensors are an order of magnitude more complex than software and wireless communication. I would appreciate seeing a clinical use contactless ECG sensor that can match a 25 cent paste electrode on a wire, after more than 30 years in development?
Each new concept in medical technology is held up for comparison against the existing standard of care by the FDA. Tough to defend the new design if it cannot match the old stuff, particularly with reliability, even with huge improvement in convenience.

Perhaps other issues can be seen by looking at an ongoing post in this group where physicians and medical device folks are debating the replacement of the basic stethoscope with an electronic version. Strong support is there to keep the 1920’s design as it is since that darn electronic stuff is just too complicated, and probably doesn’t work either!

Shannon Prather
Marketing Cultivator at Geographic Information Services, Inc. (GISinc)
What do you guys think it would take to get the “software sector in healthcare” out of the dark ages?

Bruce Grayson
Strategic Business Development – Enterprise and Mobile Software – Clinical Applications and Medical Devices
I think the frustration in the software sector is that healthcare is stuck in the past and has traditionally spent much less on “support” items like IT and Software (and nursing staff!) but will pay for critical care items and direct patient support such as IV pumps CT/MRI/US scanners, dialysis systems. Software companies see little profit in this sector. Not surprising when many small facilities hover close to bankruptcy. New laws and money are helping – but device manufactures look to insurance and clinical funding for real dollars.
This is not true for the embedded software developers, however they traditionally are not looking outside the device and large scale initiatives like Continua ([http://www.continuaalliance.org|leo://plh/http%3A*3*3www%2Econtinuaalliance%2Eorg/mPnq?_t=tracking_disc]) are helping to create the ecosystems to interconnect. Look here for some near term ideas for new devices.
Bruce

Mervi Hamalainen
Smart city governance and ecosystems, Disruptive technologies, Business Models and Stakeholder relations
The problem or positive challenge is that sw industry has not yet realized that huge market potential that exists in health care sector. Health sector is still living in a dinosaurs time. There is not enough communication between these two industries.’

Kelly O’Rear
Medical Software Consultant
Just today I read headlines about a British company who developed sensors that can be embedded in a car seat to measure a driver’s ECG while they drive. Every day I read about cutting edge mobile technology being developed in the healthcare field. My question is: what will we actually see come to market? The possibilities seem endless….but when reality sets in, what are we going to see available in 1 year? 5 years?

Shannon Prather
Marketing Cultivator at Geographic Information Services, Inc. (GISinc)
Do any of you think future devices will get even smaller? More compact sensors?

I’d like to see some of these mobile devices have improvements in durability. Glass fronts are just too fragile for some workplaces (e.g., working around autistic or severely OCD patients).

Bruce Grayson
Strategic Business Development – Enterprise and Mobile Software – Clinical Applications and Medical Devices
The next generation of mobile devices will be born of the massive reduction in cost arising from the smart phone/ tablet commercialization. We have costs dropping for touch interface, display, camera sensors, programmable radios (cellular, WiFi, Bluetooth) and GPS.
Look to the new med devices incorporating those into a whole body network of connected devices. Link those together with nano sensors and you will have remote monitoring of cardio, blood chemistry, and respiratory function. With near field connectivity now added to products like the Android Nexus family, walking into a room will trigger monitoring and diagnostic testing that will download to a central application for immediate screening or later reference. Cloud based systems are managing our identities to keep the data safe and available to the right clinicians.
Challenges are being faced by device manufactures today as the network becomes the device, and testing complexities abound. But these challenges will be universal and managed better over time as the computing power is pushed out to the edge of the network. Bruce

Alfredo Carrero, PMP, SSGB
Sr. Mobility Technical Consultant
Add to that the growing number of accessories that can be paired or linked up to mobile phones to collect biometric data. As these types of sensors continue to advance and become smaller in size, it is only reasonable to assume their integration in mobile devices including mobile phones.