• Robots
  • Robots could be good for your health

    In his book The Rise of the Robots, published by One World, Martin Ford proposes social and economic scenarios for robots that are good for output, but not so good for people. He sees significant upheaval and displacement from employment across a wide range of commercial and industrial activities and across middle and low income families. The drop in income, so spending power, will degrade economies.

    Simultaneously, robots aren’t paid and don’t spend money. He sees this as exacerbating the social and economic impact.

    Healthcare’s the activity that’s different. He sees the robots marching into healthcare that’s already over-stretched as needs and demands continuously outstrip supply. Four roles are crucial:

    Artificial intelligence in medicineHospital and pharmacy roboticsRobots that care for the elderlyUnleashing the power of data. 

    For low and middle income countries and health systems, sustained investment in robots could be part of the solution. They can improve healthcare professionals’ productivity and help to meet demand.

    They should find a place in Africa’s eHealth strategies. Small scale investment will lay out a trajectory for the future.

  • Robotic surgery is revolutionising prostate care

    Robotic surgery is a remote-control operation. Movements of a surgeon are translated through the tiny robotic arms of a machine.  The surgeon is often not in the same room and can even be on a different continent.

    Surgeons and patients are thrilled with the results.  Specifically, in prostate surgery, the Da Vinci robotic surgical machine has been used successfully in the UK and Africa countries to perform over 10,000 surgeries in men with prostate cancer, with marked improvements. Procedures are quicker, safer, and with fewer side effects than conventional open surgery or laparoscopic radical prostatectomy.  A review of 104 studies covering 230,000 patients confirmed it.

    Robotic surgery demonstrated superiority in:

    Operative timeLength of hospital staysBlood lossTransfusions requiredRate of post-operative erectile dysfunction and incontinenceLong term cost, due to the quick recovery timePositive surgical margin (PSM), which indicate whether the entire extent of the cancer was extracted during the operation. 

    The review is in line with other research on robotic surgery, which shows improved erectile function and reduced urinary continence compared to open surgery.

    South Africa has seen an increasing uptake of the robotic procedure since it was first implemented at the Urology Hospital in Pretoria in 2013. It is now more widely available.

    Doctors and patients benefit from these types of innovations. Long term net cost-benefits are likely too. The challenge for our health systems is how to find space for these, alongside other healthcare challenges, in ways that are affordable and sustainable.

    Watch a You Tube video about it here.

  • Robot Tug to help nurses in hospitals

    The field of robotics is making great leaps in healthcare today.  Take for example, Tug, the robot nurse. The aim of this robot is to improve patient care in hospitals by doing the mundane tasks like hauling food, linens, specimens and medications around the facility. This enables the healthcare workers to focus on other relevant duties and patient care.

    Appearance wise, Tug does not look like a typical humanoid robot. Instead, it looks like an oven that has wheels.  Staff begin the day by uploading activities that they would like Tug to do and then it wheels itself around the hospital performing those duties. It is programmed in such a way that employees can change the order of the tasks based on urgency.

    Tug navigates a facility using dozens of lasers therefore it is able to make quick decisions such as stopping when a person is in the way. It can carry up to 1,000 pounds on its back which can also be swapped with different models to meet other needs besides medical deliveries and food.

    This is a great use case for the overburdened, understaffed hospitals in Africa – a robot to aid nurses and health workers with their daily activities.  Will we being seeing Tug in African hospitals soon?

  • Will robots be cooking on gas in hospital kitchens?

    Inpatients need nutritious meals as part of their care plans. This puts hospital catering services as an important part of healthcare teams. While robots in clinical activity have received considerable attention, their opportunities in hospital catering hasn’t. Flippy might change that.

    A report  in Tech Crunch says Miso Robotics is rolling out a robotic kitchen assistant. It’s called Flippy. It’s first job’s flipping burgers. Already, it’s a bit of a celebrity, with a YouTube and Vimeo performances. 

    While burgers may not be the ideal meal for inpatients, Cali Burger makes and sells burgers in twelve countries and found Flippy its first job. It doesn’t look like a chef.

    It’s a small, wheeled cart with a six-axis robotic arm and  a sensor bar. It takes data from thermal sensors, 3D sensors and several cameras to assess its environment. Digital systems send tickets from the counter to the kitchen as Flippy’s orders.

    Then, it picks up unwrapped burgers, puts onto a hot grill, tracks their cooking time and temperature, then alerts chefs when to apply cheese or other toppings. When that’s done, Flippy plates the burgers.

     but doesn’t wrap them or add finishing touches like lettuce, tomatoes, avocado or a restaurant’s signature sauce.

    Momentum Machines makes kitchen robots too. Flippy’s different. It relies on  AI software and machine learning, so it learns to make new foods, adapting to a restaurant’s seasonal menu changes. This might be the potential for Flippy’s descendants to take on more sophisticated jobs in hospital kitchens. Let’s hope they’re not wayward offspring called Floppy.

  • IBM Watson supports better care plans

    Horizons provoke considerable sentimentality and concepts.  Pankaj Patel, an Indian businessman and chairman of Cadila Healthcare urged people “Dwell on possibilities to open up your horizon.”

    It seems that IBM Watson aims to help too. Its Whitepaper. Population health management beyond the EHR:Part 2 unsurprisingly builds from Part 1 that EHRs are necessary but not sufficient. It proposes a care collaboration platform based on a data lake to which all care team members contribute.

    Cognitive computing ‘s the means to achieve it, combining parallel processing with augmented intelligence. It structures unstructured data, enabling fast searches of medical literature, finding connections and patterns among myriad data types and enables computers to learn. These can be used to:

    Identify real outcomes from similar patientsEnable clinicians to make informed decisions about diagnosis and treatmentUtilise data on social determinants of health and genetic and environmental factors that influence healthProduce personalised clinical guidelines, so patients’ personalised care plans are more effectiveImprove clinical decision support over time.

    Central data registries can be expanded to include many elements not typically available through clinical and claims data alone. Extra content be added from care managers and community health workers whose pertinent patient observations might not be able to be document in EHRs.

    This wider range of data can be used for better:

    Performance management with retrospective concurrent, and predictive analytics applied to new payment and delivery modelsRisk identification and mitigation of stratified populations into cohortsOperational processes.

    Personalised care’s the core goals. Achieving it needs more than IBM Watson. Clinical eHealth leadership’s vital too. Warren Bennis, founding chairman of The Leadership Institute at the University of Southern California has a concept to achieve this. “The manager has his eye on the bottom line; the leader has his eye on the horizon.” Which eHealth horizon?

  • How can bad robots be kept out?

    Automation’s steadily progressing across healthcare. It relies on AI and robotics, but not all robots are up to the job. Keeping bad bots at bay’s vital. An eBook from Quocirca sets out a way to do it, leaving the way clear for good bots to help in a range of services. Examples are admin bots that can make appointments, help to access clinical records, answer billing queries and process payments. Chat bots can deal with routine ailments, freeing healthcare professionals to deal with more complex patients. AI’s the driver behind these changes.

    Four types of bad bot activity’s:

    Stealing personal informationCredit care fraudHealthcare insurance fraudBribery and extortion. 

    The OWASP Foundation, a global not-for-profit charitable organisation aiming to improve security of software, runs the Open Web Application Security Project that combats bad bots. Its Automated Threat Handbook lists criminals’ 20 most common activities that use bots. It also publishes its Top 10

    Most Critical Web Application Security Risks, the latest for 2017 are:

    InjectionBroken authenticationSensitive data exposureXML external entities (XXE)Broken access controlSecurity misconfigurationMissing function level access controlCross-Site Scripting (XSS)Cross-Site Request Forgery (CSRF)Insecure DeserialisationUsing components with known vulnerabilitiesInsufficient logging and monitoring. 

    Developers can introduce these vulnerabilities in their software code, making it easy for bots to find, then mimic human behaviour to achieve illicit access. Three traditional ways to mitigate their threat and enable good bots to succeed are: 

    Firewall rules can be changed to block source IP addresses used by cyber-criminals’ bots, but they regularly change IP addresses, can’t deal with previously unknown bots and may block legitimate usersWeb Application Firewalls (WAFs) protect web applications by exploiting common software vulnerabilities, but apart from vulnerability scanners, most bad bots don’t target vulnerabilities, they mimic real users, so WAFs can’t stop themCompletely Automated Public Turing tell Computers and Humans Apart (CAPTCHA), are-you-human tests can work can, annoy some users, but some bad bots can bypass themGeofencing can limit access to websites and apps to users from specified locations, but cyber-criminals can move their location using VPN links to a local Point of Presence (PoP)Direct Bot Detection (DBB) tools and mitigation can distinguish bots from humans and classify them in real time using behavioural analysis and digital fingerprinting, and across several organisations, can improve their understanding of bad-bots through machine learning, identifying bots, determining their provenance and deciding if their activity should be allowed, controlled or blocked. 

    Quocirca says all 20 of the bot types identified by OWASP can be managed using DBB and unwanted activity curtailed. DBB tools aren’t an alternative to the other measures. They can be integrated with other network protection technologies such as WAFs, Intrusion Prevention Systems (IPS) and Security Information and Event Management (SIEM). 

    Adopting the increasing range of cyber-security measures is essential for Africa’s eHealth. Keeping up with trends is too, and links with OWASP can help. Individual membership’s US$50 a year, US$95 for two years and US$500 for lifetime. Corporate membership starts at US$5,000.

  • eHealth Group offers a telehealth paradigm shift

    About a third of African countries invest in telehealth, identified by the WHO and Global Observatory for eHealth in their 2015 survey. Since then, eHealth Group, based in South Africa, has leapfrogged telehealth’s technology and its supply side. 

    Its lineage goes back to the Da Vinci Robotic Surgery. This enabled eHealth Group to incorporate the ideas, principles and techniques into its robotic telehealth services. Instead of a link between a patient and a healthcare professional, eHealth Group’s robots and products enable healthcare professionals to deal directly and easily with several patients in wards, ICUs and communities.

    At its core are:

    Direct access to a wide range of clinical data about patientsExplicit, precise and clear images of patientsIts own excellent, global telecommunication network. An example is where doctors can have two screens.

    The picture shows a doctor accessing a patient’s view and PACS side by side. It’s an efficient and effective use of his time and benefits patients directly.

    South Africa’s eHealth Group provides services across Africa. It’s part of a global network, operating in over 30 countries, across 20 specialties in over a thousand hospitals and over 4,000 medical specialists available online. About 70% of US telestroke hospitals in the USA use eHealth Group’s services, up from 30% four years ago. 

    There’s a wide product range extending from tablets to sophisticated robots that provide high quality telehealth. Alongside the products, eHealth Group provides a service range including access to advice from a network of medical specialists, specialists who can provide direct patient care, and training. 

    Elliot Sack and some of his robots from eHealth Group will be at eHealthAfro 2017 on 2 to 4 October in Johannesburg. His presentation will reveal the paradigm shift that can make a difference to Africa’s health and healthcare. eHNA has more to report on it.

  • A real fantastic voyage for robotics

    In 1966, the film Fantastic Voyage had miniaturised people in a miniaturised submarine sailing round the body of a full-sized scientist to fix his injured brain. Real life’s done it, but the film exaggerated the need for tiny people to be part of the journey. A team from Massachusetts Institute of Technology (MIT) has shown that a robot can do it without them.

    To be more precise, it’s a miniature printable origami robot. At the 2016 International Conference on Robotics and Automation (ICRA) in Stockholm, Daniela Rus and Shuhei Miyashita from the MIT research team presented their prototypes.

    The robot has a short life. Prototypes are made from materials that are soluble in liquids. After its tiny sheets of material are injected into a human body, it navigates to the required intervention site, folds up, and when it’s finished its job, dissolves. A magnetic field’s used to steer the robot to its required site in a body. In clinical use, it may rely on ultrasound and Magnetic Resonance Imaging (RMI).

     

    There’s more than one type. Another prototype has electrically conductive outer layers. The conductive robot can be a tiny sensor. Contact with other objects, such as microorganisms or cells in the body, disrupt a current passing through the robot that can generate an electrical signal to human operators. 

    It seems these robots haven’t reached their miniaturisation limits yet. By the time this robots in routine use, even smaller descendants will be on the way.

    Unlike the film’s submarine crew who intervened in clinical work, MIT’s robots will remove foreign bodies from human bodies. Examples are cells in batteries that children accidently swallow. The robots can replace the surgical procedures needed now. Beyond this, the potential for extensive clinical activities across many conditions seems extremely broad. 

    Leopold Kohr, the Austrian who inspired the small is beautiful movement, would’ve been delighted with this initiative. He saw himself as a philosophical anarchist. It seems that technology’s now ahead of his game.

  • Are robots better than people?

    eHNA posted recently about robots marching on, assuming that robots can march and it’s not just an advertising ploy. While robots may have their origins in science fiction interstellar space travel, an initiative in the USA harks back to their fictitious beginning. Science Translational Medicine has a report on the Smart Tissue Autonomous Robot (STAR) developed by a team from the Sheikh Zayed Institute for Pediatric Surgical Innovation (SZI) and Johns Hopkins University (JHU).

     

    STAR was used to complete complex surgical tasks on deformable soft tissue, such as suturing and intestinal anastomosis, a surgical connection between two structures. The project compared metrics of anastomosis, including the consistency of suturing informed by average suture spacing. The findings are clear. Supervised autonomous procedures, robotics, are “superior to surgery performed by expert surgeons and RAS techniques in ex vivo porcine tissues and in living pigs”. The results show the “Potential for autonomous robots to improve the efficacy, consistency, functional outcome, and accessibility of surgical techniques.”

    Supervision means that robots aren’t left to it. They don’t replace surgeons. They’re surgeons clinical tools.

  • Robots are on the march in medicine

    Robotics’ history in medicine’s been attributed to two different events. One version’s laparoscopic surgery beginning in 1987. Another view of its origins’ the first bionic arm available in 1998, the Edinburgh Modular Arm System. Whichever it is, robots are on the march, and they’ll keep going.

    Prof Guanf-Zhong Yang, an engineer and founder and director of the Hamlyn Centre for Robotic Surgery at Imperial College, London, presented his achievements at the Royal Society of Medicine’s 12th Innovation Summit in April. The Centre, linked to the UK’s Engineering and Physical Sciences Research Council (EPSRC) is the home of the £4m Micro-Machining Facility for Medical Robotics, a production line to develop future generations of miniaturised medical devices and robots.

    The facility’s goal’s to develop miniaturised surgical robotics to improve diagnosis of diseases and conditions, drug therapies, surveillance and minimally invasive procedures targeting smaller lesions. Advances in rapid prototyping technologies, micro-fabrication, micro-machining processes and materials compatible with human bodies means that advanced surgical tools and smart implants will be delivering targeted therapies with micro-instruments with integrated sensing and imaging technology. 

    Some robots need new manual surgical skills. Prof Guang-Zhong Yang likened these to eating a Chinese meal with a chop-stick in each hand and watching your meal on the TV screen in the corner of the room.

    Anxieties about medical robots replacing doctors are misplaced. Instead, robots will enhance doctors’ skills and precision and consistency. While some medical robots may currently be large, miniaturisation is a generic part of medical robotic development. He envisioned a mid-term future where existing tools, such as scalpels, will incorporate robotic technologies.

    Robot derives from the Czech word robota, meaning forced labour. It was first used in K. ÄŒapek's 1920 science fiction play Rossum's Universal Robots. Young Rossum turned out robots, more like cyborgs, on an industrial scale and reduced the production costs of good by about 20%. Subsequently, Rossum’s robots revolted, resulting in the demise of the human race. Luckily for us, Prof Guang-Zhong Yang and his colleagues at the Hamlyn Centre are working on smaller, benign versions with positive outcomes.