• Robots
  • 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.

  • How will Google's robots help healthcare?

    What’s the difference between a Google executive and the Star Trek crew? “Star Trek characters never go shopping” said Douglas Coupland, the Canadian novelist. Google’s been on a massive shopping spree and buying robots by the tonne.

    The Guardian, a UK broadsheet, says Google’s bought Boston Dynamics, Nest Labs, DeepMind, Bot & Dolly, Meka Robotics, Holomni, Redwood Robotics, Schaft and DNNresearch. It must have a massive shopping basket and a credit card limit to match. What can healthcare expect to gain from it?

    Robotics already play a major role in clinical work, such as surgery and imaging. The Da Vinci Surgical Robot is a well-established example.  But healthcare depends on a wide range of activities. It’s not beyond sci-fi to imagine robots with hospital cleaning roles, providing some catering services, some portering services and helping patients in their homes. They could help with some hospital engineering tasks. They already manage and dispense drugs in pharmacies, so smaller versions could do it on hospital wards. Health Robotics is a large supplier of intra-venous medication preparation, compounding, and dispensing.

    Paro is more like a cuddly harp seal with a diurnal rhythm, but it’s an advanced interactive therapeutic robot developed by Japan’s National Institute of Advanced Industrial Science and Technology (AIST).  He, she or it, provides patients with proven animal therapy benefits in hospitals and extended care facilities. It could do this in patients’ homes too. It’s claimed that Paro has:

    Helped to reduce patients’ and carers’ stress Stimulated interaction between patients and carers Improved patients relaxation and motivation Improved the patients’ socialiasation with each other and with their carers A Guinness World Records’ certificate saying it’s World’s Most Therapeutic Robot.

    Paro is the eighth generation of a design used in Japan and throughout Europe since 2003, so not exactly sci-fi.

    It’s not difficult to envisage the benefits of an expanded role for robots in healthcare. There are costs too. Robots need regulation, especially for health and safety. They can contain information about patients, so need to comply with eHealth regulations for topics such as privacy, confidentiality, informatics, cyber-security, standards and information sharing. These are not insurmountable tasks.

    With the immense demand for healthcare in Africa and the mismatched supply of health workers, robots may have an important contribution. Affordability is always a constraint, so any take-up will be gradual. One thing that distinguishes robots from the Star Trek crew is that robots can go shopping, which could be handy for home care.

  • Robots can be health workers

    Why is Google buying robotics firms? Apart from the obvious answer, to make money, there is a considerable market potential in healthcare that it can contribute too. Robots as surgical devices is well known, and can continue to expand as a market that benefits patients and new clinical techniques, but there are many other uses too.

    Best Thinking Computers & Technology is an online information service dealing with, unsurprisingly, computers and technology. It’s Artificial Intelligence site sets out a range of uses of robots in healthcare.

    If Google can see the opportunities, it is important that African countries consider a section in their eHealth and technology strategies that supports plans for an increasing role for robots as part of healthcare and related services such as disaster recovery. The potential needs rigorous assessment in order to realize the full, affordable potential.