Discussing the future in healthcare innovation : telehealth, robotics, diagnostics & devices, wearables and behavioral health.
Pondering on the convergence of industries remodeling conventional corporate thinking leading to innovation beyond.
- Improving patient outcome with hammers and nails ? September 11, 2017
At some point, healthcare has to be delivered to the patient. Ok, preventative healthcare and a healthy lifestyle do not require you to physically meet with your physician, but e.g. surgery still does. So we still need hospital buildings. Hence, buildings themselves are an integral part of the healthcare ecosystem and as such, contribute just as much to patient outcome as does the procedure performed on the patient. Welcome to the great world of healthcare architecture.
It is a recognized fact that a patient’s overall wellbeing significantly contributes to his/her faster recovery. Hence patient-centric designs for hospitals, making them look and feel more like hotels than the traditional neon-light, bleach-white cubic edifice. This is not a new idea, as exemplified by the Architecture of an Asylum exhibition at Washington’s National Building Museum. But healthcare architecture is much more than just nice designs. It addresses many of the challenges that healthcare faces. Evidence-based design is now used by architects and engineers, helping them take into account even the smallest details such as replacing metal handles by wooden ones, the former oftentimes aggravating the neuropathic hands of patients undergoing chemotherapy
Infection control and prevention in hospital settings is a major concern, especially given the increase in multidrug-resistant organisms. The fight against infectious pathogens in hospitals from the architectural angle is precisely what Wolfgang Sunder, in charge of the KARMIN project at InfectControl2020, is doing: “When it comes to the structural level, one specific issue is what a room needs to look like to counteract the spread of pathogens: what size should it be? Does it require specific building equipment and ventilation technology? What materials do we need to use? How can surfaces be cleaned and disinfected? These are some of the questions we need to ask, which is also why we see an urgent need for research in this area.”
Achieving a patient-centric environment is one thing. This must however not be done at the expense of caregivers’ workplace ergonomy. In other words, a hospital needs to remain functional for the nursing staff. Far from being a balancing act only achievable through compromises on both sides, innovative solutions can be implemented that will answer to everyone’s needs and even go beyond. Mehrdad Yazdani, design director of CannonDesign’s Yazdani Studio, created sculptural headwalls for patients’ rooms, behind which medical equipment can be hidden from the patient. As a bonus, these removable panels allow hospitals to easily upgrade their equipment as technology evolves.
Another such many-problem-solving-at-once example is AIA COTE Top Ten award winning NTFGH hospital, in Singapore. Through its use of natural ventilation and passive cooling, patients have their own operable window, providing them with sunlight and a view. In addition of being more energy efficient than mechanical air conditioning, it saves water, since no cooling towers are required, making the hospital a greener corporate citizen who abides by many of the seven elements of a climate friendly hospital, as edicted by the WHO.
Healthcare architecture extends well beyond the science and technology required to achieve better patient outcome. It also takes into account the social fabric of the community in which the hospital is established and to which healthcare services are dispensed. Karratha Healthcare Center, in Australia, was designed from the start with these considerations in mind : “Our briefing and design responded to the cultural values of Indigenous clients [and] the understanding of cultural traditions for privacy” says Coda, the firm commissioned as the project lead, in a design statement. Neighbourcare Health, in Seattle, WA, which won an AIA Healthcare Design Award, offers spaces to neighbourghood groups after hours. Its patios can double as consulting spaces for mental health homeless patients and the driveway is wide enough to provide space for farmers markets.
This brief account all but scratches the surface of what architecture can contribute to healthcare. For one, we focused on hospitals. Healthcare architectural concepts obviously apply to medical clinics, retirement homes, research labs and even private homes as well. And if we were to ask health authorities, they would certainly say everything we build should be designed with healthcare in mind, since everything we build has an impact on public health e.g. air quality in buildings, fire hazards in high-rises, etc.
The integration of architecture and healthcare begins way before the groundbreaking ceremony and even before the first sketches of the design firm. It is a way of thinking that starts with education. This is the philosophy driving the merger between Thomas Jefferson University, with its roots in medicine, and Philadelphia University, with its roots in arts, business and engineering, from which graduates will emerge with a symbiotic knowledge between healthcare and architecture.
To get an idea of some of the best healthcare architecture projects, take a look at Contract magazine’s Healthcare Environment Awards, AIA/AAH Healthcare Design Awards, or World Interior of the Year Awards shortlist, which is this year dominated by China, including the Health&Education category.
As always, comments, questions, feedback are welcome.
- Skip the hospital and get a 4D-bioprinter ! February 14, 2017
3D printing is often referred to by the term additive manufacturing, because of the way objects are printed (layer by layer). The term rapid prototyping is also used since, as the name says, it is a means of quickly producing a three-dimensional object. Invented in the 1980s and originally called stereolithograpy, the ever expanding field of 3D printing offers much more than just a way of rapidely achieving three-dimensional mock-ups. As it applies to life science, 3D bioprinting is the process of creating complex structures that mimic original tissues and organs using 3D-printing technologies, where cell function and viability are preserved within the printed construct.
In its simplest (and earliest) health care applications, 3D printers make three-dimensional models of organs to be used before and during surgeries, for planning and execution. Prosthetics can also be 3D-printed, allowing customization much more easily. An English firm is even offering a 3D-printed wheelchair, which it says can be taylored to fit the individual needs of a wide range of disabilities and lifestyles.
Another very promising area of application is personalized pharmacy, where pills are 3D-printed to the specifications of the patient’s pharmacist like e.g. drug release profile, dosage, even color and geometry. Errors in medication accounting for thousands of deaths each year in the US alone, such a way of producing patient-specific medication has the potential of significantly reduding this number.
All those applications, as useful and interesting as they are, are not bioprinting per se, since none involve the production of biological contructs. Bioprinting has its own specific challenges. To name but a few, printing devices and methodologies have to take into account the sensitivity of living cells, the biomaterial being printed (the bioink) has to first be available in a printable state―obviously. Regulatory issues need also be addressed. These additional complexities can and are being overcome, and are offset by the immense advantages 3D-bioprinting promises.
Clinical trials and drug testing can be long, complicated and costly processes. Using 3D-printed human or human-like tissues can greatly simplify these endeavors. No (or less) cultural or ethical issues are involved, and no subjects need be recruited to undergo studies
Body implants, made of foreign material, can be toxic and cause rejection, whereas 3D-bioprinting provides organic implants which, as with 3D-printed prosthetics, can be shaped individually and with precision, based on MRI and CT scans images.
Regenerative medicine is another obvious area of application. Rejection rates are lower and success of surgery is higher when tissue built from the patient’s cells himself are used to 3D-bioprint the implanted tissue. Together with the lower cost of 3D-printing the tissue itself, the overall cost to the healthcare system can be greatly reduced. Skin, bone, cartilage, teeth, even complete organs like a heart can be 3D-printed. Yet another advantage is that the possibility of “manufacturing” tissues and organs helps alleviate the difficulty of finding compatible donors for transplants. 22 people die each day while waiting for a transplant in the US.
As very briefly described, 3D-bioprinting promises to disrupt health care in many and yet unknown ways. But the next step is already being taken : 4D-bioprinting, where the 4th dimension is transformation. It is the 3D-printing of smart, stimuli-responsive biomaterials to create constructs that emulate the dynamics processes of biological tissues and organs. Imagine for instance that, instead of having to 3D-print a skin graft for a burn victim, with all the entailed complexity, you could 4D-print a basic skin graft that would, once implanted on the patient, vascularize itself, develop all nerve endings, take on the patients complexion, and even grow hair if on the head ? In a way, 4D-bioprinting is to medicine what AI is to computer science.
Are we on our way to making 4D-bioprinting synonymous with procreation ?
As always, comments, questions, feedback are welcome.
- Taking the measure of made-to-measure medicine March 24, 2016
Pharmacogenomics, pharmacogenetics, precision medicine, personalized medicine : terms often used interchangeably to talk about the tailoring of treatment to individual patients based on their uniqueness. Actually, pharmacogenomics/genetics uses the genetic profile of the patient whereas precision/personalized medicine looks at other probable causes as well, such as environmental factors, lifestyle behavior, physiology, epigenetic data, the microbiota.
The idea of precision medicine is that different individuals are subject to different diseases and react differently to medical treatments. Hence, each person should adopt a different lifestyle in order to prevent illness and should get tailored treatments should they become sick.
Part of the challenge resides in the amount data that need be first collected and then processed, in order to achieve meaningful and efficient tailoring of medical treatment. The genome of a single individual has 3 billion base pairs and 20K genes; its microbiota consists of more microorganisms than it has human cells; environmental factors, lifestyle behaviors and the like are virtually unlimited. In short, pertinent data can rapidly grow to astronomical proportions. And the rate at which data is produced will soon outweigh the rate of progress in computing and big data technology. Moreover, this data needs to be exchanged amongst healthcare practitioners, and it needs to do so securely.
Another part of the challenge is the science itself. On the genetic front, there still exists significant gaps in the sequencing of the human genome, and only a low fraction of known disease causing genes lie in high confidence regions i.e. “easily sequencable” chromosome regions. And on the mental illness side of the story, so little is known about brain functions that even a fully decode genome would be of little help.
Even as a means of prevention, pharmacogenomics has work to do : research shows that even when informed about genetic predisposition to disease, people a not likely to modify their health behavior.
In cases for which precision medicine does work, it remains a high-tech, expensive business. To the point that it is advocated by some that it is not worth it. Obviously, this is not the dominating opinion: President Obama recently celebrated the first year of his Precision Medicine Initiative, and Roche is investing up to $1B in a precision medicine company, to name a few examples.
On a lighter note, if precision medicine turn out not to deliver on its promises, it will at least be useful for singles to find love, as GenePartner.com claims. And once you found your match, Orion Health will tell you if he or she will be faithful to you.
As always, comments, questions, feedback are welcome.
- When virtual realities reshape patient realities ! February 16, 2016
Virtual reality (VR) is becoming mainstream. This year was coined “year of the VR” at CES. VR headsets are now available at your local electronics store. Although it has been used for healthcare purposes for many years, use of VR in healthcare still cannot be qualified as generalized or widespread. However, VR is rapidly expanding into the healthcare realm and, according to a recent Global Industry Analysts report, the global VR healthcare market will be reaching US$ 3.8 billion by 2020.
Currently, a main focus of VR applications in healthcare is in the treatment of fear related disorders such as Dr. Cornelius Gross, deputy head of EMBL Monterotondo, explained in a 2014 EMBL Insight Lecture, it is easier to recognize and compare fear than it is other emotions.
Indeed, VR provide safe, private, controllable environments for exposure therapy, on the most efficient methods for treating phobias. Since, by definition, VR environments are fully controllable (as opposed to exposure in the “real” world) it provides a secure set up for the patient undergoing treatment that can be customized to his or her specific needs with a few mouse clicks, and is private i.e. keeps the patient’s treatment confidential. Another important advantage of VR is that, exposure therapy requiring repeated sessions, it is more cost effective than in vivo exposure therapy.
Augmented reality (AR), a more cost effective version of VR, and can oftentimes be just as effective as VR. In AR, the subject is put in a real world environment, but aided with an AR device such as the Google Glass. In some cases, AR is even the better solution over VR.
VR is also used for training purposes. Just as for patient treatment, VR provides a safe, controllable environment in which healthcare professionals can learn and practice skills for which it would be difficult or even dangerous to do so in vivo: who would want to be a heart surgeon’s first patient ?
Other areas where VR is used include pain management, treatment of PTSD, phantom limb pain, brain injury assessment and rehab, social cognition training and more.
In many instances where VR is used, the brain is the source of the problem being treated. VR and other cognitive behavioral therapies offer efficient, non invasive diagnosis and treatment possibilities, the full potential of which is far having been reached.
Other promising methods of treating phobias, for example, include optogenetics, whereby a simple beam of light is used to selectively and very precisely activate or deactivate the neurons implicated in triggering the phobia, as demonstrated in mice by Pr. Christine Denny, at Columbia University Medical Center. But this is another subject.
As always, comments, questions, feedback are welcome.
- Gamification in healthcare January 19, 2016
Simply put, gamification is the integration of game principles and mechanics into a non-game experience in order to engage people to reach goals. In other words, the goal of gamification is not to make things fun. The goal is to create motivation, to incentivize, to engage people so that they are more likely to reach the set goal. So making things fun is not the end game (no pun intended) but a means to that end. Most commonly, the game elements used in gamification include levels, altruism, leaderboards, badges, points and some form of competition.
A simple and widely used gamification technique is quizzes or trivias. We encounter them time and again in magazines, and we more often than not take those quizzes, which makes us read about a subject we would otherwise have ignored. Another such example is the nomination of the employee of the month in many organisations, in which the competition and reward aspects of gamification are being used. A more tech savvy implementation of gamification is Oral-B’s Bluetooth toothbrush.
In healthcare, gamification is used in various ways for a wide variety of purposes. Although it has been so for quite some time, recent developments in technology have spurred renewed interest for gamification in the healthcare world. Amongst the first to implement gamification in healthcare, insurance companies devised games to attract new, and retain existing customers. Gamification can be used to improve health at the individual level, as is the claim of the Jawbone UP and other such wearable devices, or can be implemented in such a way as to have a more global, large scale impact e.g. by optimizing work procedures in the healthcare workplace.
Gamification of healthcare is seeing rapid development in the three following areas : training healthcare practitioners, educating patients and treatment/therapy for patients.
Training and education have been successfully using gamification principles for some time. It raises the motivation and involvement level of participants attending the training session, as well as increases the retention of learned skills or knowledge, as exemplified by this study. By using electronic gaming and virtual reality techniques, an adaptive, flexible and risk-free environment can be created, hence providing a more receptive environment, to help healthcare professionals practice the theory learned.
Patient adherence to treatment is arguably the most difficult hurdle to overcome, both for patient and physician. This is especially true of long term treatment and even more so for the management of chronic illnesses, which in fact require permanent changes in patient behavior more than a finite treatment. In such cases, gamification is used to help educate the patient about his or her condition. And an educated patient is a more involved, hence a more persistent patient. As reported by Accenture: “Gaming applications and applications that use the principles of gaming encourage patients to engage with their health, whether for preventative or treatment-linked reasons, because they trade on well established principles of behavioral science.”
In many cases, gamification techniques lend themselves to being the treatment itself. The level of pain burn victims experience during wound care ranges from severe to excruciating. SnowWorld uses immersive virtual reality (VR) to help burn victims cope with pain. By drawing the patient into an artificial world, the mind is tricked in feeling less pain while the patient’s wound are being treated. Immersive VR is also used to help patient suffering from phobia. By immersing the patient in a controlled virtual environment, the patient can safely confront his or her phobia and over repeated session, overcome it.
As promising as gamification can be, many pitfalls are lurking. Designing a gamified application is not designing a game. The role of the application is to help the patient reach a goal, be it modify a certain behavior or something else. It is not to distract the patient from his or her illness.
Other challenges application designers have to address are the same as with regular game design : the natural desire to win could cause users to cheat, e.g. by exploiting loop holes in the application.
Information overload is also a problem that smartphone app designers are facing : despite the many apps available (over a billion apps on itunes and android), mobile users use on average only 3 apps. So the app designer has to capture and retain the attention of users.
There are challenges more specific to healthcare gamification. An ill-designed gamified application may cause the user to take decisions not in line with the goal to attain e.g. because the application is trivializing the condition of the patient (be it the reality or the perception of the patient), or as mentioned earlier, the desire to win shifts the focus away from the pursued goal. And because the goal in question is the health of a human being, the consequences can be serious.
Intelligent, efficient and successful gamification then, requires close collaboration between a wide range of professions (behavioral psychologists, physicians, engineers, etc.) to collectively develop engaging healthcare programs.
Trying to sum it up, gamification applied to healthcare is one of many ways to engage all stakeholders, leading to better patient outcome. Gamification techniques also help save costs, e.g.by using virtual reality. And achieving better patient outcome at a lower cost is a win-win situation. You can read further about this exciting topic at Training Industry, Time to Care and SearchHealthIT.
As always, comments, questions, feedback are welcome.