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.

  • Skip the hospital and get a 4D-bioprinter ! 14 février, 2017
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    bioprinting

    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 24 mars, 2016
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    Precision-medicine-1

     

    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.

    You can read further about precision medicine, its ethical implications, and market predictions .

    As always, comments, questions, feedback are welcome.

  • When virtual realities reshape patient realities ! 16 février, 2016
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    brain circuitry

    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.

    You can read further about how VR is used in training, treating phobias, or optogenetics.

    As always, comments, questions, feedback are welcome.

  • Gamification in healthcare 19 janvier, 2016
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    gamification3

    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.

  • Robotics in healthcare 22 décembre, 2015
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    healthcarerobotics1

    When we think of robots and robotics, the first thing that pops to mind is often a human look-alike machine. But robots take on far more diverse forms than the Terminator. By the way, a company named Cyberdyne really does exist. They are located in Japan and are mainly known for their HAL 5 powered exoskeleton !

    The word robot derives from the Czech word robota meaning work or chore, and first appeared in Czech writer Karel Čapek’s 1921 play R. U. R. (Rossum’s Universal Robots). A robot can be defined as a mechatronics device executing tasks which are repetitive, unsafe, difficult or impossible for a human or executing tasks better than a human. The term robotics was coined by Isaac Asimov in his 1942 short story Runaround, in which he also states his three laws of robotics.

    Whereas a robot is any machine corresponding to the definition given above, the term android designates a robot or synthetic organism having human-like shape and behavior, and the term cyborg designates a being part organic, part robot and applies to a pre-existing living organism having restored or enhanced capabilities. But this is all semantics, and with the accelerating rate of development in science and engineering, the line between them becomes more and more blurred.

    Currently in the healthcare domain, robots are predominantly used in three types of applications : patient monitoring/evaluation, medical supplies delivery, and assisting healthcare professionals in unique capacities. Collaborative robots.

    Doctors and healthcare professionals being very busy people, on the one hand, and patients often residing in remote locations or unable to travel to the hospital or clinic, on the other hand, robots are providing new and/or easier ways for physicians to interact with patients beyond the bedside. Anybots and InTouch market telehealth robots enabling doctors to remotely interact with their patients.

    For moving things, robots are the way to do. Be it on-demand requests, regularly scheduled deliveries, for bringing medications or food to patients or transporting large payloads, today’s robots can carry out these task efficiently. More details on this topic here.

    While most experts agree that we are still a long way from completely autonomous robots, collaborative robots, as opposed to a simple telemanipulator, are the next step in healthcare robotics. Robotics companies are developing general-purpose robots which OEM medtech companies in turn are using for medical applications as varied as hair transplant or bone osteotomy. Such robots include the KUKA LBR iiwa or Staübli’s robotic arms.

    Outside of the hospital, robots and robotics contribute a great deal to healthcare. They are a big part of laboratory automation in R&D facilities, and are used in pharmaceutical production plants. 3D printing robots are used to print prosthetics (doesn’t that sound like Cyberdyne – not the Japanese one?). New research is developing 3D bioprinting technologies, which promises to print living organs. In a more down-to-earth and broader vision, I would include such simple devices as robot vacuum cleaners. Indeed, keeping a salubrious environment is a direct contributing factor to health.

    New trends in robotics steer toward connected robots and cloud robots. This puts renewed emphasis on misbehaving robots. Such misbehavior could be the result of a faulty robot or, worse, could be intentional, as researchers at University of Washington demonstrated by easily hacking the Raven II surgical robot. A hacker hijacking the painting robots on the assembly line of a car manufacturer is one thing, but the same hacker hijacking my car while I’m driving or the surgical robot while I’m lying on the operating table is something else. To help tackle the challenges of safety and security in robotics, the Foundation for Responsible Robotics was created in the Netherlands earlier this year, with the goal to “To promote the responsible design, development, implementation, and policy of robots embedded in our society”.

     

    To learn more about robotics and healthcare, Robotics Trends and Robotics Business Review have resources dedicated to healthcare.

    As always, comments, questions, feedback are welcome.

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