Peter J Ogrodnik looks at the endless possibilities of technology in clinical practice
The fifth generation (5G) mobile network and satellite communications is about to take off in a big way; it will bring interconnectivity at a scale we would not have dreamed of just a few years ago. The older of us will remember when mobile phones ‘morphed’ from the city-slicker brick to a pocket-sized handset. Younger readers, probably, cannot imagine the transformation that mobile telephones brought to society. Touch screens, computing power, and now 5G and satellite communications, bring a combined ability to create change at a greater scale. 5G, for example, has the potential to transform the ability for devices to communicate with each other and with the wider world. For better or worse the technology we shall be discussing has been collected under the banner of “digital health”.
The global digital health market is predicted to be $379bn by 2024 ; the UK market alone is worth £3bn, and in late 2017 about 200 healthcare apps were added to the online catalogues every day . The NHS have embraced this technology and have developed their own digital health strategies  and NICE has created a framework for assessing the value of digital health solutions . It is, therefore, recognised that the opportunities for clinicians, healthcare providers, and patients alike could well be staggering: equally there are opportunities for orthopaedics- related industries to provide digital health solutions. Let us explore some of the up and coming technology that may change the face of orthopaedics in the future.
How is this technology going to change the landscape? In the past, sensors had to be connected to a monitoring device with wires. Modern wireless technology (such as Bluetooth and ZigBee) allow sensors to communicate locally to some form of proxy (a device that sits in between the sensor and the data storage device and acts a communications hub). However, 5G will allow sensors to communicate without the need of an intermediary. To imagine this change, think of your tablet or iPad: at present you probably connect to the internet, seamlessly, using a local wifi, or a SIM card; that is what is coming to sensors. In addition, this technology coincides with a dramatic acceleration in smartphone development. They now have computing power far exceeding that of the Apollo Saturn V  that went to the moon. The opportunity to have dedicated apps that can both view the sensor data but that can also do some analysis is wholly viable; and this leads into the term virtual clinic.
The phrase “virtual clinic” generally provokes a long discussion about the pros and cons of telephone and video consultations, or the value of a patient app that uses mood icons, or some form of “Q&A”. The onset of 5G, Internet of Things (IoT), and smart sensors means that a virtual clinic does not need to be considered as inferior. Instead the data provided for a virtual clinic should be as good as, or better, than the face-to-face clinic. However, there can be little doubt that modern communication systems are making “virtual” clinics a reality.
IoT has long been consigned to the world of smart fridges and doorbells and this has, unfortunately, demeaned its potential value. However, there are devices on the market in COPD and rehabilitation that have taken IoT to healthcare environs. Indeed, I have been working on remote monitoring of patients with tibial fractures for nearly 30 years and have physically been involved in the development of similar technologies. And most of these technologies have been waiting for this revolution in communicatons.
If all of these devices are, potentially, sending data to ‘the cloud’, the amount of data is going to be vast. We are not just talking about one patient, but thousands – maybe millions. Indeed the system could be analysing the data (using artificial intelligence) to provide predictions and alarms for both clinician and patient alike. Should the dataset be open access for researchers to mine, study and analyse? This is a very important consideration; and it could have a massive impact on the potential for the application of data mining tools and artificial intelligence to determine and design future treatments in orthopaedics.
The ability for clinicians to ‘monitor’ patients at home will not only release bed-days but will also increase data granulation. No longer will they have to wait for four to six weeks to see some results (i.e. between clinics); they could check up on a patient’s progress everyday, if so wished. Indeed, this increase in granulation and an ability for some “artificial advice” creates an opportunity for potential savings. For example, a simple release of the need for a patient to visit a clinic has major knock-on benefits. These benefits include: carers, family and friends not having to take days off to take patients to a clinic; clinical staff having more time to deal with patients that “need to be there”; an ensuing drop in traffic and a reduction in parking; and a large reduction in carbon footprint as a consequence. If one looks at remote monitoring holistically the potential benefits are far reaching.
This next generation of devices will be heavily dependent on software. If you go onto the Apple Store or Google Play app you will find thousands of healthcare apps. But, to give you an example of their fallibilities, recently I downloaded a hearing test app from a highly reputable provider. I could be deaf in one ear, deaf in the other or deaf in both just by deciding to pull my headphones off slightly: if it were a bedside vital signs monitor app – I dread to think of the ramifications. However, this is a diversification opportunity for medical devices companies; why not have a software division within your company?
There is a clear and present opportunity, but it is one we must look at holistically and not as individuals. There are fantastic, transformational opportunities that remote monitoring brings. But if not conducted with the same rigour that all other medical devices receive the potential pitfalls are numerous. In the next article we shall look at the potential challenges and pitfalls in terms of implementation and regulations.
Peter J Ogrodnik is Professor of Medical Devices Design at Keele University. His opinions do not necessarily represent that of the University, its staff, or its students.
- Pharmaphorum, Digital health round-up: Market worth $379bn and still growing, https://bit.ly/2TgTtk (shortened URL)
- IQVIA, The growing value of digitial health in the UK, https://bit.ly/2UGQyTi (shortened URL)
- DoH&SC, The future of healthcare: our vision for digital, data and technology in health and care, https://bit.ly/2yjpVL9 (shortened URL)
- NICE, Evidence Standard Framework for Digital Health Technologies, https://bit.ly/2Uvwxzt (shortened URL)
- ZMEScience, Your smartphone is millions of times more powerful than all of NASA’s combined computing in 1969. https://bit.ly/2kg8YNx (shortened URL)