The following academic paper was written for Hyper Island’s Master programme. It assess the disruption of technology in the healthcare industry and the current relationship doctor-patient and how emergent tech can disrupt and leverage their and education. The following 08:00 minute video shows in detail the use of the proposed solution developed for the assignment.

PatientAR video. Referencing on YT.

Introduction

Augmented Reality (), Virtual Reality (VR), Big Data, Blockchain are some of the technologies that have been changing our status quo for the last years. These emerging technologies are shaping a new world. Its impact has reached every industry and disrupted process within. Economy, retail, entertainment, education and healthcare are being transformed at a breakneck pace making society reconfigure its functioning and interrelations.

Emergent technology can be defined as a “radically novel and relatively fast growing technology characterised by a certain degree of coherence persisting over time and with the potential to exert a considerable impact on the socio-economic domain(s) which is observed in terms of the composition of actors, institutions and patterns of interactions among those, along with the associated knowledge production processes. Its most prominent impact, however, lies in the future and so in the emergence phase is still somewhat uncertain and ambiguous.” (Rotolo, Hicks, Martin, 2015). By this definition, we can determine that certain attributes make a technology “emergent”: novelty, fast growing, impact in socioeconomics, its impact and uncertainty.

Med industry and Tech

Tech’s fast growth and its notable impact in the medical field has enabled innumerous possibilities. The report on Profiles in Innovation of VR and AR of Goldman Sachs (2017) estimates a $5.1 billion revenue only for the healthcare industry and foresees 3.4 million people adopting this new technology by 2025. According to the report, the potential seen for this techs are as an aid for surgical procedures, treating phobias and enabling patients to access doctors with video-based visits, but we could argue there is more to that.

The future is broad in this technologies. (Proximie, 2018) It will help democratise healthcare and develop training techniques with AR and VR. Technology will assist in everyday practice, enhance psych treatments with safe virtual environments and empower patients with the chance to start diagnosing themselves and monitoring their health.

For example, Proximie is a start-up that uses AR to enable surgeons to scrub virtually and in real time into any OR or clinical setting around the world. This collaborative visualisation tool permits to increase “access to high-quality surgical care to patients, improving their outcomes, reducing costs and delivering a highly engaging training to medical practitioners.” (Proximie, 2018)

CAE Healthcare is expanding simulation-based training solutions to enhance medical education and patient safety using Mixed Reality with Microsoft’s Hololens. “Simulation has been proven to ensure better outcomes, more rapid product adoption and fewer patient complications.” (CAE Healthcare, 2018).

What is AR?

Technology has expanded our way of learning and experiencing; even the saying “a picture is worth a thousand words” transformed to “experience is worth more than a thousand images”. (Fernandez, 2017)

“AR can be described as an interactive visualisation system (a head-mounted display, a computer, a game console, a smartphone, or a tablet) allowing the merging of digital contents with the real environment surrounding the user” In other words, AR enables to blend our real- world elements with virtual ones. “Which may involve not only the view but also hearing, touch, and smell” (Riva, Baños, Botella, Mantovani and Gaggioli, 2016). For Manuel Fernandez (2017), AR is defined as the “technology that integrates digital information with real environments in which people live. Everything is processed and produced in real time. Augmented reality uses the real world and completes it with digital information.”

“In the corporative world, AR is a collaborative, skill-learning, explainable, and guidable tool for workers, managers, and customers. Many corporations are interested in employing AR for the design and the recognition of their products’ physical parts” (Lee, 2012) and this should not exclude the healthcare industry.

The gap

Doctor-patient communication is the core of high-quality healthcare, but good communication not always happen. Today, doctors use brochures, drawings and 3D models that medical devices company give as merchandising to explain patients about a particular surgery (Dr. G. Schwarz, 2018, pers.comm.,15 Mar). Even though doctors explain prior a determined procedure or surgery and patients sign an Informed Consent -as required by law-, it is common that there are unfilled gaps about risks, complications and undesired outcomes or postoperative care (Dr. R. Dulanto, 2018, pers.comm.,17 Mar).

In this line, research shows there’s a need for better communication with doctors (Street, 2013). Furthermore, evidence suggests that patients have specific preferences and requirements concerning the display of information “they desire to ‘talk,’ and they want more participation in the decision-making process” (Matusitz, Spear, 2014). Moreover, good communication is linked to patients health outcomes, (Street, 2013) patient satisfaction and better compliance with the healthcare provider (Lei, Hang, 2017). This could mean a decrease in readmission rates and higher client satisfaction scores and the increase in users/patients referrals. In case of physicians, a weak patient education could mean a malpractice lawsuit (Ellrich, Yu, 2015).

PatientAR

PatientAR prototype visual

PatientAR is an augmented reality platform developed for a medical device orthopaedics company to enhance the doctor-patient communication with cutting-edge technology that permits interaction and guidance for knee fractures. It is designed to be used by both doctor and patient at the same time to visually review the surgical plan to understand outcomes and risks of the procedure.

To deploy the app it is necessary to have a tablet or mobile phone with PatientAR installed. First, the physician logs in and creates a profile for a new patient or selects a profile of a previous patient. Secondly, the physician needs to make sure the patient signs the authorisation release form to start filling out patient’s essential information and diagnosis in the app. Optionally, the physician can upload x-rays of fracture/fissure. After, it is required to select the prosthetics to use in surgery and point the device camera towards the patient’s knee. This will result in a high fidelity simulation of the fracture in AR that automatically will place itself in the patient’s affected area. A patient can visualise the 3D virtual fracture in his/her real environment by synchronising devices screens.

PatientAR can be the optimal experiential learning tool for doctor-patient education. On one side, it allows real-time interactivity in an ecological setting improving concentration and motivation. On the other side, it provides targeted and non-directive suggestions and guidelines that help users to develop skills and knowledge more effectively” (Riva, Baños, Botella, Mantovani and Gaggioli, 2016). Therefore, the benefit of using augmented reality as a tool for leveraging doctor-patients education and communication is to “improve the understanding of abstract and complex concepts” (Fernandez, 2017) and help overcome language barriers between doctor and patient.

The potential for this tool regarding the medical device industry is essential since this platform captures patient data that will help build case studies for the brand that will enhance doctors learning around the world. On the other hand, the constant information submitted helps scientists and engineers to improve their products and create new specific solutions. Also, the company can learn the quantity of prosthetics are most likely to be used enabling to plan stock and factory production.

The author requested feedback to Dr. R. Dulanto (2018, pers. comm., 20 Mar) and said: “(PatientAR) seems to be a helpful instrument (…) visual aids help enormously (…) I will definitely use it to give a better consultation experience to my patients”

Ethics

Innovation and emerging technologies bring several ethical implications that must be analysed regarding healthcare. (Meskó, 2015) Patient’s data, hacking medical devices, auto diagnose, switching body parts for robotics to enumerate some of the potential threats that the implementation of new tech brings into the discussion.

Patient confidentiality is at the top of the ethicals principles and the challenges concerning the use of AR or any other technology on a public IP network means that is necessary the assurance of firewalls and the use of anti-malware at both ends of any communication to protect the (Lee, 2017) unauthorized disclosure of personal health data. PatientAR sends encrypted data back to the medical device company server for their use. In that scenario, Lee (2017) suggest that to “support safe data collection, storage, and use, we must do several things (…) we ought to ensure that data and results are valid, and demonstrate usefulness. We ought not to collect and store data unless we are going to use them to improve health — not only by analysing them but also by integrating the results into policy and practice.”

The company needs to set a work framework that can ensure the precise equilibrium between data sharing and the protection of patient confidentiality for collaborative research developments and assign responsibilities between involved parties: health provider, physician, data analyst, IT (Lee, 2017).

In the other hand, AR is a very powerful technology with the capability to influence and manipulate the end users perception of reality. “Due to the immersive and persuasive nature of AR applications, the actual physical and psychological safety of end users and those around them becomes an ethical concern.” (S. Pase, G. Hare, J. L. Hogg, S. Thoennes and C. Connors, 2014).

Conclusion

It is necessary to recognise that new emergent technology not only can enhance clinical learning or assist in doctors everyday surgical practice; it can also improve doctor-patient relationship, creating a better user experience in healthcare.

It is essential for patients to feel safe and to understand their diagnosis, surgery plan, risks and outcomes. Therefore, this represents an opportunity for PatientAR to become an ally for doctors and leverage patients satisfaction. Medical device companies that adopt this solution will benefit from patients data for case studies, better plan stocks and have information to products. PatientAR is a win-win-win.

So PatientAR can function adequately, medical device companies need to assure that sensitive data is encrypted before sending it to the company’s server. Additionally, its necessary to instruct doctors in the use of the app to make sure they understand the importance of patients signing consent release form.

Medicine and technology belong together, and it is a matter of time tech finally can leverage patients experience in healthcare.

Bibliography

  • – Goldman Sachs, (2016). Virtual and Augmented Reality: The Next Big Computing Platform. Available at: http://www.goldmansachs.com/our-thinking/pages/virtual-and- augmented-reality-report.html. (Accessed March 17th, 2018.)
  • – Proximie, 2018. Proximie, the future of surgery via augmented reality technology. Available at: www.proximie.com (Accessed 30/3/2018)
  • – Street, Richard. “How clinician–patient communication contributes to health improvement: Modeling pathways from talk to outcome”. Elsevier. 2013
  • – Jonathan Matusitz and Jennifer Spear. “Effective Doctor-Patient Communication: An Updated Examination”. 2014. Routledge
  • – Proximie, 2018. Six Ways augmented reality is transforming the future of healthcare. https://www.proximie.com/six-ways-augmented-reality-is-transforming-the-future-of- healthcare/. Available at: Accessed: March 24th, 2018.
  • – Daniele Rotolo, Diana Hicks, Ben Martin. “What is an emerging technology?” Elsevier. 2015
  • – Giuseppe Riva, Rosa M. Baños, Cristina Botella, Fabrizia Mantovani and Andrea Gaggioli. “Transforming experience: The Potential of Augmented Reality and Virtual Reality for enhancing Personal and Clinical Change”. Frontiers in Psychiatry. 2016.
  • – Fernandez, Manuel. “Augmented virtual reality in education”. Higher Learning Research Communications, 7(1), 1–15. 2017
  • – Lee, Kangdon. The future of learning and training in Augmented Reality. Insight: A Journal of Scholarly Teaching. 2012
  • – Mike Ellrich and Daniela Yu. “For Patients, Pre-Surgery Education Is Lacking”. Gallup. 2015. Accessed on 26/3/2018. Available at: http://news.gallup.com/businessjournal/183365/patients-pre-surgery-education- lacking.aspx
  • – Lisa M. Lee. “Ethics and subsequent use of electronic health record data”. Elsevier. 2017
  • – S. Pase, G. Hare, J. L. Hogg, S. Thoennes and C. Connors. “Panel — Ethics and emerging technology: Ethical concerns from a cognitive, media & technology focused psychology perspective concerning augmented reality, privacy, and sigularity,” 2014 IEEE International Symposium on Ethics in Science, Technology and Engineering, Chicago, IL, 2014, pp. 1–3.
  • – Dr. Rajesh Bawale, 2018, pers.comm., 25 Mar
  • – Dr. R. Dulanto, 2018, pers.comm.,17 Mar.



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