An onslaught of cyberattacks targeting healthcare data is coming, federal officials warn. Providers are urged to step up their defenses. by Kevin Joy Kevin Joy is the managing editor of HealthTech. He previously worked in content marketing for a major university health system and as a features reporter for the Columbus Dispatch.
U.S. government agencies have warned hospitals to brace for an “increased and imminent” wave of ransomware cyberattacks that could compromise patient care and expose personal information.
A joint warning issued Wednesday by the FBI, the Cybersecurity and Infrastructure Security Agency (CISA) and the Department of Health and Human Services urges providers to guard themselves against these attacks, which involve threat actors deploying malware to obtain a victim’s data and hold it hostage for a payment.
The agencies state that the Russian botnet Trickbot is likely using Ryuk, a highly infectious ransomware that encrypts network files and disables Microsoft Windows System Restore. That means stolen data can’t be recovered without external backups, a Microsoft executive confirmed to CNN.
Recent attacks on hospitals in California, New York and Oregon are believed to be part of the campaign, which comes just weeks after a massive Ryuk ransomware attack hit a U.S. system with 250 care sites that scrambled to redirect ambulances and surgical patients in the aftermath.
Ransomware criminals can demand millions of dollars from unsuspecting victims, and the amounts are substantially higher than previous attacks on healthcare providers, a security analyst told TheNew York Times. Added costs of downtime, breach remediation and lost revenue will follow.
But ransomware’s consequences are far more than financial. A doctor at one affected target anonymously told Reuters that their hospital now cannot use some critical technologies, transfer sick patients or update electronic health records as officials deal with the situation.
“We can still watch vitals and getting imaging done, but all results are being communicated via paper only,” the doctor said.
Why Ransomware Attacks Are Increasing Now
Even before the pandemic, ransomware was a big problem. From 2017 to 2019, half of all ransomware attacks occurred in the healthcare sector, according to Bryan Ware, CISA’s assistant director for cybersecurity.
There’s a simple reason why.
“When lives are on the line and timing is critical, from the perspective of a malicious criminal actor, that’s someone who’s more likely to pay the ransom,” Ware told HealthTech in an interview earlier this month. Sites involved with COVID-19 vaccine research are a key target for ransomware threat actors, he added.
Hackers haven’t pulled back amid an ongoing global pandemic, panelists noted in two recent webinars hosted by the Healthcare Information and Management Systems Society. In fact, criminals are turning up their efforts and even targeting specialties and facilities that historically have fewer security defenses and less training.
“Attacks that tug at your emotions tend to be the most impactful and favored by cybercriminals,” Ryan Witt, managing director of the healthcare industry practice at Proofpoint, told one webinar audience.
These exchanges, he said, may include imposter emails from the World Health Organization, fake purchase orders for personal protective equipment, or bogus notices about a “vaccine ID” from the Centers for Disease Control and Prevention.
How to Prevent Ransomware Attacks in Healthcare
Federal officials didn’t offer specifics about how the latest ransomware attacks were conducted, but they have been amplifying a message of vigilance.
In September, CISA and the Multi-State Information Sharing & Analysis Center jointly released a ransomware guide that details best practices to help manage the risk posed by ransomware and other cyberthreats.
“Chinese health authorities say an outbreak of a pneumonia-like illness has sickened 305 people and killed five”… No, this is not an excerpt from a recent news report about the Wuhan virus, but it is actually one from a CNN piece from 2003 when the SARS outbreak was raging. There are many similarities between the current outbreak to the SARS one from its geolocation to its spread to the viruses themselves.
However, much has changed within the 17-year gap between those two pandemics. For one, technology in the healthcare sector has known an exponential boom. New technologies that were nonexistent or poorly developed in 2003 are now more affordable and widespread and can help manage and even prevent such cases. Let’s see how this can be the case.
What is the Wuhan virus?
First identified in the city of Wuhan, hence the name, the Wuhan virus is a member of the family of coronaviruses which can cause mild conditions like the common cold to potentially lethal ones like the severe acute respiratory syndrome or SARS. The novel 2019-nCoV strain found in Wuhan has been found to be closely linked to those found in bats, and could have initially spread in the Huanan seafood wholesale market, where live animals are sold and slaughtered.
Now that we’ve covered the basics, let’s see how technology has been or can be used in the context of the Wuhan virus pandemic and help manage or even prevent future cases.
A.I. to detect the spread of an epidemic
At the beginning of the SARS outbreak, China covered up the existence of the virus from both its citizens and the world. Even though China seems to have become more transparent in those matters, some might still not be convinced. To circumvent those trust issues, artificial intelligence can be a solution.
As a matter of fact, Toronto-based health monitoring A.I. platform Bluedot beat both the WHO and the CDC to the punch when issuing warnings about the Wuhan virus’ spread. It even correctly predicted the virus’ likely path from Wuhan to Tokyo after its initial appearance. Bluedot calls itself “a digital health company that uses big data analytics to track and anticipate the spread of the world’s most dangerous infectious diseases”. By going through piles of information about news reports, airline data, and reports of animal disease outbreaks, Bluedot’s algorithm can identify a trend which is then analyzed by epidemiologists. The company then shares the information with its clients.
“We happen to have growing access to data we can use … to generate insights and spread them faster than the diseases spread themselves,” Bluedot’s founder and CEO Kamran Khan told The Canadian Press. A.I. is also being used to model Ebola outbreaks using movement data. By having an A.I. sift through the available data and make informed predictions which are cross-checked by experts, relevant bodies can contain such diseases before they even leave their source of origin.
The data they use to visualize this is collected from various sources including WHO, CDC, China CDC, NHC and DXY, a Chinese website that aggregates NHC and local CCDC situation reports in near real-time, providing more current regional case estimates than the national level reporting organizations are capable of, and is thus used for all the mainland China cases reported in the dashboard.
Information on U.S. cases is taken from the U.S. CDC, and all other country case data is taken from the corresponding regional health departments. The dashboard is intended to provide the public with an understanding of the outbreak situation as it unfolds, using transparent data sources.
New tech for faster detection
As we’ve mentioned in the introduction, technology has dramatically evolved since the days of the SARS virus. For the current coronavirus outbreak, the culprit was identified within a week from the public announcement and the first diagnostic test was developed shortly after that. “Back then, it took days to sequence,” Georgetown University infectious diseases physician Daniel Lucey, who worked on SARS in 2003 said. “Now, it can take hours.” Thanks to technological progress, scientists don’t need to cultivate a sufficient amount of viruses before examining them anymore. Minute amounts of viral DNA can be detected directly from a patient’s spit or blood sample.
Another company based in Singapore, Veredus Laboratories, is working on a portable Lab-on-Chip detection kit that is expected to be commercially available as soon as this February 1st. With faster and portable detection solutions, identifying infected individuals for proper medical care will also be quicker by medical teams on the ground, especially when hospitals are overcrowded.
Genome sequencing to find potential vaccines
The Wuhan virus’ genome was completely sequenced by Chinese scientists in less than a month since the first case had been detected. Since the first sequencing was done, almost two dozen more have been completed. In comparison, the SARS virus outbreak started around the end of 2002 and its complete genome was only available in April 2003. This is again thanks to advances in technology and a drive for international collaboration. Richard Ebright, a biologist at Rutgers University, told Stat News that those genome sequences “will be crucially important for the development of diagnostics [and] vaccines”.
Indeed, the Coalition for Epidemic Preparedness Innovations (CEPI) has supported pharma companies with millions in funding so as to have a vaccine against the virus ready for human testing in just 16 weeks, a process that normally takes years. With such an ambitious aim, the genome sequences will prove to be very valuable. As we will be able to sequence pathogens’ genome quicker with evolving technology, the rate of finding adequate therapies will also speed up and help save more lives in the process.
Robots to the rescue
As it has been determined that the 2019-nCoV virus can spread from human to human, medical staff are at high risk of being infected. However, impervious to cross-infections are medical robots. These can be real game changers in cases of viral outbreaks.
We’ve seen one such case already in the U.S. where a man, diagnosed with the Wuhan coronavirus, is being treated by a robot. The latter allows physicians to communicate with the patient via a screen and it is also equipped with a stethoscope, helping doctors take the man’s vitals while minimizing exposure to the staff. True, it won’t be possible in a jam-packed hospital in China with hundreds of such patients, but with time, quarantined patients could be better monitored with the help of robots.
Going further, drones for medical deliveries could also be deployed in similar settings so as to reach quarantined zones like Wuhan currently is with medicines and/or supplies. If China can build a hospital in 6 days, then it might as well include digital health technologies to help with faster, more connected diagnosis and treatment.
In any case, the management and prevention of such situations will largely rely on professionals and international collaboration. With the help of technology, containment and eventual treatment of outbreaks can be run more smoothly. If you’ve come across other examples of technologies being used in the Wuhan virus outbreak or think of others that could be helpful, don’t hesitate to share them with us!
Some people will be suspicious—and rightly so—if you use shortened URLs in email or in your online or print materials. In general, do what you can to make it clear to people where they will go if they click or type the URL you provide.
Use descriptive link text with the full URL. In emails and on web pages, it is best to use descriptive link text with the full URL behind it. That lets people know where they will go if they click; they can hover over the link with their mouse to see the full URL. It is also a recommended best practice for accessibility, because it provides people who use screen readers with clear, complete information.
Don’t use a shortened URL if people must log in. If you are directing people to a page that requires login, let them see the full URL and tell them login will be required.
Be clear about the destination when you must use short URLs. On social media platforms, such as Twitter, you may need to use a shortened URL to stay within a character limit. It is helpful to let people know where the short URL will take them.
How Criminals Use Shortened URLs
Criminals use shortened URLs to:
Direct people to phishing websites—sites that ask you to log in or fill in a form and then steal your password and/or personal information. Always Look Before You Log In.
Initiate download of malicious software, such as ransomware, to your device.
If you are suspicious of a shortened URL, don’t click it.
First Trust in the North West to achieve the milestone
Alder Hey Children’s Hospital (Liverpool, UK) recently went LIVE with a new emergency department solution integrated into its MEDITECH Electronic Patient Record (EPR), enabling direct appointment scheduling from NHS 111, NHS 111 Online, and various national services. They are the first healthcare organisation in the region to develop and incorporate this type of solution within its EPR.
“Alder Hey achieved the NHS 111 First mandate from the Secretary of State, and also delivered a fully CareConnect compliant solution,” said Daniel Hallen, Head of Digital Technology and Digital Urgent and Emergency Care, NHS England and Improvement. “In a time of competing priorities, it is especially impressive to take a solution from idea to delivery in a little over a month.”
Recently, the NHS outlined new mandates to ensure that NHS 111 maintains its place as the ‘first line of defence’ for the Urgent and Emergency Care (UEC) system. One of these requirements is for healthcare organisations to enable direct bookings through NHS 111.
ED patients are urged to contact NHS 111 where they will be screened by a single Clinical Assessment Service (CAS) to determine whether they should go to the ED, visit their local GP, see a pharmacist, or call an ambulance. This ensures that patients are directed to the proper care setting. Appointments can then be booked through NHS 111 into the MEDITECH EPR, along with notes from the call uploaded to the system.
“We are delighted to be able to integrate this solution into our EPR to make things as easy as possible for our brilliant ED team,” said Alder Hey Chief Digital and Information Officer Kate Warriner. “This is the latest example of how collaborative technology can enhance patient care.”
The ability for NHS 111 to triage and schedule patients directly to the EPR will help alleviate ED overcrowding and reduce wait times. This is of particular importance during the pandemic, as organisations are challenged with increasing numbers of COVID-19 patients.
“This solution is fully integrated into MEDITECH, unlike options being considered by other organisations which can require running up to two additional systems. Using interoperability standards, in record time we have delivered a seamless experience to the user,” said Mike Hooton, Technical Executive, MEDITECH UK. “We are proud to be able to work together, in a short timeframe, to deliver an interoperable solution that will make an impact on patient care now as well as into the future.”
Caring for more than 330,000 children, young people, and families every year, Alder Hey is a certified HIMSS 6 hospital, a participant in the NHS GDE programme, and one of Europe’s biggest and busiest children’s hospitals. It will be one of the first MEDITECH NHS customers in the UK to leverage the web-based Expanse technology.
MEDITECH software is used by a quarter of all U.S. hospitals, nearly half of all Canadian hospitals, and in numerous NHS trusts and public and private sector healthcare facilities in 23 countries. We help power the best care possible in every setting, from acute centres and outpatient clinics, to general practitioner, primary care, community, home health and social care environments. Visit ehr.meditech.com and find us on Twitter, Facebook, and LinkedIn.
The Future of Healthcare: Part 1 – Care Plans, Goals, Actions and Outcomes: The Future Health Record
I do a lot of work with clinical information systems. Systems for GPs (Primary Care Physicians), hospital doctors, allied health professionals, specialists, nurses and many others. The vast majority of them have one thing in common – they’re not very good. Issues with user experience, lack of clinical coding, poorly designed workflow, dated architecture and many other problems abound.
However, there is another major problem. Virtually all clinical information systems put problem / diagnosis lists, medications, allergies and summaries of recent episodes of care at the centre. This design has a number of inherent flaws…
It focuses on the problem, not on the solution
Medications are important, and save many lives. But they are rarely long-term root cause solutions to complex issues. The central focus on conditions and medications within medical records subtly reinforces the incorrect idea that we are addressing the root causes of a patient’s health issues. What is missing is a more holistic plan to not only address a problem with medication, but to move a patient beyond their immediate symptoms and into wellness. For example, what other actions (beyond medication) does the patient need to take to bring about better health? How do exercise, sleep and nutrition play a vital role in achieving that goal? And what is the goal? What will determine when improvement has been achieved?
It focuses on the past, not on the future
Records focused around problems and medications also cement a medical paradigm that looks backward in time. What conditions does the patient have and how are we medicating them? What was done and when?
Sadly, there is rarely much evaluation of the efficacy of particular interventions. As a patient I have rarely been asked how well a prescribed medication is working for me. Clinical information systems rarely force the capture of structured outcome information (either from health provider or patient) that can then be used to refine a treatment plan.
It focuses on sickness, not on wellness
Beyond sickness lies wellness. The goal of treating sickness should surely be to become well, not just to stop being sick. And yet our medical records largely focus on the tactical, medication related steps that address the symptoms of illness.
What would a true health record look like?
Despite the arguments that I will hear in response to this article, that healthcare professions aren’t funded to, or don’t have time to worry about these things, we need a new conceptual model that creates genuine health records, not just medical records. We need a new paradigm around which we can build a new generation of health records…
As I have reflected on this problem over the last couple of years, I have come to the conclusion that at the heart of every health record should be a care plan. A care plan that allows quantifiable goals to be defined, measured and updated on an ongoing basis. Goals that can be assigned actions so that there is a clear picture of what can be done towards achieving them. Actions that can be given to patients so that they are clear what they need to do. And outcomes that can be reported against those goals on a regular basis, e.g. how am I going against this goal?
The following diagram shows a proposed structure for care plans, goals, actions and outcomes that should be at the heart of a modern health record:
The Care Plan stores information about the patient, the health provider(s) managing the plan and the health conditions / problems being treated.
A series of Goals can be defined as part of the Care Plan, e.g. bringing BMI below 30, or bringing blood glucose levels within a normal range.
A number of Actions can be defined that guide a patient with regard to what they need to do to achieve the Goals. An Action can relate to multiple Goals.
Consumer Health Observations are consumer recorded vital signs (e.g. weight, blood pressure, blood glucose, etc.) that can be recorded against a Goal, providing a history of achievement towards a particular Goal. Consumer Health Observations can also show that a patient is deteriorating or moving further away from a Goal.
Clinical Measurements are clinically record vital signs that can be recorded against a Goal, providing a history of achievement towards a particular Goal.
By taking a more structured approach to care plans, new models of care can be designed that support safe and efficient remote management of patients. By carefully defining best practice goals for a particular health condition / problem, patients can (remotely from the health provider) record consumer health observations, sharing their progress (or lack thereof) through digital channels with their health provider(s).
In the event that a patient is progressing well towards a goal, they may not require any intervention (particularly in the case of chronic condition) and can continue to be safely and efficiently monitored remotely.
However, if a patient is deteriorating, or not tracking within the safe boundaries as defined by the care plan, health provider(s) can be alerted digitally, allowing them to decide whether a patient needs an urgent or scheduled face-to-face intervention.
Health records with care plans, goals, actions and outcomes at the centre are a must have for our future health system. We need to start building clinical information systems that support this…
Japan has so far kept its coronavirus cases relatively low, with only about 18,000 infections, and a large amount of the credit goes to a system that has its roots in the 1930’s fight against tuberculosis. Since early Covid cases appeared in January, workers at Japan’s network of over 450 public health centers have been the first line of defense against the coronavirus—tracking infections, alerting contacts to quarantine and then checking in on them. The centers played a crucial but often overlooked role in getting the virus’s spread under control.
While countries such as South Korea boast high-tech methods to tackle the coronavirus, Japan’s system is among the examples at the other end of the spectrum, using a decentralized and community-based approach. Hyperlocal efforts from Germany, the tropical island of Bali in Indonesia, and the most crowded slum in India have also proved effective in containing the spread of the pathogen. In all of those places, connecting with members of the community and communicating the importance of being careful about the virus helped net results. In Japan, that link proved crucial for contact tracing—workers at public health centers emphasized privacy and took a personal approach as they dealt with patients that tested positive, getting them to share information about contacts to help trace and alert others of potential infections.
That could be an important lesson for other countries as they look to make contact tracing a more long-term part of their healthcare infrastructure. “Everyone is captivated by the potential treatment and vaccines,” said Toshio Takatorige, a public health professor in Osaka. “No one thinks about the system that’s already part of daily life.”
Tokyo’s Shinjuku district is reopening. Photographer: Soichiro Koriyama/Bloom
During normal times, Japan’s public health centers look after various functions that meld them into the local community—newborn checkups, elderly health advice, restaurant licenses, investigating child abuse and food poisoning. When the coronavirus hit, they used that connection to spring into action.
Privacy proved to be key when it came to tracking coronavirus cases. The head of infectious disease response at public health centers in Kawasaki, a city of 1.5 million near Tokyo, was quick to emphasize the need to be careful about small details when releasing generic information about patients that could unveil the identity or place of infection for locals.
Still, the next test awaits as Japan remains wary of a potential second wave after lifting most restrictions put in place during the height of the pandemic. That’s especially concerning for the health centers, whose numbers have fallen as municipal budgets in Japan shrank, adding to the workload in denser areas. In recent days, the numbers of infected in Tokyo have began to tick up, promising more action for the front-line forces.—Lisa Du
7:39 a.m. That’s the time that your smartphone’s sonar deems as optimal for you to wake up today. With its gentle vibration from your bedside table, you pick it up to turn off the smart alarm. As you do so, your phone asks for your permission to use the built-in sensors and camera to run your routine morning scan. It analyzes your voice; evaluates your stress level based on a facial scan; checks your vital signs; and notifies you to take a picture of that mole on your forearm in order to detect any anomalies.
Thereafter, it outputs a comprehensible report with recommendations which you can send over to your physician. This helps in early detection and prevention of ailments thanks to the minute changes indicative of a potential illness. All this is done in mere minutes, without even stepping out of your bed, every morning.
Such a (literally) healthy wake up isn’t too far away. In the near future your phone will pack sensors that will allow you to gauge your vitals and more in order to monitor ongoing treatments and prevent other diseases from progressing.
As a matter of fact, smartphones already have built-in sensors to analyse numerous parameters, without any add-ons. Cameras aren’t just for Instagram stories but can analyse skin lesions; voice recording isn’t only to ask Siri about the weather but can also detect Alzheimer’s; and you’re likely already familiar with the built-in fitness app in your phone. However, there are still some hurdles to overcome before we enjoy a morning screening as depicted.
Here we analyse the parameters that our smartphones can currently measure, the challenges preventing them from turning into an effective Swiss knife of digital health and give a glimpse of what awaits in the near future.
Every step counts
“Don’t forget to take your walk!” “It’s Day 3 of 5 of staying active!” These are notifications you’re probably familiar with thanks to built-in apps like Google Fit and Apple Health on your smartphone. By using your phone’s motion sensors (accelerometer, gyroscope, proximity sensor), they track your steps, estimate the calories you burnt and remind you to keep active regularly. The latter is particularly important as the WHO estimates that 1 in 4 adults is not active enough, which can increase the risk of cardiovascular complications and diabetes.
Additionally, these fitness apps can incorporate data about your sleep through smart alarm apps. Getting the right amount of sleep and waking up at the optimal time won’t only make you feel better but studies have also linked improper sleeping habits to suppressed immune systems and Alzheimer’s.
However, some experts cast a shadow of doubt over the reliability of energy expenditure and step count measurements. These show that our phones still have room for improvement on that front; but activity tracking is only the tip of the iceberg when it comes to what our phones are capable of measuring.
Eyeing hemoglobin count
In this near future, you won’t need to draw blood to evaluate your anemia risk. Rather, a simple picture of your inner eyelid, where microvasculature is visible, will do for your physician to evaluate remotely. This is exactly what a group of researchers have recently worked on.
By upscaling images of the inner eyelid taken by a smartphone’s camera, a set of algorithms can evaluate the blood haemoglobin content and help determine blood disorders. Early results show that this technique is comparable to traditional blood tests over a wide range of blood haemoglobin values.
“This new technology could be very useful for detecting anaemia, which is characterised by low levels of blood haemoglobin,” said the lead researcher. “This is a major public health problem in developing countries, but can also be caused by cancer and cancer treatments.”
Sensing oxygen saturation
You might, right now, be having a cough and sneeze every so often but not think much of it and go about with your routine. However, even without overt symptoms, there is the possibility of an underlying respiratory illness; even one that is related to COVID-19.
That’s why doctors are calling to have oxygen saturation (SpO2) measured for all at-risk patients. This parameter refers to the percentage of haemoglobin in your red blood cells bound to oxygen. A drop in the SpO2 value will indicate an underlying ailment even if no visible signs are present. How about monitoring Sp02 remotely, while in self-isolation, without risking cross-infection? This will soon be possible.
However, the Centre for Evidence-Based Medicine recently contested the accuracy of both Samsung’s sensors and apps. Researchers at the institution concluded that these methods raise “serious questions about the diagnostic accuracy”.
This is in part due to the inadequate wavelengths of light used in these sensors which can, however, be improved upon. Now that interest in this feature is gaining traction, we could see more accurate pulse oximetry sensors get integrated in our next smartphones.
Tap for temperature
With a simple tap to the forehead, your future phone will record your temperature. Traditionally, this apparently simple parameter was a challenge to measure with a phone. That’s in part due to the design aspect and also because the smartphone itself is a considerable source of heat (ever thought about frying an egg on the back of your phone after watching a couple of YouTube videos?). This makes recording ambient temperature quite the challenge, and the reason why Samsung dropped the idea.
However, with the prevalence of IR sensors in cameras, like the one used in the iPhone’s FaceID, temperature measurement is set to be easier and more commonplace with phones. For instance, dubbed as “the most 2020 phone of 2020”, Huawei’s latest phone, the Honor Play 4 Pro, integrates an IR temperature sensor at the back. With a tap to the forehead, the phone can establish the user’s temperature.
With phones making temperature measurements as easy as a tap, patients and physicians will monitor this parameter remotely, which, if elevated, can be indicative of the need to self-isolate.
Making diagnosis of rare genetic conditions more common
Our upcoming high-tech Swiss army knife of digital health will not only be a boon for the general public but also for physicians. Yearly, some half a million children are born with a rare hereditary disease worldwide. Their identification poses a challenge since doctors might not have encountered such rare cases in their career. However, early detection is crucial to provide adequate treatment and support.
With this in mind, scientists at the Kaunas University of Technology (KTU) in Lithuania developed an app to identify Huntington’s disease, a genetic condition leading to physical and cognitive impairments. It can manifest in both adults and children, with the latter being rarer and harder to diagnose. KTU’s app aims to diagnose the condition in at-risk patients when there are no visual symptoms.
It achieves this with a set of tests that evaluates the patients’ physical and cognitive skills and early signs of decline. “Although there is no known treatment for Huntington’s disease, it is estimated that a patient can gain 3-16 years of healthy life if the disease is diagnosed early,” said KTU Professor Rytis Maskeliunas.
Other researchers in Germany trained an A.I. to identify rare conditions like Mabry syndrome and Kabuki syndrome, which have specific facial characteristics, from portrait pictures and genetic data. Their method improved the accuracy of diagnosing these rare conditions.
Pocket aspiring dermatologist
In our introductory near-future scenario, we mentioned the ability to check one’s skin lesions through a phone. This is already possible today thanks to dermatology apps. With a simple snapshot of a mole, apps like SkinVision can determine the risk of your skin lesion. Upon the evaluation of a suspicious mole by the algorithm, the picture is further analysed by actual dermatologists, who give further recommendations. Moreover, the app sends reminders to regularly re-evaluate a mole after a period of time.
As innocuous as they might seem, skin lesions warrant careful attention as they can evolve into skin cancers. The WHO estimates that yearly, there are 2-3 million non-melanoma skin cancers and around 132,000 melanoma skin cancer cases. The latter is particularly serious due to its ability to metastasise to other organs. In the U.S., nearly 20 Americans die from melanoma every day, according to the American Academy of Dermatology. With the ease of early detection through a phone, there can be a drastic drop in such cases.
Decoding speech for neurodegenerative cues
In line with more specific diagnoses, doctors will be able to detect complex neurodegenerative conditions with a smartphone. Canadian firm WinterLight Labs developed an A.I. that analyses subtle cues from a patient’s voice. Such an analysis allows for the detection of conditions like Alzheimer’s, with an 82% accuracy.
“Our platform can analyse natural speech to detect and monitor dementia, aphasia, and various cognitive conditions,” the company said. “Using a short one-minute sample of speech, WinterLight can characterise the speaker’s cognitive, acoustic and linguistic state, including lexical diversity, syntactic complexity, semantic content, and articulation”. While it is implemented in a robot companion, the technology can easily be adapted on a smartphone.
For instance, KTU’s app mentioned in the previous section can also evaluate other neurodegenerative diseases such as Parkinson’s, Alzheimer’s or dementia. With such developments, it’s not difficult to imagine a doctor sliding out their phones during an appointment to enhance their diagnosis.
A regulated digital health Swiss knife
More than easing the lives of citizens of developed countries, low- and middle-income ones will largely benefit from a Swiss knife of digital health. In these resource-limited settings, having access to accurate and vital parameters measurements will be a real game-changer. Without the need for pricey equipment or any attachments, caregivers will perform quality, low-cost diagnoses with a single device.
Indeed, a current smartphone’s sensors can measure a plethora of parameters already. A review by scientists from McMaster University in Canada attested to their “incredible role” as low-cost solutions for early diagnosis and remote monitoring.
However, the authors also highlight the need for “rigorous clinical trials” to determine their safety and efficacy. They call for more defined guidelines by regulatory authorities before labelling an app as a “medical device”. Of course, there is also the ever-present matter of stricter controls over data privacy as these are often not addressed in studies.
We also saw how experts contest the reliability of smartphone’s pulse oximeters, calorie expenditure estimates and even step counts. Thankfully, these are features that can be remedied. With increased demand, companies will enhance their accuracy and reliability. With proper regulations and secure implementations happening in parallel, we will benefit from a real Swiss knife of digital health; and wake up to a similar routine as pictured in this article’s opening.
Nowhere is better positioned to benefit from the digital revolution in healthcare than Africa, where technology can help tackle the rising burden of disease and major obstacles in infrastructure and the environment. However, realizing the promise of digital healthcare technology, while avoiding its potential pitfalls, will require a comprehensive, systematic approach based on the principles of sustainability, equity and inclusion.
Africa’s public health challenges are well known. While recent decades have seen major progress in the treatment of diseases such as HIV/AIDS and malaria, the continent suffers from a disproportionate disease burden and rising incidence of chronic diseases such as diabetes, heart disease, and sickle cell anemia. Infrastructure presents its own problems: less than half the population of sub-Saharan Africa has access to electricity, and road density in the region has actually declined over the last two decades.
Digital technology holds enormous potential to bridge the gaps in healthcare provision by directing limited medical resources where they are most needed. To this end, global, national and local stakeholders should focus on six interconnected solutions, which together will help ensure equitable access to medical innovation throughout Africa.
First, we must strengthen capacity for conducting basic research and clinical trials in Africa. Outside expertise only goes so far, and African policymakers would benefit from more locally derived evidence that helps them better understand which health interventions would be most cost-effective within their country contexts.
Second, the insights gained from these and other initiatives can be translated into effective interventions more quickly through the creation of centers of excellence at the national and regional levels, which can save time and money by propagating the best access solutions and providing guidance on implementation.
Third, we can streamline approval and procurement of new medicines through secure regulatory harmonization. Developing the regulatory systems needed to ensure access to affordable, quality medicines and other products can be costly and time-consuming, presenting a significant challenge for many African governments. Regulatory harmonization would allow health authorities to validate and make new medicines and health products available across multiple countries using standardized authorization and evaluation criteria.
Fourth, new technologies ranging from data analytics to drones can help tackle supply chain challenges, improving logistical efficiency and eliminating barriers that have historically prevented medicines from reaching remote, underserved populations. New distribution systems, like the partnership Novartis has with Zipline to deliver sickle-cell medicines by drone to rural populations in Ghana, can also bolster security to address the threat of counterfeit medicines – the cause of over 170,000 deaths a year, mostly in Africa.
Fifth, stakeholders must come together to formulate high-level strategies to guide investments in digital technology. A national digital health strategy should set a clear vision for how digital technology will improve healthcare access in a given country; provide clear direction for stakeholders across the health system; and establish a supportive, predictable operating environment for solution providers. A 2017 report from the Broadband Commission provides useful guidance on the cross-sector collaboration essential for effective national digital health strategies.
Finally, suppliers of drugs and medical equipment can incorporate these measures to widen access into their own programmes, for which the Novartis Access Principles may provide a useful model. All too often public health initiatives have underestimated the powerful role the private sector can play in making access more equitable. Manufacturers of medicines and health products can do their part by systematically integrating access strategies into how they research, develop and deliver new innovations that can help reduce disease burden and improve health across Africa, incorporating perspectives from Africa’s national and local institutions.
The rapid rise of digital health technology promises to change the face of medicine across Africa, leveraging everything from AI and analytics to drones and telemedicine to expand access and make the provision of healthcare more equitable.
Africans have already eagerly embraced new technologies for applications like digital cash, banking, e-commerce and governance. This shows that there is both appetite and aptitude that can be leveraged, with the same potential to create a ‘leapfrog’ moment that positions Africa at the forefront of health systems transformation. However, it will take focused leadership, talent and creativity on the part of stakeholders throughout the private sector, government and civil society to realize the promise of these new capabilities.
Fifty years ago men went to the moon with the help of a computer considerably less powerful than today’s cheapest mobile handset. With digital networks quickly extending to every corner of the continent in the early years of the new millennium, surely Africa can solve the problem of equitable access to healthcare, yielding longer, more productive lives for the continent’s billion inhabitants.
A Telemedicine Unit to enhance healthcare delivery in the north of Nigeria has been opened.
Through Telemedicine, physicians and patients can share information in real time from one computer screen to another. They can even see and capture readings from medical devices at a faraway location.
Using telemedicine software, patients can see a doctor for diagnosis and treatment without having to wait for an appointment. Patients can also consult a physician at the comfort of their home.
The facility is the first of its kind in the north of the country and the second in Nigeria after the first in Federal Medical Centre, Yenagoa, Bayelsa State.The facility stands out because of its three components – Grand rounds, Teleconsult and Electronic Medical records.
Speaking at the ceremony, Prof. Edmund Banwat, the Chief Medical Director (CMD) of the hospital, said that the unit would enable JUTH actualise its core mandate.
He explained that the project was funded by Global Off-site Care, an American-based organisation, with the support of Rotary Club of Jos.
“The unit will place the hospital in the world map; it will make a far-reaching impact in the health sector. There is no doubt that today marks a watershed in the history of JUTH as a tertiary health institution.
“Telemedicine will not only reduce cost, ensure access to healthcare services, but will go a long way in actualising our mandate of providing training and retraining.
“Our medical students will also benefit from this in no small measure.
“This initiative will place us in the world map by matching our medical services with the rest of the world,” he said.
Dr Frances Kemelegha, Global Off-site Care Ambassador, in her remarks, said that her organisation was desirous of meeting the medical needs of the poor, hence the need for the unit.
According to her, JUTH is the first hospital in Northern Nigeria, and the second in the country, after Federal Medical Centre, Yenagoa, to have a Telemedicine unit.
“Global Off-site Care is passionate about reaching out to the less privileged ones and the poor in the society. It is my belief that this facility will serve its purpose,” she said.