Conference report: Health Tech Forward congress

The Health Tech Forward conference took place over three days from the 12-14 October, hosting leading digital health investors, entrepreneurs, and government leaders for exclusive talks and hands-on learning experiences.

The smartphone in medicine: how apps are transforming patient care?

On the second day of the conference, David Maman, founder and CEO of Binah.ai, hosted a discussion on how smartphone apps can transform patient care.

Binah.ai was founded at the end of 2016 and now has over 100 customers, including 10 of the top insurance companies in the world. They are also working with some of the largest healthcare providers in the US, Brazil and Japan to name just a few locations.

David says that an issue of key importance for the company is that half of the world lacks access to essential health services and within the next decade this will only get worse. By 2030, the WHO predict that there will be a global shortage of over 15 million medical staff.

Furthermore, each year, 100 million people fall into extreme poverty due health expenses. Because of the cost of healthcare in some countries, people are often forced to give up medical attention or leave hospitals earlier than needed, with no affordable remote monitoring solutions.

To combat these struggles, Binah.ai has developed a software-only solution which can run on any device with a camera, including smartphones, tablets, laptops and internet browsers. Within a minute, the software can extract vital signs out of a person’s face or from their finger.

The software can measure a patient’s heart rate, heart rate variability, respiration rate, oxygen saturation, stress levels and soon, blood pressure monitoring will become publicly available. There is no need for wearables or any other hardware, just a device with a camera.

The technology works by using light analysis, camera calibration, luminance correction, ROI detection, RGB data extraction and vital signs calculations in order to extract the PPG (photoplethysmograph).

If there is good lighting, the technology will be able to extract the PPG from the person’s face. However, if it is too dark, the PPG can be extracted from a person’s finger with the rear camera and flash illuminated. This is also helpful to those who do not feel comfortable showing their face on camera, which is common in some cultures and religions.

The technology has been tested on all skin types and colours to ensure the entire population is supported. It is still awaiting FDA (USA) and CE (Europe) approval, but has already gained approval from TGA (Australia) and SAHPRA (South Africa).

The technology is not currently available on an individual basis but is instead provided to large companies, giving these organisations the opportunity to integrate the technology into their offering. For smaller companies, Binah Team is available; a ready-to-use platform which allows the company to distribute the technology to their own patients and customers, allowing full control over the visibility of information.

Using VR technology to train medical students: a new perspective and a safe way to practice

Hatim Abdulhussein and Richard Price from Health Education England hosted the next presentation on how VR (virtual reality) technology can now be used to train medical students and other health professionals.

Hatim explains that the challenges presented by the pandemic have encouraged the adoption of new technologies for various reasons. Chiefly, the pandemic has made society realise the importance of preparedness if similar events occur in the future.

To overcome these challenges, Health Education England developed various technologies to help facilitate effective training. For example, trainers have frequently begun to use simulations of patients using 3D image technology, which can be broadcast to students no matter where they are.

They have also developed a hollow lens which allows clinicians to show what they are seeing in real-time. This can be useful on ward rounds, for example, as they can teach trainees who working remotely as if they were in the hospital with them.

During the pandemic, clinicians who used the technology were therefore able to show trainees a much wider, diverse range of cases and offer better training than they would have been able to otherwise.

The technology can also simulate wards, which can be used to build confidence and support people who have left the profession to be eased back into the process, for example those who left on a sabbatical or maternity leave.

Health Education England now want to ensure that this new technology is sustainable beyond the pandemic and that medical training doesn’t slip back into old ways of teaching. To achieve this, they have purchased a wide range of XR equipment, called XR hubs, which are available to all NHS organisations in the UK and can then be loaned out free of charge.

All of the technology is available at The Learning Hub, enabling Health Education England to share the new VR content with learners no matter their location.

Some universities, such as Queen Mary’s in London, are now planning on delivering their medical training in a “blended” format, with much of the training taking place online, as well as the usual in-person sessions.

Health Education England say that teaching both students and teachers how to use this new technology will have tremendous benefits in the long-term, as these technologies are bound to be used in practice settings in the future.

Diagnostics revolutionising patient care: preventing diseases faster

Himanshu Bhatia, Founder and CEO Ricovr Healthcare, hosted a discussion about the company’s “innovative diagnostics platform” which screens saliva for the presence of analytes.

Ricovr’s diagnostic platform, XALIVA, is a small, hand-held device which is capable of detecting a number of diseases and pathogens. Initially, the device was set-up to test for Covid-19 as well as the presence of marijuana.

To test for Covid-19, the user is given a swab which they put into their mouth to collect a small amount of saliva. The saliva is then injected into a tube which contains proprietary nanoparticles. The machine is turned on and the disposable cartridge inserted, followed by the sample.

The device sensor is a U-shaped fibreoptic sensor; the detection sample is then combined with nanoparticles which change the wavelength of the light, which is then detected and the concentration estimated.

In as few as five minutes, there is a quantitative readout displayed on the screen. Ricovr say their device addresses nearly all of the features the WHO is looking for in an ideal point-of-care diagnostic device.

During the presentation, Himanshu explains that while lateral flow tests are a convenient method of testing for analytes in high concentrations, they are not able to accurately detect analytes when they appear in lower amounts or in different diagnostic mediums.

This means lateral flow tests have lower accuracy rates, are not suitable for every case and often produce delayed results which can take up to 30 minutes to appear. XALIVA therefore offers a highly accurate, low-cost solution to this problem.

Ricovr say that their device makes good clinical and economic sense, as it can help to provide early diagnoses and therefore improve patient outcomes, including: lowering hospitalisation rates, reducing downstream treatment costs and cutting avoidable interventions.

How are telemedicine and personalised care technologies addressing the critical issues in healthcare?

Juljana Hysenbelli, Healthcare Lead at Vodafone, hosted a presentation about how new technologies are enabling health professionals around the world to find better, more effective ways to deliver healthcare.

Juljana said the need for telemedicine and remote technologies has grown ever more important since the Covid-19 pandemic began due to the huge backlog of patients awaiting care.

Since we are expecting to see a larger number of patients presenting with advanced, chronic diseases, such as diabetes and cancer, telemedicine is helping patients to get the care they need at a much quicker rate, rather than waiting for a face-to-face consultation, she explains.

Juljana gave various examples of new technologies that are being developed and how they could improve people’s lives. The first was a wearable device in the style of a t-shirt which measures the patient’s vital signs. The t-shirt can be worn remotely at home and sends data to the clinician so they can visibly see how the patient is coping on a day-to-day basis.

The device allows the patient to lead a normal life and is particularly helpful for older patients who may struggle to remember what has happened between appointments. It also allows doctors to give more precise treatments and allows the patient to stay at home rather than being monitored in the hospital.

Similarly, another wearable device, in the form of a wrist band, can be given to Covid patients to help continuously monitor their respiratory parameters. The band can be worn both in hospital to take some of the strain off nurses, as well as at home.

The final example Juljana gave was software which allows surgeons to perform surgery remotely using 3D eyeglasses and a tablet. Using the tablet, the surgeon can manoeuvre the laser and control a gripper to perform the procedure. Others on site can then follow instructions and assist the surgeon in the process. This technology allows for many more surgeries to take place, aiding with the backlog of patients awaiting operations.

Digital vision for health: why is healthcare workflow in an urgent need of transformation?

Michele Tarnow, Chief Executive Officer at Alliance Care Technologies hosted a discussion about the urgency of digital transformation across the workflow of healthcare.

She explains how the Covid-19 pandemic has shown the world how inadequately prepared we are to handle large scale pathogens outbreaks, as well as deliver the normal requirements of healthcare.

Michele says that healthcare needs to change from being reactive to proactive, and that means focusing on preventative care and improving the health of individuals, as this will take the strain off of the system.

Firstly, she says that patients should be involved in their health and should drive their own wellbeing. This can be achieved with devices such as wearable devices – with advancements in technology, soon we will be able to track things such as the functionality of a defibrillator, a pacemaker or a glucose monitor, for example.

Michele uses the example of a patient with heart problems to explain how this technology could improve their life: “Think of a patient who goes to their cardiologist every six months and the cardiologist says, “So, how has your heart been?” and the patient says: “Fine”.

“In the future we will be able to provide that cardiologist with an output report that gives them a snapshot of how the patient has been and how their heart has been performing. We will be able to intervene when a patient starts to have an anomaly in their heart or is nearing a crisis with their insulin management through bidirectional communication that provides quantitative data of the patient’s health status and outcome,” Michele explains.

In terms of clinical workflow, Michele says there is “tremendous opportunity” to improve provider satisfaction therefore reducing burnout among healthcare professionals.

Providers spend a lot of time documenting their engagements with patients, by either typing, writing or dictating their encounters, and as providers have become more pressed to see more patients, documentation has become increasingly incomplete or erroneous. AI technology could help to hugely reduce the time spent on these tasks, giving them more time to spend with patients.

AI software would also allow for data capturing about patients’ diagnosis and treatment, which could then be used for research and continuous quality improvement, reducing clinical variation.

AI diagnostics are also growing rapidly, particularly in radiology, but are also emerging in digital pathology. They work by utilising machine learning algorithms that have the ability to quickly and efficiently identify areas of concern and eliminate mundane tasks, such as manually counting the number of cancer cells in a tissue biopsy. These emerging solutions have the ability to identify cancer before the patient has symptoms, which would help to provide better outcomes for the patient.

Finally, Michele says telehealth services can help to establish global care networks, allowing patients to access diagnostic care best suited to their needs, irrespective of their geographical location. New health technologies therefore have the ability to improve global health and urgently need to be implemented, “because there is no later.”

Meeting patients where they are: rethinking cancer clinical trials

Rebecca Wright, a director in digital science at AstraZeneca, discussed how the company is revolutionising cancer clinical trials by putting the patient first.

“Our ambition is to provide cures for cancer in every form. We are following the science to understand cancer and all its complexities to discover, develop, and deliver life changing treatments, and increase the potential to cure,” explains Rebecca.

Since clinical trials are the key to making progress against cancer, adding digital health solutions as a default part of their clinical trials is helping AstraZeneca to progress closer to a cure.

For this reason, they are increasingly using digital health solutions to improve the patient experience during clinical trials. In this way, trials can be tailored to fit the needs of patients, improving patient recruitment and retention and therefore positively influencing their success rates.

Secondly, digital biomarkers allow AstraZeneca to expand their opportunities for clinical endpoints. By using digital endpoints, there can be an improvement in measurement precision including specificity and sensitivity of signals, efficacy and safety.

Thirdly, digital solutions offer a huge opportunity to diversify clinical trials – an issue which has presented prominent barriers for a significant period of time. For example, one study showed that patients from lower income areas travelled a median of 58.3 miles to partake in a clinical trial, compared with 17.8 miles for patient from high income areas.

Trial decentralization can therefore improve access to new drugs and help to improve health outcomes for everyone, not just those who can access it.

Digital solutions can also offer patients better monitoring and support outside the clinical visit itself. Patients therefore feel more supported and any interventions can happen more quickly. This allows for better care and better health outcomes.

These solutions can also offer significant cost savings, as sites will have more time to manage more patients, enabling fewer visits per patient. Trial dropouts also typically reduce when long commutes are reduced or eliminated completely.

So, what are the solutions? Rebecca explains some of the digital technologies AstraZeneca use to improve the efficiency of clinical trials:

• EHR screening and e-consult give AZ the ability to quickly recruit diverse patient populations.
• Improved engagement tools, such as websites (which clearly explain what the trial is for and who it is suited to) and training materials are used throughout trials to improve patient experience.
• Telehealth visits enable patients to speak to healthcare professionals when they need and want to.
• Healthcare apps with digitised reminders are used to prompt patients when they need to take medications, complete specific tasks or activities, and attend their study visits.

Ultimately, Rebecca says to be successful, digitised clinical trials must be designed with and for patients. We must be aware that simply “making things digital” doesn’t always improve the patient experience and tools therefore need to carefully crafted to make them beneficial.