Season 4: Telehealth's Quantum Leap into Patient-Centered Care
As a result of the global pandemic, telehealth has become a more comfortable tool for healthcare delivery. The reality is that the way we see telehealth today will look very different tomorrow with more technological innovations and new approaches to administering health beyond the hospital walls. Still, more importantly, it will need to be patient-centered.
Season 4 features conversations with the rising innovators, researchers, policy stewards, clinicians, and industry leaders discussing solutions on accessibility, integration, security, inclusivity, and the other necessary ingredients to migrate the future of healthcare to a patient-centered continuum of care.
Wearing It: Intelligent Physical Rehabilitation
How can we take physical therapy (PT) to the next level using real-world data from tools and devices without having to leave the home?
Josh Rabinowitz, Co-Founder & CEO at Articulate Labs, joins our host, Maria Palombini, in a discussion on a new class of RPM devices that are enabling a viable option for remote patients who do not have access to a facility, but can still rehabilitate with more data and insights to improve their outcomes with or without a certified PT therapist at their side.
Co-Founder & CEO, Articulate Labs
Josh Rabinowitz currently serves as Co-Founder & CEO for Articulate Labs, a medical device company developing wearable devices to accelerate muscle strengthening and training. In this role, Josh is responsible for fundraising, business development, proposal writing, communications, team/advisor recruitment, and continual corporate improvement. Accomplishments on Articulate Labs’ behalf include multiple awards, letters of interest from hospital systems, risk-sharing partnerships with vendors, pieces of media coverage, and support from nationally recognized health-tech accelerator programs. All the above stem from a drive toward continual improvement in both self and company as a servant leader that starts with unflinching honesty and ends only with quantifiable change.
Hello, everyone! Welcome to the IEEE SA Rethink Health Podcast Series. I’m your host, Maria Palombini and I’m the Director of the IEEE SA Healthcare and Life Sciences Practice. This podcast takes industry stakeholders, technologists, researchers, clinicians, regulators, and others from around the globe to task: how can we rethink the approach to healthcare with the responsible use of new technologies and applications that can afford more security, protection, and sustainable, equitable access to quality care for all individuals. This is an ambitious task, but this is one that we are definitely committed to.
We’re going into our fourth season of the Rethink Health Podcast, and you can look at our other seasons at ieeesa.io/healthpodcast.
So we’re getting into the question of telehealth. As a result of the recent pandemic, the term telehealth has become one of those most frequently used and it does not appear to be going away soon. The reality is that we see telehealth today and it’ll look very different tomorrow. It’s manifesting in many different forms. And it’s not commonly, as we know it, just the doctor and patient experience in some sort of audio/video platform. It has become so much more than that. And I’m sure you’ve heard the term remote patient monitoring or RPMs.
The telehealth experience has changed our expectations as patients on what we can expect on healthcare services. By that I mean, we kind of see it almost like a retail experience, right? We want VIP consierge service, we want amenities, and we want convenience.
And then there’s this growing RPM space. These wearables, these bio sensors in, on, or around the human body monitoring us for some sort of therapeutic condition. There’s so many different forecasts when it comes to the growth of RPM, it could be anywhere from U.S. 150 billion dollars by 2028 and to the idea that a patient might be wearing one or more on their body at any given time.
Here’s what we know, regardless whether we call it telehealth, RPM, mobile health, the future of delivering healthcare is no longer just confined to a facility and it will need to be patient-centered. So, season four. We’re calling it Telehealth Quantum Leap into the Patient-Centered Care.
And this gets to the innovators and the innovators we’re talking to are actually the winners of the IEEE SA Telehealth Virtual Pitch Competition. Plus we’ll talk to industry leaders, clinicians and other researchers who are at the forefront of driving innovation with solutions, looking at accessibility, human factor design, flexibility, interoperability, security, inclusivity, and all the other necessary ingredients to migrate RPM into a patient-centered care system.
So before we begin– a short disclaimer: any of our guests on our podcast series, IEEE does not endorse their products, does not financially support them. We just bring them here for their expertise. And without further ado, I’d like to welcome Josh Rabinowitz Co-founder and CEO, of Articulate Labs. Welcome, Josh!
Thank you for having me!
Articulate Labs garnered the second place position in the IEEE SA Rethink the RPM Machine Virtual Pitch Competition and their work was on wearable devices for remote direct physical therapy application and monitoring. And we’re gonna get to the core of this in just a second, but Articulate Labs has also placed favorably in other industry competitions, including winning the 12th Annual IOT Wearables Technology Innovation Award, plus a host of others.
So Josh, before we get to the core of the work you do, we’d like to humanize the experience for our audience. So can you tell us a little bit about you? You’re a co-founder of articulate labs, really? What drives your passion in your work and how did you get here?
I’ll start by answering the second question first. We got into this quite literally by accident. My co-founder survived a near fatal motorcycle accident some years ago that forced the amputation of his right leg. One of the indirect outcomes of that is that he developed osteoarthritis in the knee of the fully intact leg, the left leg, as he was relearning to walk.
He was advised by his orthopedic surgeon to delay surgery and to exhaust all the conservative options available to him. He found physical therapy to be the most effective means of mitigating the pain and dysfunction that existed in his knee, but he wasn’t able to make it to all his physical therapy sessions.
It was not a lack of desire. It was an issue of time. He had work commitments. He had family commitments, the physical therapy clinic was a half hour drive each way from where he lived. It was a really difficult thing for him to be able to budget time for self care.
He’s a control systems and an embedded design engineer. He’s using a therapy at physical therapy called neuromuscular electrical stimulation. He’s like having these electrical pulses run through the quadrants of muscles around that knee to assist with the restrengthening, the retraining process.
But it’s operating on a pre-programmed sequence and he’s wondering why on earth am I driving a half hour to basically move my leg in time with this thing? Why am I following this technology? Why is this technology not following me? Why is it not adapting to me? It’s kind of what started his development process and figuring out can he make this therapy a little bit more intelligent, a little bit more adaptive.
I got involved as someone who has no engineering or medical background. Just one day randomly looking up knee osteoarthritis and discovering, oh, there’s actually 14 million in the us impacted by this. Not to mention the tens of millions of others around the world with the same condition, not to mention hundreds of millions, around the world, dealing with all kinds of other muscular skeletal conditions.
And we found out, one, this is not a unique situation. We were both operating under the impression this was something that only impacted amputees and two, a lot of other people have the exact same issues of time, distance, reimbursement of existing commitments, all making access to physical therapy very difficult. Realizing those things made us wonder whether the thing that you know was kind of being developed almost as a hobby, as a side project is something that we might wanna really consider sharing with others.
It’s interesting that you brought up the unfortunate accident with your partner. As I talk to many more startups, I always find that there is a personal passion behind, especially in the healthcare life sciences sector, why they decided to go with this type of RPM product or that kind of thing. And that’s really where the success is. It’s that passion that fuels that commitment. So this is not atypical from what I’ve heard from other co-founders that I’ve talked to.
So you kind of got into a little bit about what Articulate Labs does. What exactly in your words is the vision of bringing this type of innovative approach to physical rehabilitation, to the healthcare domain?
I’ve been through, like other people, physical rehab for different sort of issues and I agree, going to the facility, getting the appointments, waiting for your therapist sometimes they run late, sometimes they don’t, or you can’t get there. There’s like a whole host of issues that you kind of sometimes feel like it’s almost like a job, right?
The mission that’s going to resonate with the greatest population, I think, is going to be convenience. When we think about the act of strengthening the muscle that talking about, well, how do we make this easier? How do we make this more convenient? How do we blend this more into the user’s lifestyle? It is somewhat antithetical so much of the ethos that goes into physical fitness.
That part is difficult, but so much of the issues that we run into with regards to access, is a population of people that cannot budget time for self-care, don’t feel like they can, or don’t necessarily know how to start. And being able to effectively augment movement that they’re going through every day with a proven therapy such that steps walking up and downstairs or getting out of a car, can become strength-building repetitions outside of that physical therapy clinic or gym.
You know, now there’s really an opportunity to help improve access, improve people’s ability to care for themselves on a broader, deeper, longer term. My mission would be in finding ways to talk about the process of strengthening rehabilitation of caring for the body as something that’s for everybody to get outside of the stereotypes or concepts that if you’re not looking like someone who’s showing up at one of the Marvel action movies, then why are you even going to the gym? What’s the point? I think there’s a real need to talk about maintaining your body, because this is your primary vehicle. This is your means to functional independence, to in many cases, to goal achievement, whether it’s travel or caring for loved ones or doing things that you enjoy, you’re having the strength to function the way you want to, not the strength to measure up to someone else’s standards.
I think the focus on self care comes in many different forms and I think it is important. Now we’re gonna get to the core of our interview, which is about the innovation. So I imagine your team really got into some heavy research. You probably looked at different models and there’s probably years of work and R and D that went into developing this project.
Maybe could share a little bit of insight with us on what that experience was like and what exactly. But more importantly, I’m really interested to hear what would you consider the most astonishing piece of information that came through in that R and D phase of research for the product?
I think the main astonishing outcome and the thing that we’ve had the hardest time explaining to others is that there is no average when it comes to figuring out where people need to be or where they want to be. Especially when you’re talking about people who’ve been coping with and in our case, a knee condition, but really anything on the kinetic chain.
So anywhere between lower back and ankle. When you have an injury in one of these places, you have a tendency to develop compensatory movements as a means to reduce pain in that area. So you might think about the folks we’ve seen in our studies, people who are looking to avoid putting weight on their knee or to avoid extending their knee will develop all kinds of strategies to not use that joint.
Whether they’ll pivot on their other leg, they’ll actually hitch the entire half of their body with the affected knee, they will drag the leg with the affected knee, somewhat behind them. All these things are unique to each individual and the way that these things worsen over time is unique as well.
So every happy gait is the same. Every unhappy gait is unhappy in its own way. Attempting to impose a pre-programmed gait sequence on these individuals and forcing them into a template we found, first of all, it was very difficult to actually trigger the right muscles at the right times.
Going with this average, looking more into relationship between specific quadricep bands and the function of the knee joint during movement, you actually run the risk of exacerbating the condition. If you are strengthening without regard to joint laxity or joint alignment, that really created a need to kind of scrap any sort of template based stimulation, and really start with a form of a model of the joint running on the device that is learning from and effectively distilling movements down into just sets of force vectors as a function of femur and tibia position, motion, acceleration, et cetera. And we really try to just meet the patient where they are. Working with physical therapists to calibrate the device to that user’s gait and to determine which muscles we want to trigger at what times of gait, which movements are problematic, that should be addressed by triggering muscle contraction.
That’s our way to personalize treatment. Something that you said at the beginning that really stuck with me: patient centered care. That’s our opportunity to make truly patient centered care versus imposing our own biases as it were about how a person that we’ve never met should walk.
Absolutely. We see this sort of challenge actually transcend the entire healthcare domain. It’s putting patients in a box. I think it’s really important the way you guys got to this level of, I don’t wanna say personalization, but maybe there’s an element of precision on how to use the technology to best support helping these patients.
I imagine our audience might be sitting there and saying, wait a minute, does this mean that we don’t need physical therapists anymore? We know that KneeStim, which is one of your products, is not designed to remove the physical therapist out of the process. But I think the real opportunity is in when you guys describe it is intelligent.
So from your point of view, how can KneeStim really enhance the effectiveness of a physical therapist in working with their patients? I imagine the data capture in the tool can access and utilize. Maybe you could talk a little bit from that point of view.
Sure. The first thing we’ve said when we’re talking with physical therapists who might have a little bit of that skepticism first, there’s a lot in the electrical stimulation space and two, there’s been a lot of startups that have marched into clinicians’ offices, kicked in the door saying we’re gonna drag you, kicking and screaming into the 21st century without really paying any attention to their wants and needs. So first I wanna say right up front, we get skepticism and don’t begrudge anyone for it.
The way we manage that is by saying, we’re not looking at this as a means to replace physical therapy. We’re basically taking some of the most mindless parts of your work, which is either setting someone up for electrical stimulation or guiding someone through strength-building repetitions.
And we’re trying to automate that and allow at least some of that work to occur outside of the clinic. Then you can talk about this as a means of improving workflow, saving little bits of time with each patient, as a means to increase throughput ways to maintain a level of communication with the patient that’s not present.
That’s a huge issue. You touched on earlier with regards to your physical rehabilitation experience: 70% of the population that’s prescribed physical therapy don’t show up for all their sessions and are not compliant with their home-based regimens. That represents a financial impact to the physical therapist beyond the altruistic drive to do right by their patients.
When you have a patient that’s not showing up, you’re not earning money. You have a patient that cancels or no-shows, now you’ve got the opportunity cost of having scheduled someone that isn’t gonna pay you and delayed someone that would. With a new remote patient and remote therapeutic monitoring based reimbursement codes, there’s now opportunity for the physical therapist to be able to have some level of visibility on user activity that we’ll be able to measure and report things like steps walked, stride speed, knee range of motion. We’d love to be able to provide a granular level of information to make it clear also what’s happening on stair ascent and descent, or sitting up from a chair, other metrics to make it clear whether someone is making progress in their physical rehabilitation, or if they are at risk of back sliding. By having that data collection and analysis process be reimbursable, now there’s an opportunity for the physical therapist or overseeing clinician to be able to earn some revenue on the patients that they’re not getting to see.
Physical therapists have been really deeply impacted by COVID, in general, just by the increasing difficulty with getting people in the door with decreasing reimbursement for services provided. We see this as a way to be able to provide care and maintain communication while still helping maintain the physical therapist’s bottom line.
Yeah, I think for physical therapists there’s a lot of opportunity here with access to data, for sure.
I hear misconceptions around connected wearables and from doctors sometimes they’re like, I don’t know if I wanna use this thing. They’ve got some preconceived notions about them and patients they really know about wearables from the point of commercial fitness trackers, Fitbits, you know, your Apple watches and so forth. What have you seen as the biggest misconception when it comes to these types of applications for connected wearables?
Really the biggest misconception I see is really less on the patient or provider side, it’s really in the service provider side. There are a lot of companies in the wearable space and the vast majority of them don’t have to be FDA regulated. They don’t have to really be deeply concerned about security. If they are they’re concerned at a really thin surface level, they don’t have to be concerned about encryption. They only pay a small amount of attention to HIPAA. The misconception I’ve run into that’s been the most difficult to deal with is actually finding vendors to work with on some of this development work that are able to meet the standards for security, for privacy, that are coming, not the ones that are here.
We see Europe as an example of where we think might go over here or at the very least it’s a market that we want to enter in the future and we will need to be able to meet standards for privacy. The number of companies we’ve talked with, who claim to do this work and then have really no idea of anything that’s going on, that’s gonna be necessary for a medical device versus a “wearable” or versus a fitness application. And assuming that we’ve done one, so we can do them all. That’s dangerous. We’ve had to push ourselves to learn what these standards are to really understand them. And then to really grill any potential partner that we meet with on how they intend to meet these standards. And more often than not, we’re kind of met with blank stares.
So I think anyone else who’s in this space, or who’s looking to get into this space I think it’s critical to build up a base level of knowledge of security, privacy encryption, and so forth. I don’t know enough to be able to actually affect anything, but I know enough to be able to challenge and to oversee anyone who’s gonna be doing this work on our behalf.
That’s really important. You wanna make sure you have the right partners because overall it’s a brand representation and you have to have it be aligned. Very important point.
You started to scratch the surface of this question a little bit when you first introduced Articulate Labs, but you know, the theme of this podcast is patient-centered. The competition was heavily focused on this idea of transforming RPM into patient-centered system. How do you see your technology being patient-centered from a point, whether it’s from accessibility, visibility, inclusivity, or even just the human factor design? Do you see that there’s a population of patients that you all can better reach and serve with this that maybe they were not accessible before, or they were just resistant to the idea of physical therapy? How do you think you guys are really meeting that idea of patient-centered?
I think that element of starting with a very basic concept of how that knee joint is functioning and building the model from the ground up with the user’s own kinematics, with the data coming off of the IMUs, being placed on their legs makes sure that the model that develops is exactly what the patient is what they’re doing. That there’s no concept whether at age, gender, physical ability, that it doesn’t create a conception about what someone does or does not need. It is putting a lot of control in the hands of the overseeing clinician to be able to tailor the stimulation timing and location, and also be able to adjust sensitivity, bias stimulation to one muscle over another, as a means to really make sure that this is hitting the right muscles at the right times at gait, or is contracting the right muscles in time with problematic movements as a way to ideally make those movements a bit easier for the patient.
I think one real interesting possibility that we have here for inclusivity and for access is the ability to provide physical medicine care to people in remote or austere conditions. This is certainly something that is already capable with a lot of the remote or virtual physical therapy options out there and we don’t view ourselves as placing any such service like that. What we see with this device is the ability to really augment and make use of someone’s existing movement. So the people who are in these conditions, they may be like an hour away from a physical therapist. They may be doing work that makes it really difficult for them to set aside even 15 minutes to follow along with a guided physical therapy session. With these populations, there’s an opportunity to use their actions, use their movements and get the same strength-building exercise in without requiring the patient to set aside additional concentration, additional time to change clothing, so and so forth. This is something that ideally will blend in seamlessly into the user’s life and we’re passionate about the possibility of having care, not just augment life, but having it be in support of life. The work that you’re putting in while wearing this device, the strength and reeducation of that muscle that you’re going through is gonna be exactly in line with the things that you’re already doing, the things that you want to do, or the things that you need to do.
I think that’s really intriguing to us and represents a way to integrate physical medicine into people’s lives that hasn’t really been approached previously.
I think that’s fascinating. I think this goes a lot into human factor design, the adaptability, the feasibility, these are all really important elements when we’re talking about patients and their physical ailment or condition. I think that’s really an important place and a good place to be in getting your product advocated for. You want patients to say this was the best thing that worked for me. So I think you all are on the right track for sure.
When I talk to a lot of tech startups, they say to me, oh, I wish we had a technical standard for this. Or I wish this was already in place because this would’ve made this part of our work a bit easier. So, do you think there was potentially any technical standards, if any, that would’ve been appropriate or data standard that would made any aspect of developing this product faster, more efficient, easier?
And as you went through the process, did you identify any other areas that you said, wow, this would’ve really opened the doors to innovation in our space, in the RPM space, in the wearable space. And what do you think might be the best way to address it or to go about it?
I’ll hit the second question first and say any standard that’s out there, it’s nice to have as a guidepost, but for our purposes, it’s got to be either harmonized or at least asynchrony with the FDA’s doing. If we don’t have the FDA on our side, we’re not selling anything to anyone in this country, at least. And furthermore, the FDA tends to be a gold standard adopted by many other countries that have distributors reach out and be interested in buying our devices.
So getting FDA clearance is not just the gateway to the rest of the U.S. It’s the gateway to get into much of the rest of the world. In that regard, I’d say for us having anything around FDA documentation or standards around use of real time operating systems within a medical device, there’s not a lot of that out there that I’m aware of at the moment.
I could be completely wrong here. But we’re only aware of a small handful of medical specific operating systems, none of which wound up being applicable for what we’re trying to do, because we’re trying to achieve real time application of therapy that does not line up with a lot of existing devices in the medical space that tend to be set up boxes with sets of leads or electrodes or some form of input or output that basically relies on the person remaining stationary. Having more wearable technology means having more firmware that’s operating in a really dangerous space. We’re fortunate standards wise that nothing that we’re doing here really has high risk of ending someone’s life.
But that is not the case if you’re developing a pacemaker or if you’re developing a next generation joint implant. So having frameworks in place for the next realm of operating systems and really having frameworks in place for technologies that are going to be semi-autonomous. And understanding what are the bright lines past, which autonomy cannot be allowed.
There has to be fail safes in place to stop AI from deviating in such a way that it leads to a deleterious outcome for the patient or a potentially fatal one. I think those are the places where right now we don’t see a lot of definition. And we have a path that we see to market based on previously clear devices.
But we also recognize that we’re still looking at bringing something that is gonna be relatively unique to the medical device space. So we’re hoping that us punching through will be an opportunity to broaden the discussion about software and firmware development as we get more into wearables as we get more into decentralized care.
I think inevitably need to start putting more faith or energy or authority in technologies that are gonna be assisting people on medical conditions when a clinician’s not physically present.
Absolutely, I think the FDA and EMA depending where you are in the world cannot lose sight. It’s really important to be compliant and under their guise when it comes to anything that you’re gonna use in a medical application.
Josh, you’ve given us so many great insights, especially with the application and what you guys are trying to treat. Are there any final thoughts you would like to share with the audience when you say I’m gonna develop technologies under the context of patient-centered care?
We’re actually hosting some students right now in biomedical engineering and one of the most disturbing things that come outta that situation is finding out that they’re looking at adapting, what we’re doing to the knee and fitting it onto someone’s hip.
And they wanted to actually physically prototype the dose, not even adding in electronics, not adding in simulation. Just trying to understand how to get a device to fit around a leg and the professor, as we understand it, basically kinda came screaming into the room to knock the materials outta their hands and said, no, you will only simulate this.
You will never build a single item until run this through whatever simulation package you want. And that makes a lot of sense for like an implant. Trial and error is not a viable there. For something like this, if you’re looking at developing a wearable, then yeah. By all means, try it on yourself.
That’s so much of what we had to do in terms of figuring out a form factor, figuring out how to address corner cases that would exist during gaits such as, you know, stamping your foot or sneezing or stepping off of a curb. Those are only things that we are able to figure out solutions to because we are trying this on ourselves.
For one thing, if you’re not willing to try this on yourself, or if you’re nervous or embarrassed or think about the clinician or the patient that you’re gonna be talking to. How on earth are you gonna convince them if you can’t even convince yourself?
The other thing, going back to the concept of patient-centered care and to some extent, the idea of unconscious bias, we didn’t know what this device needed to do until we had the opportunity to approach the subject with a wide variety of people– different age, gender, size, gait abnormality– all had unique points of view about what they needed out of the device that we would not have figured out and this being founded by two men, a lot of conditions or a lot of situations with women with regards to leg shape– the aesthetics, to some extent, the act of shaving your legs, opening up pores, across which current bridge the gap and create pain.
Those are things we had to learn about from others in the course of controlled experimentation, to make sure that we are developing something that other people would actually want, not just what we would want. So much of this, I think really comes down to experimentation, obviously with full respect and understanding of what the standards are imposed by FDA, understanding institutional review board, how they operate such that when you set up this experiment, you’re doing so in a way that’s ethical and safe.
But you’ve got to be able to try this out and discover problems that you would not have come across otherwise. You’re not gonna simulate your way out of it. You’re not gonna guess your way out of it. The best way is just have someone else break your stuff and tell you what’s wrong.
That’s an interesting point. I think here, if I may, maybe the moral of this part of the story is that one size does not fit all. It’s really important because you tend to think, oh, it works here. Let’s just apply. Make a little change and put it here. So really glad you drove that home, Josh.
Josh, I wanna thank you for joining me today and sharing this great insight, the innovation, and the dedication to precision therapeutic that you’re building for this pool of patients. Thank you for being here and sharing that with us.
Thank you again for having me. I really appreciate the opportunity.
If all of you out there wanna learn more about Articulate Labs, you can visit articulatelabs.tech.
Many of the concepts that Josh and I discussed today are addressed in various activities here at the IEEE SA Healthcare Life Science Practice.
The practice really engages industry stakeholders, such as Josh, around the world to come together and bring these discussions forward. As you notice, Josh already started to allude to that there are some concerns and challenges we have to look at when it comes to autonomous systems and the use of AI. They’re great technologies, but we need some more safeguards there. How can we do this in such a way that we’re gonna really open the doors to innovation and not be a barrier and kind of get this elephant out of the room?
So if you’re interested in getting involved in any of our activities, we have WAMIII (Wearables in Medical IOT, Interoperability Intelligence,) and Transforming the Telehealth Paradigm, which are Industry Connections Programs and they’re really getting to the core of all these connected technologies being used in a remote environment to address patient’s needs with privacy security, the flexibility, the human factor design– they’re attacking all these issues. If you wanna find out more about the work of the practice and all these individual programs I mentioned, please visit us at ieeesa.io/hls.
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I wanna thank all of you for joining us today and listening in, continue to stay well and until next time!
Breathing New Opportunity: Keeping Asthma Patients Connected
Breathing is essential; how we breathe is just as important. RPM tools offer an amplified opportunity for visibility for those with chronic conditions such as asthma. A majority of asthma sufferers are children, which means monitoring and getting real-time understanding of their condition is that much harder.
JC Ren, Assistant President at CMI Health, shares how the latest RPM tools offer both real-time monitoring to parents and caregivers while making it convenient for children to utilize to help better monitor their condition.
Chief Operations Officer, CMI Health
JC Ren is the Assistant President of CMI Health. He is involved in many key aspects of the company, including new product development, sales, 2B tech support, regulations, and daily operation. JC is also project lead of CMI Health’s new AsthmaGo solution.
JC has been with CMI Health since 2015. Prior to joining the company, he earned a Master’s degree in electrical engineering from Georgia Institute of Technology, and a Bachelor of Engineering degree in Electrical Engineering from Vanderbilt University.
Hello everyone and welcome to the IEEE SA Re-think Health Podcast Series. I’m your host, Maria Palombini. I am the director and I lead the Healthcare and Life Sciences global practice here at the IEEE SA. This podcast series takes industry stakeholders, technologists, researchers, clinicians, regulators, and more from around the globe to task and we asked them: how can we rethink the approach to health with the responsible use of new technologies and applications that can afford more security, protection, and sustainable, equitable access to quality care for all individuals, you can check out our previous seasons on ieeesa.io/healthpodcast.
As a result of the recent pandemic, the term telehealth has become one of the most frequently used terms and it does not appear to be going away. The reality is the way we see telehealth today will look very different tomorrow. Telehealth is manifesting in many different forms. It’s more than what we commonly see as the doctor/patient exchange on an audio or video platform and it continues to grow with the use of RPM, remote patient monitoring devices. The telehealth experience has changed the patient’s expectation on healthcare services. They’re relating it to more of a concierge-level retail experience: convenient, appropriate, and in-person.
There is a growing RPM space. There are many forecasts about RPM devices- anywhere from US 150 billion by 2028 to estimates that 40% of patients will be utilizing one or two of these devices at one given time. But there’s one thing for certain, regardless if we’re talking telehealth, mobilized health or RPMs, the future of delivering healthcare is not confined to a facility and it will need to be patient-centerED.
Season four of this podcast series, Telehealth’s Quantum Leap into Patient-centered Care, talks to the innovators. These are the winners of the IEEE SA Telehealth Virtual Pitch Competition, the industry leaders, clinicians, and other researchers who are at the forefront of driving innovation with solutions on accessibility, human factor design, flexibility, interoperability, security, and a whole host of other necessary ingredients to migrate healthcare in the form of telehealth to a patient-centered care system.
So a little short disclaimer, before we begin: IEEE does not endorse or financially support any of the products or services discussed by our experts in this series. And with that out of the way is my pleasure to welcome JC Ren, Assistant President of CMI Health, Inc. Hi, JC!
Hi, Maria. Thank you for having me. It’s an honor to be here.
Absolutely. So JC and CMI Health are the producers of a device called AsthmaGo. It’s an RPM device. AsthmaGo is a HIPAA-compliant asthma solution that consists of smart home use medical devices, a mobile app, and a physician dashboard. AsthmaGo is a great innovation.It placed third in the IEEE SA Re-think the RPM Virtual Pitch Competition.
So we’re gonna get to the details of the innovation because innovation comes with a solution. But before that, JC, can you tell us a little bit about you? You’re Assistant President at CMI Health. What drives your passion to work at this organization?
So CMI Health is a startup company. We specialize in medical devices, both clinical and for consumers, and we are a relatively small team but we really make a big impact in the industry. And then to all of our customers, it’s really a great industry to be in healthcare as well as we are highly involved in the telehealth and the RPM sector. So it really feels good to know that our products are helping people and improve their life quality, improve their medical outcomes.
It’s a good feeling to read all those customer reviews online, like the Amazon store to learn about how our products improved their life.
Absolutely. You know, I’ve interviewed quite a few innovators, especially the entrepreneurs and there seems to always be a human story behind their innovation, their products. When it comes to AsthmaGo, can you share with our audience, what was the driver behind the development of it? Was this shaped by perhaps a co-founders own experience with a friend or family member or maybe something they were exposed to while they were doing undergraduate work at a university? What was the driving motivation of bringing this product to the market?
I first started to learn more about asthma when I was in grad school. I did a small project when I was at Georgia Tech. It was a children’s hospital project with child asthma. That’s how I started to recognize this huge population, how severe it is. But the actual story behind this is one of our partners had a conversation with his golf buddy and his friend has a son with asthma. He’s really worried about his son’s sleep because sometimes there might be an attack or sleep disorder caused by the asthma condition. So he’s really worried that he cannot fall asleep. He has to get up and see his son so he really wanted something to monitor closely every night. During the sleep you wanna know his son is okay so both him and his wife feel safe.
Unfortunately, we hear more and more about children suffering from asthma for many different reasons. And of course, I imagine that brings a lot of stress to parents everywhere in the world.
So to our audience, now we’re gonna get to the core of our interview, the innovation. Just food for thought: RPM, remote patient monitoring, is more than just a device and a telemetric way of transporting information. It has to be a care system that is built around not only the patient’s therapeutic condition, but also their social and other home determinants. And JC just started to allude to an exact use case when it comes to children in the home and fear of quality of life and worrying. Your child is not breathing right. And all these kinds of other issues. We know that according to the World Health Organization, asthma affects an estimated 262 million people.
And that was in 2019 and caused 461,000 deaths. So this is not something that we can just push to the side, right? It is a non-communicable disease that affects both children and adults equally. So JC, how does AsthmaGo support this very large and diverse population of patients?
Asthma is like a typical chronic disease, so being like a chronic patient. So it’s more like a lifestyle. Everything in your life is being influenced by the conditions and there’s such a huge population. So we keep in mind that the key concept is we want to help the patient to manage asthma at home. That’s where they spend most of the time- at home.
But at the same time, they have to fight this condition. If it’s managed properly, it can minimize the impact. So we are empowering the patient and putting them in the driver’s seat of asthma management. So to accomplish that, we use this simple and very user-friendly mobile app. Because, everyone has a smartphone and that’s becoming part of everyone’s lifestyle.
So we just use the mobile app. So making it like the morning routine or something that is at their disposable anytime, anywhere. And then we also have those over the counter devices that’s really affordable and easy to use and to care that way they can do the test anywhere. And then know their vital readings so they can know early, if anything goes wrong, if they need to use a medication, they need to see the doctor by doing all that very conveniently and right out of your pocket solutions.
We can prevent a lot of the exacerbation and ER visits from happening, greatly improve their quality of life, and reduce the cost.
Absolutely. I think that you’re right. It’s a really good way of saying that asthma is a chronic condition and it’s just not gonna go away with a simple antibiotic. It’s living with a lifetime condition.
So you mentioned this a little bit before in your intro, when you were doing your studies, you were exposed to people with asthma, children. Can you share with our audience a little bit about the types of research, the modeling, and the years of work and time that went into developing this product? And in that research, what would you say was the most interesting thing that came out through this research and development phase of this product?
So let me start from our company, how we get started. One of the founders, he has 30 years of experience in the medical device industry, particularly in the respiratory area, like CPA machines, things like that.
We started in the oximetry business, like oxygen monitoring before we developed this product. We do a lot of sleep apnea monitoring because the patient’s oxygen will fall rapidly during sleep because their breathing stops. So the solution can develop from there. We have some manufacturing partners that are specialized in spirometry devices and they try to make something that’s very affordable and easy to use at home because we found it’s really difficult for the patient to manage this condition at home. Most people rely on doctor’s visits maybe once a month or so and that’s clearly not enough. So we have developed this spiraling device, that over counter spirometry, and we developed it, using a different technology that’s a pressure sensor different from the traditional turbine, which is derived from a hospital grade desktop unit. And at the same time, it’s easy to use and to maintain lower cost than the common units in the market.
So that’s how we developed one of the key devices to bridge the gap and appeal to a huge population without compromise, like accuracy or reliability. That’s how it starts and we also combine our specialty, right? Oximetry, so the patient or the child can be monitored continuously throughout the night, lowering the risk or the parents worry that something may happen during the night.
Absolutely. This is a nice segue to my next question. So we know that asthma is a common chronic disease among children, unfortunately. And like you said, parents are worried, right? They’re worried about when they’re sleeping and they’re getting enough oxygen. Obviously there’s a lot of concern there, but we also know that children are traditionally not the best at patient adherence- they’re children. They’re like, I don’t wanna wear this thing. I don’t wanna touch this thing. Their mind is in a million other places. So how do you find children using this product? Do you find that they’re compliant, that they’re using it correctly? They’re using it at the specified times they need to use it? Do you find that parents are not complaining? Oh, my child doesn’t like to use this thing. WHat are you finding in that specific area of opportunity and working with children?
Yeah. So we actually have this in mind during the whole kind of development process. So for example, our spiral link spirometry device has a really nice and narrow mouthpiece opening.
So that’s gonna be easier for the children to blow into it. And also for the oxygen monitor. Our oxide watch, we have a kids version. So for adults, they have a big finger sensor, but we have those little fingers with nice colors, like a bright blue color or pink color for the kids and with a tiny little finger sensor.
So our product has age groups and also for the children. We’re also working with some groups, trying to set up studies for children, to see their compliance and to see the best way to improve adherence. And then the outcome. There are many ways to get there, like things that appeal to children, like better UI design of the app, or even like the daily routine testing, more fun things like those. We don’t have the final product yet, but we are in the kind of active process of developing.
There are so many devices we talked about, they’re coming into the market in many therapeutic areas, many different applications and so on, but we’re seeing sometimes this one hit, I call it a one hit wonder approach, right?
We’ve developed this device. We put it on the market. It’s a monitoring device. It can connect to an app. It can collect and transmit data. And then we have to wait. The next version comes out for it to do the next thing. And you start to talk about, this is the interesting point of your particular innovation.
It’s scalable and extensible. And I wanna get your point of view when you were developing this RPM device, why did you find it important to have that in the product design and how did you feel that would best serve the patients that you’re trying to help?
Yeah, I think the key concept and the thing we always think about is the patient. So our goal is driving the patient, motivating the patient, making everything accessible and then convenient. So they have everything they need and they can do it very easily. And then, we don’t focus on one specific device. We think about it as a whole concept, the whole idea, a solution to help people with asthma.
So one thing we keep adding different devices. So it’s like different tools for the patients at home, at their disposal. For example, like a brace trainer because managing the disease testing is one thing the recovering/training exercise is another important part of this condition like chronic disease and also like inhaler, counter.
So many of these will play a critical part in the patient’s life. So we can try to make their life easier, not only just focusing on one device. We’re focusing on the patient and also with the API and SD case of our devices, all these great devices that we have are not only available to us. It’s literally available to everybody. So say like another company, like RPM or telehealth group, they have a specific need. Whether it be for seniors, for children and they have some other great solutions and our device is available to a company like this so they can make these great user friendly devices as part of their solution.
We are also helping the patients like the end user and also the industry, so many other companies. There’s a lot of different solutions and products available for different scenarios.
When you think of the patients that can benefit from the technology CMI has developed, how do you see it being patient centered from a point of view of accessibility, adaptability, flexibility, or those areas of interest? What are some of the outcomes you have seen with the ability of doctors to have access to the real time data coming from these devices to enhance the patients’ care?
If you think about the patient care, especially for this chronic disease, actually the patient can spend 90% of their time with themselves at home or with family, not with a doctor. So they are responsible for the most part, for their own care. The patients are actually the best caregiver for themselves. If they’re equipped with the correct tools, mindset, and the knowledge. We want to bridge this gap of traditional patient care. Traditionally it’s like taking photos. Patients go to doctors once at a time, but the doctor only sees photos of the patient. They don’t know what happens at home. Maybe there’s an asthma attack. There’s some trigger or some feeling the patient doesn’t even know themselves. They cannot describe it or they forget when they’re at the doctors. With telehealth and RPM solutions, like our AsthmaGo, it’s more like taking a movie that’s continuous. It records everything that happens all the time. And the doctor now has access to this movie. So the trend is very clear. They will know a lot better about the patient. Maybe the medication is not bad or maybe some other factors like weather or activity influence the condition. So it’s a lot easier for the doctor and the patient to improve the outcome, because the patient is responsible for their own care. So we try to give them the best they can have at home so they can take charge. That’s what we say, that we put them in the driver’s seat. And by doing that, we are actually promoting early prediction and early intervention. So we believe that’s the best way for all this type of chronic disease, because there’s no severe tax ER visits that will result in better quality of life and better outcome and lower cost.
Absolutely. I agree. I mean, I think that there’s so much here, you know, the opportunity for patients to definitely take control of their condition, you know, using great tools, such as these and others out there.
I talk to many different tech entrepreneurs, a very exciting opportunity to hear from them. And they always mention to me, in the development phase or in the research phase, they’re like, wow. Had this technical standard or data standard been in place, it would’ve been a huge help or policy sometimes be written in such a way it would’ve made things a lot easier.
So my question to you is after going through this development process and going through this whole experience, what are some of the things that you guys experienced? If we had this, it would’ve made it easier. And how do you see that potentially opening the doors to innovation in this RPM space? If that challenge still exists, how do you guys think maybe there’s a better way to address it?
This is a big topic. Maybe I’ll just talk about one part of it. That’s the connectivity. That’s the fundamental basis of telehealth. We want the doctors or the nurse caregiver to be able to access patient data, be able to communicate and provide care remotely.
So connectivity is key. The IOT device that’s equipped with Bluetooth technology, wifi cellular. That’s really important. And throughout our development process or the years in business, we also find out the cellular starts to play a more important role and then become convenient compared with Bluetooth and wifi. Because sometimes you’re dealing with little kids or seniors. Sometimes we have to skip the mobile connection due to personal reasons. But cellular connectivity can really close somefinal mileage. For example for seniors, for like remote areas, things like that, with no wifi.
And we are actually moving toward a lot of cellular enabled devices and then trying to keep all of our patient customers connected wherever they are.
I think that’s a really good point. I think keeping patients connected and we hear connected healthcare everywhere, keeping them really connected means more than just connecting them to their device and that’s it. It’s the whole experience across the continuum of care.
So JC, I think you’ve given us some really interesting thoughts. I mean, obviously you guys are tackling a significant global chronic condition through the use of this. Are there any final thoughts you would like to share with our audience as technologists who’re looking to develop a device in the RPM space to even go into some support of chronic conditions or just this idea of design mindset, patient-centered care. What advice or thoughts would you share with our audience on that?
Maybe just some quick points for both patients and for doctors, you’ll find a lot of great innovations and great convenience.
If we can try new things, try new technologies. I know it’s typical in the healthcare industry, because we have many hospitals and doctors. They prefer more traditional ways of doing things. We’re gradually moving toward the technology trend, but we are still years behind what actually the technology develops, but we are heading toward the right direction, especially as we are in the COVID situation in the future post COVID.
And we have a lot of these great regulations, reimbursement, everybody starts using and accepting the idea of telemedicine, telehealth using their mobile and doing things they are not able to do before at home. And suddenly we’ll find out, oh, that really makes our life easier.So, yeah that’s what I want to add.
Absolutely. So for all of you out there, trying to get into the telemedicine space, you have to think about patients from multiple different ways, just not their clinical therapeutic condition. And that’s a really important point. So JC thank you for joining me today. It’s been an absolute pleasure, hearing more about AsthmaGo.
Thank you, Maria, for having me.
If you wanna learn a little bit more about AsthmaGo and overall CMI Health, you can visit cmihealth-inc.com. If you like to see the finalist pitch videos from the Rethink the Machine Virtual Pitch Competition, they’re available on the event website at ieeesa.io/telehealthcomp.
Many of the concepts in our conversation with JC today are addressed in various activities throughout the healthcare and life science practice here at the IEEE SA. The mission of the practice is engaging multidisciplinary stakeholders and having them openly collaborate, build consensus, and develop solutions in an open standardized means to support innovation that will enable privacy, security and equitable, sustainable access to quality care for all.
There’s so many different activities here, such as WAMIII, the wearables of medical IOT, interoperability and intelligence global incubator program, the transforming the telehealth paradigm industry connections program and all of these different areas of accessibility, human factor design, seamless connectivity are all being addressed by our volunteers.
So if you’re interested and you wanna learn more about these projects or all the other additional projects, which I didn’t even get a chance to mention, you can visit the practice website at ieeesa.io/hls.
If you enjoyed this podcast, we ask you to share it with your peers, your colleagues on your networks. This is the only way we can get these important discussions out into the domain is by you helping us to get the word out. You can use #IEEEHLS or tag us on Twitter at @ieeesa or on LinkedIn at IEEE Standards Association when sharing this podcast.
Special thank you to the audience for listening and being here with us today. Continue to stay safe and well until next time.
Getting a Hold of Chronic Conditions for Patients in Developing Regions
Patients in developing regions are most often the most underserved populations whereby chronic conditions are left unchecked as a result of inaccessibility to health care, facilities, or tools. IEEE Student Member, Pramuka Sooriyapatbandige, shares how his research team is looking to mitigate the issue of accessibility with a simple, yet multi-purpose RPM tool that can be utilized, accessible, and feasible for patients in developing regions.
IEEE Student Member
Pramuka Sooriyapatabandige is a final year undergraduate student at the University of Jaffna, Sri Lanka specializing in electrical and electronic engineering. He is a student member of IEEE and the Institution of Engineers, Sri Lanka (IESL).
Pramuka is a member of the research team working on the project “Multi-Purpose Health Monitoring Bracelet,” a low-cost wrist wearable bracelet that makes remote health monitoring easily accessible for anyone. The project was placed first in the student/academia category of the IEEE SA Telehealth Virtual Pitch Competition 2022 – ReThink the Machine: Transforming RPM in a Patient-Centered Care System.
Hello everyone. I am Maria Palombini and I am the Director of the Healthcare and Life Sciences Practice here at the IEEE Standards Association and welcome to the Re-think Health Podcast Series. This podcast takes industry stakeholders, technologists, researchers, clinicians, regulators, and more from around the globe to task: how can we rethink the approach to healthcare with the responsible use of new technologies and applications that can afford more security protection and sustainable equitable access to quality care for all individuals? You can check out our previous seasons on ieeesa.io/healthpodcast.
So as a result of the recent pandemic, the term telehealth has become one of the most frequently used ones and it doesn’t appear to go away soon. The reality is that we see telehealth today will look very different tomorrow. It’s manifesting in many different forms. It’s more than what we see in the doctor/patient exchange on an audio video platform. It continues to grow with the proliferation of RPM devices, remote patient monitoring devices.
And we see that the telehealth experience is really being changed by the patient’s expectation on healthcare services. They are more relating it to a concierge level of online retail experience, convenient, appropriate, and personalized. With the growing RPM space, there are so many different forecasts when it comes to this, it could be U.S. 150 billion by 2028, or that more than 40% of patients will be utilizing one or two of these devices at one given time.
But here’s one thing we know for certain, regardless if we’re seeing telehealth, mobilized health, or RPMs, the future of delivering healthcare is not going to be confined to a facility and it will need to be patient-centered. So season four of this podcast series, Telehealth’s Quantum Leap into Patient-centered Care talks to the innovators.
These are the winners of the IEEE SA Telehealth Virtual Pitch Competition. We talk to the industry leaders on the platforms leading the way, clinicians, and other researchers who are at the forefront are driving innovation with solutions on accessibility, human factor design, flexibility, security, inclusivity, and more.
These are all the necessary ingredients to migrate telehealth care to a patient-centered care system. Before we begin just a short disclaimer, IEEE does not endorse or financially support any of the products or services discussed by our guest experts in this series. With that out of the way, it is my pleasure to welcome Pramuka Sooriyapatbandige, a final year undergraduate student at the university of Jaffna in Sri Lanka, specializing in electrical and electronic engineering.
He’s a student member of IEEE and he also placed first in the student category with his project, Multi-purpose Health Monitoring Bracelet in the IEEE SA Virtual Pitch Competition: Rethink the Machine – Transforming RPM in a Patient-Centered Care System. Pramuka, welcome to our podcast.
Pramuka, before we get to the core of the innovation, we like to share with our guests a little bit about the person behind the technology. So can you tell us a little bit about your research work and how you and your team came together to develop this project?
Yeah. With the COVID 19 pandemic, Sri Lanka University started to explore possible supports that could be contributed to manage the pandemic situation in the country. And during this period, we also needed to identify the research project to fulfill the requirements of our undergraduate course.
And this is when Mr. Valluvan, who is our current supervisor, proposed the idea of RPM, and we started working together. It seemed very time appropriate and aligned with our research interests. Also, we were able to get the assistance of Dr. R. Surenthirakumaran and Dr. Sivasothy, who were already contributing to some of the university’s initiatives during the pandemic time. They helped us develop the concept further.
Excellent. I find that most of the time, when I talk to technologists/entrepreneurs, there’s always a motivation, like a life story or some sort of passion that drives them to develop this innovation, this technology. Can you share with us maybe something you and your professor, your team members, something that was the real motivation to really take this project to the level and try to make it accessible to the underserved populations in developing regions?
The motivation for this project comes from what we saw and experienced around. Globally, non-communicable diseases, cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases account for over 70% of deaths. And three quarters of all NCD deaths occur in lower and middle income countries. And nearly 85% of global premature deaths from NCDs are reported in these countries, whether developing countries, Sri Lanka faces similar issues as other low middle income countries, where some problems are unique to Sri Lanka. NCDs are estimated to account for 75% of total debts in Sri Lanka with nearly one in five people dying prematurely from NCD.
These NCDs tend to be of long duration and have characteristics of insidious onset, chronic clinical manifestation, and long-term disability in the face of poor control. And most patients with NCDs are diagnosed in later stages, particularly after developing serious symptoms or complications. So in October, 2015, the United Nations Interagency Task Force on NCDs conducted a mission to Sri Lanka and it concluded that epidemic of NCDs has become a serious economic and public health issue in the country. And it’s fueled by tobacco use, unhealthy diet, alcohol consumption, and physical inactivity. The health system of Sri Lanka is considered a highly successful low-cost model. It is widely accessible and it has services offered by the public healthcare system, are free at the point of delivery, and other factors like wide coverage, female literacy have resulted in remarkable health indicators in the country. However, strengthening primary healthcare with comprehensive community based and family focused care, it’s the solitary solution to address the existing health issues in Sri Lanka.
So we believe that home-based monitoring of the essential health parameters is very important and that growing technology should address this need. So we thought our solution would be suited for this purpose. So this is actually the motivation behind our project.
Very fascinating and very important. So now we’re gonna get into the core of the innovation. We know for patients with chronic NCDs, non-communicable disease conditions, without easy access to healthcare, RPM, remote patient monitoring devices may be the lifeline they need to minimize risk of urgent hospital visits or other unplanned clinical visits and especially when we’re in developing regions, it’s not like there’s hospitals and clinics easily accessible to your “fingertips,” as we say. For individuals in developing regions RPM devices that are accessible (and accessibility can come in many different ways) can be a significant contributor to improving their health.
So Pramuka, what stage is the multipurpose health monitoring bracelet? Is it a concept or is there a prototype, have you had any testing in the form of a pilot done with it? What are some of the findings? What’s actually going on with this particular product right now?
Currently, we have the proof of concept prototype and we are in the process of making the final prototype, which is pilot-ready.
Can you share with us the type of research you all did, the modeling, maybe levels of work that went into actually refining this proof of concept prototype? And what would you say was the most interesting piece of information that came through in this research and discovery phase of the product?
Certainly. At first we looked into the requirements and it was quite a challenge as we had minimum exposure to the biomedical field. When identifying requirements, we had to study the vital signs, how they’re measured and existing technologies. We also looked into existing RPM solutions. As we were looking into developing a wrist wearable device, we realized that all our measurement requirements could not be fulfilled by the wrist wearable device alone.
And this is where we came up with the capability to connect add-on devices. Initially, we intended to measure a set of limited measurements and vital signs. But we were astonished that the capability to connect add-on devices would give our device the unlimited expansion of measurements, making our device the hub or centerpiece of a remote health monitoring system.
For the development, we followed the modular approach where we developed and tested different functionalities separately and later put them together as one device.
That’s fascinating. So you all are developing a device that’s accessible, right for a developing region, but also now it’s scalable.
So, can you explain how it can interoperate with other devices, such as a pulse oximeter, a blood pressure cuff? Does it require that a specific type of device can connect with the bracelet or is it the multi health monitoring bracelet that can work with any device by any manufacturer?
When building the multipurpose health monitoring bracelet, we studied the capability and size of the sensors that can be used for medical purposes. And if the sensor cannot be accommodated within the bracelet or measurement cannot be made at the wrist, we tried to use wireless connectivity, such as Bluetooth to connect the measurement device and bracelet. Therefore the bracelet gets the capability to include additional medical measurements. So when using BLE wireless connection, BLE generic attribute profile (GATT) is a better choice.
It is standard-based and this profile helps interchange data between two BLE devices. Manufacturers can implement those profiles to communicate with MHMB, for example, already some profiles, blood pressure, heart rate, pulse oximeter, insulin delivery service, low-cost profiles are available in BLE standard organization and existing devices can be easily modified to include this capability.
Great. Obviously we see so many new devices coming into the market, but unfortunately they don’t really integrate with many other things or they’re not scalable or extensible. So this is really important. I think this can be a significant attribute, especially to a population who doesn’t have so much access to healthcare.
Pramuka, one of the biggest challenges we see in remote patient monitoring, is the issue of accessibility. And like I said earlier, accessibility can mean a whole bunch of things could be from a point of view that people can’t afford. It could be that people don’t know how to use it, because it’s too technical. It could be a whole bunch of things. So I know that you mentioned that one of the main features of the MHMB is that it is accessible, especially to individuals in developing regions where they don’t have easy access to healthcare. So in helping that population of patients, what makes it so accessible?
Is it that it doesn’t require high frequency bandwidth, like consumption of data or internet, or is it something that can easily communicate? It’s very easy to use. What makes it accessible for this population?
Our device stores data locally when not connected to the internet and pushes to the cloud, as soon as it is connected again. So during this period, local analytics, which run on the device can help alert the use of abnormal measurements. So it performs basic functionalities, even in the absence of a network connection. And the device is simple. It does not require any special training. Also it does not have a display and requires minimum attention from the wearer, therefore minimizing its impact on the daily lifestyle of the wearer. I should also mention that we identify our device as a low-cost device.
Fascinating. We know that there’s a whole market of consumer driven fitness wellness devices that they say they can track your heart rate, your blood pressure, your activity level, your oxygen level. It can do all these things. What makes the MHMB different? Why a physician and/or a patient should trust that this device can be utilized to help their clinical health outcome.
This is a good question. First of all, we recognize MHMB as a clinical device, rather than a fitness or wellness device. It is a part of an entire remote health monitoring system, unlike most fitness and wellness devices. It is developed focusing on clinical requirements as its primary function. And we intend to release and get the approval of relevant authorities to identify it as a medical device.
And most importantly, MHMB has unlimited measurement capabilities due to their ability to connect add-on devices via the MHMB to a single health monitoring platform, which is not afforded by any other device.
I think this is a very important distinction, especially for patients and physicians to know this as well.
Were there any technical or data standards, if applicable, that would have made aspects of developing this concept faster or easier? After going through this process, were there areas where you would say, had we had this, it could really open the doors to innovation and especially in this RPM telehealth space? In your opinion, if there’s still these challenges, what may be one of the best ways to address it?
Yeah. The standard communication protocol among devices generating medical data would have helped make the process of development more convenient and efficient. Also a common development platform specifically designed for medical and health monitoring purposes would further open doors to the innovation in telehealth space.
An open source development platform would be able to get community contributions to accelerate the process of developing remote health monitoring devices.
I’ve heard before that the open source platform is a really important aspect for tech developers.
Pramuka, you’ve given us some really interesting insights. This is a fascinating concept prototype. We definitely are interested to see and to know when you’re going to do your pilots and how the outcome comes. But in the meantime, are there any final thoughts you would like to share with our audience? When it comes to developing technologies, specifically, if you’re going to target underserved patients in developing regions?
The key is to have the right partners and parties with the objective of taking these technologies to the underserved patients in the developing regions.
This could include the state sector, NGOs, or even commercial organizations. Affordability of the technology or device is another key factor that needs to be considered. This needs to be considered together with a scale of deployment. And I believe that healthcare is a fundamental requirement of all people and telehealth is the key contributor to making healthcare accessible for all. Healthcare systems must be reoriented to address NCDs. Today’s universal health coverage offers a global vision for healthcare systems. Achieving universal global coverage primarily depends on people-centered primary healthcare. All the more important, in the context of rising rates of NCDs affecting high income and low and middle income countries alike. In other words, to be effective, health systems must be rooted in the communities they serve and be able to not just prevent and treat NCDs, but also improve wellbeing and quality of life.
I think that’s a very important point that you’ve shared with our audience, and I hope that they embrace it when they’re developing their technologies or trying to deploy a device in those regions. Pramuka, a special thank you for joining me today.
Thank you very much. It was a wonderful opportunity for me as well, joining this session.
For all of you out there. As I mentioned, Pramuka is an undergraduate student in Sri Lanka. If you would like to see his actual pitch video from the IEEE SA Competition or any of the other winners and finalists, you can visit ieeesa.io/telehealthcomp. You’ll see highlights from the competition and everything about that.
Many of the concepts that Pramuka brought up today, we address in various ways throughout the IEEE SA Healthcare and Life Science practice. The mission of the practice is engaging multidisciplinary stakeholders and having them openly collaborate, build consensus, and develop solutions in an open standardized means to support innovation that will enable privacy, security and equitable, sustainable access to quality care for all.
Some of these activities that we have such as incubator programs for WAMIII, Wearables in Medical IOT, Interoperability, Intelligence, and Transforming the Telehealth Paradigm are addressing the many things that we discussed today from accessibility to security, to integration, to interoperability, to scalability, to extensibility.
And these groups are volunteers from all over the world, trying to build frameworks for potential global standards to address these issues. If you would like to learn more about these projects and many of the other practice activities you can visit our website at ieeesa.io/hls.
If you enjoy this podcast, we ask you to share it with your peers, colleagues on your networks. This is the only way we can get these important discussions out into the domain is by you helping us to get the word out. When you are using the podcast and sharing it with your colleagues, please reference #IEEEHLS or tag us on Twitter @IEEESA or on LinkedIn @IEEE Standards Association when sharing this podcast information.
I wanna thank you, the audience, for listening in today. I wish you all to continue to stay safe and well until next time.
Health Has No Borders with Telehealth – A Doctor’s Perspective
The need to extend telehealth services to marginalized and indigenous populations with a focus on accessibility and feasibility is urgent. As a primary care doctor converted into a healthtech advocate, Dr. Keith Thompson, shares that the work of equally reaching all populations for quality access to care will take more than setting up and/or relying on physical location.
Chief Medical Officer, Nuralogix
Dr. Thompson is a London, Ontario-based family physician, graduate of the Schulich School of Medicine and Dentistry at Western University and awarded Fellowship Canadian College Family Practice in 2005. He is a Board-Certified Medical Affairs specialist.
He is an Adjunct Faculty Professor with the Western University Department of Family Medicine. At Western, he serves as Co-investigator on 2 virtual care studies and is a Medical Mentor for the Medical Innovation Fellowship program at WORLDiscoveries.
Dr. Thompson was one of the initial Canadian Physicians hired to consult with the Teladoc/BestDoctors Canada start-up team in February of 2018 and worked as CMO for iTelemed, a telemedicine startup in Ontario, prior to his recent appointment with Nuralogix.
He is a current member of the IEEE SA Telehealth Industry Connections Program, IEEE New Jersey Coast SIGHT (Special Interest Group for Humanitarian Technology), World Congress of Family Doctors (WONCA) eHealth Working Group, Association for Corporate Growth Toronto Chapter, Digital Health Canada, C.D. Howe Institute, and Co-Founding Member of Health Technologies Without Borders.
Welcome to the IEEE SA Re-Think Health Podcast Series. I’m your host, Maria Palombini. I am Director Healthcare and Life Sciences Global Practice here at the IEEE Standards Association. This podcast takes industry stakeholders, technologists, researchers, clinicians, regulators, and more from around the globe to task.
How can we rethink the approach to healthcare with the responsible use of new technologies and applications that can afford more security, protection, and sustainable, equitable access to quality care for all individuals. You can check out our previous seasons on ieeesa.io/healthpodcast.
So as a result of the recent pandemic, the term telehealth has become a frequently used one and it does not appear to be going away. The reality is the way we see telehealth today will look very different. Telehealth is manifesting in many different forms. It’s more than what we commonly see as the doctor patient exchange on an audio/video platform.
It is so much more than that and continues to evolve with innovations in RPM, remote patient monitoring. The telehealth experience has changed the patient’s expectations on healthcare services. They’re relating to it more of a concierge level of online retail experience: convenient, appropriate, and personalized.
And then there’s this growing RPM space. There’s so many different forecasts when it comes to RPM, anywhere from 150 billion U.S. Dollars by 2028 to estimates of 40% of patients using one or two more of these devices at one time. But one thing is for certain, regardless if we are talking telehealth, mobilized health or RPMs, the future of delivering healthcare is not confined to a facility.
It will need to be patient-centered. Season four of this podcast series, Telehealth’s Quantum Leap into Patient-centered Care, talks to the innovators, the winners of the IEEE SA Telehealth Virtual Pitch Competition, the industry leaders, the clinicians, and other researchers who are at the forefront of driving innovation with solutions on accessibility, human factor design, flexibility, security, inclusivity, and all the other necessary ingredients to migrate healthcare to a patient-centered care system.
So just a short disclaimer before we begin, IEEE does not endorse or financially support any of the products or services mentioned by or affiliated with our guest experts in this series. It is my great pleasure to welcome Dr. Keith Thompson, Chief Medical Officer of NuraLogix Corp to our conversation.
NuraLogix was one of the nine finalists to make it to the pitch round of the IEEE SA Re-think the RPM Machine Virtual Pitch Competition. NuraLogix is an AI-powered solution for instant health and wellness data from your smartphone. I love this line on their website, so I’d like to share it with you all. It says: take a selfie to know you’re healthy.
And obviously Keith will share with us what that means. But in the meantime, one of the reasons why I really enjoy having Keith on this podcast is that he is co-leading a Pre-standard Work Stream, entitled Virtual Care Lexicon in the IEEE SA Transforming the Telehealth Paradigm Industry Connections Program.
So Keith, welcome to our podcast!
Thank you. Great to be here today. Really appreciate this opportunity.
Keith, you have a very well-established career in primary care as a family physician. You are an advocate for utilizing virtual care and telehealth to reach patients. You have demonstrated passion in helping patients in everything from WONCA, the World Organization of Family Doctors, but really what inspires you about the opportunities of virtual care? Most doctors are slower to technology adoption and you seem to embrace it so well. How did you get involved?
Thanks, Maria. I’ll be honest. I was really a late bloomer to technology and I jokingly say at this stage of my career I haven’t a lot of time left, so I have to make the best of it, but just seeing the advancement of technology and where workflows were going and how we were embedding this into our day to day encounter just really fascinated me. And obviously you start to see ways of doing things better.
Like they say, better late than never. So I’m so glad you migrated to it.
So can you just briefly share with our audience the goal of the work that you had started with the virtual care lexicon work stream? Are you looking to standardize and how will it positively impact the future of telehealth and virtual care?
I came to IEEE as a clinician. So just to clarify, I’m not an engineer by any means, but love what it has done just hanging out with this group. It’s an interesting combination of the humanistic and sort of the artisan form of interacting with patients, but that zero room for error and an effort to try and make things perfect. The lexicon that was started really under the IEEE Telehealth Industry Connections that I came to, not really knowing what I was getting into, initially, it has become what started as an attempt to define telemedicine, both technically and use cases and specifically terminology.
And I see where we’ve moved more recently is into that realm of culture and linguistic appropriate services. How do we make this encounter better for the people that we’re trying to engage? And so how we can use that ICT, you hear that term Information Communication Technology, using it in healthcare, but an effort to connect both the materials for health and device literacy, the other area we’re getting into. It’s connecting those educational materials on a system like GUDID, the Global Unique Device Identifier Database, and there’s really a disconnect there. So we realized the first step within the lexicon, we hope to eventually get to a PAR in this class or culture linguistic appropriate services and, or the health and device literacy. Both of those are getting traction.
We’ve begun to explore some collaboration here in Canada, actually with indigenous communities. There’s some interest in the language resurrections and the standards that might result in making that telemedicine encounter culturally safe for first nations. And this is a huge part of what’s going on here in Canada, as we’re in the midst of reconciliation within our indigenous community.
So a project like this within our lexicon really might not only provide an output for standards around connectivity and databases. And what would this look like? So we can share that information with others, attempting to do this, but here in Canada, be incredibly healing, part of a supportive measure just to make telemedicine or virtual care culturally appropriate specifically for indigenous communities.
I think that’s a fascinating project and it can transcend many different ways across geographic and other aspects as well.
You went from doctor to Chief Medical Officer of a cutting edge technology company. So NuraLogix uses AI and machine learning, and it offers patients this ability to take a selfie and determine their level of wellness. Just for our audience, what exactly is it monitoring? What area of the population pool does it really serve and what makes this platform so unique?
I’ve recently come to NuraLogix and my background was within telemedicine. I’m a primary care doc first and foremost. So my day job is seeing patients. So my side gig was boring and trying to get some telemedicine endeavors off the ground.
We had a working relationship with NuraLogix and I was immediately fascinated. I was like, wow, this takes telemedicine to the next level. Being able to grab patient parameters and some biometric measures within that encounter. So the technology is a novel form of RPPG called Transdermal Optical Imaging and TOI is our trademark terminology. So by capturing blood flow, using that principle of reflected light, we’re not just measuring one region with TOI. We’re actually measuring 21 regions in the face and each region of the face acts differently. Your cheeks behave differently than your nose and your forehead.
So we’re able to capture that pulse wave form and then do feature analysis using machine learning models that are trained on 40,000 patients. And we can capture those patterns in the data sets that allow us readings on over 40 to 30 or more parameters for patients being scanned. So we’re able to capture vital signs, metabolic biomarker risk, cardiovascular risk, mental health stress related to HRV variability, and metabolic risk for diabetes of lipids. So our blood pressure is really our crown jewel. We are engaged with the FDA in a pre-submission. So our claims on this measurement still have to be validated as we get into that territory of class two medical devices. So you’ll see a disclaimer everywhere for investigational purposes only.
That’s really why we’re about to start clinical trials. We’re pretty confident with the technology. We’ve published data verifying that we can meet the ISO 81060 standards. And so can claim accuracy on that. And we have also published some data on our biomarkers of mental stress. The population that we’re serving really the intended use is to screen for risk factors and chronic disease states, under the care of a physician.
We’re not trying to replace the lab or replace the doctor encounter, but just build that awareness. So our solution can really identify if you’re at risk for cardiovascular, hypertension, diabetes, mental stress, heart rate variability and so many metabolic risks as well that we capture.
We’re soon going to launch hemoglobin A1C, an elevated morning fasting blood sugar. So it’ll be a classifier model. Yes, no. Are you above or below a certain level? And if you look at the World Health Organization, it really identifies hypertension type two diabetes and mental stress. Those leading causes of morbidity mortality.
You can see that we’re focused with our solution on those major epidemiological indicators for NCDs, you’ll hear this term Noncommunicable Diseases, and that’s really the big push. So we want our platform hopefully to be available to as many people as possible so they can understand and just be aware of their own health risk.
And we hope to identify those populations at risk before disease develops or its related complications. So the first step in health literacy really is awareness and that’s where we intend our tool to be used.
I think that’s really important. And I think you already touched on a misconception that we often hear, oh, I’m using these wearables and it’s monitoring me. So maybe I don’t need to see the doctor as often. And it’s like, no, this is supposed to be in support of.
So yeah, important. And it comes right from the doctor’s mouth. We hear a lot about patient centered care and patient centered this in the healthcare system. So when you think of remote patient monitoring devices, systems transforming, or trying to get to this patient-centered care system, where do you think there’s more attention needed or innovation needed to really transition RPM into a true patient centered care model?
Honestly, so many things come to mind. I think for me, and really I have to give IEEE and some of the mentors I’ve been working with credit for this, but the first thing that comes to me is equitable access. So what we’ve seen such a digital divide in society is we become more technology based. Yet those social determinants of health in which you hear about have really also become digital determinants of health.
They’re one in the same. The UN declared internet access as a basic human right, almost 10 years ago and we’ve made great strides in improving connectivity in internet access, but there’s still significant disparity, especially within those low middle income regions and marginalized populations where it’s either complex care needs, high urban density or folks with disabilities.
So the application of monitoring systems to the patient point of care, I think will move care closer to the patient in terms of capturing data. But then what sort of ecosystem and workflow are we creating in conjunction with the physicians embedded into that remote patient monitoring workflow and will we see the need for physicians in that workflow at all?
Will patients still want some sort of humanistic attachment and I’ve been diving into a thought leader here; she’s since passed away Ursula Franklin. She was an archeologist by trade, but released a whole thought process around technology. And she talked about technology being either prescriptive, right?
There are rules that you must follow or humanistic or holistic. And really medicine, when you think of it, certainly primary care, is holistic. So how do we combine those two things? And how much can we transfer over to the technology side and at what cost are we losing the holistic aspect? Also, just to comment that healthcare access really is only 25% of those health outcomes. In other words, getting access to healthcare doesn’t solve those issues around social determinants of health, which play a far bigger role in health outcomes. So improving those social determinants is needed, providing the technology or access to care just with technology may not achieve that end result or outcome that we’d expect.
So I think remote patient monitoring also points us to an era of high volume and low physician touch, which I say physician specifically, because there’s another technology thought leader here, Marshall McLuhan kind of another philosopher. He said that the age of technology will be the age of do it yourself.
That’s so true and we see as the knowledge in technical skills are now prescribed or advanced to systems. It could be a Google search to determine my symptoms or at some point AI or machine learning control of robotic surgery or diagnostic systems we’re already seeing. I think there’s a lot of unanswered questions as things go forward, but equity of access for sure is a key ingredient we have to maintain.
And I think that’s what IEEE and SIGHT and HAC have really been focused on and really passionate about. And it’s been great working with this group.
Absolutely. It’s really interesting though, you mentioned the social determinants of health. In season three, AI for Good Medicine, I actually interviewed the CTO of Closed Loop AI and one of their core projects on COVID 19, like the effective risk and outcomes was using data of social determinants.
The idea was to really look at the social determinants rather than just therapeutic risk based factors that really improve the outcomes.
So we prefaced this a little bit, but there’s a lot of misconceptions around, you know, remote patient monitoring devices. You know, patients are not going to adhere, the data can’t be validated, this thing is only gonna do so much. When you think about it, what do you see or what do you think is one of the biggest misconceptions when it comes to the concept of telehealth, whether it’s from a patient perspective, a physician perspective, the payers, or any other stakeholder in the process?
I think I may be biased from where I am as a physician, but for me, the biggest misconception might center around workflow. For telemedicine to be truly sustainable for physicians and payers, for that matter, it needs to be efficient and optimized in terms of workflow. So this means it supports both patients and providers so that they’re both literate and trained in the pre-visit, during the visit, and post-visit follow-up. What does that workflow look like? How much can we do digitally? Via surveys, questionnaires is a translator needed, is connectivity appropriate? What digital modality is best video or telephone, and does a patient have access to that modality?
I feel there’s some misconceptions maybe from payers, just how much time is involved in a good telemedicine encounter. So even without telemedicine, EMRs (Electronic Medical Records) have significantly increased physician admin burdens, right? The time we spend, we see so much greater integration of technologies to improve the depth of that encounter and using virtual care tools, but we increase the clicks, the log ons several minutes added to that encounter. So how do we cover that added admin time with limited healthcare budgets? So we’re expanding the non-clinical part of that encounter. There’s a disconnect really between the system designers and payers and patients’ and providers’, real world experience.
So payers, providers and patients that digital journey that everyone goes through to access and provide care experience firsthand, go through it. Co-design is so important. Right? So what’s the actual experience for all these actors coming into the system?
Absolutely. And I think these are all relevant points, because we all think, oh, we have a new technology tool. It’s gonna make everything go faster. But the transformation is not just the technology, the digital side of it. It’s the whole process that has to be aligned with it. Otherwise maybe we’re just making more work for all of us in the process.
So I often say, I write about this, I talk about it that the future of telehealth will look very different than we see it today.
As a physician, I think for you, why is it important to envision a potential future of mobilized care? We hear about the tele ICU in the future, the mobile urgent care units, but this idea of bringing healthcare to the home, how do we really see it improving patient outcomes?
It’s an interesting question, Maria, and I think the question really challenges us to look more closely at telemedicine virtual care and its applications under the same lens that we would use for other interventions, i.e. Pharmacoeconomics right. We talk about human economic outcome or health economic outcome research and cost benefits, cost effectiveness, cost utilization cost minimization.
So cost minimization, assuming that the outcomes are equal, but we can deliver care cheaper or maybe there’s benefits in terms of lower hospitalization. So you can see moving patients into home. Absolutely, one or two days saved from a hospital admission saves thousands of dollars or reduced ER visits. Cost effectiveness is more in actual natural units. So would an intervention, lower blood pressure, and there’s studies on this, right? By partnering with patients digitally, you can prompt them to take their blood pressure meds, to exercise, behavioral change, and we can see effective gains. Lastly, cost utilization, that’s quality adjusted life years, and that’s harder to put a dollar value on, right.
Is that ease of, of access, not having to travel to the doctor and, and all that. That’s convenient. So I think we have to be careful that not all care transitions to virtual in a cost effective manner, we might, for example, see physicians order more needless tests to compensate for that insecurity, a lack of an exam.
And some studies have hinted at this. On this angle, patients might feel that seeing more than one physician just due to ease of access. And I had that counter, you know, with a patient coming to see me and saying the video assessment wasn’t really an exam doc. I needed somebody to listen to my lungs. Right. So we had two visits that could have been done in one. I think we’ll need to apply a little tougher if you look at the economic lens and it makes everybody cringe because we know the convenience. We know the patient’s love of, of ease of access and lower costs for physician encounters. For sure. But in the global economy, what does it look like?
Yeah, we may have to be careful.
Yeah, absolutely. We kind of just touched on this before, but we hear of oh, we’re bringing healthcare into the home. Right? Do we really still need doctor’s offices and hospitals and you sort of just led into that. But the real question is, how is that dynamic changing in this area of healthcare? Right? Like thinking of the hospital as the place to go for care.
There’s so many forces at play here. And certainly there is in the medical system and physicians, especially in primary care, we want continuity and longitudinal relationships. The patients want convenience of access in some ways opposing forces. Right? So I, I believe the hospital’s always gonna be the go-to for surgical treatments, radiotherapy, for example. But days in the hospital will no doubt be shorter. And I think the post-operative timelines move into the home with less inpatient time. So the question, or perhaps the danger is, is going more into remote patient monitoring and home based care. How far is a physician interaction with its patients removed from that digital ecosystem?
You saw one of my recent posts on LinkedIn, right? With an RPM system that got hacked. You could do a whole thing on security. I’m sure. All the actors weren’t notified, but the poor docs and nurses involved for that remote, fetal heart monitoring, the system was down.
Nobody knew. Patient didn’t know, physicians weren’t notified, and there’s gonna be a really messy lawsuit as a result. The other part to this, how much of that face to face is therapeutic, and really can’t be replaced by a digital workflow. And I’m not sure we know the answer to that yet, but there’s one person that can tell us and that’s the patient. Just, as I mentioned before, about Ursula Franklin, you know, that prescriptive force of telemedicine and remote patient monitoring becomes so strong that this becomes now the only way of doing things. And so i.e. that digitally and remote patient monitoring fewer face-to-face visits, but how holistic and compassionate is that healthcare system, will it be at that point?
We can, yes, have ISO 9000 perfection and supersede that need for human touch and interaction with patients, you know, how far do we go and who knows, certainly this is where we need to dig down. I think a bit more and perhaps further research on patient reported outcomes and satisfaction and not just healthcare dollar saved.
Absolutely. And I think it’s an important point that we always talk about stakeholder trust and everybody thinks well, will the patients trust the process and the device, but we also need the doctors and the clinical workers to trust it as well. And so if workflows are not designed to best mitigate risk for all the parties involved, then we’re gonna continue to have this question of trust.
I wish honestly, every one of my colleagues could at least do a couple of stents in some of our meetings to learn about that issue. I trust that my device is measuring properly. I have no idea the standards and the protocol for that trust. And I can think differently about calibration now and how I approach, you know, just simple measurements.
So we’re kind of leaning into this question here and I think you mentioned it as well earlier on, this question of health equity, right. We know there’s marginalized populations without access to healthcare, or very limited access to healthcare or understanding of the healthcare process. So telehealth technically right should reach those who are the hardest to reach.
So Keith, in your view, how can telehealth equitably reach the patients who are currently not included in the healthcare system. What do you see as some of the challenges that need to be addressed? Obviously you mentioned the language was one, but that telehealth could be a viable platform to try to close this healthcare gap.
As I mentioned earlier, those social determinants become digital determinants. They become one in the same in my opinion, but apply that technological access to a marginalized population doesn’t unto itself, improve an outcome. Certainly, access I think is the cornerstone. We’ve gotta have a secure line into those communities and it should be a basic human right just as clean water and food security. And beyond this, I think then we look to focusing or leveraging community health workers within those communities. You know, we’ve had some presentations here with IEEE Public Health Foundation of India and Dr. Aaron Jose and their telemedicine program.
Look it up, doing some great work, partnered telemedicine with community workers, right. To be that line in. We partnered at NuraLogix with LaFiya to put telemedicine kiosks into remote regions of Nigeria. What’s interesting about that platform is the solar panel that they put in that community is being used as a resource to provide some micro economies that might be the alternative business model, because really the issues move away from solving the connectivity to solving those social innovations and business models to support those regions. So there’s no longer value in the model of just selling devices and multiple units to providers or consumers rather, how do we fund a single device and platform and scale to regions needing support for tens of thousands of patients without access to primary care. The technology’s great, but we really have to keep our eyes on the ball I think on the sustainability and business model, because it’s certainly talking about compassion and humanitarian reach. I think you’re sort of assuming that it’s for free and it’s, you know, NGO and it’s a philanthropic offering, but there’s ways to do it right. That we can support communities with technology and help them sustain themselves.
Absolutely. Very, very good. All right. So Keith, you’ve given so many insights. I think your perspective as a physician working in a really technical environment is really, really refreshing. Any final thoughts you would like to share with our audience? It could be technologists who are embarking in virtual care technologies or already there and looking at this context of patient set and care, it could be a call to action, a call for attention and innovation.
Yeah. You know, really honestly, just to say thank you to you and IEEE, right? That industry connections and SIGHT, this organization has been an incredible mentor and inspiration for me.
I’ve said that combining engineering design with zero error and medical humanitarian applications, right? Compassionate care here has been an incredible journey. So call to action. Get involved in this organization, if you can, you’re gonna grow personally and professionally. And I guarantee, you know, become a better person just by helping address those needs of humanity using technology and last thanks to NuraLogix for supporting me in this right.
They’ve encouraged me, no questions asked. I love it. So great. I really appreciate Maria. Thank you.
Thank you, Keith, you always got so many great insights, your passions, and, you know, for humanitarian causes and just overall, just your empathy for patients. It’s just very refreshing.
So thank you for taking the time and being part of this podcast today.
For all of you out there, if you wanna learn more about NuraLogix, you can visit nuralogix.ai. If you would like to get involved in the work stream, Keith mentioned virtual care lexicon, or other aspects of the IEEE SA Transforming the Telehealth Paradigm Incubator Program, visit ieeesa.io/telehealthic.
Many of the concepts we talked about today with Keith are addressing so many different activities here at the IEEE SA Healthcare Life Science Practice. You know, the mission of the practice is engaging multidisciplinary stakeholders, such as Keith and they openly collaborate. They build consensus and develop solutions in an open standardized means to support innovation that will ultimately help us achieve the goal of privacy, security and equitable, sustainable access to quality care for all.
Activities such as the Transforming the Telehealth Paradigm, the WAMIII, Wearables and Medical IOT, Interoperability Intelligence are just naming a few of the different activities here. And if you wanna learn more, how you can get involved, there’s no cost to join these activities, you can visit ieeesa.io/hls.
If you enjoyed this podcast, we ask you to share it with your peers, your colleagues on your networks. This is the only way we can get these important discussions out into the domain is by you helping us get the word out so you can use the #IEEEHLS or tag us on Twitter @ieeesa, or you can tag us on LinkedIn @IEEE Standards Association when sharing this podcast.
So a special thank you to you, the audience, for listening in today and continuing to stay safe and well until next time.
Securing the Telehealth Experience is Critical for Patient-Centered Care
Security and protection of personal data are core tenants in driving trust in the use of remote devices and technologies for monitoring or delivering virtual care. As healthcare intersects more with consumer wellness trends, the vulnerabilities and threats to security and privacy are even more amplified.
Nakia Grayson and Ronald Pulivarti from the National Cybersecurity Center of Excellence (NCCoE) at NIST, share the latest trends and efforts on how the industry is educating and offering practical guides to safeguarding the telehealth experience.
IT Security Specialist, NIST/NCCoE
Nakia Grayson is an IT Security Specialist who leads Supply Chain Assurance & Autonomous Vehicle project efforts at the National Cybersecurity Center of Excellence (NCCoE), which is part of the National Institute of Standards and Technology (NIST). She is also a part of the Privacy Engineering Program at NIST, where she supports the development of privacy risk management best practices, guidance, and communications efforts. Nakia serves as the Contracting Officer Representative for several NIST cybersecurity contracts. She holds a bachelor’s in criminal justice from University of Maryland-Eastern Shore and a master’s in information technology, information assurance and business administration from the University of Maryland University College.
Healthcare Program Manager, NIST/NCCoE
Ronald Pulivarti is the Healthcare Program Manager who leads the Healthcare team at the National Cybersecurity Center of Excellence (NCCoE), which is part of the National Institute of Standards and Technology (NIST). He and his team promote the acceleration of businesses’ adoption of standards-based, advanced cybersecurity technologies for the healthcare sector. Mr. Pulivarti has a strong technical background and cybersecurity experience in multiple high-value asset applications. Prior to NIST, he worked within the Department of Health and Human Services and has served in many IT leadership roles for over 20 years.
Welcome everyone. This is the IEEE SA Re-think Health Podcast Series. I’m your host, Maria Palombini, Director of Healthcare and Life Sciences Global Practice here at the IEEE SA. This podcast takes industry stakeholders, the technologists, researchers, clinicians, regulators, and more from around the globe to task.
How can we rethink the approach to healthcare with the responsible use of new technology and applications that can afford more security protection and sustainable equitable access to quality care for all individuals? You can check out our previous seasons of the podcast series at ieeesa.io/healthpodcast.
So as a result of the recent pandemic, the term telehealth has become a frequently used one and it does not appear to be going away soon. The reality is, the way we see telehealth today will look very different tomorrow. It’s manifesting in many different forms. It’s more than what we commonly see as the doctor/patient exchange on an audio/video platform. It can be so much more involved with innovations in RPM (Remote Patient Monitoring), mobile health, hospital at home, and many different areas. The telehealth experience has changed the patient’s expectations on healthcare services. They’re relating it more to a concierge level, online retail experience: convenient, appropriate, and personalized.
And there’s the growing RPM space. So many different forecasts when it comes to RPM, anywhere from U.S. 150 billion by 2028 to estimates of 40% of patients utilizing one or two of these devices at one time. But one thing is for certain, regardless if we’re talking telehealth, mobilized health, RPMs, the future of delivering healthcare is not confined to a facility and will need to be patient-centered.
Season four of this podcast series, “Telehealth’s Quantum Leap Into Patient-Centered Care,” talks to the innovators, winners of our IEEE SA Telehealth Virtual Pitch Competition, the industry leaders, clinicians, and other researchers who are at the forefront of driving innovation with solutions on accessibility, human factor design, interoperability, security, inclusivity, and the other necessary ingredients to migrate healthcare to a patient-centered care system.
So just a short disclaimer, before we begin, IEEE does not endorse, advocate, or financially support any programs, services, technologies mentioned, or affiliated with any of the experts who have appeared in this series. And with that out of the way, it is my pleasure to welcome Ronald Pulivarti, NCCoE (for those out there, National Cybersecurity Center of Excellence), Healthcare Program Manager and Nakia Grayson, NCCoE IT Security Specialist. The NCCoE is part of the National Institute of Standards and Technology, NIST. Welcome, Ron and Nakia!
Thank you to IEEE for inviting us to do the podcast interview. And thank you, Maria, for hosting the interview. We are so excited to be here today!
I’ll echo that. Thanks a lot for having us and to the IEEE community. We appreciate the opportunity to do this podcast with you, and hopefully we’ll be able to engage deeper and we can get some great learning from our conversation.
Absolutely. I think for our global audience out there, this is gonna be a great experience. Before we get to the core, the technology, what’s going on. I like to humanize the experience for our listeners, right. We’re all in a virtual world. So Nakia, you started out in a different role while at NIST and then transitioned to an IT Security Manager.
What inspired that change? What do you love about the work you are doing now?
Before we begin, Ronald, I would like to just say that opinions we are going to share in this podcast are our own and not the opinions or positions of NCCOE and/or NIST. So to answer your question, yes, that’s correct. I started off in a different role at NIST and actually in an administrative role and later transitioned into IT Cyber Security role in 2018.
For my undergraduate studies in college, I majored in criminal justice. When I graduated, I really wanted to bridge my education and knowledge of the legal system with a career in technology, policy, and privacy, because since I’ve, you know, found all of those areas, I was already fond of those as a teenager. While working in a lead administrator role at NIST, I went to graduate school for Information Technology and while in school I became really interested in data protection and cyber security risk management and how both of these play a very important role in protecting and safeguarding the nature of critical infrastructure and privacy and sensitive data.
I really love working on this. NIST gives me the opportunity to work alongside world class talent and industry experts to tackle and solve the most complex problems in cybersecurity and privacy.
Excellent. Well, Nakia. We have a lot in common because I also did my undergraduate in criminal justice, but again, I didn’t go that path either. But an unbelievable opportunity to be working at the forefront on cybersecurity issues.
So, Ron, how about you? I understand that you’ve had an exciting professional background working in organizations, such as Health and Human Services ,the HHS. What have been some of the most exciting areas of your work? What would you say are some of the major compliments you have seen during your tenure?
It’s quite interesting. I’m a technology nut, so one of the things that I’ve always actually noticed when I started at HHS is I was the guy picking up the support phone. So from understanding the nuts and bolts to actually managing these ecosystems has been such a great opportunity. I’ve been able to launch myself throughout different agencies within the HHS space. I was able to contribute and strengthen the technology foundation so that we could grow. And one of the big things that I felt like I was able to provide in this space was my technology experience. I see something and I think five years to 10 years ahead on where we should actually be. And I think one of the things or opportunities that I enjoy doing was taking a look at the current snapshot on where things are, and actually contributing and making a significant impact within the government space so that we can advance and we can grow and strengthen the government technology, workspace, and ecosystem.
And I enjoy it each and every day.
That’s awesome. We all know that we have to love what we do otherwise it really will feel like a job. And then that is not the point.
All right guys. For our audience, you got a little insight to our background and to the things that really motivate our guests today.
So let’s get to the core. Nakia, we hear about all kinds of risk in the remote patient monitoring ecosystem. What are some of the major risks you are seeing that can no longer go unaddressed? In simple terms, what exactly are we up against?
Some of the major risks that we’re seeing in the RPM ecosystem, speaking from an organizational standpoint that can no longer go unaddressed, is when HDOs deploy RPM solutions.
These solutions are architecture that includes several components across the HDO, the telehealth platform providers, and the patient’s home. So each of these environments is managed by different groups of people and often with different sets of resources and technical capabilities.
So risk can cut across the architecture and the different methods by which one may mitigate those risks. And it can vary based on the complexity of these. So while HDOs do not have the ability to manage and deploy privacy and cyber security controls, they do oftentimes retain the responsibility to ensure that the appropriate controls and risk mitigation are applied.
So in simple terms, a lot of data is being transmitted back and forth across various platforms which can lead to access points to cyber criminals . So we need to ensure that we have the appropriate controls in place. The safeguard systems look deeper in the current infrastructure as technology advances, ensuring that we also have education training for our patients.
Yes. I think that’s a very important point, Nakia, because we all think that it can just be a simple apply, a patch and let’s move on. We really need to talk about the whole scope of what it takes in security. And that includes educating patients, because a lot of them might be completely oblivious to what’s going on.
So Ron, we’re seeing growing trends of non-clinical, let’s call ’em consumer-issued health IOT devices, being utilized by patients. They share with their health providers. With this new integration, what kind of security and privacy risks are to be considered?
What are some possible solutions? Do we rely on the healthcare delivery organization, the device maker? Who needs to step up and start creating some solutions here for all this data in these devices.
Very good question, Maria. One of the things that we all need to really consider and think about is that as these devices are evolving, they’re constantly listening to us, right?
So understanding exactly the use of it and what we’re using it for and applying that privacy and security standard on how you wanna communicate outward. So understanding your surroundings is a critical aspect of that. And all of the groups need to be involved from the technology provider, from the HDO, even from the consumer.
Understanding the layout as we do every day rely on our technology IOT devices to turn on lights, we rely on it to turn on and adjust the thermostat. These are constantly pinging in our whole household. One of the most important pieces for our project, our remote patient monitoring project in our appendix E in our practice guide, we actually talk about the benefits of these IOT devices.
We provide the device capability mapping, the device capabilities that support these functional evaluations. But one of the big things that we really need to factor in is what means of communication are we using this device for and what safeguards can we put in our own house with communicating, whether it’s medical information, personal information, when you’re talking to your bank. You have to utilize that space to ensure that if these devices are constantly listening to you, where is the safest part in your house, that safe house? And you could actually have these communications without exploiting any information that you have.
As Nakia pointed out, there are bad actors every day. We’re constantly fighting them. So using those steps, I think in place to understand that there’s a constant chatter that’s happening in the background. Where is that safe place in your environment where you could actually utilize these devices to ensure that you’re safe and you’re properly communicating things without necessarily having someone intercept something in some form or fashion?
And that’s absolutely a great point because I think in this world of everything “smart:” smart thermometer, smart this, we talk about ease and convenience and all these great things, but patient beware, right? You have to understand that all this “smartness” also comes with a lot of insecurity.
And so the same way you won’t leave your front door open, we really shouldn’t leave these kinds of things so open and vulnerable as well.
So Nakia, Ron, sort of, he did mention the guide. So I know that you all released this Securing the Telehealth Remote Patient Monitoring Ecosystem Practice Guide. Our team, the IEEE SA Transforming the Telehealth Paradigm Group, read it once it was released. We saw it was a bunch of great diverse companies involved in helping you guys create this project.
So can you share with us the supporting laboratory project around it? What was the idea? Was it tested in the lab environment to actually get to the final guide? Share with our audience the making of this guide.
We get so pumped up when we have the opportunity to share our work. It’s great to hear that IEEE has found our work very useful. So the use of healthcare delivery organizations, HDOs, rely heavily on telehealth and remote patient monitoring (RPM) capabilities to treat patients at home. That has increased.
And some of the reasons why, is because RPM telehealth service is convenient and cost effective for all parties. And that’s the HDO, the telehealth provider, and patient. And one thing that we always want to share is that there are many actors in the RPM environment and that’s the HDO, the telehealth provider, and the patient.
So in our practice guide, we assume that the HDO’s engaged with a telehealth platform provider that is a separate entity from the HDO and patient. The telehealth platform provider managed distinct infrastructure applications instead of services. The telehealth platform provider, they will coordinate with the HDO to provision, configure, and deploy the RPM components to the patient home. Also assure secure communication between the patient.
We analyze the RPM ecosystem risk factors by applying methods to describe and our NIST risk management framework. We leverage the NIST cybersecurity framework and our NIST privacy framework, and other relative standards to identify measures to safeguard the ecosystem. In collaboration with healthcare technology and telehealth partners.
We built out a RPM ecosystem and a laboratory environment to explore methods to improve the cyber security of a RPM. So we brought in different technology from vendors to build out this lab. In our practice guide, we make a note that the application of people, process, and technology is very important in having that risk mitigation strategy.
So in our practice guide, the benefits that we stress is that we want to help an organization ensure the confidentiality, integrity, and availability of a RPM solution and enhance patient’s privacy and limit HDO risk when they are implementing a RPM solution.
I know that the telehealth guide was really thinking about the RPM in this environment. And this is where we are right now, but we know the trend. We hear it coming about bringing hospitals to the home and everybody’s thinking, this is the future. But how can the work of this practice guide be either applied in some form to address what we think is going to be a huge appealing, uh, cybersecurity appetite for the hospital at home concept?
We’re a non-regulatory agency, right? So our practice guides are free for using it as a guidance for especially our targeted audience of these small and large scaled organizations. The way our practice guides are carved for folks to use, we have three different volumes in our practice guide.
We have our Volume A, it really talks about our executive summary of our remote patient monitoring. Then our Volume B is pretty much good for the actual overall architecture. It provides our approach, the architecture, the security characteristics. And then Volume C is really our how-to guide. We provide detailed instructions, how to implement our solution.
One of the things you touched on that’s very important is what was it back then to where we’re going to now. Telehealth is gonna be a very near to never going to go away type of technology. We’re gonna be utilizing this forever until something else new pops up. But I would highly encourage the folks to visit our website.
Our website is nccoe.nist.gov. So it’s nccoe.nist.gov. We have our practice guides that are listed for folks to take a look at and our remote patient monitoring practice guide is there. And Nakia has touched on it, it has valuable bits and pieces of information on the types of work that we’ve actually done specifically for this project.
Absolutely. Actually this podcast series, season two was all about cybersecurity and connected health. And all of my guests from around the world really never said it outright, but every time I asked them the question, it seemed like more, they were addressing the issue in the form of mitigation of risk in the connected health system.
So when we talk about cybersecurity talking more security or the mitigation of risk? The idea of a solution that someone’s going to develop someday can never be breached. Is that too much pie in the sky idea?
I really like this question. As we sometimes look at these things as being different, we believe that we’re talking about the same thing. They work in conjunction. So privacy and security work hand in hand. Cyber security is more focused on the physical devices and privacy is focused more on the data.
But I think we’re talking about the same thing. You just really want to get to what is the best thing that we’re trying to provide? What are the solutions that we’re trying to assure that HDOs and small companies can do? And one thing that we mentioned is our practice guide is a great tool to be used to improve cyber security and posture and potential data risk when it comes to the telehealth ecosystem.
Absolutely. We didn’t go too much into privacy in this conversation, but they do go hand in hand for sure. Ron, what do you envision as the next best steps in attempting to better secure and protect this RPM ecosystem? We’re seeing more devices enter the healthcare sector with all these cool, smart features such as AI at the edge, that are not only gonna do monitoring, but at some point they’re going to make autonomous decisions without a human intermediary. So I imagine the risk level just goes up a little more in those kinds of scenarios.
That is absolutely correct. One of the big and most important pieces here with the project and as we’re entering into new devices in our own home or different environments is understanding those risks with that architecture. We provide our privacy framework, cyber security framework, our risk management framework.
There are so many opportunities for learning to understand that level of risk. And one of the other pieces here is ensuring that your HDO as you partner with the right telehealth platform provider to extend that privacy and cybersecurity control deployment management and efficacy. One of the things that are out there is we’re constantly evolving in technology.
So you need to consider future technologies that can augment data communication safeguards. Also Maria, I will end off on this last note, which is important. Our website, we are actually pushing more and you touched on the word AI. We’re exploring so many different capabilities that are out there within the national cybersecurity center of excellence that consumes not just our remote patient monitoring piece, but we have different areas within our center. We have 20 active projects, for example, over at our center that we’re constantly looking for collaborators in. So one of the things that when, and if folks get the opportunity is again, check our website and look underneath the security guidance tab. And you have different areas by different sectors that we are looking for collaborators in.
We publish information out. We look for feedback as your comments are very valuable for us to constantly improve our information as we’re rolling it out for consumption. So take a look at that underneath again, the security guidance tab, we have different sectors that are available and as we’re evolving in different types of technologies and those areas of interest, we have our practical, usable, repeatable guides that are there and also we love feedback. So there’s a community of interest distribution list under each of these sectors. Do register. Be part of our experience to help improve our current infrastructures that exist today.
Absolutely. Last season was AI for Good Medicine. We had so many great different use cases and ideas there. We’ll make sure our guests and our audience are aware of these other opportunities at the NCCoE.
You guys have shared so many great insights with us already. You know, the guide I think is awesome.
I’m gonna pose this question to both of you and I’ll ask Nakia to go first. Any final thoughts you would like to share with our audience as it comes to developing remote care technologies under the context of patient-centered care? Any interesting upcoming projects, plans of action? Things just to think about in general? What is your parting final thought Nakia ?
So I would say that if you haven’t already checked out a RPM Practice Guide 1800-30, we definitely would encourage everyone to read it, check it out. And if you have any project ideas to contact our team. We would like to mention that when we published our RPM practice guide, we also published two tip sheets focused on telehealth. One is for the patient and one is for the provider. Each tip sheet includes a couple of strategies on what each can do. As far as the patient, the provider, to mitigate cyber security and privacy risk or other telehealth services.
And I’ll turn it over to Ron to share about upcoming projects.
Thanks, Nakia. Yeah, Maria, we’ve actually had two great virtual workshops. We had one just recently was the virtual workshop on our smart home integration project. The turnout was phenomenal. We had a lot of speakers. We had technology providers, health delivery organizations there to contribute, and we had an open panel discussion. That was wonderful.
Aside from that, we also had our exploring solutions for cybersecurity of genomic data. That was a two day workshop we had. We provide a lot of information for individuals that are registered in our community of interest for each of our different sectors, register! As we have more and more virtual webinars, and hopefully sooner than later physical workshops together. We send out communications and we post it on our website. So register for a community of interest so you’d be notified whenever we have our webinars or workshops. You will also get the opportunity to be part of our draft guidance for the public to consume and provide feedback. You’ll be notified whenever we need comments. So please do so. A lot of these projects that we do here, we try to make it very informative for people out there that actually need to have some type of guidance or some type of framework.
And because we’re such an organization where we rely on collaboration, it’s very important to get people to get involved with us. So once we’re in our labs, once we’re together, we can really do a deep dive and really figure out where these problems reside in which we can actually provide some type of output for a solution that folks outside of our lab can actually, um, use.
Absolutely. I mean, I subscribe when I get those updates as well. The IEEE SA volunteers and various projects have responded to NIST calls for feedback and that kind of thing. So for our audience, whether you’re with us or you’re on your own, definitely we are in many ways involved in trying to help the overall global community address these big challenges that we’re facing.
Ron and Nakia, thank you so much for joining me today. It’s been an absolute pleasure.
For all of you out there. If you wanna learn more about all the work going on at the NCCoE at NIST I say, all roads lead to the website, nccoe.nist.gov. All the information, as Ron and Nakia mentioned, is free for you guys to consume. I think it’s a great resource if you’re in this space, whether you’re technical, you’re innovation, you’re a clinician. I think it’s valuable for anybody to read it.
A lot of the concepts we talked about today are addressed in various activities throughout the IEEE SA’s Healthcare Life Science Practice.
Our practice is really engaging multidisciplinary stakeholders from around the globe who openly collaborate. They build consensus and develop solutions in the form of open standardized means to support innovation that will address these issues of privacy, security, and equitable, sustainable access to quality care for all.
Some of our programs: Transforming the Telehealth Paradigm Industry Connections Program and WAMIII, which is where both Medical IOT Interoperability Intelligence cuts to the core of a lot of the discussions we were having today. If you’re interested in learning about these projects and all the other areas we’re involved in, you can visit ieeesa.io/hls.
So if you enjoy this podcast, we ask you to share it with your peers, your colleagues, through your network. This is the way we can get these important discussions and ideas out into the domain, is by helping us get the word out. Be sure to use the #IEEEHLS or tag us on Twitter @IEEE SA.
Special thank you to our audience for listening in, continue to stay safe and well until next time.
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About the Host
Director, IEEE SA Healthcare & Life Sciences
As the leader of IEEE SA Healthcare & Life Sciences, Maria works with a global community of multi-disciplinary stakeholder volunteers who are committed to establishing trust and validation in tools and technologies that will change the approach from supply-driven to patient-driven quality of care for all. Her work advocates for a patient-centered healthcare system focused on targeted research, accurate diagnosis, and efficacious delivery of care to realize the promise of precision medicine.
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