Decision Support

Buzzwords like Artificial Intelligence (AI) and machine learning are commonly heard at conferences and industry events and they often conjure up images of robots or killing machines from the Terminator. However, panelists from the Innofest Unbound conference in Singapore all felt that technologies such as AI should not replace humans as it is commonly imagined – rather, they should augment the work of clinicians and hopefully, even enhance the patients’ interactions with their doctors. Human-centric AI A medical doctor by training and also the founder of MEDGIC, a startup which utilises AI to detect skin conditions, Dr Reid Lim feels that the use of AI should always involve doctors and not replace them. “Healthcare systems are becoming unsustainable and we need AI to help automate some things and to help alleviate the burden on doctors. AI is not new and it seems strange that some people are only beginning to grasp the use AI.” “A lot of radiologists are already using Computer Aided Diagnosis (CAD) for mammography and it has been happening for some time. So the idea is for us as a tech startup to pursue what we call human-centric AI. We try to make AI as explainable as possible and we always want humans to be involved in the whole process,” he added. Dr Philip Wong, a practicing cardiologist and founder of WEB Biotechnology, concurred that as doctors, there is a sense of compassion and empathy to want to help patients regardless of their health condition, and that is something AI cannot do at the current moment. “Anything thing (or tech) that is adopted by the hospitals, we always have qualified specialists or ‘men/women in the loop’. For instance in radiology, even though a lot of analysis is done by AI, in the end the person who signs off is the radiologist or specialist radiologists who have to sign off the report.” “We’re not afraid of losing our jobs as healthcare providers, and in this respect, what I think most people or most healthcare providers don't understand is the benefit that you get from the first problem I pointed out, right? The problem is we have a whole huge plethora of data, which we're trying to analyse but we haven't got a sense of it. So you pop up the electronic health records, right, I see two computer screens with approximately 1000 fields. I've looked at this, analysed all this and this is where I think AI can really help the doctor, the patient as well,” said Dr Wong. Meaningful and novel applications of tech Mr Chua Chee Yong, Emerging Services & Capabilities Group, iHIS, the IT agency for the Health Ministry in Singapore, shared that there are possible concerns about specialists being ‘replaced’ by AI even after years of training and practice. However, he stressed that it is about how to meaningfully apply technologies so that it makes a difference. “We all know today that AI is not quite explainable, not quite there yet. What do we do? We can choose to ignore it and only use it when AI reaches a point that it is explainable. Or we can choose to apply it in a safe way that allows us to improve our productivity.” “The example in this case is retinal image scanning. We use a simple AI to do a simple classification of ‘normal’ vs ‘abnormal’. Guess what, 70% of the normal cases got eliminated by AI and the leftover 30% are read by the human being – productivity suddenly increases and the person just focuses on the very complex 30% abnormal cases. The accuracy also improves – you see how we apply it? Despite the constraints and limitations of AI, if we apply it meaningfully, we can harness value out of it,” he explained. Looking into the future According to Dr Wong, what he sees in the future is that data is becoming more ‘fluid’, for example from the Spyder wireless ECG monitor that he invented. For example, even if someone is wearing the ECG monitor in the US, the ECG data can be acquired by the doctor back in Singapore almost instantaneously.  Another future development that is very exciting for Dr Wong is that the smartphone will become the ‘replacement’ of healthcare in many respects, becoming the apparatus and interface to make an appointment to see a doctor, collect health information and do much more.  He concluded with a wish as a doctor for a ‘digital health persona’ for patients, to get a lot more health information from them and try to solve their problems. With the digital health persona, health information is being collected continuously, even outside the hospital and the information can even be front-loaded to the doctor before the patient sees him/her. This gives the doctor a broader picture of the patients’ health. 

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The National Neuroscience Institute (NNI), the national specialty centre for the management and care of neurological diseases in Singapore and Iota Medtech, a local medtech company specialising in AI and surgical robotics, signed a Memorandum of Understanding (MoU) to develop a system to sort brain scans of head injury patients in order of urgency. What’s it about Currently, there is a significant waiting time for head injury patients requiring urgent treatment, especially when scans were received after radiologists' working hours. The 70 to 100 brain scans received daily are interpreted by radiologists in chronological order. The development of the priority sorting system will help ensure that patients requiring immediate medical attention receive the care they need. Radiologists will be able to interpret brain scans faster and their work will be more efficient. NNI will develop the algorithm to sort brain scans using a “triage system”, with each scan labelled red, amber or green according to the urgency of medical attention. The system will also be tested in a clinical setting, with its accuracy compared against that of radiologists in NNI. Before being implemented in hospitals, it will have to go through regulatory approval processes by the Health Sciences Authority, the national regulator for health products, which will take some time. In the future, the system developed by NNI and Iota Medtech can be modified to treat other common conditions such as stroke and glioma (a type of brain tumour).  On the record “Head injury was chosen as the initial focus of the system in accordance with current patient demands”, said Mr Benjamin Hong, CEO of Iota Medtech in a statement. Associate Professor Ng Wai Hoe, medical director of NNI said, “Iota Medtech's algorithm has already passed laboratory tests for accuracy and NNI will be providing data of brain scans to continually increase the accuracy of the system. The sharing of the data will be in accordance with guidelines in the Personal Data Protection Act.”

Given the increasing complexity of clinical care and massive amounts of data being collected through different medical devices, healthcare professionals can end up spending excessive amounts on time on documentation and often, have a lot of critical information but in a fragmented or siloed manner.  Fragmented data creates information gaps, which can potentially impact decision-making, coordination, and workflow. One way to address this challenge is to bring together the disparate sources of data onto an integrated platform, and this is where Ascom’s Healthcare Platform comes in. The modular approach of the platform means that healthcare organisations can begin their process of data consolidation regardless of their stage of development. Due to its built-in interoperable features, existing hospital information systems and devices can also be integrated into the Healthcare Platform. One practical use case of the Platform is that of patient alerts – with Ascom’s ability to analyse, filter and channel alerts to specific clinicians, they do not need to ‘chase’ the data and can respond more appropriately based on the nature of the alarm. This results in fewer needless interruptions for the clinicians.  Sengkang General Hospital is one of the first hospitals in South-East Asia to have implemented the end-to-end suite of Ascom Healthcare Platform solutions. “We are pleased to be working with the Ascom Telligence Nurse Call System as part of our integrated solutions under the new hospital infrastructure. Having the ability to bridge the information flow seamlessly with various business applications has helped to drive towards greater workflow coordination and productivity for our staff particularly in current times of manpower constraints” as shared by Lee Puay Chuan, Deputy Director Strategic Projects, Sengkang General Hospital, Singapore.  Purpose-built devices for care delivery While an integrated platform can bring about better healthcare data visibility and actionable insights which are beneficial for both clinicians and patients, the hardware or devices must also be up-to-task in terms of providing access to vital information, as well as facilitating the communication between clinicians and care teams. The Ascom Myco™ 2 is an example of such a purpose-built device which connects its users with colleagues, patients, labs, pharmacies, porters, cleaners, medical devices, patient monitors, and nurse call systems. Crucially, it merges data from these multiple sources and displays it as meaningful information to help frontline staff make the best decisions while on the move. Designed for the delivery of personalised care, the recently released Ascom Myco 3 is a versatile purpose-built Android™- device which features multiple care delivery and monitoring functions. It works with apps to integrate with nurse/call alert systems, wander management and monitoring solutions and data collection systems. To facilitate more efficient care at the bedside, the Myco 3 allows the user to perform single-entry registration of vitals to EMRs/EHRs, barcode scanning of patient IDs and point-of-care access to and management of clinical information.  Users can choose from using either the Myco 2 or Myco 3 on their own or even combine the use of both purpose-built devices within the same facility. Regardless of the device use combination, they can be easily integrated into the Ascom Healthcare Platform, enabling seamless access, sharing and tracking of information across care teams and locations. Android is a trademark of Google LLC.

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