Technology in Healthcare: How Software Improves Medical Practice?
Big data, artificial intelligence and cloud computing, smartphones, “internet of things” and wearable devices - they all emerged during the last two decades. Things that were impossible to even imagine in the past are now changing the workflow in almost every industry, including the medical field.
Can you imagine interpreting a medical image in milliseconds? Or identifying cancer faster and with more accuracy? Technology is rapidly evolving and its applications are significantly contributing to healthcare development. With increased numbers of available medical software solutions on the market, new possibilities emerged in the healthcare industry.
There are currently many examples of artificial intelligence applications helping the fight against the COVID-19. By implementing it into software of medical devices, healthcare professionals are able to detect, predict and deal with this global challenge not only faster, but also more accurately. Pandemic is not the only situation when these technologies can be used at their full potential.
In this article, we will explore the applications of technology in different medical software products, shed light on some of the most innovative start-ups and companies across the world and see what are the challenges the healthcare industry is facing to deploy these technologies.
No place for technophobia in healthcare
The latest technologies such as mixed reality, machine vision and deep learning could seem quite scary to medical professionals. Some could fear that robots and machines will replace them in the near future. But is it true?
Deployment of IT technology in the healthcare industry enabled healthcare professionals to do a lot of things that were impossible before. For example, technology is helping doctors to enrich their diagnoses with data-driven decisions. It also enables them to analyze a large number of medical images faster and more accurately. Today, doctors can be better prepared for surgery and minimize risks thanks to technology and new medical software solutions.
Medicine is about humans helping other human beings to understand and overcome difficult situations, i.e. diseases. Medical software is a mere tool that is helping healthcare professionals to dedicate more quality time to their patients. They can neither replace human judgement nor substitute human decision-making. Instead of scenarios where robots replace humans, let’s explore things which technology made possible and real within the field of medical software in the healthcare industry.
Medical Diagnosis Software
Emerging medical software solutions in the healthcare industry are providing a large spectrum of previously unimaginable outcomes. They are helping healthcare professionals to gather data in order to establish data-driven decisions, while also helping them to interpret large amounts of data.
Medical software enables healthcare professionals to make their decisions faster and more precisely. They also allow the emergence of new data and are enriching decision-making processes, which is especially important to have in mind when it comes to medical diagnosis software.
IT isn’t something new in the healthcare industry. The first step it contributed to was making available knowledge accessible online. Then it made it systematized and accessible more quickly. What followed was adjusting those steps to emerging technologies.
We can see it in an example of Diagnosaurus - a healthcare mobile app which evolved during the last decade. Former simple diagnosis list now enables doctors to explore within a tap on their phone more than 1 000 differential diagnoses by organ, symptom or disease. It stands out because its feature “See Related DDx” helps doctors to consider alternative diagnoses.
Screenshot of Diagnosaurus mobile phone app
Today, IT offers innovative solutions. One of the examples of how technology is helping doctors with diagnostics comes from the FDNA company, specialized in next-generation phenotyping. Founded in 2011, the company came up with Face2Gene - a facial recognition software combined with machine learning.
Face2Gene is “a search and reference tool for rare diseases and is permitted for use only by healthcare professionals. It is helping clinicians arrive quicker to possible differential diagnoses and helps laboratories to correlate their sequencing results to the patient’s phenotype,” emphasizes Nicole Fleischer, FDNA’s Vice President of Scientific Research. Their AI technology currently “allows facial photo analysis and clinical notes (text) analysis […] to help laboratories to correlate their sequencing results to the patient’s phenotype”.
Currently, there are more than 400 million patients globally suffering from rare diseases, half of them are estimated to be children. Healthcare professionals use the Face2Gene app for many of them. The added-value of Face2Gene’s technology has been demonstrated during the COVID-19 pandemic. FDNA’s AI provides laboratories with thorough patient phenotype and “is enabling clinicians working with telemedicine, to securely receive patient information before the telehealth session, thus allowing a more focused and precise meeting,” Nicole Fleischer concluded.
Screenshot of FDNA’s Face2Gene software
Because MedTech makes possible to produce and manage large amounts of data, many solutions emerged to help doctors identify useful information from datasets faster for setting diagnosis. Especially in the radiology field, where analyzing numerous imaging scans can be very challenging in order to avoid making a mistake while maximizing accuracy. Some medical software is made to do exactly that - to analyze patients’ medical images with more speed and accuracy.
That’s why Zebra Medical Vision came up with an AI1 “all-in-one” solution for radiologists. Their Imaging Analytics Engine receives imaging scans and automatically analyzes them for various clinical findings it has studied. Its technology is based on a “database of millions of imaging scans, along with machine and deep learning tools” which helped them to “create software that analyzes data in real-time with human level accuracy – providing radiologists with the assistance they need to manage ever-growing workloads, without sacrificing quality,” according to the company’s website.
Screenshot of Zebra’s AI1 solution software
Many start-ups emerged with the goal of making a more accurate diagnosis by implementing AI technology. One of them is Aidoc, an Israeli start-up that is using AI to analyze medical scans of head, spine, abdomen and chest. The company states how their products “help detect and pinpoint critical anomalies for radiologists through deep learning and AI algorithms that analyze medical images and patient data.” One of their biggest assets is a prioritizing tool which flags critical findings, such as intracranial haemorrhage on noncontrast CT head scans. Like that, radiologists are able to adjust their worklist if necessary.
Screenshot of aidoc’s software
Screenshot of aidoc’s prioritization tool
Imaging plays a crucial role in diagnostics and documenting diseases like cancer. A study published by NVIDIA showed that deep learning drops the error rate for breast cancer diagnoses by 85%.This was one of the reasons why Jeet Samarth Raut, Peter Wakahiu Njenga and Simon Rasalingham founded AI imaging medical platform Behold.ai in 2016. They came up with a red dot® algorithm which is based on deep learning models. That means it can classify a chest X-ray and localize its findings as heatmaps. According to the company’s website, their algorithm has been developed “using more than 30 thousand example images, all of which have been reviewed and reported by highly experienced consultant radiology clinicians.” As a result, their algorithm has over 90% accuracy to detect abnormalities within seconds.
Video of behold.ai’s red dot algorithm
Medical Visualization Software
New technologies related to 3D models, virtual reality or simulations enabled doctors and surgeons to obtain new information that they previously could not do. Such technologies empower healthcare professionals to perform their work better with medical software solutions for visualization or preparation of surgery.
In the field of visualization devices, one of the well-known companies is AccuVein. They produced a vein visualization device which helps healthcare professionals to easily find patients’ veins for blood draws. The company states that the handheld augmented reality device uses “a near-infrared (NIR) 3D imaging system to detect veins. As the device is focused on a patient’s target area, the first IR detects haemoglobin in the veins through the patient’s skin and projects it as a contrasted image. As the intensity of the first laser increases and goes deeper into the skin, the photodetector receives several vein images based on the depth.”
Screenshot of AccuVein’s vein visualization device
Another solution comes from EchoPixel company. They were eager to find a solution for surgeons to practice and prepare for operations with 3D models, instead of 2D images. Their True 3D software makes it possible to interact with 3D images of a “virtual patient specific anatomy without the need for a bulky VR/AR headset”. Special glasses for viewing and a stylus to manipulate the images are required. According to the company, the software uses machine learning to record the way doctors interact with the generated 3D image. Consequently, other doctors are able to interact with the image in the same way previous doctors had.
Video of EchoPixel’s True 3D software
3D printing technology is also the foundation for the Belgium company Materialise. Their Mimics Innovation Suite was designed for engineers and researchers “to make using medical image data for engineering purposes (3D analysis, planning and personalisation of devices) as easy and rewarding as possible.” They also made the Materialise Mimics Care Suite for healthcare professionals for image planning and medical 3D printing in hospitals.
Video of Mimic Innovation Suite - 3D heart model planning and printing
Software for therapeutic purposes
Software can have many applications in healthcare and numerous companies and start-ups work on developing new therapeutic tools for doctors. What is the status of this software when they come along with medical devices, which is often the case in the rehabilitation field? Should it be declared as software as a medical device? Is it software that is a part of a medical device? Or is it software as a non-medical service? The question is still pending in many countries which do not stop software solutions to be released in the market.
One of the examples of software programs used for the rehabilitation of cognitive disorders comes from the German company HASOMED GmbH. They came up with the RehaCom - a “system of software for computer-assisted cognitive rehabilitation”. According to the company, the system provides “nine screening modules in order to support the therapist to choose the most effective therapy modules.” RehaCom consists of 28 gamified therapy modules to “help patients improve cognitive function and compensatory skills in attention, memory, executive functions and visual field. The company emphasizes that Rehacom has been used in 95 % of German rehabilitation clinics. It also provides a computer offline solution for inpatients as well as a telerehabilitation solution via Internet for outpatients.”
Screenshot of RehaCom’s software
The emergence of video gaming concepts (or gamification) in the healthcare industry is an attempt to improve patient clinical outcomes with engaging means. Such a trend has also set the “need for a “digital practitioner” who channels these games, monitors progress, and selects the most appropriate ones for a given patient,” as emphasized in the paper by Eli G. Phillips Jr, Chadi Nabhan, and Bruce A. Feinberg.
The gamification trend is especially important when it comes to therapeutic solutions for children.
To keep them as engaged as possible and to increase their clinical outcomes, German company Caterna developed a software Caterna Vision Therapy for children with amblyopia or “lazy eye”. Their nine-game scenarios are accessible both online and as a mobile phone app for children aged 4-12. According to the company, “a special wave pattern in the background of the games stimulates the brain to activate the weak eye again” and is effective after 90 days of therapy. It is also the first European Internet-based therapy covered by health insurance as a medical device. Thus, only an ophthalmologist can prescribe it as part of the occlusion therapy.
Screenshot of Caterna’s Vision software
Patient monitoring software
Deployment of technology in the healthcare industry resulted in an increasing number of mobile health technology or mHealth market. In 2019, the global mHealth market was estimated at 37 billion dollars. With it, wearable devices also emerged, making it possible for healthcare professionals and their patients to keep in touch and interact remotely.
For example, a lot has been done in the diabetics field who mostly use data management systems. In this case, data management systems are simple programs that automatically or manually let you log data such as blood glucose levels. This data can then be displayed as a graph to identify trends, or even be sent as notifications to a healthcare professional to help patients manage their diabetes.
One of the monitoring software solutions comes from the US company Glooko. It was founded in 2010 to “transform the way daily decisions are made by leveraging the power of mobile, cloud and analytics” for people with diabetes. Today, the company’s software platforms, Glooko® (in North America) and diasend® (in EMEA/APAC), empower diabetes management by collecting data from blood-glucose meters, CGMs, insulin pumps, pens and activity trackers. Data is easily uploaded - remotely via app or in-clinic, securely shared and visualized in actionable charts and graphs. The platforms are compatible with the vast majority of diabetes devices available, giving people with diabetes and their care teams the freedom of choice. During the pandemic, Glooko is offering a free Remote Care Solution to people with diabetes and healthcare providers to enable safe and connected patient care.
Screenshot of Glooko’s mobile phone app
The SiDiary diabetes management software comes from the German company Sinovo. Similar to Glooko, it also enables patients to import their data from meters and pumps to the PC version that they can access and analyze from mobile phones and tablets. Patients can also send their data to their doctors. On their side, doctors can use the SiDiary Healthcare Professional Version, which allows them to read the patients data, get more detailed data about their patients and provide them with a closer follow-up, without installing different software from different manufacturers.
Screenshot of SiDiary’s mobile phone app
Similar software solutions are emerging in all the other medical fields beside diabetes. One of the examples comes from a young Croatian-American start-up Luxheal. Their team of doctors developed Luana - a mobile phone app that works as a digital assistant for prevention and rehabilitation of cardiac patients. “It collects and analyzes their lifestyle data, connects them with hospitals and doctors who can optimize their treatment based on the provided data,” Luxeal’s CEO Marino Sabijan emphasizes how Luana is currently declared as “patient aid”.
Luxheal’s products are GDPR compliant and in the process of becoming HIPAA compliant. But it is only the first step for this ambitious company. They are waiting for the Medical Device Regulation, planned for the end of May 2020, to get Luana classified as “Software as Medical Device”. The app is at the moment used in the USA (Maryland Urgent Care hospital) and Croatia.
Screenshot of Luxheal’s Luana software
Appointment Scheduling and Medical Billing
One of the biggest novelties that came with technology is the ability to reduce administrative workload in medical centers. One of the solutions that contributed to it is the possibility of scheduling appointments online. Most of these software programs have a billing system implemented as well as video conferencing options, enabling doctors to assess patients remotely.
A good example of how such software became practice comes from a French company Doctolib. Founded in 2013, they created a “consultation management software for health professionals and an online appointment-booking service for patients.” Today, Doctolib is also deployed in Germany. Their website is receiving more than 40 million visits each month. Doctors are listed on the app or website depending on their expertise, availability and location. Patients choose the doctor they want to schedule the appointment with and they can easily cancel it if they need to. Doctors have the same acceptance/cancellation option, and they can also have online consultations with patients and provide them with online prescriptions and bills.
Screenshot of Doctolib’s mobile phone app
Similar to Doctolib, the Swedish company Kry was founded in 2014 and since then, it allows patients from Nordic countries, as well as from the UK, France and Germany to consult a registered general practitioner by making an appointment on their mobile phone/tablet. Their app is called Kry in Nordics and Germany, while in France you can find it under the name Livi. After answering several questions about your symptoms, a doctor video-calls you to start the medical appointment.
Screenshot of Kry’s mobile phone app
A good example of a similar software used for appointments in the USA is SimplyBook.me. It is a HIPAA compliant scheduling software, which allows you to “create appointments, send reminders and enable the booking of extra services.” It is an affordable scheduling solution for medical and dental clinics.
Screenshot of SimplyBook.me mobile phone app
Electronic health/medical records systems
Being a healthcare professional means sometimes being occupied with follow-up of patients in the long run. One of the basic example to illustrate how medical software is helping to address this issue is to look at electronic health or medical records systems (EHRs and EMRs). They are basically digital versions of patients’ data that was earlier stored only on papers.
Even though it was previously described as “ poorly designed systems [that] make doctors slave to their EHRs”, and criticized for their poor interoperability and high costs, their significance is not questionable. One of their biggest assets is that they are real-time records, allowing sharing amongst authorized personnel to access the needed patient data. They significantly reduced the amount of time healthcare professionals had to dedicate to archiving and storing, therefore freeing time for doctors to have effective discussions with their patients.
There are many options when it comes to choosing the right EHR. Depending on the size of your medical center, your needs and budget you can choose between on-premise EHRs or cloud-based EHRs. Christopher Jason, journalist at EHR Intelligence, states in his article that “according to information published by HIMSS Analytics, two-thirds of IT leaders from health systems and hospitals reported that they currently utilize the cloud-based technology.” Cloud-based EHRs usually have a higher level of data security than on-premise EHRs. They also prioritize interoperability and data exchange, which enables providers to optimize care between colleagues and avoid potential misinformation.
An example of a cloud-based EHR comes from CloudMedx, one of the leading companies implementing AI technology into EHR software. They are “integrating natural language understanding (NLU) and deep learning with major EHRs and healthcare organizations nationwide.” They came up with two products - Clinical Analyzer and Coding Analyzer for “automating clinical insights generation, clinical documentation and medical coding.” In 2019, CloudMedx won the “Best Overall Connected Healthcare Solution” at the GITEX Award.
Screenshot of CloudMedx Clinical Analyzer
Screenshot of CloudMedx Coding Analyzer
Oncora Medical is a digital health company “integrating big data and machine learning into radiation oncology.” Their software solution can measure quality of patient care, suggest optimisation in the treatment and provide in-depth oncology outcomes data and imaging in order to help improve operations and patient outcomes. They also have an implemented billing feature.
Screenshot of Oncora Medical’s Patient Care software
As an example of cloud-based software in dental care, we can take a look at PerioSystem by French company Adservio. They are claiming that PerioSystem is “the only integrated cloud-based dental management software system that combines the functionalities of five dental software services.” That includes practice management, patient communication, treatment planning, patient education and accounting. PerioSystem stands out because it also uses voice recognition, motion and facial recognition, as well as augmented reality. These advanced technologies are used to provide 3D models of teeth, while voice recognition enables dentists to take notes faster and dedicate more time to their patients.
Screenshot of PerioSystem software
When it comes to solutions for archiving pictures, we can name PostDICOM as an example. It is a cloud-based software with integrated DICOM (Digital Imaging and Communications in Medicine) viewer for ultrasound imaging, MRI, CT, radiography, and nuclear imaging. It comprises all features of PACS (Picture Archiving and Communication System): storing, accessing, and sharing medical imaging files “within a cloud environment using the DICOM protocol. This eliminates the need for hardware-based storage, lowering [..] costs and further optimizing [..] medical imaging archiving system.”
Video of PostDICOM’s software
The new opportunities offered by medical software solutions
The list of medical software solutions that are changing the healthcare industry could go on. Some of the new opportunities that they are offering to healthcare professionals consist of task automation, analyzing big data sets, reducing the workload and enabling them to focus more on patients. Some software companies claim that their product may save money to healthcare systems.
The emergence of wearable healthcare technology and mHealth also helps to achieve this goal. Doctors can now easily receive patient monitored data from such devices. It helps medical professionals optimize their work time and dedicate more time to high-risk patients and to interact with engaged and informed patients. The emergence of patient portals also enables doctors to connect with their patients and to explain procedures more thoroughly.
Still, we shouldn’t forget that all technological advancements are based on data provided by humans. According to the Business Insider, that means there is “a risk of data sets containing unconscious bias.” We are yet to see if and how new rules of ethics will address these issues.
Rapidly emerging technology vs. slow regulations
Technology is developing at an incredible pace, changing the medical field in incredible ways. But to carry on, legislation is struggling to keep up with this speed. Even though there are already laws regarding privacy protection such as HIPAA in the US and GDPR in the EU, we can see in the example of Luxheal’s Luana - regulations vary between continents, even between European countries.
GDPR and HIPAA can also cause a lot of trouble for entrepreneurs and engineers by slowing down the process of placing software solutions on the market. Still, privacy isn’t the only issue that needs to be resolved when it comes to regulating medical software. There are two big questions to be answered - how should we define and how should governments regulate new medical technologies?
In the EU, it seems that we are yet to see how these questions will be answered. Because of the COVID-19 pandemic, the implementation of the Medical Device Regulation was postponed for a year. How will the medical software market react to it? One thing is sure - it will be interesting to see how technology helped to deal with and (hopefully) overcome the COVID-19 outbreak.