Augmented Reality: a turning point in health informatics

Every day, there are more bridges uniting two worlds so full of trends: technology, especially in the field of information technology, and medicine. One of the great contributions of information technology to medicine is that now doctors can carry out operations much more effectively and with lower costs, running fewer and fewer risks than they used to in previous times. This is known as ‘augmented reality.’

Augmented Reality (AR) is a technology that allows superimposing virtual elements on our natural perception of reality. Although the idea appeared in the nineties (a Boeing employee thought that workers lost a lot of time reading manual instructions) only a couple of decades later a video game was created, and it actually revolutionized the world of technology: Pokémon Go. This game consisted of going out there (at your home, your neighborhood, and your city) hunting pokémons thanks your smartphone camera and a GPS locator: you pointed to any place, and, on the screen, you had a map, a radar, and, every time you found one, you could capture the Pokémon you were looking for in your inventory. Then this idea sparked the creativity of thousands of developers, and, since 2016, this technology has gained a lot of ground. It has already reached the medical territory, by the way.

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Nowadays, there are several fields of medicine in which augmented reality has been introduced. On the one hand, the visualization of clinical data. In this case, what is sought is to visualize clinical data quickly and completely when using certain devices. For example, while carrying out a tomography or a colonoscopy, the doctor can learn more about the patient on a screen while still observing the patient’s body. The type of blood, allergies, cancerous cells, a malignant tumor, a colony of bacteria, etc., everything would appear in front of your eyes while using the device that allows you to carry out the procedure. This allows doctors to take decisive actions faster and identifying problems much earlier.

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Augmented reality is one of those phenomena in which the tremendous capacity of machines (including, of course, software) gives a hand to the intelligence and ability of doctors. In recent decades, the fear that smart machines take over human works has grown a lot, fueled by science fiction. In reality, as this article says, things are not that creepy, nor will they; and augmented reality is an example of that.

Augmented reality in medicine can go far beyond the mere visualization of clinical data. It may be a fundamental tool for surgeries in the future. Thanks to this technology, a doctor has vital information about the patient during the procedure, which will even allow him/her to choose one or another way to proceed. But, in the same way, it allows the surgeon to know the exact position of the anomalies to be solved (for example, a tumor, the remains of a bullet, an aneurysm, etc.). It eases the procedure since it saves vital time for the medical team, as well as resources and energy, and allow surgeries to be less traumatic for patients (especially recovery.)

This technology opens a plethora of doors. An operation may be streamed live so that other doctors (or students) can learn and even participate. Similarly, textbooks and software for medical students could include three-dimensional images for learning in a much more practical and playful way. Moreover, it is now possible to build models identical to human bodies to perform Virtual Reality simulations, so that a student can later perform a real operation with the same software while using Augmented Reality devices in real patients.

Moreover, when telemedicine is mixed with augmented reality, some possibilities (unthinkable before) now become real. A surgeon could operate a patient remotely, regardless of whether the first one is in the heart of Alaska, and, the other, in Madagascar, as long as there is a good internet connection. With an augmented reality system, many clinical devices could be available in one, so that you can have a microscopic view, cut, remove, and suture. In general, augmented reality will go hand in hand with telemedicine, because of all preventive procedures, all medical check-ups (or, at least, most of them), could be carried out in a remote and more effective way. What’s more, during a revision procedure, a doctor could quickly and accurately detect if a potentially dangerous anomaly exists. For example, during a CT scan of the kidneys, you might find out if there is a complicated liver injury.

This includes, of course, physiotherapy. For the proper muscle recovery of a patient, the doctor can monitor the patient’s muscles, bones, and tendons while instructing what exercises to perform. In this way, the therapist could even see how a patient’s blood pressure behaves while observing it; and if you need to take x-rays to make comparisons with earlier stages of recovery, you could do so by other methods than the traditional x-rays.

It is a good time to be alive!

Telehealth: a new medical revolution?

The Internet has transformed all industries and has made a variety of processes go digital. The health industry is not an exception. There are quite a lot of problems that require quick solutions, and the Internet has been a means to reach them or to build bridges to reach them. Some of the most frequent problems are congestion in health care centers, and this means that patients must wait a long time to be seen by doctors. In part, due to high operating costs, health centers cannot afford to hire such a large staff, and this also increases the problem. On the other hand, due to the large size of many cities, patients must drive a long time to reach a hospital or a health care center. But, in a hyperconnected world, these problems can be solved relatively easily.

Just as many companies are implementing teleworking as a way to lower costs and make life easier for their employees, many hospitals, clinics, and health care centers are allowing doctors to work remotely. This is known as ‘telehealth.’ Telehealth rethinks the doctor-patient relationship but remains essentially the same. In this case, the technology allows more people to receive medical attention. The explanation of it is simple: today, there are more cell phones than people, and this could mean a great advance from a social point of view. Many people will be able to access services that they could not previously receive due to distance and high costs. Telehealth solves these two problems.

That is not a new phenomenon, though. In fact, since the boom of smartphones, many doctors have trained their patients to make inquiries through Skype. Many medical consultations can be carried out remotely because the symptoms of patients can be evaluated through their own testimonies and thanks to the information provided by the webcam. Even when patients have smart implants, such as pacemakers and dialysis equipment, doctors only communicate with their patients online when necessary because they continuously receive information without the need for patients to consult them. This has made the medical practice more effective, and, of course, cheaper, in many cases.

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This is not a replacement for medical activity. In fact, doctors are still working, it is just that the way they operate is different. Even more interesting is that medical instruments could evolve thanks to the use of smartphones and 3D printers. Perhaps, in the future, the doctor will ask the patient to download some app to perform a certain type of scanner, hence it would avoid buying an expensive device. Or, who knows, 3D printers could print prescription drugs for patients with specific needs.

Everything can happen.

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It is important not to confuse telehealth with telemedicine. Telemedicine is a remote medical practice. This can be done through a Skype conversation, over the phone, and can even be done from Earth to the International Space Station. This is the beginning of some even more ambitious trends: the remote medical practice by means of robots. That is to say: a doctor in the United States operating online, for example, a soldier in Afghanistan. Many governments around the world are investing millions of dollars in this technology. Not only war doctors could avoid being present on the battlefield but a specialist anywhere in the world could operate on any patient anywhere in the world for a fair price.

Amazing, right? Distance is no longer a problem!

Now, telehealth goes far beyond telemedicine. Telehealth not only includes medical practice but also the care of patients, the training of medical personnel in various areas, the prevention of epidemics, the logistics behind the medical care of a given population, and the decisions made when preventing diseases.

When the telemedicine and telehealth systems are satisfactorily standardized, goals that previously seemed impossible now can be achieved. For example, databases can be updated automatically and more effectively thanks to the efficient use of algorithms. Similarly, all operations performed remotely (as well as any activity that involves the Internet) can produce high-value data which can later be used to study statistics and make studies of, for instance, the impact of a new vaccine in a local population. It can also monitor the behavior of antibiotic-resistant bacteria in different parts of the world, which could allow doctors and authorities in different countries to perform controlled quarantines to prevent the spread of such infection.

Many people believe that telehealth will change when the use of artificial intelligence is even more widespread than it is nowadays, but reality shows that the observation capacity of doctors may be much more intelligent and the empathy they may have over the patients could help solve problems that machines simply cannot do. What will happen, perhaps, is that the machines perform certain tasks at a distance (and they may be surgical operations, monitored by doctors,) which, in terms of probabilities, would be better executed than by human beings. But that’s another subject.

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Health informatics cybersecurity challenges in the times of hackers

One of the first consequences arising from the fact that tons of medical information is stored in the cloud are the risks of computer security, which are already more and more frequent in our digital world. In fact, the risk is now a current reality. It is known that the cost of leaks in security systems storing medical information costs this industry between 5 and 6 billion dollars a year. One of the main problems to protect information is that attacks are increasingly difficult to detect, and, because hacking tactics to infiltrate data networks mutate so often, it is almost impossible to take bullet-proof preventive measures. A few years ago, the world experienced simultaneous attacks on networks of major organizations, and these attacks operated as a kind of massive data hijacking: it was necessary to pay in bitcoins in exchange for ‘leaving the hostages free.’

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When it comes to computer security, people do not usually think that the data included in the databases of hospitals, clinics, and research centers is relevant to hackers, but things are actually the opposite. In reality, it could be as important as stealing banking information. In a world in which data is worth as much as gold, there will always be people who want access to huge databases or to the results of scientific researches. Otherwise, healthcare organizations would not have to face a cyber-attack at least once a month!

Given this scenario, it is necessary to ask ourselves: what can be done, taking into account that the internet is exponentially used more for the medical practice? The first thing is to identify the main challenges and threats that make up this problem.

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We got phishing on the one hand. This threat consists of sending emails to all the users of a large database with the aim of stealing important information from them. It is, in a nutshell, a social engineering technique because what it really does is tricking the victims so that they write usernames and passwords (among other data), which the cybercriminals then take advantage of. For example, they duplicate a web page of a healthcare organization, they send an email to the victim saying that they must update their personal information, and voilà.

On the other hand, when the information contained in the cloud does not have sufficient encryption, hackers just have to find the appropriate crack to break into the system they want to access. When they want to cause specific damage, hackers infect a computer with malware and ransomware and thus erase or steal the information they need. This problem is quite frequent when it comes to espionage and industrial sabotage, for example, when a laboratory is working on the patent of a new treatment, which is highly inconvenient to its industrial rivals.

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Now, what can be done? It is hard work but it is possible to reduce the risks. It has been possible considering the high costs of these attacks and the money that has been invested in shielding the networks from this type of crimes. The first thing is to promote a culture of safety in which not only the doctors but the patients and the operators of the system put into practice the basic principles of computer security. This includes, of course, adequately training employees and doctors to handle the software with which they work and always following the security protocols necessary to protect the data of patients and organizations.

Although many hackers know how to dance with firewalls, using these protection systems never hurts a bit. Installing an antivirus system and an updated firewall will close more holes for hackers. If it is a matter of minimizing risks to the maximum, shortening the chances of being hacked is fundamental, even if this is the most basic measure when it comes to cybersecurity.

Well, it is very important to be prepared for surprise situations, such as the attacks that occurred during 2016 and 2017 around the world. In order not to lose sensitive information, in case a cybercriminal is extorting an organization with the threat of erasing all the data stored in the network, the best move is always to make backups of all databases and medical records, and to do it as regularly as possible. This greatly limits criminal activity.

Moreover, while it is important to take care of communications from the cloud, it is also vital to protect the devices with which you work. Someone can steal a computer, install malware with a USB card, or simply using it without anyone seeing it for saving all the information he/she needs (or deleting it, of course.) Computers should be well protected and watched, there must be strong passwords to access them, and they should not be left unattended when there are strangers present in the medical facilities.

There is still a long way to walk here. The harder the threats, the tougher the protections. That’s how things really are in this regard.

Will artificial intelligence replace human doctors?

Thanks to science fiction, one of the biggest fears that people have about the future are the development of artificial intelligence. Great minds like Stephen Hawking and Elon Musk have frequently warned that the development of this technology could mean a disruptive change for humanity with devastating effects. According to many people, robots could not only steal our jobs and our energy resources, but they would come to the conclusion that it is us, humans, the main cause for all the problems that afflict the planet, and, therefore, we should disappear. Of course, these are just theories, and artificial intelligence is still far from becoming the fundamental basis of a dystopia such as Terminator, Blade Runner, or Matrix.

One of the biggest concerns is the fact that some machines can perform certain tasks more effectively than humans. For this reason, during this new industrial revolution, many robots have replaced workers in the factories because they not only work with more precision but also cost less (and have no salary nor labor rights whatsoever.) This has led to serious considerations when it comes to the future of several careers, such as medicine or law. Will doctors and lawyers be ever replaced by machines in the future? The short answer is no and let’s see why.

At least, as artificial intelligence systems are working today, they could not replace doctors for the simple reason that machines lack the full capacity to relate personally with human beings. Many people might think that this is not necessary, and this is not quite true. A machine could (and, in fact, already can) determine with high precision and speed the presence of cancerous tumors on the radiographs of sick patients. The machines can also identify the first moments of the expansion of deadly bacteria on the skin. But machines still cannot interpret this data with the depth with which human doctors do, nor are they able to relate humanly with patients to obtain more useful information that allows them to find solutions to complex problems.

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Although machines can process information quickly and accurately, the medical practice requires a high degree of improvisation and creativity in decision-making most part of the time, especially when patients are going through critical situations that require an urgent solution. If during surgery, a patient has sudden signs of allergy to the anesthesia, surgeons must act quickly to avoid, for example, an anaphylactic shock. If a machine does not have enough information to be aware of the current dangers involved nor the right algorithms to make unexpected and optimal decisions, the patient would simply die in a few minutes.

The truth is that artificial intelligence would not replace the work of doctors, but, on the contrary, would improve it to unexplored levels. The use of machine learning, Big Data, and real-time predictions that could make a quantum computer, for instance, would allow a doctor to process an unimaginable amount of information in a really short time, and this would allow, among thousands of things, to control an epidemic in a matter of hours. The machines are still at our service, and it seems that things will continue this way.

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Actually, the medical practice is full of operative activities that take away valuable time from doctors. It is one of the great frustrations of those who want to keep researching and working for the health of millions of people. Doctors spend hours and hours writing reports, analyzing images and x-rays, calculating costs, studying and feeding databases, among other things, and, in the long run, this means wasting a lot of valuable time. A machine could perform these tasks more efficiently and precisely, and that’s great since, although these tasks are boring, are still highly valuable to achieve the quality standards required today.

Moreover, doctors still commit several mistakes during some diagnoses, for example, when detecting genetic malformations in fetuses. A frequent problem in pediatrics is hydronephrosis: when the kidneys of patients (especially children) are not able to filter water as a normal kidneys do. Ultrasound exams are sometimes not accurate enough to determine if an obstruction is taking place and this is a job that a machine could perform without much effort.

If machines are still in the service of doctors, the prognosis is more than positive: medicine will advance as never before. Today, there are researches on robotics and nanotechnology to introduce tiny robots into the bodies of patients which not only can perform precision surgeries (remotely, by doctors, or automatic,) but they can send information to servers around the world that may help to solve problems that, in other conditions, would be an obstacle impossible to cross.

The picture is much brighter than the Netflix predictions so far, and this is good news!

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