Techfastly August 2021 by Techfastly

AUG | 2021

w w w. t e c h f a s t l y. c o m

Healthcare edition

HEALTH CARE Meets

TECHNOLOGY

p46

In conversation with

CHARLES BOICEY

p23

HIPAA 25 YEARS ON:

The Value of Healthcare Privacy In Technological Age

Co-founder and CIO Clearsense

p04 Emerging Technologies Assisting the Healthcare Industry by Johnson Cherian

p19 Book Review: The Future Is Faster Than You Think by Pranay Aswal

p72 The Wright Brother’s 1903 Flyer by Barkha Sheth

What’s Inside p .4 Emerging Technologies

Assisting the Healthcare Industry

p .30 Internet of Medical

Things (IoMT): Game-Changing Technology for Healthcare Industry

by Johnson Cherian

p .10 Blockchain

Interoperability in Healthcare Industry by Rehan Husain

p .19

Book Review: The Future Is Faster Than You Think by Pranay Aswal

p .23

by Johnson Cherian

p .40

IoT Ransomware - How Healthcare Organizations Can Protect Themselves by Naufiya Mohamed

p .46

In Conversation with: Charles Boicey Co-founder and CIO Clearsense

HIPAA 25 Years On: The Value of Healthcare Privacy In p .59 How Chatbots Technological Age Disruption Benefits by Dhruvil Patel Healthcare Industry by Shubham Gwalia

p .66 Challenges and Impact of

Cloud Technology in The Healthcare Industry by Johnson Cherian

p .72 The Wright Brother’s

1903 Flyer

by Barkha Sheth

p .78 The Role of Big-Data in

Healthcare sector by Rehan Husain

p .85 Top Five AI-ML Books

For Business Leaders by Vibha Soni

p .91 Direct-To-Consumer

Pharmaceutical Advertising (DTCPA) In The US by Anjali Prabhanjanan

Editor’s note

Dear Readers We are delighted, once again, to bring you the August edition of Techfastly. We have focused on healthcare technologies for this edition.The advancement of healthcare technologies is helping the healthcare industry in various important ways, from the diagnosis of unknown pathogens to remote patient monitoring. The implementation of blockchain, AI, Big data, IoT, RPA, and mobile technologies into the healthcare industry has resulted in streamlining processes, lowering healthcare costs, increasing efficiency and accuracy, minimizing errors, and improving quality of care. In this issue, our writers write about various technologies and how they are impacting the healthcare industry. Our writers write about how blockchain technology could be utilized to make EHRs more efficient, how healthcare chatbots are assisting patients, especially during the COVID pandemic, and the role of big data in the healthcare industry. As much as technology is advancing, cyberattacks are becoming a real threat too. We have talked about IoT ransomware and how hospitals and other medical facilities can protect themselves. Patient data is crucial, and HIPPA rules govern the physical and digital health data. In our interview series, we spoke with Charles, CEO and Co-founder, Clearsense Inc. His mission is to ensure that emerging technologies get implemented in the healthcare industry, and he has been doing that via Clearsense. He also gave some amazing tips for CIOs and what should be their top priorities. At the end of the interview, he suggested some must-read books for everyone who wants to understand the technology and its insightful data management. In the interview we discuss his vision, the future of Clearsense, and his favorite books on Healthcare. In addition, our team has also suggested top five books on AI-ML for business leaders. We bring you the story of the ‘The Wright Brothers 1903 Flyer’: The story of two brothers who set the standard for the problem-solving methodology of modern aeronautics’ in our ‘Story of Machine’ series. We would appreciate your feedback and are always open to suggestions. Here is your edition. Do read it, enjoy it, and nourish in the knowledge. Happy reading!

Srikant Rawat

Chief Operating Officer, Techfastly

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Emerging Technologies

Assisting the Healthcare Industry by Johnson Cherian

ver the years, technology has accelerated at a rapid pace. We see improvement in various areas of our life with the advancement in technology; the way we use gadgets and equipment for learning, communicating, transporting, and for health emergencies. Innovations in Artificial Intelligence (AI), automation, robotics, and smart gadgets have greatly impacted the healthcare industry. The Covid-19 pandemic has necessitated the need for early detection of infection, isolation, social distancing, and minimal human interference to reduce the transmission of the virus. Digital healthcare technologies play a significant role in supporting epidemiological intelligence right from online datasets, identifying clusters of infections, monitoring travel patterns, rapid trace contacts, and communication of public-health messages.

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Blockchain

As A Catalyst to Streamline Healthcare Services In healthcare technology, blockchain enables the medical community and researchers to create a single database for all medical data; real-time tracking of patient medical records that allows healthcare workers, doctors, and patients to share information safely and quickly.

ethnic groups, geographic areas, environments, and socio-economic backgrounds. This provides health researchers access to vast data samples to study diseases, facilitate new medical discoveries, design patient-specific treatment, and track and develop drugs quickly.

Blockchain technology could be used in storing electronic medical records enabling coordinated care for patients within the network. The shared data of blockchain allows the capture of comprehensive data sets from various countries; including various

The advantages of blockchain to the healthcare industry are - easy accessibly to electronic medical records, remote monitoring of patients, transparency, and quick accessibility of data for health insurance claims.

Blockchains are publicly distributed ledger transactions that are managed by a peer-to-peer network for use.

Robotic Process Automation (RPA) in Healthcare Technology

Healthcare providers of various departments in a hospital need to perform multiple tasks which are repetitive such as: • Patient admission • Patient scheduling • Scheduling medical professionals for the job

• • • •

Shift assignment Collecting patient data and report Billing Claims processing

RPA and automation address these issues making the healthcare system faster, efficient, minimizing errors, and improved patient satisfaction. Some of the ways RPA streamlines hospital automation: Electronic Medical Records (EMR) Management – RPA helps keep medical records updated, synced, and be made accessible to various other departments such as labs, admin, billing, pharmacies, and claims to execute their duties. Managing Staffing Levels – Caregivers are crucial to the smooth functioning of the hospital system and scheduling staff is a huge challenge. RPA automation across multiple business applications helps organize and schedule the right balance between the availability of sufficient staff for each shift without them being overburdened.

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Regulatory Compliance – Ensuring the security of sensitive patient information by restricting the data access to authorized persons and thereby adhering to the compliance and data privacy regulations. Organize Claims Processing – Processing claims is very challenging as hospital facilities use multiple business applications to process data. RPA organizes and automates individual claims by collecting and segregating patient records, grouping them, and transferring them to the respective claims management systems, thus minimizing errors and saving time.

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General Data Protection Regulation (GDPR) in Healthcare Technology General Data Protection Regulation (GDPR) is a data protection act to ensure businesses adhere to strict guidelines while collecting, processing, and storing personal data. Penalty for non-compliance to GDPR has increased significantly under the Data Protection Act (DPA).

Healthcare providers and businesses have to cope with increasingly complex global privacy policies by constantly adapting to new privacy regulations, ensuring reliable data protection, and adapting systematic and programmatic approaches to simplify these operations.

Influence of Mobile Technologies in Healthcare Technology Mobile technologies and apps are beginning to play a significant role in the healthcare industry. The development of user-friendly mobile apps has benefited healthcare by improved patient care and also helps increase the productivity of medical professionals.

Physicians can now better engage their patients using mobile computing charts and other wearable devices to help monitor patient their health and significantly reduce hospital visits and expenses.

What Is Mobile Health (mHealth)? The Global Observatory for eHealth of the World Health Organization defines mHealth as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices”. Mobile and wireless technologies have the potential to transform how health and healthcare services are delivered across the globe.

Benefits of Mobile Devices in Healthcare: Continuous Data Flow – It bridges the gap between the large volumes of data that needs to be communicated between healthcare institutions and patients every second by reducing personal interaction by the practitioners. Improved Accuracy and Efficiency – Paper documents were hard to maintain and mistakes are hard to detect. With EMR, patient records can be accessed on smart devices and apps from any location and they are accurate and reliable. This facilitates smooth functioning among various medical caregivers, departments and patients, thereby enhancing hospital efficiency.

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Real-Time Communication - With the use of smartphones, doctors and nurses can share real-time prescriptions and instructions for faster patient recovery and use mobile cameras to examine patients remotely. Enhances Physician Efficiency – Cell phones handle the cumbersome tasks of recording patient’s data, provide updated and accurate drug information, and automatically handles paperwork, thus allowing physicians more time to treat their patients. Direct Patient Management – Doctors can directly monitor patients and provide real-time consultation for faster recovery with the help of fitness apps and wearable devices. Better Communication – Using apps, doctors can make prescriptions helping patients procure the right medication and adhere to medication schedule as wells as scheduling follow-up appointments and setting reminders.

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Advanced Diagnostic Technology in Healthcare Healthcare analysts have observed that the increase in accessibility to reasonable medical treatment is evidence of how technology has changed the healthcare sector. The healthcare industry is constantly working to improve patient care and at the same time reduce medical expenses. Tools and Gadgets The advancement in technology has resulted in the availability of rapid diagnostic testing kits which are easy to use and generate test results within a few minutes.

Diagnostic Testing The test results of advanced diagnostic testing and their efficiency determine whether certain therapies should be continued or not and also ensure that the right therapy is administered at the right time.

Artificial Intelligence The introduction of Artificial Intelligence in the healthcare industry has shown significant improvement in areas of medical assistance and boosting diagnostic and treatment methods.

Conclusion

An article in Science Daily dated May 10, 2021, states that “Researchers at KU Leuven (Belgium) have developed a 3D printing technique that extends the possibilities of lateral flow testing. These tests are widespread in the form of the classic pregnancy test and the COVID-19 self-tests. With the new printing technique, advanced diagnostic tests can be produced that are quick, cheap, and easy to use.”

The advancement of healthcare technologies over the years have helped the healthcare industry in various ways, right from diagnosis of unknown pathogens and rapid test interpretation to remote patient treatment. The implementation of technologies such as RPA, blockchain, and mobile technologies into the healthcare industry has resulted in streaming

processes, increasing efficiency and accuracy, minimizing errors, lower healthcare cost, and has immensely improved quality of care. The future of the healthcare industry depends on how the health sector embraces the emerging new technologies and how efficiently they can implement them in the organization to attain the true potential they offer.

+ Blockchain Interoperability in Healthcare Industry by Rehan Husain

Introduction to Electronic Health Record The digital counterpart of the patient’s paper chart is commonly known as “Electronic Health Record” -EHR. EHRs are patient-centered records in real-time that provide information for authorized users immediately and securely. EHR systems are constructed to go beyond conventional clinical data gathering and provide a wider perspective for patient care.

EHRs are a crucial component of IT health and can:

Include patient history, diagnosis, medicines, treatment plans, vaccination dates, allergies, radiological imaging, laboratory findings, and test results.

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Allow the proof-based methods physicians may utilize for deciding the treatment of a patient.

Provide transparent information available in a structured manner which lowers the clinical errors and administrative costs.

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EHR Interoperability The lack of access to medical records has been recognized as a barrier to transparent and efficient treatment for patients for a long time. While systems with electronic health records (EHR) assist in resolving this problem to an extent, many of these systems are heterogeneous and exhibit minimal interoperability within platforms, and demonstrate varying success integrating into clinical workflows. Many EHR systems are thus unable to provide key advantages of digital technologies, like data sharing capabilities, streamlining user experience, and advanced analytics. The lack of interoperability with various EHR platforms is very challenging as complex patients are present with multiple healthcare facilities in different healthcare jurisdictions.

An EHR is characterized by its ability to digitally generate and manage health information by authorized personnel that can be shared with other physicians across various healthcare organizations.

The Lack of Interoperability Causes Many Problems Restricted exchange of data Currently, the EHR solutions available in the market limit patient information’s open flow across different platforms. For data transfer, most vendors impose interfacing costs. A lack of data sharing also encourages repetitive investigations, consuming additional healthcare resources and potentially delaying definitive care. Lack of insights The advantages of data mining and data storage are significantly limited by the lack of full data and reluctance on the part of EHR suppliers to provide customized interfaces.

The lack of a unified perspective of patients The existing solutions provided by EHR vendors are compartmentalized, which fails to capture the entire medical journey of the patient. There is no common platform or API which enables smooth communication across different proprietary and older systems.

There is no common platform or API which enables smooth communication.

Challenges in Enabling Interoperability for EHR Systems Lack of interoperability leads to massive losses, yet the number of efforts the healthcare ecosystem is making for solving the issue is far lower than expected. Much contributes to the parties’ unwillingness to interoperate with EHR systems: Failure to share data Data sharing between payers and suppliers has always been a problem primarily because they operate independently and do not share common data exchange standards. This divide has produced cultural inertia in interoperability adoption for these parties. Due to the present drive towards value-based care, numerous efforts are underway to integrate care and delivery, which needs a seamless exchange of information across stakeholders.

issues about safety and privacy. The recent Anthem violation of medical data and WannaCry ransomware is evidence that a cyber assault is threatened. When there is interoperability, the database becomes the target for cyber attackers if the whole healthcare database is housed on a single central platform.

Data security and integrity The view of a single interoperable platform, which makes possible access to all health information in one place, raises significant

Misaligned incentives The motivations of stakeholders are not aligned with the interoperability objectives.

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Furthermore, it is essential for accurate health data not to be manipulated by any authorities.

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Suppliers: Currently, each EHR vendor offers its own systems. When interoperability becomes a reality, consumers will no longer find their own lock-in and will be free to pick any seller. This would weaken the competitive advantage of EHR companies and cannibalize their current income sources. Buyers: Current users of EHR systems have spent trillions of dollars to purchase and set up traditional EHR systems. The use of an interoperable platform may force them to replace their current systems, resulting in the possible loss of trillions of dollars.

Government regulations Forcing system interoperability is not an option with huge numbers of stakeholders in a complex information processing environment. An actual implementation would need the buy-in of all the parties involved who should be prepared to accept specific principles of governance and commercial agreements. Nevertheless, the involvement of public authorities would be essential in the timely implementation of advice and certification criteria and standards.

Why Chose Blockchain To Enable Interoperability Most organizations and academics believe blockchain technology to be one of the frontiers to address the EHR interoperability issue. Blockchain is designed to address the issue of health interoperability challenge by means of distributed ledgers, an information ecosystem similar to the healthcare landscape that spreads across different nodes (payers, providers, EHR platforms, etc.). Simply said, blockchain is an encrypted or encoded ledger that is a transaction database in the form of chain blocks. Multiple users verify these blocks via consensus methods over a public or private network. The cryptographic designs built-in blockchain technology prevents data tampering and unauthorized access. Using blockchain technology to make data accessible for patients, providers, research institutes, and public

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entities offer several possible advantages. The use of healthcare at the patient level is a well-known trend that has led to a large number of patient data produced through mobile apps and other digital technologies. Patients can have an active and involved role in their treatment by making healthcare information more accessible. In addition, all pertinent health information would be sent to doctors at every meeting to allow effective and customized treatment plans and eliminate the chances for duplicate investigations. Enhanced access for scientists to the anonymized medical information on a scale may lead to more rigorous studies and better evidence-based decision-making. In addition, innovative efforts from developers and pharmaceutical companies could lead to lower research and development costs by making more accessible information and consent management via a patient-

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facing platform, thus providing patients as well as providers with more time-to-market and cheaper products and services. Despite the advantages mentioned above, many major problems need to be addressed before using them safely and effectively. Like any technology that disrupts healthcare, blockchain must be properly assessed in light of their requirements, and providers must equip themselves to make good use of the technology. While blockchain may provide

a better information platform, it is simple to believe that the aforementioned advantages are not immediately achieved when implementing a blockchain system. Although a blockchain system could facilitate sharing of information between healthcare systems, patients, providers, and governmental organizations, many technological, legal, and institutional obstacles restrict its full potential in the healthcare sector.

Any technology that disrupts healthcare, blockchain must be properly assessed in light of their requirements

The Case of Blockchain EHRs

How blockchain-based Electronic Health Records (EHRs) could impact every aspect of healthcare delivery

Providers Access to patients full past medical history, increasing the speed and accuracy of diagnosis, and reducing redundant investigations

Patients and family Patients will have access to their own health information, increasing their autonomy, and ensuring they are at the centre of the healthcare team.

Government & Health Systems Data could inform optimal resource management, and increased efficiency could expand system capacity, and control healthcare costs.

Medical Research Improved patient data accessibility & security will facilitate clinical research and development of novel diagnostic tools and therapies

Pharmaceuticals Large datasets and direct-to-patient consent processed could reduce R&D costs and time-to-market, so patients and providers get better drugs, cheaper, and faster

Industry Larger, more comprehensive data sets would facilitate development of datadriven technologies such as AI algorithms to bolster several aspects of patient care.

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Barriers To Blockchain Adoption The use of blockchain as an interoperability platform will need the resolution of several issues: Scalability The EHRs include the full health records for each person, and the database continues to grow with time. Traditional blockchains have limits on the maximum transaction pace because of the fundamental nature of blocks continuing to be added to a chain structure. Due to the complicated transaction logic, Blockchain transactions need sophisticated hardware. This begs the question: can blockchain be extended quickly enough to include EHR data? Micropayments The healthcare industry is being inundated with related medical equipment in the near future. Micropayments have to be enabled

across various IoT manufacturers to make sure these devices constantly communicate with one other and share real-time medical data. Because the conventional blockchain requires paying a fee to the miners for their computational power, it might mean paying a fee greater than the transaction value itself when processing the micropayments through blockchain. Power play of miners Validation of network members known as miners is carried out in conventional blockchain. Some of the EHR prototypes based on blockchain have stimulated the participation of public health authorities as miners and offer them access to aggregate anonymized data as mining income. This provides a way to filter or postpone specific transactions for the privileged group.

Interoperable Ecosystem – An Ideal Setup The ecosystem utilizes both the forces of blockchain and the power of computation, but removes the constraints of current technologies simultaneously.

will be on the private, licensed network or in the proprietary EHR. The fundamental concept of an authorized private network is identical to that of an authorized blockchain.

The ultimate platform should be a government or a public health agency distributed public leader, which allows all ecosystem members to connect and exchange data. The public ledger will be linked to every node family, including clinics, doctors, hospitals, and medical equipment; however, data on their systems

Blockchain platforms have a balanced set of rules to enable wider usage and flexibility to meet variations in the local practice to realize their full potential. In addition, technological solutions can be emphasized, but human aspects must be taken into account. Just as Blockchain essentially opposes a siloed,

decentralized approach, solutions should be decentralized as well and involve a broad range of multidisciplinary experts, including health care professionals, legal professionals, developers of technology and patients, so that information can be exchanged optimally while safeguarding patient safety. The advantages of utilizing blockchain to make EHR more effective are undeniable. It will lead to customized and participatory therapy alongside results-based models; helps researchers develop better goods for less expense; helps to verify claim information quickly and accurately and improves

settlements; reduces fraud, and helps to comply with regulations.

Conclusion The industry continues to focus on numbers — more patients, more consultations, additional testing, more operations and more hospitalizations. If the balance is translated into result-based charges, patient records are encouraged – interoperability becomes a compelling offer, and blockchain is the desired answer. It is already widely agreed that changes to the business model can only solve healthcare problems.

Governemnt Health Agency Medical Equipment

Clinics

Hospitals

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Doctors

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Book Review:

The Future Is Faster Than You Think by Pranay Aswal

“The Future Is Faster Than You Think” is not only a bestseller but also a reality that might be daunting for a few of us.

n the next 10 years, you will probably be commuting to work by flying taxis, going on vacations through rockets, 3D printing your lunch, living on Mars, and much more. How will all this take place? The technicalities that might occur, the insights into how various advances will affect us as a society, and the analysis required to bring out an accurate extrapolation have been well cared for by the authors’ Peter Diamandis and Steven Kotler.

Peter H. Diamandis was recently named by Fortune as one of the “World’s 50 Greatest Leaders”. Steven Kotler is an American author, journalist, and entrepreneur.

Peter H. Diamandis

was recently named by Fortune as one of the “World’s 50 Greatest Leaders”. He is the founder and executive chairman of the XPRIZE Foundation, which leads the world in designing and operating largescale incentive competitions. He is also an executive founder of Singularity University, a graduate-level Silicon Valley institution that counsels the world’s leaders on exponentially growing technologies.

Their latest book is well structured and divided into three major parts. The first part has emphasized the overreaching trends of how various independent lines of accelerating technologies are converging to form disruptive innovations. For instance, take smartphones, which combines the functionality of a camera, a music player, a telephone, and a digital personal assistant (among other things) into one device, and this convergence is not just limited to technology; it extends to almost every element of the society. Blockchain-the exponential technology of record-keeping, AI, Gene Sequencing, Augmented and Virtual Reality, 3D printing-a single exponential technology that threatens the entire $12 trillion manufacturing sector, and many more such technologies converge to bring about Disruptive Innovation. The second part of the book helps to visualize and make sense of the impacts and secondary effects that most of the converging exponentials belonging to the top

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Steven Kotler

is an American author, journalist, and entrepreneur. His articles have appeared in over 70 publications, including Wired, The New York Times Magazine, LA Times, Time magazine, GQ, Discover, Popular Science, Outside, Men’s Journal, Details, and National Geographic Adventure.

10 economic contributors and the ones with the most significant impact on our everyday lives will make. We know that global warming caused due to emissions, detritus of carbonized coal, oil, and natural gas, necessitates the shifting of the world towards a more sustainable way of energy generation and, looking at renewable power that has been riding exponential growth curves for decades, dropping in price and rising in performance on an incredibly consistent basis “This price-performance curve is like nothing we’ve ever seen in energy,” explains Ramez Naam, the head of Energy, Climate and Innovation for Singularity University.

“

The explosion of solar is almost like a digital transformation in the most fundamental category of infrastructure.

”

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Hence, it will not be wrong to think that there might be a complete inversion in the traditional power paradigm as the poorest countries in the world are also the sunniest. It’s theories like these backed by research and quantification that make the book worth its weight in gold, or should I say bitcoin. In part three, we broaden our horizons and discuss a series of dangers heading our way, like environmental, economic, and existential risks that threaten the progress we have made. We will also look at a more comprehensive picture, extending our focus from the coming decade to the century ahead, exploring five great tech-driven migrations: economic relocations, climate change migrations, virtual world explorations, outer space colonization, and hive-mind collaborations, all of which are equivalent to fishes living on land.

It might seem like a lot expected out of such a short time frame as most of us haven’t seen such tremendous amounts of development during our lifetime, but the book gives very valid points as to why this is what will occur. “Ray Kurzweil did the math and found that we’re going to experience twenty thousand years of technological change over the next one hundred years.” Firstly, technology has shrunk the time it takes for innovative development and what this means is that saved time isn’t just a benefit of technology; it’s also a driver of innovation- another force accelerating our acceleration. Secondly, according to the Stanford-Binet scale, 1 percent of the population qualifies as geniuses; this makes for 75 million people worldwide. Until now, most of this genius was either squandered or unable to unlock its potential due to not being born wealthy, third-grade education, not being recognized,

and so on. Now, thanks to the future of a hyper-connected world and the exponential explosion of networks, these intellectuals will no longer be casualties of class, country, or culture and hold knowledge at their fingertips, eventually leading to hive-minded communities sharing ideas and accelerating the rate at which we develop. If we consider our development of exponential technologies to be among the leading examples of human intelligence, then BrainComputer Interface (BCI) is the crowning achievement of those examples. BCI’s may also be our only way to survive the AIdominated world filled with robots, machines that have the ability to compute with significantly greater processing power when compared to a normal human brain. Facebook has plans for neurotech that replaces the need to type with the mind as the ultimate social media interface, and Defence Advanced Research Projects Agency (DARPA) has gotten involved as it sees potential for nextgen battlefield tech that can record a million neurons simultaneously while stimulating a hundred thousand.

The future where our brains could be connecting to the cloud would mean a massive boost in processing power and memory and, at least theoretically, could give us access to all the other minds online. And this begs to differ towards a society where our ordinary brain-based singular consciousness converts into a cloud-based collective consciousness, both a hive mind and a reminder that

“

the most remarkable journeys are often inward toward our psyche rather than outward toward the stars.

”

The book gives you several variables to prognosticate the possibilities the future holds in a very systematic way with a lot of context and examples of incredible developments that are taking place in every significant industry, hence being an excellent read for anyone and everyone, especially entrepreneurs, business owners, researchers, and students, to prepare for what to expect from the future and to thrive over it.

Send us the topics you want us to explore. contact@techfastly.com

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HIPAA

25 Years On:The Value of Healthcare Privacy In Technological Age

he Health Insurance Portability and Accountability Act (HIPAA), signed into law by President Bill Clinton on August 21, 1996, has been routinely considered a model piece of privacy legislation. Prior to its creation, a patchwork of both state and federal laws governed the communication, distribution, and use of medical data for patient care and finances. Inconsistencies in these laws allowed the access of these data without any authorization, including personal sanctioning of sharing, from the individual whose data was to be used for the purposes of assessing

by Dhruvil Patel

anyone’s potential for production and maintenance. This was especially relevant in the realm of financial lending and insurance, whereby lenders and insurers can bypass personal subjective assessments to view medical history as a means of assessing stability - determining if a candidate would be sustainable enough to produce a capital gain. This also affected employment opportunities with production being a function of health, often selecting for those without or with minimal complications, even if left undisclosed can easily be evident through this quick access.

Most importantly, individuals lost control over who and where that information was shared and were never notified of its distribution and the level of access the recipients were to have. A loss of control over one’s own data was abundant - a critical problem that has become a greater point of contention in the present. These problems required interventions that would make it easier for communication of health plans, claims, and access to those who should have the need and right to see them. While respect for healthcare privacy has been a consistent moral imperative among those in the healthcare field, one’s own health is extremely interconnected with access to services and employment required for survival, hence the distribution of this information has become a critical part of economic sustenance. Even if there were minimal health issues that could be managed successfully

with limited chances for a complication, having access to that information in the eyes of those not able to determine these intricacies provided an easy opportunity to label and select against. The establishment of HIPAA guaranteed federal protection for all citizens of their personal health information; allowing one to control its distribution, access, and most importantly the level of information sharing to be done. This meant that if employers were to request personal health information as a means of assessing one’s capability - individuals had the right to refuse and protected against being discriminated against guaranteed by law. While there are still continuous cases of employer discrimination, whereby records are accessed without permission or denied after review of records the fact that these cases exist is evidence of HIPAA working as intended.

The Invisible Rules Within HIPAA:

Is It Structuring Personal and Digital Health Privacy For Our Time? While HIPAA has had a total of 5 major rules that govern physical and digital health data, two main ones are designed for patient use and personal data protection. The other rules are meant to simplify the process of billing and identification of all parties involved in the patient care throughout their stay including the provider, health institution, and insurance services.

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1 The Security Rule

As the use of electronic health records began to widespread and mainstream necessary protection was mandated in response to easing the access of patients’ data. Electronic Health Records (EHR) began to run in a closed system, where data could be shared among systems with the same programs. It enabled the access of data to anyone working in the system or who has access to the system without proper procedure. The Security Rule was officially complied in 2003, with over the following couple of years created mechanisms for the protection, storage, accessibility, and distribution of these records within each system. These rules mandated both physical and technical securities with both software and hardware.

2 The Privacy Rule

After HIPAA’s establishment, the Privacy Rule, also referred to as the Standards for Privacy of Individually Identifiable Health Information, was established four years after its initial ratification in September 2000. The rule provided increased protection for patient data in research and clinical environments. Going into full effect in 2004 - it offered limitations on disclosures that individuals were permitting the sharing only via certain forms - the ones signed commonly by everyone during healthcare visits. It further goes onto allowing patients to obtain copies of their own records, inspect and permit any changes for accuracy by using certain request forms for this purpose.

The remaining rules that serve to streamline patient care through ensuring provider and system compensation while preventing patient overbilling are: A Transactions Rule More relevant in the eyes of the payers and lenders behind the scenes, this rule mandates the use of standard codes. ICD (International Classification of Diseases), HCPCD (Healthcare Common Procedures Coding System), CPT (Current Procedural Terminology), or NDC (National Drug Codes) codes; all of which are used to standardize diagnosis, medication, treatment, and followup services over the scope of a variety of provider and payer systems. This essentially standardizes the language that is used to create efficient and accurate transactions. B Identifiers Rule Designed for simplification, this rule mandates that providers, health plans, and the insurance payers (either federal medicare/Medicaid or private third party) all have specific standard numbers for communication and documentation purposes. If there is any failure in compliance of accurate reporting of negligence in protecting patient data either by the provider/system or limiting transparency in the eyes of the patient, then policies of the (C) Enforcement Rule (also known as the breach notification rule) are used. C Enforcement Rule The enforcement rule defines various tiers of penalties for infractions of rules while also defining reporting and investigation methods for any violation. This serves as an extra

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layer of protection by defining sanctions and monetary or potentially greater consequences under the law. They outline a certain length of time by which an infraction must be investigated and appropriately resolved per the recommendations that are defined within the law. Given the constantly changing technological landscape since the time of HIPAA’s establishment, there have been frequent additions to the original provisions in an effort to increase transparency and allow further command of one’s own healthcare. Since the law’s inception, far more efficient electronic health record systems have been developed and continue to be consolidated over a large range of hospital systems allowing for opportunities for greater access and transparency. Most recently, in April 2021, the United States Government has now demanded all healthcare organizations to make all patient’s medical records accessible electronically without any charge. This includes that all doctor authored notes, reasons for treatment plans, and assessments of patients’ conditions - all to be reviewed by patients. Prior to this, the update in 2013 was the (D) Omnibus Rule D Omnibus Rule created to better consolidate healthcare systems by mandating specific structures to be developed that collect updated agreements from all involved business associates that a part of the patient care

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payment process to comply with HIPAA, strengthening the brevity of the existing security rule. Given these recent changes, patient data protection has been continually advancing alongside a push for increased personal

access to better the transparency of data for those sanctioned to access it under HIPAA compliance. These two paradigms can often conflict with each other as more access can leave greater room for unwanted dissemination.

Data Protection Under HIPAA,

Are There Any Exceptions? A very important point to note is that only those providers and employees receiving compensation through insurance coverage are bound by HIPAA - meaning caretakers and health systems directly involved in reimbursement for patient care are responsible for adhering to the HIPAA laws. This means that those not covered by insurance are not in breach of this privacy law if they share various points of patient data - such as certain providers on medical talk shows. While these providers can still be in breach of state laws, the inconsistencies with those and federal protections can leave many areas to justify no breach and subsequent portions of medical stories that the patient themselves may not have sanctioned. While the healthcare delivery sector is where HIPAA was developed to provide better protection for health data; other health-related sectors, including fitness & nutrition, are not covered. Even while having personal data recorded by users, protections mandating security to maintain transparency of access is not required. Unlike when HIPAA was first established, technology has allowed individuals to become more aware of what kind of health-related data is relevant to their well-

being and the interplay of those data in their own lives. Simple metrics like heart rate and rhythm can now be taken on smartwatches and easily shared among friends or physicians. Blood pressures and blood glucose levels could be monitored at local pharmacies. Health tracking apps are rapidly gaining attention in the fitness sector, which tracks individuals’ weight and caloric intake daily. While many of these metrics are recorded to optimize the app experience to generate better results and create an appealing user experience, these metrics sometimes are used to make critical medical decisions in the hospital setting. Despite their importance, the laxity to which these data are given (which are the same metrics being protected under the regulations of HIPAA) underlies the collective importance placed on health-related data and emphasizes the complexity of privacy, that was not present during the development of the law.

The continued culture of innovation and entrepreneurship in the technological marketplace continues to evolve new start-ups in the healthcare sector that have arisen to simplify the increasing complexity of health care data.

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Furthermore, its purpose in optimizing patient care has become a favorable use of resources, and continued investment for the use of this data requires that such data be available. Yet, the guidelines in HIPAA that cover the specifics of which data are protected have yet to be updated relative to the brevity and complexity of the types of data that can be used to create innovations to better the healthcare experience. Mainly Protected Healthcare Information (PCI), defined as any data that is a part of an individual’s health profile and can be linked to a said individual, is said to be covered. This means that those data that are not identifiable to any person can be used for research and innovation development. Therefore, while HIPAA protects individual data, there are relatively no legal ramifications if anonymity is maintained on a population scale. The exact format is also used in clinical research involving big data analysis for treatment algorithm optimization or quality improvement, whereby blinded data can be shared upon consolidation from electronic medical records. Given these exceptions, an argument can be made for the benefit of sharing all data that is not related to identification, yet this is the exact data that HIPAA generally covers. While HIPAA was put into action to protect individuals rights to be assessed more objectively in any societal structure necessary for survival and upward mobility, the question becomes that is its relevance diminished if the health-related data is still shared, but it cannot be attributed to the individuals from which it was collected regardless of the benefits that its collection can have.

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Do We Need To, and More Importantly Want to, Update

HIPAA?

Data analysis has lead to remarkable strides in creating personalized technological experiences for almost every technology used on the planet. It has allowed individuals to leverage technical analysis of their data to better their own lives and tailor it to the way they perceive to be the best for them while also optimizing their work for outcomes that they desire. Continued innovation in healthrelated data has been shown to do the same, as evidenced by numerous testimonies of how the benefits of tracking their own healthcare metrics have helped them optimize and tailor lifestyle and nutrition changes for their benefit. Yet data collection is also concomitantly being used to tailor and target

individuals for increasing capital gain and users - such as personalized advertisements that can often be seen favorably by the enduser when they choose to click and purchase said product. This same trend could also occur in fitness and healthcare-related communities with more negative rather than intended positive outcomes for the end-user. While current regulations under health data privacy permit this under the condition that data remain anonymous, to preempt such outcomes - HIPAA may need to be updated. Yet, only further studies of these trends would confirm if necessary interventions are required.

While current regulations under health data privacy permit this under the condition that data remain anonymous, to preempt such outcomes HIPAA may need to be updated. 29

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Internet of Medical Things (IoMT): Game-Changing Technology for Healthcare Industry by Johnson Cherian

he Internet of Medical Things (IoMT) is an integrated infrastructure of the healthcare systems and services to medical devices and software applications that transmit real-time data through a network of technologies. The IoMT is a subcategory of the Internet of Things (IoT). IoMT brings together the patient, doctors, and caregivers by providing data and processes that enable the caregiver to deliver efficient patient support through connected medical devices, biometric monitors, and smart devices, and wearables. The healthcare industry has joined the digitalization bandwagon over the last few years, and COVID-19 has necessitated faster adaption of the technology. COVID-19 brought about the need for more connected medical devices and smart monitoring. Many manufacturers of medical devices came out with smart integrated medical devices, which helped the hospital systems, healthcare providers, and governments save lives by early detection of pathogens and providing appropriate patient care.

With the challenge to better serve patients and reducing expenses, IoMT can be the game-changer by streamlining processes and ultimately lowering costs. 31

The Potential of IoMT in Healthcare The IoMT has benefited the healthcare industry in many ways, right from convenience to the patient receiving treatment to hospitals and medical practitioners providing patient care. An article in the Fortune Business Insights states, “The global Internet of Things in healthcare market size was USD 71.84 in 2020. Based on our analysis, the global market exhibited a significant growth of 24.1% in 2020 compared to the average year-on-year growth during 2017-2019. The market is projected to grow from USD 89.07 billion in 2021 to USD 446.52 billion in 2028 at a CAGR of 25.9% during the 2021-2028 period.” Hospitals and clinics have readily embraced the IoMT as it is more cost-efficient and improves the quality of patient care. The technology allows medical practitioners to monitor patients remotely, and with any changes in medical parameters, the medical staff is alerted and can take the appropriate corrective measures.

Accurate diagnosis & prognosis

Reduced Treatment Cost

Better Patient Care

Fewer errors

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The introduction of medical devices in the healthcare industry played a significant role in diagnosing and preventive treatment of chronic illnesses. These assistive medical devices have eased the burden of physicians, giving them more time to focus on patient treatment. The integration of IoT in devices like scanners, x-ray machines, MRI machines, etc allows early detection and treatment of potentially fatal conditions like cancer, heart conditions, and many more diseases.

IoMT is more cost-efficient and improves the quality of patient care.

Security Concerns of IoMT Like any device connected to a network, IoMT is also vulnerable to cybersecurity threats to medical devices. Patient health and information are at risk when smart devices get hacked and crumble the healthcare system infrastructure.

Some of the security concern points are:

Endpoint Security IoMT devices are generally not designed to keep security in mind; hence medical devices are defenseless against hackers as they lack a robust firewall and mostly use default passwords. Hackers gain easy access to these devices and perform unauthorized manipulations to the device software. The lack of security can lead to failure to comply with HIPAA regulations, data manipulation, and loss of Patient Health Information (PHI). MedTech companies need to develop antimalware mechanics to protect devices from spyware and Trojan attacks.

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Medical devices are defenseless against hackers as they lack a robust firewall and mostly use default passwords.

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2 Communication Security

Mobile apps and smart telehealth devices use VoIP (Voice Over Internet Protocol) for audio and video communication for doctorpatient interaction. They carry vital signs of the patient from smart devices to the hospital network. These data can be intercepted by hackers and be compromised.

Audio and video communication for doctor-patient interaction can be intercepted by hackers and be compromised.

Different IoMT Attack Types

1 3 5 7

Side-channel A side-channel attack indirectly exploits security by monitoring the electromagnetic activity around a medical device.

Tampering devices Physically tampering with sensors to manipulate functioning by exploiting firmware vulnerabilities to install malware and then take control of the device.

Replay Reuse of previously exchanged authenticating message to hack a device.

Cross-Site request forgery (CSRF) Tricking end-user using vulnerable applications.

2 4 6 8

Tag cloning Duplication of gathered data for unauthorized access to confidential patient information.

Sensor tracking Attack of patient monitoring devices that have GPS sensors that send information to doctors and steal or send inaccurate data.

Rogue access Interception of traffic by installing forged gateway within wireless network range.

Brute force Using trial and error and guessing login info hackers gain access to IoMT devices.

10001110001010 11100100001010 01101010001010

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Applications of IoMT Hospitals and Clinics IoMT devices are increasingly used in hospitals and clinics to improve healthcare quality and reduce cost and time. Some examples are X-ray machines and CT scans. Also, smart apps are used for patient monitoring and connecting patients and doctors.

Home and Remote Areas Telemedicine enables Remote Patient Monitoring for patients with severe illnesses and avoiding frequent doctor visits. These devices can monitor glucose levels, blood pressure, heart rates and automatically alert the doctors.

On-the-Body/Wearable Devices Biosensors are used in making wearable medical devices that are embedded into apparel or attached to the skin to monitor patient health parameters.

Patient Information Management IoMT helps store useful information like a patient’s past medical history, family history, and personal information (contact details blood group, insurance details), which are easily accessible to the healthcare providers at the time of treatment.

Inventory Management The use of automation in inventory management systems in the inventory of medical supplies (storage, application, demand, orders and inspection) ensures effective utilization of resources by reducing time, effort, documentation, and money. It also helps monitor the stock of medical supplies, healthcare support supplies, locating hospital equipment like stretchers, wheelchair and other assets, making smooth functioning of hospital processes.

Research and Analysis With a large amount of patient information easily available on cloud servers, it makes analysis and research work easy and in a reduced period. The analysis of the available data sets is valuable as they help take preventive measures, improved treatment, and develop more effective drugs. Hospitals can make quicker informed decisions on treatment and minimize errors with the statistical report generated, thus improving thousands of lives.

Future of IoMT In the past, home visits were made by physicians to check on their patients. But today, we no longer need home visits. With the advancement in technology, and in particular, electronic and digital technology, telemedicine allows the healthcare practitioner to communicate with the patient requiring fewer hospital visits. Frost & Sullivan research indicates “growth of nearly 20-25% in-patient engagement management solutions in 2021 alone”. There is a demand for digital healthcare as patients are now accustomed to the convenience of their treatment.

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Platforms Offering Digital Point-of-Care testing will play a substantial role in the future as they benefit from the leverage of machine learning (MI) and artificial intelligence (AI). Biosensors and Wearables Biosensors are emerging as a key technology because of their potential analytical tools used both in point-of-care diagnostics and wearable devices. They hold an advantage over traditional methods as they can predict variations in a patient’s clinical condition by analyzing the blood, sweat and other biological agents.

Augmented Reality and Virtual Reality (AR/VR) tools are in the product development process with several software and hardware vendors collaborating to provide the best solution for patient and clinicians. Connected Devices and IoT Smart connected devices allow real-time patient’s data to be collected, processed, and shared with caregivers so they can address problems immediately. The demand for smart devices is on the rise as they play a significant role in the healthcare industry.

AR-VR Collaboration

Conclusion With the growth of the internet and medical devices, IoMT has transformed monitoring and controlling capabilities to accomplish higher standards of patient care. Wearable devices have reduced the burden of physicians and eased patients have embraced the use of these devices. In the future, medical professionals can expect further simplification with further advancements in the IoMT, which will benefit the patients and the healthcare system.

IoT Ransomware - How Healthcare Organizations Can Protect Themselves by Naufiya Mohamed In this article, we would first define IoT and then discuss its impact on the healthcare industry. The article will also talk about what IoT ransomware is, how it affects the healthcare sector, and the measures taken to protect against IoT ransomware. What is IoT? IoT (Internet of Things) is the collection of computing devices, where all the interconnected devices are connected via the internet and can receive and send data. In generic terms, we can explain IoT as a network of some physical objects that are embedded with software or sensors, that can make these objects smart. The scope of IoT begins with some mere household objects to extremely sophisticated industrial tools. It’s fascinating to know how these interconnected devices have turned out to be one of the most promising

technologies of this century and how it makes our lives more comfortable. The credit for the possibility of IoT technology goes to the internet. For instance, if your smartphone has an internet connection, you can access anything around the world, can’t you? Similarly, if any of your devices connected to the internet, it becomes a smart device.

IoT Redefining the Healthcare Industry Before the advent of IoT, the communication between doctor and patient was established either through direct consultation or text messages. A few years back, it was unthinkable for a doctor to monitor a patient remotely. However, now, we have IoT devices that let doctors examine their patients with more care and excellence without their physical presence. The impact of IoT in the healthcare sector is enormous. With the origin of IoT and its major bang in improving treatment outcomes, it is evident that the healthcare industry is redefined. When the pandemic hit us, the doctors had to go through stressful conditions. Ensuring quality healthcare to ever-increasing infected patients was not a cakewalk. Thankfully, smartphone apps and IoT technology have brought in a positive transform here. With IoT technology in the healthcare sector, doctors can collect realtime data from patients through specific IoT devices. This, in turn, enables them to diagnose the disease and provide necessary treatment to remote patients. IoT has many other applications in the healthcare domain.

Let’s take a brief look into it. 1 The patients can use wireless wearable devices to monitor vitals like pulse rate, blood pressure, heartbeat rate, calorie count, etc. The variations in these vitals are checked against normal values, and these values are shared with doctors and concerned family members without any external interference. It allows the doctors to keep a steady track of patient’s records and prescribe them treatment remotely. 2 Medical equipment like wheelchairs, nebulizers, defibrillators, etc., can be tracked in real-time using the IoT devices tagged with sensors. With the same concepts, IoT technology can help in asset management like pharmacy inventory control, monitoring temperature and humidity, etc. 3

It is not a wonder that even health insurance providers can make use of this technology. We have already discussed the wearable devices that can keep track of patients’ several health parameters; the insurance providers can use those values to ensure the credibility of the claim.

IoT technology can help in asset management like pharmacy inventory control, monitoring temperature and humidity, etc.

What is IoT Ransomware, and Why is it Underrated?

Ransomware is the breed of malware that can encrypt the files in your system, which can be accessed only after you get a private key for which you may have to pay a ransom. IoT Ransomware is a similar concept, but it has been underrated for several reasons. Primarily, ransomware attacking a computer is considered to be dangerous because of its irreversible nature. All your files, either personal or professional, are encrypted, and the only way to get them back is through the decryption key, which you may have to purchase from the culprit. Whereas in the case of IoT, things are a bit different. Mostly, we use the cloud to store the data generated by IoT devices. And so, the data available on the device is either little or nothing.

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This is one of the reason that explains why IoT Ransomware is not considered a threat by many. Secondarily, the exploitation of a PC is much easier. The strategies required to hack a PC might be similar and popular. Whereas, the IoT devices will have to be targeted differently making it a big challenge for the hackers. Besides, letting the users know that their IoT device has been hacked needs an additional step like getting their personal information to contact them, which is another challenge.

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IoT Ransomware is A Serious Threat And Here is Why? According to Neil Cawse, CEO at Geotab, a manufacturer of IoT and telematics for vehicles, IoT Ransomware allows hackers to mess around with real-world objects and it is way beyond a single PC or laptop. He also added that shutting down a vehicle or

turning off the power at a troublesome time can cause more damage. This indicates the threat in IoT Ransomware is not irreversible in nature, it is more into the impossibility of resetting the device at the time it is needed to handle a situation.

IoT Ransomware in Healthcare IoT ransomware affecting hospitals is too risky because, seemingly, the victim can be a human being, and the loss will be a human life. In case of hospitals, the risk is life-threatening, and this is exactly what makes hospitals a lucrative target for IoT ransomware attacks. As we won’t know the victim or when and where it will happen unless it occurs, all we can do is take proactive security to prevent IoT ransomware attacks in healthcare organizations. It is highly critical as the inadequate defenses to avoid such situations can affect a life or maybe more.

In case of hospitals, the risk is life-threatening, and this is exactly what makes hospitals a lucrative target for IoT ransomware attacks.

The Problems Faced by Healthcare Security Here is a list of few problems that make it difficult for hospitals to provide and ensure the appropriate security measures are not facile as we expect. 1

Ensuring security to all the interconnected devices of the IoT network in a hospital is not easily attainable. A hospital can have a large number of devices and explicitly all working on different Operating Systems (OS). Providing a security shield for these devices as a whole is possible only if the security is tailor-made for that particular IoT network.

2 In a hospital, there are chances that several devices have been under use for many years. It is crystal clear that some devices here may not be working with updated OS, indicating that patching up is no longer a possible solution. 3

Suppose a hospital gets attacked and the situation is resolved still, there is a big dilemma in getting things back to how they were. Only with an adequate backup plan can we handle this, or else, the time taken to get things right after an attack can be weeks or even months.

the time taken to get things right after an attack can be weeks or even months.

Preventive Measures to Overcome IoT Ransomware in Healthcare Before taking things into your hands, let me make it clear that some solutions can trigger other issues in the network. Healthcare organizations can still implement some actions to ease the impact of IoT ransomware at hospitals. Some of those are listed below 1 Make regular security checkups and identify the gaps, get them fixed at the earliest. In the meanwhile, backup all the critical systems and data. Make sure they are offloaded to an environment that is completely isolated from physical connections. Also, make sure that those backups can be restored by someone, and practice doing this, to make yourself prepared to face such a crisis. 2 Install an anti-malware and keep it updated regularly. Double-check whether it is configured correctly and make it a practice to do regular scans of your environment and handle the revealed vulnerabilities.

3 Make it a practice to provide staff training to keep every employee aware of the threats and the severe outcomes of it. A good approach can make them familiar with such threats. If they face any such threat, they will know what to do and how to deal with them. 4 Hospitals and health care organizations should follow the guidelines and security practices listed out by CISA, FBI, etc. It is also recommended to evaluate the cybersecurity postures to identify and fill in any gaps discovered.

Conclusion Today, the popularity of IoT has reached a situation where an average hospital room contains 15 to 20 connected medical devices. At the same time, each of these devices has a dedicated and significant role in the delivery of care and operational efficiency. However, through each connected device, we can open the door to a malicious cyberattack. It is important to make sure that the networks run while keeping everything safe and secure. This can be accomplished with enforceable security policies that focus on vulnerabilities, conﬁguration assessments, malware defenses, etc. To deal with IoT Ransomware in healthcare, the straightforward way is to focus on basic cyber hygiene.

In conversation with

CHARLES BOICEY Co-founder and CIO, Clearsense

INFLUENCING THE HEALTHCARE INDUSTRY WITH EMERGING TECHNOLOGIES

harles Boisey is a clinical information systems specialist offering 25-plus years of strategic leadership. He has successfully built health care data warehouses, clinical and business intelligence tools, big data ecosystems, and a health information exchange. A strategic thinker with exponential leadership, Charles is an evangelist for the use of clinical technology to drive daily operations, analysis, and decisions. He excels at leading the development of long-term systems strategy for major medical organizations and executing plans to select innovative technology, implement systems, and leverage and maximize system functionality to enhance the health care delivery process.

Let’s start with your clinical and research background.

I consider myself a clinician technologist. I ran the trauma unit at LA County USC Medical Center for about 15 years. During that time, my research was bound around medical informatics, medical data, and biomedical engineering. My research interests then were extracting data from physiological monitors, ventilators, infusion pumps, and different diagnostic modalities. I went to Steven’s Institute of Technology in Hoboken, New Jersey, to understand new and emerging technologies. I started applying these technologies from a healthcare perspective, leading to adopting electronic medical records in other systems. I always had trouble with enormous data sets working in relational models where queries would run forever, and they would die off. I found that large clinical data sets, genomic data sets, image data sets didn’t operate well within the confidence of technologies we had during 2006-2007.

What are the motivations that led you to start Clearsense?

These cool companies were up-and-coming Facebook, Twitter, Linked In, and Google, which was indexing the internet. A LinkedIn profile is very similar to a pathology report, oncology report, or a patient’s history and physical

fitness. If you look at a Twitter message, it’s very much like a laboratory message sent through a live stream. Then most importantly, Facebook has a temporal aspect to its underlying architecture. Healthcare data is delivered episodically over time. Your Facebook postings are created and presented over time, so I can go back and look at what happened in the 1900s or 2021, very similar in healthcare. So, I got to think that I have something because I can queer LinkedIn and could have billions of records and get back to them in half a second. I could do the same in the Twitter and Facebook environments. I reached out to these companies and queried if they would help me bring these technologies to healthcare? There are some essentials that I learned from them and carried with me throughout in Clearsense: 1 Technologies will constantly be emerging. 2 Don’t protect yourself in a box; you might be required to continually re-platform every few years. 48

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I met some individuals in Florida that were very successful in EMR implementations, and they knew that data analytics and health care were going to be the next thing. We collaborated and in 2015, it was the birth of Clearsense.

Could you talk about your mission and how did you implement it with the Clearsense platform?

There’s a quote by Thomas Edison, “The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the causes and prevention of disease”. We at Clearsense are focusing on that. It’s my mission to ensure that emerging technologies get applied in healthcare to benefit the industry. Before I embarked on any commercial venture, I had a condition: We have to develop Clearsense affordably. We were targeting small academic centers and smaller city hospitals that have to wait a lot to

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adopt the technologies considering the higher costs. We wanted to ensure that healthcare technology is evenly distributed. Why does India have to wait? Why does Africa have to wait? You know, why? There’s really no reason we can do this inexpensively. We didn’t want Clearsense to be profit-centric.

We went forward with the plan and built Clearsense as a software-as-a-service (SaaS) data platform for healthcare. It’s not a replacement for anything in the current healthcare service data ecosystem. Its objective is to help the electronic medical records. It serves the EW; it serves all of the various constituents in the clinical, financial, operational, and research components of a healthcare organization. What we do is we’re able to bring in all data that are relevant to health care, patients, and relative to citizens.

You mentioned the importance of data for a healthcare system. Can you talk about the various datasets that you collect for your clients?

For our clients, we bring in all of their historical legacy data for a few reasons. First, make it available in a new system; second, they can turn off the old systems and avoid additional expenses. Third and most importantly, as AI progresses in healthcare, the larger the

data set, the better the results. If we have 15, 20, 25 years’ worth of data, we could do much better when building data science products. So, we bring in all the data historically. We can also bring in data from streaming instruments, monitoring systems, ventilators, and anything in a healthcare organization that sends out a signal to the Clearsense platform. We could also bring in genomic data and imagery data. In addition to that, we bring in social media, what we call social determinants of health data. And exposome data, i.e., temperature, humidity, pollen counts, air quality, traffic patterns, everything in a geographic area that a healthcare organization may find themselves in.

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Last but not least, the data generated by a patient. So, think about sensors or wearables on patients that bring in data 24/7. It is essential to have a full 360 from a data perspective of everything pertinent to the patient’s prior and current medical interactions with the healthcare organization. Healthcare data is 80% of what occurs outside the healthcare organization. We now have 80% of the data that makes the entire patient’s experience.

That’s Interesting. You are solving an important problem?

What we’re doing right now is helping healthcare from where they are now to where they will be in the future. Right now, we deliver

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sick. You only come to see us if you are ill or have had an accident. The model needs to be changed. If you got a bacterial or viral infection, you’re genetically predisposed. We can know certain risk factors and check on patients occasionally to ensure their well-being. To do that, we need to build data models. Clearsense is helping the future of healthcare using these data models. We’re adjunctive. We’re not there to rip and replace systems and things that you’ve purchased already. If you have data science tools, you can plug them into Clearsense. If you have data visualization tools, you can plug them into Clearsense.

With Clearsesnse, we optimize the products you already have invested in to utilize them in a better way. You have to be multi-cloud to be able to interact with AWS or Azure, or Google. You may have clients that you need to burp all of your technology to their on-premise environment. There are private cloud environments as well. Clearsense’s multi-cloud interacts with every single one of those types of environments. We may have a client who wants us to contain all of their data, yet they would like our tools in their environment for certain data sets. So, we can push our tool in our environment; we can push data in their environment.

“

Strategically ensure that the CIO is thought of as a strategic partner and not a cost center.

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What are your scaling strategies? If you go to the United States, it’s a data-rich place country; you have data everywhere. Whereas, if you come to India, it is slightly data deficient. Are you looking at the United States and India as two different geographies to push Clearsense? Do you have different strategies for these countries?

Clearsense has marked its territory only in States yet. But we have goals and aspirations to go global; we do have folks interested in it. There’s more data in India than people are aware of. Mobile phones are the point of connectivity no matter where you are. We can monitor 24/7, via mobile. Remember that 80% of data is from outside the healthcare organization, and if we can collect that, it puts us in a better place.

I’ve done some work earlier by taking advantage of the cellular network in both India and Africa. It was a text-level data diagnosis, monitoring, and prescribing treatment. From a strategic perspective, it’s about getting enormous data and utilizing it to make significant changes.

What are your thoughts on the ethical and responsible use of AI in healthcare?

Healthcare organizations need to make their data available for research purposes. What needs to be in place is the assurance of the identification and the tokenization of that data.

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Let’s consider that while developing a predictor model for hypertension, we find patients who are already hypertensive and have not been detected. We better have a mechanism in place and reach out to those patients. We need to ensure that patient-generated data is used ethically and responsibly. AI does hold promise for everyone, but we need to use it properly. If AI could be used ethically and responsibly, I am sure more patients would sign up to allow their data for research purposes.

Now, as a CIO of any product or servicebased company. What do you think should be his/her top five or six priorities?

Sure. I think number one should be understanding technology trends and their application to your vertical. There’s a difference between something that is a trend and something trendy. Flying cars are trendy, but the cloud is a trend. You must differentiate between the two and be ready to understand how a trend could be applied to your vertical. Secondly, I think it’s essential that the CIO understands talent trends and skillsets. I’m now seeing CIOs bringing in data science teams without understanding why a data scientist team is needed and, more importantly, finding the right team for their vertical. Suppose I had a choice between a top Ph.D. data scientist who never experienced healthcare versus a pharmacist/clinician/physician with a master’s degree in data science. I would take that person that has a master’s degree in data science. It’s essential to bring on these data science teams and other highly talented teams if you can get them from your subject matter/vertical. One of the other things is absolute strategic alignment with your organization. You are there to serve the mission and objectives of that organization. Strategically ensure that the CIO is thought of as a strategic partner and not a cost center. I also believe in lifelong learning continued education.

Although you are hiring team members, they need to work independently and need some latitude to be creative within their domain.

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How do you retain talent? Does it not have any relationship with the culture of the organization?

one; it’s an inverted triangle that points down to me.

Retaining talent, that task begins at recruitment. Your hiring has to equate to the culture. Although you are hiring team members, they need to work independently and need some latitude to be creative within their domain. The leadership style has to be a servant leader model for an organization to be successful. That means I am there to support my staff. If you look at my hierarchy, there isn’t

You better have a tiered organization with levels one through four for employees to advance rapidly. Then, you can have Town Halls and one-on-one meetings to have constant communication and have an environment where nobody is afraid to talk.

What is it that keeps you motivated in the morning?

I would answer that from an application perspective. When COVID came along, everybody was transferring to telehealth. We were able to provide telehealth services to the providers that were physically close to them. So, if things go south, they would be able to follow up with them even in person. Second, we have data. There were some disparities based on economics and race; we were able to help US Congress understand the need for corrective measures with the data we have. And then last but not least, if you build an algorithm that helps the clinician understand and identify something within a patient. It

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would help get the patient get treated sooner and result in better outcomes.

Can you suggest some books to our readers?

The first one is by Daniel Kahneman; it’s called ‘Thinking Fast and Slow’. It relates to how clinicians need data to make decisions at the right time. The second book is about how people understand where we came where we were and where we are now from a genomics perspective. It is called the Codebreaker by Walter Isaacson. The last one is another colleague; her name is Amy Webb. She is a futurist. Her book, ‘The Big Nine: How the Tech Titans and Their Thinking Machines Could’ is a must-read for everyone. It contains ten emerging technologies and their applications.

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How Chatbots Disruption Benefits Healthcare Industry by Shubham Gwalia

mart algorithm-powered interfaces conversing via text or audio are becoming more and more popular. The recent surge in chatbots has led to their prominence in several industries, including retail, entertainment, social networks, finance, and healthcare. Chatbots are particularly widespread in customer services; they could help perform all the repetitive and lower-level activities of a representative. A chatbot uses machine learning algorithms with an NLP (natural language processing) layer built-in to communicate like humans with users via text or audio. Healthcare providers, doctors, and medical assistants

are now leveraging these artificial intelligence solutions to streamline patient care and reduce unnecessary expenses. There have been various cases where a digital personal assistant or a chatbot has helped patients with their queries.

The patient may not even be aware that the human-like medical representative is actually an intelligent conversational machine in many cases. 59

Healthcare Chatbots: Future Analysis The demand for healthcare services has reached an all-time high in the wake of the COVID-19 pandemic. Doctors are in short supply around the world, and chatbots have proved to be an essential tool in healthcare delivery. Chatbots could help patients detect symptoms, manage medications, assist with chronic health issues, and schedule their appointments at healthcare facilities. According to ‘The Global Chatbots in Healthcare Market Report’ by BIS Research, the market is expected to grow at a significant CAGR of 26.29% during the forecast period from 2019 to 2029. Healthcare chatbots, thanks to improved internet access, a rise in smart device adoption, and advancements in speech recognition and NLP, will see significant growth in coming years. Governments of various countries are investing money in the healthcare sector, resulting in better healthcare infrastructure and increased digital technologies usage.

Why use Chatbots in Healthcare?

38%

of the users believe that chatbots offer good experience

33%

have rated chatbots as friendly and accessible

Healthcare chatbots are growing at a CAGR of

26.29%

Clinical chatbots have a satisfaction rate of

73%

Healthcare bots will save

$3.6 billion worldwide

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The Importance of Chatbots in The Healthcare Industry Amidst the new coronavirus (COVID-19) pandemic, the CDC and WHO have suggested using chatbots to distribute information about symptoms, recommend behavior changes and provide emotional support. If we implement chatbots properly, we will be able to actively share current information that enables suitable health practices and reduces the psychological harm caused by anxiety and social isolation. It is possible that chatbots could lead to a major healthcare overhaul. They can enhance efficiency and accuracy. Here are the key advantages of a healthcare chatbot: Reduce waiting time: Time is essence, specifically in medical issues. Chatbots can answer your queries within seconds. Patients need not wait in line, call or email hospitals to get answers to their questions; they can just type in their queries and get an immediate response. Daily Medication Reminder: Doctors prescribe medicines to help patients with various health conditions. A research study suggests that over 50% of patients do not take their medication on time.

Chatbots can provide not only timely medical advice but also send daily reminders to patients for their medication. Appointment Scheduling: Scheduling an appointment over a phone call could be time-consuming and even frustrating sometimes. The call operator will need to get details about the patient, the doctor they need to see, and manual check if the slots are available. It leads to an additional administrative cost. A well-employed chatbot 61

could assist patients in booking their appointment with the right doctor. Improved Internal Communications: Chatbots aren’t limited to helping patients. They can be used to facilitate better internal communication among employees. Chatbots can even provide links to training material, videos, and other relevant information, making it easy for employees to access necessary information. Billing and Registration: Healthcare facilities can use our platform to integrate with backend billing, insurance

claims, and inventory management systems. This allows quick and easy generation of invoices and payments. Health insurance providers could utilize the bots to answer common queries related to coverage, claims, and procedures. 24*7 Availability: Doctors may not be available all the time for every patient. Bots can be available 24/7 personally for you and assist you throughout your recovery. They can provide medical information, give tips, remind you about medication, and care for your overall health.

Famous Healthcare Chatbots There are quite a few variants of healthcare industries. Here, we are mentioning some of the chatbots characterized by their biggest features.

Real-Time Healthcare Assistance

Elomia

An AI-powered virtual therapist trained using thousands of consultations conducted by doctors. The virtual therapist could take care of the user’s emotional well-being and can help patients with: • Depression • Anxiety • Lower self-esteem

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• Sleep Issues • Relationship Issues

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Youper: Self-Guided Therapy A mental health app that uses AI and is backed up by an army of healthcare professionals. It helps users with personalized conversations and offers: • • • •

Personality Assessments Emotional State Test Mood Tracking Mindfulness Exercises

Babylon Health A chatbot that gives medical advice before you have to go in for an appointment. Here is how it works • The robo-doctor talks to you • If needed, it redirects you to a video conference with a Babylon’s full-time physician • The physician prescription is sent to your nearest pharmacy right from the app Note: The app also stores consultation notes for future reference.

Ada Health Companion Ada Health is a diagnostic tool that requires users to fill out a detailed health assessment based on their symptoms. Ada helps you have basic conversations while also inputting information from a massive database of relevant inputs and cases. It feeds into a larger machine-learning model to provide an accurate estimation of your overall health and pinpoint the causes of your problem, as well as possible solutions. 63

Buoy Health Data-Backed Discussions

Used as a diagnostic tool. It helps users self-assess for their symptoms. Here is how it works: • Talk about your symptoms • Get clinical insights on your symptoms • Choose the best care option based on your symptoms

SafedrugBot Aimed to help out physicians. The bot has three different commands: • Information on Drugs • Active Ingredients • Alternative Drugs In the future, it can help identify allergies and foreign prescriptions.

Note: They will follow-up with you if you allow the access and they also have an ‘Buoy Community’ where they can connect you with people experiencing similar symptoms.

Content-Rich

CancerChatbot’s An AI medical chatbot software for helping people learn about different types of cancer, various treatment options and the long-term outlook. This bot crowdsources the information from relevant sources on various types of cancers, organizes them, and makes it available for users in an approachable way. Cancer-related information is regularly provided to users via a chatbot, which also answers users’ queries and runs them through a database of cancer research data, and treatment trials.

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Your.MD A symptom diagnostic chat tool with a database of information. It can be accessed via various platforms like • Skype • Telegram • Facebook

• Slack • Android App • iOS App

Reminders

Florence Used to remind patients to take their medication. They need to enter the medicine name, quantity, and the time patient has to consume it. It has several other features like: • Track weight and periods • Send prescription refill reminder • Daily health tips

• Moderate mood • Locate nearest physician or pharmacy

Conclusion Chatbots are undoubtfully beneficial in the healthcare industry. They are an important part of the future of health IT. In the wake of the pandemic, these bots have multiplied. Although, they offer a lot of advantages; there are concerns about data privacy and security. The future is yet to be determined but the healthcare industry could definitely leverage them to improve patient care as well as customer service.

Challenges and Impact of

Cloud Technology in The Healthcare Industry by Johnson Cherian

Cloud computing (technology) is an infrastructure that operates on a subscription module and provides services such as servers, storage, databases, software, and allows users to access the information remotely. The ‘cloud,’ in simple terms, is storing and accessing data over the internet. The data is hosted remotely on data centers and is managed by a cloud service provider (CSP). This technology allows for easy access to data from anywhere in the world without having to have the software installed into a particular computer.

Cloud technology allows easy access and exchange of data between various departments as they are stored on a cloud platform and not on physical hardware.

Cloud Technology in Healthcare Industry The healthcare industry works under immense pressure to operate in real-time and provide healthcare professionals and patients with access to data across various locations. Cloud technology allows easy access and exchange of data between various departments as they are stored on a cloud platform and not on physical hardware. According to a study done by the marketing research firm iHealthcareAnalyst, Inc., “The global market for cloud computing in the healthcare industry is expected to cross $23.7 billion by 2027, expanding at a CAGR of 16.1% throughout the forecast period, driven by its unique advantages in data flexibility, security, and scalability.”

Many hospital leaders and technology leaders are adopting the idea of the cloud as an extension to their already existing infrastructure, and this has helped transform the healthcare sector with ease in functioning and reducing operational costs. With many medical devices using the cloud to wirelessly collect data for storage, computation, and share datasets, new cloudconnected devices are emerging, offering immense value to patients and healthcare providers.

Benefits of Cloud Technology in Healthcare 1

Cost-effective and flexible The data is stored on cloud servers; it is more cost-effective as software is not installed on individual hardware, thus reducing operational costs and flexibility to access data across various locations and platforms. 2 Transparency The technology allows healthcare practitioners and patients to share health information more openly and in real-time.

3 Intelligent insights Empowers doctors and patients with precise data that help in proper decisionmaking. It also helps them predict potential risks and threats in advance.

4 Accurate decisionmaking and treatment Human errors can be reduced significantly with the help of cloud computing analytics.

5 Real-time access With the data accessible across multiple departments at the same time, each healthcare system can study and communicate across departments to ensure better output.

Cloud Computing in Medical Devices In the medical industry, the term “smart devices” is generally devices used to receive and/or transmit data over the internet, whereas “connected medical devices” can receive and/or transmit data over the internet to/from other devices. Connected medical devices use the internet to collect, store, manage, transfer, and analyze patient data sets. These medical devices can be connected wirelessly to another device by using Wi-Fi, Bluetooth, or radio transmission. Some of the major players in the connected medical device market are

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Challenges in Medical Device Industry Medical devices play a vital role within the healthcare industry. they need made healthcare operations smoother and hassle-free additionally as eased patient care. However, most of the devices being cloud-based are prone to cyber threats, and managing regulatory compliance and internal control are key areas of concern. Cybersecurity Connected medical devices and instruments, although high on innovation, are vulnerable to potential cyber threats. It is a huge challenge for medical equipment manufacturers to manage and secure the enormous amounts of sensitive data that are collected and stored on the cloud infrastructure from this equipment. Complex Regulations Manufacturers of medical devices are bound by government guidelines and regulations that differ from country to country. The medical device regulations of the EU differ from that of the FDA. In the European Union, General Data Protection Regulation (GDPR) gives security to the basic identity records of personal information, biometric records, health, genetic information, etc. While, in the United States of America, HIPAA Title II mandates standardization of electronic health records systems and addresses the privacy and security of patient health data. These differences in regulations make it difficult to maintain similar standards across the globe. Remote Connectivity Though IoMT seems to be an ideal solution, there is a dearth of skilled talent to handle the sophisticated electronics, communicating, handling, and evaluating the information

gathered. Clinicians, patients, and healthcare infrastructure rely on continuous connectivity. Internet connection failures can be due to numerous reasons such as insufficient network capacity, physical barriers interrupting the wireless signals, and inadequate staff to fix problems. Product Quality Despite the technological advancements, OEMs face the challenge of ensuring the quality of the products. Poor quality products not only lead to recalls but can hurt the brand reputation and hurt the company’s finances. Defective products can lead to incorrect test results, contamination, malfunctioning, or even unexpected shutdowns. 69

Impact of Cloud Computing on Healthcare

Cloud computing has greatly impacted the healthcare sector by increasing the industry’s efficiency, reducing costs, and making medical record sharing safer and easier.

Ease of Interoperability The power of cloud computing allows healthcare professionals to gain easy access to patient data collected at various sources and share the data with other stakeholders. This allows real-time access and review of cases and obtains quick opinions despite the geographical limitations. As patient’s health data is stored in the cloud, it allows interoperability among several departments such as hospital administration, labs, finance, insurance, pharmaceuticals, etc. This seamless data transfer among various stakeholders accelerates healthcare delivery and increases process efficiency.

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Access to Powerful Analytics With the large pool of healthcare data on the cloud, performing analytics on patient data has paved the way for more personalized patient care. Artificial intelligence algorithms and the application of big data analytics are powerful for medical research. Patient’s Data Ownership As patient data is available on the cloud, the patient gets control over their health and boosts their participation in making informed decisions relating to their health. The medical records and medical images of patients can be easily stored on the cloud for easy access.

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Patient Care Standards With the patient medical records stored on the cloud, this reduces paperwork and delay in treatment as physicians can remotely access the data and provide necessary treatment and recommendations. Freeing Up Essential Resources With cloud computing, it is possible to allocate resources in the best possible manner, better and at a minimum cost, thus improving the resources’ working efficiency. It provides better support for repetitive admin works, HR, and other operational functions. Predicts Device Maintenance With the help of Machine Learning technology, the medical device connected to a cloud network can predict the need for maintenance for the medical device of a hospital, clinic, or

patient. This allows for organizing and scheduling periodic maintenance, thereby avoiding malfunctioning and unforeseen breakdown of medical devices. Telemedicine Since the COVID-19 pandemic, cloud computing has revolutionized the healthcare industry by virtual medicine (telemedicine). Using cloudbased software and apps, medical practitioners can provide virtual consulting and precise, personalized care to patients. Patient monitoring tools like wearables, inhome care devices, and biosensors provide continuous patient care, detect and alert distress signals, and remotely monitor vital signs and parameters. This information can be received over the cloud by the physicians, and appropriate treatment can be initiated.

Conclusion The healthcare industry is yet to realize the full potential of cloud computing. The sheer volume of healthcare needs demands more companies to focus on research and innovate new and better products that can collect, analyze, and interpret medical data. There is a vast potential for cloud computing in the healthcare industry due to the interoperability, which simplifies day-to-day hospital administration and patient care. However, cloud technologies need to work around providing cybersecurity to medical devices and work with various governments to come out with standardized compliance regulations. Channelizing the power of cloud technology in combination with evolving technologies like machine learning, robotics, big data analytics, and IoMT will help streamline healthcare delivery.

The Wright Brother’s 1903 Flyer by Barkha Sheth

“The desire to fly is an idea handed down to us by our ancestors who... looked enviously on the birds soaring freely through space... on the infinite highway of the air.” – Wilbur Wright

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One of the most important and well-known mechanical artefacts in the history of mankind is the Wright Brothers 1902 Flyer. The original aircraft can be found hanging in the expansive exhibit gallery of the Smithsonian Institution’s National Air and Space Museum. Suspended in the air, this hand-made wooden assemblage is an awe-striking structure in its own right and is credited with inaugurating the aeronautical age.

en of simple tastes and towering ambition, the Wright Brothers, were skilled where it mattered and resolute in the face of failure. The fragile piece of minimalist engineering that took to the skies almost 120 years ago was no small feat for these bicycle mechanics. With no institution backing them, no masterminds to guide them, and nothing in the way of tangible ideas, the credit for the 1902 Flyer lies solely with their ingenuity and perseverance. From the Dawn of Time Ever since the start of the literary ages, mankind seems to have been predestined to study flight. One scholar in Spain in the year 875 is known to have covered himself with feathers in an attempt to fly. Others devised wings and jumped from rooftops only to meet untimely demises. Leonardo Da Vinci claimed he was preordained to study flight, ever since he saw a kite soaring into his cradle. His studies were considered the most scientific in early history. For the Wright brothers, it began with a toy created by Alphonse Penaud. A little more than a stick with twin propellers and twisted rubber bands, the helicopter was a gift for the boys from their father, Bishop Milton Wright. So enamoured were they with this bit of plaything that Orville would tell his teachers when he was still a little boy that one day, he

Picture: Penaud Helicopter (replica)

and his brother would create a machine that would let them fly. The Early Days Both Wilbur (born in 1867) and Orville Wright (born in 1871) never completed their highschool degrees. While a conscious decision on their part, foregoing higher degrees did not mean the end of learning for the two. Supplanting what they had learnt in school with a great deal of private study, the boys at a young age had shown that they were far ahead of their peers in almost every subject. As Orville once reflected, “We were lucky to grow up in an environment where there was

Picture: Wilbur Wright (left) and Orville Wright (right) in 1905

always much encouragement to children to pursue intellectual interest; to investigate whatever aroused curiosity…” Around 1892, when bicycles had become the rage, the Wright Brothers, much like the rest of the country, took to the streets with their newfound passion – cycling. By 1893, the brothers opened the Wright Cycle Exchange, selling and repairing bicycles and within two years started building their own bikes, available to order. In the summer of 1896, Orville Wright was struck with the dreaded

typhoid fever. While nursing the then 25-yearold Orville back to health, Wilbur came across the works of German glider Otto Lilienthal whose published works and stories reignited the brothers dormant passion for taking to the skies. From there, one book at a time - ‘Animal Locomotion’ to ‘Dissertation on Aeronautics’, the brothers consumed it all. On May 30, 1899, almost three years after Orville’s recovery, Wilbur finally felt ready to embark on what many termed a mad man’s gambit.

The Wings of Birds Wilbur turned to the Smithsonian’s extensive library of resources for help with their own literary resources exhausted. Within a month of gaining access to even more exhaustive resources, Wilbur felt he was onto something. By now, he had come to the conclusion that the key to successful flight lay in one word - Equilibrium - the difficulty was not to get into the air but to stay there with sufficient control.

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1900 By Spring 1900, the brothers were ready to experiment with a manned glider. All they needed was steady winds and sandy beaches, and a remote fishing town on the Outer Banks of North Carolina, Kitty Hawk, fit the bill perfectly.

Wilbur’s observation of birds in flight had convinced him that all avians used their wings to adjust their balance in the air. By varying the tips of their wings so as to present one end at a raised angle and the other at a lowered angle, birds maintain their balance and equilibrium during flight. This was in contrast to what humans had been trying. Past experiments had pilots shifting their weight towards the left or right to control the movement of the aircraft, thereby affecting their stability while in the air. For the Wright brothers, this was their first significant discovery – Wing Warping, a critical and altogether original advancement towards their goal. Theoretically, with wing warping, a pilot could pull wires to maintain the craft’s equilibrium or bank into a left or right turn, known as roll control. Ailerons, which are control flaps on the trailing edges of the wings, are used today, but the concept was developed by the Wrights and was a crucial component in their patent for the plane.

In September 1900, they set up their tent in the sandy banks of Kitty Hawk. Initially seen as a couple of eccentrics, they soon had even the humble townsfolk rooting for them. In the words of a long-time resident of the time - the Wrights were the “two of the workingest boys” ever seen, and in a place where everyone worked hard to make ends meet, their grit and hard work felt right in place and won many a supporter. On October 19, Wilbur made his first manned flight in the engine-less glider, recording flights of 300-400 feet in length and speeds of nearly 30 miles an hour. Now that the glider worked better than anyone else’s had in the past, they felt sufficiently ready to notch things up a bit.

1901 By July 1901, the brothers were back in Kitty Hawk, with a larger glider and a wing design recommended by Lilienthal. But after days of experiments, most of which were massive failures, they eventually realized that Lilienthal’s calculation on the curvature of the wings was drastically wrong. Verses that their own design from the previous year had more stability and control.

So they reverted back to their design, and the new machine, as Wilbur himself wrote,

“

never failed to respond properly to even small movements of the rudder

”

But for that year, that was the last time luck favoured them. Any more attempts to fly the glider proved to be a failure. With downed spirits and feeling like they had hit the lowest point in their endeavour, the brothers headed back to Dayton. But as with many inventors, the thrill of a new idea ultimately wins, and Wilbur once again began work in earnest. With their former trust in the calculations of those they looked up to shattered, the brothers set out in the autumn of 1901 to crack the code of the aeronautics themselves. By the summer of 1902, the brothers were back in Kitty Hawk with a new and improved glider. Improving the design as they went along, the brothers added a movable back rudder and attached that to the warping of the wings, by way of a hip cradle, much like the use of hips in manoeuvring a bicycle. The new glider performed remarkably well – it flew better, glided 600 feet in one test and gave the pilot a lot more control in the air. All in all, 1902 ended as a successful testing season. Now all they had to come up with was the motor.

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1903 By 1903 Dayton was firmly in the midst of an industrial revolution. Automobiles had hit the streets. Gasoline pumps were becoming more and more common, and as far as the brothers were concerned, interest in a flying machine was on the rise. In December 1903, the brothers once again headed back to Kitty Hawk, with a glider and an engine in tow. On December 17 1903, the brothers decided to carry out their first tests with the new motor on a freezing cold day. It was Orville’s turn to pilot the new craft. At exactly 10:35, Orville, now positioned on his stomach at the controls, slipped the rope restraining the Flyer, and it slowly headed forward, pushing against a fierce headwind. At the end of the track, the Flyer lifted into the air and stayed afloat for a total of 12 seconds, covering 120 feet. As the Flyer lifted off the ground, Daniels, a long time resident of Kitty Hawk, snapped the shutter in what would become the most historic photograph of the century. At around noon, Wilbur took the aircraft for a fourth test. This time around, he was in the air for 59 seconds and a distance of 852 feet. Their original Flyer never took to the air again after its single day of triumph. It had served its purpose as a proof-of-concept vehicle, and the Wrights moved on to the larger, more durable craft. By 1905, they had substantially improved the design and added a sturdier motor.

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But not until 1908 did the Wrights begin to receive recognition. Wilbur’s test flight in France won over doubters in public demonstrations that year, while Orville’s in Virginia brought an Army contract. Wilbur Wright died of typhoid fever on May 30, 1912, at 45. His younger brother died on January 30, 1948, at 76.

Today the brothers are survived by more than a museum artefact. They, after all, have set the standard for the problem-solving methodology of modern aeronautics. Never again has the world been the same. What’s remarkable, though, even after more than a century of flight in air and space, the Wrights would find some of the fundamental things very familiar.

*This article is inspired by the exceptionally well researched and a New York Times Bestselling book “The Wright Brothers by David McCullough.”

Picture: Wrights brothers national monument made with bronze for the first aviation in the history in Outer Banks, NC USA

The Role of

Big-Data

in Healthcare sector

by Rehan Husain

What is Big Data Big data is a broad term that refers to an extensive collection of complicated data, whether unstructured or organized. The collected data could be efficiently utilized to reveal additional insight and to address business issues that were previously unsolvable using traditional analytics or software. Typically, data scientists use artificial intelligence-powered analytics to examine these massive databases constructively to find relationships and correlations that might give valuable business insights.

Big Data in Healthcare Sector: In healthcare, big data refers to the application of prescriptive, predictive, and descriptive analytics services to derive actionable insights from healthcare data. Three objectives underpin big data’s use in healthcare: Improve clinical results through the use of patient data; 2 Boost employee productivity by using operational data; 1

The “Three Vs” are the pillars of big data technology -

Volume Velocity Variety

These three characteristics or aspects define effective big data analytics in healthcare.

Apart from these three, big data has two new Vs:

Veracity Value

Utilize financial data from healthcare to help hospitals or healthcare institutions enhance their income stream.

Volume refers to the massive quantity of data generated by healthcare organizations via their applications, portals, websites, and EHRs (electronic health records) The term “velocity” relates to the rate at which datasets are created and processed. Variety refers to the numerous sorts of data that we may currently produce, collect, and evaluate.

The term “value” refers to the monetary value of the data being created, gathered, or evaluated. Finally, but certainly not least, veracity refers to the reliability, integrity, or quality of healthcare organizations’ data generation, collection, and analysis.

Big data in healthcare will grow at an astounding 36 percent compound annual growth rate through 2025. 79

Big data is projected to enter the healthcare industry more quickly and deeply than it did in other sectors such as media, financial services, and manufacturing. This is unsurprising given that healthcare is the largest private sector employer in the United States and accounts for 20% of GDP. Indeed, it is anticipated that the worldwide healthcare big data market would expand gradually at a compound annual growth rate (CAGR) of 22.07 percent to reach around $34 billion by 2022. Another comprehensive analysis predicts that big data in healthcare will grow at an

astounding 36 percent compound annual growth rate through 2025. The term “big data in healthcare” refers to the massive amounts of health data gathered from a variety of sources, including electronic health records (EHRs), medical imaging, genetic sequencing, payor records, pharmaceutical research, wearables, and medical devices. It differs from typical computerized medical and human health data used for decision-making in three ways: It is available in unprecedented volumes; data travels at a rapid rate and encompasses the vast digital universe of the health business; and, because it originates from a variety of sources, it is extremely varied in structure and character.

Applications of Big Data The major application of big data in the field of health care sector are discussed below:

Maintaining patient health and preventing illness and disease should always be a top concern: • Consumer gadgets such as the Fitbit activity tracker and smart watches, monitors an individual’s physical activity and can also report on particular health trends. The resultant data is already being uploaded to cloud servers, where it is being used to tell clinicians about their patients’ general health and wellness. • Fitbit has already collaborated with United Healthcare, which pays its insured members with up to $1500 per year for frequent exercise. The One Drop app from Informed Data Systems for Android and Apple is

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causing substantial improvements in A1c levels in persons with diabetes. Meanwhile, Apple’s HealthKit, CareKit, and ResearchKit applications utilize the technology built into Apple’s mobile devices to assist patients in managing their diseases and to enable researchers to collect data from hundreds of millions of users globally.

Expanding diagnostic services enables patients to receive expert treatment more easily: Apps for mobile devices, such as Aetna’s Triage, advise people about their medical conditions based on aggregated data and even recommend them to seek medical treatment depending on their input. • Apple has teamed up with Stanford researchers to examine if the Apple Watch’s heart sensor can be used to detect atrial fibrillation, a disease that claims roughly 130,000 lives each year in the United States. If the gadget is successful in identifying the illness, Apple can alert wearers to the need for medical treatment. • Propeller Health utilises a Bluetooth-enabled sensor that connects to inhalers and spirometers used by individuals with asthma or COPD. The business monitors ambient conditions at sensor locations and delivers information directly to patients’ phones, enabling them to gain a better understanding of the reasons of their symptoms and take preventative steps. Additionally, the business sends reminders when prescriptions should be taken.

Propeller says that patients are reporting 79% fewer asthma episodes and 50% more symptom-free days as a result of its 34 peer-reviewed papers.

Cost savings Medical data provides clinicians with more insight, which translates into improved patient care, shorter hospital stays, and fewer admissions and readmissions. • Additionally, analysis of healthcare big data helps to a better understanding of patient cohorts at highest risk for sickness, allowing for a proactive approach to prevention. In brief, study of healthcare big data enables the identification of outlier individuals who spend much more health services than the average. It can identify methods and processes that provide inferior results or are too expensive in comparison to the results. • The knowledge gained through big data analysis provides healthcare practitioners with clinical insights that would not be available otherwise. It enables them to prescribe therapies and make clinical decisions more precisely, removing much of the guesswork associated with therapy and resulting in cheaper costs and improved patient care.

Importance of Big Data in Health Care Sector Yes, there is growing enthusiasm for the potential of big data in healthcare, and investment in analytics is expanding. However, according to a recent Dimensional Insight research, 56% of hospitals and healthcare institutions lack adequate big data governance or a long-term analytics strategy. Here are some of the reasons why big data is critical for healthcare: • Inadequate data governance results in record duplication, unclaimed reimbursements, financial benchmarking issues, and other operational inefficiencies. That is something that big data can correct! • Patient care is also becoming more complicated, and without adequate analytics, it becomes increasingly impossible to offer high-quality, safe, and effective patient care. Numerous healthcare companies have had inconsistencies between their clinical and accounting departments as a result of data errors and incompatibilities.

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• In healthcare, big data is widely utilized to assist in identifying and managing patients who are both high-risk and expensive. • Indeed, 71 percent of respondents to the aforementioned research reported seeing discrepancies between data from several sources inside their company, most notably financial, clinical, and administrative information. Additionally, 51% of executives discovered discrepancies between data from several clinical departments.

• Additionally, big data is utilized to identify high-risk regions where patients may get more efficient treatment, thus lowering costs and increasing patient satisfaction. • By assisting payers and healthcare providers in identifying high-risk and costly patients, big data and analytic technologies enable these people to get appropriate intervention and save money on preventative treatment well in advance.

Challenges to Big Data • The Difficulties of Data Aggregation To begin, patient and financial information is often dispersed among many payers, hospitals, administrative offices, government organizations, servers, and file cabinets. Bringing it all together and preparing for future collaboration amongst all data providers when new data is generated takes considerable preparation. Additionally, each participating business must comprehend and agree on the kinds and formats of big data to be analyzed.

• Management Obstacles Finally, achieving the promise of big data analytics in healthcare would require companies to change their business models. Data scientists will very certainly be required, as will IT personnel with the necessary expertise to operate the analyses. • The scalability of data is also a problem in this sector, that needs to be taken care of.

Road Ahead Big data is just now starting to transform healthcare and propel the sector ahead on a number of fronts. The advances in medicine, technology, and finance that big data in healthcare offers will enable healthcare companies to enhance patient care and generate value. However, it will need stakeholders — providers, payers, pharmaceutical manufacturers, government and politicians, as well as scientific and research communities — to cooperate and innovate in order to reinvent their systems’ design and performance. They must develop the technical infrastructure necessary to store and consolidate the enormous amount of healthcare data expected to reach

2,314 exabytes by 2020, according to industry experts. Additionally, they must invest in human capital—information technology professionals, data scientists, data architects, and big data engineers—to lead us into this new and exciting frontier of human health and well-being.

Final Verdict Big data has the ability to completely transform healthcare. Healthcare companies should make significant investments in big data in order to improve patient outcomes, reduce costs, and increase efficiency across all departments. More importantly, big data will enable doctors and hospitals to provide more focused treatment with improved outcomes. For pharmaceutical firms, big data is a catalyst that will aid in the creation and development of more creative medicines and products. On a broad level, healthcare stakeholders may depend on big data and predictive analytics to address critical problems like as readmission rates, high-risk patient care, staffing difficulties, and medication mistakes.

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Top Five

AI-ML Books

For Business Leaders by Vibha Soni

ccording to a recent new forecast by Gartner, Inc., the worldwide hyper-automation would enable the software market up to $596.6 billion by 2022. The prediction is enough to say that technologies become a dire need for the highly competitive market. Among emerging technologies, Artificial Intelligence (AI) and Machine Learnings (ML) are positioned at the top to bring automation to businesses. Business leaders are seeking to implement AI & ML to transform their traditional business processes. They are looking for resources to understand how it works. Here is a list of books that would help understand how AI and ML could be gamechangers for their business.

Competing in The Age of AI: Strategy & Leadership When Algorithms And Networks Run The World AU T H O R :

Marco Lansiti & Karim R. Lakhani R E L E AS E D :

2020 R E V I E W & F E AT U R E S :

The central idea of the whole book is to provide information about AI and how it has been changing the business industries. The authors have explained that AI, networks, and data analytics can remove traditional business constraints like scope, scale, and learning and support companies to design new business models. The book has covered the concept “Age of AI” to point out that AI has been transforming businesses’ working styles and changing economic models. Authors urged that “AI is becoming the universal engine of execution”. AI is bringing new companies operating execution models by integrating different software, algorithms, and operating systems. The authors used the example of “Amazon” to articulate this concept and compared it with Walmart. 86

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The transformation in competition is possible through the emergence of various digital operating models. The book has provided examples of some companies competing with each other. Snapchat, Facebook, Tencent (WeChat), and TikTok have adopted scalable digital operating models to stay in the competition.

The explanation about other concepts like AI factory, Strong and Weak AI, Framework, Strategic Collisions, and Ethics has been described with real-life examples. The authors took three industries, including entertainment: YouTube, Netflix; banking: Ant financial; and hospitality: Airbnb, to explain the recurring pattern. The author pointed out that Weak AI is more impactful to enhance business growth. The book is perfect for every business leader who is thinking of transforming the business to compete in the market. www.techfastly.com

The Algorithmic Leader: How to Be Smart When Machines Are Smarter Than You AU T H O R :

Mike Walsh R E L E AS E D :

2019

R E V I E W & F E AT U R E S :

The book is not like a traditional book. It has been considered a practical approach to learning AI, automation, and algorithms to transform everyday operations. According to the author, we live in a world where wonders happen every day because of technology. Still, we assume that robots are replacing human jobs. The author argues that it is not true; the fact is that human beings are unwilling to adopt the changes. The author has extensively researched, interviewed business leaders, industry experts, and scientists to explore the potential of human intelligence in the future. He provided a simple definition of algorithm leader, “An algorithm leader is someone who has successfully adapted their decision making, management style, and creative output to the complexities of the machine age.” To encourage human beings and push them to become ‘smart’, the author developed the “10 Principle” shown in the picture. The author explored varied industries, cultures, and history to understand how to get success using AI. His principles are surrounded by futuristic ideas such as machine learning,

probabilistic thinking, disruptive innovation, decentralization, and digital ethics.

Through this practical knowledge, the author pointed out that first, change your mind, change the work style, and then you can change the world. This change is not stuck for business purposes only but also applicable to personal life. The book articulated the power of algorithms and how it plays a vital role in every aspect of the business. This book is best for anyone who wants to learn from real-life experiences and those who want to learn only specific principles. The 10 principles are: • • • • • • • • • •

Work backwards from the future Aim for 10x, not 10% Think computationally Embrace uncertainty Make culture your operating system Don’t work, Design work Automate and elevate If the answer is X, ask Y When in doubt, ask a human Solve for purpose, not just profit

Business Data Science: Combining Machine Learning and Economics to Optimize, Automate, and Accelerate Business Decisions AU T H O R :

Matt Taddy R E L E AS E D :

2019

R E V I E W & F E AT U R E S :

“Business data science refers to a modern standard for data analysis to implement it for businesses”. The book aims to provide an essential concept of machine learning for solving business problems and help grow the business economy. The author has provided a toolset for business data science by integrating machine learning, statistics, and economics concepts. The uncertainty, regression, regularization, validation, classification, controls, and factorizations are building blocks of machine learning. All of these concepts have been explained with various examples. It has been pointed out that ML and statistics are closely related to each other, which is

inspiring new ideas for designing new ML algorithms to solve any business problems.

Another feature of the book is snippet codes of R language to explain the data analysis methods. It would be helpful for readers to use these codes as references and develop new codes. Technologies have been changing everything, and it is forcing business leaders to make wise decisions. Applying the prediction concept and developing a system would help understand the future risk and make better decisions. Henceforth, the book is an excellent resource for learning the principles, applications, and practices to explore business data sciences.

According to the author,

“Machine learning is the field that thinks about how to automatically build robust predictions from complex data”.

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Artificial Intelligence for Business Leaders AU T H O R :

Matt Taddy R E L E AS E D :

2019

R E V I E W & F E AT U R E S :

Readers do not require prior knowledge of AI and relevant topics. They do not need to learn complex algorithms and code to apply AI to drive their business. The book has covered all essential theoretical concepts to explain AI and how it can change every business. The author has provided a lucid definition of all concepts. For instance, “Machine Learning is a kind of Artificial Intelligence that provides computers the ability to learn without being explicitly programmed.” This simple definition of Machine Learning is easily understandable by anyone.

“Enterprise and Economic strategy” to help business leaders create effective business strategies.

Another exciting feature of the book is that the author explained AI use-cases and practical examples to find out how AI makes business operations easy. Strategy formation before technology implementation is challenging for every business leader. The book has covered

All this information would be beneficial for readers to make a wise decision before adopting AI. In my opinion, the book is best not only for business encaustics but also for technology leaders to get the updated information in one place.

Apart from this, most business leaders try to find other details about the technology, such as how disruptive it is, how it generated results in the past, where it failed, and what would be the future, or who is providing the services. The author has used examples of big companies like Amazon, Apple, Microsoft, and Google to describe all these.

The book has covered “Enterprise and Economic strategy” to help business leaders create effective business strategies. 89

The AI-First Company: How to Compete and Win with Artificial Intelligence AU T H O R :

Ash Fontana R E L E AS E D :

2021

R E V I E W & F E AT U R E S :

The author wrote this book to encourage the formation of AI-First companies with capabilities of data gathering, processing, and using it in the required place. The author himself founded, The AI-First Company to support this encouragement. The author highlighted that AI-First companies are trillion-dollar companies that would take top place among all industries. These companies follow the design principle to develop predictive models which perform prediction and automation of business functions. And, the book would help them to understand the practical implementation of AI. The cornerstone of the book is its framework which consists of eight parts. The author explained each part through a single chapter. For instance, the first part brought a new concept, “Data Learning Effects (DLE)” designed using

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network, scale, and learning effects. The author has designed the following formula: DLE = Economics of scale to data + data processing capabilities + data network effects Also, Output = function (data, data processing capabilities, and data network effects)

Besides this part, the next parts are related to lean AI, strategy formation, team building, execution, and advantages. All these parts would help readers to integrate AI with existing business processes to automate it. The recent conversation of Author Christian Lutz, founder of Crate.io has also pointed out the importance of AI and ML in business. The book is unique to find out the systematic steps of AI implementation in the existing business.

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Direct-To-Consumer Pharmaceutical Advertising (DTCPA) In The US

by Anjali Prabhanjanan

Marketing and advertising pharmaceutical products directly to the consumers as patients, opposed to specifically targeting healthcare professionals.

irect-to-consumer pharmaceutical advertising (DTCPA) refers to marketing and advertising pharmaceutical products directly to the consumers as patients, opposed to specifically targeting healthcare professionals. DTCPA refers to advertising prescription medicines via mass media communication platforms such as television, radio, magazines, newspapers, and online platforms. Most countries ban any advertising of prescription drugs directly to the consumers. Direct-to-consumer pharmaceutical advertising is only legal in the US and New Zealand. Still, it is subject to regulations concerning the balanced disclosure of a prescription’s benefits in comparison to its risks, including the side effects and

contraindications. Typically, the regulations for DTCPA are applied to advertising materials describing the indications and benefits of the prescription and may be more lenient to advertising materials that don’t discuss its uses. There are ethical and regulatory concerns surrounding DTCPA, explicitly the extent to which these ads may influence the prescribing of the medicines based on consumer demands when in some cases, they may not be medically required, or other cheaper options are available. Critics of the DTCPA have argued that excess money is spent on marketing the medications instead of research and development in the US. The ad spending by the pharmaceutical industry reached US$5.2 Billion in 2016.

Types of Direct-to-consumer Pharmaceutical Advertising (DTCPA) The Food and Drug Administration (FDA ) defines several common types of DTCPA for prescription medication in the US.

Product Claim Advertisement This is the most common DTCP advertising that identifies the drug name and trademark brand name of the medication and summarizes the efficacy and risks of the drug.

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Reminder Advertisement Generally, it serves to build brand recognition instead of promoting the drug’s uses and benefits. Though this type of DTCPA ad can provide information about the price or dose, it avoids making claims. Moreover, it cannot contain any information or imagery of the drug itself, including how it functions or the advantages, but may still contain a call to action (CTA) urging viewers to seek an external resource for more information

or ask their doctor. The reminder ads may include themes that vaguely allude to the drug’s purpose. For instance, a reminder commercial for the erectile dysfunction drug Viagra featured the show tune “Good Morning” and scenes of a man walking to work happily, emphasizing a sexual innuendo in the lyric “it’s great to stay up late”.

Help-seeking Advertisement This is more of an awareness campaign for a specific medical condition instead of marketing the drug name or treatment. So, this type of advertising includes information about a medical condition and encourages individuals to see a doctor or seek an external resource such as a website or a phone hotline for more information. These external outlets may, in turn, be used for promoting specific prescription options. Usually, these types of DTCPA are used as preliminary marketing for new drugs. The pharmaceuticals often use reminder and help-seeking ads to bypass onerous restrictions such as listing side effects or outright prohibitions on product claims advertising. This is because the types of DTCPA don’t focus on promoting the drug itself. In some cases, a campaign may mix both of these ads with one ad discussing the condition. Another similarly-styled ad mentions the product but not the medical condition, letting the viewers infer the association between the ads. 93

Regulation in the US Direct-to-consumer advertising of drugs has been legal in the USA since 1985. FDA eased up the rules obliging companies to provide a detailed list of side-effects in their infomercials (long format television commercials) in 1997, and DTCPA really took off. Under the regulation in the US Food and Drug Administration (FDA) requires all DTCPA information:

To be accurate and not misleading

To make claims only when supported by substantial evidence

As per the FDA, the direct-to-consumer “product claim” advertisements for prescription medication must include information about the major side effects and contraindications in the main body, with a “fair balance” of benefits to risks in its coverage. Unless these prescription drugs are given “adequate provision” at a variety of different outlets, the DTCPA ads must include a “brief summary” of all risks related to the medication. Typically, in print ads within magazines, this summary is given on a second page. The print ads must contain a standard notice that instructs the patients to report negative side effects to the FDA’s MedWatch program.

To reflect the balance between risks and benefits

To be consistent with the FDAapproved labeling

Whereas, in the ads carried on broadcast media, such as the radio and television commercials, only the major side effects of the drugs are listed, and the ad contains blurbs directing viewers to where they can obtain more information, such as on a website, phone hotline, or a current magazine issue. If the drug is subjected to a boxed warning from the FDA, it indicates a serious risk. So, the warning must be reproduced in all advertising materials, and reminder ads for the drug are prohibited. Further, the ads that do not make any health claims do not fall under the FDA’s jurisdiction but can still be regulated by the Federal Trade Commission.

What Can You Say? The FDA has rules for what drug ads MUST tell the consumers. The FDA criteria include: • At least one approved use for the drug • The generic name of the drug • Not be a false or misleading advertisement • Include the facts about the uses of the advertised product 94

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• Present a fair balance of information about the risks and benefits of the drug • A brief summary of the risks of using the drug or the important ones under certain circumstances www.techfastly.com

1 This product claim ad identifies the

fictional drug’s brand name- Arbitraer and generic name- misvastatium. 2 It accurately states an FDA-approved use for the drug, in this case, Arbitraer is approved to treat seasonal allergy symptoms. 3 It says Arbitraer is a prescription drug. 4 This ad as a whole provides the required “fair balance” of information about the risks and benefits of Arbitraer. 5 The man on the beach who is pictured in the ad is in the approved age range for users of Arbitraer. So, this ad reinforces that the drug is for adults 18 and older and is not for use in children. 6 As required by the Food and Drug Amendments Act of 2007, this print ad includes the statement “You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch, or call 1-800-FDA-1088.” 7 This print ad includes a “brief summary” of all the risks listed in the drug’s FDA-approved prescribing information. 8 This ad directs the reader to seek a doctor’s advice about taking Arbitraer. The

Picture: Correct Prescription Drug Product Claim Ad. Image Source: www.fda.gov

pharmaceutical company has included this statement to ensure that a consumer will not think he or she is qualified to make the prescribing decision. 9 This ad provides sources of further information, such as a website and a toll-free telephone number.

What Can You Not Say? When the industry’s use of direct-to-consumer advertising was challenged in the US in January 2008, it led to an investigation of several advertisements including the one featuring Robert Jarvik rowing a boat for Lipitor by Pfizer. A month later Pfizer pulled that ad and Ian Read, President of worldwide pharmaceutical operations of Pfizer, expressed regret about people

getting the wrong impression. Later the pharmaceutical industry announced that it will update its voluntary standards for direct-to-consumer advertising. Moreover, it pledged to stop using actors to play doctors, and to ensure that the endorsers who said they had used a particular drug had actually done so.

1 The image of the young girl in this fictional drug ad is misleading because Arbitraer is approved for use only in adults 18 years of age and older. 2 Though the claims must be supported by data from well-designed studies, consumers may not know if such studies exist and show this specific stat. If the FDA determines that claims are not supported, it will take action to have the ad fixed. 3 This ad falsely states that the fictional drug Arbitraer is approved to help control asthma symptoms while in the correct product claim ad it is approved to treat seasonal nasal allergy symptoms. 4 This ad shows a specific stat that the consumers may not know about whether such a study exhibited this data. Moreover, if the FDA determines that the ad claims are not supported, it will take action to have the ad fixed. 5 This ad presents the risks of Arbitraer in small type size and positions this information far from where the benefits are discussed. This makes it harder for the reader to notice and read the risks of this drug. So, this product claim ad doesn’t follow the “Fair balance” needed to specify the risks and benefits of the drug.

Picture: Incorrect Prescription Drug Product Claim Ad. Image Source: www.fda.gov

6 This ad does not include the “brief summary,” that includes additional required risk information that should be present in print ads by the Food and Drug Amendments Act of 2007. Usually, a brief summary is given as a statement “You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088.”

Additionally, pharmaceuticals can choose whether or not to disclose other information such as the drug’s price, if insurance plans will cover the cost, the number of people the drug has helped, if the drug is necessary, or if there’s a cheaper generic version or an older medication that works well. 96

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DTCPA and Online Ads Most marketers are beginning to recognize the enormous potential of DTCPA and online ads as it reaches millions of potential consumers globally. Though a vast majority of DTCPA budgets are still allocated to traditional media such as the television, magazine, newspaper, and radio, the marketers are beginning to shift some of their promotional expenditures on digital promotions including product Websites, search engine marketing, online display advertising, mobile advertising, and social media campaigns. With the health-related information searches ranked as the third most common activity among the online users in recent years, the drug marketers have also increased their expenditures for marketing efforts on the Internet. The pharmaceutical industry spent $59 million on DTC advertising and promotion on the Internet in the year 2003, and now the spending is estimated to have grown to $1 billion. That’s because the online channel of promotion promises to be lucrative as the data show a 5:1 return on investment for online DTCPA, which is targeted better than print or television ads in reaching the intended audience. Though the FDA has not yet issued formal guidelines for online DTCPA, it did send warning letters to over a dozen pharmaceutical manufacturers for company-sponsored search engine links that failed to mention the risks of the product. So, now the drug companysponsored links include the indication or the name of the product and not both. In the absence of regulation for DTCPA and online

ads, the drug companies have asked the FDA for guidance regarding what is acceptable especially when advertising on social media platforms. The internet has become an increasingly popular source of medical information for consumers. As per a 2005 study of over 6,000 adults, though the physician was still the most trusted source of information. Nearly 48.6% of the patients went online before consulting their physician whereas only 10.9% talked to their doctor first. 97

DTPCA and International Acceptance DTCPA and international acceptance include informing the patients by communicating the safety risks and public health information and warnings about topics such as adverse reactions and online drug purchasing, etc.

This type of advertising informs, educates, and empowers the patients by allowing them to take charge of their health. Consumers can benefit from having access to multiple information sources about drugs and other treatment options instead of solely relying on healthcare providers. It encourages patients to contact their doctors and seek medical advice. As per a 2004 FDA consumer survey, exposure to DTCPA has prompted 27% of Americans to make an appointment with their doctor to talk about a condition that has not been previously discussed. Another study found that the small print in a drug ad has a strong impact on the patients

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As per the FDA survey, 73% of doctors believed that the DTCPA helped patients to ask more thoughtful questions and 53% of doctors said that it has led to a better discussion with them. to contact their physicians. Moreover, the effect of DTCPA increases the patient contact with the doctors through promoting dialogue about the lifestyle changes necessary to improve the patient’s health. As per the FDA

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survey, 73% of doctors believed that the DTCPA helped patients to ask more thoughtful questions and 53% of doctors said that it has led to a better discussion with them. So, the DTCPA promotes heightened awareness and detection of any adverse reactions among the patients that lead to a healthy discussion with a physician. As per studies, DTCPA strengthens the patient-clinician relationship due to the participation of an informed patient in the clinical decision. Because 83% of the ads focus on the physician-patient communication and 76% explicitly promotes consulting your healthcare providers. Additionally, DTCPA reinforces the doctor’s recommendations and make the patients follow treatment instructions diligently. In the 2004 FDA study, 33% of physicians reported that DTCPA increased patient adherence. In another study by Harvard University/Massachusetts General Hospital and Harris Interactive, 46% of physicians said that they felt DTCPA increased patient compliance. DTCPA decreased the under-diagnosis and undertreatment of medical conditions among the patients. As per the 2003 Harvard University/Massachusetts General Hospital/ Harris Interactive study, it was found that 25% of patients who visited their doctor after seeing DTCPA received a new diagnosis; of

these, 43% were considered to have a highpriority health condition. However, the physicians thought the DTCPA did not convey information about risks and benefits equally well. About 78% of doctors believe that their patients understand the possible benefits of the drug very well or somewhat, compared to 40% who believe their patients understand the possible risks, while 65% believe these ads confuse patients about the relative risks and benefits of prescription drugs. Moreover, nearly 75% of physicians believed that the DTCPA causes patients to think that the drug works better than it does, and 80% of doctors feel pressure to prescribe the specific brand-name drug when asked. As per the currently available evidence, the effect of DTCPA on consumers is both positive and negative. An increased understanding of the effects of DTCPA will have significant implications for public health in the U.S. and New Zealand as well in other countries and regions where the ban on such advertising is being challenged. Although a ban on DTCPA has occasionally been called for in the US owing to the debate regarding the rising prices of drugs, it is hoped that the measures to maximize the benefits and reduce the risk of such advertising will allow this controversial, but powerful, medium to be better utilized for the improvement of public health.

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