BioSpectrum (Asia) - - Front Page - Priyanka Ba­j­pai­j­

In­for­ma­tion tech­nol­ogy devel­op­ment in health­care has been rapidly mov­ing from prod­ucts to ser­vices to so­lu­tions. The present decade is one of med­i­cal plat­forms fo­cused on real-time, out­come­based care. The next decade is mov­ing to­wards med­i­cal so­lu­tions – us­ing Ar­ti­fi­cial in­tel­li­gence (AI), ro­bot­ics, and vir­tual and aug­mented re­al­ity – to de­liver in­tel­li­gent so­lu­tions for both ev­i­dence­and out­come-based health and fo­cus­ing on col­lab­o­ra­tive, pre­ven­ta­tive care. This dras­tic con­flu­ence is lead­ing to AI and ro­bot­ics defin­ing the face of new health.

The ever-grow­ing health­care in­dus­try is go­ing through a hu­man re­sources crunch and this has led ev­ery­one to look to ro­bot­ics and au­to­ma­tion as a po­ten­tial so­lu­tion. This sit­u­a­tion also leads to a big­ger ques­tion- how much can be au­to­mated? Ar­ti­fi­cial in­tel­li­gence (AI) and ro­bot­ics have in­creas­ingly be­come a part of our eco-sys­tem and are be­ing adopted in equal mea­sure in the health­care space. How­ever, the idea of a doc­tor­less hos­pi­tal still comes with a lot of uncer­tainty and con­cern. Are we ready yet to let a med­i­cal ro­bot with AI probe us, make a di­ag­no­sis and pre­scribe a treat­ment plan suit­able for our con­di­tion? Eth­i­cal and sus­tain­able growth of tech­nol­ogy adop­tion is also in ques­tion. It is only fair to as­sume that if these ro­bots take the role of our pri­mary sur­geons, hu­man clin­i­cians will be job­less.

Ac­cord­ing to a sur­vey by Mar­kets and Mar­kets in May 2017, the mar­ket for AI in health­care is ex­pected to grow from $667.1 mil­lion in 2016 to $ 7,988.8 mil­lion by 2022, grow­ing at a CAGR of 52.68 per cent dur­ing the fore­cast pe­riod. Swami­nathan Van­gal-Ra­ma­murthy, Gen­eral Man­ager of the Ro­bot­ics

Busi­ness Divi­sion at Om­ron Asia Pa­cific says, “AI and ro­bot­ics are al­ready viewed as im­por­tant com­po­nents in driv­ing ad­vanced health­care. At the heart of this trans­for­ma­tion is the abil­ity of AI and ro­bot­ics to ease the man­power crunch, es­pe­cially in tak­ing on the more mun­dane, repet­i­tive or sim­ple tasks.”

In a num­ber of hos­pi­tals in Asia, ro­bots are al­ready be­ing used for lo­gis­ti­cal pur­poses. Equipped with nav­i­ga­tion ca­pa­bil­i­ties, these ro­bots can trans­port doc­u­ments, medicines and li­nen to dif­fer­ent parts of the hos­pi­tal. Hos­pi­tal staff can then fo­cus on more im­por­tant tasks such as pa­tient care.

Swami­nathan fur­ther says, “AI and ro­bot­ics have also en­tered into drug dis­cov­ery. Ear­lier this year, the Uni­ver­sity of Cam­bridge re­ported that a ro­bot sci­en­tist named Eve played an in­stru­men­tal role in dis­cov­er­ing a pos­si­ble an­ti­malar­ial drug. This, along with her abil­ity to carry out thou­sands of tests, led to her dis­cov­ery of Tri­colan, a com­mon in­gre­di­ent in tooth­paste that could pos­si­bly limit the spread of malaria.”

AI and Ro­bot­ics in di­ag­nos­tics and treat­ment

AI is al­ready be­ing used to de­tect many deadly dis­eases, such as can­cer, more ac­cu­rately and in their ear­lier and more treat­able stages. An excellent example is the stats pre­sented by the Amer­i­can

Can­cer So­ci­ety, ac­cord­ing to which 12.1 mil­lion mam­mo­grams are per­formed an­nu­ally in the US, but a greater pro­por­tion of these mam­mo­grams yield false re­sults, re­sult­ing in 1 in 2 healthy women be­ing told they have can­cer. Review and trans­la­tion of such mam­mo­grams is 30 times faster and with 99 per cent ac­cu­racy with the use of AI, thus re­duc­ing the need for un­nec­es­sary biop­sies as well as re­duc­ing the uncer­tainty and stress of a mis­di­ag­no­sis.

On the hori­zon, Mi­crosoft is de­vel­op­ing com­put­ers pro­grammed for use at a molec­u­lar level to start fight­ing can­cer­ous cells as soon as they are de­tected. They are also do­ing re­search for us­ing

AI to in­ter­pret on­line search en­gine be­hav­iour, for example, at the point where some­one might re­search symp­toms on­line long be­fore they ap­proach their physi­cian.

Health­care providers have adopted ro­bot­ics tech­nol­ogy since a while back. Ac­cord­ing to Frost & Sul­li­van, the global per­sonal ro­bot mar­ket, in­clud­ing ‘care-bots’, could reach $17.4 bil­lion by 2020, driven by rapidly age­ing pop­u­la­tions, a looming short­fall of care work­ers, and the need to en­hance per­for­mance and as­sist re­ha­bil­i­ta­tion of the el­derly and phys­i­cally hand­i­capped. Ja­pan is lead­ing the way with onethird of the govern­ment bud­get on ro­bots de­voted to the el­derly. The Ja­panese ‘care-bot’ mar­ket alone is es­ti­mated to grow from $155 mil­lion in 2015 to $3.728 bil­lion by 2035 (source: Ja­panese Min­istry of Econ­omy, Trade & In­dus­try).

Ro­bots are also mak­ing a de­cent place in el­derly care. In Singapore, where the Health Min­istry es­ti­mates that it needs to fill 9,000 med­i­cal sup­port po­si­tions by 2020 to meet ris­ing de­mands of an ag­ing pop­u­la­tion, ro­bots are also be­ing tested in hos­pi­tals, es­pe­cially for porter ser­vices – de­liv­er­ing items from point to point. Nurs­ing homes in China have started us­ing ro­bots to pro­vide care for the el­derly. One such great example is RoBear. This is a nurs­ing-care ro­bot that is able to lift and move pa­tients in and out of bed into a wheel­chair, help those who need as­sis­tance to stand, and even turn pa­tients in bed to pre­vent bed­sores.

Swami­nathan em­pha­sises the need of ro­bots to lessen the strain on al­ready-stretched health­care sys­tems. “In Australia, there is an in­creas­ing num­ber of aged care fa­cil­i­ties that have started us­ing ro­bots to per­form du­ties such as trans­port­ing li­nen, med­i­cal sup­plies and meals. This ef­fi­cient del­e­ga­tion of tasks en­ables staff to fo­cus more on pro­vid­ing qual­ity care to pa­tients”, he says.

Dr Chuan Kit Foo, Head of Me­dia Af­fairs, Bayer Phar­ma­ceu­ti­cals Divi­sion Asia Pa­cific says, “As a phar­ma­ceu­ti­cal com­pany, we see very clear ap­pli­ca­tions across the en­tire value chain for AI be­cause of its abil­ity to an­a­lyse large amounts of data and draw in­fer­ences by com­par­ing var­i­ous data sets. AI can im­prove de­ci­sion mak­ing across the en­tire value chain and the po­ten­tial pa­tient ben­e­fit is as mas­sive as po­ten­tial ef­fi­ciency sav­ings. In ad­di­tion, AI and other dig­i­tal tech­nolo­gies such

as wear­ables, con­nected de­vices, and telemedicine can help drive greater pa­tient en­gage­ment.”

Are we ready?

The ben­e­fits are nu­mer­ous

- higher pre­ci­sion al­lows for smaller in­ci­sions, low­ers the risk of com­pli­ca­tions and speed­ier re­cov­ery times - there are also associated risks. Wilson Tan, Se­nior Di­rec­tor, IQVIA An­a­lyt­ics, Med­i­cal De­vices & Di­ag­nos­tics Asia, says, “The re­cent wave of devel­op­ment has been more fo­cused on ro­bot as­sisted surg­eries. There is the additional risk of equip­ment mal­func­tion. Ro­bot as­sisted surgery typ­i­cally takes sig­nif­i­cantly longer, and is also much costlier to per­form the pro­ce­dure (slightly mit­i­gated by shorter re­cov­ery pe­ri­ods and lower com­pli­ca­tion rates lead­ing to shorter post­op­er­a­tive hos­pi­tal stays).” How­ever, he does be­lieve that ro­bot­ics and AI is the way to go. “We are still in the nascent days, but this devel­op­ment has great prom­ise in im­prov­ing out­comes, es­pe­cially when cou­pled with AI and big data. Cur­rently it is hard to make the cost-ef­fec­tive ar­gu­ment for ro­bot as­sisted surg­eries. How­ever, the pos­si­bil­i­ties of­fered jus­ti­fies the con­tin­ued devel­op­ment. While the po­ten­tial ben­e­fits out­weigh the risks, more com­pre­hen­sive data is re­quired to bet­ter un­der­stand the risks and how to mit­i­gate”, he says rhetor­i­cally.

Though ro­bot­ics tech­nol­ogy, and the role it will have in health and health care, is still evolv­ing, re­search shows there is a grow­ing en­thu­si­asm among con­sumers to en­gage with new tech­nolo­gies for their health care needs. But it seems those in de­vel­oped economies with en­trenched health care sys­tems show some re­luc­tance to em­brace AI and ro­bot­ics com­pared those in emerging economies with mixed health care cov­er­age. One pri­mary con­cern amongst com­mon pop­u­la­tion in re­gards to ro­botic treat­ments is that un­like sur­geons, they are not able to change sur­gi­cal course should

the pa­tients’ con­di­tion change, or an al­ter­na­tive pro­ce­dure be bet­ter suited. The ap­pre­hen­sion also lies in the fact that robo­ti­za­tion may lead to an in­crease in un­nec­es­sary in­ter­ven­tions, or take fo­cus away from pa­tient ex­pec­ta­tions. How­ever, the com­mon per­cep­tion is chang­ing and pub­lic is more open and will­ing to en­gage with a non-hu­man health­care provider. In a re­cent sur­vey by PwC on pub­lic will­ing­ness, a sig­nif­i­cant per­cent­age of re­spon­dents were highly will­ing to choose cer­tain treat­ments, tests or ser­vices ad­min­is­tered by an AI or ro­bot and there was wide­spread agree­ment about these ser­vices across the coun­tries sur­veyed.

So, will this lead to an era of sur­geons be­ing re­placed by ro­bots? The con­cern is le­git­i­mate but un­war­ranted. Swami­nathan looks pos­i­tive, “The health­care in­dus­try is the per­fect example of how ro­bots have not taken over the jobs of hos­pi­tal at­ten­dants, nurses, doc­tors and sur­geons. In fact, ro­bots come in as an aid for these work­ers so that they can do their job bet­ter, or work­ers can be reskilled to be able to per­form jobs that pro­vide more value-add.” Ro­bots are only go­ing to work handsin-hands with the health­care pro­fes­sion­als in the com­ing fu­ture. Tan agrees, “It is un­likely in the near fu­ture for sur­geons to be re­placed. These ro­bots can only help the sur­geon per­form spe­cific tasks faster in of­fer­ing im­proved pre­ci­sion, bet­ter imag­ing and nav­i­ga­tion. The sur­geon is still needed to per­form the surgery.”

Com­mer­cial­iza­tion and In­vest­ment op­por­tu­ni­ties

Given the long-term view, and the po­ten­tial of AI and ro­bot­ics, where should the in­vest­ment go? Kuldeep Singh Rajput, CEO & Founder, Bio­four­mis Pte Ltd. says, “In­vest­ing in health is al­ways a long- term prospect, whether it is a mat­ter of train­ing a doc­tor, de­vel­op­ing a new drug, build­ing a new fa­cil­ity or de­vel­op­ing AI and ro­bot­ics. Al­ready AI is com­ing of age, and the AI health­care mar­ket is poised for dra­matic growth. Frost & Sul­li­van pre­dicts that the AI mar­ket for health­care will in­crease by 40 per cent be­tween 2014 and 2021 and they es­ti­mate growth from $633.8 mil­lion to $6.662 bil­lion. Ac­cord­ing to CB in­sights, health­care is the hottest area of in­vest­ment within AI. They iden­ti­fied over 100 com­pa­nies that have raised eq­uity fund­ing round since Jan­uary 2013. From in­sights and an­a­lyt­ics, imag­ing and di­ag­nos­tic, drug dis­cov­ery to re­mote pa­tient mon­i­tor­ing and vir­tual as­sis­tants, AI is poised to im­pact ev­ery as­pect of health care.”

AI is cur­rently the fastest grow­ing health in­vest­ment area, with re­searchers and clin­i­cians look­ing to the tech­nol­ogy to aid in train­ing, re­search, early de­tec­tion, di­ag­no­sis, treat­ment, and even end of life care. Along­side AI, ro­bot­ics is an­other boom­ing mar­ket in tech. Ac­cord­ing to IDC, the over­all mar­ket has been grow­ing at a com­pound rate of 17 per cent a year and will be worth $135 bil­lion by 2019, with a boom tak­ing place in Asia, Ja­pan and China. Tan

says, “As with any new tech­nol­ogy, the high cost of devel­op­ment leads to high cost of im­ple­men­ta­tion and re­sult­ing low Re­turn on In­vest­ment. Hos­pi­tal ad­min­is­tra­tors find it hard to jus­tify the in­vest­ments re­quired. Specif­i­cally re­fer­ring to ro­bot as­sisted surg­eries, sur­geon train­ing is a slow process. In­vest­ment op­por­tu­ni­ties lie in help­ing to speed up this process. Clin­i­cians and hos­pi­tal ad­min­is­tra­tors need data sup­port­ing and quan­ti­fy­ing the claim of im­proved out­comes. Pa­tient path­ways from di­ag­no­sis to treat­ment need to be re­de­fined, sup­ported by data.” The in­tro­duc­tion of ro­bot­ics has opened up new op­por­tu­ni­ties by al­low­ing busi­nesses to cre­ate new ap­pli­ca­tions. This has led to an in­crease in in­no­va­tive pos­si­bil­i­ties ex­po­nen­tially rather than lin­early.

Safety of Health In­for­ma­tion

Health in­for­ma­tion is very sen­si­tive, and needs spe­cial pro­tec­tion un­der pri­vacy laws. With the ad­vent of AI and ro­bot­ics in the health­care sec­tor, in­vest­ment in in­for­ma­tion pro­tec­tion is im­per­a­tive. Tan takes it with a pinch of salt. “In the longer term, AI to­gether with big data and wear­ables has sig­nif­i­cant po­ten­tial in health­care, from help­ing peo­ple stay healthy, to more ef­fec­tive screening and early de­tec­tion, aug­ment­ing di­ag­no­sis and im­proved treat­ment. This po­ten­tial is limited at present due to the chal­lenges in ac­cess­ing and manag­ing the avail­able data. The im­me­di­ate op­por­tu­nity is in im­prov­ing the ef­fi­ciency, tar­get­ing the over­load on the health­care sys­tems glob­ally. The con­sis­tent short­age of physi­cians, al­lied health pro­fes­sion­als, hos­pi­tal beds and in­fra­struc­ture can be al­le­vi­ated by im­prov­ing the ef­fi­ciency via big data an­a­lyt­ics and au­to­ma­tion, in line with how the lo­gis­tics in­dus­try has been af­fected.”

What is next?

It is ev­i­dent that ro­bots are go­ing to be a main­stay in the health­care and med­i­cal in­dus­try. They are al­ready mak­ing an im­pact at ba­sic porter ser­vices lev­els, and mak­ing a dif­fer­ence in drug dis­cov­ery and care for the el­derly. How­ever, the true value that ro­bot­ics will bring to the in­dus­try is yet hard to de­ter­mine.

While there are ex­cit­ing ad­vances in health­care ro­bot­ics, there are some chal­lenges in­her­ent that should be con­sid­ered. Tan adds, “One chal­lenge lim­it­ing adop­tion is the lack of good out­comes data. In­vest­ments in gen­er­at­ing this data can help drive adop­tion, and more im­por­tantly cre­ate the feed­back loop to un­cover and mit­i­gate po­ten­tial risks.”

The gov­ern­ments also need to cre­ate qual­ity stan­dards and a reg­u­la­tory frame­work which are ap­pli­ca­ble to and oblig­a­tory for the en­tire health­care sec­tor, as well as the ap­pro­pri­ate in­cen­tives for adopt­ing new ap­proaches. Also, the pri­vate sec­tor de­vel­op­ing AI and ro­bot­ics need to cre­ate so­lu­tions to solve the big is­sues of de­mand and re­source that ev­ery health sys­tem faces. In essence, by pro­vid­ing AI and ro­botic-driven so­lu­tions, the pri­vate sec­tor has the op­por­tu­nity to dis­rupt health­care for the good.

Need­less to say, AI and ro­bot­ics tech­nol­ogy will cer­tainly con­tinue to ad­vance. Swami­nathan says, “AI and ro­bot­ics can lead to new pos­si­bil­i­ties, and the first step is for lead­ers in the health­care sec­tor to ac­cept and ex­am­ine where these tech­nolo­gies can be best de­ployed, and where they can bring the best ben­e­fits.” With teams in cor­po­rate and uni­ver­sity re­search labs mak­ing progress daily in ro­bot­ics, we may just be a day away from the next break through.


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