Les grandes innovations 2016-2017

Le patient connecté:

Un « objet » dans l’IoT

Philippe A. COUCKE

pcoucke@chu.ulg.ac.be

Dont ils ne connaissent pas grand chose

Afin de traiter des maladies dont ils

connaissent encore moins

Pour des êtres humains dont ils ne

savent rien

Les médecins prescrivent des

remèdes

François-Marie Arouet Voltaire21/11/1694 – 30/05/1778

Pourquoi changer ?

Les 4 indicateurs clés de la médecine d’aujourd’hui:

50 – 42 – 10 - 5

Personalized medicine:

Time for one-person trialsNicholas J. Schork

29 April 2015 Nature / Comment

Precision medicine requires a different

type of clinical trial that focuses on

individual, not average, responses to

therapy, says Nicholas J. Schork.

L'Internet des objets (ou IdO, en anglais « Internet of Things » ou IoT) représente

l'extension d'Internet à des choses et à des lieux du monde physique.

L'Internet des objets connectés représente les échanges d'informations et de

données provenant de dispositifs présents dans le monde réel vers le réseau

Internet.

Considéré comme la troisième évolution de l'Internet, baptisé Web 3.0 qui fait suite à

l'ère du Web social, l'Internet des objets revêt un caractère universel pour désigner

des objets connectés aux usages variés, dans le domaine de la e-santé, de

la domotique ou du quantified self.

L'Internet des objets est en partie responsable d'un accroissement exponentiel du

volume de données généré sur le réseau, à l'origine du big data (ou méga-données

en français).

Source Wikipedia

Healthcare investments in IoT will grow fast between 2016-202005 January 2017 ICT&Health

Worldwide spending on the Internet of Things (IoT) is

forecast to reach $737 billion in 2016

Compound annual growth rate (CAGR) of 15.6%

over the 2015-2020 forecast period, reaching $1.29

trillion in 2020.

The industries that will see the fastest spending

growth are Insurance, Consumer, Healthcare, and

Retail.

Remote health monitoring will see the greatest

investment in the Healthcare industry

Artificial Intelligence

will eliminate all the dark

areas of medicineIclinic stanford

Ross, an Artificially Intelligent Lawyer, Has Its First Official ClientMay 11th 2016 FUTURISM.COM

Ross, the world's first artificially intelligent attorney, has its first official law firm. Baker & Hostetler announced that they will be employing Ross for its bankruptcy practice, currently comprised of almost 50 lawyers.

An AI Completed 360,000 Hours of Finance Work in Just Secondswww.futurism.com March 13th 2017

JP Morgan Chase & Co. is the biggest bank in the United States. It is one of the largest employers in the American banking sector, with more than 240,000 employees serving millions of customers. Some of those employees are lawyers and loan officers who spend a total of 360,000 hours each year tackling a slew of rather mundane tasks, such as interpreting commercial-loan agreements. Now, the company has managed to cut the time spent on this work down to a matter of seconds using machine learning.

“People always talk about this stuff as displacement. I talk about it as freeing people to work on higher-value things…”

En médecine nous sommes

à l’abri de la robotisation et

de l’automatisation !

Sir John FORBES MD (1787-1861)

contemporain de LAENNEC

« That the stethoscope will ever come in

general use, nothwithstanding its value, I am

extremely doubtful; because its beneficial

application requires much time and gives a

good deal of trouble both to the patient and

the practitioner, …. …and because it is

opposed to all our habits and associations »

« It must be confessed that there is something even ludicrous in the picture of

a grave physisan formally listening through a long tube applied to the patient’s

thorax, as if the disease within were a living being that could communicate its

conditions to the sense without »

La démarche médicale et la

disruption « numérique »

Le patient connecté

• Anamnèse

• Examen clinique

• (Examens complémentaires)

• (Traitement)

• Suivi

Babylon Health partners with UK’s NHS to replace telephone helpline with AI-powered chatbotPosted Jan 4, 2017 The Medical Futurist Newsletter

Working with a number of health authorities in London,

Babylon will begin a six month trial starting at the end of

January to offer its AI-powered chatbot ‘triage’ service as

an alternative to the NHS’s 111 telephone helpline that

patients call to get healthcare advice and be directed to

local and out-of-hours medical services.

That ultimately may mean being advised to seek a face-

to-face consultation with a doctor or emergency care but,

like NHS 111’s exiting telephone service, part of the aim is

to avoid unnecessary doctor appointments or to direct

patients to over-the-counter help from a pharmacy.

L’examen clinique

• La mesure ponctuelle:

– L’apport de la technologie en matière de

reproductibilité & efficacité (efficience).

• La mesure en continu:

– D’une image partielle à une image plus

complète.

– D’une technologie de type « wearable » à

la technologie « forgettable ».

10 minutes check up with smart phoneJohn Hopkins University (TEDMED 2013)

• Digital stethoscope

• Body composition

• Blood pressure

• Oxygen saturation

• Visual acuity

• Optic disc visualization

• Eardrum visualization

• Lung function

• ECG

• Blood vessel visualization

SpiroSmart Spirometer

Des cabines de télémédecine dans les pharmacies

15/03/2016

Siège incliné, écran d'ordinateur pour guider le patient ou organiser une téléconsultation, instruments

de mesures "pour peser, mesurer, calculer l'indice de masse corporelle, prendre la tension, le pouls,

connaitre le taux d'oxygène dans le sang", mais aussi stéthoscope, dermatoscope, rétinographe, la

cabine créée par la société française H4D (Health For Development), est présentée par ses

promoteurs comme un véritable "petit cabinet médical connecté".

OslerMD Rapid 6 Vital Sign Measurement System for Home and

ClinicNOVEMBER 22ND, 2016 MEDGADGET

The device is yet to be available,

and the firm is currently raising

round A funding to have the

money necessary to get through

the FDA’s class 2 device clinical

trial. So far the company

performed an in-house trial similar

to what the FDA would require,

and has been satisfied with the

accuracy of the OslerMD.

The final cost is expected to be

between $200 and $250.

Doctors’ offices can use the system during check-ins and to make things transparent,

the data can be routed to the default electronic medical records (EMR) used by the

physician group. Because other device can be tied into the OslerMD, the company is

thinking of eventually producing a health kiosk based on its device that can be

integrated into various health facilitie

AI-Powered Breath

Detector Diagnoses 17

Different DiseasesDECEMBER 28TH, 2016

www.medgadget.com

Thanks to the AI component of this

research, the average diagnostic

accuracy of the system was

demonstrated at 86% for 17 different

diseases, including such disparate

conditions as a number of cancers,

Crohn’s disease, two types of

Parkinson’s, preeclampsia, and

pulmonary hypertension.

Voice Used as Diagnostic Biomarker for Coronary Artery DiseaseNOVEMBER 15TH, 2016 MEDGADGET

Beyond Verbal, a company that provides voice analysis software, has

announced that its algorithms were used successfully to help detect the presence

of coronary artery disease (CAD) in a group of patients. Results of a study

conducted at the Mayo Clinic show that voice can be used as a biomarker for

CAD

FDNA launches app-based tool for clinicians using facial recognition, AI

and genetic big data to improve rare disease diagnosis and treatment

www.mobihealthnews.com March 21st 2017

Boston startup FDNA, makes a suite of apps called Face2Gene that use facial analysis, artificial intelligence and genomic insights in hopes of improving diagnoses and treatment of rare diseases. Using de-identified data from their patients, clinicians can now share their findings and test and analyze patient cohorts with other clinicians around the world on Face2Gene’s Research application.

After snapping a smartphone photo of a patient the doctor suspects of, the app (which is only available to clinicians) analyzes the photo based on facial characteristics and compares the image against Face2Gene’s database, and within seconds, the clinician is offered a list of possible diseases along with the degree of probability for each one.

Mesure en continu

Life style

Wellness

Nanowear gets FDA clearance for cardiac-monitoring clothingBy Jonah Comstock December 05, 2016 MOBIHEALTHNEWS

New York City-based Nanowear has received FDA clearance for SimpliECG, a "remote cardiac-monitoring undergarment". This is the first clearance for the company, which has been in talks with the FDA since 2015, according to a press release.

Dexcom G5 Mobile Bluetooth-Enabled Continuous

Glucose Monitor FDA ApprovedAugust 27th, 2015 WWW.MEDGADGET.COM

CMS will cover some CGMs, starting with Dexcom G5By Heather Mack January 14, 2017 WWW.MOBIHEALTHNEWS.COM

The Centers for Medicare and Medicaid Services has deemed certain therapeutic continuous blood glucose meters (CGMs) as durable medical equipment and thus are eligible for coverage.

It’s not all cut and dry, of course. Eligible devices must fit several definitions: ▪They must be a class III, FDA-approved device, ▪They must be CGMs that measure blood glucose levels periodically by using sensors, a receiver and transmitter and eliminate the need for blood glucose strips, informing patients and their doctors in treatment decisions.

Senseonics receives CE Mark for implantable

continuous glucose monitoring systemBy Aditi Pai May 11, 2016 MOBIHEALTHNEWS

Senseonics and Roche expand distribution

partnership into Europe, Middle East, AfricaBy Heather Mack December 02, 2016 MOBIHEALTHNEWS

The Eversense System consists of a pill-sized sensor that is entirely implanted in the user’s upper arm so that it can continuously monitor their glucose levels.

Senseonics launches in Norway, completes FDA premarket submissionBy Jonah Comstock November 09, 2016 MOBIHEALTHNEWS

Senseonics, the Germantown, Maryland-based company which went public in January and is working on a longterm implantable continuous glucose monitor, has submitted its PMA application to the FDA, President and CEO Tim Goodnow said on the company's third quarter earnings call last week. In addition, the company continues to work on a second generation device and its first pediatric clinical trial.

Une puce RFID implantée sur des salariés belges comme badge d'accès8 Février 2017 FUTURATECH

Newfusion est une société belge spécialisée dans le marketing numérique qui a décidé de recourir à des implants RFID sous-cutanés pour remplacer les badges d'accès. Huit salariés ont déjà accepté d'utiliser cette technologie qui leur permet de déverrouiller les portes et d'accéder à leur ordinateur.

New portable device counts leukocytes through the skinNovember 18th 2015 SINC

A novel way to count white blood cells without a

blood test, simply by applying a small device on

the fingertip, is being developed by a team of

young bioengineers. The technology, that

combines an optical sensor with algorithms, has

already three prototypes on the go and is

specially designed to be used on chemotherapy

patients, who could know their immune system

levels in real time. It could also serve to detect

serious infections.

« Big Data »

• La cascade des “omics”

• Les données du DMI

• Les régistres (cancer)

• Les études cliniques

• Les objets connectés

• L’imagerie

• L’anatomopathologie

• La littérature médicale

• “Habitomics” “Exposomics”

By 2020, physicians will face 200 times more data than today !

L’observance thérapeutique

On estime que 90 % des personnes atteintes de maladies chroniques seraient

non observantes à un moment ou un autre de leur traitement.

Les capteurs MedPeanut, pour penser à prendre ses médicamentsFUTURA TECH 6 Janvier 2017

Les nouveaux capteurs MedPeanut, de Sen.se, offrent un suivi de la prise de médicaments simple. Chaque capteur se fixe sur une boîte de médicaments et se transforme en pilulier intelligent qui offre un suivi approfondi sur son mobile de la prise des médicaments.

Proteus Swallowable Smart Pills FDA Approved to Measure Medication

AdherenceJuly 6th, 2015 MEDGADGET

Texas hospital testing Proteus's ingestible sensor with pediatric organ

transplant patientsBy Jonah Comstock August 22, 2016 MOBIHEALTHNEWS

Proteus Digital Health is working with Children's Health in Dallas, Texas in one of the first trials of its ingestible sensor technology in pediatric patients, The Dallas Morning News reports.The trial involves patients recovering from an organ transplant, a group that typically needs to take a lot of medications on a fairly strict schedule. Fifteen patients are using the Proteus platform now and Children's Dallas ultimately intends to enroll 75.

Major step for implantable drug-delivery deviceMIT spinout signs deal to commercialize microchips that release therapeutics

inside the body.Rob Matheson | MIT News Office June 29, 2015

An implantable, microchip-based device may soon replace the injections and pills now needed to treat chronic diseases

Now Microchips Biotech will begin co-developing microchips with Teva Pharmaceutical, the world’s largest producer of generic drugs, to treat specific diseases, with licensing potential for other products.

While its first partnership is for treating chronic diseases, Microchips Biotech will continue work on its flagship product, a birth-control microchip, backed by the Bill and Melinda Gates Foundation, that releases contraceptives and can be turned on and off wirelessly.

Changement de paradigme majeuren matière de maladies chroniques

Il est temps de repenser les structures

hospitalières10 février, 2017 News4MedUn rapport d’ING vient d’être rendu public

à propos des perspectives en matière

d’organisation du système de santé.

Il est important de différencier et de mener,

indépendamment des mesures « urgentes

» de maîtrise des coûts, des actions qui

impliquent des changements profonds et

structurants de notre système de soins de

santé et qui assureront son financement à

long terme. Ces changements supposent

une mutation importante de celui-ci.

Could 13 beds be this hospital system's lucky number?By Kristen Schorch, Crain's Chicago Business | January 30, 2017 MODERN HEALTHCARE

Many hospitals nationwide have been ditching plans for big hospitals in favor of

outpatient clinics and surgical centers, which has fueled a wave of emptier

medical centers. Advances in technology mean patients don't need to be

hospitalized as much. And under federal health reform, insurers are paying

doctors to focus on prevention and treat patients in the least expensive place,

which often is an outpatient facility.

"Building a very small 13-bed micro-

hospital to primarily serve those patients

who are coming in for a simple procedure

and may need to stay overnight."

UK NHS to spend nearly 6 billion$ to go digital including remote care &

health appsFebruary 12th 2016 imdeicalapps.com

One of the NHS’ goals is to have

25% of chronic conditions like

hypertension and diabetes

monitoring their health remotely

by 2020

Millions of people will receive devices and apps free on the NHS to help them manage conditions such as diabetes and heart disease in an major drive to use technology to reduce patient deaths.

NHS to offer free devices and apps to help people manage illnessesJune 17th 2016 www.theguardian.com

Défis & Conclusions

Prédictions 2020 Deloitte

• Les patients se transformeront en consommateurs de soins

éclairés.

• Le développement de la médecine numérique et connectée va

s’accélérer.

• Il y aura une utilisation croissante des capteurs de données

portables et d’applications diverses en matière de santé.

• Il faudra gérer une croissance exponentielle des données

médicales.

• Une adaptation des lois et réglementations sera indispensable.

Healthcare and Life Sciences Predictions 2020. January 2015. Luxembourg.

Les défis:

• Commodité:

– Ubiquitaire

– En tout temps

• Accessibilité:

– Facile

– Sans heurts

– Sécurisée

– Avec une « literacy »

numérique restreinte

Anamnèse

Mesure Ponctuelle & Continue

Dossier Médical

Nécessité d’une « plateforme »Dénominateur commun de la disruption dans l’industrie

Nécessité d’un nouvel écosystème

Les plateformes visent:

•L’interopérabilité & transversalité.

•Une économie d’échelle (beaucoup de solutions nécessitent une

infrastructure de base et des éléments identiques).

Ce qui change la donne aujourd’hui ?

• Les objets connectés génèrent un nouveau savoir

pour les utilisateurs.

– Amélioration de la « literacy »

• Chacun devient acteur = « empowerment »

– IKWIWAIWIN (Joël de Rosnay)

• Changement de l’équilibre entre soignant et soigné

– Fin du « colloque singulier »

– Nouvel écosystème.

• Monitoring permanent centré sur le patient.

LE CHANGEMENT TECHNOLOGIQUE

EST BIEN LE VECTEUR DU

CHANGEMENT SOCIOLOGIQUE

DÉTERMINISME TECHNOLOGIQUE

Aujourd’hui, la relation entre soigné et soignant va loin au-delà de

la simple consultation ponctuelle.

Il devient dès lors difficile, voire même impossible, d’ignorer ce qui

se passe entre deux contacts.

Ce changement de paradigme majeur est particulièrement vrai

pour la prise en charge des maladies chroniques

Comment réagir ?

To increase adoption, digital therapies

need to fit into patients’ and doctors’

livesBy Jonah ComstockSeptember 16, 2016 MOBIHEALTHNEWS.COM

Survey: 21 percent of Americans

have used virtual healthcare, 78

percent are interestedBy Jonah Comstock February 09th , 2017 www.mobihealthnews.com

Consumers are clear: In the 21st century, 20th century healthcare is not good enough !

Uber-Like Innovation Is Coming: Are Physicians Ready?March 04, 2016 MEDSCAPE.COM

"Uber's message for health care is

clear," they write. Providers have three

choices:

•Ignore innovators and hope for the best.

•Call for increasing regulation to make it

harder for innovators to enter the

market.

•Compete on quality and efficiency,

disruptive though that might be.

They suggest providers take the last

option and hop on the innovation bus

before it drives off without them.

Survey: Four in ten doctors say patient-generated data will among the

most useful data sources in 5 yearsBy Jack McCarthy March 13, 2017 www.mobihealthnews.com

The importance of genomic and patient-generated data will increase dramatically in the next five years as healthcare managers gain control of big data to develop precision medicine.

Forty percent of respondents to a new survey, in fact, said genomic data will become one of the most useful data sources in five years, up from just 17 percent today. And 40 percent said patient-generated data will be a top source of data in five years, opposed to 30 percent listing it as a top source today.

Changing how doctors get paidBy Dave Barkholz | March 11, 2017 www.mobihealthnews.com

Hospitals and physician groups across the country are beefing up merit pay for

quality and patient satisfaction in their physician compensation plans. But

Geisinger Health System is doing something radically different.

The 12-hospital system based in Danville, Pa., did away with physician bonuses

altogether this summer and put all of its 1,600 employed doctors on a straight

salary.