adrid · Spain
Juan Reig
Medical Doctor, Specialist
in General Surgery,
Former President of the
EUROREC
Institute, Osuna Health
Area, Andalucia, Spain.
Jose A. Valverde
Medical Doctor, Specialist
in Emergency Medicine,
Empresa Pública de
Emergencias Sanitarias
(EPES 061), Sevilla,
Andalucia, Spain.
Monica Reig
Medical Doctor, Specialist
in General and Digestive
Surgery, Surgery Department, San Juan de Dios
Hospital, Bormujos
(Sevilla), Andalucia,
Spain.
Keywords: health
technology, innovation,
ICT, early adopter,
technological trends,
transformational
technologies
Correspondence:
[email protected]
Reprints:
jose.valverde.albacete@
gmail.com
Conflicts of interest: None
42
Great opportunities ahead!
Don’t miss the boat!
Where tech meets health
care…
ABSTRACT
Technology is transforming almost everything
in our daily lives, and there are few spaces
or sectors not affected by this unavoidable
change. However, sometimes our pace of
coping with change is not always as good as
it should be. In this article, we review recent
technological breakthroughs and discuss
ways by which they can improve the work
of healthcare professionals and allow us to
deliver better care to our patients. Which
technologies will have the greatest impact
on wound management and the closely related field of chronic care? We suggest that
big data, 3D printing, communication and
collaborative technologies, and innovative
devices can lead to higher quality and more
efficient care.
Not only new technologies, but also new professional roles, societal challenges, and the
sense of personal empowerment are deeply
changing the way we deliver care. These
factors in combination with advancements
in medicine, genetics, neuroscience, new materials, nanosensors, increased consciousness
about environment and energy as well as the
influence of other non-medical disciplines
opens the way for progress in the healthcare
arena. Such advancements are closely tied
to ethical, privacy, and security concerns that
should be thoroughly considered.
EWMA n GNEAUPP 2014
Submitted to the EWMA
Journal, based on a
presentation given at
Plenary Session:
Innovation, Know-How,
and Technology
at the EWMA - GNEAUPP
2014, Madrid
INTRODUCTION
“Prediction is very difficult, especially about the future,” said Niels Bohr, winner of the Nobel Prize in
Physics. However, it is also true that we must take
risks. In our work and daily lives, we cannot rely
on making mistakes as a way of learning and avoid
guessing what may happen in the future. Based on
the evidence we have today, we use this article to
imagine how tomorrow will look. Contrary to many
opinions, we are convinced that the best is yet to
come.
That is, advances in medicine, neuroscience, genetics, information and communications technology
(ICT), and technology in general; new roles for individuals and society; and increasing concern for our
environment together set a foundation for progress in
the health sector, which appears full of opportunities.
These future developments will occur in a synergistic manner. Isolated advances are not only difficult but are often doomed to failure. The future is
relentless. We cannot hide and believe that we are
not going to be affected.
As individuals in a changing social environment
we want to play a leading role in the healthcare ecosystem and have key decision power over ourselves
and other public and private actors, whether organisations, providers, payers, or insurers.
Determinants of progress in the health sector include mobility; breaking the physical links to fixed
areas, organisations, or traditional processes; vanishing distance and barriers; democratisation of technology access; emergence of new professional roles;
generation of large amounts of information from
heterogeneous and accessible sources; and growing
interest in the environment and the proper use of
energy resources1.
Today’s technology enables us to more easily manage the healthcare policies we design and to implement our vision. It is no longer merely a tool for
EWMA Journal 2015 vol 15 no 1
Scientific Communication
executing an idea; rather, it has intrinsic value and acts
as a catalyst or enabler of strategy. As decision makers,
we cannot wait until a technology is mature or else we
will lose competitive advantage. Instead, we must become
“early adopters” if we want to differentiate ourselves, and
we must actively use and benefit from technology in our
daily lives, because its potential to improve quality of life
for the patients or support the role of health professionals
has never been more obvious.
TECHNOLOGICAL INNOVATIONS
In this current global economic crisis, the healthcare
system is highly valued by its users, who not only apply
constant and incremental pressure to gain access to the
last technological innovations but who also benefit from
affordability of common technologies. At the same time,
healthcare professionals do not perceive ICT as important
to their work.
There is a rationale for this changing environment.
As a driving force common to all industries and not just
the health sector, technology is now an integral part of
everyday life. Technology has become invisible and is incorporated as a natural part of life, not just for younger
generations considered “digital natives” but also for society
as a whole.
The intensity of innovation and the incorporation of
new technologies unprecedented, and the resulting changes increasingly affect us individually and collectively.
Moreover, the growth of computer networks, their increasing accessibility, and the rise of content sharing in
the cloud leads to a distribution of information across
devices and systems without barriers. Because the content
of the information is the same, only slight variations in
sizes and formats need to be considered when presenting
the information.
Another driver of change is that solutions from other
sectors are now permeating the health sector. We cannot
continue saying that healthcare is different and that strategies from other sectors do not work or do not apply to
our environment.
The concept of health itself is constantly evolving, not
only in relation to the paradigm shift from cure to prevention, but also in terms of including broader concepts
such as welfare or “wellness”, as well as integrating traditional remedies and other unconventional therapies. For
example, a currently available app for weight control not
only includes tools for measuring calorie intake, keeping
track of exercise, and monitoring metabolism, but also
incorporates information on personal mood, shared goals
among social networking groups, and personalised virtual
“coaching” messages.
The active presence of communities of action or groups
of people with common interests in diseases and related
EWMA Journal 2015 vol 15 no 1
conditions or their experiences in healthcare systems reflects a different reality of today’s society. We care more
and more about opinions, suggestions, tips, and ideas from
our neighbours in social networks, and this virtual meeting
space will be increasingly present as an everyday part of the
healthcare process, building the concept of “conversation”. 1
!
!
Figure 1. Word cloud of terms used in this report (www.worldle.net).
Aspects of the health system such as the experience of
patients—a concept that exceeds the classical term “satisfaction”—and good communication can influence the
quality of care and improve health outcomes. Such aspects are eventually recognised either because they improve
treatment adherence, for example, or because they generate
confidence and positively impact the course of a disease
or condition2. The incorporation of technology into our
daily lives can greatly improve patient experiences, allowing personalised communication and increasing a sense
of belonging in and closeness to the healthcare system.
In summary, we believe that technological and societal
innovations are directly influencing the challenges that
face our healthcare system at patient, professional, and
organisational levels.
IDENTIFYING TRENDS
The concept of “transformational technology” relates
to how some technological elements have the ability to
induce deeper disruptive changes than the functions for
which the technology was originally designed3,4. It is
opposed to adaptive technology or transition technologies considered as simple evolutions or improvements on
performance. Classic examples are the World Wide Web,
Internet search engines, and the mobile phone.
Experts consider six groups of technologies with the
potential to transform the healthcare sector5,6: big data,
connectivity (including interoperability), improvements in
computer manufacturing (e.g., micro and nanotechnology,
graphene), 3D printers, cloud computing, and the Internet
of Things. These are not considered isolated elements but
rather different pieces of a jigsaw puzzle. For example,
43

common healthcare technologies within the Internet of
Things, improved positioning systems, and miniaturisation can offer opportunities to reduce risks of medical or
diagnostic errors and enable less invasive treatments.
Let’s review the possible contributions of each of these
six technologies.
The amount of data produced is estimated to grow
by 60% annually. When we talk about big data7, we are
referring to the 2.5 quintillion (2.5 × 1018) bytes of data
generated daily8. Big data is characterised by the “4 V’s”:
volume, referring to the continued increase in the amount
of data produced; velocity, referring to the speed at which
data is generated and used; variety, referring to the heterogeneous nature of data obtained from multiple sources;
and veracity, referring to uncertainty in the value of data
and its contribution to decision making.
Connectivity is necessary to ensure that our technological world works smoothly. It is the “sine qua non” for
data exchange between devices or intercommunication
between machines. Connectivity must occur at high speed
and capacity, without barriers, to allow data to easily flow
in an unobstructed manner and to be filed automatically
but with some degree of control. Connectivity is one of
the biggest challenges of the near future due to the exponential increase in the number of connected devices
and terminals, the volume of data exchanged, the need
for connections to be permanently available and safe, the
numerous mechanisms and means of connections, and
the need for a single device to simultaneously connect to
different nodes of the network and in different ways. The
healthcare environment will become a hyper-connected
space where interoperability plays an unquestionable role.
Although computing power in the past has traditionally been linked to computers, today computer power is
present in most different devices in our everyday lives.
Improvement in the manufacture of computing elements
is another element of the technological transformation of
our health system. Nanotechnology and the miniaturisation of components, the integration of graphene circuits
and plates, and the embedding of computing modules in
almost any element of the healthcare environment will
profoundly change our near-future reality. As an example, chip-based systems for examination, diagnosis, and
treatment can be capable of transmitting data and images.
3D printers can also play a role in solving health problems. For instance, a recent New England Journal of Medicine paper describes the creation of an implant using a 3D
printer and biomaterials to treat a child with tracheobronchomalacia9. The possibilities of producing prostheses or
tissue on demand, adapted to the particular anatomy of
each patient, are tremendous. In the future, we will refer
to “cell cartridges” and “organ printers”!
44
Remote storage or cloud computing is another great
revolution in today’s industries, including healthcare. Although a secure cloud is possibly the greatest demand of
the health sector, in general, this technology can greatly
contribute to the advancement of ICT and be widely implemented in healthcare. Hybrid public/private clouds that
are immediately available whenever and wherever needed,
regardless of where the data are stored, can be powerful
tools for professional work. The paradigm shift from ownership of resources to availability of services (e.g., Software
as a Service) radically changes the approach to business in
the health sector, helping to implement concepts such as
availability of relevant clinical information at the point of
care or effectively build unique electronic health records10.
One key issue, however, is the necessary synchronisation
of information across all devices, systems, and media.
The Internet of Things11 refers to the 6,000 million
artefacts potentially connected to the Internet by 2015,
many of which are related to health and wellness. In conjunction with other technologies, the potential savings
from the use of remote monitoring and control systems
for the treatment of chronic diseases could reach 20%.
Moreover, their potential for application in other aspects of
care management, especially those related to quality, safety,
or productivity, is considerable. However, there is the risk
that devices in patients’ homes or personal networks can be
hacked or malfunction, which warrants the need to consider security and ethics. The Internet of Things enables concepts such as ambient intelligence, which will have much
influence on the health environment. The combination
of this technology with connectivity and miniaturisation
of sensors will expand its use exponentially in the coming
years. Like connectivity, Interoperability is necessary to
allow the predicted massive deployment of technology.
A concept that reflects both technological and sociological trends is “Bring Your Own Device” (BYOD)12. In the
health sector, this has obvious implications for security
and privacy, but it is spreading, aided by two factors: 1)
the near-universal availability of tablets, smartphones, or
similar devices and 2) the economic crisis, which minimises investments.
WHERE TO EXPECT NEW DEVELOPMENTS
Advances in the consolidation, analysis, and interpretation of big data will provide objective evidence that can
aid clinical diagnosis and treatment, care planning, and,
more importantly, produce a radical change allowing anticipation to the health evolution. This information will
be more valuable if it can be used to anticipate the occurrence of health events, either through the simple analysis of
large datasets, the use of algorithms, or the use of artificial
intelligence tools.
EWMA Journal 2015 vol 15 no 1
Scientific Communication
In contrast to today’s sporadic measurement of vital
signs, the immediate future leads us to continuous nonintrusive monitoring and control of physiological activities,
even in healthy individuals, in any place and under any
condition. Such monitoring can be performed through
embedded technologies that form an integral part of health
spaces or that even exist in our clothing, and such monitoring will in most part be transparent to the end user.
Another element of great importance for improving the efficiency of the health system as a whole has to
do with finding and using information. There will be a
breakthrough in the emergence of intelligent and focused
search engines that will be able to continuously provide
personalised information to patients based on their specific
conditions. Such information can be provided in a way
that encourages motivation, commitment, and adherence
to treatments and activities for self-management and selfcare, thus significantly increasing the ability of people to
make decisions in a more informed manner. Also, on the
service provider side, knowledge-based decision support
systems for qualified professionals will spread improving
availability of updated clinical evidence and resources
when needed.
People in the health system will not only participate as
individuals but also as members of a community.
We are transitioning from a system
focused and composed of individual health
professionals to one composed of health care
teams coordinated by a personal health
counsellor, who is not necessarily a medical
professional. Understanding that patients
are the centre of the health system serves to
drive this paradigm shift.
What to expect in wound care? Let’s expect technology
that will support more effective and secure care based on
anticipation and prevention rather than just cure, technologies that speed up healing through printed 3D skin
patches, better information systems for follow-up and
maintenance, and new collaborative tools that improve
communication and coordination among members of the
care team. An example of such an advance is smart surgical
sutures that are sensitive to temperature or infections and
are capable of sending information about wound status
from their micro-sensors, thus enabling a fast and efficient
response13.
Obviously, these advances will be distributed asymmetrically across our health system. As a result, the coexistence
of different levels of development and different stages of
implementation will undoubtedly lead to practical difficulties in day-to-day performance.
CONCLUSIONS
The aim of this short article was to convey the wide range
of opportunities and upcoming technological trends in
healthcare settings over the next few years. Healthcare professionals will enjoy greater patient participation and coresponsibility, technologies that are more helpful and easy
to use, more accurate and less invasive diagnostic tests, and
more personalised treatments. Above all, however, they will
have enhanced ability to anticipate, prevent, and perform.
In terms of sociological trends, we make note of empowerment, co-creation, sharing, online reputation, community, collective or mass intelligence, and the concept
of conversation.
Progress driven by technological and sociological trends
should flourish in sustainable health systems characterised
by high social support, efficiency, and the ability to adapt
to new circumstances, in which technology is no longer
just a tool but an indissoluble part of their development.
Will we be able to re-imagine (almost) everything? It will
be the only way to achieve a healthier future.
REFERENCES
1 Reig J. El Reto de la eficiencia en el sistema sanitario.
Las ideas de los expertos. Club GerTech, 2013. http://
www.clubgertech.com/wp-content/
uploads/2013/03/12636-El-reto-de-la-eficiencia-en-elsistema-sanitario-Las-ideas-de-los-expertos.pdf
[Accessed 23.10.14].
2 Manary MP, Boulding W, Staelin R, Glickman SW. The
patient experience and health outcomes. N Engl J Med
2013;17;368(3):201-3.
6 Reeves, J. Transformational Technologies. Fool 2012.
http://www.fool.com/investing/general/2012/08/31/3transformational-technologies.aspx [Accessed
23/10/2014].
3 Lukas, H. Disruptive and Transformational Technologies. Robert H. Smith School of Business, University of
Maryland. http://blogs.rhsmith.umd.edu/lucas/
disruptive-and-transformational-technologies/
disruptive-and-transformational-technologies/
[Accessed 23.10.14].
4 Krugman, P. Transformational Technologies. The New
York Times 2014. http://krugman.blogs.nytimes.
EWMA Journal 2015 vol 15 no 1
com/2011/01/30/transformational-technologies/
[Accessed 23.10.14].
5 Savitz, E. Gartner: 10 Critical Tech Trends For The
Next Five Years. Forbes 2012. http://www.forbes.com/
sites/ericsavitz/2012/10/22/gartner-10-critical-techtrends-for-the-next-five-years/ [Accessed 23.10.14].
7 Wikipedia. Big Data. http://en.wikipedia.org/wiki/
Big_data [Accessed 23/10/2014].
8 IBM Watson Foundations. IBM big data and information management. http://www-01.ibm.com/software/
data/bigdata/ [Accessed 23.10.14].
9 Zopf DA, Hollister SJ, Ohye RG, Green GE. Bioresorbable Airway Splint Created with a Three-Dimensional
Printer. N Engl J Med 2013;368:2043-5.
10Rouse, M. Software as a Service (SaaS). TechTarget.
http://searchcloudcomputing.techtarget.com/definition/
Software-as-a-Service [Accessed 23.10.14].
11Wikipedia. Internet of Things (IoT). http://en.wikipedia.
org/wiki/Internet_of_Things [Accessed 23.10.14].
12Healthcare IT News. Bring your own device (BYOD).
http://www.healthcareitnews.com/directory/byod
[Accessed 23.10.14].
13Kryska S, Grajek M, Rej A. A new weapon in the hands
of surgeons. Intelligent sutures. MEDtube. http://
medtube.net/
tribune/a-new-weapon-in-the-hands-of-surgeonsintelligent-sutures/ [Accessed 23.10.14].
45