Outsourcing your healthcare

How long before we see healthcare services such as healthchecks, online diagnosis and medical tourism being outsourced to more cost-effective countries such as India, South America or Asia where highly skilled doctors are in abundance?

17/03/12

Outsourcing has been the trend over the last 10 years, particularly in the service industries.

This makes sense where skills in the outsource organisation are abundant, communication links are well developed and the language of the outsourcing entity is the same as the company or organisation that is outsourcing.

The question is how far can this concept be taken, and in particular, can it be applied to healthcare? There are already hospitals in India that are developing relationships with hospitals in Africa for medical treatment. The patient can take advantage of a wide range of services for a much lower price than in the developed countries.

Could we see in the near future a call centre full of doctors that are diagnosing patients for western countries?

Please comment on this very interesting debate by completing the form below, please also see our article on Telehealth in developing nations here.

Next debate – Medical Tourism, how can technology make this possible?

Technologies that will change healthcare

technologies-that-will-change-healthcare

This week we look at real-time technologies and how these technologies are bringing improved connectivity to, and therefore availability of, live data. This means that healthcare professionals can now view real-time data on the move or on demand, giving them vital additional time to make life dependent decisions.

We look at one of the technologies that will make this possible, the WebSockets protocol and API.

Accuracy, availability and predictability

In our article on 06/03/12 (here) we looked at how new technologies are able to improve healthcare services, by improving accuracy, availability and predictability. These technologies allow immediate communication between a wide variety of devices (platforms) in real-time, giving users instant access through the web to information such as ECG and oximetry, chat and video conference, which makes them perfect for telehealthcare and remote monitoring.

But there are very few real time cross platform applications at present and healthcare has been very slow to adopt them because of issues when using the standard communications protocols, problems such as connectivity, security, speed and distribution (installing on computers). The standard client/server application platforms don’t really cut the mustard for this type of application because they have to repeatedly request large amounts of data from the server, making them very slow and almost impossible to maintain a live connection without huge bandwidth and overhead.

The web-sockets protocol and API

The web sockets specification allows upstream and downstream communications through a single socket over the web, hugely reducing the amount of traffic required to transfer data from one location to another. The web application sends a handshake request to the WebSocket server and quickly establishes a secure encrytped connection for the communication of data between source and destination. The data can be exchanged in full duplex mode, in other words in both directions and the connection remains open for all data exchanges.

What advantages does this bring?

Communication using web technologies has been based on ‘request/response’ – in other words the client (Internet browser such as Internet Explorer or Firefox) requests a web page or information and nothing else happens until the user requests something else (another web page). WebSockets technology means that once the connection has been made to create a ‘tunnel’, the data can be freely exchanged whenever available, reducing the ‘overhead’ of constantly requesting, opening the connection, receiving and closing the connection again. This means a much faster, less resource hungry solution.

How can applications be developed to take advantage of this?

Once a WebSockets server or gateway has been created, a web application can be developed on a compatible development platform (such as Java) and configured to communicate with the server. Development on a ‘web’ platform also has it’s advantages:

It needs no time consuming roll out or installation (it just works)

It shouldn’t conflict with your existing software (so compatible provided the browser is compatible)

It’s available over a number of different devices provided they have access to the Internet

It has a secure encrypted connection (uses HTTPS) The technology is relatively new but has recently been standardised which means it is now widely recognised as the agreed standard for realtime communication between client and server, finding experienced WebSockets developers however is very difficult.

How new technologies can change healthcare

how-new-technologies-can-change-healthcare

Facebook, Twitter, You Tube, all changing the way we communicate and how often we communicate. Real time data now enables us to know exactly what is happening, at the time it happens. So with the advances in real-time technologies, how can real-time data be used in healthcare and what changes might that make to the way healthcare is delivered?

We investigate why these technologies are particularly relevant to the healthcare sector.

The changing face of technology

There have been a number of technologies that have changed the way we do things, in fact it seems that technology is constantly helping us to connect to more accurate, relevant, information, quicker and from more computers or gadgets than ever before. We are now addicted to our ‘apps’, whether to stay up to date with Facebook, tweet our latest meeting with Aunty Barbara or to follow the latest episode of King Arthur on IPlayer.

I have certain apps that I can’t live without, train arrivals, bus departures and of course my ever faithful e-mail makes that sound to tell me yet another ‘top ten’ has been lovingly compiled and sent for my pleasure (this morning it was the top ten tips to avoid metal theft). So we are seeing the incredible popularity of technology for delivery of ‘consumer’ data and to an extent, in the wake of social media, this has become extremely important for business, but mainly for marketing purposes.

So why is this technology so important?

The big deal is that the latest technologies allow immediate communication between a wide variety of devices (platforms) in real-time. Traditionally applications were installed on computers and ‘asked’ servers (databases) for data, the server searched for the data and sends to the computer, but there are a number of problems with this model:

  • The computer has to install the application, it may conflict with other software on the machine
  • The application is usually limited to one platform (for example Windows XP on a PC) so different installation needed for each OS (Apple, PC etc)
  • The application is usually only available in a closed network, not globally available unless major security changes
  • The data is static – to read the latest record on the database the user has to ‘do’ something like query the database This is very different to the latest web technologies, which provide the user with:
  • Instant access to data through a web browser, so provided a machine has a compatible, recent version of the browser, the application just works
  • Access from multiple platforms (including smart phone or tablet)
  • Access from anywhere provided there is a data connection (ADSL, 3G etc)
  • Real-time data available – on screen live data such as video, chat or (for example) live sales data graphsSo the latest web technologies bring immediate, real-time data (accuracy), wherever there is a connection to the Internet (availability) to allow a number of real-time engines such as reporting (predictability).How are these technologies relevant to healthcare?In what other scenario can accuracy, availability and predictability make a huge difference to quality of service?

    The technology fits perfectly into the telehealth and remote monitoring box for hospitals/clinics that have a live data requirement. Patients that need to be monitored from home on a regular basis, for example post operation or with an illness or condition, usually connect themselves to a device (such as blood pressure or ECG), take a test and then add the details of the test to a machine that then communicates to a database. This data is monitored and where the data is outside certain parameters (such as high heartrate or low blood pressure) actions can be taken.

    Where web technologies are implemented, this data can be viewed in real-time (such as an ECG trace), on multiple platforms (PC for monitoring, web application for remote clinician and a smartphone or tablet device for a mobile care provider such as a local nurse.

    This means that finally healthcare professionals have:

  • Accuracy – immediate medical data such as live ECG or blood pressure at the time of connection (not hours later when they can access a PC)
  • Availability – from whatever device they can access (PC at home, Ipad on daily rounds and IPhone when shopping)
  • Predictability – Real-time data combined with history means they have much more current data to make decisionsWith this in mind, it should be clear that web technologies can vastly improve healthcare, especially given that telehealth and remote monitoring are becoming the win-win solution for reducing costs and increasing healthcare availability. These technologies can also be implemented where large geographical areas are covered by one hospital or clinic, such as Africa or Australia. The technology a cost effective and easily distributed solution, support can be remote and operators don’t need to be qualified doctors, they can be healthcare assistants communicating with clinicans or specialists in other locations (different cities, regions or even countries).