This shift is changing our global economy and ncreasing competition between regions to attract the businesses, jobs and workers that will increase prosperity and create other social and economic advantages.

Global urbanization is upon us. For the First time ever, more than half of the world’s population lives in cities. That number will continue to grow as more than 5 million people move to cities every month. By 2030, it is estimated that 60 percent of all people will live in cities, compared to 1950 when just 30 percent of the population was urban. This shift is changing our global economy and increasing competition between regions to attract the businesses, jobs and workers that will increase prosperity and create other social and economic advantages. Some cities and communities are already implementing new strategies for growth, laying the groundwork for transformation, and redening what it means to be smarter. They are focused on implementing programs and services to improve individual and population health and productivity, to make their community a more desirable place to live and work, and to reduce the cost of doing business.

In its simplest form, individual health is determined by four factors: enetic makeup, behavior, environment and access to high-quality edical care. Life sciences companies and research organizations are ctively pursuing genetic research and the development of new products and services that aect the rst factor.

The actions of cities, communities, regions and local stakeholders can inuence and improve the last three factors. Those that establish the necessary infrastructure, programs and services that place citizens at their center; innovate across regions to promote healthier behavior and environments; and improve access to high quality healthcare, social programs and citizen services can improve quality of life and support economic sustainability.

This paper describes the steps cities, communities or regions of all sizes and stages of development can take to begin this transformation, and it oers examples of communities that are already on their way forward.

Characteristics of healthier, smarter cities, communities and regions

Smarter cities, communities and regions that are committed to ensuring healthier individuals and populations have much in common. Their leaders understand the nancial and social burdens that aging populations and increasing chronic disease rates are placing on them, and they are taking action to contain costs and improve quality of life. They realize that healthier populations require much more than a few good hospitals and that what is needed is a holistic approach and a
commitment to developing the infrastructure required to support change.

These leaders are forming coalitions of business, education, healthcare, government and community stakeholders to work together to create prosperous and sustainable communities that are truly great places to live. These coalitions are collaborating to develop innovative programs and strategies to help keep healthy people well and productive, and to ensure that those who are ill or challenged can easily access integrated, high-quality services.

The programs that cities are putting into place include:

• Integrating health and social program agencies so that authorized service providers can view complete citizen information from multiple locations and easily determine eligibility and coordinate care needs.
• Making it easy for citizens to access social programs and health services at the most convenient place – from home to hospitals, retail and other locations
• Facilitating wellness and nutrition programs in the community
• Implementing convenient transportation and park systems that contribute to healthier lifestyles
• Investing in educational and research centers that focus in the healthcare and life sciences ecosystem to help develop talent, faster innovation and create jobs.

As part of their overall prosperity and sustainability strategy, these regions are also addressing the need for aordable housing and education, clean air and water,
public safety and protection, crime prevention, and emergency response capabilities for natural disasters and pandemics.

How can cities and regions get started on making healthier people and populations a cornerstone of their future success?

By focusing on the following six areas:

• Fostering government leadership, business and community collaboration
• Improving environmental factors
• Encouraging healthier behaviors
• Providing easy and convenient access to healthcare and social programs
• Sharing data to support holistic program and care delivery
• Measuring the success and impact of new programs and services

Some cities, communities and regions have already started to act on these areas to improve the quality of life of their citizens and to attract and retain the businesses, educational and research institutions, and talent needed for growth. Fostering government leadership and community collaboration City or regional governments that commit to making healthier citizens and populations a cornerstone of their future economic development can lead a number of eorts. These eorts can include creating the optimal model for change; instituting tax, grant or funding incentives; forming collaborative teams of business and community leaders; and providing necessary governance and measurement.

Members of the collaborative team could include:

• Companies that want to promote wellness and behavioral and environmental changes to improve employee health, decrease absenteeism, reduce costs and attract and retain high-quality workers
• Government agencies that need to streamline systems and organizations to provide citizens with better coordinated care and services
• Hospitals that can digitize their front oces integrate their acute and ambulatory care operations and share data to improve care quality and measurement capabilities
• Health payers that will make improved care quality and outcomes-based payments a priority and require providers to report on program eectiveness.
• New care delivery organizations, such as retailers, community-based clinics and home health providers that help to improve care coordination and management and ake it easier for citizens to access services
• Educational institutions that are committed to developing a skilled population, putting the right kind of research capabilities in place and investing in the healthcare and life sciences ecosystem

How cities, communities or regions begin their journeys will vary based on their goals, priorities and resources. However, after they get started, they can begin to realize the economic and quality of life benets these changes can deliver.

Rochester, New York: A revitalization success story having lost many corporate headquarters and jobs over the last few decades, Rochester has reinvented and revitalized itself since 2005. In January 2012, the Brookings Institution ranked Rochester the third best metro economy in the US, 46th in the world. The area has some of the lowest healthcare and health insurance costs in the country because of a commitment to health as a pillar of its economic development, along with the support and collaboration of healthcare, business, university and government leaders. These leaders provided the resources needed to create integrated healthcare delivery systems; wellness and nutrition programs; and research, behavior and environmental programs that enhance individual and population health.

Improving environmental factors implementing a range of environmental improvements can help cities and communities improve the quality of life and health of their citizens. Developing cities and regions often focus on meeting baseline public health requirements with programs that provide clean air and water, proper
wastewater treatment facilities and a minimal public safety infrastructure.

All communities can help to ensure the long-term health and wellness of residents by allocating enough parks, recreation facilities, walking trails and cycling paths for current and future populations, and they should locate these outdoor spaces in areas that make it convenient for people to exercise. In addition, communities can provide public transit systems, pedestrian walkways and bike lanes that reduce trac, make commuting less stressful, and provide easy access to preventative health services and recreation facilities. Toronto, which has 1,500 parks, more than 20,000 acres of parkland and 116 miles of bike paths, has reduced diabetes in those areas of the city that are accessible to parks and other spaces for physical activity.

In China, the Nationwide Physical Fitness Program was created in 1995 with a goal of having 40 percent of the population exercising regularly by 2010. To help achieve this goal, since 2000, tens of thousands of tness centers have been installed in public parks, squares, schoolyards and other convenient urban locations and are used by people of all ages, including China’s rapidly growing elderly population.

Encouraging healthier behavior

Cities and communities and local stakeholders can offer new programs and services to motivate citizens to engage in healthier behavior. They can also use social media and other online collaboration methods to help residents connect with their personal networks of friends and family that help support positive changes. For example, cities, communities or regions can implement citizen portals that provide easy access to information about health and wellness. These portals enable individuals to track their weight loss and exercise results and offer contests and games to encourage citizens to lose weight, exercise and adopt other healthy behavior. Cities, communities and regions can also host community and school events such as runs, walks, exercise programs and health fairs, and they can provide accessible public transportation so more individuals can participate.

To encourage healthier behavior further, other stakeholders can introduce their own programs. Healthy lunch programs in schools, healthy menu options in
restaurants and healthy recipe and eating campaigns in grocery stores can improve nutrition. Businesses can help to improve the health of employees and their families by promoting community health events and services and implementing programs that encourage employee fitness and weight loss. Health providers and payers can introduce programs and services to bring people with chronic diseases together to better manage their conditions; these could include exercise and walking programs, nutrition services, disease management programs and information on the services that individuals are qualied to receive.

Dubuque, Iowa, focused on encouraging healthy behavior and has become a model for the Live Healthy Iowa and America programs. The city has programs such as the Live Healthy Dubuque 100-Day Challenge, a team-based weight loss and physical activity program for adults and children; the Exercise Your Character Day that teaches students about character, exercise and healthy eating; and the Grandview Gallop, an annual 4-mile run through town that
is open to any age or exercise level.

In Bogota, Colombia, city ocials are encouraging more citizens to walk and cycle by shutting down more than 97 km of city streets to motorized trac on Sundays and most public holidays. Although the =program costs the city $1.7 million each year, for every dollar invested, it saves between 3.23 and $4.26 per citizen in healthcare costs.

Providing easy and convenient access to healthcare and social programs

Cities, communities and regions can work with their coalitions to help ensure that citizens receive the social program and healthcare assistance they need at the right time and place. Services can be coordinated around an individual’s social context that takes into account their clinical health, educational background, income, relative job satisfaction, safety, shelter, and food and nutrition.

Gaps in all of these dimensions can be assessed to develop a plan that treats a person’s overall wellness. Removing barriers between healthcare providers, social programs and other government agencies can help ensure that eligible citizens receive the services they qualify for and that individuals with special needs or chronic diseases get better coordinated care and services. The ultimate goal is to create communities that are more desirable places to live by reducing healthcare and social program costs, by improving care quality, by increasing citizen and economic productivity and by making it more cost effective to conduct business.

Citizens with chronic diseases who are elderly or poor usually have the highest healthcare and social program costs. By enabling integrated and better-coordinated care, cities, communities and regions can reduce overall costs, improve the economic health of the community and increase the quality of
life for these individuals. For example, elderly citizens with chronic diseases or individuals with disabilities living on xed incomes may need help with lling their prescriptions, shopping for and cooking nutritious meals, monitoring and reporting their conditions, getting to and from the doctor or physical therapist, or paying their heating or cooling bills.

Receiving such assistance can help keep them stable, in their home and out of expensive acute care facilities. Japan and Korea have had integrated health and social program organizations for decades. In Queensland, Australia, most of the disabled population have mild conditions and use a tool to assess their own needs and get referrals to appropriate social and health services and resources. The rest of the disabled population, those with the most chronic and challenging conditions, is assessed by professionals who examine their entire social context and identify the barriers and challenges of each person. They then develop a coordinated care plan specic to that individual. Based on the plan, a care team is created that is made up of a broad range of professionals such as physicians, nurses, teachers, occupational therapists and more. Those providers work together to support the individual’s care plan and to ensure that their needs are met.

Sharing data to support holistic program and care delivery cities, communities and regions that enable authorized service providers to share citizen information through private and secure channels have tremendous opportunities. By implementing an infrastructure that integrates healthcare and social program data from numerous agencies and providers, all authorized case workers and healthcare providers can access a complete view of each individual and their social context. In general, about 20 percent of individuals consume 80 percent or more of all health resources. Many of these individuals suer from one or more chronic diseases, and the cause of their high cost of care is often hospitalizations that could have been prevented with better-managed care.

Today, organizations do not share data with others and, as a result, most case workers and care providers do not know which services a person might need or is already receiving. When authorized health and social program providers are able to share information, they can more easily determine if additional care and services are needed and signicantly improve the health and overall quality of life of individuals and families. A complete, secure view of citizen data can help
providers determine eligibility, detect fraud, predict and avoid potential problems and evaluate the eectiveness of programs and procedures. These improvements can produce better outcomes at the right cost. Singapore has implemented a national electronic health record (EHR) program that enables authorized clinicians and healthcare providers to access information securely in real time to improve care coordination and enable more informed
decisions.6 Caseworkers in Alameda County, California, use a new system to access a complete view of each person they serve, to identify the relationships between those individuals and their families, to easily detect gaps in services and to better determine how they can efficiently provide services.

In Bolzano, Italy, elderly citizens living in their own homes can be monitored to improve their safety and quality of life. Remote technologies, such as telemonitoring, telecare and mobile teleassistance services and air quality, water consumption and environment systems, are used to monitor participants. They also provide medical advice and access to medical professionals remotely and alert designated family members or friends if there is a potential problem.

Measuring the success and impact of programs and services

The ability to measure and report on the success of programs, and analyze and learn from data can be critical for cities, communities and regions. Metrics are especially important today because governments face declining revenue and rising expenses and often must clearly demonstrate the success of their eorts to secure further investments. Integrated data that can be easily accessed and analyzed makes it easy to report on the impact of programs on the local economy and quality of life. Data can also be used to develop predictive and prescriptive analysis that can help advance care coordination and improve individual and population health and wellness. For example, in 2007 Oklahoma City was designated America’s 15th fattest city. To address the city’s growing obesity problem, the mayor challenged citizens to lose one million pounds and created the This City is Going on a Diet program. The program included tness events, wellness educational activities and a portal where citizens registered, tracked their weight and accessed information about healthy eating, tness and more. The portal also measured the program’s results: 1 million pounds lost, more than 8,000 waist inches lost and over 11 million calories burned.

Since its revitalization eort began, Rochester has relied on statistics to help with its achievements and to attract new employers and workers. The city has collected a range of statistics to demonstrate its successes, including some of the lowest healthcare costs in the US. These successes include:

• 30 percent lower commercial insurance costs
• 21 percent lower Medicare costs
• Savings of more than $490 million over ve years from its generic drugs initiative
• Expected savings of $150 million over four years from a community initiative to reduce emergency room use and to avoid preventable hospital admissions
• An award of one of the largest US government grants ever received: $26 million to save $48 million with preventive care measures

Cities, communities and regions can gain signicantly from making health and wellness of individuals and the population a cornerstone of their economic development. Getting started can be as easy as instituting some or all of the programs and services that are presented in this paper. All of these initiatives can help improve the overall health and productivity of citizens, attract new businesses and workers, increase employment and achieve other economic and social advantages.

IBM: Your partner for smarter, healthier cities, communities and regions

The transformation to smarter, healthier communities begins with the vision, leadership and governance of city and community leaders. To improve individual health, population health and overall productivity, these leaders should provide a technology infrastructure that has societal impact and enables economic prosperity and financial sustainability. The transformation can be successful with the support and collaboration of regional business, education, health and government stakeholders who are also committed to the journey to becoming smarter and healthier.

IBM solutions and services can help cities more easily determine which programs might impact the health of their citizens most (environmental, behavioral, access to health and social program services), so they can better focus their strategy and investments to achieve outcomes that matter. The technology infrastructures that cities and communities can use to create smarter healthier cities include:

• Flexible, secure information-sharing infrastructure that provides the right information at the right time
• Complete views of individual health and social context information to ensure the service provider ecosystem can efficiently connect services to needs
• Protection for data privacy, security and integrity
• Social business applications that enable the creation of information portals and community sites, wellness competitions, games to enhance tness, interactive guides to parks and recreation and more
• Big data technologies that support large volumes, wide varieties and high velocities
• Advanced analytics that enable real-time predictions and insight for better decision making

IBM has the expertise and technology to help communities with their journey. With insights gained from more than 2,000 Smarter Cities and 3,000 healthcare transformation projects worldwide, IBM can help cities and communities of all sizes become smarter and healthier.

Luton & Dunstable University NHS Foundation Trust (L&D) is a typical acute hospital: a regional hub, busy, multidisciplinary and concerned with costs and productivity. The NHS deals with over one million patients every 36 hours and with the UK population projected to rise from 62m to 71m by 2030 the NHS has been tasked to increase efficiency in dealing with patients.

Business Needs
A key focus is improving the time spent with patients. At present doctors have to return to shared desktops in shared office space to log requests for blood tests, check patients’ records and update files. An experiment in having desktop computers wheeled around wards had proved unsuccessful. There were no portable devices to use on ward rounds, and medical staff were unable to transfer sessions between, for instance, the ward, a consulting office and an outpatient clinic. This not only disrupted patient-facing time, but, as the many different applications required different passwords, made for an environment that was complex and time-consuming.

For clinical professionals this daily frustration of having to manage multiple user accounts was costing time in logging on to different applications. It was not uncommon for clinicians to need up to eight different passwords for various applications, and to spend a quarter of their day on computers. There was no possibility of using a personal device for work purposes. This inefficiency was far from ideal when patients might be allocated just ten minutes face time with a doctor.

“In terms of time spent and practicality, having to enter a password for every system and having to select the patient in every system was just not proving acceptable to clinicians,” says Mark England, Director of Information Management & Technology at L&D, “and frustration is a clinical risk.”

To compound matters, the IT service desk answers 400 requests for password updates each month; this workload ties up its staff and keeps doctors from their work.

“One of our main challenges is resource,” says Sarah Kennedy, IT Service Desk Manager, overseeing a team of 15 responsible for 4,000 user accounts. “We don’t have enough resource for the amount of calls we receive on a monthly basis. It is a struggle to meet our SLAs and find the right resource to support the roll-out of new applications.”

Historically, Mark England admits, the healthcare sector has lagged behind in terms of deploying technology to improve productivity, but he believes this culture has changed.

“I think this has been largely due to the complexity of the activity. In other industrial sectors there might only be a few patterns and processes and service lines to support, whereas within healthcare when a patient arrives in A&E they can go down so many different pathways and involve many multidisciplinary teams.”

The challenge for healthcare CIOs, he continues, is to adapt existing systems. “The off-the-shelf, single-supplier solution has been largely disproved over the past ten years. The idea of having a single sign-on solution that knits together these different systems, where the clinician selects the patient and context only once, fits the current state of the healthcare market. It’s a proven, much safer way of delivering benefits sooner.”

Previous solutions, he says, were incapable of ensuring a complete ‘follow-me’ experience, allowing a session to transfer between locations and devices.

England turned to OCSL, a long term supplier of IT solutions to the healthcare sector. Developed in partnership with Microsoft, OCSL’s acceSSOnce Clinical Desktop Solution directly addresses the issue of multiple log-ons and slow access speeds. As with England’s request, the solution sits across all applications, knitting them together with access via the users’ personal identification details. It is designed to reflect the requirement for sessions to be mobile, where users move between locations, switching between fixed and portable devices.

“With a launch bar across the top it gives you the ability to sign in once and then select the patient once,” says England. “It means clinicians can view multiple applications – correspondence, diagnostic reports, images, ordering systems – with just one click. Once logged in, the session follows the user: it can be viewed on a tablet on the ward or a desktop in their office. There’s more coherence and it fits with our governance requirements.”

Solution

OCSL’s acceSSOnce Clinical Desktop Solution delivers seamless, fast and secure access to clinical and business applications on any device anywhere with an Internet connection. The solution uses a Microsoft Private Cloud. Desktop services and applications are delivered seamlessly from this platform to the end user, with a consistent look and feel irrespective of device type.

acceSSOnce uses Single Sign-On (SSO) and Patient Context technology from Caradigm to complete the technology stack, making it highly relevant to a clinical setting. Hosted on HP Converged Infrastructure, the acceSSOnce solution is available on premise or via OCSL Managed Services. Devices including iPads and HP ElitePad tablets provide the interface via Windows8 to the clinical teams.

The follow-me desktop functionality of acceSSOnce allows the clinical user to deliver care closer to the bedside, while the fast user switching ensures a ward workstation is never left locked to another user if a clinician leaves their session open. Streamlining the search for patient information across multiple applications means less time wasted logging in and out of disparate systems and more time for the clinician to focus on delivering patient care.

From an IT department perspective, acceSSOnce provides a smooth migration path to Windows 8 and beyond, while leveraging the Microsoft Server 2012 Hyper-V and System Center 2012 platforms, to give a dynamic and fully integrated management stack. Employing the System Center 2012 Automation and Orchestration features allows the more mundane tasks to be managed by users, removing the headache from the IT department.

Finally, acceSSOnce is delivered as a scalable appliance-based architecture making the whole solution simple for a healthcare organisation to adopt and support.

England rejects the idea that clinicians are resistant to change, or unwilling to embrace new technology: “Clinicians and consultants are pushing for a higher percentage of the patient record to be captured electronically – they want an IT experience that is as simple as their use of personal devices. They know and we know that point-of-care access to information is crucial. It is the number of people involved, and the workflow planning that makes this so complex.”

The L&D site is already fully wireless, so the network infrastructure was already in place to support mobile devices. Advances in tablet computing – light, gesture commands, high definition screens, extremely portable – mean clinicians would be able to now retrieve patient records at the bedside. This would allow them to order medication at the same time, rather than waiting until the end of the ward round, with the pharmacy immediately responding. Follow ups with specialist consultants could also be logged.

England says the ease of adoption of acceSSOnce, particularly on tablet devices, has been well received by clinicians: “Tablets, small touch devices that you can use ergonomically and move around, really fit into clinical workflows. Delivering technology to the point of care is always a challenge because it’s an extra device between the clinician and the patient but as soon as you get data entry happening away from the patient the quality, timeliness and the accuracy of the data start to degrade. The closer to the patient you capture it, the more ergonomic it is. The quicker it is to use, the better.”

All of this has been achieved with no loss of security, he continues: “The single password with acceSSOnce means we can take a stronger line with regard to information security and governance. We have a faster refresh rate for passwords, and a much improved audit trail on access to the applications. The more we put onto a person’s individual log on the more interested they are in keeping it secure and maintaining good governance.” 

Dr Nicola Simmonds, Consultant Gastroenterologist and Clinical Lead for IT at L&D, says acceSSOnce has transformed the job of gathering clinical data: “I’d be working through results, procedures and correspondence, across endless applications. Work that used to take weeks can be finished in hours. ”Historical data from as far back as 2006 can be accessed in seconds, at the bedside, she says: “And this gives the patient far greater confidence that the doctor understands what’s going on and that their information is to hand.”

The use of slates and tablets, with Windows 8, carried on ward rounds, makes for a more tactile, visual experience, for both clinicians and patients. Dr Simmonds says patients’ families appreciate having information shared, and it’s also easier to call up data in between patient sessions: “It might only be a few minutes at a time, but those moments of extra productivity add up.”

Even the simple act of combining five core clinical applications, says Sarah Kennedy, has improved start-up times by 90 per cent. “Previously, clinicians may be delayed because the applications won’t launch or they’re unable to get the right correspondence from an application because it is just taking too long to load. This has been improved immediately by using acceSSOnce.”

Calls to the helpdesk requesting password reminders are down by an estimated 90 per cent, says Kennedy, freeing more time to work on new, higher-value projects. Network issues are also down as applications launch through the virtual desktop.

Dr Gandhi, a Paediatric Consultant at L&D, estimates 30 minutes of time saved each day: “I was using a desktop in my office, a shared desktop on the ward, another at an outpatients’ ward, consulting my notes…using one portable device has made my working life more time efficient.”

Benefits

Mark England admits there were concerns with being among the first to adopt Windows 8 technology. OCSL’s support was needed to handle the complexity of integrating different application vendors, but ultimately the solution has delivered beyond expectations:

• Improved session persistence for clinicians between different locations and devices
• Delivered faster access to clinical information, saving time on ward rounds and improving patient care experience, even at the bedside
• Facilitated the roll-out of tablet devices and BYOD, delivering organisational change and transforming user expectations
• Reduced strain on IT helpdesk: fewer calls allows more time to focus on delivering high-value IT projects
• Reduced time to launch applications by 90 per cent
• Saved clinicians 30 minutes per day on average from multiple password retrieval and securing a PC device
• Simplified password count, on average from eight to one

Summary

Luton & Dunstable Hospital: At A Glance
• Patient population 315,000
• Number of staff: 4,000
• 2604 are clinical staff (excludes Administrative and Clerical, Estates and Ancillary and Students)
• Manages 400 new doctors and students Per annum
• 29 junior doctors a year
• 68,000 inpatient admissions
• 240,000 out-patient appointments
• 700 beds
• Reduced time to launch applications by 90 per cent
• Saving clinicians 30 minutes per day on average
• Simplified password count, on average from eight to one

This is roughly the challenge confronted by cardiologists when performing what are known as “interventional” procedures, such as implantation of a stent or valve by means of a remotely controlled catheter. During such procedures a nearby monitor typically displays a high resolution pre-operative computed tomography (CT) image of the vascular anatomy while a separate X-ray fluoroscopy image produced in the interventional suite itself displays the real-time location of the catheter tip.

“Surgeons are skilled in putting these images together in their minds,” says Daphne Yu, who heads the Image Visualization Lab at Siemens Corporate Technology in Princeton, New Jersey. “But by using advanced visualization, we can put the pictures together for them.” The big picture, however, is much broader than that. Indeed, what Yu and her colleagues at Corporate Technology and at Siemens’ vast Healthcare Sector have in mind is nothing less than a vision of tomorrow’s operating and interventional environments in which all modalities are ergonomically integrated.

Such modalities include, for instance, live endoscopic images, ultrasound, real-time CT, fluoroscopy, electrophysiology (used in neutralizing cardiac tissues responsible for arrhythmias), and, above all, 3-D pre-operative CT or magnetic resonance (MR) image sets. The latter are particularly important because they can provide the navigational landscape into which all other modalities will eventually be integrated.

A Roadmap Takes Shape. With this vision of tomorrow’s integrated treatment environment in mind, researchers at Siemens Corporate Technology have developed learning-based software that can identify and segment (separate from its surroundings) any organ in any digital medical image, regardless of occlusions, angle of view, imaging modality, or pathology.

An example of this capability is a heart model segmentation software that automatically separates the heart from a 3-D CT or MR image set. When used in combination with live fluoroscopy, segmented heart models can be used, for instance, to locate the exact areas on the heart’s surface to be ablated in order to neutralize arrhythmia-causing tissues.

In addition, at the U.S. National Institutes of Health (NIH) in Bethesda, Maryland, live image-model fusion software developed by Siemens Corporate Technology in cooperation with Siemens Healthcare has been used experimentally to help guide an artificial valve to its target in a pig’s heart. “This fusion of heart models and live images provides the landmarks that help physicians identify exactly where a catheter is located in real time,” says Yu. “It is a promising example of the power of image fusion in the interventional suite and operating room.”

Working along similar lines, Razvan Ionasec, PhD, a specialist in machine learning applications for medical imaging at Siemens Imaging & Therapy Systems Division in Forcheim, Germany, is combining pre-operative 3-D CT images with 2-D X-ray video images generated in the operating room itself by a Siemens “C-arm” CT scanner. “What typically happens,” he explains “is that before an operation you have a lot of high-resolution equipment and time to produce images. But what you want is to make this pre-op information available in the operating room, where time is short and imaging power is limited. To bridge this gap, the pre-op information is mapped to the fluoroscopy data. As a result, all of a sudden, you have real time motion information — something you would never be able to get from fluoroscopy alone.”

The integration of modalities is already paying off. A technology for the interventional placement of aortic valves has recently been bolstered by the addition of pre-operative CT data. The resulting product, syngo.CT Valve PilotTM, not only automatically segments the aortic valve and related structures from a CT scan, but provides measurements, such as the radius of the valve, which are essential for planning and conducting an intervention.

Meanwhile, another technology, which is known as “eSieFusionTM imaging”, overlays live ultrasound images on previously-acquired 3-D CT and MR image sets. The technology, which is now available on Siemens’ ACUSON S3000TM ultrasound systems, is used to guide a biopsy needle to its target with enhanced confidence. Ultrasound will eventually also be integrated with CT and X-ray images to support the placement of aortic valves, says Ionasec.

Data Fusion Goes Mobile. In addition to the integration of multiple clinical modalities, researchers at Siemens Corporate Technology have their sights set on making such images available wherever they are needed in real time. “Rather than having a huge screen with separate views of the area to be treated,” says Yu, “we have come to the conclusion that it is more practical and comfortable to have a single, integrated image that is portable.” Such an image could be available on a stand-mounted tablet or could even appear in a head-mounted device. The latter would support the integration of visual and mental activity with hand-eye coordination and might even be used in an augmented reality context, thus allowing a surgeon to superimpose diagnostic information on his / her actual field of view.

To realize this vision, Siemens researchers are developing techniques to promote extremely fast visualization. For instance, a team led by Dr. Andreas Hutter at Siemens Corporate Technology is focusing on ways to tailor streaming and video compression to medical applications, while others are working with chip manufacturers to minimize the computing and power demands needed to process images. “These efforts are starting to pay off,” says Yu. “They have made it possible for us to stream real-time images to a tablet using standard Ethernet technology.”

The need for achieving a virtually imperceptible delay is clear. “If you are pushing a needle or a catheter through a patient’s anatomy you need to have instant feedback,” says Yu. “For instance, if you are doing a procedure in which angiography is involved, our scanner works super fast to produce each image and encode it. The images must then be streamed to the viewing device, decoded and rendered.” Naturally, processing demands are even higher as additional imaging modalities are added and fused. Nevertheless, whatever delay this adds will probably not be noticeable. With eSieFusion imaging, for instance, initial registration of CT and ultrasound images requires three seconds, after which any two images can be fused in real time.

Adding Expert Systems to the Picture. Nor will multimodality data fusion in tomorrow’s operating rooms and interventional suites be limited to images. “Our vision is that all the information that’s needed will be available when and where it is needed,” says Yu. “In addition to pre-op and real-time image fusion from multiple sources, we will have live patient monitoring, such as heart rate and blood pressure.” Further down the road, demographic data and expert systems built on thousands of similar cases could be brought to bear on individual procedures, thus opening the door to virtual consultation functions and the analysis of alternatives.

On-the-spot simulation functions might, for instance, provide advice as to the best spot to clip an aneurysm based on real-time computational fluid dynamics. Virtual angiography, individualized anesthesia and drug dose interactions — all could be simulated during a procedure and then tracked as administered to refine underlying algorithms.

Last but not least, data fusion can be expected to save money. “It will provide a method for automatically recording procedures,” says Yu; “this will support effective systems for reimbursement, and can be exploited by learning systems to further refine treatments.” For all its potential, multimodality data fusion will need to overcome many challenges. Software from different systems will need to become far more interoperable, standards for everything from image quality to transmission speed will need to be developed, and a virtually unlimited appetite for bandwidth will demand ever-increasing processing power and energy efficiency. “It is still early days for real-time data fusion,” says Yu; “but when you add up everything that is happening in this field, you see that we are in the process of creating an ecosystem that will transform the way we plan, perform, document, and learn from a vast range of treatments.”

By fusing innovative digital solutions with existing healthcare knowledge, communications and high-tech companies and the health industry are developing cost-effective new ways to engage patients and deliver care, anywhere, anytime.

“Wait—are you playing my video game?!?”
Billy was shocked at the prospect of sharing his game console with his grandmother, Maria. In fact, Maria was monopolizing the gaming system—but not to shoot space aliens. Instead, she was using it to interact with her healthcare team from her living room couch.

The 71-year-old grandmother with chronic obstructive pulmonary disease was receiving real-time advice from her healthcare provider on how to use her new inhaler. Maria then slipped on her Bluetooth-enabled pulse oximeter to measure the saturation level of oxygen in her blood and instantly transmitted the results to her doctor, who communicated his satisfaction. The whole experience took only minutes, and Maria was back to her routine without the time and expense associated with a visit to the clinic.

By fusing innovative digital solutions with existing healthcare knowledge, communications and high-tech companies and the health industry could, in the not-too-distant future, make this kind of virtual healthcare interaction a reality in the United States by developing cost-effective ways to engage patients and deliver care virtually anytime, anywhere. For their part, leading communications and high-tech players are offering a growing range of potentially groundbreaking solutions that address some of the healthcare industry’s greatest challenges. By targeting patients and providers with cloud-based application portfolios as well as with breakthroughs in using infrastructure in healthcare, the industry seeks to cut medical costs while improving delivery quality and patient outcomes.

While the terrain remains largely uncharted, the prospects for healthcare and high-tech companies to unlock massive amounts of clinical value are significant.

Contrasts
While the playing field is already large and rapidly growing larger, communications and high-tech firms in the United States are pursuing several different application groups that promise major payoffs when fully implemented.

The major players
A number of leading communications and high-tech companies are already dedicating core assets and capabilities to solving some of healthcare’s most pressing problems. For example, Microsoft’s HealthVault gives consumers access to more than 140 health-related apps and connects to 226 different kinds of medical devices, from blood pressure monitors to glucose meters. It also enables users to upload their medical images, including X-rays, MRIs and ultrasounds.

HealthVault offers a wide array of solutions under one umbrella, including everything from wellness apps to chronic disease management plans. Meanwhile, technology company Verizon has repurposed its cloud and mobility capabilities to launch an FDA-approved remote patient-monitoring solution. Its Converged Health Management platform enables patients to use biometric devices to automatically transmit patient data through a wireless connection to a secure server that resides in Verizon’s HIPAA-ready cloud.

AT&T has developed technology that gives medical professionals instant access to review patient diagnostic images, enabling radiologists to see more patients, reduce their long-term technology costs and thus boost profitability. The solution also allows hospital networks to manage medical images centrally and collaborate efficiently with other institutions, physicians and radiologists.

Communications hardware provider Qualcomm offers Qualcomm Life, based on its FDA-listed 2net hub and platform. With this solution, users can capture biometric data and deliver it to designated portals, sharing medical data across a wide spectrum of care situations. Likewise, Cisco HealthPresence software enables providers to deliver care to distant patients by integrating high-definition video, advanced audio, third-party medical devices and collaboration tools.

Similarly, a number of startups are maneuvering to upend healthcare business models by delivering physical solutions directly to patients. VGo Communications, for example, has developed a robotic telepresence solution with remote-controlled mobility capabilities. The robot acts as a physician’s avatar, enabling doctors to make virtual patient rounds across multiple sites without really being there.

In other cases, a variety of smartphone apps and wearable recording devices powered by sophisticated communications and advanced health analytics work behind the scenes to assess whether users require medical intervention. For example, Ginger.io employs predictive models developed by the MIT Media Lab to catch subtle changes in an individual’s behavior via apps on his or her mobile phone. The technology enables doctors to assess the patient’s physical and mental well-being, predict potential future issues and, if necessary, reach out to him or her for treatment.

Barriers to innovation
Every industry has unique requirements and challenges, but healthcare’s many regulations and multiple stakeholders can make it an uncommonly hard nut to crack. And that distinction can be challenging for communications and high-tech companies as they attempt to deploy their service delivery and network technologies in pursuit of healthcare innovation.

Developing effective health solutions will pose a variety of significant challenges. Here are three of the biggest.

Go-to-market strategies
Beyond building health industry expertise and insights, communications and high-tech companies should also determine the most effective go-to-market strategies. Success will require balancing the goal of capturing the maximum value possible against the time required to extract that value. Companies have a spectrum of options to explore in this area, ranging from building a dedicated business to collaborating with other players in order to share both risks and rewards.