TECHNOLOGY AND FUTURE TRENDS
Remote Healthcare depends on a wide range of technologies, including diagnosis and monitoring techniques, network approaches, such as cloud and fog computing, data and devices to be possible. With such technologies, the physicians and other medical personnel can acquire essential information while patients proceed with their daily activities, hence eliminating the need for regular visits to a healthcare facility for checkups and diagnosis. In this regard, technologically enhanced Remote Healthcare possesses immense potential to improve the outcome of medical services, especially by reducing the congestion in the healthcare facilities and the general wellbeing of patients, by enabling continuous monitoring and early diagnoses, hence treatment. However, providing healthcare services over a network of computers incorporates a wide range of challenges, including information security, resulting in substantial losses to healthcare facilities, system failure risks, which may lead to delayed services or even death and change management issues, especially in the absence of the necessary skills and knowledge of operating the involved equipment. Moreover, difficulties in operating machines and devices and efficiency of involved technologies and techniques can considerably reduce the accuracy of medical services (Hsiao, Hsu, Lee & Lin, 2017). Thus, healthcare facilities must conduct sufficient evaluations of each element of technology and techniques with regard to the risks and vulnerabilities involved and future trends before implementing them in Remote Healthcare services.
Because of the increased importance of blood flow information in a broad range of diagnosis and treatment prescriptions, Photoplethysmography (PPG), a technique of establishing time-related information of the blood flow, is one of the most essential and applicable techniques in remote healthcare. Introduced by Alrick Hertzman and colleagues, in 1938, PPG is a cost-effective and simple optical bio-monitoring method, which is utilized to non-invasively identify changes in blood volume that transpire beneath the micro-vascular layer of tissue beneath the skin. In general, PPG elements can offer essential information regarding cardiovascular systems. Although its single spot monitoring and the need of applying a PPG sensor on the skin considerably limit its deployment in practicality when free movement is needed, perfusion mapping and healing assessment, the underlying concepts of the technique possesses immense potential and applicability in the healthcare. Coupled with substantial advancements in microelectronics, integrated circuits, and signal/image processing methods, scholarly PPG research yielded some of the most improved biomedical and clinical applications, including Imaging Photoplethysmography, that are immensely applicable in physiological assessments.
Along with its improved versions, PPG has immense potential to improve Remote Healthcare services outcomes. According to Shea (2017), the only technique to accurately identify the absolute changes in blood volume in the extremities is by the use of chamber-plethysmography. Using F=dV/dt, the change in volume can be converted into blood flow. Nevertheless, in some instances, such as in the calculation of the heart’s pulsation rate, the only information that matters is the relative volume, which can be obtained from timing information rather than the amplitude or the shape of the signal details. In this regard, the electric photo-plethysmography PPG or impedance-plethysmography algorithm can be used to generate heart rate data. The overarching principle of photoplethysmography is the heuristic observation that the reflected light from or transmitted through the living tissue acquires a modulation in sync with heartbeat frequency.
Because of its tremendous cost efficiency and ease of use, PPG has been considered in a wide range of previous efforts to reduce the cost of healthcare services, including Remote Healthcare. The technology only requires two components, a source of incoherent light, including natural illumination, and a photo-receiver to deploy; hence, it is considerably cheaper to implement. Moreover, PPG systems can be deployed along with a wide range of technologies, including smartphones; hence, they are considerably accessible to patients. However, the technology includes immense issues that are yet to be confirmed through empirical research. For instance, the impact of contact on the accuracy of results is yet to be verified through research. Moreover, regardless of its increased usability, the technology requires an understanding of the overarching principles, which may be considerably complex for patients. Thus, because such demerits can introduce significant accuracy, there is a need to focus on more efficient techniques.
Compared to the PPG, ECG offers a more efficient in terms of accuracy and the number of possibilities, simple to use, but considerably expensive technique of monitoring and recording heart information. Electrocardiography, a procedure involving the amplification and recording of the heart’s electrical impulses, is significantly applicable in healthcare, especially in routine physical checkup for the middle age and the aged persons, and when heart conditions are suspected. The procedure is considerably simple to use and painless to the patient; hence, it can be used without necessarily demanding the help of technical assistance. The electrocardiogram, a record of the heart’s electronic impulses captured through the electrocardiography procedure, offers details concerning the part of the heart, sinus node or sinoatrial or the pacemaker, which triggers each heartbeat, the nerve conduction network of the heart and the rhythm and rate of the heart. In some cases, the electrocardiogram can enhance the diagnosis of some heart-related conditions, such as the blood vessel blockage, by indicating that the heart is receiving inadequate oxygen or high blood pressure when the procedure depicts an enlarged heart. Furthermore, electrocardiograms obtained during routine physical checkups, when the patient is healthy, can be used for comparisons with future ECG in the event of a heart disorder. Because unusual heart rhythms and insufficient blood flow to the heart muscles of the heart may happen unpredictably and briefly, it is essential to use a considerably prolonged monitoring approach, while a patient engages in normal routine (Hsiao, Hsu, Lee & Lin 2017). With mechanisms like continuous ambulatory electrocardiography and increased ease of use, ECG, therefore, has immense applicability in Remote Healthcare compared to the PPG.
In the process of obtaining an ECG (electrocardiogram), the examiner sets electrodes, minute circular sensors, which stick to skin, on the patient’s legs, chests and arms. Because these electrodes do not possess any hurting components, such as needles, they are painless to the patient. In the presence of thick hair, the process may begin with shaving the region of application. The electrodes capture the direction and magnitude of the electrical currents in the heart in each heartbeat. A tracing machine, linked to electrodes by a set of wires, generates a record for each sensor, which depicts the heart’s electrical activity from different angles. These tracings compose the ECG, which takes about 3 minutes to generate, with no risks involved.
Readings. Compared to the PPG, ECG is considerably easy to use, especially because of its considerably easy to understand concepts and simple output. An ECG depicts the electric current transmitted across the heart, which is triggered by a heartbeat. The current’s transmission is divided into components which are assigned an alphabetic designation in the electrocardiogram, as shown in figure 1 below. At the beginning of a heartbeat, the sinoatrial or sinus node, or the heart’s pacemaker triggers an impulse, which activates the atria, upper chambers of the heart. The P wave denotes the activation of the upper heart chambers. Then the impulse travels down to the ventricles, lower heart chambers, whose activation is denoted by the QRS complex (Shea 2017). Finally, in an opposite direction, the electrical currents scatter back over the ventricles in an activity referred to as the recovery wave and denoted by the T wave.
Apart from enhancing diagnosis through future comparisons, the ECG can reveal several previous abnormalities, including myocardial Infarction, heart attack, arrhythmia, an abnormal heart rhythm, ischemia, insufficient supply of oxygen and blood to the heart muscles and hypertrophy, excessive thickening of the muscular walls of the heart. In this regard, compared to the PPG, ECG provides a higher number of capabilities, hence does not necessarily require immense information or skills to use. Unlike the PPG, which only provides heart information, the ECG can reveal specific abnormalities suggesting aneurysms, bulges, resulting from a heart attack and develop in weak regions of the heart’s walls. Furthermore, in the case of unusual heart rhythm, too slow, too fast or irregular, the ECG can reveal the specific source of the abnormality in the heart. With such details, it is easier for physicians to identify the cause and the most suitable treatment of a heart condition. Therefore, although the ECG devices can be considerably expensive to acquire, implement and use, especially because they are considerably power intensive compared to the PPG, the impact of their long-term benefits surpass the short-term drawbacks.
Figure 1: an overview of an ECG output: Source (Shea 2017).
Remote Healthcare Enhancing Technologies
For Remote Healthcare to be possible there must be a means of linking the physician or medical personnel and the remote patient. Specifically, a computer network or technology is required to ensure that healthcare facilities can collect information from patients in the field. However, while there are numerous computer-network technologies, most of them include considerable vulnerabilities that can immensely impact the quality of HealthCare services offered. Moreover, specific computer network technologies possess significant weaknesses with regard to remote healthcare enhancements. For instance, while cloud computing may be beneficial to Remote Healthcare, because it significantly reduces the cost of computer security information and event management (SIEM), it may include considerably longer response time, hence leading to delayed medical actions, which in some instances, can lead to severe health impacts, including death. While there are enhancement techniques, a high number of them rely on the current immensely dynamic technology, hence become obsolete in the near future. Therefore, healthcare facilities implementing Remote Healthcare services must identify technological enhancements that can ensure maximum benefits and reduced drawbacks.
Overview of Cloud Computing
Cloud computing is one of the recently emerged technologies which can significantly enhance the concept of Remote Healthcare services, especially because of its immense potential to lower computing costs, including that of data storage and network management. Based on the idea of shared resources and responsibilities, cloud computing enables the transfer of a significant portion of computer network operations and management activities, including security information and network availability management, to third-party services providers, hence allowing the contracting organization to maximize its focus on the achievement of the primary organizational goals and objectives. Moreover, the technology eliminates the need for implementing a sophisticated in-house IT (information technology) infrastructure, including immense equipment and personnel, hence considerably lowering the cost of deploying and running computer networks (Lounis, Hadjidj, Bouabdallah & Challal 2016). Furthermore, cloud computing offers access and use of data and application on a pay-per-request arrangement to significantly reduce the cost of information technology services, hence indicating that organizations can afford an extremely enhanced quality of services, including an increased period of data storage spanning months and years. Because cloud computing technology resources are hosted on the internet, facilities are accessible from anywhere around the globe provided there is internet coverage. However, because of the expansive geographical region, a high number of interconnected devices and amounts of data, and involvement of third-parties, the technology includes a plethora of information management issues, including information security breaches, reduced response time, use of sophisticated and complex Big Data Analytics and graphical dashboards that can be considerable complex to manage, operate and understand. Therefore, regardless of having immense potential to improve computing capabilities, cloud computing in its, current state, requires additional improvement to be applicable in Remote Healthcare.
Fog computing is one of the techniques that can be used to overcome the challenges associated with cloud computing. The method involves the addition of a layer of computing power between the cloud and the device, by keeping critical analytics near the device to reduce the time taken from request to response. In this kind of arrangement, each device is transformed into a processing node, which can handle smaller and time-sensitive requests without necessary sending all data to the cloud. Because each device is converted into its small analytics base, they can process a wide range of narrowly defined process variety in milliseconds, hence leaving the cloud infrastructure free for large-scale analytics tasks (Thota, Sundarasekar, Manogaran, and Varatharajan & Priyan 2018). Compared to cloud computing, this technique maximizes the existing Big Data analytics resources, especially by withdrawing some jobs from the primary cloud storage queue and enabling them to be quickly processed. Cisco indicates that with fog computing, it is not necessary for every analytics action to involve back and forth movements from device to cloud. In this regard, unlike in cloud computing, fog computing devices have improved performance in areas without reliable broadband internet and significant bandwidth (Rahmani et al. 2018). Thus, this technology is significantly applicable in rural areas, which do not necessarily possess reliable internet connections. Moreover, fog computing can be used to overcome cloud computing challenges, especially information security, by acting as small centers for data processing that enhance data exchange between devices without involving the cloud. However, HealthITSecurity (2018) indicates that the technology is not a replacement of cloud computing; hence, both techniques must be implemented together. Thus, implementing fog computing is more expensive than a purely cloud-based systems, but has an increased amount of benefits, which makes it one of the most favorable technology for remote healthcare services.
In the near future, the computing power, in terms of data processing speed, cost, and storage, is expected to significantly improve. With the invention and improvement of powerful techniques, such as machine learning and artificial intelligence, analysis of Big Data is becoming less costly and more accurate. In this regard, cloud computing will significantly improve, especially by having a reduced response time and complexities in data representation. In this regard, while healthcare organization may, currently implement fog computing capabilities, because of its considerably high processing speed, they need to consider cloud computing in their plans to be able to access a vast geographical region and a prolonged node aggregation, hence improved accuracy of healthcare services output, in future. However, while the implementation of IoT systems, which introduce immense information security vulnerabilities, is projected to considerably increase in the near future, the anticipated growth in the cyber-security industry, hence techniques, does not seem to match the expected amount of information security risk (Gia et al. 2017). Because of such factors, cloud computing may significantly impact the outcome of healthcare provided using remote systems. For instance, increased information security breaches will possibly affect the accuracy of data processing output, by introducing errors or deleting some essential pieces of information, a considerable reduction in the quality of services or exposure of private information. Such drawbacks may discourage patients and facilities from adopting Remote Healthcare, while simple and cost-effective techniques, such as sensitizing patients, can significantly mitigate information security risks. Thus, large scale adoption of Remote Healthcare must be accompanied with the appropriate sensitization programs to ensure patients have adequate information concerning the manner in which to react in the event of information security incidences or difficulties in obtaining equipment readings. Without such approaches, implementation of Remote Healthcare services may considerably reduce the quality of the overall healthcare outcome.
Nature and categories of the existing technology
Healthcare facilities intending to offer remote services must extensively evaluate the nature and categories of the existing technology to implement hence maximize benefits, while significantly reducing the number of drawbacks associated with information systems. While there are a myriad of modern techniques, a segment of them include considerable demerits, such reduced ease of use and ability to provide in-depth information that can substantially improve remote monitoring, diagnosis and treatment. Moreover, the current computer network technologies possess unique merits and demerits with varied implications for Remote Healthcare. For instance, despite enabling a global coverage and a reduced cost of resources and services, such as storage and computer network operations, cloud computing involves several issues of concern, which include a reduced speed of request processing, diminished information security and considerably increased amounts of data that are difficult to analyze. In this regard, healthcare facilities must implement alternative technologies to overcome the drawbacks associated with cloud computing. Fog computing, which significantly improves request processing speed from minutes, days and weeks in cloud computing, to milliseconds and sub seconds and simple to use analytics and graphical dashboards, can improve remote healthcare services. However, the technology has considerably reduced network coverage, because it includes local storage and processing of data. Therefore, towards the future, while computer processing speed increases and cost reduces, facilities must keep drifting towards cloud computing to significantly increase coverage and lower the cost data storage, but keep sensitizing patients on matters concerning Remote Healthcare to enhance the outcome of healthcare.
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