The health technology revolution starts with trust and privacy

This article was originally published in the Winter 2018 issue of The Record. Subscribe for FREE here to get the next issue delivered directly to your inbox.

Healthcare providers in the early 21st century enjoy unprecedented benefits from technological advances but struggle with multiple challenges around finances, service delivery and staffing. Data is at the heart of these challenges, says Elena Bonfiglioli, regional business lead, Health and Life Sciences, Microsoft. “Three key issues that are top of mind for health authorities today are Data Commons, data interoperability, and the need to balance data privacy and security with the innovation potential of extrapolating data at population or individual level.”

A key factor holding back the transformation of health systems is that health and patient data have been locked away in numerous silos, limiting the ability to combine and leverage data to drive innovation, says Bonfiglioli. “The causes are partly technical, with divergent systems holding data in formats that are not easily used by other systems, and partially based on outdated laws and policies. There are significant privacy and trust issues that need to be overcome before we can effectively leverage large ecosystems of data for broader uses.”v

Microsoft’s recent ‘Healthcare, artificial intelligence, data and ethics: a 2030 vision’ report identified the need for a foundation of trust and communication of the benefits that broader use of patient data is already delivering. “Linked to this, the use of artificial intelligence (AI) in the healthcare context is already raising a series of important societal and ethical questions which we will need to address now,” says Bonfiglioli. She regards this as critical to ensure respect for existing norms as well as the development of norms for emerging issues.

Bonfiglioli believes that Microsoft has an important role to play in this debate. “We are confident that these new technological developments can be harnessed for social good, to deliver unprecedented improvements in many aspects of our healthcare. But we also understand our obligation to play a role in the important conversations that must take place if we are to balance new opportunities with established and emerging social norms and regulatory frameworks.” 

In this respect, she argues that Data Commons is an emerging need for health organisations, to allow for new approaches to data-sharing and governance, “built upon open and interoperable data platforms uniquely equipped to accelerate research and advance science.”

Moving data to the cloud is a crucial part of modern health information management, but trust in the cloud is under continuing pressure. A recent report by Cloud Security Alliance (CSA), ‘Treacherous 12 Threats to Cloud Computing’, listed data breaches among the top cloud threats, specifically breaches caused by system vulnerabilities, malicious insiders, and shared technology vulnerabilities.

Microsoft is engaged in several initiatives to address these concerns, says Bonfiglioli. “In November 2017, in an effort to facilitate greater sharing of the many questions around key health issues, we convened a year-long consultation with a series of discussions with stakeholders across Europe. The goal was to exchange practical ideas on the design of a European framework that maximises the benefits to all from the use of health data. We have also drawn from our collaboration with the European Cloud in Health Advisory Council to advocate for an environment which allows healthcare institutions and patients to reap the benefits of data-driven health care.”

The rise of digital devices in healthcare is part of an ongoing shift in public health management. According to a study by Transcend Insights, 64% of patients use a digital device to manage their health, forcing providers to rethink their strategy for patient engagement. Microsoft and Innofactor worked with HUS in Finland to develop a digital twin of a hospital, servicing 1.6 million people across 20 specific conditions. Patients were treated remotely with digital tickets prescribed by the doctor, with symptoms navigators, virtual consultations and remote monitoring.

“The intelligent cloud and the intelligent edge have a lot to offer to the health sector, as well as to the transformation of other sectors,” says Bonfiglioli. “As the physical and virtual worlds are increasingly interwoven, more powerful and ubiquitous computing will power seamless experiences that are distributed, event-driven, and serverless. In 10 years, everyday devices will be connected – smart devices that can see, listen, reason, predict and more, without a 24/7 dependence on the cloud.”

The need for data security is growing as advances in machine learning capabilities and modern cloud computing platforms fuel the development of health applications of AI. “Microsoft Azure became the first cloud platform to enable new data security capabilities that protect customer data while in use,” says Bonfiglioli. “The Azure team, alongside Microsoft Research, Intel, Windows, and our Developer Tools group, have been working together to bring Trusted Execution Environments (TEEs) such as Intel SGX and Virtualization Based Security (VBS - previously known as Virtual Secure mode) to the cloud.”

Many companies are moving their mission critical workloads and data to the cloud, drawn by the security benefits that public clouds provide, she says. “Azure Confidential Computing is aimed at protecting data while it’s processed in the cloud. It is the cornerstone of our ‘Confidential Cloud’ vision.”

Healthcare delivery using bots is on the rise in today’s data-rich environment, creating a seamless link between patients and health service providers. “Microsoft Healthcare Bot service offers Conversational AI for Healthcare that is built especially for the healthcare industry,” says Bonfiglioli. “The service is designed to empower healthcare organisations to build and deploy AI-powered virtual health assistants and chatbots that help them improve processes, enable self-service to users and reduce costs. It can be applied to scenarios like triage and information intake, based on built-in medical protocols, or own protocols.” 

Early initiatives are already showing impressive results. At Karolinska, a leading Swedish hospital, Sigma and Microsoft developed a tumour-board solution leveraging Teams-based care coordination scenarios, allowing doctors to take faster and better informed decisions before performing pancreatic cancer surgeries, leveraging real-time info from electronic medical records, real life videos from patients, images and more. 

“In a different scenario, Merck researchers interact hands-free with a smart Bot to call up standard operating procedures and compliance requirements in the lab without ever taking their sight off the task at hand and being more efficient to troubleshoot and solve problems in real time.” 

The integration of bots in traditional healthcare systems leads to optimised clinical operations by coordinating people and assets more efficiently, enabling employees to respond to issues in real time and solve them pre-emptively, Bonfiglioli says. “It’s transforming the care continuum and enabling precision medicine by embedding technology and tools directly into services to enable higher quality of care and lower per capita costs.”

Partnership is central to the Microsoft business model for health, which engages with 12,000 health partners and over 168,000 customers. “Through partnership we can build on economies of scale with platforms, data, and creating a collective knowledge,” says Bonfiglioli. “Microsoft is transforming healthcare by developing innovative, patient-centric technologies and cloud-based services to improve access and patient outcomes while protecting privacy and meeting compliance standards at every step of the patient journey.”

But this checklist of positive outcomes will not happen without the right conditions in place. “The first step is to make sure organisations invest in the right underlying technology foundation,” she says, citing the establishment of appropriate data stewardship as an essential step in this regard, accompanied by enabling the platform infrastructure in the cloud, and embracing a ‘cloud first’ policy.

“This is about trust as gatekeeper to innovation that saves lives,” says Bonfiglioli, “focusing on experiences, not the digitisation of processes but imagining new processes altogether as trusted online experiences that put the person at the centre. After all, it is about people: citizens, patients, clinicians, researchers and their stakeholders. It is about us and new ways of doing things.”