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Features

Cutting-Edge Technologies
that Could Reshape
HTM and Health IT
Jeff Kabachinski

About the Author Healthcare technology continues to evolve, pharmacy, purchase the medication
affecting how healthcare technology manage- blueprint and chemical compounds, and
Jeff Kabachinski,
MCNE, MS-T, is
ment (HTM) and healthcare information print medication in their homes—in
senior director technology (IT) staff function as it is intro- essence doing “for the discovery and
of technical duced into facilities. This article provides a distribution of prescription drugs what
development glimpse into several eye-opening technolo- Apple did for music.”2
at Independent gies that are positioned to have wide-ranging • Medical models. Researchers are working
Technical
effects on HTM and health IT. to recreate tumors from magnetic reso-
Development in Charlotte, NC. Email:
jlk22@roadrunner.com nance and computed tomography scans, in
3D Printing in Healthcare order to give surgeons the ability to prepare
Although three-dimensional (3D) printing is for and shorten surgeries. This research
no news flash, here are a few noteworthy also is expected to one day allow for
examples of how it's being used in custom-generated implants.2
healthcare:
• Human tissue and blood vessels. Harvard Others research advancements in bioprint-
University has continued to make progress ing include gaining the ability to print heart
with bioprinting, announcing in March
2016 that it had the ability to print vascular-
ized living thick tissue, as well as to inject
bone growth factors to induce the growth
of bone cells.1
• Custom prosthetics. Low-cost 3D printing
enables more patients to be able to afford
what were typically expensive and labor-
intensive prosthetic devices. These
3D-printed prosthetics also can be custom-
ized easily and delivered to the patient
quickly.2
• Medications. Louisiana Technical Univer-
sity has found success printing bone
cancer medications at the molecular level.
In addition, the University of Glasgow is
looking toward a future where patients can 3D printing has allowed customized prosthetics to be
enter a digital prescription at their online produced quickly and inexpensively.

140 Biomedical Instrumentation & Technology March/April 2017

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valves, ear cartilage, cranium replacements,
synthetic skin, and livers. In addition,
surgical tools, including hemostats, forceps,
and clamps, have been 3D printed. These
instruments come out of the printer already
sterile and at 10% of the cost of the typical
stainless steel equivalent.3
Nanobots in the Bloodstream
Think of it: Tiny robots as big as white blood
cells swimming around in your blood with
their own sensors and propulsion systems.
They’re fighting bacteria, delivering chemo-
therapy more effectively, carrying oxygen, or
repairing cells. Get out your microscope and
microtools to service and repair nanobots! Or
as in the old movie Fantastic Voyage, we could
shrink the HTMs into a miniature subma-
rine in order to complete the preventive
maintenance inspections on the robots.4
mHealth
mHealth (mobile health) technology, includ-
ing a slew of mobile apps, has given patients
the capability to remotely access health
information and manage appointments,
prescriptions, and test results. Other
advancements in mHealth include the ability
to communicate with care providers using
video conferencing over the Internet, allow-
ing physician to treat patients who are unable
to schedule an in-person visit. The takeaway
for HTM is that due to the requisite Internet
access—and the inherent privacy and
security risks present in mHealth—effective
cybersecurity is paramount.5
Interoperability and
Clinical Informatics
If realized, interoperability would be a true
game changer for healthcare. For full
interoperability to become a reality, health-
care systems and devices, including
disparate electronic health record (EHR)
systems, will need to be able to easily share
and interpret data. This advancement would
allow better continuity of care among
providers, giving them a more complete
view of a patient’s past and current health
and therefore leading to improved out-
comes. It also would help foster precision
medicine, giving clinicians the ability to
provide customized and individualized
Features
treatment plans.
“Big data” is being collected from EHR
systems, and we are beginning to be able to
analyze it—a process called clinical informat-
ics. After deidentifying patient data, clinical
informatics seeks to evaluate the database to
arrive at usable, actionable information. This
process enables healthcare providers to, for
example, craft best practices for certain health
conditions, trend blood test results across
providers, and compare digital microscope
images for patient care, research, and medical
education. Clinical informatics also is growing
into subspecialties such as nursing, nutrition,
Video conferencing over the
Internet has broken new ground
in giving patients access to
physicians, but the privacy and
security risks inherent in mobile
health technology underscore
the importance of strong
cybersecurity.
pharmacy, and medical informatics.
An important consideration for HTM and
health IT professionals is the immediate
effect of big data on the systems needed to
support, store, manage, move, sort, and
calculate it. In addition, the interpretation of
big data might vary from one facility to
another. Big data might mean a couple of
hundred gigabytes to a few terabytes at one
facility. Other facilities might only start to get
challenged at a couple of hundred terabytes
and forced to consider new data management
and storage choices to grow from there.
This quote from the Institute for Opera-
tions Research and the Management
Sciences perhaps sums it up best: “Analytics
asset management will emerge as a major
challenge … Analytics data, models, findings
and recommendations are corporate assets,
and these assets require continuous manage-
Biomedical Instrumentation & Technology March/April 2017 141
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Features
ment in order to deliver a stable source of
financial return for firms.”6 And that’s where
HTM comes in.
SDN in Health IT
Software-defined networking (SDN) is a
concept to virtualize network devices, such as
switches and routers.7 As in most things
electronic, the operating network has two
main aspects. First is the hardware portion,
from wires and antenna through chipsets to
the speaker on your phone. Called the data
plane, it boils down to the set of devices and
functions that forward packets to the right
places at the right time. The second aspect is
the control plane (or software portion), where
OpenFlow is a protocol, or application programming interface,
that modifies forwarding tables in network switches. Like the
hypervisor, OpenFlow fits between the switch hardware and its
controlling software.
all the decisions are made as to how, when,
and where to forward the packets. This is a
fundamental model of hardware and soft-
ware working together.
Virtualization separates the hardware and
software connection with what is known as a
hypervisor. The hypervisor controls the
communication between the data plane and
control plane. In this way, the data plane can
be shared by several control planes. Each
control plane assumes it has sole control of
the data plane and is unaware of other
control planes sharing the data plane.
In alignment with the virtualization wave,
what if we could run the control plane and
some of the data plane in software? Let’s
separate the control and data planes from the
network devices themselves. This idea has
been getting more widespread promotion
since the advent of the open-sourced Open-
Flow Switch Specification. OpenFlow is a
protocol, or application programming
interface, that modifies forwarding tables in
network switches. Like the hypervisor,
OpenFlow fits between the switch hardware
and its controlling software.
SDN also applies these concepts to net-
work function; for example, it can be applied
to an unprogrammed network router box.
142 Biomedical Instrumentation & Technology March/April 2017
With OpenFlow, it looks for the packet’s
destination address and defines a table entry
with associated attributes that can create a
particular path or flow through the network,
which the packet and subsequent packets are
to follow. The table becomes a flow listing,
where a flow defines end points and the path
or some other action to take. It can do this
because it knows the entire network map and
can plan it out in advance. A new router
would get this as a set of rules that will
configure the device. Each device would use
the information according to its type. A
router will update its IP access lists, a switch
would see and use the MAC address tables,
and a firewall would update its rules.
This allows programmers to program the
machine code of network control software in
high-level languages like Python. This leads
to the next level, where central processing
units and systems can reconfigure them-
selves on the fly to best suit the task at
hand—accurately called a framework for
innovation.
“The benefits of SDN are especially
valuable to healthcare organizations because
[they address] their needs for nimble applica-
tions development, reduced management
complexity, enhanced security and simplified
compliance, among others,” according to
Nuage Networks. “This makes it much
simpler for the IT organization to satisfy
government compliance requirements, such
as those mandated by the Affordable Care
Act.”8
Solid-State Memory
Will solid-state drives (SSDs) ever completely
replace hard disk drives (HDDs)? Other than
cost, SSDs have everything going for them.
Most notably, unlike HDDs, they don’t have
mechanical parts that can wear out. In
addition, because of the lack of moving parts,
SSDs are quiet, are more physically robust,
are much smaller, and use less power. The
biggest advantage of SSDs is that they allow
for ultrafast data transfer while maintaining
random accessibility.9 On-chip densities also
are getting higher. For example, Intel
announced that in 2013 it was building chips
on 14-nm technology and that they were
planning to ship 10-nm technology in 2015
and 7-nm technology in 2017. In terms of
 © Copyright AAMI 2017. Single user license only. Copying, networking, and distribution prohibited.
SSD, this can only mean higher densities and
more memory in smaller, less-power-hungry
formats at a lower cost.10 It can be difficult to
imagine how small a nanometer really is. For
comparison, if the earth represented a meter,
a nanometer would be the size of a marble.11
The Flash Durability Issue
Over time, with many read/erase/write
cycles, the oxide layer in the logic (individual
transistors) starts to degrade from spurious
electrons that are cast off during a read,
erase, or write operation. Is this a cause of
concern? In the author’s opinion, too much
is made of degradation. It’s related to how
many read/write cycles the transistors can
handle before the oxide layer degrades to a
point where the memory cell holding elec-
trons becomes unreliable. Called a program/
erase (P/E) cycle, the maximum number of
cycles can be as low as 2,500. Intel rates its
flash memory based on 10 GB being erased
and rewritten every 24 hours for 365 days.
This equates to about 22 total P/E cycles per
year. Therefore, 2,500 cycles divided by 22
cycles per year works out to 113 years. Even at
more than doubling this rate (48 cycles per
year), it’s still a 52-year lifespan.12 Will SSDs
degrade and wear out? The answer is “yes,”
but it appears to be much longer than the
mechanical life span of HDDs (usually 4–5
years).
One important utility to mention is TRIM.
You should look to see if the SSD you’re
thinking about buying uses TRIM. TRIM
manages file deletion efficiency somewhat
like garbage collection—but on the fly. If you
delete a file at the user level, it affects many
pages spread around memory blocks. TRIM
will take any remaining pages from an
affected block and temporarily store them in
cache, then go back to purge the entire block.
Once cleaned out, TRIM recovers the other
pages from cache and orderly puts them back
in the same block, allowing the rest of the
system to efficiently add new pages. This
process helps to maintain maximum effec-
tiveness and data transfer speeds.9
Finally, here are a couple tips for preserv-
ing your SSD. 1) Turn off indexing. There’s
no need for constant surveillance in reading/
tracking what’s in memory, as we’re already
running at incredible speeds. 2) Ensure your
Features
operating system and drive controller are
using TRIM. 3) If you’re a defragger, resist
the urge to defrag your SSD. It’s a useless
effort in SSD and you’re ultimately using up
read/write cycles.
Mind Transfer and Head Transplants
Yes, you read it right. Research is in progress
for downloading an entire brain’s worth of
information—only 20,000 TB—including the
connection patterns of a thousand or so
synapses. However, due to the many varia-
tions in brain function and the mapping of
the 85-billion neurons, human brain simula- Staying in the Know:
Suggested Websites
tion will most likely need to wait for super
computers to get more super. • www.aami.org
Researchers also think it’s possible to • www.technation.com
remove someone’s head and connect it to a • www.24x7mag.com
decapitated body of another person. Then, • www.himss.org
simply reanimate the new head to the new • www.healthcareitnews.com
body. Researchers think this will be possible • www.healthit.gov
in two years! However, I have not been able
to determine if it’s Dr. Frankenstein in
Transylvania leading the research.4
Will FIDO Eliminate Passwords?
Fast IDentity Online (FIDO) is a way to do
away with passwords. FIDO is a standards-
based open protocol supported by an alliance
of companies that will
eschew the antiquated
password process in lieu of Due to the many variations in brain
the FIDO authentication function and the mapping of the
process13 “Down with 85-billion neurons, human brain
passwords” is the battle cry of simulation will most likely need to
the Petition Against
wait for super computers to get
Passwords group. Its objec-
tive is to bring awareness that more super.
the system of hashed pass-
words is outdated and can be
easily hacked. The group also encourages
plans and proposals for the next generation
of passwordless authentication options.14
One of the main aspects of the process is
the authenticator device on your PC or
smartphone that has the FIDO-specific
“secret” that’s part of the nonspoofable
identifier. Your authenticator is verified by
the FIDO-compliant relying party or website
where you have an account. For most
websites, this single-factor authentication
will be all that’s needed—you’re logged in
normally at this point. Two-factor authentica-
Biomedical Instrumentation & Technology March/April 2017 143
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Features
tions are when FIDO asks you to perform an action to verify
that you’re the owner of the authenticator device. This can be
a personal identification number (PIN) or fingerprint scan.
The two factors include something you know (e.g., PIN),
something you have (e.g., the token or authenticator device),
or something you are (e.g., your fingerprint or another
biometric). Again, all of this is performed locally rather than
negotiated online.
Holographic Images
The EHR is becoming more common, to the point that
physicians are spending as much time during a patient visit
typing into the record as they do in direct patient care. A
holographic image of a keyboard allows the healthcare
provider to retain clean practices when treating patients,
reducing infections from unclean surfaces like keyboards.
Other uses of holographic images are in recreating patients’
organs. For example, holographic images of a patient’s heart
could help surgeons plan surgical procedures, resulting in
faster and more efficient surgery.4
Summary
Data storage costs are continuing to decrease and analytic
tools are proliferating rapidly. These trends will result in new
methods for dealing with a number of developments
described here—big data, SDN, mHealth, interoperability,
and FIDO—as well as make better use of faster and more
robust memory.
In no way does this article address all of the new technol-
ogy that will be descending upon HTM and health IT.
Readers are encouraged to set routine appointments to
explore the websites listed in the sidebar. By keeping an eye
on emerging technologies, we can be ready when they land
on our doorstep. n
References
1. Harvard John A. Paulson School of Engineering and Applied Scienc-
es. Scaling up tissue engineering. Available at: www.seas.harvard.
edu/news/2016/03/scaling-up-tissue-engineering. Accessed Dec. 7,
2016.
2. Meskó B. 12 Things We Can 3D Print in Medicine Right Now. Avail-
able at: https://3dprintingindustry.com/news/12-things-we-can-3d-
print-in-medicine-right-now-42867. Accessed Sept. 8, 2016.
3. The Future of Things. 7 Major Advancements 3D Printing Is Making
in the Medical Field. Available at: http://thefutureofthings.com/8973-
7-major-advancements-3d-printing-is-making-in-the-medical-field.
Accessed Sept. 8, 2016.
144 Biomedical Instrumentation & Technology March/April 2017
4. Referral MD. Biggest Innovations in Health Care Technology in
2015. Available at: https://getreferralmd.com/2015/02/the-10-biggest-
innovations-in-health-care. Accessed Sept. 8, 2016.
5. University of San Diego. 8 Technologies That Are Changing Health-
care. Available at: https://onlinedegrees.sandiego.edu/8-technolo-
gies-changing-healthcare. Accessed Sept. 8, 2016.
6. Analytics Magazine. 2012 predictions: banner year for big data,
healthcare analytics. Available at: http://analytics-magazine.
org/2012-predictions-banner-year-for-big-data-healthcare-analytics.
Accessed Dec. 7, 2016.
7. Lippis N. Lippis Report 173: Software Defined Networking The
OpenFlow Way, Grabs Industry Attention. Available at: http://lip-
pisreport.com/2011/06/lippis-report-173-software-defined-network-
ing-the-openflow-way-grabs-industry-attention. Accessed Dec. 7,
2016.
8. Nuage Networks. Frequently Asked Questions: Understanding the
Benefits of SDN in Healthcare. Available at www.nuagenetworks.net.
Accessed Sept. 15, 2016.
9. Fitzpatrick J. What’s a Solid State Drive (SSD), and Do I Need One?
Available at: www.howtogeek.com/howto/45359/htg-explains-whats-
a-solid-state-drive-and-what-do-i-need-to-know. Accessed Sept. 15,
2016.
10. Mujtaba H. IDF13: Intel Showcases 14nm Broadwell CPU Powered
Laptop and Haswell-Y-Broadwell Chips to Ship by End of 2013. Avail-
able at: http://wccftech.com/idf13-intel-showcases-14nm-broadwell-
cpu-powered-laptop-haswelly-broadwell-chips-ship-2013. Accessed
Sept. 15, 2016.
11. Newton H. Newton’s Telecomm Dictionary. New York: Flatiron
Publishing; 2011.
12. Wikipedia. Flash memory: NAND memories. Available at: https://
en.wikipedia.org/wiki/NAND_flash#NAND_memories. Accessed
Sept. 15, 2016.
13. Leddy W. Run, FIDO, Run: Alliance Works on Non-Proprietary
Authentication. Available at: www.tmcnet.com/voip/departments/
articles/336051-run-fido-run-alliance-works-non-proprietary-authenti-
cation.htm. Accessed Sept. 15, 2016.
14. Higgins KJ. Campaign Launched to Kill Off The Password.
Available at: www.darkreading.com/vulnerability/campaign-
launched-to-kill-off-the-passwo/240158879?cid=NL_DR_Week-
ly_240158879&elq=5d37e58ab39d4936ab810f59bfae7927. Accessed
Sept. 15, 2016.
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