With 5G able to deliver high bandwidth and very low latency, vital signs could be streamed to medical equipment or screen monitors during surgical training with almost no delay. A private network – or network slice – would support thousands of medical devices simultaneously (sensors, mobile devices, medical equipment, surgical cameras, high-resolution medical imaging, etc.), all of which could connect to a central cloud platform or server without network congestion.”
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In June 2018, Professor Prokar Dasgupta, Professor of Robotic Surgery and Urological Innovation King’s College, London, led a prostate surgery at Guy’s Hospital, London. While it is a common procedure, Professor Dasgupta was in an entirely different part of the building at the time of the surgery.
Present at the operating theatre itself was Malaysian urologist Dr. Warren Lo and an expert medical team. Dr. Lo operated on the patient using the state-of-the-art da Vinci robotic surgical system. He manipulated four modular and highly manoeuvrable robotic arms via a sophisticated, wired control unit.
Dasgupta observed the surgery in real time from his location and directed Dr. Lo via an extended reality (XR) interface that “projected” his hand gestures onto a high-resolution video feed that Dr. Warren and his team were looking at in the operating theatre.
But Dr. Lo, now a consultant urologist at Gleneagles Hospital, sees a future where not just the tele-mentoring portion of the surgery – but control over the robotic surgical system itself – is done remotely, wirelessly, and with near imperceptible delay over a 5G network.
“Consider the key elements that make up this remote, robotic surgical system. There is the high resolution, XR-enabled livestream capability between two locations and the control over the machine itself. There will come a point when I could be sitting in a room with a control unit, manipulating a robotic surgical system located in a different building, perhaps even in another city.
“Assuming both locations are covered by 5G networks and the surgical system is slaved to my control unit via a common software suite, remote robotic surgical applications could actually go mainstream.”
This, Dr. Lo says, would mitigate the problems of scarcity of robotic systems in general (there are fewer than 6,000 da Vinci machines in service globally), and a lack of medical specialists who are further qualified to safely handle these sophisticated machines for surgical applications. There may come a time when a cardiologist in Petaling Jaya “scrubs-in” and operates on a patient in Seremban.
NEXT-GEN MEDICAL TRAINING
“Assuming both locations are covered by 5G networks and the surgical system is slaved to my control unit via a common software suite, remote robotic surgical applications could actually go mainstream.”
Dr. Warren believes 5G networks could unlock exciting remote surgical applications
This tele-mentoring aspect of the procedure has been replicated over a 5G network elsewhere in the world. In October 2019, Spanish telco operator Telefonica successfully livestreamed seven digestive endoscopy surgeries between Spain and Japan, over a 5G network. The procedures were conducted by a surgeon in Malaga under supervision and with advice from his Japanese counterpart all the way in Osaka, Japan. Telefonica’s 5G set up allowed the entire demonstration to be livestreamed in 4K ultra high-definition (UHD) and with near imperceptible delay despite the vast distance.
Tele-mentoring is uniquely suited to medical schools and teaching hospitals. A UHD and near instantaneous livestream would allow for large numbers of trainees to dial-in and remotely observe senior specialists in other states/countries.
This allows for a level of interactivity that does not exist with pre-recorded sessions. Trainees can ask questions, interact with the surgeon, and might even influence patient outcomes for the better.
“Such instantaneous knowledge transfer enables cardiologists in Malaysia to learn new techniques from their counterparts overseas,” says Chua Yong Howe, Chief Digital Officer of Edgenta Mediserve Sdn Bhd (Edgenta). The company provides various tech-enabled, cloud-based support services to over 300 hospitals in Asia.
Image quality and lag time are crucial considerations when livestreaming cardiac procedures. The video feeds typically employ a 3D-colour mapping system for greater detail and depth perception. In order for the service to be reliable, these videos must be livestreamed to the cardiologist at the other end without any loss of visual fidelity and in near real time. This enables the cardiologists remotely supervising procedures to identify areas of concern and accurately determine the location of the treatment.
Tele-mentoring is uniquely suited to medical schools and teaching hospitals. A UHD and near instantaneous livestream would allow for large numbers of trainees to dial-in and remotely observe senior specialists in other states/countries.
Dr. Warren Lo and his team prep a patient for robotic surgery
It also allows trainees to view near real-time outputs of multiple monitoring equipment such as a point of view camera, a fluoroscopic navigation system, a 3D-heart mapping system, and the graphical displays of an electrocardiogram machine to better guide junior specialists performing surgical procedures.
Outside of training hospitals, tele-mentoring would help address the longstanding problem of a lack of specialists in the general population. A tele-mentoring service running over a reliable 5G network with sufficiently wide coverage would make specialists more accessible to rural areas of the country, be it for teaching or consulting with general practitioners.
“Tele-mentoring mainly caters to medical specialists and doctors by enabling and extending the reach of specialised training. It helps increase the pool of medical specialists which in turn enables greater patient access to specialist care, especially for patients in rural and semi-urban areas,” says Dr. Nik Fawaz Nik Abdul Aziz, Edgenta Managing Director.
A NEW SPIN ON OLD TECH
In many ways, tele-mentoring was ahead of its time. It isn’t a new concept and for Malaysia, dates back to the Multimedia Super Corridor’s Telemedicine Flagship Application back around 1996.
It never caught on in the nineties because most videoconferencing systems back then communicated over 384 Kbps dial-up ISDN (Integrated Services Digital Network) lines. Video streams tended to suffer from 700ms delays between continents, resulting in a poor viewing experience with long buffer times. Moreover, video camera technology was relatively low resolution and the overall setup was expensive. These bottlenecks can now be overcome with 5G speeds of up to 10Gbps and very low latency (<10 milliseconds).
But why would healthcare providers adopt 5G private networks when most public and private hospitals already have some combination of fibre broadband connection, in-house Ethernet wired LAN, and wireless WiFi connections?
According to Prem Kumar Menon, Head of Enterprise Strategy at Digital Nasional Berhad (DNB), managing a complex Internet of Medical Things (IoMT) network for critical patient-centric services will require a shift away from legacy, general-purpose telco networks to a dedicated 5G private network (or 5G network slice) that provides enhanced mobile broadband, low latency, and no compromise in security.
“Older hospital buildings would have been designed before wiring the facility for internet access, making fibre-based upgrades an expensive proposition. The lack of mobility and reliability in existing connectivity solutions make it impractical for hospitals to incorporate next-gen technologies that demand high bandwidth and low latency.
“In this regard, healthcare providers can either incorporate a comprehensive 5G private network into their facilities or opt to be covered by a smaller network slice, assuming they don’t require scale. 5G network slicing can give healthcare providers access to highly customised networks, tailored to their specific requirements, which can be governed by a service level agreement.”
Network slicing refers to the provision of a dedicated virtual network with functionality specific to a particular customer, over a common network. This is an effective strategy to build and manage a network to meet new and emerging needs from a wide range of users.
Prem adds that traditional fibre, wired LAN and WiFi connectivity could not support a facility’s advanced healthcare needs, which would typically consist of a large volume of medical wearables and portable devices, all of which have high mobility requirements and are bandwidth intensive. The more high-end technologies are introduced into a healthcare facility’s IT infrastructure, the more robust and reliable the networks need to be.
Courtesy of Digital Nasional Berhad
“With 5G able to deliver high bandwidth and very low latency, vital signs could be streamed to medical equipment or screen monitors during surgical training with almost no delay. A private network – or network slice – would support thousands of medical devices simultaneously (sensors, mobile devices, medical equipment, surgical cameras, high-resolution medical imaging, etc.), all of which could connect to a central cloud platform or server without network congestion.”
DIAGNOSIS IN-ABSENTIA
Vodafone launched a Telemedicine Programme in 2013, which it implemented across 100 remote mainland regions and islands. More than 500 doctors general practitioners were trained under the programme with over 51,000 examinations conducted since it began.
75% of patients reported fewer hospital visits, 53% said primary care in their area had improved, 51% noted an improvement in diagnoses, and 89% said their health had improved in some way. A further 90% of doctors said it enabled them to provide better quality care to their patients, while 73% said it enabled more efficient primary care and 68% said it reduced congestion in regional hospitals.
Remote patient monitoring, if delivered as a 5G-enabled suite of services, could take the concept mainstream and significantly alter the patient-doctor relationship.
In Malaysia, AINQA Health Sdn Bhd is enabling RPM at home by providing patients with various Bluetooth-enabled devices such as a glucometer, blood pressure monitor, pulse oxygen saturation monitor, non-invasive blood pressure monitor, thermometer, weighing scale and an electrocardiogram monitoring device.
Patients perform the required readings at home using these devices. They would all be connected via Bluetooth to a 5G-enabled “gateway device” that would be available in the patient’s home. This gateway device then transmits the patient’s readings to a hospital’s data centre or cloud network, allowing doctors to monitor readings in near real-time via a virtual dashboard on a computer or smartphone.
According to Saravanan Govindasamy, Director of Consulting at AINQA Health, a 5G network could support the growing number of health-based wearables and the volume of transmitted data in near real time. “There are significant potential cost and time savings for users as a result,” he says.
On average, he adds, a patient with a non-communicable disease (NCD) needs roughly five appointments a year, each involving a 20-minute consultation. Consider then, a family of five with two middle-aged parents, two school-going children, and a grandparent living with them. Suppose the father suffers from hypertension, the mother is diabetic, and the grandparent has several NCDs, while the two children are healthy except for the occasional fever.
A home-based RPM service replete with various “plug-and-play” devices would save the family time and money that would otherwise be spent travelling for medical appointments. They would all be able to receive care and accurate diagnoses at home and would only make physical visits when absolutely necessary. Certain patient home monitoring systems also allow doctors to remotely monitor patients’ vital signs on an ongoing basis and trigger an alarm should their blood pressure drop unexpectedly or if no movement is detected for a length of time.
Doctors could obtain continuous clinical insight and would be able to detect problems early on. “Multiple research projects have shown that with proper monitoring, lifestyle adjustments and medication, patients with NCDs can live long and happy lives,” Saravanan says.
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