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Unlocking the full potential of healthcare with software research at Lero

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Researchers at Lero are discovering how software engineering can help healthcare catch up to the digital age.

Our world is one where healthcare revolutions come in many forms. Penicillin, insulin, vaccination, the discovery of DNA – the list goes on. All of them have shaped the way we conceptualise and treat our bodies, and the way clinicians treat their patients. The field of medicine is rapidly advancing, and yesterday’s science fictions are now in early trials.

What, then, is the role of Lero, the Science Foundation Ireland research centre for software? Hosted by the University of Limerick, Lero’s research covers everything from driverless cars and artificial intelligence to cybersecurity, fintech, gov-tech, smart communities, agtech and health-tech.

But what can software engineering and computer programming offer healthcare? Connection, digitisation and integration are just some of the benefits.

‘I talk about technology supporting, not replacing’
– PROF ITA RICHARDSON

Lero researchers have a plethora of health problems they would like to solve with software. A recent example involved a public health nurse arriving to check on an elderly patient. Of the 15 minutes assigned to the visit, thirteen minutes were spent recording the details required for a new mattress. After taking down this information, later to be transcribed to an online system, the nurse did what she could for the patient in the short time left.

The following day, the nurse was shopping and noticed a shipment of bread being delivered. The barcodes had all of the information needed for the process and were quickly scanned with a handheld device. Why did this similar process take less than 10 seconds, while the health system had no such ability? Why not scan the mattress, and send this information to the system?

For all of our amazing advances, there is a disconnect that hampers our healthcare. Technology is of no help if the user doesn’t have sufficient access. A profile of health problems is futile if it is stored on an inaccessible paper file. A treatment plan for a brain disorder lacks efficacy when it is misplaced or, worse still, never recorded for a patient. A doctor can’t analyse information they never received. And this is all too often the world we live in.

Our healthcare system is handicapped not by a lack of understanding or ability, but by inadequate communication systems that can’t cope with the volume or sophistication that must be accommodated. For Lero, software is the answer.

An ear for surgery

Our world is one where sound is abundant with information. Auditory analysis can map the seabed. The depth of a turkey’s ‘gobble’ might infer how many kilograms it weighs. And, most importantly to mechanical and medical engineer Dr Daniel Riordan, sound can tell a surgeon when to stop scooping bone marrow from a femur.

When a hip is being replaced, the ball of the ball and socket joint is sawn off. Its replacement is put in, and a stem is inserted into the femur to attach it. If the stem is inserted directly into the soft marrow, there will be some wobble and an instability in the hip. As a result, it is necessary to scrape out the marrow until the stem can be secured. If too little marrow is taken out, the hip won’t be secure. Too much, and the bone will crack.

Currently, surgeons performing a hip surgery replacement know when to stop by the sound and feel of the instrument inside the bone. There’s no precise measurement or feedback system. No exact way to know when the surgery is finished. There is just a sense from the tactile and auditory feedback, honed from years of experience.

New medical students practise with fake limbs before levelling up to pig bones (the closest animal analogue) and then onto human cadavers before finally taking the reins in the operating theatre.

Dr John Rice is an orthopaedic surgeon with years of experience in the process, and Lero’s team hope to replicate his ear in software. By recording auditory information as well as the level of success of the surgery, Riordan hopes to replicate this feedback system and empower other surgeons with Rice’s finely tuned experience.

‘The real research is the AI to make this work, to understand every bone and every person’
– DR DANIEL RIORDAN

Capturing Rice’s inherent knowledge of hip surgeries has the potential to save years of surgery training. But giving software this auditory intuition isn’t easy. Hips vary. People vary. Some are taller, some are wider, some are older. All of these factors affect the acoustics of the bone as if it was a musical instrument. Capturing the variation requires as many surgeries as possible. Riordan reckons it would take 100 participants for the software to be effective but the more, the better.

“The real research is the artificial intelligence to make this work, to understand every bone and every person. This project has a duration of four years, and if we find positive results, we would be looking at contacting teams that make surgical robots,” said Riordan.

Paging Dr Google

Our world is one where the knowledge gap between doctor and patient hinders both sides. Patients will try to help a doctor understand their situation in as much detail as they know to provide, but doctors are often left playing medical detective, picking up what they can in an effort to provide cure, care or both.

The more driven patients will take to Google to self-diagnose and speed the process along, as well as advocate for themselves. Practitioners, in response, will fall into one of two camps: those who dismiss the search results as unreliable, and those who parse through the information and evaluate through a medically trained lens.

From a doctor’s perspective, the problem with Google is multi-layered. Its search algorithm is not optimised for accuracy or balance. What’s more, many of the articles will be inaccessible due to medical jargon.

Lero is working to close this patient-doctor information gap. Dr Marco Alfano’s objective is to design an intelligent platform that will empower patients to act as their own advocate. This involves translating existing medical texts so they can be understood, and filtering existing web search results with an algorithm that reflects a patient’s needs, rather than a commercial driving force. It also involves fostering a medical understanding, as well as patient-to-patient relationships, and connecting communities.

As Alfano points out, very few of these needs even require innovation. What’s needed is a coherent design that can be given to patients. The technology is already there, if only it can be integrated.

He and his research team have been working on a prototype website. He types ‘diabetes’ into the custom search engine and the results are ranked on various degrees of accuracy and quality, with the logic of their ranking explained. He then takes this information and feeds it into the team’s text translator. Difficult words are highlighted and a brief explanation of tricky medical terminology is included. Medical files, textbook definitions and doctor’s comments suddenly make sense. He brings up a diagram of the human body, where he can point and click and assign an ailment in an effort to diagnose.

The technology is there. The knowledge is there. And integration could mean diagnosis and treatment is within reach.

Patient-led design

Sometimes the practice of healthcare is older than the technologies and techniques that comprise the system. Digital imaging files and results from advanced analytical techniques are often kept on paper. Physical space constraints can mean that the file is all too often out of reach when needed. Patients’ voices, if heard at all, are lost to mountains of paperwork and a system not yet digitised.

Lero’s work, however, is distinctly patient-driven. This philosophy is no more prominent than in the research conducted by Prof Ita Richardson and Dr Jim Buckley.

Richardson works on software processes for groups in need. These have included diabetics, people with mild intellectual disabilities, and the ageing population. By talking to these cohorts alongside their medical professionals, Richardson hopes to build apps that reflect what people need, rather than what software producers think they need. She acknowledges that many patient-generated apps have been amazing, but often fail to comply with EU regulations surrounding data safety and accessibility. And as these accessibility guidelines are more than 100 pages long, it is easy to understand why.

A man in a blue check shirt smiles as he leans with his back against a large tree.

Dr Jim Buckley. Image: Alan Place/Fusionshooters

Once data-compliant, patient-led apps have been designed and implemented, Richardson said the benefits are almost immediate. In the case of an app designed to measure a diabetic person’s weight, blood pressure and glucose levels, patient outcomes improved purely through the process of recording data and visualising it in graphs. By seeing how their blood sugars improved after a walk or with a healthier meal, patients implemented their own interventions.

Even the simple act of recording the data is valuable. And Richardson said the goal would be to feed this data back to the doctors to reduce the visits necessary and relieve stress on both patient and doctor contact hours.

“I talk about technology supporting, not replacing,” said Richardson. “Diabetes patients need to meet with their doctor for medical assessment. That’s different than needing to have their blood pressure checked every six weeks. They need to work out medically how often they need to meet.”

Reaching out to the relevant groups, fostering relationships and getting real-life patient feedback is key to what researchers call PPI: public and patient involvement. Through this process, needs can be understood, accounted for and integrated. It can also take researchers down unconventional routes.

Richardson told me of one colleague working with mastectomy patients who joined the Shannon Dragons, a group of Dragon Boat rowers. Rowing is particularly beneficial to those who have undergone mastectomies as the upper body and arm workout is essential to rehabilitation.

‘One of the big battles is adoption’
– DR JIM BUCKLEY

Buckley, on the other hand, is involved in the Covigilant project to evaluate the Irish public’s attitude to the Ireland’s Covid-19 tracking app. He and his team have been seeking out the public’s opinion on different aspects of the app. What works well and what doesn’t? What are their worries? What would they like to see implemented? They have no hypothesis or point to prove – their work simply aims to find out how people genuinely feel about the app on their phone.

The Covid Tracker Ireland app is likely the healthcare app people have become most familiar with. Developed by Waterford company Nearform for the Irish Government’s Health Service Executive (HSE), there is no weightier example of an app coming from the top down.

“One of the big battles is adoption. You want to get people adopting it, and people using it,” said Buckley. “My job isn’t to coerce people to use it, but to evaluate how it is perceived and see best international practice. And to feed that information back to the HSE so that they can consider the insights for future evolutions of the app.”

The first results of the Covigilant study found that 82pc were supportive of the app and intended to download it. The study also revealed fears, largely around data protection and privacy. However, after deployment, user reviews on the Apple and Google Play stores indicated that the public’s perception of the app, in terms of data protection, was favourable.

Lero researchers continued to seek people’s opinions in order to configure the app moving forward, often with interesting insights.

The Covid-19 tracker app isn’t without its flaws. An earlier iteration saw it draining the battery of thousands of Android phones, which was a big blow to adoption. A fix was applied within days, however, and the real strength of integrated health came to the fore.

While old systems can exist for decades with delays and issues, Lero hopes to put patient needs first and fully utilise every opportunity on offer. They hope to revolutionise healthcare using what is already there – the software that can unlock its full potential.

By Sam Cox

Sam Cox was named the science and technology winner in the 2020 National Student Media Awards (Smedias). This award category is sponsored by Science Foundation Ireland and includes a €1,000 bursary to support and encourage up-and-coming science and technology journalism.

The 2021 Smedias are now open for entries. The deadline for applications is 15 April 2021.

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I can’t charge my electric car cheaply because I’m too close to an RAF base | Money

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A few months ago I decided to switch energy supplier and moved to Octopus Energy’s Go tariff, principally because it offers cheap electric car charging overnight at a rate of 5p/kWh.

I applied to have the required smart meter installed. But after being given a date, I was later declined on the basis that smart meters cannot work at my address because they interfere with the missile early warning system at RAF Fylingdales.

Initially, I thought this was a joke. I have been involved with the construction of hundreds of new homes in Teesside, all of which have had smart meters installed.

Smart Energy GB, the body responsible for the rollout, has confirmed that this is very real, and smart meters installed in the area will not have had their smart capacity turned on.

I was told that a new meter is being worked upon and will eventually replace those already installed.

Meanwhile, I am having to charge my car at a premium rate of 16.76p/kWh which is costing me about £26 more a week than it would be on the Go tariff.

AM, Guisborough

Given that your house is more than 20 miles from the RAF base in question, I, too, was amazed that this could be an issue, but it is – and also in other areas close to bases.

Smart Meter GB has confirmed this is the case and says it is working on a solution – a communications hub that will enable people living near sensitive RAF sites to use smart meters.

It says these will be offered to customers “in the coming months”.

It adds those in the affected area, who had already had smart meters installed should be able to have the hubs retrofitted.

Meanwhile, Octopus has come up with a solution for your problem. It has offered to add you to the trial of these new meters, which, in turn, will allow you to go on the Go tariff.

It says it hopes to install your new meter before Christmas. It has also said that if you get the log from your charging firm, showing how much electricity you have used for the car since the switch took place, it will retroactively apply the savings that you would have gained had the smart meter worked from the start – a generous offer.

We welcome letters but cannot answer individually. Email consumer.champions@theguardian.com or write to Guardian, 90 York Way, London N1 9GU. Include a phone number. Letters are subject to our terms: gu.com/letters-terms

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China’s Yutu rover spots ‘mysterious hut’ on far side of the Moon

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Cube-shaped object is probably just a rock. Yutu will check it out anyway

China’s Moon rover, Yutu 2, has sent images of a strangely geometric object.…

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Strikepay struck gold at National Startup Awards 2021

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Strikepay, founded by fintech entrepreneurs Oli Cavanagh and Charles Dowd, scooped the top award for its fast-growing cash-free tipping tech.

Irish fintech company Strikepay has scooped the top prize at this year’s National Startup Awards.

The start-up, previously called Strike, was founded in 2020 to enable cash-free tipping without the need for a payment terminal or a new app on a customer’s phone.

Its founders, fintech entrepreneurs Oli Cavanagh and Charles Dowd, raised €625,000 in seed funding earlier this year and said they intended to seek a further €6.5m in investment by the end of 2021.

Strikepay has already begun acquiring and collaborating with other companies to bolster its product offering. In June, it acquired UK payments rival Gratsi and in April it appointed former Just Eat exec Edel Kinane as its chief growth officer.

Earlier in the year, it teamed up with Camile Thai Kitchen to enable contactless tipping for food delivery drivers and partnered with mobility company Bolt to bring its cashless tipping technology to taxis in Dublin.

Strikepay was one of several winners at the awards ceremony, which was livestreamed last night (2 December).

Other winners included health-tech start-up Stimul.ai, customer analysis tech business Glimpse, and sheep monitoring start-up Cotter Agritech, which has been participating in a new accelerator programme at University College Dublin.

As well as taking the top award, Strikepay also won Best Fintech Startup.

This year marked the 10th year of the National Startup Awards. The event was sponsored by Enterprise Ireland, Microfinance Ireland, Sage, Cronin Accountants and McCann Fitzgerald.

Last year’s top award was given to drone delivery service Manna. The start-up had been working with companies such as Tesco, Just Eat and Camile Thai to test its drones, and has seen further growth since then.

The full list of winners at the 2021 awards, in order of gold, silver and bronze, are:

Startup of the Year 2021

Strikepay

Early Stage Startup

Imvizar, CyberPie, The Fifth Dimension

Emerge Tech Startup

Xunison, Helgen Technologies, LiveCosts.com

Fintech Startup

Strikepay, ID-Pal, Itus Secure Technologies

Food and Drink Startup

Fiid, SiSú, Thanks Plants

Social or Sustainable Startup

Altra, Peer, Fifty Shades Greener

Product and Manufacturing Startup

Cotter Agritech, Orca Board, Filter

E-commerce and Retail Startup

FinalBend, The Book Resort, Nufields

Tech Startup

Glimpse, LegitFit, Examfly

Medtech Startup

Stumul.ai, SymPhysis Medical, Bonafi

Covid Pivot or Response Startup

Zoom Party/Find A Venue, KSH Group, Streat School

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