Speakers:
Professor Jim McDonald Principal of Strathclyde University - Introduction
Professor David Wyper NHS Technology Pull
Professor Patricia Connoly Strathclyde Institute of Medical Devices
-Minimally Invasive Monitoring
Professor John Soraghan Strathclyde IEEE Dept and CESIP (signal processing)
- Clinical Facial Monitoring
Dr Mark Begbie ISLI - Autonomous Sensor Systems
Douglas Anderson CEO OPTOS
– Developing and commercialisation of Healthcare Technology
John Gilchrist Gilden Photonics
– Medical Applications of Hyperspectral Imaging
Janette Hughes Wellness and Health Innovation – future challenges.

Organisers
The University of Strathclyde
ISLI
Wellness and Health Innovation
Department of Health



These are my notes and thoughts on a complex series of presentations. They are not thorough, and reflect my personal views, but they do convey the key points of the day.
Executive Summary and authors comments
The challenge that this type of event is working to overcome is simple. Those with knowledge of the problems (typically medical staff) have little or no understanding of what technologies may be brought to bear to solve the problems, however those with good ideas or technology have no way of identifying what the problems are.
In other words there are medical conditions or hospital processes that could be significantly improved upon, however as no technology exists to affect an improvement the status quo is not challenged. On the other side there are technology companies who may have new IP or are simply looking at “healthcare” as an addition to their business model. They have no way of knowing what problems they can solve, and consequently have nothing really to sell. This event tries to build bridges.
When I have listened to Industry technology experts give opinions on where the opportunities lie in healthcare they tend to reach the same conclusions. They go for easy options which appeal to mass markets such as the worried well. We talk about heart monitors that communicate via the mobile phone to our GP or perhaps simple equipment in the home to monitor vulnerable people. These low hanging fruit require little innovation to make them work. The real barriers to these ideas however are legislative or are in system ownership and not is system design.
A medical expert raised a very real question during our debate, which the technology companies had given no thought to. Let us say that a remote monitor detects that an individual may need medical attention. Who owns that decision?
This seems a simple problem, however it is actually very difficult to answer. Engineers are used to a straightforward go / no go decision tree based upon measureable criteria, with trend analysis and distribution curves etc. Medicine does not work like that. Doctors are presented with vague feelings and use very fuzzy logic. The NHS only wish to intervene if someone is actually ill. It is not their job to comfort the worried well.
Let’s ask this same question from a different angle. Your monitor detects some negative data. Later on you get ill. Who do you sue for inaction? Your GP? Your private insurer? Your IT provider? This is a real issue for remote health, who is responsible for looking at the data. It is often difficult to get a GP appointment when you are ill, never mind just maybe ill.
What was eye opening at this event is the plethora of potential applications for technology intervention. The trouble is that it needs a clinician to explain what the need is.
This event highlights the real need to improve dialogue between technology owners and medical staff. The golden rule for any tech company is – go in with your eyes and ears open. You do not need to have an application in mind, just the will to succeed.
And, according to a number of experienced voices, a lot of patience and a deal of money.
In short this is not an easy route to diversify your company’s market portfolio if your current market is getting a bit risky. If however you do commit to the health market you also have the comfort that it is huge and growing and , whilst competitive, will be there for a long time.

1. Technology Pull from the NHS Professor Dave Wyper
NHS Glasgow develop technology for use in wards, theatres, health centres, homes and R&D labs. Often they articulate the need and then supervise the application, however they farm out the product development.
For example, the Insulin Pen injection device was developed by NHS Glasgow to improve the self management of diabetes patients. Once the need had been identified a design company, Hypoguard developed the product and a third party (Nova) provided the channel to market.
A second example would be in stroke and head injury rehab’. A powered standing frame was designed as the answer to aiding patients to rise up from a seated position. Insignis Ltd in Paisley designed the product with sales of over 300 in the UK so far.
These are two quick examples of a high volume market and niche market product technology that is demand led by the NHS. For more opportunities follow the Health Technologies KTN link for technical requests.
The current focus is upon novel clinical measurements and test equipments for existing medical devices (calibration or repair).
Often the process improvement requires an acute understanding of the system flaws. E.g. Hearing Aids for Doctors. It is not that doctors are deaf, however many of their patients are. The idea is that the doctor can (without shouting and losing her voice) can simply place a speaker of some sort on the ear of the patient and then talk normally to allow a partially deaf person to hear her clearly.
Another simple suggestion is the conversation prompter. Many patients who are too ill to talk much, but can listen, have to suffer interminable boring diatribe from well meaning visitors. Often repeating the same story. The idea is for a prompter with simple controls which the patient can easily use to alert the visitor to change the subject!
Other demand led products require more injection of science, for example there are UV cabinets which provide automated dosimetry for psoriasis, however there are no test systems to calibrate them or to confirm to the medical team that the required dose is delivered.
All of these ideas and equipments are being generated within the NHS now and yet the UK seem poor at commercialising these needs. In the field of osteoporosis the standard tests could take up to 3 years to conclude. A system was sought that could measure this in real time. Scotland had the idea but it was eventually commercialised by a German company who now sell the equipment.
To combat this in future the Glasgow Health Technology Cooperative (GHTC) has been set up.
If you are considering medical equipment as an outlet for your company. This would be a great place to start.

2. Minimally Invasive Monitoring Professor Patricia Connoly
Head of Strathclyde Institute of Medical Devices
Why minimal invasion?
• How do you check the whole population without resort to expensive testing?
• Can you test at home cheaply?
• We may be looking at blood or heart diagnostics.
• This will benefit the patient and the health care costs.
For example – Glucose.
Portable electromechanical meters came on stream in mid 1980’s (UK technology).
The next stage however needs to be continuous monitoring (not reliant on the patient remembering to do the test and to work out the dose). The latest sensors (e.g. Dexcom Sensor) requires the injection under the skin of the sensor which lasts 3 days. This is a $Bn market but is still invasive and expensive.
The new idea is for Transdermal Monitoring. The skin is nano-porous and conductive. Using reverse Iontophoresis screen printed electrodes with a programmable current source you can analyse the ions that come through the skin to check for glucose and lactate. (and possibly other measurements for other illnesses.) This non-invasive system would be real time, accurate and much cheaper to administer. It ought to be commercialised in the UK!
A second research programme is within the area of wound management for acute & chronic wound treatment.
(This is where the engineers in the room were shown some graphic images of nasty wounds – well out of our comfort zone. We decided to do physics and not biology for our highers for good reasons. Not looking at weeping pus was one of them!)
Wound management is a serious business worth some £2.6Bn per annum!
There is a large population of patients, many are self medicating at home.
The challenge is moisture balance, too dry and the wound cannot heal, too wet and the wound will rot! There is no technology to measure the moisture level accurately.
SIMD spent three years (2001 to 2004) in developing a base technology that can measure accurately.
A further three years was spent in developing a sensor which then had to enter medical trials.
In 2009 Ohmedics has been spun out of Strathclyde to market their disposable sensor.
This activity demonstrates that in many medical technology applications the time to market can easily be a decade, so this is not a quick fix for a temporary market slump in another sector. You may need to commit many years of development, for which you can get government support. There are risks of course – but the rewards can be potentially huge.

3. Clinical Facial Monitoring Professor John Soraghan
Strathclyde IEEE signal processing. CESIP (Centre for Excellence in Signal & Image Processing)
7 academics and 30 researchers.
They create the algorithms that run the engines for the machines.
Application in Biomed research models, MRI, ECHO, ECG, EEG, Sleep Apnoea, Auscultation, hearing.
CESIP collaborate with many hospitals.
They have developed the Glasgow Facial Palsy Scale.
How do you measure the severity of palsy and categorise this between 1 to 5? The standard system is very subjective and simply requires the medic to look at the patient and decide how affected the patient is. i.e. how drooped are the features. The problem is that diagnosis between different medical staff will vary and even one doctor may have a different view between appointments. The challenge was to develop an impartial and repetitively accurate system. CESIP have developed a system using a simple video camera. Using an algorithm loaded into a pc the image is then processed to determine the scale of the palsy. All you need to do is buy the license and upload the software from a disc and you have a measurement system that works!
This idea is successful in that the technology required to make it work is a pc and any video camera, highlighting the “low cost” approach to problem solving.

4. Autonomous Sensor Systems Dr Mark Begbie
ISLI (Institute for system level integration) a collaboration of Edinburgh, Herriot-Watt, Strathclyde and Glasgow Universities.
The top level driver of Moore’s law applies to microchips and hard-drives, however the same logarithmic growth is also applicable in other technologies such as the complexity of satellites or the number of sensors in vehicles.
Additionally the history and the near future of mobile phones demonstrates the convergence of technologies into one ultra small yet ultra smart system. The latest handheld products include phone, pc, camera, music player, navigation system and now with MEMS devices (the equivalent of Victorian engineering on a micro-chip!) you can include motion sensors and potentially chemical sensors.
It would seem likely therefore that future autonomous sensor systems are likely to be built into the mobile phone (or whatever we call it by then as it is a long time since the primary function was solely phone calls). You can also then use the mobile network and the internet to communicate data to and from any medical system. Data such as Cardiac parameters, glaucoma monitors, glucose monitors. All of these may well become an “APP” for the next generation of phones.
This “star trek” future seems inevitable and tantalisingly close. Most of the innovation and technology is already out there. Bear in mind though the comments at the start of this report. If thousands of otherwise “healthy” individuals start to collect billions of pieces of data. Who will take the legal responsibility of analysing this data? And would you want your insurance company to get hold of it? This technology could be used to determine the onset a diabetes, but equally it could be used to prevent you from starting your car if the system says you have too much alcohol in your system, the computer says NO!

5 Opportunities in Healthcare Douglas Anderson
As Chairman of Crombie Anderson and founder of Optos PLC ( a £50M medical tech company) Douglas is well placed to give the inside story on medical technology development and commercialisation.
There exists a $4Bn market for Optos’ very narrow product line demonstrating the potential market rewards in the healthcare field even for niche market product.
When a GP examines your eye the maximum field of view (by peering at your retina through the iris with a bright light) represents a maximum of 1/200th of the eye surface or 0.5%. Additionally these examinations are subjective – what is normal and what is not depends often on a doctor’s point of view and experience of a particular disease. This test can be enhanced by adding a chemical to the eye to dilate the pupil, allowing for a wider field of view. However this more invasive test is rarely completed as it is expensive. The undiluted eye test (most common) has less than 30% of the sensitivity of the diluted test. The goal of the Optos development was to design a system that would make the undiluted test equivalent to the diluted whilst at the same time giving any GP the data to be as accurate as a specialist.
The drive behind the Optos product was personal experience. When market research was done into the product the medical practitioners agreed that the product was unnecessary.
Optos required 24 separate cash injections over a 15 year period prior to flotation of its scanning laser technology.
The system makes everyone into a retinal specialist and can detect eye disease and symptoms of many other illnesses like bowel cancer or stroke risk. The system is gaining respect.
It has not been easy. Outsourcing production too early cost the business £5M and two years of delay, let alone the bad press. Now they have 150 service engineers in the USA and a purpose built training centre to train the clinicians to understand the system images.
Thus far they have conducted 21 million exams using 4,000 machines in US, UK, Canada, Germany & Scandinavia. The channel to market is to give the machine to the hospital for free and charge per treatment which is not how the company originally envisaged the business model.
This revealing talk emphasised again, that for big ticket technology there are many hurdles, a lot of pain and risk but eventually high reward.
The lesson is that you need to know what you are committing too when you take investors money to develop a new medical product. Management of expectations is a primary skill in the development of a new business in this arena.

6. Hyper-Spectral Imaging Dr John Gilchrist Gilden Photonics.
Hyperspectral imaging is about measuring a rainbow, from UV through to past Infra red.
The goal is to collect a full spectrum from each pixel for both quantitative and qualitative analysis – for some purpose. The grey scale (black to white) tells you how bright the pixel is whilst the three primary colours (RGB) give you colour. Hyperspectral however defines 500 pieces of data per pixel and is routinely available now. Even some cameras have these systems.
The push-broom spectral camera works in a whole range of frequencies. The camera can visualise chemical configuration – not just shape and colour – but what is the subject made of!
John showed some photographs which initially looked like some off colour normal images, a bit like a highly accurate night vision camera image. “So what” I thought to myself. We were shown an image of the outside of a wooden house with streetlamp and trees and sky etc. John then explained that this image is not just a visual representation, the camera can detect what type of paint is on the streetlamp – just by looking at it! i.e. The chemical composition. Once you grasp the idea (maybe I was a bit slow) that this is a real time chemical imaging system you start to understand that massive potential in all sorts of applications from security to baking cakes and whatever process you need to control!

7. Future Challenges in Healthcare Janet Hughes Wellness & Health Innovation
Some facts about the near future of our healthcare systems.
• Current healthcare models are not sustainable as our demographic shifts to older people.
• We need to design a new model urgently.
• Some diseases such as diabetes are growing as more young people are acquiring this and needing life-long treatment.
• Philips / Intel / GE all have spotted the trend and are spending big dollars to re-align their business model to exploit this growing market.
• Any system must keep people out of hospital (and healthy)
• Current rough estimate is £700 per night in hospital versus £700 per week at home.
• Independent living is therefore a priority.
• Maintaining a healthy workforce (that is ageing) also becomes a corporate demand.
• A greater need to own your own health!
• Early diagnostics to reduce long term costs.
• Self management of complex drugs.
• Telecare
• A shift from treatment to prevention.
And who are the customers for the technology to deliver this new model?
The patient, the carer, the family, local authority, community health partnerships, NHS, care homes, Insurance companies and employers.