Scalpel, clamp, VR headset: A surgeon’s quest to fix healthcare

    Healthcare education is getting a revamp

    Shafi Ahmed, a cancer surgeon at Bart’s hospital in London, is making waves with his innovative use of Virtual Reality (VR) in healthcare. Here, he tells IoB why VR, Augmented Reality (AR) and Internet of Things (IoT) are set to take the defibrillator to a sleeping industry.

    Shafi Ahmed is not your ordinary surgeon. Far from it. Indeed, how many surgeons do you know that spend half their time in theatre, and the other half working for two technology start-ups?

    Perhaps we shouldn’t be surprised. After all, this is the man who made headline news in 2014 when he live-streamed an operation using Google Glass, with this being watched in real-time by 14,000 students in 132 countries.

    He followed that up this April, becoming the first surgeon to broadcast a live surgery in Virtual Reality (VR). He carried out this surgery, which involved cutting off a tumour from a man in his 70s, with a 360-degree camera rig mounted over his head, capturing every movement in his point-of-view at almost 4K resolution. If that wasn’t daunting enough, this operation was being watched by over 50,000 people in real-time. There simply was no room for error.

    In addition to the day job, today Ahmed is director and co-founder of Medical Realities (which is developing Google Glass for telemedicine and tele mentoring), and founding partner of Virtual Medics (which has built a Virtual Reality platform for surgical training).

    Ahmed spoke exclusively to Internet of Business about these industry-leading case studies, and how newer technologies like AR, VR and IoT will fundamentally challenge the perceived way of providing medical care.

    Technology and healthcare

    Ahmed is a keen adopter of new technology, but admits that implementing new ideas in an NHS hospital is not an easy task.

    There’s the difficulty of convincing management of the benefits of the project, while compliance and regulation must be considered at all times. Then there’s the technical challenge of hooking up new systems, new sources of data, with the existing technology stack.

    “There’s a lot of technology out there, a lot of amazing stuff being developed, but quite how you translate that, how you make it work…that’s always been challenge for the NHS, and for me,” he told IoB.

    “We’ve been stuck with dogma and tradition for many years in medicine. We don’t challenge things enough, we’re not disruptive enough. We accept mediocrity, and in my opinion things need to be challenged and moved on. The whole education training has gone bit stale.”

    Yet with obstetricians now looking to use the Internet, and mobile devices, he believes that AR and VR can help to train the surgeons of tomorrow.

    “I think education has been continuum from paper to books, to computers, mobiles and iPads. AR and VR are natural extensions for all of those ideas. It’s a new platform to create new educational content.”

    Related: Meet the man who hacked his own healthcare monitor

    First case study: Google Glass training for 14,000 people

    Ahmed’s first project, in 2014, was to use the fledgling Google Glass device and a customised app to livestream an operation, of him removing a tumour from the liver and bowel of a patient.

    He wore the device during the operation, with the stream watched in real-time by thousands worldwide. Students were able to type questions as these watched, with these appearing on the bottom left-hand side of Ahmed’s wearable device. He answered these questions verbally as he proceeded with the operation. 90 percent of students watching the broadcast said they wanted this type of learning to be part of their curriculum.

    Looking back now, Ahmed is proud of the surgery, but he admits there were teething issues. He says his hospital were a “little wary” of the project at first, while there was the personal challenge of doing a live operation with thousands watching your every move.

    “The first operation was a bit uncomfortable, you are thrust upon the global stage,” he admitted. “It was a great demonstration of what could be done. That was an augmented reality (AR) approach using simple headsets, and then we moved onto VR.”

    Second case study: VR live-operation

    Apple, Facebook, Google and Samsung are just some of the big Silicon Valley technology giants pumping serious money into Virtual Reality, but Ahmed saw the technology’s potential to move beyond gaming and entertainment and into the B2B world.

    His operation this April saw people download Mobile Realties’ mobile app (via Google’s Play Store or Apple’s App Store) and then watch the operation using the $5 Google Cardboard device.  The app was also available to users of Samsung’s Gear VR headset.

    The camera rig was provided by Greek company Mativision (who also did the MTV Music Awards), with their software also stitching the 360-degree image together.

    “The demonstration there was that we could use VR, which is hi-tech, and convert to low-cost tech model for people so it could be used around the world.

    “I think it’s quite ironic, and that was the beauty of it. It was the cusp of the VR revolution. It seemed to capture imagination of public completely”.

    The operation was viewed by 55,00000 people in 140 countries and 4,000 cities. Ahmed says the narrative ‘struck a chord’ with the public.

    Technically, the project was smoother than he perhaps expected.

    “We tested the equipment, the bandwidth, the computer and the streaming, and actually all seemed to work reasonably well, even streaming in terms of the bandwidth and Wi-Fi in hospital was fine for this venture.

    “The camera rig we had was one of the few in the world that could livestream and stitch together 360-degree video.”

    The camera rig was suspended above the patient, and had six lenses. Pictures were stitched together and streamed in real-time.  Ahmed says the latency was ‘good’, although he said picture quality could be better (it was meant to be 4K, but ended up at nearer 2K). The hospital had considered using two cameras, but bandwidth was cited as a potential issue, so the idea was dropped.

    Critically, he added that measures were put in place in case of disaster: “We did put a one-minute delay in the feed of case of any potential catastrophes…which was part of governance issues we had.”

    Operation challenges for me and the team

    Ahmed, a keynote speaker at the upcoming Internet of Healthcare, says that, in addition to the personal and technical challenges of this surgery, getting the hospital on-side was vital. Ethics, confidentiality, the legal framework and patient consent all had to be taken seriously, and mitigating risk was front of mind.

    “You have to acknowledge each one (challenge) in turn, and make sure you cover all bases and that you’re doing right thing, and that you are not creating risk unnecessarily, or at least you are mitigating risk where it may arise.

    “We went through the whole process to make sure the hospital was supporting this venture, and I was lucky Bart’s is a very forward-thinking and supportive hospital in that sense.”

    He urged fellow practitioners to drive innovation – so long as they take their hospital with them.

    “You have to drive it, you have to have a vision and be bloody minded… but you can’t do these things in isolation.”

    Related: Huge growth expected in IoT healthcare market

    IoT: Connecting man and machine

    Ahmed believes that new technology in healthcare should be embraced, so long as you ‘take the system with you’. In particular, he believes that the Internet of Things (IoT) could lead up to an age where everything and person is connected.

    “If you look at what happens in future, its biosensors, monitoring remotely, its telemedicine, the future is going to drive nanotech. If you think about the patients, we need to empower them.”

    In San Francisco recently, Ahmed met a firm developing a pad-based biosensor that sits on the skin, sending back data to a paired smart phone. This data can include oxygen and blood lactate levels.

    “Suddenly you are connected constantly, that is the IoT,” said Ahmed, although he adds that this vision could ultimately be a few years off. Indeed, speaking to IoB, he admits that while data could be streamed back to GPs in the future, whether they are ready for this is another conversation entirely.

    Nonetheless, he sees secondary care as a huge opportunity for the IoT. Speaking at an event in London earlier this year, he said:

    “Imagine a world we don’t need to see the person for follow-up, it’s better for us and the patient. Suddenly we might decide the whole outpatient appointment can be done remotely, becoming more cost effective.”

    He said that it will be ‘a while’ before the benefits of IoT are truly understood in primary care, and the processes around it (such as who alerts the patient, how these alerts are managed, and what fail-safe mechanisms are implemented to prevent disaster).

    A future of AR, VR and AI working together

    “AR, VR and AI working in parallel will change almost everything. All three will be introduced over time, partially driven by technology companies and early adopters.”

    Ahmed in collaborating with companies around the world, in North America, South East Asia, the Middle East and Africa. His mission is to improve educational content, and he’s excited by the potential of AR, biosensors and exoskeletons.

    All of this may sound like something straight out of Back to the Future, but Ahmed is adamant that innovation is possible, if driven by clinicians. He encourages peers to drive the change, to work with hospitals and tech hubs – even if it means governance and legal frameworks lag behind.

    “You need to be visionary, look around and see what’s going on. And you need to take the system with you.”

    Shafi Ahmed may not be that ordinary surgeon – but perhaps he’s the first of a new breed.

    Taking place in London on the 21st-22nd September, the Internet of Healthcare will examine how IoT is supporting clinicians to improve efficiency and raise the quality of care.

    Through real-life case studies, workshops and roundtable discussions, explore the future of healthcare alongside pre-qualified healthcare leaders– including NHS England, WHO, Dubai Health Authority, and more.