SHARPEHR

Digital Twin Overview

An AI enabled (Virtual Human) VH-EHR Digital ecosystem capability

Opportunities & Challenges

High level description of the SHARPEHR project

SHARPEHR (Simulated Human Anatomic Registry of Personal Electronic Health Records)

An AI enabled (Virtual Human) VH-EHR Digital ecosystem capability

The SHARPEHR research and delivery capability program is unlike any existing EHR system capability on the planet. It is a future-proof expandable capability that will follow a citizen from the cradle to their life span’s end. (And with appropriate data permissions, further human anatomical research and learning can be undertaken with such historical data for the betterment of the Australians and global society).

The SHARPEHR outcome is a personal patient record facilitating PHR development.  A photorealistic simulation facilitating security/records management.  The longitudinal history, facilitating evidence-based medicine abstract. A visual interactive 3-D image of a specific person (patient) that contains all the data/information (structured & unstructured, anatomy, physiology, pathology etc) from existing electronic health records (EHR). The image that is produced we define as a Holographic 3D VR Virtual Human view of any patient. Our AI-VH/EHR (AI-Virtual Human EHR); is, in a certain sense, an intelligent avatar in virtual reality. Unlike a virtual avatar which is anthropomorphic, the virtual human (VH) is anthropometric. The 3-D image is derived from high resolution 3D scanning to reflect individual body habitus, and is populated with every named element of human gross anatomy. Thus, when relevant, any clinical data that relates to an explicit structure (e.g., surgical resection of a lung lobe, left Supraspinatus rotator cuff injury) is collocated at that site within the virtual body. Other data of whole body or regional nature) e.g., the latest panel of blood values, pelvic MRI) are stored and retrieved from the body image itself. The virtual human/EHR (VH/EHR) acts as human interface technology (HIT) which is a visual intuitive interface for the data that is easily understood by the patient and their physician. As data is added (either from a stored paper/pc health record; EHR or from real-time streaming from sensors and monitors), its visual representation changes to demonstrate the updated status of the patient. The repository (EHR) data can also be used to personalize patient treatment, and to visualize likely outcomes of drug-drug interactions, show growth of a tumour over time, or predict likely outcomes of surgical procedures. As a HIT, it can be added to most any type of EHR record and provide clinical applications, such as consenting complex medical therapies or surgical procedures to the patient in an easily understood fashion, or for surgeons to do pre-op planning and surgical rehearsal simulation of challenging surgical procedures. (You first or the Virtual you first)

The above of course can be many things.

In essence the “virtual humanising” of a patient’s body for continuous EHR data input, storage, retrieval and interaction with same in VR/MR/AR begins with:

A 3D high-resolution model is created to reflect the individual’s body habitus; this is then populated with every known element of human gross anatomy. This would be from libraries of DICOM data as well as morphologic reconstructions such as the Visible Human Project. Any new clinical data for a patient that relates to an explicit structure is co-located at/to the site within the virtual body. This results in an individualized anthropometric virtual human record.

Expertise and methods from different disciplines will be brought together and integrated in pursuit of our objectives.

Regarding integration of social sciences and humanities, relevant expertise from the social sciences, economics and/or humanities will be included, e.g., for spatial studies, ethics, interpretation, human geography, demography, economics, business administration and marketing, communication, education, political sciences, law, psychology, or sociology.

Depending on the content required, this can be done by staff from our own partnership, associated partners, or through an advisory board or other committee; for example it may be appropriate to dedicate a separate work package or “task” to this aspect. To ensure a good integration of social science and humanities expertise into the project, the relevant researchers will be involved from the very beginning in the formulation of the problem and the project design. We are aware of the challenges associated with highly interdisciplinary projects and will proactively address them.

Building upon the actual project’s demonstration of the totally novel concept to use a photorealistic 3-D anthropomorphic avatar of an individual patient as the EHR data repository, we envision the following intermediate- and long-term impacts congruent with emerging healthcare IT and delivery trends:

  • Visualization by the patient of his/her “digital twin” as the frame of reference for the aggregation of one’s clinical history provides a personalization factor now missing in flat-file EHR products
  • The visual image will afford data reliability and assurance about patient identification as EHR interoperability becomes better established and patients present in diverse care locations
  • Effective communication between patient and provider, now often a glaring disconnect, will be improved as diagnostic/therapy/outcomes discussions are had in the context of the patient visage
  • The value of this same personal context of communications extends to the clarity/confidence of patients/caregivers to understand the outpatient/home care and recovery instructions/procedures
  • The anatomical paradigm for clinical data I/O offers a visual paradigm for personalized patient education pre-/post-treatment, reducing the likelihood of misinformation from Internet searches
  • Patient access and input to their own healthcare data, already a key issue, will be advanced by our blockchain-secured digital twin EHR available for constant wearable health device data input
  • As care-at-home regains societal and economic priority, the individualized virtual patient makes full access to clinical data realistic anywhere outside the silos of hospital system EHR products
  • Patients seeing their data within their virtual self is empowering, furthering the growing trend of meeting them where they are, through portals, telehealth, RPM*, etc., not at the clinicians’ locus
  • Growing adoption of our innovation will afford metadata aggregation and AI analytics of both global and unique subset digital twin datasets, contributing greatly to improved, impactful CDS**
  • Creating our EHR de novo enables inclusion of elements missing in current EHRs such as social determinants of health factors, data from genetic studies, behavioural/mental health variables, etc.

*Remote Patient Management

**Clinical Decision Support

Requirements and Potential Barriers

The remarkably diverse, advanced and sophisticated spectrum of expertise and experience offered by our partners relative to our project proposal affords a level of competence and preparedness meeting and exceeding all our requirements for the successful conduct and completion of our proposed initiative.

This research and delivery program will super charge; and enable the Health and Life Sciences, Digital Technologies, digital health and the wellbeing space including home care.

It will clearly unlock the full potential of new tools, technologies and digital solutions for a healthy society.

Future outcomes currently planned in our pipeline beyond the SHARPEHR delivery will be:

  • Interactive VR-MR medical assessment which will engage and deliver clear understandings between a doctor/specialist/nurse/first responder and the patient.
  • The delivery of realistic humanistic empathy nurse training modules for any patient gender, age and issue presentation.
  • Additionally, the ability to undertake surgical practise and preparation on the digital twin of the patient prior to actual surgery.
  • Delivery of exponentially better anatomical/diagnostic teaching and learning outcomes for medical and nursing students, as well as for specialist accreditation and skills assessment.

Our TRL is 5.

We have a patent; and

We have Significant knowhow

VIRTACH’s CTO, Robert Rice, Ph.D. is a Professor of Anatomy and was contracted by NASA from 1996-2004 to create precise VR anatomical/biomechanical simulations of Space Shuttle astronauts showing ROM within the spacesuit, and tactile (Haptic) interaction with both human and mechanical simulation elements. The program was terminated in 2004 due to the 2nd Shuttle disaster; Dr. Rice was granted the IP and US patent rights related to use of virtual anatomy to model human factors/biomedical engineering. He has been with VIRTACH since 2000.

BALTECH has a significant scientific advisory board:

  • Dr Richard Satava. Prof. Emeritus of Surgery, University of Washington (Senior Scientific Adviser)
  • Dr Brian Athey, Prof. and Chair, Dept. of Computational Medicine & Bioinformatics, Univ. of Michigan
  • Prof. Norman Eizenberg, Prof. of Anatomy, University of Notre Dame, Australia; Head of Anatomedia company

A potential barrier to a more advanced ambition of the proposed EHR development is the timely development of fine motor skills haptic capability; VIRTACH is working with Generic Robotics UK (GR) and the Robotics Lab at the University of NSW; who will be subcontracted when required. Among the three groups we have the technical expertise to deliver this advanced haptics outcome, and we have been and are working collaboratively on this capability. This level of haptic interaction within simulations is required to deliver surgical and medical practise training and procedure preparation down to the human tissues level of tactile fidelity. This outcome will exponentially improve the training and education of medical, dental and nursing students, the competence and confidence of medical and surgical specialists, and skills assessment for certification, relicensure, and new procedure training. Additional time and funds may be required to achieve these outcomes. Our project plan will specify, if we are successful in this Stage 1 process, what additional time and funds may be required.

Responding to this bold initiative and challenge, a novel, open-source EHR as we propose overcomes the current intrinsic obstacles to cross-border interoperability. Rather than the constraints of the unique design, programming, performance and data I/O mechanics of each commercial or governmental EHR product now in use in the Australia, our format is both individual and universal, the anthropomorphic virtual avatar of each citizen, each patient.

The anatomy of the human body is universal (with technical ability to modify each avatar according to health history), age, gender, and body habitus precisely reflected in each virtual patient. Clinical data access is immediately available to any category of provider at any geographic location, organized under the rubric of human structure which is congruent with the presenting signs and symptoms that inform diagnostic and treatment decisions. There would be a personalized record of each Australian resident that has the visual appearance of the individual (which helps to avoid the danger of mismatched clinical data), as unique as a driver’s license or a health insurance card. In the present and future conduct of healthcare delivery the EHR is essential, but available products must undergo fundamental transformation to remove obstacles to providers’ delivery of optimal patient care and to realign clinicians’ focus from reactive treatment of the sick to proactive management and maintenance of the healthy. Our delivery of an innovative next-generation model may catalyse progress toward that goal as physician numbers drop, patient numbers soar, other providers slowly get expanded licensure, and equitable healthcare access for diverse populations remains elusive, with unsustainable and negative global socioeconomic and clinical facilities and care delivery resource consequences if such challenges and widespread trends are not addressed. Our innovative EHR solution will contribute directly and positively to that transformation both in Australia and a worldwide scale.

The Market

The Global Electronic Medical Records Market is expected to register a CAGR of 7.5% during the forecast period (2021-2026). Moreover, factors, like rising need for integrated healthcare system, big data trends in healthcare industry, and technological advancements in the field of data storage are driving the growth of the EMR market.

Benchmarks:

  • A 2015 report 3 by PwC estimates that digital health could save the EU €99bn in healthcare costs.
  • The same report indicates that digital health could enable 11.2 million people with chronic conditions and 6.9 million people at risk of developing chronic conditions to extend their professional lives and improve productivity. This would add a further €93bn to the EU’s GDP. (Health Europa, Digitalizing the Healthcare Ecosystem in the European Union, June 2020)
  • In a US study; the lack of access to, and interaction with, Cadaveric and living anatomy for medical education and skills training is leading to significant misdiagnosis freefall.
  • Globally misdiagnosis causes over half a billion deaths PA, 220 thousand+ in the US alone, costing over 80B dollars PA

We (VIRTACH) believe; The SHARPEHR (Simulated Human Anatomic Registry of Personal Electronic Health Records) AI enabled (Virtual Human) VH-EHR Digital ecosystem capability; can redress all of the benchmarks above.

Peter Moon

CEO VIRTACH LTD UK

Summary of existing material

1116917609_VIRTACHBusinessConceptPPT.pptx VIRTACH Develoment PPT.pptx VIRTACH Vision Overview PPT.pptx