Medical use of sensor-based devices, the debates around and implementation in education

Medical Use of Sensor-Based Devices, the Debates Around

and Implementation in Education

Yekbun Adiguzel*, Kristel P. Ramirez Valdez† and Gulkizilca Yurur‡

*Department of Biophysics, School of Medicine

Altinbas University, Istanbul, Turkey

†

Department of Medical Microbiology, School of Medicine

Altinbas University, Istanbul, Turkey

‡

Department of History of Medicine and Ethics

School of Medicine, Altinbas University, Istanbul, Turkey

Received 29 January 2018

Accepted 29 March 2018

Published 12 September 2018

Sensor-based diagnostics are increasing rapidly and in clinics, they can transform the health care

as they will be in use out of clinics as well, namely, by the non-clinicians and people without

expertise. The trade-o® between the advantages and disadvantages of their implementation into

the clinical settings should be decisive in their use, at the current state. Yet, disadvantages must

be carefully worked out and tried to be eliminated in any case, while keeping the inborn bene¯ts.

Therefore, we would like to draw attention to the reliability and security risks of personal health

data and associated concerns. We further discuss the related issues of sensor-based diagnostics,

mobile health (mHealth) and eHealth. The debate starts with the current states of the rules

and regulations. It is argued that there is prompt need for internationally consolidated

solutions for vast device types and uses onto which the local needs may have to be implemented

without violating the basic assets such as the inherent privacy rights of the users/patients.

The resistance factors against the sensor-based healthcare devices and applications are also

conferred. There are additionally data quality and assessment issues, and in relation to the data

assessment, concerns that are associated with the psychological responses of the layman to

the health data are mentioned. For these and more reasons, and ¯nally for proper use and

implementation of sensor-based tests and devices in the clinical settings, education of both

professionals and non-professionals seems to be the key. All these require much work and maybe

even more workforces to be allocated for the emerging, associated tasks. However, there are

economic bene¯ts, and beyond those, they bring new features in the health care that were

deemed to be impossible. Besides, despite the apparent unethical use risks, they can result in

better ethical practices, e.g., possible prevention of unnecessary tests on animals when similar

test on organ-on-chips would be failing.

Keywords: Sensor-based diagnostics; healthcare applications; eHealth; mobile health (mHealth).

This is an Open Access article published by World Scienti¯c Publishing Company. It is distributed under

the terms of the Creative Commons Attribution 4.0 (CC-BY) License. Further distribution of this work is

permitted, provided the original work is properly cited.

Reports in Advances of Physical Sciences

Vol. 2, No. 1 (2018) 1850001 (31 pages)

#.c The Author(s)

DOI: 10.1142/S2424942418500019

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1. Introduction

Sensor-based diagnostics are abundant in the current era. These include test strips,

handheld devices, miniaturized instruments, lab-on-a-chip devices, point of care

devices and organs and tissues on chips. Also, for personalized medicine, they give

the opportunity to optimize the medicaments for patients or to work together with

the wireless data transmitting, continuous monitoring systems. Their implementa￾tion together with smart phone applications is among the ongoing e®orts in this

¯eld. In brief, advantages of employing such systems in the ¯eld of health care

include less material use (patient sample and reagent) and low energy consumption

and hence reduced cost, high reliability and accuracy, fast response, ease of use,

portability, multiplexing and personalization. In clinics, it can transform the health

care with completely new possibilities that were deemed out of reach with the con￾ventional tools and devices. Personalized medicine, continuous individual and

population health monitoring are among those possibilities. New insights on the

mechanisms and epidemiology of the diseases will be gained. Yet, there are objections

to the ultimately optimistic scenarios about this ¯eld and to the expectations on their

potentials to transform our lives. Those objections generally include (sometimes

rightfully) the fact that the current state of the sensors is still far from their suggested

capabilities. Besides, the rising technological trend is not a guarantee for the reali￾zation of those potentials. Apart from those discussions, we would like to draw

attention to the issues that should be considered in realistic scenarios and realize the

prospects, including the safety risks of personal health data and associated or other

concerns. It may appear to the patient and the rest of the society, who are not

working by any means in the healthcare services, that the only task of health care is

its primary task, which is disease diagnosis, treatment and prevention. This is of

course true for being the reason of its presence. However, health care is a system that

involves education and patient data management as well, the latter of which involves

data storage, protection and re-use for vast number of purposes. These are all needed

to be regulated and synchronized, which requires the governmental management and

the contribution of all the relevant parties involved. Here, we discuss these and the

other related issues of sensor-based diagnostics, mobile health (mHealth) and eHealth.

Our discussion starts with the current states of relevant rules and regulations,

which require internationally consolidated solutions. The discussion follows with the

discrepancies between the nations in terms of implementing the mHealth applica￾tions. Later, factors that can lead to resistances to the sensor-based healthcare

devices and applications, even if the standards would be met, are discussed. The state

of compromise between the advantages and disadvantages of implementing the new

sensor-based tests and devices into the clinical settings should be decisive there. Then

we discuss the factors that in°uence data quality, together with the data assessment

and the question of by whom the data will be assessed. Several concerns that

are associated with the psychological responses to the health data are also debated

there. Accordingly, for dealing with the present concerns, and for proper use and

Y. Adiguzel, K. P. R. Valdez & G. Yurur

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implementation of the sensor-based tests and devices in clinical settings, it is sug￾gested that the society and the next generation healthcare workers need to be well

prepared to the presence of these new tools everywhere in our lives and health care.

Health data security will become a high concern, considering the present lack of

understanding about its importance and the absence of appropriate security levels

and measures of the mediums, where the health data are stored and transmitted.

Ongoing e®orts would be promising for eliminating the latter, but that would not be

the case for the former. We could at least expect that levels of understanding about

health data security would be highly variable among distinct societies and even among

individuals and would not rise at the same pace with the advancements in the technology.

Other than social, ethical and educational issues, we will discuss brie°y some technical

issues and the organs-on-chips, which can have several critical uses in clinics.

2. Driving Force and the Rules and Regulations Issue

The world population is growing steadily. This brings an increase in professional

interactions between patients and healthcare providers, as well as in demands

associated with health problems and the related costs that increase each year

in return (see Table 1). The average ages of societies increase steadily. The fragile,

aged-bodies are now higher in number in most of the societies. Advances in the

information communication technologies including the sensors ¯eld is maybe the

only absolute success of current civilization, in terms of almost non-stop achievement

of the technological goals and improved performances. These advances transform lives

and societies, the way jobs are done, how countries are ruled and regulated and how

healthcare services function (Fig. 1). This is simply named eHealth, but it includes vast

variety of digital platforms such as the computer algorithms, analytical tools that inform

and help in decision making, biosensors for diagnostics that can also work with smart￾phones and maybe even robotics for operations and interventions or body prosthetics,

remote monitoring systems and devices, smartphone applications, TeleHealth (digital

assistants and remote medical consultation) and ¯nally the health record systems.

We do not know how long it will take until doctors start prescribing sensors-based

treatment (Table 2), yet we would like to delineate the ways to go through to make

it happen and to present limitations and obstacles that stand against change.

As mentioned, this work deals with the pros and cons of the full implementation of

the present sensor-based healthcare tools into clinics, necessary educational advances

Table 1. Indicators on health expenditures, 1999–2016, Turkey.

Total health expenditure

(million TL) between

years 1999 and 2016

1999 2000 2001 2002 2003 2004 2005 2006 2007

4,985 8,248 12,396 18,774 24,279 30,021 35,359 44,069 50,904

2008 2009 2010 2011 2012 2013 2014 2015 2016

57,740 57,911 61,678 68,607 74,189 84,390 94,750 104,568 119,756

Source: TurkStat, Health Expenditure Statistics.4 Population and advanced technology-driven needs5–8

and incentives9–11 for healthcare reforms,12–14 and their associated implications15 and costs are present in

Turkey.

Medical Use of Sensor-Based Devices

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