The following are the outputs of the captioning taken during an IGF intervention. Although it is largely accurate, in some cases it may be incomplete or inaccurate due to inaudible passages or transcription errors. It is posted as an aid, but should not be treated as an authoritative record.
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>> AMADO ESPINOZA: Okay. Well, thank you very much for everybody coming here to this session. This is the session for the Dynamic Coalition Dedicated to Robotics in Healthcare. A little bit also about data. Our main coordinator is online, Amali, and she will introduce herself. Amali, the floor is yours.
>> AMALI DESILVA-MITCHELL: Thank you, Amado. So thank you very much, everyone, for joining us today. We are a Dynamic Coalition on data-driven health technologies with the Internet Governance Forum.
And what we have today is a topic of robotics and how it is integrating with the Medical Internet of Things. We have seen artificial intelligence flourish over the past decade or so. And robotics is basically Artificial Intelligence with now a physical format as well. So there are many similarities when we discuss the issues going forth.
And we have been discussing this with the public as a coalition over the past year. This has been the focus of our study. And we have had a number of questions come out to us in terms of, one, how do you reach remote locations? Can robotics and the Internet of Things support people in rural areas? For instance, how can they support People with Disabilities and other marginalized groups?
So we are going to try to discuss these issues. We have a number of distinguished speakers with us, and they will share their insights. And after that, we will open the discussion to the public.
Now, I'm trying to share my screen. I hope this will work. Is this sharing? Let's see. Is that showing?
>> AMADO ESPINOSA: Yes.
>> AMALI DESILVA-MITCHELL: It is, okay. So, as you can see, we have a lineup here of Mr Oscar Garcia. Dr Samo Grasic unfortunately can't be here due to something that -- emergency. He actually just became a new father so he can't join us, but he has sent us a YouTube. And then we have Jutta Croll with you in the room. We have Judith. We have Professor Gupta as well with you in the room .
So let's start with Oscar Garcia, please, who will share with us a little bit about his work on medical records and going to outer space and how that actually can be relevant to reaching rural populations. I will stop sharing here. And I ask Oscar to please take the floor.
>> OSCAR GARCIA: Hello, everyone. Can you hear me?
>> AMALI DESILVA-MITCHELL: Yes, we can. Thank you.
>> OSCAR GARCIA: Okay. Appreciate very much this invitation of the Dynamic Coalition about healthcare that we have been talking also extensively with Amalia and with other persons in this group.
This is something that we have been working for, for 20 years, more or less. I'm going to share my screen. I will try to show you a short presentation of our works in medical records for all these years from our experience and some lessons that we have learned through all these years working in this Dynamic Coalition.
Let me see if the sharing is working. Share screen. It is not showing to me the option. Let's see. Let me -- tell me if you can see my presentation. Hello?
>> AMALI DESILVA-MITCHELL: We can see it, Oscar. Thank you. Good.
>> OSCAR GARCIA: Okay, perfect. Fantastic.
This is the initial slide. So, as I said, my name is Oscar Garcia. I'm the chief software architect of Unified Medical Records. I also founded the Digital Health Information Network. And I'm also the project leader of the project working group of the ISO Inter-planetary chapter. And I have been working in digital health since 1985 when it was not called digital health yet. And I started the Unified Medical Records in year 2000.
Some topics here. We had an award of the World Summit of the Information Society for Argentina in 2005. The same year Medline from the National Library of Medicine in the United States, also received this award.
As we have been in the space medical records, we were nominated to the British Inter-planetary Society, the Arthur C. Clarke award two years ago. We have been 23 years in medical records deployments. Our system at around 60,000 patients and more than a million of clinical tests and what, some numbers.
We have presented this technology in World Health Organization, World Summit of Commercial Society, NASA, several hospitals. Also in different cities and different countries.
What kind of users we work with. We work with health insurance of the labour unions, with dialysis centres. That area is very challenging and difficult. We work -- we have been working also in very challenging environments where there is no Internet connectivity. And this is quite a point very important in the digital health record, which I'm going to explain later. Work with doctors, laboratory for tests, RX systems and patients. We say in a way that the need for monitoring medical records in an integrated digital system has become essential in the healthcare systems.
The best method for diagnosis and medical care that you all know, because you are all experts in this area, the extension of life expectancy, which is in an aging population. The new technologies all require deep knowledge to interface all that things. There have been multiple ventures to try to solve this problem, but with diverse fight. Because most time they start from some concept that lack deep knowledge of how the health systems work not only in terms of technology terms, but in how is the relationship between doctors, governments, insurances and all of the different providers of healthcare that we have studied, indeed, these relationships to make things work.
Because otherwise it is only an idea, fantastic idea, but few organizations have had a successful experience in managing all of this information and being able to operate in big cities where the Internet connection is permanent or very stable; and rural communities where computer system usually are not so stable. And understanding the needs, the needs of the different medical professions because every doctor has a different way of seeing these things. I'm going to explain more about that later.
Let me see. I think my presentation jumped a bit. I'm going to -- well, some issues that I have found over the years are that each specialty doctor from different specialty needs different views of the patient medical report. There are about 40 specialties and 87 subspecialties in different countries. And every doctor would like to see the medical record to be shown in a different way and to upload different data. But each patient is unique and has different parameters. And also we have semantics and semiology and signs and symptoms. And this means there is a lot of interpretation from the professional in how and to exchange this information is very difficult many times because of the different semantics, a way of interpreting things and the doctors need to make fast decisions and does not have much time to log the information to a system.
And this has to do also with the interface between the professional and the system. There are also what are called the dictionaries you may have heard about the World Health Organization International Classification of Diseases, ICD 9, 10, 11. There are modification, for example, in the United States. There are modifications in Europe. And they are different codings for procedures, for example, that a doctor makes.
And so what is the problem with this? If we need to compare the information between different countries or between different pathologies or situations, the problem is that we cannot match one thing with the other. And we have been working with this for many years.
Also, medical records are disseminated and disconnected. There are several providers of information for the same patient. You all know that you go to a doctor, to the hospital, but then sometimes they say go to a laboratory to make a test. And there are also paper and digital medical records and different technologies of electronic medical records. And most healthcare providers are not fully connected or partially connected.
Also, the healthcare system in most countries uses a third payer model which means that the patient is not paying but the health insurance is paying for the practice. And this require also to interface between the doctor's activity and the administration system. Many times regulations in many countries make not easy for the patient to access the medical records. And you also need to have public statistics to take policy decisions.
At the same time, some years ago in 1997 in Jakarta, Conference at the World Health Organization, it has been said and it is trying to be that is to empower the patient to be more aware or more connected with the medical decisions that they are involved for him and for his family and his safety. And this needs to also acknowledge an information for the patient to be more empowered. And that's the right and correct one.
And also there is the concept of privacy that medical records have private information, but need to be accessed from third persons like the doctors or the administration. And there are different regulation in different countries that need to be complied. And this is a changing process all the time.
That's what we have been -- I described challenges. That was we have been working interconnecting the healthcare system for many years. You see a lot of computers and networks there in the design. Our first deployment was in 2004 connecting healthcare providers, insurances, clinical laboratories, imaging, diagnostic centres. The pictures that you are going to see now are real. They are not pictures that are from designers.
And for health system to work, you need to have all of the parts and communicate between them and interface these parts between them. So you have to have system for the doctor office, for the health insurance. Apps for patients. You can see some who are referred to -- if you take a picture, they are going to refer you to some web pages.
We also developed recently this pen drive that allows doctors in challenged environments where there are no connectivity to go from one computer to the other in different places. And we have make it -- developed this in English, French, Spanish -- to bring it anywhere with no installation to connect with the clinical test or transmit information. But if you have no communication, it connects. Something that we have been asked a bit. This can also connect, for example, with devices, robots. You have a link there, and you can also upload a form if you want to be part of our development of this.
During the pandemic, we discovered the need for apps for patient, telemedicine, remote auditing, a health dashboard to administer the system because people, even doctors could not go to the places many times. We have here a long list of technologies and outcomes. But more important, I'm going to show you something later about the DTN technologies, many things that we have developed. And outcomes that are better healthcare, more simple interfaces for doctors, cost reduction with keeping a very good, very high level of care and to analyse pathologies and outcomes and results of the treatments.
And our next step is something that we have been asked as well is to -- we started to work in medical record for space exploration. We want to make consultations between space and earth. We are -- we presented this in 2020 in several dispositions. And we also have shown this to NASA and other space agencies.
What are the applications? Of course, research, tourism in the space, and of course living in space and other planets. That's something that humanity is thinking at this time.
We are going to make this system. We plan to start off next year. This is the model of the spacecraft. This is a plan for the moon. You have it there. As well these are problems that we have invested research in the last times related to difficulties that will happen in space.
And what we want to give this collaboration with the Dynamic Coalition on data-driven health technologies, what it is like to work in underserved communities and provide the services for free when it is possible, contact us. And to contact, you have there our web page. And afterward we are going to have a query and answer session. So thank you very much for your time for this long presentation.
>> AMALI DESILVA-MITCHELL: Thank you very much, Oscar. We really appreciate hearing about all of that. And I know you are working with Dr Grasic closely in the development of your work. And he is not able to be with us, as we know. Would you be able to play the YouTube that he has sent us?
>> OSCAR GARCIA: Can you give me one or two minutes while I look for the right link? While you keep -- I will be glad to show you.
>> AMALI DESILVA-MITCHELL: Thank you so much. So, you know, we are really interested in this Medical Internet of Things because we are finding more and more, at least in western countries for sure now, that patients spend very little time in hospital. So they will have an operation and they are sent home very quickly soon after.
The monitoring then takes place by digital means actually. By e-mail, by Internet connectivity of various monitoring devices to them in their bed. And as a result, of course, they are able to attend to way more people going through the hospital system. But also the patient is now in a position where they have to have very good Internet access to make sure that all of these devices are working very well for them.
Most recently, for instance, in Europe when there was the power shortage last year, you know, there were tremendous cries for help from patients asking to have reliable Internet connections to support the devices that were supporting their, let's call it, bodily functions as well.
So the Internet is becoming very, very important. These medical devices might be little robots, now bigger robots, might have been developed independently, but are now increasingly being connected to the Internet. And now, of course, we are getting much larger robots. For instance, China with the very large population, about 300 million people over the age of 60, is now looking to see how to take care of these elderly populations. And they are starting to roll out nurse robots this year to support nursing staff.
Now we know Japan, for instance, for decades has been developing robots for helping elderly people. Whether it is to do their cleaning, whether it's to do their delivery or bring their food to them. Or, for instance, climbing stairs. And Japan has been a tremendous powerhouse of development of this robotic activity.
But now, as we see, artificial intelligence is becoming ubiquitous with this and the robots can use ChatGPT and so forth. So it's now becoming, you know, an ecosystem where the robot is now increasingly connected to the Internet. And obviously when it comes to healthcare, SDG 3, health and well-being for everyone, we know we want to give that option to everybody on the planet to be able to access the sophisticated healthcare and the advanced healthcare. Okay. Oscar?
>> OSCAR GARCIA: Amali, thank you very much. Another of our collaborator is going to share his screen with some of presentation. And related to what you have just said, there is an important thing that I mentioned in my presentation. And some of Dr Samo Grasic has because as you said, the Internet has turned into a very important thing for healthcare, but many times the availability is not so good because that is not the problem of the Internet, but of the connectivity. That are different things.
And we have been working with ETM, the delay and disruption working to work with different flavours. And some of us have been working on this to resolve these kind of situations. I would appreciate if he can share his screen.
>> AMALI DESILVA-MITCHELL: Amado, I think he is onsite in the room.
>> OSCAR GARCIA: He is online.
>> AMALI DESILVA-MITCHELL: Oh, he is online? Okay.
>> AMADO ESPINOSA: I'm not sure he is online. Do you have -- I'm not sure he is online. Do you have another user online? I'm not sure he is online, Amali. If you wish, we can continue with speakers here locally.
>> OSCAR GARCIA: He says to me in the chat that he is online, Amado.
>> AMADO ESPINOSA: Okay, if he can --
>> OSCAR GARCIA: But he is not allowed to share screen. Could be some -- aah, there.
>> AMADO ESPINOSA: Thank you.
>> OSCAR GARCIA: Appreciate it. Thank you very much.
>> AMADO ESPINOSA: We have no sound.
>> OSCAR GARCIA: I'm going to explain this myself, if that is okay.
This is a platform for that we -- that several have been working for many years in the Arctic from Sweden and the concept -- University of Sweden and the concept is that the communication is very difficult in that situation. You have seen the ice. The University of technology developed at Dalvvadis economical association and he is also a member of the Interplanetary Networking Group special interest group where we work together. And the challenges of Internet in space can be applied also for these difficult situations.
If you can see, the lines between earth and space are not continuous lines because -- I can start my camera as requested. They are not continuous lines because communication between earth and space is disrupted. What we call disrupted. But here there you can see the radio link disruptions and as distance increases it is more -- this disruption increases. For example, if we go to Mars, there are 21 minutes coming before the information between the different points, end points that we call it.
The concept is what is called store and forward, meaning the information arrives to a certain point and then when the connectivity is available again the information jumps to another step of this network. This is in a standard that has been developed for many years.
We have been working with persons like this is in ADR for a group that is GTPL, Laboratory of NASA influenced by Vint Cerf and that is also the creator of the GDPCAP protocol. And also that it can run other different technologies. Already has been adopted by NASA, by JAXA, the Japanese Aerospace Organization, ESA, the European organization for the space. And what we have been working for some time about three years is to apply this technology to earth for these kind of situations. Samo, Dr Grasic has been with his group working in this project for more than ten years.
This was initiated, Dalvvadis is an organization in Sweden that works with the community very far north in the ices. And they keep reindeers herds. And these reindeers, as you imagine, are all around in the Arctic racing. And so what Samo has developed this technology using this DTM technology that with very difficult situations and challenging where there is no infrastructure, they track the deers all around and with technologies that are very not expensive at all.
And this was part of this project that was very important because what happens is that, for example, satellite technologies are now getting more affordable, you know, because there are companies that are launching these tracts of satellites.
And not to mention the commercial names. But this was very expensive, we have used satellites years ago and was very expensive to get this. And what Samo Grasic has developed this technology that is very -- you can work with this with not much money at all. You have there some of the specifications. I'm not a real expert in his development, but I have been following this for about three years so I can explain a bit.
One of the concept is to use solar and battery-powered with very low power consumption. And set up, for example, you can see there. And well, using a technology that is called LoRa, Low Range Radio System. This radio system has the capability of working with the small messages. And these small messages allow to send like SMS messages and they develop also mobile apps. So the herders of the reindeer can follow where the herds are all around with just a mobile phone.
And well, developed this antenna. I have seen perhaps there is some picture of this. I have seen this covered with ice. They can withstand very challenging situations. And each antenna can connect with -- it builds a network with the different -- with the different connections. So with the information for the different herds that the population that lives there can keep track. And we have been working also and talking with some time ago of using all of these same kind of technology to apply to technologies like medical records or healthcare information to keep when people are in the Arctic and situations very, very difficult, very complicated, they can request connection.
Here is this trail that they -- that they connect, they take the antennas to the Arctic. Samo goes often. And this is a collar that they use in the reindeer that was developed by Samo and his group. You can see that the battery life is two and a half year. And it was printed with a 3D printer. And has an internal antenna. So the -- with this, they identify, identify each of the reindeers.
Well, these are different developments that are used -- that are -- have been developed by his group. This is a node that can be attached to a drone. And I know that they have been working also here you have how is this applied. They work in also to go under water and this is the application that runs on the mobile and cell phones. And this is, you see the map and the different messages that are received from the network, the DTN network that Samo has developed there.
The idea with this is the concept of developing application to work with what you have mentioned, Amali, that these -- the concept and I mentioned that before as well, that centralized databases many times are not the solution for this kind of situation. Distributed databases make this kind of service more resilient and more resistant and these can help to resolve situations like the one you mentioned.
Well, and you have there the e-mail address of Samo. And he will be happy to respond what I cannot respond and try to help us. Thank you.
>> AMALI DESILVA-MITCHELL: Oscar, that was very, very helpful. Thank you so much for your help with that. Oscar and Samo work closely together so we are very thankful for this opportunity that Oscar can explain and share with us. So what we will do, we will post this presentation from Samo onto the IGF DC, our own Dynamic Coalition web page so that anyone can access that in Samo's words as well into the future.
So I am very pleased with this, you know, this sharing of this information because I know, for instance, in a lot of countries we are increasingly getting nervous, let's say about climate change. We are hearing of floods and earthquakes, fires. And sometimes in very remote areas. And then how, you know, are these people to be served? And you know, these are solutions that probably can be put in place very quickly to serve some of these people in distress. So, you know, disaster relief. This is another area that the work of Oscar and Salo are appreciated for. Thank you so much. Okay.
So now I am going to ask our own Dynamic Coalitions at IGF to please share some thoughts with us. And there you can see them on the panel there. And I would really appreciate if you could share with us some thoughts that you might have. I know some of you were requested to join us, you know, with very short notice. So I appreciate you all helping at this Dynamic Coalition out.
And I know all of you have been studying and researching artificial intelligence. And I think sharing some of those thoughts with us in terms of what you are experiencing with artificial intelligence in your own areas would I think be very helpful for us working with robots because robots are powered by artificial intelligence.
So I'm going to take this opportunity to ask Jutta Croll to introduce herself and give us insights as they come close to her. Please.
>> JUTTA CROLL: I think it is working. I have already been introduced by Amali so I only would say a few words about my position. I'm coming from a German NGO called Digital Opportunities Foundation which is dealing since more than 20 years now on the developments that digitalisation brings to society and what impact digitalisation will have on society.
I would like to go in my statement a bit back to 1989 when the UN Convention of the Rights of the Child was adopted. And the UN Convention states in Article 24 that State parties should recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of the health. So it is laid down there more than 30 years ago.
And obviously no one could imagine what role digitalisation would play in health not only for children but as it is laid down from the UN Convention. And what we already heard about medical statistics and data that can be used for the health for everybody in regardless of their age. But still, the right of the children are laid down in the UN Convention. And so from the year 2019 to 2021, the Committee on the Right of the Child was considering how could we adapt what we laid down 30 years ago on the health for children to this new environment that children are growing up now and how could we also try to describe how health technologies could be used for the health of children.
And then in March 2021 a so-called general comment on Children's Rights in relation to the digital environment was adopted by the committee which I brought some copies and I will spread them around. I just want to quote from one of the articles of this general comment which is kind of an interpretation how to better understand what the rights that were laid down in 1989 mean now that we live in a digital environment.
And in this general comment there is much attention given to birth registration and the right to identity of children. And that is the one point that I would like to pick up because health of children, of course, starts with the beginning so that means at the time of their birth.
And we have heard from Amali and also from Oscar about rural areas where probably we are not in the same situation like in a city like Kyoto where, of course, children are mostly born in hospitals and then their birth certificate is laid down and they get health treatment from the beginning. That is different in rural areas. And, therefore, it's important to consider what digitalisation can mean for children born in rural areas and how the right to birth registration and identity can be laid down there. And how like that unified service for medical data can also be used to register children from the beginning and give them their identity and also then afterwards give the medical system and also the people themselves, the parents as well as other caregivers access to the data to treat the children right from the beginning and throughout the whole development.
There are many other things in the general comment number 25 on children in relation to the digital environment and, of course, the committee also took notice that digitisation has probably also risks for children's health growing up. Like over extended usage of digital media, that is all addressed. In this I would only like to focus on the benefits and what digitally processed data can bring to the health of children. Thank you so much for listening, and I'm ready to take questions.
>> AMALI DESILVA-MITCHELL: We will take all questions at the end once the speakers have gone through their spaces.
I just want to add a little bit to Jutta, what she talked about birth records and so forth.
And something that has been made aware to me is also Indigenous populations and their languages and scripts. And I have heard sometimes that identities have got lost. And you know, all of this comes together. I'm so glad, Jutta, you mentioned this, because that has sometimes been the case where good translations and documentations have also meant to losing children, as it were. Thank you so much, Jutta, for that. Thank you very much.
I would now like to ask Dr Gupta if he would share some insights with us, please, and introduce himself.
>> RAJENDRA PRATAP GUPTA: Thank you, Amali. I'm Rajendra Gupta.
I chair the Dynamic Coalition on Digital Health. And also chair the Commonwealth AI Consortium for Capacity Building Across Commonwealth.
First thing I would like to say to demonstrate the difference between robot and human being is as you can see me, I'm almost sleepy, I woke up at 2:00 a.m. Robots don't do that, you know. And this is what a few years back when I was in the same country I saw a robot and asked them why would they need robots in the hospital? He said they don't chat when they go into the aisle so they can just work. And they don't ask for the wage increase.
But jokes aside, last month we hosted the Global Digital Health Summit in Bombay, if you look up Global Summit.health. And what we demonstrated was interesting. Like we have a panel here. One of the panelists was a robot. And this was indicative of the things to come in future. I mean you can look up the video. The robot answers the questions that he was thrown. And the questions were thrown by the global strategy head of Google.
I think robots are for real and they will innovate medical field for various reasons. And last couple of weeks I have been working with one of the architects of Da Vinci. You know, trying to make the leaders aware of what robotics can do.
So there are two major roles that I see for robots in healthcare. One is they will replace routine tasks. Routine tasks is like carrying blood samples, taking medicines, transporting patients. And just like you don't require a human intervention. And the second is most important which is medicine.
So let's accept that, that that robotic capability exceeds human capability, that's the first one. Cost savings and probably bring in some efficiencies on the floor. But where the medicine part comes, this is very interesting. And this I have been having discussions because of not only the summit but also the course we run on digital health. We have been talking to actual leaders involved in robotics and the development of robotics as a field.
I think the biggest thing that would happen is that surgeries would be precise. And that is what I have spoken with a hospital that implemented robot. I said why did you implement? What is the outcome? He said clinical outcomes. Less blood loss. Patients are happy. Better healing. So there is a proven benefit of robots on the clinical side. When you look at the functionalities they can take on, too. So like you have a physical therapist today; a robot can do that better. A robot can be an exoskeleton for a person who has met with an accident and, you know, needs the artificial limbs. Transplants. Today they are doing almost all of the surgeries.
I think one of the biggest things that you will see and I think aging nation like Japan is a very good example. All nations will eventually, the social interactions, doing that for seniors. And other than that, like in COVID we saw, you know, some of the hospitals starting using for interaction with patients to avoid the spread of infection including sanitizing of the rooms and serving the patients.
So robots are getting there. My worry is that this is not democratisation of robotics. It is very high end. So the robot that I spoke to was two and a half million dollars. Expecting that robots will be used in every hospital, that's not going to happen very soon. It will be far, far away. Have they been able to demonstrate the ability? Of course, yes. They can do much better job than doctors seeing patients. In invasive surgeries they can do what a hand can't do, what the doctor's eye can't do. So this is clearly there.
But what I envision in the future, and this is what I have been talking with the man who was behind the architect of da Vinci is that eventually I would see robot like radiology robot, urology robot, gastroenterology robot. We will hear I think in next few months, another company with a robot.
When that happens, I probably feel that cost may come down a bit, but will it be democratised, absolutely not. So as a part of medicine, most of the high end hospitals maybe in specialized, you know, departments or maybe big hospitals, private hospitals, they may use robotics. But will public facilities use it? Clear no. I mean they would still prefer surgeons who would do a job at a much cheaper rate because the initial investments are very high, the cost to maintain is high. And the technology changes, what do you do?
But there was another question with were talking about with remote surgeries. So there is ample of evidence to show that hundreds of miles away you can mimic a surgeon movement and do a surgery. I was in Poland early this year and actually tried my hand from the robot actually. For me, it was not easy because I'm not a surgeon.
I tried to, but it is like if you train people you can end up doing remote surgeries. But it will mean like we are still years away until the cost comes down and we have enough trainers to train doctors.
As a field I think it is developing fast. I see a future when there will be specialized robots. But still on the clinical side we are far out, but on the routine side we will have faster adoptions. Clinical routine will take off fast. Clinical are still years away. Thank you.
>> AMALI DESILVA-MITCHELL: Thank you so much, Dr Gupta. You just introduced us to just the whole spectrum of where robots can be working. And thank you very much for that sharing with us.
I just want to add that ITU, the AI group there is actually working very extensively and recently put out a number of procedures I would say and processes for AI working with medicine. And I think they are a group that is quite actively pursuing robots as well. So I think that, you know, we are hoping that into the future there will be someone obviously from our side, our Dynamic Coalition comes from the perspective of the patient and how the patient is going to interact with the robots and artificial intelligence in medicine.
So I think, you know, thinking of bringing in standards. They are already working on that. And I think that would be very helpful for the patient side because we are going to approach the technologies coming to us and be used on us, all of us would want to know a little bit beforehand what it is about. What are the risks and potential harms and so forth. And depending on, I would say, the sophistication of the patient, you know, they would be, you know, more forthcoming or not to these kinds of medical interventions.
So this is the Dynamic Coalition is very focused on the patient perspective. Sharing from a multistakeholder perspective on what the patient can expect for the future. And in this case why our discussion this year is there something that the patient should share with the multistakeholder group that we are concerned and worried about before it gets put into the actual development of devices and systems. The design process just like, you know, privacy and so forth, the design process is actually very important.
So going to this, privacy is of concern to all of us as patients. Going in even just a regular checkup, you know, perfectly healthy patient. So I'm going to hand now to our own coalition members -- and thank you so much for our panel -- to share on privacy and security.
>> HOUDA CHIHI: Thank you so much, Amali and all of the coalition staff for inviting me.
In fact, let me introduce myself. My name is Houda Chihi. I have PhD In communication. My main job is chief engineering.
In fact, today I will share some of my insights about the cybersecurity into robots. In fact, the idea of robots which is basic in cyber physical system. It is very important nowadays in our life, we use it in many sectors such as education, healthcare and agriculture. But at the same time it can be -- just a second, I have to turn on the camera. Do you see me?
>> AMALI DESILVA-MITCHELL: It is blurred now.
>> HOUDA CHIHI: Now I am visible? Thank you so much. My pleasure.
In fact, as robots are in cyber physical process, we find physical process and we find software ones. So here we speak about advantages and drawbacks of the use of robots. The use of robots is very when you are towards healthcare we may or we must take a great attention because it can be very important. Because for impact further towards the problem of COVID-19, for example.
It helps doctors to reach some patients or the case of complicated surgeries, it will be a very important to use robots. But in the same way, if we don't take care of that cybersecurity, it will be -- it will be very challenging. In fact, for this because the cost will be to human life of our person. So this is not the good idea in this case.
For this, there is some steps or pillars of cybersecurity that all of us we should respect. We should respect cybersecurity. The use of robots in the healthcare is very important.
And second, we should raise awareness and trainings to doctors and all healthcare staff. For example, for authorisation it is not -- it should respect specific process, specific authentication process. We can use multiple authentication process. So, for example, doctors to open platforms in open wi-fi process or public wi-fi, it should be very secure and use specific and complicated password and should be always updated.
In addition, the software should be always updated and patched following the recent process. And in particular in addition, as robots are based in artificial intelligence algorithm, it should be resistant to threats. And we should include intrusion detection process into robots and should do some things before that we put them into the process of application. Some tests are threats detection. If it is good, the test and are well received and well done. So these robots will be dedicate and could be applied for healthcare.
If the process are tested and valid, we should review the artificial intelligence algorithm process. In addition, as today's we speak a lot about emerging technology, so our robots is normal, that will be connected to clouds. Because here we have a lot of sensors, Medical Internet of Things so we have a lot of sensors, leaders. So we need a lot of information to connect from patient and from many sources.
So there is a huge occurrence of a security problems here. So we should encrypt the communication. The data communication between the robot and the cloud. And in general the communication between the robots and each whether it is doctors for any digital platform should be encrypted to save the data and to ensure a safe communication and to protect the life of the human beings or patient and to ensure that this robot is used for the benefit of both doctors or patients.
In addition here, we speak about virtual platforms to use ChatGPT should be used and respect specific cybersecurity rules and laws. It can't be used by any doctors without specific cybersecurity norms. Otherwise, it can't be in the benefit of anyone ever, patient or doctors.
In addition, we should collaboration between IT team who is responsible of building the artificial intelligence and the collaboration between the different stakeholders. Even if it is because here we have different actors who intervene the communication of the robots -- between the communication of the robots and the patient or doctors here. A global collaboration between many stakeholders should be done whether it is operator because here we have the communication is always enabled by for better communication and connectivity.
We found 4G, 5G, 6G or other technology. So here is important to have a global conversation between different actors whether it is operator or service providers. Actor, doctors, government and policy maker, decision makers to state specific rules and laws and to either -- it is also the responsibility of the IT team to raise awareness and organize free training session for doctors to teach them how to use digital platforms in secure ways. And to always be update their passwords and to ensure complicated passwords that in a way that the access will be done only or will be -- the access is only dedicated for the health staff and there is no possibility of intrusion or threats.
Here also a process of updating all of the software end-to-end and the cloud, too, and security tools to secure the cloud process. And here we will speak about other -- cryptographic process of the end-to-end communication whether from the patient to the cloud. This is my intervention. Thank you so much.
>> AMALI DESILVA-MITCHELL: Thank you very much, Houda. Very much appreciate that.
And I'm going to pass it on to Jorn now. Please introduce yourself.
>> JORN ERBGUTH: I can share a slide if you want. I'm affiliated with the University of Geneva and I will keep it short.
So robots and data protection. I would like to focus on data protection, while Houda tried to focus on IT security. And robots have many sensors. They can see. They can listen. They can feel the temperature. They have access to external sensors. And suppose you would have a surveillance system in your hospital room that does all that. You would not feel comfortable.
But as a robot, people tend to me more comfortable because it looks like a human, but actually it is a spying tool. Of course, it is spying is at least first for your good. It helps to watch you if you need something to give you the proper care.
But so how will this data be processed. First, is the data being stored? The robot needs vision to move. But do they need to record everything? And if it is stored, how long will it be stored? And what is it used for? Of course, it would be used for your medical treatment, but it could also be used to analyse the robot, where is the robot performing well and where does it fail. It could be used to monitor the humans, the human staff in the hospital whether they perform the tasks well or not.
It could be used to record how visitors behave or if it is used in your home how other people in your household behave. And who has access to that data? Just the doctor? The whole hospital staff? Or maybe even the manufacturer because they say well, of course, we need that data to improve the robot. And actually this is not wrong. But do you want your data, your images lying in the hospital being accessible by some manufacturer? Of course, we say well, you need consent. Has the patient consented? Yes, of course, you do consent. But is the consent informed and voluntary?
I mean, of course, you can get a piece of paper with everything listed on it. But to be voluntary, it has to be granular. That means that you need to have the choice to reject all usages of your data that are not really necessary for your treatment.
And can relatives, for example, access this -- these records? For example, somebody dies in the hospital, can they access the records to sue the hospital? Well, do doctors have to consent to that? Or is it a right of the patients or the relatives that they get access to the data? Can law enforcement access it? So there are many questions, many open questions. And it is not an easy part like IT security, there are many standards that need to be applied and not just a list of things like complicated password. It is much more complicated. And data protection is also quite sophisticated thing because in the hospital you have very sensitive data. It is one of the most sensitive data.
And you are processing large amounts of this data, much more than before, and this will require very proper governance. Thank you.
>> AMALI DESILVA-MITCHELL: Thank you, Jorn and Houda, for that very insightful I guess nuance to medical records, as it were. And --
>> JUTTA CROLL: Amali, would you allow that I comment only a few words to Jorn?
>> AMALI DESILVA-MITCHELL: Sure.
>> JUTTA CROLL: I'm so glad to be on a panel virtually with Jorn because we have been in contact. What he is saying and what he is showing on his slide reminds me that we had a session on the Internet of Things and children sometime ago at the Internet Governance Forum where we were discussing Teddy the guardian. And that was like a robot looking like a cozy Teddy bear for children.
You could put that in the bed of the child and the Teddy would measure all of the data we have been talking about. How is the oxygen and the blood of the child? How is the body temperature of the child? How is their rapid eye movement? So everything that you would like to know about the child could be measured and monitored by the Teddy that you just put in the bed of the child. Of course, the child feels cozy with having such a plush bear in the bed. And the parents could monitor that wherever they would be. They could monitor that on their smart phone. The same medical data that could go to the parents could go to the pediatrics of the child.
SO we have the same situation there that you can monitor everything. But we need to answer the question where does the data go? Is there probably a risk of the interception of the data from the parents to the phone and to the doctor, the hospital. I do think these questions are not yet answered.
>> AMALI DESILVA-MITCHELL: Totally agree with that, Jutta. In the interest of time, I think Judith may respond to one of the questions we had online on accessibility.
>> JUDITH HELLERSTEIN: Sure. I'm Judith Hellerstein representing the Dynamic Coalition on Accessibility and Disability.
But first I do want to respond to Jutta. Yes, we had those. But a lot of those Teddy bears are viewed to be very insecure because they are at that time the Internet of Things was not secure. There was old data on those. There was problem of being hacked and the child data could be stolen.
Or the child could be told to give out different things. It was a very -- there was no rights and protections on that data, especially for data for children.
But I also wanted to respond to the couple of things with the robot where you were talking about the other Dynamic Coalition is that there is a really grave danger for Persons with Disabilities for using robots where they cannot communicate to persons who may be visually impaired or hearing impaired or cognitively impaired. And how would the robot respond to that? And they can't.
And so these people are being disenfranchised and they cannot do it in the hospital. Especially during the COVID they said oh, we'll do video conferences. But they didn't have -- people could not see the person through the masks. There was no -- there was no right -- there was no clear mask. You couldn't read people's lips. You couldn't have a visual sign language. You couldn't have any of that.
And so it was as if Persons with Disabilities were not allowed to get sick because no one would care for them. And so there is a grave danger when you have robots doing that is that you are now disenfranchising a huge part of the population who cannot get that.
And so instead, where it used to have the telephone relay, where they would call up and show a picture and there would be a sign language interpreter or there would be another interpreter, these types of things won't be existing. And that is the grave danger with the robots in that section.
And I think that the question on accessibility, I guess let me just look again in the chat. Is that like, as you said, if the AI is being used in a surgical robot, the -- if the misidentification can result in the AI providing bad surgical guidance which could lead to surgical errors.
And especially as people are starting to use instead of human captioning, they are using artificial intelligence captioning which often is -- could be really bad and does not tell you what the person is saying. And there's a reliance on that. They think, oh, it's great, I don't have to pay for human captions, but then people are losing out. Not being clear. The guidance is not being clear. And there is a huge danger of that.
So we have to make sure that Persons with Disabilities are taken care of and that you don't lose out, disenfranchise a whole population in the effort to make things cheaper. I know in the interest of time, so I will just stop there. But happy to answer any questions on that.
>> AMALI DESILVA-MITCHELL: Thank you, Judith. We have -- thank you very much for that to bring accessibility. I'm so happy that you responded there for us. In the interest of time, I just had to make a couple of announcements which I promised to do.
And it is that we have a book called Health Matters. And it is published online on the DC-DDHT web page at the Internet Governance Forum. And each year we add articles to this book.
And we have three writers of articles in 2023, Frederic Cohen, Jao Gomes and Yao Amevi Soussou. So I just want to highlight that. And I would like, you know, I would please encourage you to take the opportunity to read these articles. They have a tremendous insight. Yao, for instance, is talking about healthcare. Frederic about collaboration in technology. And Joao was talking about, you know, development of medical in tech technologies. Please take that opportunity, please, to read those papers.
Now I'm going to ask Dr Joao Gomes to give us a little summary of what we have been discussing over the past year on robotics. We are due to publish a DC paper on robotics by the end of this year which will bring together everything we have heard and our own discussions as well. So, Dr Joao, can I give you the floor here, please.
>> JOAO GOMES: Indeed, yeah. Greetings. It's a pleasure to be reaching out from Portugal, actually where it is still morning time. And I'm honoured to share with you the summary of this paper which is titled Robotics in the Healthcare and Ethical and Technical Considerations.
I'm going to do so on behalf of the Dynamic Coalition on Data-driven Technologies which is guiding the session today. Just a broad overview on the paper that sheds an overview perspective in the robotics in healthcare; a topic we have been talking about today.
Some of these points that were mentioned in the paper were also discussed already in here. The idea is to promise or to promote these trends to revolutionize patient care while also presenting both the ethical and technical situations of doing so which is also very relevant.
And it is precisely with the dichotomous structure so it seems to be exhausting in naming each one of these challenges, but leaves a lot of space for discussion within the challenge itself. So that is precisely the same structure I will follow.
I will start with the ethical considerations that are mentioned in the paper and that arise from the integration of robotics in healthcare. So imagine this world where systems are collecting the vast amounts of sensitive patient data. It was mentioned with the example, for example, of the Teddy bear just now.
And we need to make sure that data privacy is one of the elements that comes first. And it must be ensured with the utmost care. And that is precisely where encryption and other security mechanisms are necessary to prevent the data breaches. We also need to make sure that whatever data we are collecting is of good quality and interpretable. The idea in the end is to inform healthcare decisions so we need to be accurate in what we are collecting. And analysis of the data should also be Paramount.
And this is also very much linked with the topic of accountability and autonomy. As robots become autonomous in the decision-making capabilities, we need to ask ourselves who should be accountable in case of adverse events? The developer? The user? So these are the questions that we also try to discuss in this paper.
And they are also linked with the fact that the technology should be safe and reliable. Our suggestion on one side falls into the realms of transparent governance which can be essential outlining the roles and responsibilities of the stakeholders in the development of these technologies. But also at the lower level ensuring rigorous design, testing and that there is an existence of emergency stop systems and regular maintenance of the systems so they function as intended.
Then there is the element of the human-machine interaction, which is inevitable. How do we ensure that patients and providers are comfortable and knowledgeable enough about these interactions. And what we discuss in the paper as well is potentially setting up guidelines for the users and providers as well.
And lastly on the ethical considerations we talk about fairness and equity. This is all fun and games, but if at the end of the day no one is able to access the technology in rural areas with limited healthcare access, for example, we need to make sure that the ground is set at equal level for all of the players and users.
And we talked about the ethical considerations in this paper and then we jumped into the technical ones. We can start with the obvious, which is hardware and software integrations. So we need to make sure that we have a seamless integration of both hardware and software, which is critical for the operations of robots and these technologies.
In an idealic setting, we have these medical devices working in harmony with intelligence algorithms. But for this to be a reality, we also need accurate sensors and actuator selection. This was part of the first intervention as well and mentioned there. As well as an adapted power management, which may seem a very obvious easy to meet requirement. But if we need to ensure a continuous power supply, we also need backup systems to avoid disruptions that could compromise the care in healthcare itself.
Also on the topic of the accessibility, we need the same thing in the access and connectivity and infrastructure itself. So we need a secure and reliable connection which is vital for the data exchanges that we mentioned in our ethical considerations, but also for remote robot operation in the examples of surgeries being performed at a distance. But for that to happen, we need the infrastructure in place.
And when we look at production, we also need to guarantee the elements of scalability and a good user interface design which makes it easier for the healthcare providers and users at the end of the day to navigate and control these robots. And this is not a possibility also without proper training on both sides. There are many other elements.
And for the sake of time, I will keep them aside of my intervention, but I'll briefly mention like maintenance and support, regulatory compliance for them to become true medical devices. Job displacement and creation, which is something that I didn't talk about but it would lead to another full discussion on this topic. And economic impacts.
In conclusion, the integration of robotics to healthcare, of course, offers potential, a lot of potential but also demands a balance between these ethical and technical challenges and that is what we seek to do with this paper. It is still a live document so we definitely invite you to make your additions and collaborations.
Feel free to either forward them our way to make the interventions now, either verbally or written form, and we will take them into account for the paper itself. Thank you for your attention and looking forward for further engaging discussions on this.
>> AMALI DESILVA-MITCHELL: Dr Joao, thank you very much for that. So I think he summarized that well so we have the key takeaway I think as well.
So just now I think we have about 10 minutes left. And I -- I just want to ask whether a couple of our DC members would like to make an intervention. What about Yao, would you like to make an intervention?
>> YAO AMEVI SOUSSOU: Thank you, Amali, for giving the floor. I'm Soussou Yao, I'm currently at (?) and university. I'm also a member of the DC.
I would like would thank all of the DC members for this intervention and all of the distinguished speakers. My contribution would be I would like to give some reflection on the convention of the human computer interface with robotics and its transformative potential for creating in healthcare environment.
And taking into consideration what have been already discussed and also the important impact of the human computer interface with robotics. And we see there can be -- they can help actually on our health system as highlights in the conclusion of one of my paper which is design principle for healthcare in -- in healthcare and medical things and also -- Medical Internet of Things and also second which is healthcare is sustainable.
I would like to mention some keynotes on this in regard to the recent development in the fields. Which is it implies. So but the journey towards the green healthcare environment is not without challenge. We mentioned that. And it is imperative to -- for us to tackle these obstacles.
And in recent development, inevitable in improve integration of AI into human computer interspace and how the integration and what the are the systems. But also take into account how they are AI driven and analysis and prediction and patient treatment can be recommended and can be it has and also I would say are needed to help healthcare outcome while reducing waste in the field.
Not to forget that telemedicine platform are also becoming increasingly used but we need more user friendly interfaces, provide accessible feature. But also compare healthcare service so that the accessible features are useable and manageable. And those human computer interfaces play a vital role in ensuring that apart from the medical healthcare and many elements mentioned, intuitive and inclusive for all patients.
Of course, innovation in medical robots are not only improving surgery decision but also can help reduce energy consult of medical procedures and like with energy efficiencies robotic systems are becoming the norm now as you mentioned already in model. So key consideration for my side to consider to take into account when is willing to help the environment, I think is to mention that we need to work on reducing the carbon footprint for healthcare facilities and that could be done by prioritizing the solar and wind power for technology. But also the energy of data centres which are used to support human computer interfaces and robot application are crucial aspect to take into account.
And one other aspect that was mentioned, employing advanced technologies and optimizing the service so that they can have significant -- they can significantly help reduce energy consumption like temperature sensoring and sophisticated control measure. And when it come also to designing.
>> AMALI DESILVA-MITCHELL: Yao, could I ask you to close please.
>> YAO SOUSSOU: I would like to conclude, when manufacturing the interfaces and mobile devices we should prioritize sustainability with renewable materials and contribute to so that the -- to have a smaller ecological footprint. This is my take on this discussion. Thank you very much.
>> AMALI DESILVA-MITCHELL: Thank you, Yao. I want to ask Frederic Cohen if he would like to share some thoughts.
>> FREDERIC COHEN: Thank you. I'm happy to meet you today. I would like to thank you for our get together this year and our last year together.
It was very important year to work together. We were travelling very much in Asia and we were meeting with the ITU.
So with the ITU and in the first development. So for the Internet because of development with the wrapup -- we will wrap up now in the world and very important for us. The medical health system also the problem with different and now it is important to meet each other for other development in edge technologies which is continuing with different regions for everywhere.
I think it is our focus for the developing countries and island situation, are important to reconnect to focus to a digital communication with the communities and the rural area. Thank you very much. And have a good year. See you next year. Thank you very much.
>> AMALI DESILVA-MITCHELL: Thank you. I just want to pass over to Amado. Thank you very much from my side. We are out running out of time, we can't take too many questions. I'm going to pass over to Amado right now. Thank you for joining us today.
>> AMADO ESPINOSA: Thank you very much, Amali. I think it was a very interesting discussion with all of the panelists very well selected and the topics.
I only want to close this presentations by inviting all of the attendees to join our Dynamic Coalition. We are really concerned about this concept of robotics which it is not only in the physical world but software is also nowadays considered as medical device. And software is intervening in different aspects of the healthcare system by analysing imaging, by undergoing symptom checking processes or triaging patients in different situations and so on.
Then as Dr Garcia said at the beginning the electronic medical records are one of the most important sources of data for the analysis of all of those AI applications related to the medical, to the healthcare system. And digital health, of course, is nowadays the new trend to make the universal coverage a reality.
Then I certainly invite all of you to join us in this study at the coalition. The governance of the -- the Internet Governance applied the medical care at the healthcare system. It is a very, very important topic which everybody is looking at. And but, thank you very much for your participation here and thank you very much for all of the speakers that were involved in this discussion. And we hope to meet next year again at this event. Thank you very much. Appreciate it.
>> AMALI DESILVA-MITCHELL: Thank you so much for all of the speakers. Thank you. We are adjourned now. Thank you very much for your presence.