Globally each country has electronic health records (EHR’s), digitalised paper logs that provide a full medical history of each individual patient.

They replaced the old paper based documentation systems and it was a legal requirement as of 2015 to have fully digitised patient records, due to data protection. EHR’s are present in every healthcare system in the world from the publicly funded NHS in the UK,  to huge private institutions like the United Health Group in the United states.

They provide complete healthcare data about what has happened to each patient over at least a period of two decades and are all accessible within the cloud based system. The question is however, with the advancements of digital software, are EHRs enough? Is a fully fledged digital twin, that can model all of our previous ailments, a possibility that will enable us to assess risk factors and methods of how to improve our overall health? There are many avenues to go down which would enable this, however there is more to it that just digitising human anatomy.

The objective is not to have a digital twin that can run simulations and see what will happen in the future, it is to see if a superficial digital twin medical record is feasible to produce. For example if you have broken your leg, it will display the bone and type of break with information of how to aid healing and encourage bone growth or if you previously had an ear infection it can highlight this via a virtual representation on the humanised digital twin. It is a visual representation of you medical history. With the current digital software out there, are EMR’s enough? There are digital twins in operation throughout not only healthcare but in most other industries, so Is it time we had one for our own bodies? The question is, what would it take to create a digital twin, luckily, Babylon Health has just released its pilot version of a digital twin, which provides us with an insight of what the future holds.

Babylon teamed up with bupa and other partners to produce their “digital twin” in july 2018, as part of their patient health check section of the digital gp service they also provide. The first part of the process is to complete a health questionnaire about past illnesses, current excise rates etc, then after completion your digital twin appears.  It is displayed as a transparent human figure, with colourful organ structures, each of which you can click and see the organ health and risk factors for future disease. It does this via using a large database powered by babylons “cutting edge AI technology” and uses a deep neural network, presumably via deep learning technology, created from millions of data samples collected and input by their scientists and doctors to provide up to date, accurate information. They do however stress that the digital twin only provides health information and not a diagnosis, and all information is based statistics and risk factors via the information the patient provides. It covers 20 diseases based as a UK burden, which will be expanded to 80 in the near future. Currently it does not integrate your EMRs with the questionnaire outcome, but judging by their recruitment sight, it will not be long until they find a way to, the numbers of vacancies for AI and machine learning currently on their website, Babylon show no signs of slowing down in regards to advancements in digital twin technology.

In regards to future prospects, Dassault Systèmes, a French software company, has been developing “3-D digital twins” in multiple industries over the past 3 decades with great success and have recently taken their concept into medicine and healthcare – they will speak at Challenge Advisory’s virtual twin seminar as well. In essence, they believe that the foundations for the future have to be laid organ by organ to enable a complete digital twin. They have already developed the “living heart”, which they can complete in silico models on and also complete cardiac research. They believe this is step one if their digital map. They did this via creating software that can turn a 2-D Heart scan from a patient into a full digitised complete model of the human heart.

The model took 2 years to create the Living Heart and contains around 209,000 minute digital tetrahedrons, each having is own cardiac properties from electric pulses to muscular arrangements. The properties encapsulated within the model can be altered to display individual patient requirements via, conditions or devices and uses current EMR data to predict outcomes and so far completely imitate the behavior of a real anatomical heart.  The chief strategy officer for Dassaults Simulia department, Steve Levine, believes a digitally constructed image of every persons EMR and body functions is possible stating that “Over time, my medical record could be a digital twin of me”.

His project is driven by personal reasons regarding issues with his own daughters cardiac health, which inspired him to created his daughters data digitally and begin his inspiring branch into healthcare. That inspiration and personal decision to branch into healthcare and create not only a functioning digital replica of the heart but wishing to implement a whole organ by organ system and enable it to help patients globally can only be a positive towards the future of EMR digital twins and a commendable feat. This, coupled with the fact the food and drug administration have recently signed a 5 year partnership shows that Dassault are edging ever closer to it becoming a reality.

https://www.3ds.com/products-services/simulia/solutions/life-sciences/the-living-heart-project/#player1190078#vid1

There are numerous other companies striving for success in creating a digital twin with the capability of displaying your EMR.  The Virtual Physiological Human (VPH), which is currently under production at the The Virtual Physiological Human Institute for Integrative Biomedical Research, in Belgium. Using individualised physiology based computer simulations and in future patients EMR They aim to create in-silico models of human health and disease, with its main target being a digital patient for doctors to see their medical records. 

There are of course current limitations amongst development, such as incomplete data sets, access to human tissues to enable complete modelling and data protection issues. But with the process still in the early stages, these issues can be overcome with the right cooperation amongst data providers, cyber security and data protection increases and sharing of big data, All of which are easily feasible would enable progression.

With many other big name companies currently researching digital twins, such as IBM, Microsoft, oracle, and numerous others, amongst them also are Academic centres such as Imperial college in London and MIT in the United states, all of which are continuously pushing the boundaries of digital science via many mechanisms such as deep learning, AI and importantly Cloud computing, amongst many others. Which will eventually enable a fully fledged EMR digital twin becoming a possibility in the near future.

Within the NHS, the digital healthcare is still far behind its private counterparts in the UK and all other public sectors throughout Europe. The delivery of digital healthcare to patients, staff, service users and equipment needs to be of optimal importance. For a health system that employs over 1.7 million people and treats over 1 million patients a day, innovative planning needs to be completed not only to improve overall health care requirements, but also increase privacy and security on Medical records within data protection laws.

Electronic medical records are still not fully digitized, Machine based AI is still primitive within the public sector and the use of digital twins to optimize ward based performance is still non-existent, unlike its private counterparts. With the increase of everyday smart health equipment such as smart watches and diabetic sensors, surely the digital revolution should be of utmost importance when advancing patient healthcare.

The government however has begun to address this in their recent policy paper, in which they admit they are behind their counterparts not only in Europe, but globally. They accept that they have too many systems that work individually and do not interact, sometimes making patient care difficult. That the research has not been developed into functional architecture within and that they have not taken full advantage of creating partnerships. But what they are doing now is addressing all of these faults, with a 4 point priority plan.

Firstly they plan to implement a better all infrastructure, firstly to enable different NHS systems to communicate with each other, as seen in their WSIC (Whole Systems Integrated Care) case study. They us analytics on top of integrated health and social care information to support both population health and direct care to help identify people who require extra help. This plan also includes measures to aid in safeguarding and cyber security measure to prevent the WannaCry 2017, which would require buying the best technology and enabling cyber security staff technology development.

Secondly The digital services are receiving a huge overhaul, The NHS website is one of the most visited web pages nationally, with over 500 million visits per year. They are currently developing an NHS app to help support patients. They envision digital care as being of pivotal importance. Their priority is to ensure that all patient needs can be met electronically, so that conversations can be had quickly and efficiently thus preventing post delays for patient appointments etc. They plan on backing all innovators who can help progress teh digital market and plan to help fund these innovations.

Point three, is innovation, as mentioned the government plan to help innovators succeed. They have just implemented a “world class” ecosystem to help the uk lead in financial tech, and plan to do so in health tech. Hampshire council recently trialled the use of amazon echo in adult social care in partnership with PA consulting. Through the use of Amazon’s alexa, they designed an app that records tasks and reminds the caregiver to on. Tasks ranged from taking medications reminders to enabling audio books to being read to those unable. The validity of this trail can not be underestimated in regards to patient wellbeing, as this enables patient care obviously, but also acts on decreasing patients feeling isolated and gives assurance to other family members, that loved ones are more adequately cared for.

Their 4th benchmark is for development of skills and the ever changing culture. The government plans on empowering the whole workforce with the skills and technical ability to identify where technology can improve healthcare needs. They plan on recruiting specialists in all areas, and also develop those currently in employment ro drive innovation and enable government adaptability into the digital age.

The government has the resources to to create a digital healthcare system that has the potential to become not only a leader in europe but globally. If they can competently manage demand for digital tech in healthcare and take advantage of all the research becoming readily available then there are no excuses for the UK to fall behind. But as with all governmental policies, most of them only stand whilst the current government is in power. For the UK to truly succeed there has to be an infrustruce placed within, to prevent any advancements being lost or replaced with other initiatives that will not work. If they can successfully implement all 4 points and enable a successful transfer into the healthtech leaders, than the UK will most likely be able to provide the best digital healthcare in the world, but as past experience has taught us, the reality is different.