The field of healthcare has seemingly always been an important area for IOTA. The Tangle theoretically pairs well with health data encryption and transfer, so it makes sense.
To emphasize the importance that IOTA puts on healthcare: one of the board members at the IOTA Foundation is a practising medical doctor. They dedicated a portion of their early work to healthcare streams. The website has a slot for their eHealth vertical. IOTA imagines a future of remote patient monitoring, a healthcare data exchange, and research data integrity.
We were fortunate to sit down with Brian Bong, an entrepreneur in eHealth who is a massive contributor to the IOTA ecosystem. Let's meet Brian. Enjoy.
HelloIOTA Question #1
The IOTA community will know you as a long time IOTA enthusiast, dating back to 2017. Since then, you’ve been hard at work building the IOTA community in Kuala Lampur (KL) while serving as the IEN Regional Community Leader of your region. Can you briefly tell us about where you grew up, your educational background, and your career interests? Are you originally from Malaysia? How did you decide to study hotel management? And then making the trip to SIU? What did you study at Southern Illinois? Was that your first time living in America? Any thoughts on that experience? You’ve got lots of project management and consulting experience! We’d love to hear more about that mixture of talents.
I grew up in Bau, a small town in Sarawak (on Borneo island), Malaysia. Fascinated with hotel life, I went to Switzerland in 1985 to study Diploma in Hotel Management after HSC (A level equivalent). I did my service and kitchen internship in Kongresshaus, Bienne and Holiday Inn in Frankfurt am Main respectively.
After working about a year in a hotel in Singapore, I found that hotel life was not for me. I enjoyed the fun in working with people in hotels, but not the working hours and having to work on holidays (including Chinese New Year), which spurred me to move on (yes, I am a very traditional Chinese 😊).
I then went to Southern Illinois University at Carbondale to study computer science. That was the time when Windows 3.1 was launched, and Solitaire was the game of the day.
I was lucky indeed to have the opportunity to study in both Europe and America. It was an absolutely eye-opening experience being able to interact with people from all over the world of different cultures and languages. I remember in SIUC, they had International Festival that celebrated the cultural diversity of the international student community that made up 10% of the 25,000 student population on campus. I would say I had the best time of my life studying in America. Beautiful campus with wonderful and fun people in a university town.
After SIUC, I worked as an Application Software trainer for Lotus 123, Word Perfect (yes, that long ago…) for 6 months in my home town in Sarawak where job opportunities were limited. Then I took a job to manage a fast food chain of 6 branches that gave me lots of corporate training which was very helpful in helping to see things from a management perspective. After 18 months of managing fast food operation I left for Kuala Lumpur (KL) to look for new opportunities.
First job in KL was for a travel agency focus on European travel, guess my IT and Europe experience helped. The job was to support about 10 PCs and to handle printer issues. The job was not challenging at all and I simply got bored (compared to previous job of making management decisions with 80 staff). Then an opportunity came when a newly established hospital service (biomedical, facility engineering, cleansing, laundry, clinical waste) support company was looking for staff. I got the job as the IT employee No. 2 and this started my healthcare career.
Within a span of a year, my project size grew from setting up office IT infrastructure to designing wide area networks for 37 hospitals. I did ERP application requirement studies and took on the IT Project Manager role of the first paper-less and film-less hospital in the world at that time.
Managing the Total Hospital Information System (THIS) implementation was the best thing that happened to my career. I had neither hospital nor large complex IT project experience at all, but I just loved the challenge. It was a great learning experience as the project had just started. I attended the ground breaking ceremony and worked closely with all of their consultants (architect, M&E, hospital planner, medical equipment…), contractors and clients including end users (doctors, nurses, administrators) to go through the whole hospital design. It was the perfect time to learn and understand the whole hospital design concept and functional requirement of each department, in additional to IT-centric hospital work processes and policies.
The company I worked for sub-contracted the whole IT portion to a company from Austria knowing we did not have the know-how locally. The company put together a solution encompassing Siemens, Cerner, Spacelabs, Oracle, and PeopleSoft to meet the paper-less and film-less requirements.The whole implementation took about 3 years and it was the best learning experience.
After Selayang Hospital, I was involved in a few other hospital IT consulting and project management engagements. This included a role as the lead project management consultant for a medical campus project chairing construction meetings (supported by a team of professional consultants of various disciplines) since I am familiar with the Malaysian government construction contract conditions.
For overseas projects, I implemented the first hospital data warehouse in Fuzhou, China (2002), conducted feasibility studies in Indonesia, Vietnam, Tajikistan, and Kyrgyzstan.
HelloIOTA Question #2
With such a rich and diverse background, you’ve gotten a taste of many different cultures which makes you uniquely aware of Western culture vs Eastern culture. With this background, I’d be interested to hear if there are any differences in how cryptocurrencies are perceived by the different cultures, in your experience. With tempers flaring in Hong Kong, it seems like your locale (Malaysia and Singapore) is positioned to be a financial and technology hub in Hong Kong’s stead. Do you have any insights into the regional geopolitical instability with regard to its potential positive impact on KL?
I think both cultures have a similar perception of cryptocurrencies as a currency. The more obvious part is the western culture has more emphasis on building applications on the technology behind the cryptocurrency instead of just figuring out how to profit from this movement. Western culture is also more willing to share thoughts, findings and experiences to build things together, especially in opensource projects.
In Asia, e-wallets are common and governments are pushing for their caseless society agenda. It will take some time to achieve that, however, as the success depends on availability of mobile data or coverage of 3G/4G. So, I don’t think cryptocurrency will be able to take over that area especially since buying crypto remains such a painful and stressful exercise in Asia.
What's happening in Hong Kong benefits Malaysia’s property market a little. There is a surge of Hong Kong people buying property and staying here under Malaysia’s Second Home program, which allows retired foreigners to stay here after they purchased a property of certain value.
The Hong Kong incident has no impact to KL as a financial or technology hub. It probably benefits Singapore on the financial side. We don’t see Hong Kong as a strong technology hub as it is right next to the hardware Silicon Valley, Shenzhen. In fact, some Malaysian companies already built their development center in Vietnam due to lack of interest in local graduates to get into programming. What benefits Malaysia more is the US-China trade war due to relocation of factories.
HelloIOTA Question 3
You’ve started a project called SmartOptz that’s built on the Tangle. As people look through the project’s materials, they’ll see reference to another project called SmartLifez. It looks likeSmartLifez is a smart-medical-device vendor. With your extensive healthcare consulting background, can you tell us what you saw in the industry that led you to starting this bluetooth device company? How did these companies come about?
SmartOptz PLT is a company registered in 2014 to develop an Internet Bandwidth Optimizer solution, thus the name “SmartOptz” for Smart Optimization. The solution is based on open source technology intended to help companies to do bandwidth allocation.
Remote Patient Monitoring is a project developed under Smartoptz in 2016 inspired by a business trip to Shenzhen, China. In theory, this is a good project to work on as it helps patients to monitor their vitals together with their care provider. It also sounded financially viable even if we just focus on diabetes care based on the statistic of 1 in 4 Malaysian is a diabetic and 1 in 2 of those is over 60 years old.
The immediate challenge we had to face in 2016 was unavailability of bluetooth home-care medical devices in Malaysia. So we had to register as Local Representative with Medical Device Authority in order to import those devices (from Taiwan), which was a costly and time-consuming process.
To market those devices, we built a website called SmartLifez with e-commerce function in late September, 2016. We have since moved the online sales to Lazada, a local e-commerce platform as we find it too challenging to manage an e-commerce site on our own.
When we presented the prototype and concept to one hospital, we found the key incentive to the hospital is to reduce the average length of stay so they can take on more new patients. Note that the first 2 days of a patient’s hospital stay is is the most profitable part of a stay to the hospital because of various test orders being placed during that time period. Remote Patient Monitoring will help to increase bed turnover rate by sending some recovering patients home for home monitoring. Patients in general are happier to do follow up at home especially when they are aware that the hospital is still monitoring their vitals remotely.
I must thank you for pointing out the confusion about SmartLifez. We have converted the site solely for our users and care providers to log in via QR code with the Missi app to access medical records.
When we learned about IOTA in November 2017, it changed everything. Smartoptz’s long term vision is to build an EHR (ElectronicHealth Record) so users can access their health record anywhere, anytime anonymously. After a few months of studying IOTA's protocol, we were so excited and convinced that IOTA's Tangle was the missing piece in our vision of managing the self-sovereign identity to achieve our vision that we rebuilt the whole solution to be based on IOTA protocol.
HelloIOTA Question #4
The SmartOptz website promises to help with remote patient monitoring (RPM), which looks like at-home weight measurements, blood glucose levels, and pulse oximetry, among many others. It also promises to free hospital nurses from having to manually record vitals, and boasts that it can do so by being used in conjunction with the Taidoc vital sign monitor. Are you more focused on the home health market or the institutional hospital market? Maybe you can give us an idea about the differences between the two? And give us an overview of the general state of RPM along with smart devices in healthcare. (we assume that RPM is the way of the future)
There are 2 categories of devices:
· Single-device single-parameter designed for home care like glucose meter, SpO2 or blood pressure monitor.
· Single-device multiple-parameters typically used in hospital wards, ambulance service, and assisted living centres.
In terms of market segments:
· Homecare
For example, diabetes a patient purchases a bluetooth glucose meter to keep track of his glucose and shares the trend with his doctor. This is a very hard concept to promote to individuals locally who don’t mind recording their reading on paper and bringing it to the doctor. Lack of insurance coverage for homecare and extra cost incurred also discourage the acceptance rate. Another thing to note is that Malaysia has universal healthcare coverage, so the public in a way has less incentive to stay healthy. In short, the market segment needs hospitals to work out a care plan together to provide as part of the hospital service at home for it to work.
· Hospital / Assisted Living Centres
In a hospital ward, the nurse will take usually SpO2, blood pressure and pulse of the patient. In a hospital with EMR, the nurse can push a computer on wheel (COW) to the bedside, take the reading and key in the vital sign reading in the computer. The common practice is: nurses will record vitals of a few patients, go back to the nurse station then enter it into the system, which can lead to medical errors. In our solution using Taidoc Vital Sign Monitor (5 parameters –blood pressure, ECG, glucose, temperature, SpO2, Pulse) which supports WIFI, the nurse only needs to scan a patient’s wristband barcode to take vitals which will be automatically uploaded to the server in 5 minutes. For urgent cases, the nurse can press the Upload button to push the data to the server immediately. We can also interface to the hospitals’ Hospital Information System so there is no user intervention to ensure data quality.
So it is clear to us that Hospitals, Ambulances and Assisted Living Centres will be our primary focus to push our solution. We have just signed up a chain of 3 assisted living centres (Zen Villa) to deliver Taidoc Vital Sign Monitors together with our Smart VSM solution to be implemented next week. This is a small project but a major milestone as this is our first Smart VSM site. One of the requirements of Zen Villa is for their client’s family members to have assess to the patient’s vitals taken in the centres.
The vital sign data sharing will be implemented in the second phase using IOTA powered self-sovereign identity after the launch of Chrysalis 2.0 to make sure the change of protocol will not break our implementation. Subsequent to that, when the Zen Villa's patients go to collect investigation reports, we'll will move on to connect to medical centres where the Zen Villa’s patients go to collect investigation reports, medication to sort of building a mini EHR ecosystem. This will take time tomaterialize and we are all looking forward to it.
RPM is gaining rapid adoption due to this Covid-19 pandemic, even in Malaysia, primarily in the form of tele-consultation. The adoption of smart devices to provide data as part of the RPM service is still lacking in this region. I am not sure how the progress has been in other markets. Smartoptz is looking into building an API to integrate with other RPM players so we can stay with our data centric service and they will do their own consultation part.
HelloIOTA Question #5
My rudimentary understanding of the process: a bluetooth-enabled medical device is used to measure some health metric from a patient. This can happen at home or in a hospital. The bluetooth-enabled medical device is paired with a SmartOptz gateway. When health metrics are measured by the device, that data is uploaded onto the IOTA Tangle via the SmartOptz gateway. From there, both the patient and their physician can access the data from a secure dashboard. Does the gateway itself have an embedded IOTA node? Will hospitals need one gateway per patient room? Once the device and gateway are paired, does data automatically get uploaded to the Tangle as it’s collected? Does it use IOTA Streams? Tell us more about the gateway.
The medical devices is paired with theSmartOptz Gateway via Bluetooth Low Energy (BLE).
The data connected is cryptography signed by the gateway and pushed to SmartOptz server.
The current IOTA WOTS and POW is just too resource intensive for uploading data into the Tangle.
Retrieving data from the Tangle is not quick enough as vast amount of data is not related to the Data you want. Until a selective PermaNode solution is in place, storing Data in the Tangle does not make economic sense.
From there, both the patient and their physician can access the data from a secure dashboard. Does the gateway itself have an embedded IOTA node?
SmmartOptz Gateway does not run the IOTA node software but has the IOTA client (wallet features).
Will hospitals need one gateway per patient room?
We have another product for hospitals. This is a Vital Sign Monitor (VSM) with five parameters: Blood Pressure, Blood Glucose, Temperature, SPO2 and ECG. We prefer the use of a Docker/VM as it can handle multiple VSM simultaneously.
Once the device and gateway are paired, does data automatically get uploaded to the Tangle as it’s collected?
The device and the Gateway are paired via the mobile app called Missi. Missi also has the IOTA Client. For example, if a patient is done and they unpair the gateway using the Missi app, another patient pairs to the gateway, the gateway will regenerate a new seed and Self-Sovereign ID. In short, the Seed and Self-Sovereign ID on the gateway is ephemeral.
Does it use IOTA Streams?
Yes, the Self Sovereign ID of the Missi and SmartOptz Gateway are stored in IOTA Streams.
Tell us more about the gateway.
The SmartOptz Gateway is based on the Raspberry Pi3B+ with an added Secure Element.
HelloIOTA Question #6
An app called Missi handles user verification, and does so without needing a phone number or email address. It presumably provides the IOTA address associated with the account and uses this for all subsequent user data validation. Is this correct? So the patient would set up their account on the Missi app and give their physician the IOTA address associated with their account? No need for any other personal data? How does this play in the eyes of healthcare regulators?
Yes, this is where the Self-Sovereign ID is created and uploaded into the Tangle
So the patient would set up their account on the Missi app and give their physician the IOTA address associated with their account?
The patient scans the QR Code on the WebPortal where the Physician is also login to (both used Missi to login) toregister. Login and association of accounts are done via QR code andauthentication and verification is done both on the web portal and Missi. Thisis done by exchanging the IOTA Address of the IOTA Streams and each side verifyeach other's Stream Message. Both sides must accept for the registration toproceed.
No need for any other personal data?
Missi app – there is no need for the individual user to enter any personal info. Every data field is optional during installation including User Name, which is used for the messaging within missi.
Health portal – when a patient, say Bob, visits a hospital, he needs to scan the rotating hospital QR code give consent to the hospital to view his data. The registration clerk will then register him in the portal with Bob’s Patient ID only. However, the hospital may choose to enter a patient’s name and DOB which are not compulsory for easy reference. Personal data in this case will be stored together with the actual vital sign or clinical data. After the hospital visit, Bob can choose to disable the hospitals’ access to his medical data.
How does this play in the eyes of healthcare regulators?
There are many healthcare apps in the region including a few from insurance companies collecting a lot more personal identifiable data with health info. SmartOptz’s RPM solution, in its on-premise type of implementation, will work even without any personal identifiable info in the cloud. This we trust will probably be welcomed by the healthcare regulators. 😊
HelloIOTA Question #7
Talk about the process of developing the Missiapp. And talk about the process of developing the SmartOptz gateway hardware. Are both of these products in the market already? If they’re both already functional, what was the process like trying to find engineers to build each one? Specific challenges and/or surprises? Is there a team behind this company, or is it a solo-enterprise for now?
To develop Missi, we first needed to learn how to handle the bluetooth so we could manage the device connectivity. Initially we thought bluetooth was a standard protocol, but then we started working with it on Android phones. The challenge is not the bluetooth healthcare standard, but rather that noone really follows the standard strictly enough. On top of this, different phone manufacturers implement bluetooth differently and each Android version upgrade changes the bluetooth management to save battery power, which was my presumption.
We had a team 4 doing the development at the initial stage. My partner who handles the development worked with 3 interns to get the prototype. The team spent about 3 months to understand fully how bluetooth healthcare protocol works. The testing was done against a smartwatch, blood pressure and glucose monitor. We managed the whole solution working but were having nightmares trying to support the bluetooth connection problem between the devices and smartphones. That prompted us to change to a gateway approach and use the smartphone for the purpose of one-time gateway configuration only.
Missi app and gateway are available now. The gateway is developed using Raspberry PI 3 with a secure element. We are planning to use ESP32 to build the gateway in the next iteration.
I am lucky that my partner is a very experienced system engineer and programmer who can architect the whole implementation using IOTA. Currently, he has another full-time programmer assisting him with the development. An intern and I are helping to do the testing and documentation.
Our project is funded by revenue from our hospital IT consulting and project management. We have tried approaching government agencies for funding to engage a bigger team to speed up the development, but no luck yet.
HelloIOTA Question #8
You’ve got nine partners listed on the website, including multiple hospitals. The partners appear to span from Asia to Germany. Are these active partnerships? How did you come to form these relationships? Talk a little about where these partnerships might take theSmartOptz project.
Those hospitals (Island, Tung Shin and Beacon) are not partners; they are our HIS project management service customers. Mediconsult is a healthcare consulting company for whom I worked for a few years.They provide hospital planning, medical equipment planning, public health planning and health IT planning services with many international engagements. The hospital IT feasibility study works with giz in Tajikistan and Kyrgyzstanwere was referred by them.
We have been in the healthcare IT industry for the past 20+years dealing with Total Hospital Information System (THIS), Hospital Information system (HIS) implementation, project management and consultancy. We are also well versed in the software and hardware, medical equipment interfaces aspect of an hospital IT implementation.
Talk a little about where these partnerships might take theSmartOptz project
· Taidoc Corporation. A medical device manufacturer in Taiwan that produces excellent bluetooth medical devices and has a particularly good working relationship with us. Their global reach will make it easier for SmartOptz to market our solution and services overseas.
· Dr. House and Zen Villa are home and assisted living players. These partners enable SmartOptz to promote our solution to their clients.
· BiiLabs and SmartOptz had signed an MoU to work together. We met in Taipei to discuss potential collaboration utilizing BiiLabs TangleID in the presence of Andrew Greve from IOTA Foundation. At the end, we decided to do our own implementation of Self-Sovereign ID.
HelloIOTA Question #9
How does using IOTA, or any distributed ledger in general, improve the medical data experience? Compared to a private health company storing the data on their own private server, covered by insurance and institutional control? Have you seen companies that are receptive to the more open DLT direction?
IOTA and DLT in general will herald new ways to ensure data integrity and authenticity via cryptography. IOTA is among the very few DLT projects that is fee-less where Data and Value transactions are treated equally.
Data silos have existed since the start of computerization, and the phenomenon inherently the customer in. We are of the opinion that the data collected by healthcare providers should be shared to improve care management and reduce repetitive expensive diagnostic procedures when the patient moves from one facility to another.
Compared to a private health company storing the data on their own private server, covered by insurance and institutional control? Have you seen companies that are receptive to the more open DLT direction?
Yes, but only a hand full. That, however, may change as Ant Group just announced their partnership with a local vendor to market their AntChain solution.
HelloIOTA Question #10
In conclusion, paint a picture of what the future of healthcare data looks like. How do you see SmartOptz ultimately playing out if it achieves everything it’s setting out to do?
The big picture is that a patient walks into any healthcare facility anywhere in the world and he/she can just use Missi to scan the QR code on SmartOptz Healthportal. The physician can view the whole Electronic Health Record history in chronological order.
