Intelligent Transformation enables Upgrading of Medical Care

        The increasing popularity of Big Data+ AI+IoT not only helps enterprises to find new commercial value, but also greatly improves the service quality of the medical industry, and even helps to link the whole industrial ecological chain and further develop the medical economy. This issue of "Cover Story" invites FEMH President Fang-Yue Lin to share with you the development direction of Taiwan's intelligent medical care, and how Far Eastern Memorial Hospital built a smart hospital to leap into the medical 4.0 era!

Network connection to Construct Intelligent Hospital
The advent of the aging society and the shortage of medical and nursing manpower are two major problems in Taiwan's medical industry in recent years. Fortunately, the booming development of intelligent technology has brought new dawn to improve the quality and efficiency of medical care. Therefore, as early as the planning of the expansion project of the hospital, Far Eastern Memorial Hospital, aiming at building a smart hospital, actively cooperates with technology manufacturers, integrates databases, and uses digital and cloud-based networks to construct the Internet of things (IoT) for instruments and equipment.

        At present, Far Eastern Memorial Hospital has introduced a digital registration and queuing system in outpatient areas and check-ups, and publishes hospital information through a public e-board. The physiological measurement instruments and respirators in ward areas can automatically upload patients' physiological data. Meanwhile, the efficiency of nursing work can be improved by means of instrument positioning system and interactive electronic whiteboard of nursing station. In addition, interactive TV beside the hospital beds can also provide customized health education information for patients. In view of the payment process, the hospital has also considered a lot, in addition to providing automatic payment machines to facilitate self-help payment, Happy Cash e-payment, APP in the mobile devices and other multi-payment methods are also promoted.

It is worth mentioning that Far Eastern Memorial Hospital is also the first hospital in Taiwan to automatically upload physiological monitoring database for analysis and calculation. FEMH President Fang-Yue Lin said that EWS（Early warning Scores）can automatically upload the physiological data in 15 seconds and red, yellow and green are used to stand for high, medium and low risk respectively after calculation. It is presented on the electronic whiteboard to facilitate medical staff to identify the risk level and early intervention treatment. In addition, Far Eastern Memorial Hospital was awarded the Gold Prize in the Electronic Medical Record Innovative Application Service Promotion Competition held by the Health and Welfare Department for the establishment of Cloud Medical Record System, Blood Transfusion and Drug Checking System, Electronic Form and construction of Electronic Medical Record.

        In the future, the hospital also plans to connect the physiological measurements of outpatient areas to the Hospital Information System (HIS), so that the patient's height, weight, blood pressure, body temperature and other index can be automatically uploaded to the doctor's advice system, avoiding copying errors, and providing historical measurements as a basis for health assessment. In view of the ward, President Lin also plans to connect the infusion pump with the doctor's advice, and to reduce the burden of nursing manpower and the probability of misuse of drugs through the notification s of mobile devices (e.g. mobile phones and work cars). "By the way, the electronic bedside card in the ward should be combined with nursing calls, electronic whiteboard and other equipment to optimize communication between the doctors and patients; and if the controlled chemotherapeutic drugs can be sent directly to the ward by the pharmacy through the pharmacy-safety robot, the possible risk of loss or spilling can be avoided in personnel transportation... Speaking of the plans to be launched, President Lin's tone was full of expectations.

Realizing long-distance medical treatment by means of Production and school
Far Eastern Memorial Hospital and Far EasTone Telecommunication jointly launched “Health ＋” in order to improve the health care of discharged patients and community residents and to provide better treatment and health control for patients with chronic diseases. Patients at home can measure blood pressure and blood sugar, upload data to the hospital and the health manager can monitor immediately, if there are abnormalities, there will be prompt consultation. Since the launch of the service, nearly 400 people have used the home health management devices that are rented monthly. According to the statistics of members' medical treatment and medication, it has indeed produced substantial benefits for the control of chronic diseases.

As the telecommunication industry is about to enter the 5G era, President Lin hopes to further cooperate with Far EasTone Telecommunication to conduct telemedicine consultation at selected demonstration sites in downstream hospitals, and to cooperate with technology manufacturers to develop telemedicine solutions so that users can share measurements with doctors for instant video detection and reservation of video diagnosis, and cloud database can also use machine learning algorithm to develop pre-processing mode.

        On the other hand, President Lin also found that "throat problem is a common health disease in modern society. Because vocal cords are deep in the throat, it is difficult for patients to find well-equipped hospitals and experienced specialists, so the opportunity to see a doctor is often delayed." In addition, the treatment process requires frequent trips to and from the hospital and continuous practice, which is also a major problem for busy commuters or patients with traffic inconvenience. "Far Eastern Memorial Hospital Otolaryngology Voice Team published the world's first professional paper using in-depth learning about the technology to detect pathological voice in 2018, combining Big Data of voice with Professor Fang Shihao's expertise in AI artificial intelligence in Yuan Ze University, and successfully integrated acoustic signals with pathological voice in 2019. The first innovative system that can automatically classify voice and throat diseases is put forward in the medical history record. It is not only favored by IEEE (The Institution of Engineering and Technology), a multinational competition for artificial intelligence to recognize pathological voice is held as well for two consecutive years.

        In order to put the academic research into practice, Far Eastern Memorial Hospital, in collaboration with Yuan Ze University, has also proposed a voice health screening program for telecom customer service personnel, which can be used to predict vocal discomfort in the throat and vocal cords by filling in a simple online questionnaire and recording a little sound piece and then the results of the examination can be transmitted to the hospital to get timely treatment. "At present, we are actively discussing cooperation plans with Far EasTone Telecommunication, hoping to benefit more colleagues in the group and improve everyone’s health in the future," Lin said. "
Intelligence Empowerment Unlocking Predictive Medicine
"In fact, the further development of intelligent medicine requires cross-border communication between medical and information professionals," Lin said. "If engineers can assist in developing labeling tools and analysis programs, physicians can perform symptomatic labeling and database analysis, and then through the establishment of artificial intelligence and in-depth learning modules, the accuracy and efficiency of diagnosis and treatment can be further improved."

Far Eastern Memorial Hospital has launched Collaboration between industry and school with Yuan Ze University, Acer, Quanta and US start-ups for this purpose, for example, through Big Data of Heart Failure Center Database and Health Care Database and combination with clinical care and nuclear myocardial scanning in patients with heart failure. The diagnosis of etiology and level of care will be improved. It will also be helpful to develop new biological indicators and home-based intelligent medicine in the future. On the other hand, the hospital should also use artificial intelligence to detect 6,000 chest CT images in two months, detect 9 clinical events, and scan 12,280 CXR, improving the accuracy. Normal image module and automatic report system have been integrated into the report making system of the Department of Medical Image. According to the classification of image diagnosis, various interpretation modules have been developed successively.

"The X-ray pneumonia diagnostic module of our hospital participated in the global AI competition in 2018, winning the 16th place among more than 1,400 teams and the first place in the whole Taiwan. However, President Lin is not complacent. In the future, he plans to retrospect about 1 million pieces of chest X-ray, head computed tomography and magnetic resonance imaging in the past few years. After removing personal information, medical staff will complete the labeling and send it to the artificial intelligence server for in-depth learning to produce the AI model. "In order to validate the AI model, we will compare 300 cases in which the physician labels the target features separately to confirm the predictive ability of the model. Then we will repeat the above steps for each target feature to develop a new model, establish a medical computer-aided classification system based on in-depth learning, and improve the reporting efficiency and image reporting quality. "

In addition to the active development of AI diagnostic projects by medical teams, it is felt that the application of AI in the medical industry is becoming more and more important. At the beginning of this year, the hospital has also opened "AI School" in cooperation with the Institute for Information Industry and Oriental Institute of Technology to strengthen the cross-border understanding of medical staff in order to continuously promote the innovation of intelligent medical care. The president also plans to co-ordinate related resources, set up artificial intelligence laboratory (AI Lab), appoint special analysts and engineers, and establish medical AI database to assist medical research.

In addition, with the wide application of new technologies such as Virtual Reality (VR), Augmented Reality (AR) and Mixed Reality (MR), voice and image recognition technology, machine in-depth learning technology are becoming more and more mature, and Far Eastern Memorial Hospital plans to introduce the application of virtual patient human-computer interaction and 3D printing step by step. The training of clinical skills, virtual reality first aid training, virtual clinical diagnosis and treatment training, operation simulation teaching and long-distance medical teaching will be carried out to improve the learning effect of medical personnel and the quality of medical technology and care.
"Developing smart hospitals is an opportunity to improve efficiency and patient safety. Taiwan has excellent medical standards and research and development capabilities of communication. As long as science and technology are combined with medical development, we can change and innovate the medical care model, so that smart medicine can create greater output value. President Lin is confident about the future of the medical industry, and this confidence will lead Far Eastern Memorial Hospital to the "Smart Hospital 4.0" road.