Robotics and the Medical Internet of Things /MIoT

Dr. Joao Gomez

The integration of robotics in healthcare has the potential to revolutionise the industry, but it also presents a range of ethical and technical challenges. Striking a balance between these challenges is crucial to effectively and responsibly integrate robotics into healthcare systems.

Ethical considerations are paramount in the successful implementation of robotics in healthcare. Data privacy and accountability are priority concerns. Patient data must be protected from breaches, and encryption and security mechanisms are necessary to safeguard patient information. Furthermore, addressing questions of accountability is essential to attribute and rectify errors or malfunctions. By addressing these ethical considerations, healthcare providers can build trust with patients and ensure the confidentiality of personal information.

On the technical front, several elements are integral to the seamless integration of robotics in healthcare. Harmony between hardware and software is key, enabling accurate and reliable performance. This involves careful selection of sensors and actuators to ensure accurate perception and interaction with the environment. Seamless integration is vital for intelligent algorithms and support for advanced functionalities. Additionally, accessibility and good user interface design are crucial for easy use and navigation of robotic systems, enhancing efficiency and effectiveness.

Fairness and equity should also be central to the integration of robotics in healthcare. Technologies should not only serve those with easy access to healthcare facilities but also be made available in rural areas or regions with limited healthcare access. Ensuring equitable access to these technologies can help reduce inequalities and improve healthcare outcomes for all individuals.

In conclusion, the integration of robotics in healthcare holds significant potential, but a cautious approach is required. Prioritising ethical considerations such as data privacy and accountability is critical. Technical aspects, including hardware and software integration, accuracy, accessibility, and user interface design, are essential for seamless integration. Moreover, ensuring fairness and equity in access to these technologies is crucial, particularly for underserved areas. Addressing these challenges enables healthcare professionals to utilise robotics to enhance patient care and improve health outcomes globally.

Frederic Cohen

During the discussion, the speakers emphasised the significance of international collaboration and development in edge technologies. They highlighted a focus group meeting that took place in Shanghai, involving the International Telecommunication Union (ITU) and focusing on the metaverse. The participants stressed the importance of physically meeting each other to further advance the metaverse and medical health systems.

The speakers also mentioned ongoing development initiatives with global partners, aiming to drive progress in the metaverse and medical health systems. These partnerships demonstrate a commitment to working together towards common goals, pooling resources and expertise. This collaborative approach reflects the importance of partnerships for the goals of industry, innovation, and infrastructure, as outlined in SDG 9.

Furthermore, the speakers expressed a positive outlook towards future meetings and ongoing developments. They expressed hope to see everyone next year, indicating a strong desire to continue collaborating and building on the progress made so far. The speakers specifically mentioned previous Asian business travel and meetings held in the past year, serving as a testament to the commitment and enthusiasm for collaboration in the region.

This extended summary provides a detailed understanding of the importance of international collaboration and development in edge technologies. The emphasis on physically meeting, ongoing development initiatives with global partners, and positive outlook towards future meetings contribute to fostering innovation and achieving the goals of industry, innovation, and infrastructure. The speakers’ reflections on past Asian business travel and meetings further highlight the commitment and dedication to collaboration in the region.

Overall, the discussion underscored the critical role of partnerships in advancing technological developments and meeting the challenges of the modern world. By working together and sharing knowledge and resources, stakeholders can address complex issues and drive progress in the metaverse, medical health systems, and other areas. The speakers’ positive sentiment and optimism towards future collaboration bode well for achieving desired outcomes and realising the potential of edge technologies.

Dr. Erbguth

The analysis explores the ethical concerns surrounding data collection by robots in the healthcare sector. It highlights the potential privacy issues and misuse of information that can arise from robots equipped with sensors capable of gathering sensitive data. For example, while robots are used for caregiving purposes in healthcare, their data collection capabilities may inadvertently lead to privacy concerns. Additionally, robots have the ability to collect more sensitive data compared to conventional surveillance systems, further exacerbating these concerns.

Another significant ethical concern relates to the processing and storage of data collected by robots. The analysis raises concerns about the ambiguity surrounding data access and potential non-medical uses, such as monitoring human behavior. This raises questions about the control and appropriate utilization of the collected information.

However, there are positive aspects to consider. The importance of obtaining informed and voluntary consent from users regarding data collection and usage is emphasized. This consent should be granular, ensuring that individuals fully understand what they are consenting to and have the ability to reject unnecessary data uses. The concept of consent acts as a safeguard to protect individual privacy and autonomy.

Furthermore, the analysis underscores the need for comprehensive implementation of data governance in hospitals. Given the sensitivity of hospital data, robust data governance measures are vital to effectively manage data collected by robotic systems. The increased data processing capabilities of these systems further underscore the importance of strong governance practices.

In conclusion, the analysis highlights several ethical concerns pertaining to data collection by robots in the healthcare sector. These concerns include privacy implications, potential data misuse, the necessity for informed and voluntary consent, and the importance of data governance in hospitals. The findings promote an ethical approach to data collection and usage in the healthcare industry, ensuring the protection of individuals’ privacy and rights.

DC member

The speakers discussed the challenges and importance of achieving a green healthcare environment. They emphasised the integration of artificial intelligence (AI) into healthcare systems, which has revolutionised the field. AI-driven diagnosis and prediction analysis, along with personalised treatment, can significantly enhance healthcare outcomes while reducing waste. The speakers also highlighted the increasing use of telemedicine platforms, which require more user-friendly interfaces to accommodate the growing demand for remote medical consultations.

Another crucial aspect discussed was the energy efficiency of data centres, which are vital in supporting human-computer interfaces and robot applications in healthcare. The speakers underscored the need to reduce the carbon footprint of healthcare facilities by prioritising renewable energy sources such as solar and wind power. They also emphasised the importance of implementing advanced cooling technologies and optimising server farms to reduce energy consumption.

Furthermore, the speakers stressed the significance of designing and manufacturing sustainable human-computer interfaces and robotic devices. This involves recycling materials and reducing waste to contribute to a smaller ecological footprint. By prioritising sustainability, healthcare providers can not only reduce environmental impact but also set an example for other industries.

In conclusion, the journey towards a green healthcare environment is not without challenges. However, the integration of AI, the promotion of energy efficiency in data centres, and the prioritisation of sustainability in the design and manufacturing processes of healthcare technology are crucial steps towards achieving this goal. By adopting these practices, healthcare providers can enhance patient outcomes, reduce waste, and contribute to a more sustainable future.

Amali Desilva Mitchell

The integration of robotics with the medical internet of things (IoT) has the potential to support people in remote and rural areas, as well as assist individuals with disabilities and other marginalized groups. This integration combines advancements in artificial intelligence (AI) with physical robotics, enabling the delivery of healthcare services in areas with limited access to medical facilities. The Dynamic Coalition on Data-Driven Health Technologies has actively engaged with the public over the past year to study this topic and promote the benefits it offers.

Additionally, there is a focus on the use of medical records and space technology, which could have implications for reaching rural populations. Dr. Oscar Garcia, a renowned expert in the field, has been invited to share insights on how medical records and space technology can contribute to improving healthcare delivery in remote areas. This exploration aims to bridge the gap between healthcare services and underserved communities.

The Medical IoT is increasingly crucial for healthcare. With patients spending less time in hospitals, post-operation monitoring is occurring digitally. However, there is an increased reliance on reliable internet connections for health-related devices. This poses challenges, particularly in regions where internet connectivity may be unreliable or inaccessible.

The integration of AI and robotics in healthcare is on the rise, as seen in examples from China and Japan. China has utilized nurse robots to support staff in elderly care, while Japan has adopted robots for tasks such as cleaning and food delivery for the elderly. This integration enhances the efficiency of healthcare services and improves patient care, particularly for the aging population.

While advanced healthcare is becoming more digital and accessible, patient concerns must be considered. The ITU’s AI group is actively developing processes and procedures for AI working in conjunction with medicine. Patients will increasingly interact with these technologies, and addressing their concerns and ensuring they know what to expect is important. A patient-centric approach to design and implementation can build trust and acceptance of AI and robotics in healthcare.

However, there are privacy and security concerns associated with the use of AI and robots in medicine. Patients have legitimate concerns about the potential risks and harms of medical interventions involving AI and robots. Privacy concerns also arise with health checkups that involve patient data, highlighting the importance of protecting patient information. Ensuring robust security measures and transparent handling of patient data is essential to address these concerns and build public confidence in these technologies.

Moreover, the use of IoT devices for children raises data privacy and security concerns. Amali Desilva Mitchell highlights the potential risks associated with data collection by devices like “Teddy the Guardian,” an IoT teddy bear that collects children’s medical data. The question of where the collected data goes and the interception of sensitive information must be carefully addressed to safeguard privacy and ensure the safety of children.

In conclusion, the integration of robotics and the medical IoT holds promise in supporting remote areas and marginalized groups. The work on medical records and space technology offers opportunities to reach rural populations. The Medical IoT plays a crucial role in healthcare, but challenges relating to internet connectivity persist. The increasing integration of AI and robotics in healthcare requires addressing patient concerns and privacy issues. Ensuring data privacy and security in IoT devices for children is also of utmost importance. Considering these factors will help maximize the benefits and mitigate the risks associated with these technological advancements in healthcare.

Judah Crow

The analysis focuses on the potential benefits and concerns associated with digitization for the improvement of children’s health and the right to identity in rural areas. It argues that digitization can play a significant role in enhancing children’s health by providing unified services for their medical data. The Digital Opportunity Foundation, an organization that has been working on the societal impact of digitization for over 20 years, emphasizes the potential of digitization in the health sector to offer streamlined and integrated services for children’s medical information. This approach can potentially improve the efficiency and effectiveness of healthcare delivery for children, ensuring that they receive the necessary treatment and care.

Furthermore, the analysis highlights the importance of birth registration and the right to identity for children in rural areas. It states that birth registration and the right to identity are crucial for ensuring that children in these areas receive adequate healthcare and treatment from the very beginning. By registering a birth and establishing an identity for a child, the medical system and caregivers gain access to vital data, enabling them to provide timely and appropriate healthcare services. This aspect emphasizes the significance of digitization as a means to facilitate birth registration and the right to identity in remote and underserved regions.

However, concerns are raised regarding the security of personal data collected by Internet of Things (IoT) devices. The discussion highlights the example of an IoT device called ‘Teddy the Guardian’, which measures and tracks children’s health data. While this device offers the convenience of allowing parents and pediatricians to access the data via a smartphone, questions have been raised about the location and potential interception of this sensitive information. The analysis suggests that there is ambiguity regarding where the data from IoT devices like ‘Teddy the Guardian’ is stored and how it is protected.

In conclusion, digitization holds the potential to significantly improve children’s health and the right to identity in rural areas by providing unified medical services and facilitating birth registration. However, the security of personal data collected by IoT devices remains a concern. This analysis highlights the need for robust data protection measures to safeguard children’s sensitive health information in the digital age. Further research and efforts are necessary to address these concerns and ensure the responsible and secure use of digitization for children’s health and well-being.

Judith Hallison

The analysis examines how technology can affect vulnerable groups, specifically focusing on children’s data security, persons with disabilities, and the reliance on artificial intelligence (AI) for tasks like captioning. One concerning issue is the potential risk posed by internet-connected toys, such as teddy bears, to the security of children’s data. These toys can be hacked, putting children’s privacy at risk. Moreover, the analysis highlights the absence of established rights and protections for children’s data, further exacerbating their vulnerability.

Another concern raised is the potential disenfranchisement of persons with disabilities with the introduction of robots. Robots face challenges in effectively communicating with individuals who are visually impaired, hearing impaired, or cognitively impaired. This creates barriers to the full engagement and inclusion of these individuals in society. The analysis also highlights the difficulties faced by people with disabilities during the COVID-19 pandemic, where mask-wearing and limited access to video conferences further restricted their communication options.

The analysis also emphasizes the potential consequences of relying on AI for tasks like captioning. It argues that this reliance can result in errors and marginalize individuals with disabilities. For instance, AI providing incorrect surgical guidance can lead to surgical errors, posing risks to individuals with disabilities. Additionally, AI captioning can be inaccurate and fail to clearly convey spoken words, hindering effective communication for those reliant on captioning services.

In summary, the analysis highlights the importance of inclusive technology design and ensuring that technological advancements benefit all members of society. It underscores the potential risks related to internet-connected toys, robots, and AI concerning children’s data security and the inclusion of persons with disabilities. The analysis calls for designers, policymakers, and stakeholders to consider the needs and rights of vulnerable groups in technology development, aiming for a more equitable and inclusive technological landscape.

Dr. Oscar Garcia

Oscar Garcia discussed the challenges of managing interconnected, digital health information in his presentation. He highlighted the diverse perspectives and individual needs of healthcare specialists, which complicate the unification of patient data. The third-payer model used in most countries further complicates data access and usage, and varying privacy regulations across different countries add to the complexity of managing health records.

Unified Medical Records has deployed a system to connect various healthcare components, facilitating collaboration among providers, insurances, laboratories, and imaging centers. They have also developed a pen drive that enables doctors to access and transfer information effortlessly, even in challenging environments. During the COVID-19 pandemic, they identified the need for telemedicine, remote auditing, and a health dashboard for remote administration.

Unified Medical Records is also working on medical records for space exploration, aiming to facilitate consultations between astronauts and healthcare professionals on Earth. They are committed to collaborating with underserved communities and providing services for free whenever possible, in alignment with the Sustainable Development Goals (SDGs).

However, connectivity issues pose challenges to internet-based healthcare. Delay and Disruption-Tolerant Networking (DTN) technology has been applied to mitigate disruptions by storing and forwarding information until connectivity is available again. This technology has been used in Arctic regions to track reindeer herds with small message sizes and cost-effectiveness. It also holds potential for remote healthcare services in challenging environments.

Overall, Oscar Garcia’s discussion shed light on the complexities of managing interconnected health information. Unified Medical Records strives to address these challenges through innovative solutions, collaborations, and a focus on inclusivity. DTN technology offers promising opportunities to overcome connectivity issues in healthcare delivery.

Dr. Gupta

The potential applications of robots in healthcare are significant, as they have the ability to replace routine tasks and perform precise operations. For instance, robots can carry out tasks such as transporting blood samples and patients, which not only saves time but also reduces the risk of errors. Moreover, robots are capable of performing surgeries with high precision, resulting in less blood loss and better healing outcomes.

However, the high cost associated with implementing robots in healthcare settings poses a major barrier to widespread adoption. It can cost up to £2.5 million to introduce a robot in a hospital, making it unfeasible for every healthcare facility. Additionally, the cost of maintaining these robots is also high. Moreover, there is a concern that the rapid advancement of technology may render the existing robots obsolete, further adding to the expenses.

Despite these challenges, the field of robotics in healthcare continues to evolve. Research is being conducted to develop specialized robots for specific medical fields like cardiology and urology. These specialized robots have the potential to revolutionize treatments and improve patient outcomes. Furthermore, the possibility of remote surgeries, where procedures are performed from hundreds of miles away, has become a reality due to the advancements in robotic technology. This breakthrough allows expert surgeons to operate on patients who are in remote or underprivileged areas, improving access to quality healthcare.

It is notable that the adoption of robots in healthcare is likely to be faster for routine tasks compared to clinical applications. This is because routine tasks can be easily automated without extensive human intervention or advanced technology. On the other hand, clinical applications require specialized robots and trained professionals, which may take longer to become mainstream.

In conclusion, the application of robots in healthcare holds great promise for improving patient care and outcomes. While there are challenges such as high implementation costs and the need for specialized robots, ongoing research and development are addressing these issues. As the field continues to evolve, it is anticipated that robots will increasingly play a significant role in routine tasks and even clinical applications, ultimately contributing to the advancement of healthcare.

Moderator

The challenges faced by healthcare systems today are numerous and complex. These include the differing perspectives required by various medical specialties, discrepancies in international medical codification, the divide between paper and digital medical records, privacy laws, and the need to empower patients.

One of the key solutions to address these challenges lies in the advancement and utilization of digital technology in healthcare. Digital technology offers numerous benefits, such as improved efficiency, better coordination of care, and enhanced patient outcomes. Dr. Oscar Garcia, a renowned expert in digital health, has been working in this field since 1985. As the chief of Unified Medical Records and the founder of the Digital Health Information Network, his system has catered to around 60,000 patients and conducted over a million clinical tests, showcasing the potential and success of digital health technology.

Furthermore, the importance of internet access for patient monitoring is growing rapidly. Patients now spend less time in hospitals, and digital means are used for monitoring their health remotely. In Europe, there have been instances where patients faced difficulties due to unreliable internet connections for their medical devices during power shortages. This highlights the crucial role of internet access in ensuring effective monitoring and care.

Robots are also becoming an integral part of healthcare, particularly in tending to the elderly. China has already started implementing nurse robots to support nursing staff, while Japan has been developing robots to assist the elderly for decades. These innovations in robotics help to alleviate the strain on healthcare professionals and provide personalized care to the aging population.

Additionally, concerns over internet availability and connectivity in the healthcare sector are being addressed. While there may be some issues with connectivity, efforts are being made to improve delay and disruption-tolerant networking (DTN) to ensure reliable internet access for healthcare providers and patients alike.

The concept of robotics in healthcare extends beyond physical robots to software that is now considered a medical device. Software interventions are gaining momentum in various aspects of the healthcare system, such as analyzing imaging, symptom checking processes, and triaging patients in different situations. This broadens the scope of robotics and its potential in revolutionizing healthcare delivery.

Digital health is seen as the new trend for achieving universal healthcare coverage. With the wider adoption of digital technologies, it becomes possible to overcome the challenges of differing views among medical specialties, discrepancies in international medical codification, and the divide between paper and digital records. This paves the way for more efficient and comprehensive healthcare services that are accessible to all.

Electronic medical records play a crucial role in supporting AI applications in the healthcare system. They serve as one of the most important sources of data for analyzing and implementing AI technologies. The ability to harness and analyze vast amounts of medical data can enable better diagnoses, treatment plans, and overall healthcare outcomes.

Furthermore, internet governance applied to the healthcare system is an important focus area. Ensuring appropriate governance and regulation of digital technologies and internet access in healthcare is essential for patient safety, data security, and overall system effectiveness.

In conclusion, addressing the challenges in healthcare systems requires a shift towards digital health, utilizing digital technology, internet access, robotics, and improved governance. These advancements have the potential to overcome the various obstacles faced by healthcare systems and pave the way for more effective, efficient, and inclusive healthcare services.

Houda Chihi

The analysis highlights the critical importance of cyber security in robots, particularly in sectors such as healthcare. Failure to comply with cyber-security standards can have severe consequences, including risking human life. It is therefore crucial to regularly update and patch robots to enhance their safety and integrity. Additionally, AI algorithms used in robots need to be resistant to threats and include intrusion detection mechanisms to prevent cyber-attacks.

In the healthcare sector, respecting and adhering to cyber-security laws and regulations is imperative. Raising awareness among healthcare staff about the importance of cyber security and providing training on proper authorization and authentication procedures is essential. Staff members should avoid using open or public Wi-Fi when accessing patient platforms to protect against data breaches. Encouraging the use of strong, regularly updated passwords is also recommended.

Encryption and secure communication play vital roles in cyber security. Data communication between robots and the cloud should be encrypted to protect sensitive information and ensure privacy. Encrypting communication channels between robots and users is also crucial to secure data and protect human life. Robust encryption measures can significantly reduce the risk of unauthorized access and data manipulation.

The analysis also emphasizes the need for multi-stakeholder collaboration in addressing cyber-security challenges. Effective collaboration among service providers, healthcare professionals, government entities, and policy makers is essential. IT teams should take the lead in promoting cyber-security awareness and organizing training webinars to educate stakeholders on best practices and emerging threats. This coordinated effort will foster a proactive cyber-security culture and enhance security resilience in critical sectors like healthcare.

In conclusion, cyber security is vital for the safe operation of robots, particularly in sectors where human lives are at stake. Adhering to cyber-security standards, regularly updating robots, and implementing robust encryption and secure communication measures are key to mitigating cyber threats. Raising awareness and fostering multi-stakeholder collaboration are essential components in creating a cyber-resilient ecosystem. These measures should be prioritized to ensure the safety, security, and integrity of critical systems and protect both data and human life.

Moderator:
you Okay, well, thank you very much for everybody coming here to this session. This is the session for the Dynamic Coalition dedicated to robotics and health care. A little bit also about digital health. 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 the 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’s 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’ve 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 then 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? Is that showing? Yes. It is. Okay. So, as you can see, we have a lineup here. We have Dr. Oscar Garcia, Dr. Samuel Grasick, unfortunately can’t be here due to something that emergency. He actually just become a new father, so he can’t join us but he has sent us a YouTube. And then we have Judah Crow, he’s with you in the room. We have Judith, we have Professor Gupta as well who’s 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 out to space, and how that actually can be relevant to reaching rural populations. So I’m going to stop sharing here. And I ask Oscar to please take the floor.

Dr. Oscar Garcia:
Can you hear me? Yes, we can. Thank you. Okay. I appreciate very much this invitation of the Data Coalition about healthcare. I’m talking also exchanging with Amalia and with other persons in this group. This is something that we have been working for 20 years more or less. I’m going to share my screen. We’ll try to show you a short presentation of our work in medical records for all these years and for our experience and some lessons that we have learned through all these years working in this technology. Let me see if the sharing is working. Short screen. It’s not showing to me the option. Let’s see. Let me tell me if you can see my presentation now. Hello? We can see it, Oscar. Thank you. Good. Fantastic. Well, this is the initial slide. So as I said, my name is Oscar Garcia. I am the chief of Unified Medical Records. I also founded the Digital Health Information Network. I am also the project leader of the project working group of the ISOC Interplanetary Chapter. And I’ve been working in digital health since 1985 when it was not called digital health yet. And I started Unified Medical Records in year 2000. Some topics here. Well, we had an award from 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 space medical records, we were nominated to the British Interplanetary Society, the Arthur C. Clarke Award two years ago. We have been 23 years in medical records deployments. Our system had around 60,000 patients and more than a million of clinical tests. Well, some numbers. We have presented this technology in World Health Organization, World Summit of the Information Society, NASA, several hospitals, also in cities and collections in different countries. What kind of users? We work with health insurance of the labor unions with dialysis centers that are areas very challenging and difficult. 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 terms of digital health that I’m going to explain later. We work with doctors, laboratory for tests, our systems, 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 derives in the aging of population, the new technologies, all require deep knowledge to interface all that things. And there have been multiple ventures to try to solve this problem, but we diversified 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, insurance, and all the different providers of healthcare that we have studied in deep these relationships to make things work. Because otherwise it’s only an idea, fantastic idea, but a few organizations have had a successful experience in managing all this information and being able to operate in big cities where the internet connection is permanent or very stable. And everywhere communities where computer systems usually are not so stable and understanding the needs of the different medical professionals, because every doctor has a different way of seeing this thing. 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 found over the years are that each specialty doctor from different specialty need a different view of the patient medical record. There are about 40 specialties and 87 specialties in different countries this varies. 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, semiology, signs and symptoms, and this means that there’s a lot of interpretation from the professional and 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 take fast decisions and doesn’t have much time to upload information to a system. And this has to do also with the interface between the professional and the system. There are also what I call the dictionaries, you may have heard about the World Health Organization, International Classification of Diseases, different based on 9, 10, 11 recently. There are modifications, for example, in the United States, there are modifications in Europe, and there are different codings for procedures, for example, that a doctor makes. So, what’s the problem with this? If we need to compare the information between different countries, or between different pathologies or situations, and we have been working with this for many years. Also medical records are disseminated and disconnected, and there are several providers of information for the same patient. You all know that you go to a doctor, to a 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 requires also to interface between the doctor’s activity and the administration system. Many times, regulations in many countries make it not easy for patients 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 the Jakarta Congress made by the World Health Organization, it has been said, and it’s trying to be, is to empower the patient to be more aware or more connected with the medical decisions. There are many issues that are involved for him and for his family and his city, and this needs also knowledge and information for the patient to be more empowered, and that’s the right and correct one. Also, there’s the concept of privacy, that medical records are private information, but need to be accessed for third persons, like the doctors or the administration, and there are different regulations 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, networks, they are in the design. Our first deployment was in 2004, connecting healthcare providers, insurances, clinical laboratories, imaging, diagnostic centers. All the pictures that you are going to see now are real. They are not pictures that are from designers. And for a health system to work, you need to have all the parts and communicate between them and interface this part between them. So you have to have a system for the doctor office, for the health insurance, apps for patients. You can see some QR codes referred to, if you take a picture, they are going to refer you to some web pages. We have also developed recently this pen drive that allows doctors in challenging environments where there are no connectivity to go from one computer to the other in different places, and we have made, developed this in English, French, Spanish, to bring it anywhere with no installation to connect and receive clinical tests to transmit information, but if you have no communication, it connects and works, and 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, and if you want to be part of our development on this. During the pandemic, we discovered the need for apps for patients, telemedicine, remote auditing, a health dashboard to administrate remotely the system, because people, even doctors, could not go to the places many times. Well, we have here a long list of technologies and outcomes, but more important, and I’m going to show you something later about the technologies, interchanges, model of information, many things that we have developed, and outcomes that are better healthcare, more simple interfaces for doctors, cost reduction, with keeping a very good, a very high level of care, and to analyze pathologies and outcomes and results of the treatments, and our next step is something that we have been asked as well, is to, we have started to work in medical record for exploration. We want to make consultations between space and earth. We presented this in 2020 in several expositions, and we also have shown this to NASA and other space agencies. So, what are the applications? Well, of course, research, tourism in space, and of course, living in space and other planets, that’s something that humanity is thinking at this time. So, we are going to make this testing. We plan to start off next year. This is the model of the spacecraft. This is a plan for the moon. You have a web there. And well, these are problems that we have been researching the last times related to difficulties that will happen in space. So, to give this collaboration with the Dynamic Coalition on Data-Driven Technologies, we would like to work in underserved communities and provide the services for free when it’s possible. Contact us, and to contact, you have there our webpage, and afterwards, we are going to have a query and answers session. So, thank you very much for your time and for this long presentation. Thank you very much, Oscar. We really appreciate hearing about all of that. And I know you’re working with Dr. Grzegorz closely in the development of your work, and he’s not able to be with us, as we know. Would you be able to play the YouTube that he has sent us, or? Yes. Can you give me one or two minutes that I look for the right link, while you keep exchanging? Yes. And I will be glad to show you.

Moderator:
Okay.

Amali Desilva Mitchell:
Thank you so much. So, you know, we are really interested in this medical Internet of Things, because we’re finding more and more, at least in Western countries, for sure now, that patients spend very little time in hospitals. So they will have an operation, and they’re sent home very quickly soon after. The monitoring then takes place by digital means, actually, by email, 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 all 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, the little robots, now bigger robots, might have been developed independently, but are now increasingly being connected to the Internet. And now, of course, we’re getting much larger robots. For instance, China, with a very large population, we hear 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, they have started 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’s do their cleaning, whether it’s do their delivery, bring their food to them, or, for instance, climbing stairs. And, you know, Japan has been a tremendous powerhouse of development of this robotic activity. But now, as we see, artificial intelligence is becoming ubiquitous, and, you know, the robots can use Jack GPT, and so forth. So it’s now becoming, you know, an ecosystem where the robot, perhaps, was independent, is now increasingly connected to the Internet. And, obviously, when it comes to healthcare, SDG number three, health and well-being for everyone, you know, we want to give that opportunity to everybody on the planet to be able to access the sophisticated healthcare and the advanced healthcare. Okay. Oscar.

Moderator:
Amelie, thank you very much. Facundo, that is another of our collaborators, is going to share his screen with some of our presentation. Okay. Related to what you have just said, there is an important thing that I mentioned in my presentation, and Dr. Samograsi has, because, as you said, Internet has turned into a very important thing for healthcare, but many times, the availability is not so good, because that’s not the problem of the Internet, but of the connectivity that are different things. And we have been working with DTN, the delay and disruption-tolerant networking, to work with different flavors, and Samo has been working on this, to resolve this kind of situation. I would appreciate if Facundo can share his screen. Amado, I think he is on site, am I right, in the room? Yes. He’s online. He’s online? Oh, he’s online. Okay. But he’s not, I’m not sure he’s online. Yes. Do you have another user online? Do you have another user? No? I’m not sure he’s online, Amelie. If you wish, we can continue with the speakers here locally. He says to me in the chat that he’s online, Amado. Ah, okay. If he is, can he… But he’s not allowed to share screen. It could be some… Oh, there. Yeah. Okay. Yes. Thank you. Bye. Appreciate it. Thank you very much. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. We have no sound. We have no sound. I’m going to explain this myself, if that’s okay. So, he’s been working for that we, that some have been working for many years in the, in the Arctic, he lives in Sweden. And the concept is that the communication is very, very difficult. And the situations you have seen the eyes. Well, some from the University of technology developer at that body is economical association. And he’s also a member of the interplanetary network and especially interest group with where we work together.

Dr. Oscar Garcia:
He CEO. The challenges of internet in space can be applied. Also, for these, these difficult situations. If you can see the lines between space are not continuous lines, because I can start my camera as requested. There are no continuous lines because the communication between earth and space is disrupted, what we call disruptive but here. You can see the radio, radio link disruptions. And as a distance increases, there is more disruption increases, for example, if we go to Mars, there are 21 minutes. Come on forward between the information between the different points in points that we call the concept is what is called a store and forward, meaning the information arrives to a certain point, and then when the connectivity is available again, the information arrives to another another step of this network. This is a standard that has been developed for for many years, we have been working with persons like this is a was an idea for a group that started in GPL Jet Propulsion Laboratory of NASA. And allows that it can run over different communication technologies already has been adopted by NASA by JAXA, that is the Japanese Aerospace Organization. The European Organization for the space. And what we have been working for some, some time about three years is to apply this technology to earth for this kind of situation. Dr. Grasick has been with his group, working in this project for more than 10 years, that this was initiated. But this is a an organization in Sweden that works with the salmon community very far north in the in the ISIS and They, they keep reindeers herds, and these reindeers, as you can imagine, are all around in the Arctic, racing and come and go. So what the salmon has developed is a technology using this DTN technology that with very, very difficult situations and challenging. There were there’s no infrastructure in terms of antennas, they track the deers all around. And we technologies that are very, 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 are getting more affordable, you know, because there are companies that are Launching these tracks of satellites. I’m 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 Dr. Grasick has developed is a technology that’s very, very, very You can work with this with not much money at all. You have there are some of the specifications. I’m not a real expert in technology. His development, but I’ve 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, those are antennas. And Well, using a technology that is called LoRa, that’s 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 reindeers can follow where the herds are all around with just a mobile phone. Well, they develop this antenna. I’ve seen, perhaps there is a picture of this. I’ve seen this covered with ice. They can stand very, very challenging situations and each antenna can connect with. It builds a network with the different With the different With the different Connections. So with the information for the different herds that the Sami population that lives there can keep track and we’ll be working also I’m talking with some Some time ago of using all these same kind of technology to apply to technologies like medical records or healthcare information to keep when people are in the Arctic in 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. Some of those often and this is a collar that they use in the reindeer that was developed by Samo and his group. If 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 of the reindeers Well, these are different, different developments that are used that have been developed by his group. This is a note that can be attached to a drum and I know that they have been working also Here you have How it is applied. They have been working also in a buoy to go underwater. And this is the application that runs on their mobile cell phones and 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 To work with what you have mentioned, Amelie, that is The concept that, and I mentioned that before as well, that That centralized databases. Many times are not the solution for this kind of situation. Distributed databases make this kind of service more resilient, more resistant and this can help to resolve situations like the one you You mentioned. Well, and you have there the email address of Samo at JurassicNet and He’d be happy to Respond What I cannot respond and try to to help as much as I can. Thank you.

Amali Desilva Mitchell:
Oscar, that was very, very helpful. Thank you so much for your help with that. Oscar and Samo work very closely together. So we are very thankful for this opportunity that Oscar can Explain the slides that the audio was not able to share with us. But what we will do is we will host 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’re increasingly Getting nervous, let’s say, about climate change. We’re hearing of floods. We are hearing earthquakes, fires, and sometimes in in very remote areas. And then how you know 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 was something that this Dynamic Coalition was really very interested in over several years. So this is another area that the work of Oscar and Samo are appreciated for. Thank you so much. Okay, so now I am going to ask our own Dynamic Coalition at IGF to please share some thoughts with us. And they are, 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 your helping 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’re 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 as Judah Crowell, if she could introduce herself and to please give us some insights about her work. As they come, flow for her, please.

Judah Crow:
Okay, I think it’s working. I’ve already been introduced by Amalie, 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 digitization brings to society and what impact digitization will have on society. I would like to go in my statement a bit back to 1989, when the UN Convention on the Rights of the Child was adopted. The UN Convention states in Article 24 that state parties should recognize 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 health. So it’s laid down there more than 30 years ago, and obviously no one could imagine what role digitization would play in health, not only for children, but as it’s laid down in the UN Convention. And what we’ve already heard about medical statistics and data that can be used for the health for everybody, regardless of their age, but still the rights of the children are laid down in the UN Convention. And so in the year 2019 to 2021, the Committee on the Rights of the Child was considering how could we adapt what we’ve 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. And there 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 Amalie and also from Oskar about rural areas where probably we are not in the same situation like in a city like Kyoto, where, of course, children mostly are 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 digitization can mean for children born in rural areas, how their right to birth registration and right to identity can be laid down there, and how 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 this data to treat the children like from the beginning and throughout their 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 digitization has probably also risks for children’s healthy growing up, like overextensive usage of digital media, for example. That’s all addressed, but in this session, I would only like to refer to the benefits that digitization and medical treatment based on 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:
Thank you so much, Dutta, for that very, very important identification of those issues. I just want to say that we’ll take all questions at the end once all the speakers have gone through their spaces. I just want to add a little bit to Dutta, what she’s talked about, birth records and so forth. 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, Dutta, you mentioned this because that has sometimes been the case where good translations and documentations have also meant to losing children, as it were. So thank you so much, Dutta, 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.

Dr. Gupta:
Thank you, Amali. I am Rajendra Gupta. I chair the Dynamic Coalition on Digital Health, and I 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 like almost sleepy. I woke up at 2 a.m. Robots don’t do that. And this is what a few years back when I was in the same country, I saw a robot and I asked them, why would you need robots in a hospital? They said they don’t chat when they go in the aisle, so they can just walk. And we don’t ask for wage increment. But jokes apart, last month we hosted the Global Digital Health Summit in Mumbai, if you look up globalsummit.health. And what we demonstrated was very 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 question that he was thrown. And the questions were thrown by the global strategy head of Google, Bakul Patel. So I think robots are for real. And they will invade medical field for various reasons. And last couple of weeks I’ve been working with one of the architects of Da Vinci, you know, trying to make the future 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 routine stuff, I mean. This is just like you don’t require human intervention. And the second is most important, which is medicine. So let’s accept that robotic capability exceeds human capability. That’s the first fundamental truth. So that is where when you look at routine, what we’ll do is cost savings and probably, you know, bring in some efficiencies on the floor. But where the medicine part comes in 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’ve been talking to actual leaders who actually were involved in robotics and the development of robotics as a field. So I think the biggest thing 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’s the outcomes? Clinical outcomes, less blood loss, patients are happy, better healing. So there is a proven benefit of robots on the clinical side. And when you look at the functionalities they can take on too, so like you have a physiotherapist 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 the surgeries. I think one of the biggest things that you will see, and I think aging nations like Japan is a very good example, and I think all nations will eventually reach that stage, is the social interactions, you know, doing that for seniors. And other than that, like in COVID we saw, you know, some of the hospitals started using for interaction with patients to avoid the spread of the infection, including, you know, the sanitizing of the rooms, serving the patients. So robots are getting there. My worry is that this is not democratization of robotics. It’s very high end. So a robot that I spoke to in a hospital like, you know, they had implemented was $2.5 million. So expecting that robots will be, like, used, like, everywhere in every hospital, that’s not going to happen very soon. We are far, far away. Have they been able to demonstrate their ability? Of course, yes. They can do a much better job than doctors in precision operations. You know, in invasive surgeries, they can do what a hand can’t do, what a 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 to the people who work behind the architect of Da Vinci, is that eventually I would see robots like a cardiology robot, urology robot, gastroenterology robot. So I see a specialization of robotics happening over the future, and I think we will hear, I think, in the next few months, another company launching a miniaturized version of a robot. Da Vinci is, like, a huge setup. When that happens, I probably feel that cost may come down a bit, but will it be democratized? Absolutely not. So, well, 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? Very clear no. I mean, they would still prefer surgeons who would do a job at a much cheaper rate because the initial investment is very high, the cost of maintenance is high, and if the technology changes, what do you do? So it is still to go a long way, but there was another question, I think, that we were talking about the remote surgery. So there is ample of evidence to show that hundreds of miles away, you can actually mimic a surgeon’s movement and do a surgery. I was in Poland early this year and actually tried my hand from that robot. Actually, for me, it was not easy because I’m not a surgeon. It’s like if you train people, you can end up doing remote surgeries, but it will mean like we are still years away unless the cost comes down and we have enough trainers to train doctors. But as a field, I think it’s developing pretty fast. So I see a future when there will be specialized robots, but still on the clinical side, we are far off, but on the routine side, I think we will have a faster adoption. So between clinical and routine, routine will take off fast. Clinical is 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’s quite actively pursuing robots as well. So I think we’re hoping that into the future there will be some. One, 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 they’re thinking of bringing in standards. They’re already working on that. And I think that would be very helpful for the patient side because we are going to approach these technologies coming to us and being used on us. And I think all of us would want to know a little bit beforehand what it’s about, what are the risks, what are the potential harms, and so forth. And depending on, I would say, the sophistication of the patient, they would be more forthcoming or not to these kinds of medical interventions. So our 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, 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? Because we are saying, okay, the design process, just like privacy from bottom up 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, we’re perfectly healthy, we’re still a 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. And I’d like Yon Erbkut and Huda Shihi to please take the floor, please.

Houda Chihi:
Hello, everyone. Could you hear me, please? Yes, we can, Huda. Okay, thank you so much. So thank you so much, Emily, and all the DCC-Hash coalition staff for inviting me. In fact, let me introduce myself. My name is Huda Shihi. I am a PhD in telecommunication, Senior Researcher at UNFCOMM Laboratory of CYPCOM Tunisia. My main job is Chief Engineering at Tunisia Telecom Operator. In fact, today I will share some of my insights about the cyber, the necessity of cyber security into robots. In fact, the idea of robots, which is based in cyber physical system, it’s very important nowadays in our life, which is used in many sectors, such as education, healthcare, and agriculture. But at the same time, it can be just a second. Could you see me? It’s blurred now. I’m so sorry. Now I am visible? Yes, thank you. Okay, thank you so much. My pleasure. In fact, as robots are based in cyber physical process, we find it physical process and we find software ones. So here we speak about advantages and drawbacks of urban and rural use of robots. In particular, the use of robots is very, towards healthcare, we must take great attention because it can be very important because advantages in particular towards the problem of COVID-19, for example, it helps doctors to reach some patients or the case of complicated surgeries, it will be very important to use robots. But in the same way, if we don’t take care of cyber security, it will be very challenging for this, because the cost will be the human life of our patients. So this is not a good idea in this case. For this, there is some steps or pillars of cyber security that all of us should respect. We should respect laws, cyber security laws towards the use of robots in healthcare. It’s very important. Second, we should arise awareness and trainings to doctors and all healthcare staff. For example, for authorization, it should respect a specific process, authentication process. We can use multiple authentication process. So, for example, doctors don’t be advised to open platforms or patient 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 tests before that we put them into the process of application. Some tests of threats detection. If it is good, the tests and the incidents are well received and well done. So these robots will be dedicated and could be applied for healthcare. If the process are tested at pilot show, we should review the artificial intelligence algorithm. process. In addition, as today 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 that we have a lot of sensors, camera, readers, so we need a lot of information to collect from patients and from many sources, so there is a huge occurrence of security problems here, so we should encrypt the communication, the data communication between the robot and the cloud, and in general, the communication between robots and each end, whether it is doctors or 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 patients and to ensure that this robot is used for the benefit of both sides, doctors or patients. In addition, here we speak about virtual platforms due to use of chatgbt, so chatgbt use should be used and respect specific cyber security rules and laws, it can’t be used by any doctors without respecting specific cyber security norms, otherwise it can be in the benefit of anyone, either it is patients or doctors. In addition, we should have a collaboration between the IT team, who is responsible for building the artificial intelligence, and the collaboration between the different stakeholders, because here we have different actors who intervene between the communication of the robots and the patients or the 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 find 4G, 5G, 6G or other technology, so here it is important to have a global conversation between different actors, whether it is operator or service providers, doctors, government and policy makers, decision makers to state specific rules and laws, and it’s also the responsibility of the IT team to raise awareness and organize free webinars, free training sessions for doctors to teach them how to use digital platforms in security ways, and to always build or update their passwords and to ensure complicated passwords, that in the way that 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 the software end-to-end and the cloud security tools to secure the cloud process, and here we speak about the overall cryptography process of the end-to-end communication, whether from the person to the cloud. This is my intervention, thank you so much.

Amali Desilva Mitchell:
Thank you very much, Uda, very, very much appreciate that, and I’m going to pass it on to Jörg now. Jörg, please introduce yourself. Yes, thank you, I can share a slide if you want,

Dr. Erbguth:
I’m affiliated with the University of Geneva and I will keep it short, let me see, so robots and data protection, I would like to focus on data protection while Uda 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 be more comfortable because it looks like a human, but actually it’s a spying tool. Of course, this 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? A robot needs vision to move around, but do they need to record everything? And if it is stored, how long will it be stored? And what is it used for? I mean, of course, it will be used for your medical treatment, but it could also be used to analyze the robot, where is the robot performing well, and where does it fail? It could be used to monitor humans, the human staff in the hospital, whether they perform their task well or not. It could be used to record how visitors behave, or if it’s used at 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 uses of your data that are not really necessary for your treatment. And can relatives, for example, access 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’s not an easy part. Like IT security, there are many standards that need to be applied and not just a list of things like a complicated passport. It’s much more complicated. And data protection is also quite sophisticated thing because in the hospital, you have very sensitive data. It’s 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, Johan. So thank you, Johan and Huda, for that very insightful, I guess, nuance to medical records, as it were, and information gathering.

Judah Crow:
Amalie, would you allow that I comment only a few words to Johan? Sure, sure. I’m so glad to be on a panel also virtually with Johan because we’ve been in contact. In contact. But what he’s saying and what he’s showing on his slide reminds me that we had a session on Internet of Things and Children some time 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 the data that we’ve been talking about. How is the oxygen in 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 into the bed of the child. And of course, the child feels cozy with having such a bear in their bed, and the parents could monitor that wherever they would be. They could monitor it on their smartphone, 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 interception of the data when it goes from the teddy bear to the smartphone of the parents, or to the hospital, or to the doctor? And I do think these questions are not yet answered.

Amali Desilva Mitchell:
Totally agree with that, Judith. Totally agree with that. In interest of time, I think Judith may respond to one of the questions we had online on accessibility.

Judith Hallison:
Well, sure, but I’m Judith Hallison, representing the Dynamo Coalition on Accessibility and Disability. But first, I do want to respond to Utah. Yes, we had those, but a lot of those teddy bears are viewed to be very insecure, because at that time, the Internet of Things was not secure. There was old data on theirs. There was a problem of being hacked, and the child data could be stolen, or the child could be told to give out different things. 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 Dynamo Coalition, is that there’s a really grave danger for persons with disability for using robots, where they cannot communicate to persons who may be visually impaired, or hearing impaired, or even cognitively impaired, and how would a robot respond to that? And they can’t, and so these people are now being disenfranchised, and they cannot do it in the hospitals, especially during the period of COVID, when 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 white, there was no clear mask. You couldn’t read people’s lips. You couldn’t have visual sign language. You couldn’t have any of that. And so it was as if persons with disability were not allowed to get sick, because no one would care for them. And so there’s a grave danger when you have robots doing that, is that you’re now disenfranchising a huge part of the population who cannot get that. And so instead, where I used to have the telephone relay, where they would call up and sell a picture, and there would be a sign language interpreter, or there’ll be another interpreter, these type of things won’t be existing. And that’s 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, if the misidentification can result in the AI providing bad surgical guidance, which can lead to surgical errors, and especially as people are starting to use, instead of human captioning, they’re using artificial intelligence captioning, which often 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 captioning. But then people are losing out. They’re not being clear. The guidance is not being clear. And there’s 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 lot of population in the effort to make things cheaper. And I know we’re in the interest of time, so I’ll just stop there. But I’m happy to answer any questions on that. Thank you.

Amali Desilva Mitchell:
Okay. Thank you, Judith. We have, thank you very much for that, to bring accessibility. I’m so happy that you responded there for us. So in the interest of time, I just have to make a couple of announcements, which I promised to do. And it’s that we have a book called Health Matters. And it’s published online on the DC DDHT webpage at the Internet Governance Forum. And each year, we add articles to this book. And we have three writers of articles in 2023, Frederick Cohen, Dr. Joao Gomez, and Yaw Amebe Emisi Susu. 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 tremendous insight. Yaw, for instance, was talking about healthcare in Benin, Frederick on about collaboration in technology, and Joao was talking about, you know, development of medical in tech technologies. So please take that opportunity, please, to read those papers. Now I’m going to ask Dr. Joao Gomez to, to give us a little summary of what we have been discussing over the past year on robotics. We are due to publish a DP paper on robotics by the end of this year, which will bring together everything that we have heard and all our own discussions as well. So Dr. Joao, can I give you the floor here, please?

Dr. Joao Gomez:
Indeed. Yeah. Hello, everyone. Greetings to Kyoto. It’s a pleasure to be here reaching out from from Porto in Portugal, actually, where it’s still morning time. And I’m honored to share with you the summary of this paper, which is titled robotics in healthcare and ethical and technical considerations. So I’m going to do so on behalf of the Dynamic Coalition on Data-Driven Health Technologies, which is guiding the session today. Just a broad overview on this paper, it sheds an overview perspective into the integration of robotics in healthcare. It’s a topic that we’ve been talking about today. Some of these points that are mentioned in the paper were also discussed already in here. And the idea is to promise or to promote these trends to revolutionize patient care while also presenting both the ethical and technical considerations of doing so, which is also very relevant. And it’s precisely with this dichotomous structure that the paper is actually structured. So it seeks to be exhaustive in naming each one of these challenges, but at the same time, it leaves a lot of space for discussion within the challenge itself. So that’s precisely the same structure that I’m going to follow. I’m going to start with the ethical considerations that are mentioned in the paper, in the paper, I mean, and that arise from the integration of robotics in healthcare. So imagine this world where automatized systems are actually 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 ensure that data privacy is one of the elements that comes first and it must be ensured with the utmost care. And that’s precisely where encryption and other security mechanisms are necessary to prevent these patient data breaches that eventually are patients. But at the same time, we also need to make sure that whatever data we are collecting, it 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 these data should also be parallel. And this is also very much linked with the topic of autonomy and accountability. So as robots become autonomous in the decision-making capabilities, we need to ask ourselves, who should be held accountable in case of adverse events? Is it the developer? Is it 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 technology should be safe and reliable. And our suggestion on one side falls into the realms of transparent governance, which can be essential of planning, for example, the roles and the responsibilities of of the stakeholders in the development and deployment of these technologies, but also at the lower level, ensuring that there’s rigorous design, testing, and that there’s an existence of emergency stop systems and regular maintenance of the system so that they function as intended. Then there’s the elements 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 are potentially setting up guidelines for human-robot interaction and education for the users and the providers as well. And lastly, on the type of 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 these technologies, including in rural areas, with more limited healthcare access, for example, we need to make sure that the ground is set at an equal level for all the players and all the users. And then 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 idyllic 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 and healthcare itself. Also on the topic of accessibility, we need the same continuous need in the aspects of connectivity and infrastructure itself. So we need a secure and reliable connection, which is vital for the data exchange that we mentioned in our ethical considerations, but also for remote robot operation. You’ve seen the examples of surgeries being performed at a distance, but for that to happen, we need this 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 the 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’ll keep them aside of my intervention, but I’ll briefly mention them, like maintenance and support, regulatory compliance for them to become true medical devices, job displacement and creation, which is something I didn’t talk about, but it would lead to another full discussion on this topic and economic impacts. In conclusion, the integration of robotic stealth care, of course, it offers a lot of potential, but it also demands a balance between these ethical and technical challenges, and that’s what we seek to do with this paper. It’s still a live document, so we definitely invite you to make your additions and your collaborations. Feel free to either forward them our way to make the interventions now, either verbally or in written form, and we’ll make sure to take them into account for the paper itself. So thank you for your attention and looking forward for further engaging discussions on this matter.

Amali Desilva Mitchell:
Thank you, Dr. Jaro. 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 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?

DC member:
Yeah, thank you. Thank you, Amary, for giving the floor. I’m Sosui Yao, I’m a researcher currently at FH uranium in the University of Wisconsin-Australia Trust. I’m also a member of the DC. I would like to thank all the DC members for this intervention and all our distinguished speakers. My contribution here 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 green and healthy healthcare environment. And taking into consideration what have been already discussed, and also the profound impact of the human-computer interface with robotics. And we see that can be, they can have actually on our health system as highlights in the conclusion of one of my paper, which is a design principle for healthcare, e-healthcare and medical things. And also a second paper, which is future healthcare is sustainable. I would like to mention some key notes on this in regard to the recent development in the field, which is, it implies. So the journey towards a green healthcare environment is not without challenge, we need to mention that. And it’s imperative for us to tackle these obstacles. And in recent development in the field will inevitably include integration of AI into human-computer interface and robots, how they are revolutionizing healthcare system, but also take into account how AI driven diagnosis and prediction analysis and personalized treatment can be recommended and also can be enhanced. And also I would say are needed to enhance 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, accessibility features, of course, but also convey healthcare service so that the accessible features are usable and implementable. And those human-computer interfaces play a pivotal role in ensuring that platform developed for medical healthcare, mainly telemedicine, are intuitive, inclusive for all patients. And of course, innovation in medical robotics are not only improvising surgery precision, but also can help reduce energy consumption of medical procedures. And lightweight energy efficiency robotics system are becoming the norm now, as you mentioned already, in modern healthcare setting. So a key consideration for my team to consider, to take into account when it comes to greening the healthcare environment, I think is to mention that we need to work on reducing carbon printing for healthcare facilities. And this could be done by prioritizing renewable energy sources such as solar and wind power for technology, but also the energy efficiency of data centers, which are used to support human-computer interfaces and robot applications are crucial aspects to take into account. And one of the aspects also, Dr. Zhao, I’ve mentioned in the book we have with Dr. Shisa, employing advanced cooling technologies and optimizing server farms so that they can significantly help reduce energy consumption like temperature, sensoring, and sophisticated control measure. And when it’s come also to designing and manufacturing- Could I ask you to close, please? Yeah, I would like to conclude, which is when it comes to designing and manufacturing these interfaces and robot devices, we should prioritize sustainability, recycling materials and contribute to the waste so that to have a smaller ecological footprint on this. So this is, on a nutshell, my take on this discussion. Thank you very much for the floor.

Amali Desilva Mitchell:
Thank you, Yao. I want to ask Frederic Cohen if he would like to share some thoughts.

Frederic Cohen:
Hello, thank you, everyone. I’m very happy to meet you today. I would like to thank you for all our work together this year and for our past work the last year together. It was an important year to work together this year because we were traveling very much in Asia and we were meeting each other in Shanghai for the focus meeting group with the ITU on the metaverse and further development would be important also for the internet because of development with other partners everywhere in the world are very important for us. Medical health system are also developing with a different accuracy and now it’s important to meet each other for other development in edge technologies, which is continuing with different regions for everywhere. I think this, our focus for these development countries and our island situation are important to reconnect to a focus to a better communication with the communities everywhere in the world. Thank you very much. And I hope we could see you so the next year. Thank you very much.

Amali Desilva Mitchell:
Okay, okay. Thank you, Frederic. Thank you very much. Okay, okay. Thank you, Frederic. I just want to pass it over to Amado. So thank you very much from my side. We’re running out of time. We can’t take too many questions, but I’m gonna pass it over to Amado right now and thank you for joining us today.

Moderator:
Oh, thank you very much, Amalie. I think it was a very interesting discussion with all the panelists very well selected in the topics. I only want to close these presentations by inviting all 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 a medical device. And software is intervening in different aspects of the healthcare system by analyzing imaging, by undergoing symptoms checking processes or triaging patients in different situations and so on. Then as Dr. Garcia said at the very beginning, the electronic medical records are one of the most important sources of data for the analysis of all 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 this coalition. The internet governance applied at the medical care at the healthcare system. It’s a very, very important topic which everybody is looking at. And well, thank you very much for your participation here. And thank you very much for all 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. Thank you so much for all our speakers. Okay. We adjourn now in. Bye-bye. Thank you, Oscar. Thank you very much. Thank you. Thank you. Bye-bye. Bye. Bye. Thank you, Yao, Frederick. Joao. Dr. Mado. Dr. Mado.