Today, accurate pain assessment requires expert support from pain specialists. ePAT Technologies wanted to augment caregivers’ ability to manage pain with a simpler, more objective assessment method.
ePAT is working with nViso to develop a medical device that will use a smartphone to visually analyze facial muscle movements, assess pain levels in real time, and update medical records in the cloud.
Reducepatients’ need to visit hospitals for pain assessments, enabling in-home care
Empowercaregivers to monitor and manage pain accurately without expert support
Automatekey assessment processes, saving time and reducing the risk of error
Business challenge story
Monitoring the fifth vital sign
As healthcare costs continue to rise, governments, healthcare providers and insurers need to find smarter, more efficient ways to maintain quality and improve outcomes for patients. One major objective is to move away from the traditional reliance on acute and primary care—which is delivered by specialist physicians at hospitals and clinics—and towards a model where patients and their families can manage their conditions at home, reducing the need for expensive hospital visits.
Philip Daffas, CEO and Managing Director of ePAT Technologies, which specializes in innovative pain management solutions, explains: “In-home care gives patients a better quality of life, while reducing the strain on hospital beds and healthcare providers’ finances. It’s a much better model for managing long-term chronic conditions—particularly here in Australia, where we have a small population scattered across a huge geographic area. If you can find an alternative to driving for several hours to the nearest hospital every week, it’s a huge advantage.
“In recent years, we’ve seen huge advances in a lot of areas that make in-home care much more practical. For example: in the past, you had to visit a doctor for something as simple as taking a blood pressure reading. Now, you can get a digital blood pressure monitor for a few dollars and do it yourself at home. And the level of instrumentation around diabetes care just keeps advancing: blood glucose monitors and insulin pumps help patients keep their blood sugar levels in check without professional intervention.”
However, not everything can be monitored quite as easily as blood pressure and insulin. In particular, pain—which we now often think of as the fifth vital sign, after pulse, temperature, blood pressure and respiration—has always been difficult to measure. Today, pain assessment is a specialist field, requiring the skills and experience of expert professionals to ensure accurate results.
Daffas comments: “The lack of a simple method of objective pain assessment is a major barrier to making home care safe for patients who suffer chronic pain. This is especially true for those who are unable to communicate their pain levels—for example, very young children, dementia sufferers and people with severe disabilities. At ePAT Technologies, that’s what we’re trying to change.”
ePAT was founded by scientists from Curtin University in Perth, Western Australia—one of the world’s leading pain management research centers. The company saw an opportunity to transform the way pain assessments are performed by combining cutting-edge academic research with a new generation of cognitive computing technologies, such as machine learning and artificial intelligence (AI).
“We knew from 30 years of research that there are certain movements of patients’ facial muscles that correlate strongly with their experience of pain,” says Daffas. “We realized that if we could teach an AI to analyze those movements, we could start to build a much more accurate and objective way of measuring pain levels. We just needed the right partners to help us develop the technology. That’s how we found nViso, who were already working with IBM.”
Building a robust architecture
Tim Llewellynn is the CEO and co-founder of nViso, one of the world’s leading specialists in AI-driven facial analytics. When ePAT reached out to his team, the initial discussions led both organizations to realize that they had a huge opportunity to change pain management for the better.
“Our scientists talked to their scientists, and there was a real meeting of minds,” says Llewellynn. “We quickly decided to kick-start an innovation process and design a prototype to prove the concept.”
Daffas adds: “When you are trying something new in healthcare, you need to do it in stages. You start by working with healthcare organizations and helping them see that a new technology is genuinely beneficial. Next, you need to gain regulatory approval. Finally, you can start thinking about making a consumer-grade product.
“So our first goal was to build a tool that would help pain management specialists, physicians and other professional caregivers conduct assessments more easily and reliably.”
ePAT began working with nViso to develop a medical device in the form of a smartphone app. The app uses the smartphone camera to record a ten-second video of the patient’s face, and analyzes the images using nViso’s sophisticated facial analysis algorithms. If it recognizes any muscle movements that indicate pain, it takes note of them.
Next, the caregiver uses the app to answer questions regarding a total of 42 pain indicators, such as how the patient is moving and how they are vocalizing their pain. Finally, the app calculates an overall pain score for the patient, and syncs the results with a central database in the cloud. This allows caregivers to keep track of patients’ pain scores over time, and monitor whether medication and other pain management strategies are working effectively.
Daffas comments: “From a technical perspective, the project was challenging. Although the solution is delivered like a regular smartphone app, it needs to be engineered to medical device standards in order to pass regulatory scrutiny. We’re aiming to achieve Australian and European approvals later this year, and then start the complex process of gaining FDA approval in the United States.”
Llewellynn adds: “At nViso, we’ve had success in the past using IBM technologies to build solutions for other heavily regulated industries, such as finance. We also know that IBM has a lot of expertise in medical device development. So, we were confident that IBM was the right partner for this project.”
The design of the device needed to embrace “offline first” principles: it must be able to work without a data connection in case a user is temporarily unable to connect to the internet. At the same time, it needs the ability to send data to the cloud when a connection is re-established, so that the patient’s data is stored and protected in the event that the device is lost or broken.
Llewellynn says: “IBM® Cloudant® offers seamless replication capabilities, making it the perfect choice for us—it’s very easy to store data locally on the device and then sync it seamlessly with the central cloud data store when you’re next connected.
“We also liked the fact that Cloudant is a fully managed service, so we don’t need to worry about database management—we can focus on developing our application and leave the underlying infrastructure to the experts from IBM. And finally, unlike a traditional relational database, Cloudant doesn’t have a rigid schema, which makes it much easier to rethink our data structures as the project’s requirements evolve.”
Daffas agrees: “Flexibility is vital for any innovative project, and particularly for one that involves a multi-stage process, with different groups of stakeholders providing input at each stage. We have to be able to listen to the healthcare professionals, the regulators and—where possible—the patients themselves, and adapt our app to their needs. Technologies such as Cloudant can give us the ability to do just that.”
Moving from prototype to production
The ePAT device is now being trialed by a number of major healthcare organizations in Australia, and has completed its initial validation and implementation studies.
“Validation studies aim to show that our device provides good results compared to other tools that are currently in use; implementation studies explore how compatible it is with caregivers’ current workflows,” explains Daffas. “The feedback from both types of study has been very positive—our users are confident that the ePAT app is accurate compared to traditional paper-based assessment forms, and we are now exploring its clinical utility in daily caregiver practice.”
Llewellynn comments: “The current version of the app is just a first step on the journey—it gives caregivers a computer-assisted data collection tool that harnesses AI for one aspect of the assessment process. In the future, we aim to expand the use of AI to other areas too, and we’re excited by the prospect of harnessing IBM Watson® cognitive services to augment our capabilities.
“For example, one of the most common problems in healthcare—and one of the biggest barriers to unsupervised in-home care—is the risk of a patient accidentally taking the wrong medication. We could use Watson Visual Recognition to scan the barcodes on medication bottles, helping patients and caregivers double-check that they’re doing the right thing before they administer the meds.”
Daffas agrees: “It’s all about making pain management as easy and user-friendly as possible—using technology to make life simpler for healthcare professionals, patients and their families. Collaborative partnerships between companies such as ePAT, nViso and IBM are essential to make this happen.
“As we move ahead with the regulatory approval process, we’re confident that we have the right skills and technology in place to deliver a solution that helps healthcare organizations around the world transform the way they deliver pain management services. Ultimately, the outcome should be a model that helps patients live fuller, happier lives—relieving their pain more successfully, allowing them to spend more time at home and less in the hospital, and reducing the cost of care.”
About ePAT Technologies
ePAT Technologies is a global leader in innovative pain assessment techniques. Based in Sydney, Australia, the company was initially founded by scientists from Curtin University in Perth, Western Australia. The company’s mission is to improve the quality of life for people in pain through novel, cost-effective pain assessment products and services.
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Take the next step
IBM Watson Data Platform offers a complete portfolio of data and analytics services providing unique and seamless product integrations to build apps faster and gain new insights easier with flexible deployment and pricing options. For more information about how IBM Watson Data Platform can help businesses solve tough big data problems rapidly and cost-effectively, please visit ibm.com/analytics/us/en/watson-data-platform/.
For healthcare professionals who would be interested in working with ePAT Technologies, please contact the team via www.epattechnologies.com. Or to learn more about facial analytics and emotional AI products and services from nViso, please visit www.nviso.ch.