Franco
da Silveira
Universidade
Federal do Rio Grande do Sul, Brazil
E-mail: franco.da.silveira@hotmail.com
Italo
Rodeghiero Neto
Universidade
Federal do Rio Grande do Sul, Brazil
E-mail: rodeghiero.hoe@gmail.com
Bruno
Miranda dos Santos
Universidade
Federal do Rio Grande do Sul, Brazil
E-mail: brmiranda10@gmail.com
Rafaela
Maria de Oliveira Gasparetto
Fema
- Fundação Educacional Machado de Assis, Brazil
E-mail: rafaelagasparetto.maria@outlook.com
Filipe
Molinar Machado
URI, Brazil
E-mail: fmacmec@gmail.com
Paulo
Cesar Chagas Rodrigues
Instituto
Federal de Educação, Ciência e Tecnologia de São Paulo, Brazil
E-mail: paulo.rodrigues@ifsp.edu.br
Fernando
Gonçalves Amaral
Universidade
Federal do Rio Grande do Sul, Brazil
E-mail: amaral@producao.ufrgs.br
Submission: 2/27/2020 3:25:10 PM
Revision: 2/28/2020 5:32:58 PM
Accept: 3/9/2020 7:57:50 PM
ABSTRACT
Health 4.0 can be understood as the set of procedures that seek to improve the efficiency and speed of health professionals with possible guidelines for combining patient data in hospitals. However, systematizing and qualitatively describing the contributions of industry 4.0 in the context of the Brazilian health sector is a complex task. The aim of this paper is to present an analysis of industry 4.0 related to the health sector and its respective characteristics in Brazil. In addition, it discusses the prospects for greater use of technology in health care. In methodological terms, an exploratory field research was conducted with a non-random and intentional sample of professionals working in the technological context of Brazilian health. The research is classified as descriptive and qualitative, exploratory. The results contribute to narrow the information gap about industry 4.0 in the Brazilian health sector. The study allowed to develop a concept map of health 4.0 regarding the professional profile, considering the adoption of technologies that may favor the sector.
Keywords: Industry 4.0; Health 4.0; Brazil
1.
INTRODUCTION
Industry 4.0 is based
on technology combined with intelligence in data processing (Kamble et al.,
2018). The recently proposed concept of industry 4.0 represents the fourth
industrial revolution, which is defined as a new level of organization and
control over the product life cycle value chain, with an emphasis on customer
requirements that become more individualized (Vaidya et al., 2018).
The term appeared in
Germany in 2011, through an integration between associations of business
representatives, politicians and academic researchers who sought to promote the
idea as an approach to strengthen the competitiveness of the German
manufacturing industry (Bahrin et al., 2016) and transpose the limits between
the digital, physical and biological world (Wegener, 2018).
In health, the
principles of industry 4.0 will incorporate the digitization of clinical,
medical and laboratory data, implementing the automation of various manual
processes used today in hospital and healthcare environments in general
(Elhoseny et al., 2018). However, services in the health sector always present
challenges as different diseases can develop over the years (Darwin et al.,
2017).
Thus, to improve the
efficiency and speed of doctors, explore patient data in hospitals, allow the
optimization of resources and minimize the deterioration of patient health
(Costa et al., 2018), real-time communication technologies (Botta et al.,
2016), Big Data, human-machine cooperation, remote sensing, process monitoring
and control, autonomous equipment and interconnectivity (Stergiou et al., 2018)
are becoming major assets and responsible for positive impacts on health and
safety management occupational (Badri, Trudel & Souissi, 2018).
Current developments in
different technological areas lead to new solutions that can provide
improvements in the health sector. In Brazil, the health sector is highly fragmented
and accounts for R$ 291 billion in business annually. Investments in the
Brazilian health industrial complex are mainly focused on patient care, while
the information and systems infrastructure tend to play a secondary role.
This is one of the reasons
for the low level of interaction between industries and users (Abiis, 2015).
Due to the lack of integration between industries and users, innovation in
Brazilian hospitals is considered an endogenous factor. This lack of
integration is responsible for making access to knowledge produced in
universities difficult and for impregnating processes and products with
innovations (Barbosa & Gadelha, 2012).
In this context, it is
important to highlight the term health 4.0, developed by the Brazilian Alliance
of the Innovative Health Industry (Abiis, 2015) based on the characteristics of
industry 4.0, which proposes an interaction between technology and human beings
in the health sector. In Health 4.0, the possibilities of collaborative
partnerships between actors in the same value chain, who can share the
coordinated planning of production and distribution, in an agile and effective
way to the needs of users, are facilitated.
The works are developed
with adequate stocks to the demands avoiding delays or unavailability of
products and there is a fast attendance in the demands of the end users and an
efficient control in the transaction of the patient data in the hospitals
(Abiis, 2015). However, understanding how to digitize data, interconnectivity
between machines and commands, more efficient databases and, above all, greater
patient autonomy in relation to their own health is a complex task (Brasil,
2017).
Exploring
technology-related initiatives that make life easier for human beings will be a
stronger trend. This article presents perspectives of industry 4.0 related to
the health sector and its characteristics in Brazil through the experience of
professionals in the field. As a complement, we seek to verify what are the
perspectives for the use of technology in the health area.
It is noteworthy that
although the study presents an analysis of industry 4.0 in the health sector,
it is not the objective of the research to define rigorously the semantics and
syntax of the Brazilian context. The proposed results of the analysis
demonstrate which perspectives should be adopted in the health sector,
facilitating the dissemination of knowledge regarding health 4.0, which can
help to characterize the development of a new traditional model for Brazil.
The main contribution
of the article refers to the identification of health 4.0 variables, at a
qualitative and exploratory level, for the analysis and adaptation of
technologies that can be used in hospitals. The propositions and reflections
raised in the study also contribute as subsidies for future academic research
on the subject, which may continue this initial study.
2.
TECHNOLOGIES OF INDUSTRY 4.0 USED IN
THE HEALTH SECTOR
Technological innovations have
driven the health sector to an unprecedented level. Different medical devices,
many of them laptops, are being sold in the consumer market to provide a
healthier lifestyle for society (Trinugroho, 2014). Part of the technologies
relate to Cloud Computing (CC) and the Internet of Things (IoT). These are
platforms that provide alternatives to medical support by solving various
problems in health applications, with smart hospitals, control of medicines and
remote medical services (Botta et al., 2016; Darwish et al., 2017). In
addition, with cyber-physical systems, they can interconnect with a combination
of software, sensors, processing and communication technologies that together
play an important role in decision-making from the provision of information
(Bahrin et al., 2016).
With the interconnection of
hospitals, people and systems provide real dynamics with optimized and
self-organized time in relation to the patient's condition. Industry 4.0
technologies that have similarities in the use of the health sector should also
develop new paradigms on occupational health and safety management, as safer
equipment is needed to operate and environments and practices with better
control and management (Badri, Trudel & Souissi, 2018). Another technology
that should facilitate the exploration of areas that cannot be easily achieved
by traditional means of medicine is computational intelligence, which includes
simulations of genes and proteins related to the development and immunity of
cancer (Chang, 2018).
As in the context of industry 4.0,
the literature does not present a unique way to name health technologies 4.0.
The classifications used in the literature are often incompatible with each
other, as they classify the same technologies into different categories
(Almeida, Cavalcante & Fettermann, 2017). Table 1 includes the main technologies
that include the principles of industry 4.0 and which are commonly used in the
health sector. To facilitate understanding, it was necessary to present the
description of each technology to verify its function and, from the objective
of this article, what seek to improve in hospitals and in the theme of health
in general (Silveira et al., 2019).
Table 1: Technologies developed in industry 4.0 used in the health
sector.
Authors/Year |
Technology |
Description |
Objective |
Countries |
Pang et al. (2013) |
Internet ofThings (IoT) |
Home health services based on IoT to solve
problems caused by population aging. |
Propose a business-technology developed in
co-design that realizes an integration of devices and services of home health
attention. |
Sweden |
Trinugroho et al. (2014) |
Internet ofThings (IoT) |
Support IOT-based communications between
devices and health services in an event-driven manner. |
Describe the platform developed, with
emphasis on reliability aspects, including availability, scalability and
security. |
Norway |
Catarinucci et al. (2015) |
Internet ofThings (IoT) |
Identification by radiofrequency, wireless
sensor network and intelligent mobile technologies of patients' physiological
parameters. |
To propose a new intelligent architecture,
with IoT recognition, for automatic monitoring and tracking of patients,
people and biomedical devices inside hospitals and nursing institutes. |
Italy |
Zhang et al. (2015) |
WearableDevicesand Smartphones |
Continuous monitoring of health conditions,
remotely diagnose phenomena and share health information in real time. |
Investigate the security and privacy
protection of multifunctional wearable devices and the widespread use of
smartphones, including aggregation of privacy data that preserves privacy,
secure health data processing, and detection of misbehavior. |
Canada |
Darwish et al. (2017) |
Cloud Computing (CC) e Internet of Things
(IoT) |
The integration of technologies provides a
solution to various problems in health applications, drug control and
distance medical services. |
Present a new concept of CC and IoT
integration for health applications (CloudIoT-Health). |
Egypt |
Elhoseny et al. (2017) |
CloudComputing (CC) |
Intelligent systems based on cloud
environment for hospital health services. |
Improve scheduling of tasks and reduce stakeholder
engagement time (patients, doctors, nurses, for example) and maximize
resource utilization in clouds. |
Egypt |
Pramanik et al. (2017) |
Big Data e Smart Healthcare |
Big Data and Smart Healthcare systems
independently attract great attention from the academia and industry and can
streamline healthcare industry perspectives. |
Evaluate Big Data technologies and
intelligent systems focusing on state-of-the-art advanced health systems. |
China |
Costa et al. (2018) |
Internet of Health Things (IoHT) |
Intelligent monitoring of vital signs on
hospital wings through IoT. |
Describe the possibilities of IoT in the
scope of vital signs monitoring by hospital wards. |
Brazil |
Mshali et al. (2018) |
Health Monitoring Systems (HMS) |
Provide timely electronic health services
for individuals who wish to maintain their independence. |
Present a review of intelligent health
monitoring and health care systems for individuals, especially for the
elderly and dependent. |
France |
Rahmani et al. (2018) |
Internet ofThings (IoT) |
Develop health solutions
with smarter and predictive capabilities for both daily living (home/office)
and hospitals using IoT and the strategic position of such gateways. |
Explore the concept of Cloud Computing in
Healthcare IoT systems, forming an intermediate layer of intelligence
distributed geographically between the sensors and the cloud. |
USA |
Source: Adapted from Silveira et al. (2019).
There are other devices, such as
wearable products that are developing widely and can be used to provide
continuous medical care, such as monitoring physiological parameters for health
care through monitoring (Liang et al., 2012).
These are wristwatches, wristbands,
rings and smart hair covers that fall within them as ubiquitous products and
use mobile networks (WIFI) and computer servers that are responsible for
collecting health information detected by such products (Wang et al., 2010;
Liang et al., 2012; Zhang et al., 2015). In addition, they process the data to
properly monitor and diagnose integrity and allow social interactions with
users, so that errors do not result (Carnevalli, Sassi & Cauchick, 2004;
Toninelli, Montanari & Corradi, 2009; Zhang et al., 2015).
3.
METHODOLOGY
A research has a qualitative
approach. To achieve the objectives of this study, an exploratory field
research was conducted, with an unransom and intentional sample (Carnevalli,
Sassi & Cauchick, 2004). As this sample was not probabilistic, it is not
possible to affirm that it is representative of the current situation of the
country in the context of health 4.0. However, it is worth mentioning that as
criteria for the selection of professionals and business consultants in the
health sector, similarity and experience in the field of knowledge of the
research were considered.
In addition, the purpose of the
sample is to produce in-depth and illustrative information: whether it is
small, what matters is that it is able to produce new information. Through
field research, it is possible to verify the health sector and its
characteristics and also provide an exploratory view on a subject where the
relevant variables are not yet fully determined and the phenomenon is not
completely known.
Data collection was performed based
on an open questionnaire and the results obtained in the research underwent an
analysis process. The questionnaire used was divided into ten questions. Its
structuring was based on the Brazilian health sector. Regarding the
characterization of the health sector, we sought to identify different opinions
on the impacts of industry 4.0 on health, the prospects for the use of
technology in the health area, the challenges of industry 4.0 in the country
(in addition to the health sector), the impacts (technicians, economic) that
will be absorbed by customers (patients) due to the incorporation of new
technologies and devices in health 4.0 and the health professional 4.0.
In order to maintain the
confidentiality of the participants, numbering was used to characterize them.
To analyze the information, the answers were encoded and the data were
tabulated in order to interpret the particularities of each participant. The
questionnaire was applied through the use of a digital platform (Google Drive),
facilitating file storage and formulating questionnaires using the internet as
a means to apply them to respondents. Thus, it is only required from the e-mail
address (e-mail) of the person responsible selected in the study to submit the
questionnaire. This was performed with two participants in the research,
because they did not present availability of time for interview and lived in
cities far from the site of the interviews.
CmapTool was adopted for data
analysis. It is a tool used to develop conceptual and graphically represented
schemes, constituting a program that helps to design concept maps. Help in the
organization and representation of knowledge. The concepts displayed in the
boxes and the participants between them are identified by means of connecting
phrases that are each of the concepts.
4.
RESULTS AND DISCUSSIONS
4.1.
Characterization of respondents and
impacts of Industry 4.0 on health
All interviewees are male and
Brazilian nationality. Two are medical professionals, with a doctoral school
level and currently work in the context of digital innovation in hospitals. The
other two interviewees are consultants in the health sector. Table 2 shows the
other information of the professionals who contributed to the development of
the research.
Table 2: Characterization of professionals who contributed to the
research.
Interviewee (I) |
Profession |
Education |
Gender |
1 |
Health
Sector Consultant |
University Graduate |
Male |
2 |
PhD |
||
3 |
Medical |
||
4 |
According to I1, the impacts of
industry 4.0 in the health sector are related to the increased availability of
products and services to meet health needs, especially through product
differentiation and adaptation to the characteristics of each patient, characterizing
a medicine precision or personalized medicine. This theme has been corroborated
in several researches, such as research that affirms that the fusion of
technologies is not just a product of science and engineering, but is a product
of values and institutions (Jayanthi et al., 2019). Work within hospitals must
be articulated with industry, government and universities to create a joint
vision of the future.
I3 added that other positive factors
will be provided, such as efficiency and speed in diagnoses and hospital
procedures, new alternatives for transplants, such as 3D printing, and finally,
real-time integration of services, from primary care to cases of discharge.
complexity. Analyzes by artificial intelligence, interconnectivity of platforms,
predictive models in patient health are changes that are developing and affect
people directly. The ability of algorithms to process and transform available
data to make accurate predictions about disease classifications, resource
optimization and cost reduction are already used in some hospitals, especially
in developed countries (Brown-Martin, 2017).
I4 and I2 emphasized that these
changes open the door to a model with better traceability and transparency in
the care offered to patients. It is noteworthy that with the integration of
data and technologies, better results for the patient and cost reduction
throughout the health chain should occur. In fact, machine learning algorithms
have made it possible for forecast quality to improve according to experience,
that is, the more data, the better forecasting mechanisms are created (Jayanthi
et al., 2019).
4.2.
Description of Health 4.0 in Brazil
According to I3 and I4, there is
still little incentive for the creation and adoption of new technologies in
educational institutions, mainly due to the lack of economic and government
incentives and because Brazil has a highly bureaucratic system. The economic
incentive for the adoption of new technologies in the scope of health 4.0 is
fundamental, as well as government support and partner institutions, however,
this has not been characteristic of governments in underdeveloped and emerging
countries (Park, 2016).
The latter are slowly waking up to
the health benefits 4.0 (Almeida, Cavalcante & Fettermann, 2017). For I3,
another aspect is compliance with traditional management models, resistance to
computerization with real-time data sharing. Brazil has the potential to be a
great developer of interaction platforms for health, connecting data, equipment
and health professionals, but for this to happen it is necessary to act in the
organizational culture (Almeida, Cavalcante & Fettermann, 2017).
For I2, there are four major
barriers to be overcome in general. The first is strategy - today, company
leaders are rewarded for thinking in the short term, about generating rapid
increases for their shareholders, so long-term planning is not a priority. The
second addresses social aspects - industry 4.0 is seen as something that will
generate impacts such as the change in jobs and business models, but the
proposal is far from participating in this change.
The third barrier refers to the
process of training and skills development - there is no urgency to demand or
facilitate the training of people with the knowledge that will be required. The
fourth is technology - most companies are not prepared for changes in
paradigms, especially in organizational culture.
The health sector regulations are
emphasized, which are neither political nor protectionist. For I1, the
professional health class society treats the subject of technologies as a
problem that will harm the doctor-patient relationship. However, for I3, the
technological evolution in health will bring integration, process improvement,
avoid waste and better treatments for patients.
It also adds that doctors and health
professionals will have to evolve together. If disruptive technologies are
inevitable, they must also be directed to health, in a qualified and applied
manner. I2 and I4 state that technological innovation in health comes to add to
the professional and the patient, not to compete. According to them, the theme
will not be just health but the life of the human being as a whole.
For I2 and I3 in relation to the
treatment of diseases, intelligent systems can suggest effective ways and also
improve prevention. According to them, health professionals should make use of
sophisticated machines and have access to a large amount of organized data,
contributing to a decision making process with less likelihood of errors. The
information ends up being used only reactively.
For all respondents, based on an
extensive relationship between patients, their illnesses and treatment
targeting, it would be possible to identify better treatment alternatives for
each type of patient based on analytical models. Finally, they add that
accessing a complete medical history would allow understanding of predecessor
treatments and their relationship with future ones. Everything is a matter of
understanding the patient's need and what the information leads us to conclude.
Figure 1 presents the conceptual map of the health sector 4.0 in Brazil.
Patient data is collected manually
in hospitals from autonomous medical devices, including vital signs (Costa et
al., 2018). Such data are sometimes stored in electronic spreadsheets, not
being part of the electronic medical records of patients, and therefore it is
difficult for those responsible in the hospital to combine and analyze them.
Thus, a solution to overcome these limitations is the interconnection of
medical devices via the Internet using a distributed platform, the IoT. This
approach allows data from different sources to be combined to better diagnose
the patient's health status and identify possible anticipatory actions (Costa et
al., 2018).
Figure 1: Conceptual map of the Brazilian
health sector 4.0 based on respondents.
The adoption of CC and IoT in the
health field can improve health services and contribute to continuous and
systematic innovation in a Big Data environment as applications in industry 4.0
(Elhoseny et al., 2018). However, the resources needed to manage this data in
the Cloud-IoT environment are still challenging. Figure 2 shows the
technologies that should be used in the context of health 4.0. The illustration
was prepared using data from interviews with professionals in the sector. Note
that different technologies that together make up health 4.0 have been exposed.
Figure 2: Technologies that characterize health
4.0.
The technologies in Figure 2 are
already present as technological improvements in some hospitals. They are
responsible for managing the large amount of data through intelligent
management systems, constantly monitoring the patient with the IoT interface.
New innovative techniques have emphasized the offer, with long-term gains in
efficiency and productivity. Transport and communication costs must be reduced
substantially, logistics and global supply chains tend to become more
effective, and commercial costs will decrease (Klaus, 2016). In addition,
connectivity and information analysis are the main pillars of this
transformation (Jayanthi et al., 2019).
Connectivity because the patient
will be able to carry all his medical history with greater data security, which
is allowed by block chain, the same that made Bitcoin one of the safest virtual
currencies today. And with information analysis because an artificial
intelligence can process information much faster than a human being. This
repetition of comparisons allows the assessment of causalities to preventively
respond to a patient at risk. Being able to understand the variables that
signal a higher risk for the patient is only possible with this intelligence in
hand. It is also noteworthy that in Brazil there are currently archaic
electronic medical records and backward management systems that do not talk and
with the technological evolution of health 4.0 there will be a standardization
of languages and integration.
5.
FINAL CONSIDERATIONS
The objective of this article was to
present perspectives of industry 4.0 related to the health sector and its
characteristics in Brazil through the experience of professionals in the area.
As analyzed in the research, in the health sector, health technologies that
embrace the principles of industry 4.0 should be adopted to improve data
digitization, interconnectivity between machines and commands, more efficient
databases and, mainly, greater patient autonomy in regarding their own health.
The main technologies identified in the interviews refer to CC and IoT
developed for hospitals, as they seek to support communications between devices
and health services.
In addition, the article contributed
to health professionals who seek to better understand the definitions and
concepts related to health 4.0, also providing, for researchers and interested
parties, a study on the topic. The description of the results was focused and
critical, structured, as far as possible, for the expansion of knowledge about
industry 4.0, given its topicality and relevance in the health sector, which
are necessary to interconnect hospitals, people and systems to provide real
dynamics with optimized time and self-organized regarding the patient's
condition.
The main limitation of the research
is related to the collection of data through a restricted number of
respondents. A broader proposal by participants from the health sector 4.0 in
the survey could be developed to verify new useful information about the
context under analysis. As future steps, it is suggested to carry out research
that deepens the field of health knowledge 4.0, such as: i) analyzing how
developed countries are promoting the health value chain 4.0; ii) verify how
product development by Brazilian companies in the health sector should be in
the coming years; and iii) identify how smart hospitals are empowering
employees, while new technologies are being developed annually to control
patient data.
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