Exploring telerobotic cardiac catheter ablation in a rural community hospital: A pilot study.

Background: Telerobotic surgery could improve access to specialty procedures such as cardiac catheter ablation in rural and underserved regions in the United States and worldwide. Advancements in telecommunications, internet infrastructure, and surgical robotics are lowering the technical hurdles for this future healthcare delivery paradigm. Nonetheless, important questions remain regarding the safe implementation of telerobotic surgery in rural community hospital settings. Objective: The purpose of this study was to pilot test a system and methods to explore telerobotic cardiac catheter ablation in a rural community hospital setting. Methods: We assembled a portable preclinical telerobotic catheter ablation system from commercial-grade components using third-party vendors. We then carried out 4 telerobotic surgery simulations with an urban surgeon and a rural community hospital operating room (OR) team spanning a distance of more than 2000 miles. Two challenge scenarios were incorporated into the simulations, including loss of network connection and cardiac perforation with subsequent life-threatening tamponade physiology. An ethnographic analysis was then performed. Results: Interviews and observations suggested that rural OR teams readily adapt to the telesurgery context. However, participant perceptions of team trust, communication, and emergency management were significantly altered by the remote location of the surgeon. In addition, most participants believed the OR team would have been better equipped for the challenges had they received formal training or had prior experience with the procedure being simulated. Conclusion: We demonstrate the utility and feasibility of a system and methods for studying specialty telerobotic surgery in a rural hospital OR setting.

Neurosecurity: security and privacy for neural devices.

An increasing number of neural implantable devices will become available in the near future due to advances in neural engineering. This discipline holds the potential to improve many patients' lives dramatically by offering improved-and in some cases entirely new-forms of rehabilitation for conditions ranging from missing limbs to degenerative cognitive diseases. The use of standard engineering practices, medical trials, and neuroethical evaluations during the design process can create systems that are safe and that follow ethical guidelines; unfortunately, none of these disciplines currently ensure that neural devices are robust against adversarial entities trying to exploit these devices to alter, block, or eavesdrop on neural signals. The authors define "neurosecurity"-a version of computer science security principles and methods applied to neural engineering-and discuss why neurosecurity should be a critical consideration in the design of future neural devices.

Computer security for data collection technologies.

Many organizations in the developing world (e.g., NGOs), include digital data collection in their workflow. Data collected can include information that may be considered sensitive, such as medical or socioeconomic data, and which could be affected by computer security attacks or unintentional mishandling. The attitudes and practices of organizations collecting data have implications for confidentiality, availability, and integrity of data. This work, a collaboration between computer security and ICTD researchers, explores security and privacy attitudes, practices, and needs within organizations that use Open Data Kit (ODK), a prominent digital data collection platform. We conduct a detailed threat modeling exercise to inform our view on potential security threats, and then conduct and analyze a survey and interviews with technology experts in these organizations to ground this analysis in real deployment experiences. We then reflect upon our results, drawing lessons for both organizations collecting data and for tool developers.

A review of the security of insulin pump infusion systems.

Insulin therapy has enabled patients with diabetes to maintain blood glucose control to lead healthier lives. Today, rather than injecting insulin manually using syringes, a patient can use a device such as an insulin pump to deliver insulin programmatically. This allows for more granular insulin delivery while attaining blood glucose control. Insulin pump system features have increasingly benefited patients, but the complexity of the resulting system has grown in parallel. As a result, security breaches that can negatively affect patient health are now possible. Rather than focus on the security of a single device, we concentrate on protecting the security of the entire system. In this article, we describe the security issues as they pertain to an insulin pump system that includes an embedded system of components, which include the insulin pump, continuous glucose management system, blood glucose monitor, and other associated devices (e.g., a mobile phone or personal computer). We detail not only the growing wireless communication threat in each system component, but also describe additional threats to the system (e.g., availability and integrity). Our goal is to help create a trustworthy infusion pump system that will ultimately strengthen pump safety, and we describe mitigating solutions to address identified security issues.

Clinically significant magnetic interference of implanted cardiac devices by portable headphones.

BACKGROUND: Little is known about the magnetic field strength of portable headphones and their potential to cause magnetic interference with implanted pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). OBJECTIVE: The purpose of this study was to evaluate the magnetic field strength of portable headphones and to determine if they can cause clinically relevant magnetic interference. METHODS: PM or ICD function was assessed in 100 patients during exposure to eight different models of portable headphones to determine the incidence of clinically relevant magnetic interference. The magnetic field strength of the headphones also was measured in vitro. RESULTS: Clinically relevant magnetic interference from portable headphones occurred in 30 (30%) of 100 patients and more commonly affected ICD than PM patients (21/55 [38.2%] vs 9/45 [20.0%]; P = .048). All patients affected by magnetic interference experienced a magnet response, characterized by asynchronous pacing in PM patients and by inhibition of tachyarrhythmia detection in ICD patients. In all but one of the 30 cases of magnetic interference, removal of the headphones from the patient's chest immediately restored normal device function. Headphones with a measured magnetic field strength > or =10 gauss at 2 cm were much more likely to cause magnetic interference than were those with lower magnetic field strength (30/100 [30%] patients vs 0/100 [0%] patients; P <.0001). Magnetic interference was not observed when headphones were placed > or =3 cm from the skin surface. CONCLUSION: Clinically significant magnetic interference can occur when portable headphones are placed in close proximity to implanted PMs and ICDs. Patients with such a device should be advised to keep portable headphones at least 3 cm from their device.