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Medtronic, Inc. (“Medtronic”) offers RemoteView, which permits a user (“Programmer User”) of the Medtronic CareLink® 2090 Programmer (“Programmer”) to allow the viewing of information presently displayed on the Programmer screen with one or more individuals in remote locations anywhere in the world (“Remote Viewer”), including remote health care professionals or Medtronic representatives.
Limited License Grant. You are hereby granted a nonexclusive, nontransferable, terminable, nonassignable, nonsublicensable, limited license to install and use a copy of the Licensed Software solely for authorized and legitimate purposes. You may not otherwise copy, use, modify, reverse engineer, decompile, disassemble, create derivative works based on, or integrate with other systems or programs the Licensed Software without the prior written consent of Medtronic. You shall have sole responsibility for any fees or charges, including service or data charges, incurred by you in connection with your use of the Licensed Software. You shall not remove any proprietary or other legend or restrictive notice contained or included in the Licensed Software or other documentation associated with such Licensed Software. You agree to maintain any and all copyright, trademark, and other notices on the Licensed Software and any associated documentation.
Licensed Software Functionality and Data Use, Collection, Viewing, and Transfer.
“Active Remote Viewer” as referred to herein shall mean a Remote Viewer that has installed the Licensed Software and has at the relevant point in time an active network connection to a Medtronic server via the Licensed Software.
By installing or using the Licensed Software or clicking any acceptance button in connection with this Agreement, you acknowledge, understand, agree to, and consent to all of the following, including when you are an Active Remoter User:
) Registration. To obtain access to the Licensed Software, you must register at the Medtronic RemoteView website and establish a user name and password. All information that you provide in connection with such registration must be complete, accurate, and truthful. The user name and password are personal to you and must not be shared with anyone else. You will also not attempt, directly or indirectly, to disable, bypass, or defeat any password protection associated with the Licensed Software. Medtronic reserves the right to deny or disable any user name or password or request for any user name or password.
) Your Personal Information. Medtronic will collect information in connection with your registration and installation and use of the Licensed Software, including your first and last name, your email address, a selected security question(s) and your corresponding answer(s), your address, and your telephone number. You agree that Medtronic may store this personal information about you on a Medtronic server, including a server located in the United States of America.
) Session Key. To view the information on the Programmer, the Remote Viewer must generate a Session Key that must be shared with and entered by the Programmer User. “Session Key” as used herein means a unique token active for a limited period of time generated by the Remote Viewer. You agree not to share this Session Key with anyone other than the Programmer User who has initiated the specific session.
) Logging of Session Activity. Each time you log in to the Licensed Software, Medtronic will collect information about your activity, including in an aggregated log or database, regarding you and your session, including your name, username, computer name, IP address, operating system details, and session details (including transferring and sharing activity, start and end times, view only or control activity, and any chat messages between or among any Active Remote Viewers. You agree that Medtronic may store any personal information about you on a Medtronic server, including a server located in the United States of America.
) Active Remote Users. When you are an Active Remote Viewer: (1) you will be able to view the name and/or user name of any other Active Remote Viewer who is logged into the same Medtronic server; and (2) any other Active Remote Viewer who is actively logged into the same Medtronic server will be able to view your name and/or user name. The Licensed Software also permits one Active Remote Viewer to share the information being viewed to any other Active Remote Viewer. You must not share any information from the Medtronic programmer, including with any other Active Remote Viewer, absent the express permission from the Programmer User that is allowing you to view the information.
) Availability. Medtronic has limitations on the number of users that can concurrently log in to the Licensed Software at any given time. Thus, installation of or accessing the Licensed Software does not guarantee that it will be available to you for use at any time.
Permissions. By installing and using the Licensed Software, you represent that you have permission to do so from any associated clinic, hospital, or medical practice and that your use of the Licensed Software complies with any policies or requirements of such associated clinic, hospital, or medical practice. You are also responsible for confirming that the Programmer User has obtained any necessary patient consent before allowing you to view any patient information via the Licensed Software.
Your Acknowledgements. You acknowledge that the Licensed Software is not the exclusive method of viewing information from the Programmer and that the Licensed Software is not the exclusive method by which to obtain a patient’s implanted cardiac device data, including any data on the Programmer. You also acknowledge that the Licensed Software is not intended to be used as a life-sustaining or interventional tool during medical emergencies. You further acknowledge that Medtronic is not, and shall not be deemed to be, a provider of patient health care services by virtue of its provision of access to the Programmer screen information via the Licensed Software. You also acknowledge that information from the Licensed Software is not an electronic medical record and use of the Licensed Software does not in any way relieve you from using your best medical judgment to determine a proper course of treatment for patients.
Security/Privacy of Patient Data. Your use of the Licensed Software and any Session Keys shall be solely for legitimate and lawful purposes and not for any malicious purpose. You are solely responsible for and will use your best efforts in maintaining the confidentiality and security of any copies of the Licensed Software as well as any user name, password credentials, and any Session Keys that can be used in accessing the Licensed Software, a Medtronic server, or any information from a Programmer. You are solely responsible for and will use your best efforts in keeping any patient information you may receive or view in connection with the Licensed Software confidential and secure, and you will not attempt to capture or copy any patient information you view in any electronic or hard copy format without the express permission of the Programmer User. You will be responsible for any obligations or liabilities associated with any lost, stolen, or otherwise compromised patient information.
Reporting Issues and Feedback. You agree that you will report any issues or questions, technical or otherwise, regarding the Licensed Software promptly and directly to Medtronic. If you submit any comments or ideas to Medtronic, in the absence of a separate agreement regarding such submissions, you grant to Medtronic an unrestricted, royalty-free, irrevocable license to use, reproduce, display, perform, modify, transmit, and distribute such ideas in any medium and agree that Medtronic is free to use them for any purpose. In addition, Medtronic has no obligation to provide continued maintenance and support to you in connection with the Licensed Software. Any maintenance and support services provided by Medtronic shall be at Medtronic’s sole discretion.
Limitations of Liability.
THE LICENSED SOFTWARE IS PROVIDED TO YOU “AS IS,” AND MEDTRONIC EXPRESSLY DISCLAIMS ANY AND ALL WARRANTIES WITH RESPECT TO THE LICENSED SOFTWARE AND YOUR USE THEREOF, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND NONINFRINGEMENT. MEDTRONIC DOES NOT WARRANT THAT THE USE OF THE LICENSED SOFTWARE WILL BE UNINTERRUPTED OR ERROR-FREE.
Legal Compliance. You shall at all times use the Licensed Software in compliance with all applicable laws. You shall ensure that your installation and use of the Licensed Software complies with all applicable export and import laws, regulations, orders, and policies of the United States of America and any other applicable jurisdiction. You represent and warrant that (i) you are not located in a country that is subject to a U.S. Government embargo, or that has been designated by the U.S. Government as a “terrorist supporting” country, and (ii) you are not listed on any U.S. Government list of prohibited or restricted parties.
Term, Termination, Modifications, and Support. This Agreement shall be in effect from the date when you first install or use the Licensed Software. Medtronic may modify, amend, or terminate this Agreement at any time, including by providing notices or an updated version of this Agreement on a Medtronic website. Medtronic may modify, disable, or terminate your use or Medtronic’s support of the Licensed Software at any time, including by providing notices on a Medtronic website. All obligations which are ongoing in nature shall survive termination or expiration of this Agreement. At any time upon Medtronic’s request (including via a notice on a Medtronic website), you agree to promptly delete and terminate use of any and all copies of the Licensed Software. In addition, upon Medtronic’s request, you agree to provide written verification that you have destroyed all copies of the Licensed Software together with the manner, date, and time of such destruction.
NayaMed International Sárl Customers: Whether the RemoteView feature shall be used in connection with NayaMed customers or devices shall be solely within the discretion of NayaMed International Sárl. If the Licensed Software is used connection with NayaMed customers or devices, this Agreement shall be directly between you and NayaMed with respect to those uses.
Overwhelmed and under-equipped, some health centers are innovating in the midst of the global pandemic.
by Kelley A. Wittbold, Colleen Carroll, Marco Iansiti, Haipeng Mark Zhang, and Adam B. Landman
April 03, 2020
On Monday March 9, in an effort to address soaring patient demand in Boston, Partners HealthCare went live with a hotline for patients, clinicians, and anyone else with questions and concerns about Covid-19. The goals are to identify and reassure the people who do not need additional care (the vast majority of callers), to direct people with less serious symptoms to relevant information and virtual care options, and to direct the smaller number of high-risk and higher-acuity patients to the most appropriate resources, including testing sites, newly created respiratory illness clinics, or in certain cases, emergency departments. As the hotline became overwhelmed, the average wait time peaked at 30 minutes. Many callers gave up before they could speak with the expert team of nurses staffing the hotline. We were missing opportunities to facilitate pre-hospital triage to get the patient to the right care setting at the right time.
The Partners team, led by Lee Schwamm, Haipeng (Mark) Zhang, and Adam Landman, began considering technology options to address the growing need for patient self-triage, including interactive voice response systems and chatbots. We connected with Providence St. Joseph Health system in Seattle, which served some of the country’s first Covid-19 patients in early March. In collaboration with Microsoft, Providence built an online screening and triage tool that could rapidly differentiate between those who might really be sick with Covid-19 and those who appear to be suffering from less threatening ailments. In its first week, Providence’s tool served more than 40,000 patients, delivering care at an unprecedented scale.
Our team saw potential for this type of AI-based solution and worked to make a similar tool available to our patient population. The Partners Covid-19 Screener provides a simple, straightforward chat interface, presenting patients with a series of questions based on content from the U.S. Centers for Disease Control and Prevention (CDC) and Partners HealthCare experts. In this way, it too can screen enormous numbers of people and rapidly differentiate between those who might really be sick with Covid-19 and those who are likely to be suffering from less threatening ailments. We anticipate this AI bot will alleviate high volumes of patient traffic to the hotline, and extend and stratify the system’s care in ways that would have been unimaginable until recently. Development is now under way to facilitate triage of patients with symptoms to most appropriate care setting, including virtual urgent care, primary care providers, respiratory illness clinics, or the emergency department. Most importantly, the chatbot can also serve as a near instantaneous dissemination method for supporting our widely distributed providers, as we have seen the need for frequent clinical triage algorithm updates based on a rapidly changing landscape.
Similarly, at both Brigham and Women’s Hospital and at Massachusetts General Hospital, physician researchers are exploring the potential use of intelligent robots developed at Boston Dynamics and MIT to deploy in Covid surge clinics and inpatient wards to perform tasks (obtaining vital signs or delivering medication) that would otherwise require human contact in an effort to mitigate disease transmission.
Several governments and hospital systems around the world have leveraged AI-powered sensors to support triage in sophisticated ways. Chinese technology company Baidu developed a no-contact infrared sensor system to quickly single out individuals with a fever, even in crowds. Beijing’s Qinghe railway station is equipped with this system to identify potentially contagious individuals, replacing a cumbersome manual screening process. Similarly, Florida’s Tampa General Hospital deployed an AI system in collaboration with Care.ai at its entrances to intercept individuals with potential Covid-19 symptoms from visiting patients. Through cameras positioned at entrances, the technology conducts a facial thermal scan and picks up on other symptoms, including sweat and discoloration, to ward off visitors with fever.
Beyond screening, AI is being used to monitor Covid-19 symptoms, provide decision support for CT scans, and automate hospital operations. Meanwhile, Zhongnan Hospital in China uses an AI-driven CT scan interpreter that identifies Covid-19 when radiologists aren’t available. China’s Wuhan Wuchang Hospital established a smart field hospital staffed largely by robots. Patient vital signs were monitored using connected thermometers and bracelet-like devices. Intelligent robots delivered medicine and food to patients, alleviating physician exposure to the virus and easing the workload of health care workers experiencing exhaustion. And in South Korea, the government released an app allowing users to self-report symptoms, alerting them if they leave a “quarantine zone” in order to curb the impact of “super-spreaders” who would otherwise go on to infect large populations.
The spread of Covid-19 is stretching operational systems in health care and beyond. We have seen shortages of everything, from masks and gloves to ventilators, and from emergency room capacity to ICU beds to the speed and reliability of internet connectivity. The reason is both simple and terrifying: Our economy and health care systems are geared to handle linear, incremental demand, while the virus grows at an exponential rate. Our national health system cannot keep up with this kind of explosive demand without the rapid and large-scale adoption of digital operating models.
While we race to dampen the virus’s spread, we can optimize our response mechanisms, digitizing as many steps as possible. This is because traditional processes — those that rely on people to function in the critical path of signal processing — are constrained by the rate at which we can train, organize, and deploy human labor. Moreover, traditional processes deliver decreasing returns as they scale. On the other hand, digital systems can be scaled up without such constraints, at virtually infinite rates. The only theoretical bottlenecks are computing power and storage capacity — and we have plenty of both. Digital systems can keep pace with exponential growth.
Importantly, AI for health care must be balanced by the appropriate level of human clinical expertise for final decision-making to ensure we are delivering high quality, safe care. In many cases, human clinical reasoning and decision making cannot be easily replaced by AI, rather AI is a decision aid that helps human improve effectiveness and efficiency.
Digital transformation in health care has been lagging other industries. Our response to Covid today has accelerated the adoption and scaling of virtual and AI tools. From the AI bots deployed by Providence and Partners HealthCare to the Smart Field Hospital in Wuhan, rapid digital transformation is being employed to tackle the exponentially growing Covid threat. We hope and anticipate that after Covid-19 settles, we will have transformed the way we deliver health care in the future.
Kelley A. Wittbold, MD
Kelley A. Wittbold, MD, is an emergency medicine attending physician at Massachusetts General Hospital and an administrative fellow specializing in digital health, emergency telemedicine, and emergency operations management.
Colleen Carroll is a senior engagement manager at Keystone Strategy. Her work focuses on digital health strategies and healthcare economics for biotechnology firms, pharmaceutical companies, and healthcare systems.
Marco Iansiti is the David Sarnoff Professor of Business Administration at Harvard Business School, where he heads the Technology and Operations Management Unit and the Digital Initiative. He has advised many companies in the technology sector, including Microsoft, Facebook, and Amazon. He is a coauthor (with Karim Lakhani) of the book Competing in the Age of AI (Harvard Business Review Press, 2020).
Haipeng Mark Zhang, DO
Haipeng Mark Zhang, DO, is a palliative care and clinical informatics attending physician at Brigham and Women’s Hospital and Dana-Farber Cancer Institute. He is the medical director of the Brigham and Women’s Digital Innovation Hub and focuses on the application and creation of digital tools for clinicians, staff, and patients at Brigham Health and throughout the Partners HealthCare enterprise.
Adam B. Landman, MD
Adam B. Landman, MD, is an emergency medicine and clinical informatics attending physician at Brigham and Women’s Hospital, where he also serves as vice president and chief information and digital officer. He is responsible for developing system-wide strategic IT initiatives, with the goal of evolving the next generation of information systems across the Brigham Health enterprise.
This article originally appeared on HBR.org and is being brought to you by Medtronic.
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