PDF(Pubmed)
Abstract：
BACKGROUND: Our case report provides the first clinical evaluation of autopsy practices for a patient death that occurs on the cloud. We question how autopsy practices may require adaptation for a death that presents via the \'Internet of Things\', examining how existing guidelines capture data related to death which is no longer confined to the patient\'s body.
METHODS: The patient was a British man in his 50s, who came to the attention of the medical team via an alert on the cloud-based platform that monitored his implanted cardioverter defibrillator (ICD). The patient had a background of congenital heart disease, with previous ventricular fibrillation cardiac arrest, for which the ICD had been implanted two years earlier. Retrospective analysis of the cloud data demonstrated a gradually decreasing nocturnal heart rate over the previous three months, falling to a final transmission of 24 beats per minute (bpm). In the patient post-mortem the ICD was treated as medical waste, structural tissue changes precluded the effective evaluation of device hardware, potential issues related to device software were not investigated and the cause of death was assigned to underlying heart failure. The documentation from the attending law enforcement officials did not consider possible digital causes of harm and relevant technology was not collected from the scene of death.
CONCLUSIONS: Through this patient case we explore novel challenges associated with digital deaths including; (1) device hardware issues (difficult extraction processes, impact of pathological tissue changes), (2) software and data limitations (impact of negative body temperatures and mortuary radio-imaging on devices, lack of retrospective cloud data analysis), (3) guideline limitations (missing digital components in autopsy instruction and death certification), and (4) changes to clinical management (emotional impact of communicating deaths occurring over the internet to members of family). We consider the implications of our findings for public health services, the security and intelligence community, and patients and their families. In sharing this report we seek to raise awareness of digital medical cases, to draw attention to how the nature of dying is changing through technology, and to motivate the development of digitally appropriate clinical practice.
METHODS: The patient was a British man in his 50s, who came to the attention of the medical team via an alert on the cloud-based platform that monitored his implanted cardioverter defibrillator (ICD). The patient had a background of congenital heart disease, with previous ventricular fibrillation cardiac arrest, for which the ICD had been implanted two years earlier. Retrospective analysis of the cloud data demonstrated a gradually decreasing nocturnal heart rate over the previous three months, falling to a final transmission of 24 beats per minute (bpm). In the patient post-mortem the ICD was treated as medical waste, structural tissue changes precluded the effective evaluation of device hardware, potential issues related to device software were not investigated and the cause of death was assigned to underlying heart failure. The documentation from the attending law enforcement officials did not consider possible digital causes of harm and relevant technology was not collected from the scene of death.
CONCLUSIONS: Through this patient case we explore novel challenges associated with digital deaths including; (1) device hardware issues (difficult extraction processes, impact of pathological tissue changes), (2) software and data limitations (impact of negative body temperatures and mortuary radio-imaging on devices, lack of retrospective cloud data analysis), (3) guideline limitations (missing digital components in autopsy instruction and death certification), and (4) changes to clinical management (emotional impact of communicating deaths occurring over the internet to members of family). We consider the implications of our findings for public health services, the security and intelligence community, and patients and their families. In sharing this report we seek to raise awareness of digital medical cases, to draw attention to how the nature of dying is changing through technology, and to motivate the development of digitally appropriate clinical practice.
摘要：
背景：我们的病例报告为发生在云端的患者死亡提供了首次尸检实践的临床评估。我们质疑尸检实践如何需要适应通过“物联网”呈现的死亡，检查现有指南如何捕获与死亡相关的数据，这些数据不再局限于患者的身体。
方法：患者是一名50多岁的英国男子，他通过基于云的平台上的警报引起了医疗团队的注意，该平台监测了他植入的心脏复律除颤器（ICD）。病人有先天性心脏病的背景,之前的心室纤颤心脏骤停,两年前植入了ICD。对云数据的回顾性分析表明，在过去的三个月中，夜间心率逐渐下降，下降到最终传输24次每分钟（BPM）。在验尸后的患者中，ICD被视为医疗废物，结构组织变化妨碍了对设备硬件的有效评估，未调查与器械软件相关的潜在问题,并将死亡原因归入基础心力衰竭.与会执法人员的文件没有考虑可能的数字危害原因，也没有从死亡现场收集相关技术。
结论：通过此患者病例，我们探索了与数字死亡相关的新挑战，包括：（1）设备硬件问题（提取过程困难，病理组织变化的影响)，(2)软件和数据限制(负体温和房无线电成像对设备的影响，缺乏回顾性云数据分析)，（3）指南限制（尸检指令和死亡认证中缺少数字组件），和（4）临床管理的变化（通过互联网向家庭成员传达死亡的情感影响）。我们考虑我们的发现对公共卫生服务的影响，安全和情报界，病人和他们的家人。在分享这份报告时，我们努力提高人们对数字医疗病例的认识，为了让人们注意到死亡的本质是如何通过技术而改变的，并促进数字适当临床实践的发展。
方法：患者是一名50多岁的英国男子，他通过基于云的平台上的警报引起了医疗团队的注意，该平台监测了他植入的心脏复律除颤器（ICD）。病人有先天性心脏病的背景,之前的心室纤颤心脏骤停,两年前植入了ICD。对云数据的回顾性分析表明，在过去的三个月中，夜间心率逐渐下降，下降到最终传输24次每分钟（BPM）。在验尸后的患者中，ICD被视为医疗废物，结构组织变化妨碍了对设备硬件的有效评估，未调查与器械软件相关的潜在问题,并将死亡原因归入基础心力衰竭.与会执法人员的文件没有考虑可能的数字危害原因，也没有从死亡现场收集相关技术。
结论：通过此患者病例，我们探索了与数字死亡相关的新挑战，包括：（1）设备硬件问题（提取过程困难，病理组织变化的影响)，(2)软件和数据限制(负体温和房无线电成像对设备的影响，缺乏回顾性云数据分析)，（3）指南限制（尸检指令和死亡认证中缺少数字组件），和（4）临床管理的变化（通过互联网向家庭成员传达死亡的情感影响）。我们考虑我们的发现对公共卫生服务的影响，安全和情报界，病人和他们的家人。在分享这份报告时，我们努力提高人们对数字医疗病例的认识，为了让人们注意到死亡的本质是如何通过技术而改变的，并促进数字适当临床实践的发展。
