Dr. Leigh Anne Poole Lead Follow or Get Out Of The Way
1. Lead Follow, or Get Out of the Way:
Technology is Transforming the Delivery of
Healthcare
Dr. Leigh Ann Chandler Poole, PhD, CRNP, FNP-BC, CTCP, CTC
2. Objectives
• Discuss the Coming Change and Paradigm Shift
in Health and Healthcare
• Review Technological Innovations poised to
reshape the healthcare system and the health of
our population
• Discuss how these technologies could completely
change the healthcare system
3. What Words Would You Use to Describe
the Current State of Healthcare?
• Revolution
• Disruption
• Transformation
• Paradigm Shift
Technological Innovations are resulting
in a new way to provide healthcare
4. Key Buzzwords
• Value-Based Care
• Quality Care
• Improved Access
• Decreased Readmission Rates
Telehealth Provides for it All
5. Telehealth
• Telemedicine growing industry
• Leading Telemedicine experts believe
up to 50% of healthcare visits may be
conducted by TM within 5 years
– Big Changes
6. Telehealth
• Technology has always outpaced legislation
• Need legislators and regulators to know and understand
– Uses, quality, safety, possibilities
– About the need to bring parity of HC to all citizens
– Interstate practice problems that exist
– Licensure and Credentialing issues
– The importance of reimbursement
• Should not be dependent upon patients residency status
• Should not discriminate against certain types of providers
12. Significant Innovations
• Nanotechnology
– Engineering at the molecular scale (1-100 nanometers)
– At the nanoscale many materials behave in different and
unexpected ways
– Promises from Cancer cures, to regeneration, to faster computers to
cleaner water, & energy crisis solutions
– Examples:
• Silver (anti-microbial) Incorporated into products it kills bacteria without
altering product.
• Cancer treatment – nanoparticles coated with polymers evade detection
and deliver substances to nuclei causing cell death
– Great potential – need to understand how behave, to synthesize
reliably, evaluate efficacy and safety
http://recent-inventions.
lv2lvu.com/nanotechnolog
y-in-medical-science/#.VDgtsL60kpw
13. Significant Innovations
• Optics
http://physicsinventions.com/index.php/new-fiber-
optic-technology/
– Behavior and properties of light and interaction with
matter or construction of instruments that use or
detect it
– New laser technologies
– Measurement of body temperature, blood chemistry,
less invasive procedures, targeted treatment, more
effective imaging and diagnostic procedures
14. Significant Innovations
• AI
http://www.avatargeneration.com/2012/10/10-ways-artificial-
intelligence-can-reinvent-education/
– Human like behaviors in machines or software
– In medicine, increase efficiency, safety, productivity, and
outcomes while decreasing costs
– Example: IBM Watson
• Virtual Reality / Gaming
– Near Reality – Computer generated simulated environment
with interaction capabilities
– Seeking care through Avatar representation
– Example: Oculus Rift, Sony Project Morpheus, Second life
15. Significant Innovations
• Wearable's
• Ingestible’s
• Implantable’s
• Big Data
http://tommytoy.typepad.com/tommy-toy-pbt-consultin/2011/11/proteus-biomedical-a-biomedical-
technology-company-out-of-redwood-city-california-was-selected-as-one-of-the-
world-tec.html
18. Significant Innovations
• Sense-making
– Giving meaning to experience and enabling us to
investigate and improve interactions between
humans and technology. Assists in making sense
of complex information
• BCI and BBI
• Cognitive Technology
– Example: IBM Watson
• Semantic Web
19. Incentives Lead to Innovation
• X-Prize(s)
– Life Sciences
• Tricorder, diagnostic technologies
• Direct to Health Consumer
– Energy and Environment
– Exploration
– Global Development
– Learning
20. Other Health Related Prizes being
considered
• Brain-Machine XPRIZE
• Crypreservation XPRIZE
• Lie Detector XPRIZE
• Organogenesis XPRIZE
• Rare Disease XPRIZE
• Bionics XPRIZE
• Robotic Home Healper XPRIZE
21. Brain Mapping Innovation
• Brain Initiative
• Brain Research through Advancing Innovative
Neurotechnologies
• Aim to revolutionize our understanding of the human brain
• Multiagency and Multi-partner’s
• $100 million request for FY 2014
• Recent plans to double to $200 million in FY 2015
22. To the Future and Beyond …
• Ask yourself these questions:
• How do you see the world of healthcare
changing with the implementation of one or
more of these technologies?
• How does direct to consumer marketing
change our current paradigm?
23. Questions continued …
• Will it matter where our providers
physically are?
• Will we need the same type of healthcare
providers?
• The same numbers?
24. The BIG Question
Will you:
• Lead?
• Follow?
• Get Out of The Way?
It’s not if there will be a disruption,
it’s when. The Future is Here; Impact it,
or Be Impacted by It.
25. Thank You
Contact: Dr. Leigh Ann Chandler Poole
PhD, CRNP, RN, FNP-BC, CTCP, CTC
Dr.lacpoole@gmail.com
Twitter: @LACPoole
Editor's Notes
Telehealth Provides for it all
Big Changes: Decreased Brick and Mortar, increased access to quality, safe care that results in decreased re-admisisons and increased quality of care
Healthcare is experiencing a Paradigm shift. So HC providers will have to ask themselves, are they going to lead, follow, or get out of the way?
Now we can use our smart phones as high-resolution microscopes, stethoscopes, determining vital signs from light in our face from a 99 cent app, perform retinal scans. EKGs, and ultrasounds through various devices that hook right to a smart phone.
Personalized Medicine is an emerging practice of medicine. It uses an individuals genetic profile to guide decisions made in regard to prevention, diagnosis and treatment of disease. looks at is the use of detailed information about a patient’s genotype or level of gene expression and clinical data in order to select a medication, therapy or preventative measure that is particularly suited to that patient at the time of the administration. Benefits: accuracy, efficacy safety and speed.
Genomics open the possibility of a new approach to drug development as well as unleashing the potential of significantly more effective diagnosis, therapeutics, and patient care.
The human genome project was an international collaborative research program. The HGP has revealed that there are probably about 20,500 human genes. The completed human sequence can now identify their locations. The full sequence was completed and published in April 2003. The Human Genome Project has already fueled the discovery of more than 1,800 disease genes.
As a result of the Human Genome Project, today’s researchers can find a gene suspected of causing an inherited disease in a matter of days, rather than the years it took before the genome sequence was in hand.
There are now more than 2,000 genetic tests for human conditions. These tests enable patients to learn their genetic risks for disease and also help healthcare professionals to diagnose disease.
At least 350 biotechnology-based products resulting from the Human Genome Project are currently in clinical trials.
Having the complete sequence of the human genome is similar to having all the pages of a manual needed to make the human body.
TOMORROW An ambitious new initiative, The Cancer Genome Atlas (http://cancergenome.nih.gov/), aims to identify all the genetic abnormalities seen in 50 major types of cancer.
Based on a deeper understanding of disease at the genomic level, we will see a whole new generation of targeted interventions, many of which will be drugs that are much more effective and cause fewer side effects than those available today.
NIH is striving to cut the cost of sequencing an individual’s genome to $1,000 or less. Having one’s complete genome sequence will make it easier to diagnose, manage and treat many diseases.
3d printing involves using digital instructions to build an object one layer at a time.
Increasing popularity in the medical field. It’s being used for everything between skulls, ears, esophagus, kidneys, to prosthesis and robotic exoskeletons.
there are “10,000,000 3D printed hearing aids in circulation worldwide” Soon we will be on a wait list for replacement organs
This picture is of a prosthesis that cost $50 to build and print and beat out a $40,000 myoelectric hand counterpart
*3D printers used for living tissues use a synthetic tissue like material with living tissues which contain living cells.
Robotics: Robotics are quickly advancing medical treatment. Ekso Bionics has already launched the first version of its eksoskeleton, which enables paraplegics to stand and walk independently. This revolutionary technology allows a person who has spent 20 years in a wheelchair to stand on her own. This holds huge promise for the next generation of robotics.
Nanotechnology is the engineering of functional systems at the molecular scale. Nanotechnology is the understanding and control of matter at dimensions between approximately 1 and 100 nanometer. nanotechnology involves imaging, measuring, modeling, and manipulating matter at this small scale. When things are this small, they are much too small to see with our eyes, or even with a typical light microscope. Scientists have had to develop special tools, like scanning probe microscopes to see materials that are on the nanometer size scale. recently scientists have been able to use new tools and processes to synthesize and manipulate materials common at the macroscale to this size, At the nanoscale, materials may behave in different and unexpected ways.
At the nanoscale, many common materials exhibit unusual properties, such as remarkably lower resistance to electricity, lower melting points or faster chemical reactions. Researchers want to harness these different and unexpected behaviors to make new technologies.
By harnessing these new behaviors, researchers in many different disciplines hope to create many new things ranging from everyday products such as antimicrobial socks and lighter tennis rackets to state of the art solar cells, faster and smaller computers or medical treatments that selectively treat the disease. Many scientists and engineers think that the possibilities are endless. One of the most common instances is the use silver nanoparticles in consumer products. Silver is inherently anti-microbial and has been used to control bacteria since ancient times. By incorporating nanoscale silver into textiles, plastics, and household appliances, manufacturers can make materials that use a small amount of silver to kill bacteria without affecting other properties of the products. Source: http://education.mrsec.wisc.edu/35.htm cientists and engineers that work on nanoscale materials still have to better understand how nanoscale materials behave and how to synthesize them reliably.
Cancer – nanoparticals can be coated with certain polymers in a “stealth mode” to avoid detection by the immune system and deliver substances right to a cancer cell nucleus and cause cell death.
Optics is the branch of physics which involves the behaviour and properties of light, including its interactions with matter and the construction of instruments that use or detect it.[
Artificial intelligence – human like behaviors in machines or software. Artificial intelligence is what gives computers the ability to learn, think, reason, and even understand human emotions, allowing computers to do more then just repetive tasks. - See more at: http://www.healthcentral.com/depression/cf/slideshows/8-ways-artificial-intelligence-is-affecting-the-medical-field#slide=2
Artificial intelligence: IBM's Watson is just the first step toward using artificial intelligence in medicine. The supercomputer, which defeated two human champions on "Jeopardy!" two years ago, is now being used to diagnose and manage lung cancer treatment. Imagine a computer that could evaluate and analyze a patient's entire genome, biometric data and environmental and personal data, including diet and activity level. The quantity of information is too much for a person to analyze efficiently, so adding an artificial intelligence component could help achieve a new level of understanding.
Virtual reality – the creator of Facebook Marc zuckerberg recently purchased Oculus Rift. "Imagine enjoying a courtside seat at a game, studying in a classroom of students and teachers all over the world or consulting a doctor face-to-face – just by putting on goggles in your home." Oculus VR is often seen as a games hardware company, but its founder, Palmer Luckey, has made it clear that he, too, sees a wider future for VR. "Right now you have very abstract social networks. So it will be really interesting to see what happens if virtual reality ever progresses to the point where you can have a very realistic way of interacting,"
Devices assisting with Aging In-Place
MC10 is prototyping a temporary tattoo (epidermal electronics) that remains for two weeks and effortlessly and continuously captures biometric data.
Sensemaking Sensemaking is the process by which people give meaning to experience. Since Sensemaking has been under development since 1972, it cannot be explained in a few sentences. It is important to know that the project has been based on three central assumptions regarding communication practice: a) That it is possible to design and implement communication systems and practices that are responsive to human needs; b) That it is possible for humans to enlarge their communication repertoires to pursue this vision; c) That achieving these outcomes requires the development of communication-based methodological approaches.
the term cognitive technology to describe how electronic devices and other tools can assist and influence humans' mental activities, such as learning, retaining and retrieving information from memory, and problem solving. Cognitive technology encompasses not just electronic gadgets, but a range of other things that can assist human thinking, from pharmaceuticals to brain-training games. We can get information as well as see how it interacts. a brain machine interface, or BMI, which essentially is a communication pathway that allows your neurons to send signals to external gadgetry, just as easily as they do to your muscles we'll be wirelessly connected to thought-controlled computers and devices that will continually provide us with information -- for example, the names of people whose faces we can't place. What if we could capture and digitize the entire information content of our brains and then upload that data to a computer or a robot? Russian industrialist and media mogul Dmitry Itskov told attendees at a recent futurist conference in Moscow that he hopes to achieve a cruder work-around version of that vision -- transplanting a working human brain into a robot -- in just a decade. But that's just the first step. Within 30 years, Itskov envisions finding a method of copying and uploading human consciousness into a machine, or even a holographic virtual body -- basically, a software replica of a person [source: Dillow].
That may sound totally, impossibly crazy. But given researchers' recent progress in developing neurosynaptic computer chips -- that is, machines that mimic the neurons and synapses of the brain -- it's hard to just scoff at Itskov's bold prediction. Such chips eventually may have the ability not just to store information, but to learn and remember, just as real brain cells do [source: Boyle]. That could mean that we'll not only be able to create complete copies of our brains' content, but that those copies would be able to keep using what we know and build upon it, long after our original meat bodies have vanished.
BCI and BBIs: As brain-computer interfaces become more advanced, healthcare will incorporate more complex human-computer connections. The uses range from helping people manage pain to controlling robotic limbs. Harvard University researchers recently created the first brain-to-brain interface that allowed a human to control a rat's tail — and another human's movements — with his mind, proving that controlled robotic limbs have far-reaching possibilities for patients.
Watson is a cognitive technology that processes information more like a human than a computer—by understanding natural language, generating hypotheses based on evidence and learning as it goes. Watson, he added, is not going to make diagnoses, not give a physician a single answer, but make suggestions, recommendations and determine probabilities. The more information Watson is fed, Dr. Kohn said, the more it learns and understands, in its way.
Electronic diagnoses: Technology promises to put the burden of care and diagnosis directly in the hands of patients. The XPRIZE Tricorder Challenge is sponsoring a $10 million race to develop a handheld, non-invasive electronic device that can diagnose patients better than a panel of physicians could. Patients would no longer have to go to a doctor's office or hospital. Instead, a device in their homes would analyze their data, diagnose the problem and send their information to a physician who could treat them remotely. Such a device could make healthcare more accessible in rural areas and developing nations. One of the devices up for the challenge is being developed by Scanadu, which also has an electronic urinanalysis stick, similar to a pregnancy test, which performs up to 12 different tests and sends the results through the cloud to the treating physician, eliminating the need for routine lab visits.
Contains 100 billion cells and trillions of conections.
Brain Computer Interfaces
What if we could capture and digitize the entire information content of our brains and then upload that data to a computer or a robot? Russian industrialist and media mogul Dmitry Itskov told attendees at a recent futurist conference in Moscow that he hopes to achieve a cruder work-around version of that vision -- transplanting a working human brain into a robot -- in just a decade. But that's just the first step. Within 30 years, Itskov envisions finding a method of copying and uploading human consciousness into a machine, or even a holographic virtual body -- basically, a software replica of a person [source: Dillow].
That may sound totally, impossibly crazy. But given researchers' recent progress in developing neurosynaptic computer chips -- that is, machines that mimic the neurons and synapses of the brain -- it's hard to just scoff at Itskov's bold prediction. Such chips eventually may have the ability not just to store information, but to learn and remember, just as real brain cells do [source: Boyle]. That could mean that we'll not only be able to create complete copies of our brains' content, but that those copies would be able to keep using what we know and build upon it, long after our original meat bodies have vanished. As the power of modern computers grows alongside our understanding of the human brain, we move ever closer to making some pretty spectacular science fiction into reality. Imagine transmitting signals directly to someone's brain that would allow them to see, hear or feel specific sensory inputs. Consider the potential to manipulate computers or machinery with nothing more than a thought. It isn't about convenience -- for severely disabled people, development of a brain-computer interface (BCI) could be the most important technological breakthrough in decades. In this article, we'll learn all about how BCIs work, their limitations and where they could be headed in the future.
The Electric Brain
The reason a BCI works at all is because of the way our brains function. Our brains are filled with neurons, individual nerve cells connected to one another by dendrites and axons. Every time we think, move, feel or remember something, our neurons are at work. That work is carried out by small electric signals that zip from neuron to neuron as fast as 250 mph [source: Walker]. The signals are generated by differences in electric potential carried by ions on the membrane of each neuron.
Although the paths the signals take are insulated by something called myelin, some of the electric signal escapes. Scientists can detect those signals, interpret what they mean and use them to direct a device of some kind. It can also work the other way around. For example, researchers could figure out what signals are sent to the brain by the optic nerve when someone sees the color red. They could rig a camera that would send those exact signals into someone's brain whenever the camera saw red, allowing a blind person to "see" without eyes.
In the next section, we'll learn about the basics of the interface itself.
Technology will change everything you know. Nanotechnology, Robotics Personalized Medicine and Genomics, Cognitive and Sense-making technology, Drones, Telemedicine, Stem-cell use, 3 and 4D organ printing, mHealth devices, wearable sensors, wireless electricity, labs on chips, movements away from needles, exoskeletons and spinal nerve regeneration for persons who have spinal injuries, robotic prostheses that have the ability to produce the sense of touch, pills that can be swallowed that can alert the person before they have a heart attack, what we know about the brain, ETC. Flying cars, already exist. Cars that drive themselves should become widely accessible soon. Food generation such as seen on Star Trek are in development, Tricorders that scan your body and can diagnose your disorder already exist, decoding genes to help you know what diseases and disorders you may face and head-off in the future is in use. The first took gene took 10 years and 3 billion dollars to decode, now we can do it for well under 1,000 in a day). Did you know we can ……. These things and so many more remarkable technologies are here already, they aren’t 30-40 years down the road. I highly encourage you to look into these emerging technologies and to think about how they will impact your future world, and even how you can use these emerging technologies to create new inventions and possibilities for the world.
