The Future of Healthcare
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The document discusses the future of healthcare in terms of knowledge, agents, and networks. It explores how knowledge is collectively formed and how physicians represent medical practice. It also examines how human and AI collaboration can enhance healthcare and how trust and data sharing across networks are important. The document suggests healthcare will evolve through continuous improvements to systems and the integration of new technologies.
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The Future of Healthcare
- 1. The Future of Healthcare On Knowledge, Agents & Networks Felix Ankel & Daniel Cabrera April 25, 2017
- 2. The following are the personal ideas of Felix & Daniel and do not represent the opinions of our employers
- 3. what and what not JD Hancock | flickr | CC BY SA 2.0 | goo.gl/oeEvRR
- 4. BagoGames| flickr| CC BY SA 2.0 | goo.gl/oeEvRR like Freddie Mercury & David Bowie
- 5. ankel | knowledge | what is it?
- 6. ankel | knowledge | what is it?
- 7. โโฆโฆphysicians, who are co-conspirators โฆ..in the misrepresentation of medical practice as a science governed by natural laws and rational principlesโ ankel | knowledge | what is it?
- 8. cabrera | knowledge | collective cognification
- 9. ankel | agents | mirrors
- 10. ankel | agents | mirrors
- 11. ankel | agents | mirrors
- 12. Emiliano Felicissimo| changes made| CC BY SA 2.0 | goo.gl/oeEvRR cabrera | agents| humans + AI collaboration
- 13. ankel | networks | trust
- 14. ankel | agents | mirrors
- 15. Rain Love AMR | flickr | CC BY 2.0 | goo.gl/Pjdtos cabrera | networks| data and centrality
- 16. JD Hancock | flickr | CC BY SA 2.0 | goo.gl/oeEvRR artificial intelligence | information | networks continuous care | new systems
- 17. The real problem of humanity is the following: we have paleolithic emotions; medieval institutions; and god-like technology - EO Wilson
- 18. The future [of healthcare] is already here but not evenly distributed yet - William Gibson
- 19. Knowledge Agents & Networks Felix Ankel Daniel Cabrera on
Editor's Notes
- COVER
- We will discuss how things may change in the short/mid term future We are going to focus in the knowledge and its management Through a lens of triple aim and โteamingโ behavior We are not discussing bioengineering and CRISPR related issues These are ideas adapted from Harari, Kelly, Bostrom, Kurzweil, Asimov, Hidalgo, etc Introduction to the dynamic, the lecture is like a duet (Freddie Mercury and David Bowie) โPrediction is very difficult, especially if it's about the futureโ - Niels Bohr โThe problem with the present is that we have Paleolithic emotions, medieval institutions and god-like technologyโ - EO Wilson
- The dynamic of the talk. It is like a duet. It is like Freddy Mercury and David Bowie.
- SLIDE 5 | ANKEL KNOWLEDGE1 What is the double helix in the middle? Is this data? Is this information? Is this knowledge? Is this wisdom?? Is this organic? Is this inorganic? How about the nucleotides? How about carbon, nitrogen, oxygen, phosphorous? Today I want to provoke you a little in having a discussion about data, about information, about knowledge, about wisdom, about intelligence, about competence, about organic, and inorganic, about the head, the heart, the skeleton, and the skin, about where I think we are and where I think we are going in health care What is the definition of knowledge? What is the definition of intelligence? What is the definition of competence? Before there were dot.com and real estate bubbles, there was an artificial (AI) bubble in the 1908s, with the rise and fall of such companies as Symbolics. Dreyfus and Dreyfus, brothers from UC-Berkeley- one an existential philosopher, the other industrial engineer-predicted the AI bubble. They suggested that humans has innate decision-making skills in the domains of autonomy, managing context, and managing complexity that could not been replicated by computers. So people have lived in an AI winter at least from the 1970s to the 1990s ########################################### Concept: Creation and sharing of knowledge. How to manage this change. From data to knowledge: https://en.wikipedia.org/wiki/DIKW_pyramid Reflective practice https://icenetblog.royalcollege.ca/2016/12/13/170936/ Prayer, psychoanalysis, journaling Why information grows: https://www.ft.com/content/36cad2c0-1038-11e5-ad5a-00144feabdc0 Shared decision making and http://www.ipfcc.org/ Wealth is on attention (what is important and what is not) Creation of new things remixing old Characteristics of knowledge: immediate, personal, explained, accessible, discoverable Examples: Watson recommend chemotherapy (http://www.livescience.com/58124-ibm-watson-works-with-cancer-doctors.html) AI winter Dreyfus and dreyfus Paul Bataldan Cbme Watson and ohare Second spring of ai Data to knowledge Reflective practice Shoen Shared decision making How information grows (Hidalgo)
- SLIDE 5 | ANKEL KNOWLEDGE2 One of the most fascinating articles that I have read as a medical educator is this article in Health Affairs by these authors in 2002. Does anything strike you as interesting in the list of authors? For many years knowledge and even intelligence was equated with competence. These authors started us on a journey from from a knowledge based medical education system to a competency based medical education system through the lenses of autonomy, managing complexity, and managing context. Here you can see on the right is a lens I call autonomy (really metacognition)โฆable to think about thinking, able to see context, and able to manage complexity almost in an intuitive manner. Heading back to this knowledge management pyramid. I see moving data to information as pattern recognition, moving information to knowledge as context management, and moving knowledge to wisdom as reflective practice. Part of my learning process these days is spending much for time in context management and reflective practice and looking and relying on other tools for pattern recognition. ########################## Concept: Creation and sharing of knowledge. How to manage this change. From data to knowledge: https://en.wikipedia.org/wiki/DIKW_pyramid Reflective practice https://icenetblog.royalcollege.ca/2016/12/13/170936/ Prayer, psychoanalysis, journaling Why information grows: https://www.ft.com/content/36cad2c0-1038-11e5-ad5a-00144feabdc0 Shared decision making and http://www.ipfcc.org/ Wealth is on attention (what is important and what is not) Creation of new things remixing old Characteristics of knowledge: immediate, personal, explained, accessible, discoverable Examples: Watson recommend chemotherapy (http://www.livescience.com/58124-ibm-watson-works-with-cancer-doctors.html) AI winter Dreyfus and dreyfus Paul Bataldan Cbme Watson and ohare Second spring of ai Data to knowledge Reflective practice Shoen Shared decision making How information grows (Hidalgo)
- SLIDE 5 | ANKEL KNOWLEDGE3 Well, what about the future? I mentioned relying on other tools for pattern recognition so I can put more time into context management and reflective practice. They used to say content is King. I say curation is Queen and there are more heads of state that are Queens these days. There are many curators out there. I tend to use ALiEM as my main curating tool, but also use traumapro and others. I think there will continue to be a lot of energy on the pros and cons of AI. This is an recent article that states that you can rely on the ekg interpretation of a normal ekg in triage and not be interrupted. This is a curator that was annoyed that ekg interpretation of aFib is sometimes incorrect. Watson is continuing to improve and more health systems are using it. And then there are people that are saying that just focusing on the head and on knowledge and intelligence may the wrong focus. Maybe you need to focus on the heart also ########### I view knowledge as the start of moving data from inorganic to organic phase Information is composed of data..the building bricks...information also is patterns of dataโฆ. can see this in our environment Knowledge is the ability of of seeing information through the lens of autonomy, complexity, and context (see competence framework) Wisdom is knowledge through the lens of reflective practice (use dna analogy) What is relationship of knowledge, intelligence, and competence So if we want to move from Lets bring it back to the EDโฆ..want to provide value, value is quality + experience/cost, how does knoweldge help (wears example), shared decision making, Lastly move from knowledge to wisdom Reflective practice Psychoanalysis Prayer Journaling Concept: Creation and sharing of knowledge. How to manage this change. From data to knowledge: https://en.wikipedia.org/wiki/DIKW_pyramid Reflective practice https://icenetblog.royalcollege.ca/2016/12/13/170936/ Prayer, psychoanalysis, journaling Why information grows: https://www.ft.com/content/36cad2c0-1038-11e5-ad5a-00144feabdc0 Shared decision making and http://www.ipfcc.org/ Wealth is on attention (what is important and what is not) Creation of new things remixing old Characteristics of knowledge: immediate, personal, explained, accessible, discoverable Examples: Watson recommend chemotherapy (http://www.livescience.com/58124-ibm-watson-works-with-cancer-doctors.html) AI winter Dreyfus and dreyfus Paul Bataldan Cbme Watson and ohare Second spring of ai Data to knowledge Reflective practice Shoen Shared decision making How information grows (Hidalgo)
- KNOWLEDGE CABRERA Concept: Creation and sharing of knowledge. Addition of AI to all domains. How to manage this change. Cabrera Rapid development of deep learning Rapid development of quantum computing Cognification (adding AI to data and processes) Collective creation and sharing knowledge (SoMe, CC) Filtering and curation (content bubbles, overfeeding) Free Open Access Medical (Information)
- SLIDE 6 | ANKEL AGENTS1 Lets talk about the heart. What is agency, agency is the capacity of individuals to act independently and make their own free choices. What makes people actโฆ.it is E-motion. Knowledge does not get set into motion until emotion fuels it What is the picture of the left? Mirror cells. Mirror cells are interesting, they were found by some Italian researchers in the 80s that were looking at hand and mouth motor movements when monkeys were eating. They were measuring single neuron activity. What they found out was that some neurons would fire when the monkey would see a human eat. Eg you could feel what you were doing when someone else was doing this. There has been a lot of discussion of the role of mirror neurons in the human capacity for empathy If you need knowledge and emotion to have agency, how do you accelerate action. Most human behavior is motivated by autonomy, mastery, and purpose. In other words, how free are you in having choices, how able are you to achieve mastery (eg why people will practice guitar hours on end without pay), and how purpose driven is the action ############################### Concept: How humans interact and work together leading to Eusociality They want to share, privacy paradigms Humans want Eusociality, Humans want feeling of belonging, worry about connection. Robots (and hospitals) want performance, worry about value: https://en.wikipedia.org/wiki/Eusociality https://opinionator.blogs.nytimes.com/2013/02/24/the-riddle-of-the-human-species/?_php=true&_type=blogs&_r=2 Human brain/mind and therefore behavior is based on mirror cells https://www.edge.org/conversation/mirror-neurons-and-imitation-learning-as-the-driving-force-behind-the-great-leap-forward-in-human-evolution Ability to keep attention despite the abundant noise in the system AI: machine learningโฆ#meded http://www.royalcollege.ca/rcsite/events/icre/icre-pre-con-learning-analytics-summit-e Community above personal Harari and human enhancement: 1. Tinkering with organic body, 2. combining organic and inorganic, 3. Complete inorganic with AI. AI making healthcare more accessible and cheaper (imagine a AI ran NHS) Not what they can do better, but what they can do we canโt Example: Crowsourced Medicine https://www.crowdmed.com/ Definition of agent Eusocial Mirror cells Reflective practice Competence based on mood emotions Tribalism
- SLIDE 6 | ANKEL AGENTS2 Who has seen the movie. If it were up to me, I would have every clinician see this film. I have learned more about emotions and microexpressions from this movie that in 20 years read. What are the six core emotions ? Joy/sadness fear/anger disgust/surprise Truly if we are we are agents of health and well being, we need to get in touch with our inner motor neuron and we need to be trained as such, it is something that will separate us from robotsโฆ.maybe ######################################### What is happening these days, people are looking more at emotions and more at microexpressions Concept: How humans interact and work together leading to Eusociality They want to share, privacy paradigms Humans want Eusociality, Humans want feeling of belonging, worry about connection. Robots (and hospitals) want performance, worry about value: https://en.wikipedia.org/wiki/Eusociality https://opinionator.blogs.nytimes.com/2013/02/24/the-riddle-of-the-human-species/?_php=true&_type=blogs&_r=2 Human brain/mind and therefore behavior is based on mirror cells https://www.edge.org/conversation/mirror-neurons-and-imitation-learning-as-the-driving-force-behind-the-great-leap-forward-in-human-evolution Ability to keep attention despite the abundant noise in the system AI: machine learningโฆ#meded http://www.royalcollege.ca/rcsite/events/icre/icre-pre-con-learning-analytics-summit-e Community above personal Harari and human enhancement: 1. Tinkering with organic body, 2. combining organic and inorganic, 3. Complete inorganic with AI. AI making healthcare more accessible and cheaper (imagine a AI ran NHS) Not what they can do better, but what they can do we canโt Example: Crowsourced Medicine https://www.crowdmed.com/ Definition of agent Eusocial Mirror cells Reflective practice Competence based on mood emotions Tribalism
- SLIDE 6 | ANKEL AGENTS3 What do I think will happen in the future I think we will move from L to R From the L brain to the R brain. From facts and information to stories From the L heart to the R heart. From carrots and sticks to autonomy, mastery, and purpose From the L soul to the R soul. From six sigma and lean, to appreciative inquiry and human centered design. Does everyone know what appreciative inquiry is. Think of a time you left the ED and everything was well. Think of hibernating for 5 years and coming back and everything is going well, how would it look. This is more of a synthetic process than an analytic process All of these processes will be done in conjunction with patients in the framework of the triple aim. We are moving from a product dominant-logic to a service dominant logic ################################### So we talked about knowledge, knowledge is fundamental but not sufficient to achieve the triple aim, you need agents The most traditional agent has been the human, the doctor. You have a medical condition, you go to the doctorโฆthe doctor tells you change a behavior, gives you a potion, or cuts something out or puts something in your body. The doctor relies on his or her knowledge, maybe his or her wisdom, and sources of information. More recently it has become a team sport and the doctor relies on his or her team. Humans are unique, the have mirror cells, they can empathize with others (save eusocliality and feeling belonging to networks) Concept: How humans interact and work together leading to Eusociality They want to share, privacy paradigms Humans want Eusociality, Humans want feeling of belonging, worry about connection. Robots (and hospitals) want performance, worry about value: https://en.wikipedia.org/wiki/Eusociality https://opinionator.blogs.nytimes.com/2013/02/24/the-riddle-of-the-human-species/?_php=true&_type=blogs&_r=2 Human brain/mind and therefore behavior is based on mirror cells https://www.edge.org/conversation/mirror-neurons-and-imitation-learning-as-the-driving-force-behind-the-great-leap-forward-in-human-evolution Ability to keep attention despite the abundant noise in the system AI: machine learningโฆ#meded http://www.royalcollege.ca/rcsite/events/icre/icre-pre-con-learning-analytics-summit-e Community above personal Harari and human enhancement: 1. Tinkering with organic body, 2. combining organic and inorganic, 3. Complete inorganic with AI. AI making healthcare more accessible and cheaper (imagine a AI ran NHS) Not what they can do better, but what they can do we canโt Example: Crowsourced Medicine https://www.crowdmed.com/ Definition of agent Eusocial Mirror cells Reflective practice Competence based on mood emotions Tribalism
- AGENTS CABRERA Concept: Current paradigms and new jobs. Coexisting with AI and robots. How technology is going to change humans? How humans will adapt? The future is human+AIs, not humans against AIs Agents organize efficiently in stigmergy We are nothing but insects The only currency between agents is information/data We are organizing around the new religion of dataism The enhanced human will run business The problem will not be access to knowledge but how to manage it The future is for those who can pay complete attention to something The future is for those who can create the best question AI is going to be like electricity, cheap and widely available, part of everything (KK) AI taking over data management will discover things AI making decisions we canโt make well Examples: Pepper the Robot (empathy) and Xenex cleaning robot https://www.ald.softbankrobotics.com/en/cool-robots/pepper https://www.xenex.com/video-demos
- SLIDE 9 | ANKEL NETWORKS1 So we talked about knowledge and agents, now I want to talk about our environment Humans are eusocial which is an advanced level of social organization and cooperation. We are hard wired to hang in tribes groups of around 30 people with a shared purpose What is interesting in health care, is that there are formal and informal tribes. The formal tribe is often based on the org chart and is hierarchical, the informal tribe is often based on networks and is best on common interest. Most real work is done in 3 networks. A trust network, a learning network, and a communication network. How many of you have deliberately cultivated a trust network?? Trust is the lubricant of networks. If you have trust, anything is possible, if you donโt have trust, nothing is possible. Warren Buffet once said. Trust is like the air we breathe, when it is present, nobody notices it, when it is absent, that is all one notices. There is a difference between being factual and trustworthy. Factual is the facts. Trustworthy is the facts presented in the context that the receiver would like to receive them rather than the facts sent from a strategic manner from the sender. A few tips in being trustworthy. Be trusting, be vulnerable. How many of you have a personal learning network and a personal development plan. My recommendation is to write down who you learn most from, identify where you want to go, and identify people you can learn from. Look for week links these are people at the periphery of networks that span multiple networks The third platform is the communication platform. How many of you have a communications platform?? Michael Hyatt wrote a great book about communications platforms and described thee parts. A home base where your information is eg a CV, a blog, a portfolioโฆ.the second is embassies on how people can access your home page many use twitter, email links etcโฆ. The third are outposts or analytics to help you learn who is interacting with your communication platform and what you can learn. That is the skin of learning ############## We are eusocial Here we are going from inorganic to organic Most clinicians work in organizations with former org charts, trained in a heirirachial medical-industrial complex Natural in an information poor evirnment Unatural in an information rich environment Networks prevail in information rich envirnments Curate, CoP, creation of value In health care, three networks pln, 2. trust network, 3. communication network. What is your pln??, what is your plan to build your trust netwrk and communication network Mastermindgroup, incubators Learning orgโฆ.head, heart, skeleton, skinโฆwhat is your personal learning envirnment Examples of learning envirnments Aliem, SMACC, Icenet Concept: We need to create our own networks based on learning and trust Importance of PLN, communication, and trust networks https://icenetblog.royalcollege.ca/2015/11/24/building-trust-more-oxytocin-less-epinephrine/ https://icenetblog.royalcollege.ca/2016/04/12/building-effective-communication-networks-part-ii-more-nerve-conduction-less-bone-conduction/ https://icenetblog.royalcollege.ca/2016/04/05/building-effective-communication-networks-part-i-home-bases-embassies-and-outposts/ https://icenetblog.royalcollege.ca/2015/10/02/personal-learning-networks-a-hack-to-maintain-competence/ Lack of ownership of objects Sharing data and objects Constant stream of data (like FB) will turn in a stream of objects (Netflix) Links to things are more important than ownership Dyads and density of connections in health care https://icenetblog.royalcollege.ca/2016/08/26/resilient-meded-leaders-using-a-co-leadership-dyad-model-to-increase-the-density-of-connections-part-2/ Immediate, personalized, distributed Structure: head, heart, skeleton and skin. We need to define those in our systems? Example https://www.healthpartners.com/hp/about/ head and heart, also need skeleton (org chart or network) https://www.healthpartners.com/hp/about/leadership/election/index.html or skin https://www.myvoicehealthpartners.com/Portal/default.aspx How Iโm changing a system to be ready for the future https://en.wikipedia.org/wiki/Cynefin_framework Examples: ICENet/ALIEM learning networks Human work in organizations Organizations are edifices Information flow is linear and unidirectional R head and L head R heart and L heart R soul and L soul Trust network Oxytocin Vulnerability Communication network Home base, embassies, outposts Truly a learning org head, heart, skelton, skin Myvoice, st paul police Consumer governed
- SLIDE 10 | Ankel networks2 What will happen in the future. I think learning will happen more systematically. Organizations are going to look beyond the head and the heart and look at the skeleton and the skin to create learning organizations 2.0. This is an article in Jama about childrenโs hospital in Cincinnati and how they are incorporating feedback loops in everything they do. I donโt know if you know Raina Merchant, and ED doc in Philly on looking at the volume of data on Yelp. To the left is what our Health plan is doing to get feedback in the pursuit of the triple aim. I would challenge you to look at your own learning system 2.0. I would tell you that most of my learning is from curating, communities of practice, and creation of value. I learn most through mastermind group and incubators. They are both essentially peer mentoring and differ in size. To the right are all the incubators I am part of, most of my learning is on my Iphone. My communication platform is Linked in and twitter. Linkednin is my homebase where I have my bio, my blogposts, links to my publications (and analytics on who is looking at my profile and what feedback they have). My embassy is twitter where I follow curators, archive links to great articles and conversations. I also get anayltics on my posts and get a sense on what is hot in medical education by the number of impressions I get. My hope is that we have provoked in a conversation about knowledge, what is organic, what is inorganic, what is our role as health care agents in the future and the importance of the environment in our leraning and our opportunity to shape it Thank you ###################### AI is here to stay and be part of everything (Electricity) Information is as important as humans and institutions (Stigmergy) The way we create and share knowledge will different and likely based on networks (Rhizomatics) http://therainforestbook.com/ Healthcare will be more of a commodity in a stream more than a object of episodic access (Netflix) http://www.membershipeconomy.com/ We need to prepare ourselves and our institutions for the new roles and systems coming (AI run healthcare systems with human providers)
- NETWORKS CABRERA Concept: The architecture of everything around us is arranged as networks, we donโt notice but is key to understand the present and future Problem with privacy (and privacy laws) Networks are going to advance very rapidly where they are allowed. China? Impact is based on network centrality (hubs), it is not what you owe, but where in the network you are New paradigms, self-organization from billions of entities connected / self organization The startups are going to face legal issues New systems based on new ideas, bending legislation Different delivery (3 layers: providers, AI and masters) Stream of healthcare instead of discreet encounters (Netflix vs. blockbuster) https://www.forbes.com/sites/miguelhelft/2017/01/17/meet-forward-an-ex-googlers-plan-to-reinvent-healthcare/#2c2d8380325b
- Key points AI is here to stay and be part of everything (Electricity) The way we create and share knowledge will different and likely based on networks (Rhizomatics) http://therainforestbook.com/ Healthcare will be more of a commodity in a stream more than a object of episodic access (Netflix) http://www.membershipeconomy.com/ We need to prepare ourselves and our institutions for the new roles and systems coming (AI run healthcare systems with human providers) AI will become part of everything we do Information is as/more important than people and infrastructure Healthcare will be based on a network architecture Transition from episodic care to continuous/streaming care We need to prepare for new roles and new systems
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