Rx disruption: technology trends in medicine and health care.
Doctors and patients alike are navigating wave after wave of new technologies that promise to alter how we manage our health. Digital technologies also offer opportunities for doctors and patients to become better strategic partners in medical decisions.Being a medical futurist means I work on bringing disruptive technologies to medicine and health care, assisting medical professionals and students in using these in an efficient and secure way, and educating patients about how to become equal partners with their caregivers, in both face-to-face and virtual relationships.
As online platforms and digital technologies rapidly emerge and change, we need partnerships between patients and health-care professionals, as well as a guide to prepare for the future technologies that will have to be implemented quickly in everyday practices and in the health management of patients. Based on what we see in other industries, this is going to be an exploding series of changes. While redesigning health care takes a lot of time and effort, the best we can do is to prepare all stakeholders for what is coming next.
The following overview of the major trends in health care offers guidance for preparing individuals, organizations, and medical practitioners for the health-care landscape ahead. This guide will be continuously updated, so reader feedback is welcome.
The white paper was originally published on Medicalfuturist.com.
The Guide to the Future of Medicine Infographic
The basic idea of this visual representation was to add three perspectives to one infographic featuring the main trends that shape the future of medicine:
1. Which stage of the delivery of health care and the practice of medicine is affected by that (Prepare and Prevent, Data Input and Diagnostics, Therapy and Follow-Up, and Outcomes and Consequences).
2. Whether the trend affects patients or health-care professionals.
3. The practicability of the trend (already available, green boxes; in progress, orange boxes; and still needs time, red boxes).
The infographic represents the way I see the development of key trends and innovations in the process of delivering health care. Some elements could certainly be added to other parts, as well, although I chose the points with the most potential.
Description of the Trends
1. PREPARE AND PREVENT
Already Available
Curated Online Information
In the near future, whether it is correct and reliable medical information, dynamic resources, or medical records online, everything will simply be available to everyone. This would clearly be the most important development in the history of medicine. As people have to deal with false or unreliable information and resources, curation by medical professionals and expert patients is crucial. Examples include Webicina.com.
Digital Literacy in Medical Education
The only way to prepare healthcare professionals for the digital technologies coming to medicine is to include digital literacy in the official medical curriculum. The Social MEDia Course (thecourse.webicina.com) at Semmelweis University in Budapest, Hungary, has been teaching medical students about the use of social media and mobile applications. Medical students can access the materials in a game-based e-learning platform and answer questions about the topics covered in the lectures on a Facebook page for bonus points. A new course, Disruptive Technologies in Medicine, aims at introducing students to technologies ranging from genomics to telemedicine that they will be using in practice. Such courses should be available in every medical school worldwide.
Virtual Dissection
Medical students will study anatomy on virtual dissection tables and not on human cadavers. What we studied in small textbooks will be transformed into virtual 3-D solutions and models using augmented reality. We can observe, change, and create anatomical models as fast as we want, as well as analyze structures in every detail. Examples include Anatomage, ImageVis3-D, and 4D Anatomy.
In Progress
Microchips Modeling Clinical Trials
Switching from long and extremely expensive clinical trials to tiny microchips that can be used as models of human organs or whole physiological systems provides clear advantages. Drugs or components could be tested on these without limitations, making clinical trials faster and even more accurate (in each case, the conditions and circumstances would be the same). Microchips with living cells that model how a lung works are already available. The Organs-on-Chips technology, such as that at the Wyss Institute at Harvard, has been developed for years and now provides a range of chips modeling organs. More-complicated microchips that can mimic the whole human body are needed, and this ultimate solution could arrive soon.
DIY Biotechnology
The methods and materials of biotechnology have increasingly become more available to anyone interested in them. Expensive laboratory equipment is no longer needed as much for performing biological experiments; materials for experiments can be ordered on demand, and the data or information required are much more accessible than before. For example, iGem events (International Genetically Engineered Machine competition) made it absolutely clear that opportunities to use biotechnology for different purposes are almost limitless. Biotechnology, especially among do-it-yourselfers, is the new IT industry. The new generation of scientists represented by Jack Andraka--who, as a high-school sophomore, invented an inexpensive cancer-detecting test--leverages the power of already available resources and materials in order to come up with real innovations.
Still Needs Time
Full Physiological Simulation
What if it were possible to examine the human body with all its physiological functions without experimenting with people? One application being developed in this area is the Virtual Physiological Human, a framework enabling collaborative investigation of the human body. Medical students would be able to study the human body in detail like never before, understanding the core concepts of how our body works and the pathology of diseases. Another example, HumMod, consists of 5,000 variables describing cardiovascular and metabolic physiology, among others.
Gamification-Based Wellness
Gamification seems to be the key in persuading people to live a healthy lifestyle or stick to the therapy they have been prescribed to; 63% of American adults agree that making everyday activities more like a game would make them more fun and rewarding. Wearable gadgets, online services, or mobile health solutions can lead to better results if gamification with the right design is included. Improving our health or making our job more efficient can and should be fun. Examples include Shine, FitBit, and Lumosity.
2. DATA INPUT AND DIAGNOSTICS
Already Available
Digestible Sensors
It is possible to swallow digital devices and tiny sensors for gathering and storing data and transmitting body temperature and heart and respiration rates to an external device. In diseases related to our gastrointestinal system, it could give instant diagnosis by combining the results of lab markers and colonoscopy (if the device swallowed includes a video camera). Examples include Proteus Digital Health and Equivital.
Personalized Genomics
Since the completion of the Human Genome Project, we have been envisioning the era of personalized medicine in which everyone gets customized therapy with customized dosages. The truth is that there are only about 100 cases when personal genomics can be applied with evidence in the background 11 years after the Human Genome Project was declared complete, according to the Personalized Medicine Coalition. As we move along this path, we will have more and more opportunities for using DNA analysis at the patient's bedside, which should be a must-have before actually prescribing drugs. It means patients would get drugs and dosages exactly customized to their own genomic backgrounds. Fast and accurate DNA sequencing is needed to reach this goal.
Smartwatch
Smartphones have not been able to replace pagers due to practical reasons, but an easily accessible wearable device might have the potential to make this step. A smartwatch could be used for consultations, making calls, sending messages, scheduling visits, paging, or even displaying fresh lab test results.
Real-Time Diagnostics in the Operating Room
The intelligent surgical knife, iKnife, uses an electrical current to heat tissue to make incisions with minimal blood loss. The vaporized smoke is analyzed by a mass spectrometer to detect the chemicals in the biological sample. The device thus can identify whether tissue is malignant during an operation in real-time without need to send a biopsy to the pathology lab. A clinic in Germany started experimenting with an application using augmented reality on tablets in the OR. During operations, surgeons can see through anatomical structures, such as blood vessels in the liver. They can therefore perform more-precise excisions based on the patient's radiology images.
In Progress
Embedded Sensors
As an addition to digestible and wearable sensors, tooth-embedded sensors can recognize jaw movements, coughing, speaking, and even smoking. Imagine the same wireless technology used in organs providing real-time data from an artificial pancreas or constantly recording EEG (electroencephalography).
Medical Tricorder
The concept of the medical tricorder that can diagnose diseases quickly, as seen in the TV series Star Trek, has tantalized us for decades; now there is a chance to make it real. The Qualcomm Tricorder X Prize challenge may lead to the development of a portable, wireless device that can monitor and diagnose several diseases and give individuals more choices in their own health. An example, Scanadu, can measure body temperature, heart rate, ECG (electrocardiogram), pulse oximetry, and other basic parameters simply by placing it on the forehead. What matters is that patients should be able to access bioparameters about themselves and get the right devices/data to control their own health.
Semantic Health Records
The only way to constantly improve a system is to generate and analyze data about it. The basic requirement of improving health care is to give everyone access to their own medical/health data, which is stored in semantic databases. This would facilitate public-health research, as well. Semantic datasets could generate alerts about upcoming medical issues and potential complications. Ongoing efforts include ElationEMR, CureMD, drchrono, Medopad, and Practice Fusion.
Augmented Reality
Augmented reality is a live view of a real-world environment that is supplemented with computer-generated input, such as sound, video, graphics, or GPS data. Getting information from the Internet by wearing a Google Glass or digital contact lenses would be a huge addition to the practice of medicine. Operations have already been streamed live from the surgeon's perspective, but these streams could also display the patient's electronic medical records in real time or organize live consultations with colleagues. IBM's Watson would look for potential errors in the recorded operations. Augmented reality could also be used in emergency situations, such as summoning an ambulance to your GPS location while you're performing CPR. Google Glass can be controlled through voice and hand gestures, while digital contact lenses will be controlled with brain waves. The potential to leverage the power of augmented reality is huge, but medical professionals should deal with patient privacy and put evidence behind using it in practice.
Robotic Nurse Assistant
With the growing number of elderly patients, introducing robot assistants to nursing homes and hospitals is inevitable. It could be a fair solution for moving patients and performing basic medical procedures, such as drawing blood. A prototype made by a U.S. company combines robotics and image-analysis technology to find a good vein on the patient's arm and draw blood in a safe way. In the next step, it might also perform analysis on the blood, detecting biomarkers or obtaining genetic data.
Wearable E-Skins
Measuring easily quantifiable data is the key to better health. Therefore, the future belongs to digestible, embedded, and wearable sensors that work like a thin e-skin. These sensors will measure all important health parameters and vital signs-- e.g., temperature, blood biomarkers, and even neurological symptoms--24 hours a day. They'll transmit data to the cloud and send alerts to medical systems in real time when, for example, a stroke is happening. It will call the ambulance itself and send all the related data immediately. Examples include hydration sensors for athletes and intelligent textiles that change color to indicate diseases.
Still Needs Time
Holographic Data Input
While better data input solutions arise, hardware will probably not even be needed to add data. Screens and keyboards will be projected on surfaces, such as a wall or table, making data accessible everywhere in the clinical settings. Holographic keyboards will make us forget about smartphones and tablets, while the data will be stored only in the cloud.
Home Diagnostics
Patients have been able to measure their own blood pressure for many years. Today, they can measure ECG, and tomorrow they will sequence genomes at home. Plenty of laboratory methods and procedures will be available at home, which could also mean the detection of diseases at an early stage, making intervention simpler and more effective. Patients will bring the data to the doctor on any device they use; therefore, a new role of digital health data analyst will appear soon. Examples include Nanobiosym, the Google Smart contact lens project, and AliveCor.
3. THERAPY AND FOLLOW-UP
Already Available
Robotic Interventions
The number of studies examining the use of robots in the operating room has been increasing rapidly in the past couple of years. Robots can be used in remote surgery, surgical rehearsal in pre-operative planning, intra-operative navigation, and simulation and training, among other applications. It is clear that robotic interventions can add a lot to the success of operations and different procedures. One of the best examples is still the Da Vinci system, but other robots in the fields of emergency response and radiosurgery are also available. We might soon see operating rooms with no people inside except the patient. Surgical instruments will be so precise in a few years' time that it will be impossible to control them manually; therefore, robotic or mechatronic tools will be needed in order to reach the required accuracy.
Interdisciplinary Therapies
Without a doubt, the future belongs to interdisciplinary innovations. Examples include neurosurgeons at the University of California, San Diego School of Medicine, and UC San Diego Moores Cancer Center using magnetic resonance imaging (MRI) guidance for delivering gene therapy as a potential treatment for brain tumors. This way, the rest of the brain remains unaffected, so the risk of the procedure is minimized. Medical specialists have to start looking at the same medical problem from different angles. As medical education focuses on developing specialized knowledge, social media and other digital technologies can help us get glimpses into other areas for new collaborations. Combining cognitive computing with the knowledge of physicians from different specialties could result in the best outcomes for patients.
Telemedicine
In the digital era, the use of IT solutions in medical communication and even in health care is inevitable. In the future, it will include not only giving medical advice through online communication channels, but also sending life through the same channels. For example, DNA sequences would be sent over the Internet to synthesize proteins, viruses, and living cells. We are not far from breaking the barriers to exchanging medical information, drugs, medical equipment, or life itself through biological teleportation and the advances of 3-D printing.
Virtual Trials
In the era of open access and crowdsourced scientific information, we will have to find a solution for conducting clinical trials without experimenting on people. We will gather the same amount of information in the same quality as before, but in a much faster, noninvasive, humane, and reliable way. In order to reach this goal, a revolution is needed in medicine. Every country needs an E-patient Dave, a Jack Andraka, and a Regina Holliday to fulfill these goals.
In Progress
Optogenetics
Optogenetics uses a combination of methods from optics and genetics to control the activity of individual neurons in living tissue. Optogenetics will provide new solutions in therapies. A recent study published in Science reported that scientists were able to create false memories in the hippocampus of mice. This is the first time that fear memory was generated via artificial means. In time, we will understand the placebo effect clearly. And just imagine the outcomes we can reach when false memories of taking drugs can be generated in humans, as well. The ultimate goal is to be able to modulate our senses, repair lost senses, or even perform specific DNA targeting with femtosecond lasers.
Customized Mobile Apps
The number of medical mobile applications has been rising for years. Patients and doctors find it harder and harder to choose the right app for their health management or work. The next step could be customized mobile apps, such as the pApp, which lets doctors create mobile apps for their patients. Functions should include, for example, logging blood pressure or medications chosen from a menu; the patient should be able to download the app right away.
3-D Printed Biomaterials and Drugs
More and more objects can be printed with 3-D printers, and the biotechnology industry is keeping an eye on potential opportunities. Printing medical devices in underdeveloped areas, printing living tissues, and printing cells or drugs might not be far from everyday use. This capability will restructure the whole pharmaceutical industry and the world of biotechnology. However, regulation will be a huge challenge, as anyone will be able to print drugs containing patented molecules. Bionic ears and simpler organs will be printed at the patient's bedside; printing transplantable human organs could eradicate waiting lists. Current technological issues such as the lack of available models and blueprints will be solved through crowdsourced and open-access databases from communities of designers.
Meaningful Use of Social Media
Medical communication is something that affects all patients and medical professionals worldwide, no exceptions. This is one reason why social media has the potential to become a huge "digital brain." It will become possible to transmit, share, crowdsource, and store pieces of medical information, either for e-patients or for medical professionals, if such social platforms are used properly. Digital medical communication is a potentially powerful tool, but balance is needed: E-patients cannot and should not break from medical professionals entirely. This is why we have to train doctors to be ready for the digital era. Examples include online communities like Smart Patients, Patientslikeme, and Sermo (for physicians).
Evidence-Based Mobile Health
While the number of medical mobile applications has been rising, persuading users to keep on using the apps is a real challenge. The question is not whether such applications could be used in the process of practicing medicine or delivering health care, but rather which ones and to what extent they can be useful. Therefore, evidence-based background is needed for implementing mobile apps in clinical settings. The FDA has issued guidance that might facilitate the process.
Artificial Organs
An artificial organ is a device or biomaterial that is implanted into the body to replace a natural organ or its function. Three-dimensional printing is not the only solution for creating body parts and artificial organs, as such organs can also be grown in labs. Surgeons have been able to implant artificial skin, cartilage, synthetic windpipes, and blood vessels. In the near future, we will be able not only to replace the functionality of our organs with biomaterials and synthetic devices, but also to grow organs that can replace a nonfunctioning natural organ in its full physiological capacity. Artificial organs could also be used for other tasks, such as helping the body conserve water (as envisioned in Takram's Shenu hydrolemic system).
Adherence Control
Adherence and compliance represent crucial issues in improving patients' health and decreasing the cost of delivering health care. Several start-ups have targeted this issue with different solutions, such as the pill bottle that glows blue when a medication should be taken and red when a dose is missed to alert family members about it. In another example, tiny digestible sensors can be placed in pills and transmit pill digestion data to physicians and family members. In the future, it is going to be extremely difficult not to comply fully with the prescribed therapy. Moreover, compliance with medication should be as simple and comfortable for patients as possible.
Still Needs Time
Multifunctional Radiology
Radiology will probably be a combination of imaging techniques and personalized diagnostics, with real-time interventions. One multifunctional machine will be able to detect plenty of medical problems, biomarkers, and symptoms at once. With one quick checkup, a machine like that used in the film Elysium would tell patients what percentage of their cells are cancerous. Further examples could include resting-state and task-functional MRI for examining cognitive patterns and large-scale initiatives involving neuroimaging and the brain macro-connectome. The recently launched Human Brain Project could become even bigger than the Human Genome Project.
Remote Touch
While the human touch is the key in the practice of medicine, we will eventually have to use remote touch due to the shortage of doctors and increasing number of patients. The force-feedback technique used by the video-game industry has the potential to be used in medicine, as well. It has been demonstrated that biopsy sampling can be simulated in a 3-D environment using a force-feedback-controlled device. Surgeons could be trained with the technique to master a procedure before operating on real patients. It could also assist medical students in improving in palpatory diagnosis.
Humanoid Robots
Robots built to resemble the shape of the human body might soon play a role in our lives. Due to the shortage of caregivers worldwide, humanoid robots could provide basic care or keep company for patients. Developments from DARPA such as Atlas, the 188 cm-tall humanoid robot, or the robotic AlphaDog, show the rapid advances and amazing potential in this area. In a few years' time, we will be able to print these robots in 3-D based on specific blueprints. Whether serving as companions for sick children, teaching kids with autism, or providing personal assistance for elderly patients, humanoid robots have the potential to transform the face of health care.
Augmenting Human Capabilities
Medical research is meant to discover and develop methods to replace nonfunctioning organs and capabilities or to restore certain functions in the human body. But with the rapid advances of research, instead of only replacing functions, it would be possible to add to our current capabilities and create "superpowers." We could decide what to dream about, how to metabolize drugs, or how to digest different types of food. We could choose to increase brain function or improve our strength through powered exoskeletons.
Nanorobots in Blood
Medicine today is based on interventions after the diagnosis is given. What if nanorobots in the bloodstream could intervene even before the disease appears? Nanorobots called respirocytes could be used to keep a patient's tissues safely oxygenated for up to four hours after a heart attack; they could serve as white blood cells, remove platelets, or repair damaged cells. The opportunities are almost limitless. Moving it to the next level, modules that self-assemble inside the stomach could perform more-sophisticated diagnosis and treatment. The number and range of noninvasive operations could increase with such self-assembling robots.
4. OUTCOMES AND CONSEQUENCES
Already Available
Artificial Intelligence in Medical Decision Support
The knowledge of even the most acclaimed professors cannot compete with cognitive computers. As the amount of information is exponentially growing, the use of such computing solutions in assisting medical decision making is imminent. While a physician can keep a few papers in mind--maybe a few dozen papers with digital solutions--IBM's supercomputer Watson can process more than 200 million pages in seconds. This is why Watson has been tested in oncology centers to see whether it could be used in the decision-making process of doctors regarding cancer treatments. Watson does not answer medical questions, but, based on the input data, it comes up with the most relevant and potential outcomes. The doctor has the final call; artificially intelligent support can only facilitate the work of physicians, not replace them.
Still Needs Time
Virtual-Reality Applications
New disease categories as a result of the excessive use of virtual reality (VR) in gaming and other industries will appear. Examples include virtual post-traumatic stress disorder, where gamers who participate in large virtual battles such as Call of Duty experience symptoms similar to soldiers who fought in real wars. But VR could also be used in psychotherapy or to prepare patients for an upcoming operation.
Redesigned Hospital Experience
Improving diagnostics and treatments is not enough anymore. We need to massively improve the health-care experience, whether the process takes place in a hospital or at home. The delivery of health care must acquire features regarding the customer experience from other industries. Clear, smart design ensuring comfort and privacy is needed. Patients should have access to transparent decision trees after getting a diagnosis, helping them to make informed decisions with their partner doctors. Early examples include the National Health Service in the UK, Stanford Hospital, and Ottawa Hospital. Companies such as Google's recently launched Calico, focusing on health and well-being, will make attempts at reaching these goals.
Recreational Cyborgs
Cyborgs will be everywhere around us, including a new generation of hipsters who implant devices and technologies in their bodies just to look better or have new functionalities. Advances in medical technology will not just repair physical disadvantages such as impaired eyesight, but will also create superhuman powers--the eyesight of an eagle, the hearing of a bat. Patients wearing implanted defibrillators or pacemakers can already be classified as cyborgs, but there will also be more cases of patients without medical problems asking for certain digital implants to augment their capabilities, creating biological "wealth" gaps.
Virtual-Digital Brains
In his book You Tomorrow, futurologist Ian Pearson writes that we would one day be able to create digital selves based on neurological information. This means that we could upload our minds to a computer and live on in a digital form. Since Google hired Ray Kurzweil, author of The Singularity Is Near, to create the ultimate Al-controlled brain, this opportunity should not be so far away. We might have been searching for the clues of living forever in the wrong places so far.
How to Prepare for the Future of Medicine
1. Whether you are a patient or a medical professional, follow the main trends and try to be up-to-date, using digital technologies ranging from message boards to mobile apps.
2. Constantly look for solutions to improve your practice as a medical professional or your health as a patient.
3. Embrace digital technologies in a comfortable way and use techniques that make your life easier and your work more efficient.
4. Look for examples and trends outside of medicine, as well.
5. Understand that evidence backed by massive data is needed for any uses of digital solutions in medicine.
6. Beware of hype in medicine. Strategically analyze trends and extrapolate to the future in a meaningful way.
7. Influence decision makers if your idea can make a change. Be bold and use social media channels to spread the word.
8. Remember that, no matter how important a role digital will play in our lives, the human touch is and will always be the key in the doctor-patient relationship.
For Further Reading
* Exploring Personal Genomics by Joel T. Dudley and Konrad J. Karczewski (Oxford University Press, 2013).
* Physics of the Future by Michio Kaku (Doubleday, 2011).
* The Singularity Is Near by Ray Kurzweil (Viking, 2005).
* Think Like a Futurist by Cecily Sommers (Jossey-Bass, 2012).
* You Tomorrow by Ian Pearson (CreateSpace Independent Publishing Platform; 2nd edition, 2013).
By the author:
* Scienceroll.com.
* Social Media in Clinical Practice by Bertalan Mesko (Springer, 2013).
* The Medical Futurist Newsletter, medicalfuturist.com/newsletter/.
Bertalan Mesko, MD, PhD, is a medical futurist. He is the managing director of Webicina.com, a service that curates medical and health-related social media resources for patients and medical professionals. He is the author of the multiple award-winning medical blog Scienceroll.com, The Medical Futurist newsletter, and the book Social Media in Clinical Practice (Springer, 2013). Web site medicalfuturist.com/. E-mail berci@ medicalfuturist.com.
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| Author: | Mesko, Bertalan |
|---|---|
| Publication: | The Futurist |
| Geographic Code: | 1USA |
| Date: | May 1, 2014 |
| Words: | 4594 |
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