Ebook: Future of Health Technology

“What Renata Bushko has done over last five years leading the effort to define the future of health technology resulted in many exquisite chapters in this book. “Future of Health Technology” will lend itself to those who want to know now what the future looks like. Understanding that vision of the future is a necessary step in applying health technology to improving healthcare quality in the future. This book sets the direction for the next century.”

Michael Fitzmaurice, Ph.D., Senior Science Advisor for Information Technology Immediate Office of the Director, Agency for Healthcare Research and Quality, US Department of Health and Human Services

Health technology becomes the center of healthcare systems' strategic planning process. Developing a clear vision of the future of health technology and smart investment in technology are the critical success factors. Healthcare leaders need to develop a vision of future health technology to lead effectively in the new century. The social and economic issues surrounding health care will be inextricably linked to the technological aspects of medicine in the next century. Given rapid progress in nanomedicine, the pressure towards detailed outcomes analysis, growing use of Internet, robotic surgery, genetic therapy, telemedicine, on-line consumer education, and bioinformatics health technology becomes the key to intelligent health care. To embrace technology is the only way health systems can assimilate with the technologically advanced society. On-going massive medical data collection, instantaneous analysis, affective computing with emotional intelligence, and nanosurgery will be possible soon. We are entering the biomechatronics and nanobiomechatronics era.

Last century took us from the first electric switch back in 1880s to the first nanomotor’s switch in the year 2000; from 30 ton computer to polymer transistors on a plastic that one can print at home; from electric light to electronic paper, windows, mirrors and wallpaper. In the next century most current diseases will be history and medicine will be focused on maximizing joy and pleasures of long lives of humans augmented with biomechatronics. Most healthcare cost will be shifted from end-of-life to prenatal care. Since everybody will be augmented with biomechatronics, the word “disabled” will not exist anymore — we will all have the same chance to be truly human.

The “Future of Health Technology” book provides a comprehensive vision of the future of health technology by looking at the ways to advance (1) medical technologies, (2) health information infrastructure, and (3) intellectual leadership. It also explores new technology creation and adoption processes including the impact of rapidly evolving technologies. People discover and respond to the future as much as they plan it. Health systems and societies with the clear vision of future health technology will have a better chance of reducing human suffering. This book will make you look technology straight into its glittering eyes and you will see how many tears it can eliminate from the Earth if we all join in the quest for a better tomorrow for us, our children and the generations to follow.

Renata G. Bushko, Editor, Future of Health Technology book, Founder, Future of Health Technology Institute, Hopkinton, MA, US

Future progress in healthcare and medicine depends on today's investment in research, development, and education. We cannot leave such urgent issues to determine themselves, but rather must actively collaborate to ensure a stable healthcare system. This chapter describes efforts made by leading experts in industry, government, and academia to better ascertain future healthcare management. Such collaboration has occurred during a series of Future Healthcare Technology Summits [1] helping in planning investments in health technology. Deliberating and reviewing plans before taking action will accelerate progress as it will (1) save costs, (2) encourage compliance, (3) improve clinical outcomes, and (4) ensure greater patient satisfaction [2]. What we must resolve is: How can we invest a couple billion dollars to save hundreds of billions and, most importantly, increase human health in the future. A new branch of science, Biomechatronics, with millions of Intelligent Caring Creatures– is the answer.

Attempts to predict the future are typically off the mark. Beyond the challenges of forecasting the stock market or the weather, dramatic instances of notoriously inaccurate prognostications have been those by the US patent office in the late 1800s about the future of inventions, by Thomas Watson in the 1930s about the market for large computers, and by Bill Gates in the early 1990s about the significance of the Internet. When one seeks to make predictions about health care, one finds that, beyond the usual uncertainties regarding the future, additional impediments to forecasting are the discontinuities introduced by advances in biomedical science and technology, the impact of information technology, and the reorganizations and realignments attending various approaches to health care delivery and finance. Changes in all three contributing areas themselves can be measured in “PSPYs”, or paradigm shifts per year.

Despite these risks in forecasting, I believe that certain trends are sufficiently clear that I am willing to venture a few predictions. Further, the predictions I wish to make suggest a goal for the future that can be achieved, if we can align the prevailing political, financial, biomedical, and technical forces toward that end. Thus, in a sense this is a call to action, to shape the future rather than just let it happen. This chapter seeks to lay out the direction we are heading in knowledge management and decision support, and to delineate an information technology framework that appears desirable. I believe the framework to be discussed is of importance to the health care-related knowledge management and decision making activities of the consumer and patient, the health care provider, and health care delivery organizations and insurers. The approach is also relevant to the other dimensions of academic health care institution activities, notably the conduct of research and the processes of education and learning.

Nanotechnology is engineering and manufacturing at the molecular scale, and the application of nanotechnology to medicine is called nanomedicine. Nanomedicine subsumes three mutually overlapping and progressively more powerful molecular technologies. First, nanoscale-structured materials and devices that can be fabricated today hold great promise for advanced diagnostics and biosensors, targeted drug delivery and smart drugs, and immunoisolation therapies. Second, biotechnology offers the benefits of molecular medicine via genomics, proteomics, and artificial engineered microbes. Third, in the longer term, molecular machine systems and medical nanorobots will allow instant pathogen diagnosis and extermination, chromosome replacement and individual cell surgery in vivo, and the efficient augmentation and improvement of natural physiological function. Current research is exploring the fabrication of designed nanostructures, nanoactuators and nanomotors, microscopic energy sources, and nanocomputers at the molecular scale, along with the means to assemble them into larger systems, economically and in great numbers.

This paper describes some of the implant experimentation presently underway. The basic approach taken is introduced and general techniques are explained. Achievements already attained are summarized and short term plans are expanded. Potential results, as they could impact on healthcare and related issues, are thrown into the arena. The author speculates ‘a little’ on what might be achieved in the future with implant technology.

For a long time people have kept emotions out of the deliberate tools of medicine and science; scientists, physicians, and patients have often felt and sometimes expressed emotion, but no tools could sense, measure, and respond to their affective information. A series of recent studies indicates that emotions, particularly stress, anger, and depression, are important factors with serious and significant implications for health. This paper highlights research at the MIT Media Lab aimed at giving computers the ability to comfortably sense, recognize, and respond to certain aspects of human emotion, especially affective states such as frustration, confusion, interest, stress, anger, and joy. Examples of recently developed systems are shown, including computer systems that are wearable and computers that respond to people with a kind of active listening, empathy, and sympathy. Results are reported for computer recognition of emotion, for teaching affective skills to autistics, and for having computers help users manage emotions such as frustration.

The practice of medicine is inherently dependent upon health technology. Clinicians use a wide variety of technologies in diagnosing, treating, and assessing the care of their patients [1]. In this book, The Future of Health Technology, many different aspects of health technology are discussed in detail. Considering this breadth of coverage, it is challenging to ascertain what remains to be discussed in this chapter on “the future of medical computing”. Given this considerable coverage, this chapter will open with a brief vision of the future of medical computing from three perspectives — the Patient, the Ambulatory Provider, and the Hospitalist. Discussion follows on the current and future driving forces for change in healthcare technology, and an overview of the unresolved issues that must be addressed. Necessarily, this chapter will not provide more than an overview of these topics and issues. Rather, it is the author’s intent to present several visions of the future of medical computing and outline the issues, which must be overcome to achieve the vision.

An important trend for the future of health technology will be the increasing use of intelligent agent software for medical applications. As the complexity of situations faced by both patients and health care providers grows, conventional interfaces that rely on users to manually transfer data and manually perform each problem-solving step, won't be able to keep up. This article describes how software agents that incorporate learning, personalization, proactivity, context-sensitivity and collaboration will lead to a new generation of medical applications that will streamline user interfaces and enable more sophisticated communication and problemsolving.

This chapter focuses on Speech and Language Technologies, Intelligent Content Management and Intelligent Assistants. It describes impact of these technologies on healthcare assuming a 10-year scope.

Consumers, patients, and their families; health care providers and managers; public health professionals and policy makers need integrated multi-function health information structures that allow them to locate and apply information when and where they need it to make better decisions about health. The National Committee on Vital and Health Statistics (NCVHS), which advises the Secretary of Health and Human Services (HHS) on health information policy, is promoting a comprehensive vision of the National Health Information Infrastructure (NHII). The NHII is defined as the set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health. It is not a unitary database. The broad goal of the NHII is to deliver information to consumers, patients, professionals, and other health decision-makers when and where they need it. The NCVHS’ Interim Report presented three overlapping “dimensions” of the NHII: the personal health dimension, the health care provider dimension, and the community health dimension, to highlight the functions and value of information linkages from various perspectives. The content of an NHII includes clinical, population, and personal data, practice guidelines, biomedical, health services, and other research findings; and consumer health information. This data is, and will likely remain, stored in many locations. To succeed, such an effort will require coordinated, collaborative action. The NCVHS' final report to the HHS Secretary will include recommendations for Federal leadership and for other relevant stakeholders, including public health agencies; health care providers, plans and purchasers; the IT industry; standards development organizations; and consumer groups.

Despite a decade of tremendous advances in telemedicine, it still has potential far beyond current reality. New technologies are making the use of telemedicine ever more compelling and cost and payment barriers are being tackled so fewer barriers will impede the broad adoption of a now-proven cost-saving delivery of a variety of health care services. Adoption of telemedicine will accelerate with the aging of the Baby Boomer generation and globalization forces will broaden adoption and drive cost down.

This paper describes an initiative begun by the Advanced Technology Program in 1994 referred to as the Information Infrastructure for Healthcare (IIH) focused program. The IIH focus program began with an initial exchange of ideas among members of the private and public sectors (industry's submission of “white papers”; workshops conducted by the ATP; meetings held between individuals from both groups) to identify those technologies necessary for the development of a national information infrastructure in healthcare. A discussion of the development of the focus program through a “white paper” process notes differences that existed between what the ATP had hoped to gain through this method and how the private sector responded. A statistical description of the participants as well as a brief discussion of the ATP review and selection process is included.

The scientific and the medical communities are among the first asked both to advance highly specialized knowledge and to make it available to a wider community of users, accessing specialized knowledge and searching for single pieces of information for a whole variety of purposes that require diverse information needs and demands. Health advisors may want to update progress in research in a certain field of medicine, to ask experts the right kinds of questions and, even more fundamentally, to be able to describe those health problems they may encounter in their patients’ community with words and expressions that can be both understandable and accurate.

Researchers, physicians and nurses all face the need to share information that comes out of stabilized, or established, research, meaning research that has been accurately tested as opposed to new and untested assumptions, and to thus establish a common code. A common code may be used by experts in the field to communicate, exchange and compare results and to translate some of the results into common sensebased explanations that can be made widely available. In order to circulate new discoveries and highly specialized knowledge in medicine and to disseminate it to a larger community, accurate planning of consistent metaphors and analogies are of crucial help.

Accurate metaphors and analogies come as a result of a skilled art and science; no metaphor or analogy can represent a specific topic within a highly specialized knowledge domain without having first undergone major processes of redefinition. This is precisely what will be explored in this chapter, the added value of both powerful and reliable conceptual tools in the medical field, such as metaphors and analogies, and a commonly shared code to make qualitative reasoning about medical information possible. To improve progress in research and medical care, everyone needs to establish a common language to work with and from. In terms of medical advice documentation, the use of a visual system, CTML, would be instrumental in providing and documenting information. This system can be understood by and thus connect researchers, health care professionals, and patients.

We can surely lean well towards the optimistic in envisioning health care. In the world 10-25 years ahead of us. This optimism is based on rapid developments in genomics, the essential basis of molecular medicine, and on advances in computer power. At the time of writing this paper, the Human Genome Project was planned to have a working draft by 2000 and indeed completion was announced on June 26th from Washington. This paper describes the situation and vision at that time. Though there has been much subsequent more thought about the influence of genomics on healthcare, the aspirations and visions have not fundamentally changed from those of 2000, except for the greater attention to practical details that comes from increased confidence in the practicality of the vision.

The pressure on Materials Managers, Information Technology Managers and Chief Executive Officer's has never been greater to re-imagine, re-invent, and re-architect their operations. The need for speed and for emerging Internet skills and sensibilities has led many operations to look to E-business service providers for assistance. The United States market for E-business services, including consulting, IT outsourcing, software development, and system integration has grown from $7.01 billion in 1998 to approximately $10.3 million in 2000 according to Dataquest [1]. With the growth in E-business accelerating, the market is expected to mushroom to $59 billion by 2003. Material Managers know they must introduce E-commerce to their business strategy, but many are not sure how, which is driving them to consulting and services companies. There is confusion in the ranks on whether they need to change their business model and systems structure in order to do this, and the organization is reevaluating how to move forward in the dot.com world.

What is the future of communication technology for health in developing countries? This chapter sets out to answer this question by first considering the background and potential of information technology, identifying some of the issues and trends in communication, and finally following with some challenges and opportunities of how communication technologies can make a difference in health in developing countries. Past research has shown that communication can contribute to all aspects of population, health, and nutrition programs and is relevant in a number of contexts. Some of the trends in using information technology can be classified in the following categories: competition, cognitive-based presentations, comprehensive translation, convergence, and culture. Challenges include finding a way to include the South in the exchange of ideas and information. In addition, reaching a consensus on worldwide quality standards will not be easy. Yet, beyond these challenges, there are many opportunities being created for international development agencies to increase their capacity for impact.

Changes in health care are a fundamental part of social and intellectual evolution. The modern practice of scientific medicine depends on the existence of the written and printed word to store medical information. Because computers can transform information as well as store it, new digital tools cannot only record clinical data, they can also generate medical knowledge. In doing so, they make it possible to develop “digital medicine” that is potentially more precise, more effective, more experimental, more widely distributed, and more egalitarian than current medical practice. Critical steps in the creation of digital medicine are careful analysis of the impact of new technologies and coordinated efforts to direct technological development towards creating a new paradigm of medical care.

The modern health care system is being irrevocably changed by the development and introduction of new health information technologies (such as health information systems, decision-support tools, specialized websites, and innovative communication devices). While many of these new technologies hold the promise of revolutionizing the modern health system and facilitating improvements in health care delivery, health education, and health promotion, it is imperative to carefully examine and assess the effectiveness of these technological tools to determine which products are most useful to apply in specific contexts, as well as to learn how to best utilize these products and processes. Without good evaluative information about new technologies, we are unlikely to reap the greatest benefits from these powerful new tools. This chapter examines the demand for evaluating health information technologies and suggests several strategies for conducting rigorous and relevant evaluation research.

Today, issues of privacy and confidentiality in healthcare are dealt largely informally. Little legislation exists, and the awkwardness of accessing paper records makes violations of patients’ privacy sporadic. As healthcare institutions move towards a future where all information is kept in an Electronic Medical Record (EMR), the casual attitudes that are prevalent will be in conflict with the desires and expectations of the patients. Legislation has been passed to make the holders of medical data responsible for securely protecting the patients privacy. Specific implementation guidelines are still lacking. There is much institutional resistance to the adoption of rigorous rules, but we expect that in the near future reliable procedures will have to be implemented to comply both with legal guidelines and patient’s expectations.

After introducing the issue more precisely we provide an overview over the concepts needed to understand the roles of technology of privacy and security and the people that must manage the technology. We then discuss the components of secure EMR systems and will point out where adequate technology exists and where future improvements are essential. We conclude with some advice to healthcare management facing the demands for security and privacy that the future will bring.

This chapter explores the potential of using computer technology to support and augment psychotherapeutic interventions in hospitals, communities and homes. We describe two applications piloted at Children's Hospital Boston. The first pilot explored how patients with pediatric heart disease used the Storytelling Agent Generation Environment (SAGE) computer program to create interactive storytellers and share their personal stories. The second involved youngsters on hemodialysis for end stage renal disease using the Zora graphical multi-user environment to create a virtual city and form a therapeutic virtual community. In this chapter we show how computer technology can be used to help patients explore their identity, cope with their illness and provide mutual support and interaction. We also present design recommendations for future interventions of this kind.