Ebook: Future of Intelligent and Extelligent Health Environment

“The Future of Intelligent and Extelligent Health Environment” book brings you closer to the world where technology on our body, in our body and all around us enhances our health and wellbeing from conception to death. This environment is emerging now with intelligent caring machines, cyborgs, wireless embedded continuous computing, healthwear, sensors, healthons, nanomedicine, adaptive process control, mathematical modeling, and common sense systems.

Human body and the world in which it functions is a continuously changing complex adaptive system. We are able to collect more and more data about it (wearable body monitors will be soon in each household just like toothbrushes) but the real challenge is to infer local dynamics from that data. Intelligent Caring Biomechatronic Creatures and Healthmaticians (mathematicians serving human health) have a better chance of inferring the dynamics that needs to be understood than human physicians.

Humans can only process comfortably three dimensions while computers can see infinite number of dimensions. Will we enjoy doing medical science if computers become better at it than us? We will need to trust the distributed network of healthons, Intelligent Caring Creatures, and NURSES (New Unified Resource System Engineers) – designers who inbuilt medical intelligence in our external environment – creating Health Extelligence.

We need new vocabulary to push forward in a new way – healthons are tools combining prevention with diagnosis and treatment based on continuous monitoring and analyzing of our vital signs and biochemistry. The “Healthon Era” is just beginning. Authors of the chapters of this book all are on the cutting edge of thinking in their respective fields. They all sense the Healthon Era and push forward to create a better life for us all.

At Future of Health Technology Summit^™ 2003 Space Elevator example was used to show how seemingly impossible conceptual designs could become real. Celestial hospitals and errorless healthcare are possible. We may need to use bionic arms and extended cognition to do that but if we spend as much time designing our preferred future as we do researching the past we can get there in no time.

Developments like robo-docs, robo-cats, and space elevators are not just exotic; they are a reaffirmation that with creative thinking we can go a long way to the discoveries that will allow us to fix our healthcare system and set it on a high road for the future.

The dream of an intelligent caring creature is closer to reality considering that Timothy Bickmore's relational agent can help you with your fitness training, Yulun Wang's robotic doctor can help you even from a remote location (remote presence); Astro Teller's BodyBug^™ can collect your lifestyle data and tell you what to eat and how much to sleep. We are closer and closer to the world with healthons on your body, in your body and all around you; where not a doctor but your primary care healthmatician warns you about an approaching headache; and where NURSE programs your intelligent caring creatures so they can talk to your cells and stop disease in its tracks.

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

Errorless, invisible, continuous and infrastructure-free healthcare should become our goal. In order to achieve that goal, we need to rapidly move from current episodic and emergency-driven “healthcare delivery system” to an intelligent and extelligent health environment. That requires introduction of distributed affective Intelligent Caring Creatures (ICCs) consisting of healthons. Healthons are tools combining prevention with diagnosis and treatment based on continuous monitoring and analyzing of vital signs and biochemistry. Unlike humans, who posses only two or three dimensions of thinking, healthons can assure errorless health because of their adaptability, flexibility, and multidimensional reasoning capability. ICCs can do “the right thing” based on (1) state-of-art medical knowledge, (2) data about emotional, physiological, and genetic state of a consumer and (3) moral values of a consumer. The transition to the intelligent health environment based on ICCs requires the solutions to many currently unsolved healthcare problems. This paper lists the unsolved problems (by analogy to mathematical unsolved problems list) and explains why errorless healthcare with bionic hugs and no need for quality control is possible.

Powerful forces encourage the growth of medical technology (health benefits, private equity capital, public funding, pervasive academic research, consumer demand, specialist training, reimbursement mechanisms, and industry competition). Countervailing forces that inhibit growth are the costs of the technology, difficulty in evaluating clinical and cost effectiveness, unequal patient access, and misuse, overuse, and underuse. While technology funding sources continue to expand, so do the methodologies for technology assessment.

They are part of a broad movement to better manage the diffusion of medical technology. Specific proposals include more centralized planning, more discriminating federal funding, drug price controls, curtailing insurance reimbursements, more selective adoption of new technologies, and more rigorous attention to cost effectiveness. Savvy develops of and investors in new medical technology will anticipate these changes and take them into account in their planning.

The convergence of information technology and telecommunications, including Internet technologies, is emerging as a key tool to drive increased efficiency and effectiveness in health systems worldwide. With part of its roots in medical research for military and space applications, telemedicine is expected to make it possible to link medical expertise with patients in the most distant locations-providing clinicians with valuable new tools for remote monitoring, diagnosis, and intervention.

“Technology Forecast” from Medical Device Link, at http://www.devicelink.com/mddi/archive/00/01/012.html.

Electronically-linked knowledge plays an increasingly central role in the delivery of health services worldwide. Medical data collection, archival, and analysis are all increasing in both rate and volume; large, cohesive collections of personal health information are emerging rapidly. Factors driving this integration include value-added methods of diagnosis and therapy, interest in evidence-based practices, safety concerns, and increased consumer demand for personalized, comprehensive medical services. Practitioners, businesses, patients, and the public at large would be well-served to develop and sustain a dialogue addressing these phenomena, including assessments their of economic, ethical, legal implications.

Widespread adoption of sensors that monitor the wearer's vital signs and other indicators promises to improve care for the aged and chronically ill while amassing a database that can enhance treatment and reduce medical costs.

Major advances in science and technology are converging to enable the development of a broad range of diagnostic aids for use in the home. These range from devices designed to diagnose infectious disease, to real-time continuous monitoring of endogenous biomarkers for cancer, cardiovascular health, and the like. This chapter briefly reviews some of the technical, biological, and social challenges associated with home diagnostic aids. In addition to providing several scenarios of how such devices might be used, we describe our own efforts in this area.

At MIT, a multi-disciplinary team of researchers is studying how to create pervasive computing environments for the home. We are developing technologies and design strategies that use context-aware sensing to empower people with information by presenting it at precisely the right time and place. Contrary to many visions of future home environments in the literature, we advocate an approach that uses technology to teach as opposed to using technology primarily for automated control. We have constructed a “living laboratory” that will provide a unique, flexible infrastructure for scientifically studying the power of pervasive computing for motivating learning and behavior change in the home. This facility, called the PlaceLab, is being used to study technology for creating homes that are supportive.

What if clinical quality medical equipment were available to every consumer in a form factor that was inexpensive, accurate, and easy to use? What if this equipment provided information that previously was un-measurable or very difficult to measure? What if the physiological state of individuals, at resolutions measured in thousandths of a second instead of in visits per year, could be measured easily, making it possible to ascertain caloric intake and expenditure, patterns of sleep, contextual activities such as working-out and driving, even parameters of mental state and health. What aspect of healthcare wouldn't change? We present a system that is available today that enables this vision. This award-wining multi-channel wearable physiological monitor has enabled the collection of more than 90 million minutes of data in natural settings from thousands of subjects engaged in diverse activities. Data modeling efforts are resulting in applications that present meaningful and actionable information in real-time to users and their designated collaborators (physicians, family members, counselors, coaches, etc.) We describe the SenseWear system, its design, and a summary of validation studies, current commercial applications, and ongoing research. This discussion will show how the convergence of design for wearability, advances in machine learning, and improvements in wireless technology will manifest the future of health care as personal, ubiquitous, and collaborative.

Two factors are driving a new wave of medical products. The first is the use of technology to make products “intelligent” – that is, build them not only to measure a particular parameter, like blood glucose, but to help patients and caregivers manage conditions. This allows the users of these products focus less on the technical aspects of treating a condition (e.g. calculating the proper amount of insulin to treat a given level of blood glucose) and more on the overall management of the disease. The second development is the rapid movement of devices from the doctor's office to the home. Chain drugstores carry dozens of medical devices for home use by consumers. The challenge for manufacturers and designers is to present the medical device's intelligence in a way that is palatable to the consumer. One important theme is that medical product consumers are also consumers of everything else: home electronics, appliances, clothing, etc. These consumers are applying the same decision-making processes they use when buying a blender to the process of buying a medical device. It is therefore necessary for medical product manufacturers to create devices that interact with consumers in consumer-friendly ways. Putting intelligence into a product is one thing; helping the consumer utilize and appreciate it is quite another. This chapter covers some principles to keep in mind, and discusses a framework for better design of intelligent medical products that connect with consumers on emotional and functional levels beyond simple medical efficacy.

Linking the human nervous system and brain directly to a computer opens up innumerable possibilities, not only in the future world of medicine, but also as a potential way of technically evolving all humans. This, however, presents something of an ethical problem. Nevertheless, the only way to actually find out what is realistically possible and what is not is to carry out practical experimentation using implant technology and to witness the results. This chapter describes the most recent self-experimentation trials carried out by the author and his team.

Feeling cared for has profound effects on physiology, cognition and emotional state, and has significant health ramifications whether the source of this feeling is an intimate other, friend or health provider. Unfortunately, not everyone has access to social networks populated with caring individuals or has health providers who are patient, empathic and reliably available when emotional support is needed. Over the last decade, a range of computational artifacts and technologies have been developed that could help fill this unmet need in many peoples' lives. Caring machines are technologies that interact with an individual to accomplish a goal while also behaving in ways that give the individual the feeling of being cared for. This chapter presents evidence that these machines can begin to lead to significant health benefits, such as increased adherence to prescribed health behavior change and medication regimens.

For the first time cyber-anthropology is defined as a concept and a new field of study aimed at the analysis of person's reciprocal relations with the computer-generated (CG) world evolved as a result of technological progress. In the cyber-era, simulated reality has come to the point of becoming a force that has the potential to transform the human race. Digital beings such as virtual and embodied agents, although not a part of the natural human habitat, have become necessary elements of people's surroundings and life conditions. As a theoretical construct, Cyber-anthropology is concerned with the merger of natural and artificial worlds mediated by the human imagination, as well as compatibility between people and digital life they have created. As an empirical study, Cyber-anthropology deals with the psychophysiology and psychophysics, semantic and semiotics of human engagement with computer-generated reality that is viewed as a Complex Interactive System. Personal competence as a crucial element of any cyber-system underlines the importance of psychological culture in artificial world exploration. A newly developed concept of Psychological Culture is viewed as an essential part of Cyber-anthropology while concentrating on the following core issues: (1) ethical questions, such as whether or not technological tools can be employed to solve human problems; (2) moral consequences of bringing cutting edge technology into our every day life; (3) studies of individual differences regarding psychological competence of technology users through effective vs. ineffective, independent vs. addictive, and active vs. passive dichotomies. Psychological Culture is defined as the study of a person's competence associated with the use of modern technology and individual acceptability of technological innovations. Several crucial dilemmas arise when a human being is engaged in a simulated environment, and artificial agents inhabit a human world. The ultimate goal of Psychological Culture is to provide people with the knowledge necessary for adequate recognition of scientific innovations to overcome obstacles in the process of implementing technology to enhance human well being.

In 1971, when Congress declared “war on cancer,” the public's perception was driven by an image of a single cure for a single disease. What researchers have learned since that time is that cancer is a formidable enemy made up of more than 100 different disease etiologies. The war on cancer became a war of the 21^st century; a war to be fought on multiple fronts against a diffuse enemy and for which prevention was the most judicious path to victory. To fight this new war on cancer, the National Cancer Institute must seek to harness the power of health informatics to create a supportive environment for transforming science, delivering safe and patient-centric health care, and creating an environment of personal empowerment in public health. Three different types of health informatics applications are implicated: (a) applications in bioinformatics, which are intended to revitalize the engine of scientific discovery; (b) applications in medical informatics, which will create a safer and more effective environment for delivery; and (c) applications in consumer informatics, which will enable individuals to advance the charge of their own ongoing health care over the course of their lives. To keep these applications on track, health care administrators must take a sociotechnical approach to implementation. The new systems must be built into the health care environment in such a way that they support human capacities, provide failsafe backups in the face of cognitive and physical limitations, and support continuous quality improvement.

The medical rational for using anti-drug antibodies in the serum as a treatment is to reduce drug levels in the brain and to bind drug before it enters the brain. Drugs of abuse are small molecules that can readily cross the blood brain barrier, while antibodies are larger molecules that cannot get into the brain. Thus, any drug that is bound to antibody also cannot cross the blood brain barrier and cannot enter the brain. Active anti-drug vaccines stimulate the body to makes its own antibodies, but the small size of abused drugs prevents them from stimulating an immune response. Thus, individuals do not ordinarily produce antibodies to abused drugs, and vaccines to stimulate antibodies are made by chemically linking these abused drugs to toxins such as cholera toxin. Alternatively, passive immunotherapy uses monoclonal antibodies that are generated in a laboratory and then administered via intravenous injection. Antibodies can be used to treat drug overdose; to reduce drug use relapse; or to protect certain at risk populations who have not yet become drug dependent. The advantages of anti-addiction vaccines are that antibodies target the drug, not the drug's sites of action in the brain and antibody binding inactivates the drug. These vaccines can complement behavioral and other medical therapies with minimal side effects and are not addictive like some chemical agonists. Technology advances in manufacturing and delivery systems will improve future anti-addiction vaccines, but social acceptance of anti-addiction vaccines will depend on substance abuse program staff and the families of substance abusers, who have some values that oppose medical solutions to addictive diseases and view addictions as moral problems.

The country's system of providing treatment for people struggling with addiction requires a fundamental overhaul. To address these daunting problems, a group of experts from outside the addiction field met in an intensive retreat and envisioned a new future for addiction treatment that would use the latest available technology. Retreat leaders employed creative techniques to help free up thinking beyond incremental improvement ideas. Current and former addicts or alcoholics and family members also attended the retreat to provide the panelists with a realworld understanding of their lives. Through this process, the panelists generated eight idea categories that visualized future treatments for addiction using technology. They were: (1) Integrated System and Record; (2) Monitoring/Treatment; (3) Virtual Experiences; (4) Treatment Access and “One Stop Shop”; (5) Networks; (6) Tailored Media Campaigns; (7) Diagnostic Tools; and (8) Help for Family. Two stories illustrate how these ideas could help a heroin addict and an alcoholic. The sponsors plan another meeting to bring these visionary concepts closer to real application.

It may seem premature to be discussing approaches to the effective elimination of human aging as a cause of death at a time when essentially no progress has yet been made in even postponing it. However, two aspects of human aging combine to undermine this assessment. The first is that aging is happening to us throughout our lives but only results in appreciable functional decline after four or more decades of life: this shows that we can postpone aging arbitrarily well without knowing how to prevent it completely. The second is that the typical rate of refinement of dramatic technological breakthroughs is rather reliable (so long as public enthusiasm for them is abundant) and is fast enough to change such technologies (be they in medicine, transport, or computing) almost beyond recognition within a natural human lifespan. Here I explain, first, why it is reasonable to expect that (presuming adequate funding for the initial preclinical work) therapies that can add 30 healthy years to the remaining lifespan of healthy 55-year-olds will arrive within the next few decades, and, second, why those who benefit from those therapies will very probably continue to benefit from progressively improved therapies indefinitely and thus avoid debilitation or death from age-related causes at any age.

Demographic trends clearly indicate that the US population aging patterns will continue to skew increasingly older for decades to come. Driven largely by healthcare and environmental improvements, the average life expectancy in the industrialized world has increased almost 30 years in the last century, allowing people to routinely live well into their 70s and beyond. A concomitant trend has also emerged as a result of increased longevity – the increased number of family caregivers responsible for managing the diverse needs of an elderly spouse or parent. This chapter reviews these emerging trends and their ramifications in more detail. It will also provide insights into some of the issues facing family caregivers as they attempt to balance this added responsibility along with other demands in their lives. Finally, this chapter will outline some of the technology-driven, needs-based solutions that are necessary for maintaining the quality of life for both the family caregiver and the care recipient.

Americans are life-long drivers. It is imperative that aging drivers remain on the road safely. This chapter addresses one strategy for achieving this end, namely the utilization of low-tech vehicle modifications for addressing challenges with driving due to functional deficits that normally occur with aging. It focuses primarily on the selection of useful features to be demonstrated in a video intervention in a research project to assess whether watching the video would increase elders' awareness of and likelihood of using the features. The features were chosen with the assistance of a panel of experts in transportation, aging, rehabilitation, and related fields plus a focus group of older drivers. Selecting the features, developing survey instruments, and producing the video constitute Phase I of the study. Phase II investigates whether watching a video would increase older drivers' awareness of such features and motivate them to use any of them. This chapter also includes an overview of Phase II and some comments with respect to high-tech features and the future of automobile travel.