Slide1: HealthQuake David Ellis Corporate Director, Planning & Future Studies The Detroit Medical Center March 25, 2008


Agenda: Agenda What? The Acceleration of Innovation So What? The Tremors Now What? DMC response Questions DMC on LiveSearch


The DMC has a history of initiating tremors . . .: The DMC has a history of initiating tremors . . . 1952: World’s first successful open-heart surgery 1964: Synthesis of AIDS drug AZT 1978: First radial keratotomy in US 1984: One of the first to use carbon dioxide laser in kidney surgery 1993: World’s first embryo-fetoscopy procedures 2002: First successful robot-assisted pediatric surgical procedure in US Houses 1 of only 4 neutron beam therapy machines in US First to use Gamma Knife Own cyclotron for PET Biggest fleet of healthcare robots in the world . . .


. . . And they are accelerating . . .: . . . And they are accelerating . . . Whole Body Hypothermia Vision Restoration Therapy & Vision Chips Ultrasound Breast Tomography (KCI) Implantable Blood Pressure Control Device SWI MRI Center for Mitochondrial Medicine Preventing Sepsis: Keystone ICU project participant Mucosal Stem Cell Treatment of SCI Patients Pediatric Gene Bank African-American Multiple Sclerosis: Genetic Discovery Home Medical Monitoring Virtual Reality . . .


Acceleration: The Foundation: Acceleration: The Foundation Human beings Mechanical tabulators Vacuum tube Transistors Integrated Circuit Silicon/copper GaAs Serial /Parallel Massively Parallel Multiprocessor computers Cluster computing Grid computing Quantum computing 150,000 10 150 50 TODAY Photonic Molecular/atomic Quantum Years


Acceleration: Supercomputing: Acceleration: Supercomputing Supercomputers


Acceleration: Imaging: Acceleration: Imaging Spiral CT Neuroimaging modalities 9.4T MRI


Slide8: Acceleration: DNA Sequencing Instructions per second, per US$ Base pairs of accurate DNA sequence per US$ Base pairs sequenced per minute Source: Shendure, Jay; Robi D.Mitra; Chris Varma; George M. Church (2004): “Advanced Sequencing Technologies: Methods and Goals.” Nature Reviews (Genetics), 5:335-344, May. !


Acceleration of Life-Like Characteristics: Acceleration of Life-Like Characteristics Smart AI (ES, NN, EP) Small MEMS, Nanotech, LIDAR Mobile Wireless, Robotics Aware Sensors Communicative ASR, NLP, MT, VR, Haptics Connected LAN, Internet, Wireless Autonomous Control Nets, IAs, Bots Complex Emergence


So What? Tremors: So What? Tremors Simplification (Patient self-care) Automation & Robots Postmodern Medicine Globalization Defeat of chronic disease Longevity


Simplification (Patient self-care): Simplification (Patient self-care) Self-diagnosis Self-therapy


Automation & Robots: Automation & Robots Cyborgs exist Implantees Pacemakers Bionic arms DBS (1:14) BrainGate Etc. External devices Thought to speech (4:15) Exoskeleton coming Robots Rounding (ITH) Therapeutic (Paro) Logistic (Tug) Pharmacy (PhRED) Surgical (Da Vinci, Penelope) BrainGate™ Neural Interface System The BrainGate™ Neural Interface System is currently the subject of a pilot clinical trial being conducted under an Investigational Device Exemption (IDE) from the FDA. The system is designed to restore functionality for a limited, immobile group of severely motor-impaired individuals. It is expected that people using the BrainGate™ System will employ a personal computer as the gateway to a range of self-directed activities. These activities may extend beyond typical computer functions (e.g., communication) to include the control of objects in the environment such as a telephone, a television and lights.


Postmodern Medicine: Postmodern Medicine Regenerative Stem cells Gene therapy/RNAi Tissue engineering Bionic Mitochondrial Genetic Personalized (biomarker tests; pharmacogenomics) Digital Bioinformatics/Computational biology/Systems biology (e.g., Archimedes, Physiome, Cancer Genome) HIT (EMR/CPOE, Imaging/PACs, gene banks, . . . ) Telemedicine Telesurgery Medical education & CME Disease management Disease/Bioterror surveillance Home medical monitoring Personal biomonitoring Postmodern Surgery Radiological (e.g. HIFU) Nanobots Regenerative Medicine


Globalization: Globalization Radiology reads Stem cell research Medical tourism


… = Defeat of Chronic Disease: … = Defeat of Chronic Disease Cancer 2015 Cervical cancer vaccine done Gene therapy success against advanced melanoma and chronic granulomatous disease Diabetes (artificial pancreas) Heart disease (mortality declines in recent years)


Longevity: Longevity


DMC Responses: DMC Responses


Simplification: Home Medical Monitoring: Simplification: Home Medical Monitoring 140+ signed up Issues: Cost, data, reimbursement 5 years from now: More sensors, more sensitive; substantial percentage of nursing home stays averted 10 years from now: Invisible – implanted in body, built into clothing, furniture, fabric of home Glucose BP Weight ECG Resp flow Blood Ox Comms


Robots: Robots http://www.hsi.gatech.edu/hrl/ele_video.shtml


HIT: EMR/CPOE: HIT: EMR/CPOE ALL DMC HOSPITALS NOW AT STAGE 5 BY 2008, ALL WILL BE AT STAGE 7


Digital Medicine: Surgical Simulators: Digital Medicine: Surgical Simulators 4 lap/endo sims in Dept. of Surgery Seed for larger simulation facility in Education Commons 5 years from now: Holographic display of actual patient from CT/MRI/PET imaging 10 years from now: Obsolescent, as non-invasive methods replace surgery (including regeneration of tissues, organs, limbs) Guided virtual cholecystectomy


Digital Medicine: Patient Simulators: Digital Medicine: Patient Simulators Virtual Geriatric Patient, based on Tactical Iraqi


Digital Medicine: Holographic Diagnostic Scans: Digital Medicine: Holographic Diagnostic Scans 3DH.net


HIT: RFID: HIT: RFID Emerging major technology for supply chain & inventory management Pilot planned for Harper Low-hanging fruit: PCAs Epidurals Infusion Pumps Flowtrons 5 years from now: All major equipment tagged 10 years from now: Everything tagged (you too!) Radianse active RFID tag PanGo active RFID tag


Working on it…: Working on it… ASTI Libya Data mining Second Life MOTORABILITY ISLAND SLURL Telemedicine Stroke Turkey Devices Medtronic gastric pacemaker Doctors use “printed” skull in discussing the approach to a complex interdisciplinary intervention


The Cosmic Calendar: The Cosmic Calendar


1/10th Sec. Before Midnight: 1/10th Sec. Before Midnight


Questions: Questions The Challenge Facilitate and promote the transition to postmodern medicine even as it accelerates, retaining the character traits of the responsible steward and employing the arts of the pre-modern physician-artisan in the absence of anything better but discarding them without hesitation in favor of validated science and tested technology What needs to change? Understand acceleration Recognize the tipping point from medicine as art to medicine as science Dynamically re-pack the doctor’s black bag with new armamentarium Make structure and content of medical education flexible and dynamic Emphasize bioinformatics and biostatistics Hire mathematicians, philosophers Use simulation, telemedicine, etc. technologies in education Focus on where medicine will be tomorrow, not where it was yesterday Become familiar with and use futures forecasting tools and resources