robotics, machine intelligence, and the future of hospitals final
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Robotics, Machine Intelligence, and the Future
of HospitalsDonald G. Bellefeuille
Healthcare Strategist
April 24, 2015
Driving ForcesReduce cost and increase reliability
National Healthcare Expenditure Projections
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.htmlhttp://kff.org/report-section/how-much-of-the-medicare-spending-slowdown-can-be-explained-issue-brief/
2013 2023
17.40%
19.30%
NHE as a Percent of GDP2013 Actual - 2023 Projected
2013 2023
$936,900,000,000$1,671,513,719,136
$1,963,100,000,000
$3,502,346,648,506
Hospital Expenditures as a Percent of Total Expenditures2013 Actual - 2023 Projected
Hospitals All Other
NHE projected at 5.6% Y13-14 and 6% Y15-23; hospital remains as constant percentage of total – 32%
The costs are being passed on to you and me
The Commonwealth Fund Issue Brief January 2015: State Trends in the Cost of Employer Health Insurance Coverage, 2003-2013
Enabling Technologies
http://www.wired.com/2014/10/future-of-artificial-intelligence/
Cheap parallel computation
Data, lots of it
Better algorithms
Expanding imaging modalities and the ability to project in 3D and 4D holograms
Micro electro-mechanical arrays that can feel heat and give haptic feedback
http://www.bioopticsworld.com/articles/print/volume-6/issue-2/departments/biooptics-breakthroughs/wavelength-modulation-overcomes-drawbacks-of-raman-spectroscopy-.html
http://www.memsnet.org/mems/what_is.html
Are We Reaching Our Human Limits to Improve?
Arnold Millstein, MD, Director, Stanford Clinical Excellence Research Center http://cerc.stanford.edu/about/team.html
The pressure to improve value will force increasingly complex healthcare process specs.
As the complexity of process specs expand, human cognitive limits will be exceeded.
IT – enabled 3-layer control systems well-tailored to human factors will spread.
Some Definitions
http://blogs.sas.com/content/subconsciousmusings/2014/08/22/looking-backwards-looking-forwards-sas-data-mining-and-machine-learning /http://time.com/3641921/dont-fear-artificial-intelligence/?utm_source=Newsletter+list&utm_campaign=4f0dd73f67-Newsletter_2014_07_177_17_2014&utm_medium=email&utm_term=0_efd6a3cd08-4f0dd73f67-217135337&ct=t(Newsletter_2014_07_177_17_2014)
• Passive robot: Human operator controlled
• Active robot: Acts on own according to programming
• Bounded intelligence: Cannot operate outside its programming
• Unbounded intelligence: Can program itself
Present State of Logistical Robotics and Machine Intelligence
202520202015
Xenex Robot: Pulsed Ultraviolet Light Disinfection System
http://www.xenex.com/xenex-robot/
http://www.aethon.com/wp-content/uploads/2013/10/TUGBrochureWeb.pdf
Robotic Transport Systems
TUG TransCar and Robocourier
http://www.swisslog.com/en/Products/HCS/Automated-Material-Transport
Robotic Pharmacy
https://www.youtube.com/watch?feature=player_embedded&v=oumlYbwfAsI
http://www.swisslog.com/
Automated Labs
http://www.bd.com/scripts/europe/labautomation/productsdrilldown.asp?CatID=455&SubID=1835&siteID=20309&d=&s=europe%2Flabautomation&sTitle=Lab+Automation&metaTitle=Work+Cell+Automation&dc=europe&dcTitle=Europe
BD Kiestra™ WCA
http://www.theranos.com/
Blood War
http://www.radisens.com/technology/
Present State of Clinical Robotics and Machine Intelligence
202520202015
CyberKnife
http://www.accuray.com/solutions/treatment-delivery/cyberknife-treatment-delivery/m6-series
DaVinci Surgical Systems
http://www.davincisurgery.com/
Medrobotics FlexSystem
http://www.medrobotics.com/
Orthopedics
http://www.thinksurgical.com http://www.makosurgical.com/makoplasty
IGAR: Image Guided Autonomous Robot
https://www.youtube.com/watch?feature=player_embedded&v=Q1RMUwRkxSc http://www.csii.ca/about_csii
http://www.artashair.com/artas-experience/how-it-works/https://www.youtube.com/watch?v=_kFCnudEoPs
eICU
http://www.healthcare.philips.com/main/products/patient_monitoring/products/eicu/
http://www.sentrian.com/technology/how-sentrian-works/
Machine Intelligence
http://www.twinehealth.com
https://www.remedypartners.com/
http://hbisolutions.com/http://www.hinfonet.org/
Super intelligence induced psychosis
http://www.dccomics.com/graphic-novels/watchmen
Emerging State of Robotics and Machine Intelligence
20252020
Digital, Mobile, and Tele-Health
http://mobihealthnews.com/32476/in-depth-revisiting-topols-top-ten-digital-health-targets/
Sensors: Inside and OutsideSensor Use
On-organ Data specific to organ function
Ingestible Med management, heart rate, sleep, stress, physical activity
Body-worn glucose Blood sugar monitoring for athletes
Portable spectrophotometer Phone analysis of urine strips: diabetes, kidney disease, UTI
Wearable UV Preventing skin cancer
Pill bottle Medication adherence
Stick-on health monitoring patch EKG, EEG
Electronic skin Muscle disorder from Parkinson’s and epilepsy
All-in-one skin sensor Heart rate, heart variability, respiratory rate, temperature, posture, and fall detection
Blood monitoring patch Glucose, potassium, other levels
Brain control sensor Controlling artificial limbs
On-heart sensor Multiple cardiac markers: rhythm, pH, etc.
Baby monitoring patch temperature
Microfluidic home health sensor Inflammation, Vitamin D, fertility, influenza, etc.
http://bionicly.com/sensor-innovations-in-digital-health/?utm_source=Newsletter+list&utm_campaign=6da742e30b-Newsletter_2014_07_177_17_2014&utm_medium=email&utm_term=0_efd6a3cd08-6da742e30b-217135337&ct=t(Newsletter_2014_07_177_17_2014)
http://www.samsung.com/us/globalinnovation/innovation_areas/#digital-health
Wearables: Moving from Wellness Devices to Medical Devices
Qualcomm Tricorder Xprize & Nokia Sensing XChallenge
http://tricorder.xprize.org/teams/zensor http://sensing.xprize.org/
Telemedicine Kiosks
http://www.healthspot.net/wp-content/uploads/2014/12/HealthSpot-station.jpg http://www.computerizedscreening.com/products/9kex/
India’s Swasthya Slate
http://www.swasthyaslate.org/index.php
Robotic Brain Surgery
http://www.sciencedaily.com/releases/2014/10/141015152556.htm
KidsArm
http://www.nasa.gov/mission_pages/station/research/news/kidsarm/MDA & CGIGITI
http://www.asc-csa.gc.ca/eng/canadarm/kidsarm.asp
Robophobia
Future State of Robotics and Machine Intelligence
2025
Next gen soft tissue robotics is focusing on
Soft Tissue Robotics – The Next Generation; MD Buyline, V3, #3, June 2014
Tactile feel
Greater flexibility to robotic arms
Smart systems
Active and passive microsurgery for long space voyages
http://blog.sfgate.com/techchron/2014/04/04/nasa-outlines-plan-for-tiny-robotic-space-surgeons/
Design and Assembly of Parabolic Flight Payload to Evaluate Miniature in vivo Surgical Robots in Microgravity, Kearney M. Lackas, University of Nebraska-Lincoln, kearney.lackas@gmail.com, Spring 5-2014
http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1074&context=mechengdiss
Raven Surgical Robotic System
http://citris-uc.org/telehealth/project/raven-surgical-robotic-system/
Advanced Machine Intelligence
Amelia by IPsoft
http://www.content-loop.com/meet-amelia-computer-thats-job/?utm_source=LinkedIn&utm_medium=status_update&utm_campaign=Capgemini_Yearlong_HMI_INT_2013
http://www.alicebot.org/chatbots3/Eugene.pdf
Micro Tech: Mu-grippers
http://hub.jhu.edu/2013/04/24/micro-grippers-biopsy
Nano Tech
SINGLE CELL PUNCTURE WITH OPTICALLY MANIPULATED HYBRID NANOROBOT, Takeshi Hayakawa* and Fumihito AraiDepartment of Micro-Nano Systems Engineering, Nagoya University, JAPANhttp://www.rsc.org/images/loc/2013/PDFs/Papers/349_1037.pdf
DARPA In Vivo Nanoplatform Program
Nano Tech
‘Flying Carpet’ Technique Uses Graphene To Deliver One-Two Punch Of Anticancer Drugs
https://news.ncsu.edu/2015/01/gu-graphene-2015/
Nanotoxicological Shock
http://www.pfi.no/New-Biomaterials/Projects/Nanofilter/
The Future of Hospitals
Intense Acute Care
Hospital
Intense Ambulatory Care Center
Telehealth Facility
Urban and Rural Critical Access
Hospitals
The Hospital of the Future is More Than One Type of Facility
The Intense Acute Care Hospital
Activity will be constantly monitored, measured, and adjusted using a variety of sensors and data streams.
• Optical, sonic, and wavelength detectors and sensors will integrate with direct feeds from equipment. • Data will come from implanted/wearable patient biometric devices, autonomous machines, current volumes,
staff locations, supplies, equipment locations, ambient conditions and energy use, and expected volumes from crowd-sourced data
• The IACH’s machine intelligence will constantly adjust and ensure maximum efficiency in the use of all resources, anticipate future need, and ensure just in time resource consumption and staffing.
The Intense Acute Care Hospital
Purpose designed autonomous robots and machine intelligence will replace routine functions.
• Machines will do most of the housekeeping, dietary, pharmacy, care assistance, business, central sterile processing, and maintenance functions among other duties.
• General labs will no longer exist.• Specialized robots will be used routinely in the operating room and other clinical areas replacing some physicians, nurses, and technical
specialists.• Diagnosis and treatment plans will be developed by the IACH’s machine intelligence.• Doctors and nurses in the IACH will be experts at deploying the vast amount of data and robotic capabilities to cure and repair patients in
the shortest amount of time.
The Intense Acute Care Hospital
Most patient rooms will be multi-functional enabling a wide variety of procedures, imaging, and types of care to be conducted in the room.
• The patient will use any number of features that connect with family or loved ones, the treatment plan and overall health record, active memory stimulation, and entertainment.
• The room will monitor the patient’s condition, respond to requests, adjust the environment, and provide a machine intelligence generated ‘counselor’ (avatar or robot) to converse with, knows the patient’s condition and history, and is programmed to be empathetic.
• That ‘counselor’ may have followed the patient from another place and, if not, could follow the patient to home care.
The Intense Acute Care Hospital
Operating rooms, per se, won’t exist.
• Individual rooms will give way to very large spaces where procedures are performed.• The room will reconfigure automatically to accommodate multiple scheduled and unscheduled procedures.• The operating space will accommodate autonomous or operator assisted robotic surgical equipment• Imaging equipment will be integrated directly into the space and not be hybridized.• Hologram images will be overlaid exactly onto the patient. Data read-outs will be within the hologram field.
• Advances in sterilization and other methods to isolate multiple operations going on in the same space will accommodate these changes.• Necessary parts, biologics, implants, and surgical equipment will be custom made in the OR.• Anesthesia will move to electric cerebral cortex manipulation instead of drug injection.• Surgical times will be halved.
The Intense Acute Care Hospital
Teaching and research will be dispersed to a variety of care settings.
• Hospitals built on the triad of research, teaching, and care will struggle with maintaining that mission as teaching venues move to other types of facilities.
• Many IACH’s will simply provide the most advanced care possible while research and some teaching are conducted elsewhere.• A new healthcare workforce will emerge, trained in the programming, deployment, and maintenance of machine intelligence
and autonomous robotics. • Medical and nursing schools and GME programs will change curriculums to keep up with the demand for this specialized
knowledge.
The Intense Acute Care Hospital
Designs that accommodate machine intelligence, robotics, and efficiency while enhancing the human/machine interaction will be the norm.
• New service pathways that keep machines out of public view will need to be created along with the necessary docking, storage, and maintenance spaces.• Grand hotel features, expansive lobbies, and other visitor spaces won’t be financially feasible or desirable because being admitted to an IACH will be a very
unusual event in a person’s life• If admitted the length of stay will be very short
• A new generation of staff, weaned on the integration of machines into their lives, will not object to co-working with machine intelligence however manifested.• Designs will need to ensure this co-existence in such a way that it preserves the humanity of the place.• This is more an imperative for the workforce than the patient.
Humans Need Not Apply https://www.youtube.com/watch?v=7Pq-S557XQU
Ten Diseases That Might Afflict Us in the Futurehttp://io9.com/10-diseases-that-might-afflict-us-in-the-future-1666688319?utm_source=Newsletter+list&utm_campaign=bdd3ec26a1-Newsletter_2014_07_177_17_2014&utm_medium=email&utm_term=0_efd6a3cd08-bdd3ec26a1-217135337&ct=t(Newsletter_2014_07_177_17_2014)
A Roadmap for U.S. Robotics 2013https://robotics-vo.us/sites/default/files/2013%20Robotics%20Roadmap-rs.pdf
Cyborg GPs: healthcare in an imagined futurehttp://www.theguardian.com/healthcare-network/2015/mar/04/gp-healthcare-imagined-future-nhs?utm_
Donald G. Bellefeuille1 Beacon St., Suite 5200Boston, MA 02108617-378-4800dbellefeuille@nbbj.com
@dbellefthestratexcrossroad.blogspot.com
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