Reality Check on the Future of Medicine, as of 28 Aug 2016

Here's a couple of posts on the Future of Medicine.

http://singularityhub.com/2016/08/22/exponential-medicine-2016-the-future-of-health-care-is-coming-faster-than-you-think/

http://www.latimes.com/business/hiltzik/la-fi-mh-why-an-uber-for-healthcare-may-not-happen-20160201-column.html

https://www.globalcitizen.org/en/action/wash-explainer/

Key takeaways:

1. The "8 Areas to Watch": 1) The Connected, Interactive Home 2) Medical Tricorders to Connected Emergency Kits 3) Healthcare Chatbots 4) VR in the OR to AR on the Streets 5) From Quantified Self to Quantified Health 6) Uber for Health 7) Cancer Moonshots  8) Crowdsourced ‘Omic's...
... are all underpinned by the way data flows and disparate systems are able to connect with each other (interoperability) - which we haven't quite got right - or ubiquitous - yet. In healthcare, there is an important translation from "Physical to Digital back to Physical" delivery that has been (for the most part) overcome by logistic mechanisms like Uber's, but whether it's efficient or a wise investment of healthcare resources remains an argument to be proven.

2. The bigger question is who is addressing (and how) the dissonance between payment and ownership: the challenge (as identified in Michael Hiltzik's article) is that the person paying and the person receiving the service are often two different people. It's a rare thing in healthcare that they are the same person, without government compensation in one form or another (as it is in Australia) or insurance dropping the price to enable it to be palatable.

3. In a global context, we're still struggling to provide the basics of healthcare: clean water and sanitation. Combined with any lag in access to education, or the skill to assess if this is the best or most trustworthy information to use to inform one's subsequent actions, we still have a number of hurdles to overcome before "full stack" healthcare is available to everyone anytime and everywhere.

Linchpins and a post-Seth Godin binge on "What it means to be a Healthcare Startup"

One of the most inspiring talks, critical for any entrepreneur who is "leaning in", changing the way their industry behaves.

The great thing about the 7 things that linchpins do, sounds exactly like the team of a great company, one that everyone who is trying to change the world wants to work with.

This is the list (or watch the video):

1. Providing a unique interface between members of the organization
2. Delivering unique creativity
3. Managing a product, project, situation or organization of great complexity
4. Leading customers - how to establish a tribe and take them somewhere
5. Inspiring staff - who will the rest of the staff follow to do almost anything
6. Providing deep domain knowledge - the Uber Geek :)
7. Possessing a unique talent

Summary of Seth Godin's insights:

1. Be the purple cow - be remarkable. People talk about the unusual and if you feel like you're standing out, realise it's a good thing.

2. ... unless you are three steps ahead.
It's a bit too far out for people to fathom, according to Godin. Though we see extraordinary mouthpieces of the creative and technology future, like Peter Diamandis and Ray Kurzweil, talk about things coming in the next 25 years... they always mention what is on the horizon, just on the edge of possible.

3. Ah, the edge... the ability to push til you find a boundary, or a No... and possibly fall off.

4. Cull your customers... or at least be selective.

5. But not so selective that the people in the club get "old". Refresh regularly!

Bonus: "if I can write down what you do, I can find someone who will do it cheaper". Godin mentions the role of radiologists as an example and it's important as we see the tech disruption curve move across medicine into areas of diagnostics and pathology... The science of medicine is being simultaneously expanded and replaced by computers: mobile phones, network computing, AI... leading to faster, better algorithmic processing. The art of medicine is being lost in the fear that we stand out - amongst our peers, that we are judged to have not performed in a way that others would have.

There are times to do that eg lumbar puncture (scientific, procedural), and times not to eg how your patient can watch you tell them about their procedure at any time they want, or how your front desk staff rings each of your post-op patients personally to thank them and follow up after a procedure (artistry, feeling, the experience).

Now, combining with PG's comments about startups needing to make life better, then I truly think that every doctor, every healthcare practice, every medical app out there hanging out a shingle, from a surgeon to a multipractice physio-Pilates-massage clinic to a dermatology app, starting up their own business can benefit from how PG's and Godin's advice to startups applies to healthcare startups, which I see as:

1. Make someone's life better. Quickly. In small doses. (the good news is, this is what we've been training for, for most of our lives!!)
2. Don't be ordinary. Stand back and look at what people care about. For example, take a look at this list of UK Charities. To what health-related causes will people give their post-tax, cash-in-their-pocket? What will people go out of their way to experience:  belonging, making a difference, ensuring others don't have to experience X or Y...
3. Be the artist, the creative, the indispensable. Especially as a doctor. Artistry might be through relationships, or how we make people feel... it's just not something that one can write a manual to do. 
4. Find, be or partner with a linchpin organisation. 
5. Operate at the highest level of the value chain: if all we do as health practitioners is mechanical, then we're at risk of missing out on expressing the artistry that is an intrinsic part of our practice. We're blessed to be in an industry where we blend both art and science (though you could argue, which industry isn't): but the way we make patients feel on both spectrums means that if we continue to practice and evolve the artistry of medicine, there will always be a demand for our service to the community.

Periop Partners will be at the Annual Scientific Congress 2016 on "Surgery Technology and Communication" in Brisbane, at Booth 24. Please come by, say hello and learn more about the technology affecting medicine. 

Preparing for the future - Alec Ross - AI, robotics and importance of life-long learning

Brilliant video, explaining the rise of AI and the importance of being a lifelong leading learner.

Key take-aways:

1. "Disruption": from the technologies in your reality now that weren't available 3 - 5 years ago. How is this going to change the way the users access the service you're providing (or the value chain you're part of?)
2. If you're a largely services economy (as Australia is) - what percentage of your workforce is in easily replicable / replaceable knowledge jobs eg AI, robotics and learning
3. This video reminds me of something that Sam Altman from Y Combinator said during his Blitzscaling talk: "I think if you could pick one thing to do that would help the poorest half of the world the most tomorrow you would pick friendly superhuman intelligence". 

Thoughts on Artificial Intelligence in Health

Thoughts on Artificial Intelligence in Health (last updated 27 Feb 2016)

Key points:

1. Current edge in AI is self-teaching systems
2. Data scientists offer a unique edge to information-dense, complex systems - make better decisions in the oncoming period of disruption.
3. The use of AI in Healthcare will aim to reduce the downside of the critical human element (eg fatigue, mistakes, gaps in knowledge) and augment the benefits (more patient-doctor time, comprehension / observation of complex emotional situations, comfort, human touch and compassion)

Latest News:

1. 26 Feb 2016: Google AI group, DeepMind, launches DeepMind Health with two initial apps: Streams, to find patients at high risk of acute kidney injury; Hark, to manage clinical tasks and interventions. Here's Imperial College London's experience with Hark.
3. Artificial intelligence startup MedyMatch launches, former Philips exec tapped as CEO

Current Weaknesses in the System

1. Dependent on the accuracy of structured data
2. Ability to interpret unstructured data still rapidly developing
3. Disease is multifactorial - and treatment success is in part driven by patient compliance (human factor again)

Artificial Intelligence and its Impact on Health

The aim of this post is to capture some static points on AI, catch up myself and readers on AI's history, definitions and touchpoints. Also cos the original post was getting super long.

For the latest updates and more interpretative components, you should read this post.


Where AI was
Here's a great article summarising the key milestones of AI and predicting where the technology is trending.

This was a particularly seminal moment: "In 2011, IBM's AI system, dubbed "Watson," won a game of Jeopardy against the top two all-time champions" but it wasn't til I played with Google Photos on a walk through Hobart that I realised this amazing potential spanned data in all its forms - not just words, but images, sound, light...

A Rose by any other name
Business Intelligence, Data Mining, Sensing, Pervasiveness, Ubiquity and Intelligent Agent

... essentially, data gathering + pattern recognition + prediction + learning / modifying rules = AI

AI in Health

From the 2015 EPIA conference in Coimbra, the organisers provided an overview of the expansive range of topics that fall under the AI banner, loosely:

Medical methodologies, architectures, environments and systems:

Agents for information retrieval;
AI in Medical Education and Clinical Management;
Wellbeing and lifestyle support;
Interoperability, Security, Pervasiveness, Ubiquity and Cloud Computing in Medicine;
Methodological, philosophical, ethical, and social issues of AI in Medicine;
Pervasive Healthcare Environments;
Software architectures.

Knowledge engineering and Decision Support Systems:

AI-based clinical decision making and Clinical Decision Support Systems;
Automated reasoning, Case-Based Reasoning or Reasoning with medical knowledge;
Business Intelligence in Health Care;
Clinical Data Mining;
Data Streaming;
Diagnostic assistance;
Expert, agent-based or knowledge-based systems;
Medical knowledge engineering;
Pervasive or Real-Time Intelligent Decision Support Systems in Critical Health Care.

Medical Applications and Devices:

Computational intelligence in bio- and clinical medicine;
Electronic Health Records (eHealth);
Image recognition and interpretation;
Intelligent devices and instruments;
Sensor-based applications;
Telemedicine and mHealth solutions;
Ubiquitous devices in the storage, update, and transmission of patient data;
Usability and acceptability.

AI in Healthcare Information Systems:

Autonomous systems to support independent living;
Healthcare System Based on Cloud Computing;
Intelligent Healthcare information systems;
Pervasive Information Systems;
Pervasiveness and Security in Clinical Systems;
Smart homes, hospitals and Intelligent Systems;
Simulation Computer systems.

Essentially: ... data drives decisions in large complex systems, and that's not a bad thing. Dan Sullivan from Strategic Coach, in a podcast on healthcare and education, observed: "to the degree that hospitals have data scientists, those are the ones that will have great breakthroughs".

What is the impact of that?
The human element is a strength and a weakness - so the use of AI will aim to reduce the downside of that (eg fatigue, mistakes, gaps in knowledge) and augment the benefits (more patient-doctor time, comprehension / observation of complex emotional situations, comfort, human touch and compassion).

See Fastcompany's assessment on how AI will fit into the hospital workflow:

"Robots won't steal doctors' jobs, says [Venkat] Rajan, but they will spare overworked docs some of the dangerous fatigue that can lead to mistakes. "They're stressed, they’ve got a million different things they're looking at, so [there's] stuff they might have missed."

*Venkat Rajan, Global Director, Visionary Healthcare program, at Frost & Sullivan.

Hope and Future Nanotechnologies

"A Leader is a dealer in Hope" - Napoleon Bonaparte.

(... Notice it doesn't say *false* hope.)

This year at the Abundance 360 summit, I had the distinct delight of meeting Ray Kurzweil.

Described as the "rightful heir to Thomas Edison", and a prediction success rate of 86%, Mr Kurzweil's predictions about the future of human consciousness are:

• in 2029 (or well, 2045), we will reach the singularity
• in 2030, human brains will be able to connect to the cloud, allowing us to send emails and photos directly to the brain and to back up our thoughts and memories - via nanorobots

(The singularity is Mr Kurzweil's prediction of a point in time when improvements in artificial intelligence generates an intelligence explosion and surpasses human intelligence. Read more: Wikipedia and Kurzweil.AI)

Imagine what this means for the capacity of cognition, emotion, engagement, experiences... the presence and management of mental health conditions, intellectual pursuits and physical endeavours?

Read more: coverage on Huffington Post and Ray Kurzweil's talk on TED.

Neuro nanorobotics. The idea itself is appealing... to reach the corners of the human mind that have been hard to sweep clean, to scratch the itch that lies beyond the blood-brain barrier.

It is the ultimate in personalised medicine: robots derived from and integrating with your own DNA strands... Add to the trend of shrinking the size of technology and you have your own diagnostic, investigative and therapeutic agent swimming around your bloodstream.

Even better than that, according to Mr Kurzweil, is the augmentation of thought: the hybridisation of logical and emotional intelligence. Expansion of physical or quantitative (read: sheer volume) of the brain will lead to a qualitative leap in culture and technology. Want proof? We did it before - humans have a frontal cortex and our primate cousins do not.

Fortunately, we've got 14 years to get there.

And his answer to my question: "Where could I join the nanorobotics revolution?" (after all, it is the ultimate in personalised patient-centric medicine (hence my fascination): robots derived from and integrating with your own DNA strands...)

With a smile he said, "Why don't you apply to Singularity University?". :)

What are your suggestions? Where is the edge of neurorobotics research and who (or which institute) leads the field? 

Interface moment and VR / AR

Take a look at Peter Diamandis' blog entry about "11 steps for going BOLD".


For the VR, AR, 3D printer, Wearables and AI fans out there, this sentence is the take-away: 

"One key is looking for the creation of an ‘interface-moment’ (e.g. Andreessen’s creation of the Mosaic browser for the Internet) which allows entrepreneurs to build new businesses."

Interface moments, like VR and AR headsets, like 3D printers, like wearable (sensor) technology and like AI / big data analytic platforms out there, take heart. You're paddling at the beginning of the wave (as Roger Hamilton would say).

Get ready to ride the AR/VR (Mixed Reality) wave. 

Update 5 Aug 2017:

For VR companies focusing in health - don't be disheartened. You're almost through the valley of despair.

Applications in

• Aged Care - https://probonoaustralia.com.au/news/2017/07/virtual-reality-help-combat-social-isolation-ageing-population

• Depression - http://www.ucl.ac.uk/news/news-articles/0216/150216-virtual-reality-treat-depression
• Phobias (eg Needle phobia) - http://www.news.com.au/technology/innovation/inventions/the-revolutionary-way-virtual-reality-is-curing-phobias/news-story/e71e4648c711e698e1164fdb6e8efa30

• Surgery & Anaesthesia - http://www.independent.co.uk/news/long_reads/vr-surgery-pain-mexico-research-vazquez-sedatives-anaesthetic-hospital-virtual-reality-a7552746.html
• Surgeons in China show Liver transplant patients the procedure - https://www.youtube.com/watch?v=V34yf4_vIT8