It’s summer, 2010, and an Oriole fan collapses at Oriole Park at Camden Yards. The usher calls 911. The fan is taken to an emergency room.
Notification has been transmitted to the attending physician. An implanted device has alerted Dr. Smith that an adverse event has occurred with one of his patients. Data is up-linked to a local ISP. The link has sent notification of a critical value, the patient’s location and an identifier which indexes to the “patient-specific diagnostics and therapeutics” registry and repository.
The EMTs have reviewed the PSDAT dump, and are aware of the patient’s history of hypertension and his valve-replacement surgery in 1999. He has recently started on a novel antihypertensive agent.
They know he has been in ventricular fibrillation for four minutes; his most recent potassium was 3.3, his hematocrit was 40 and his INR was elevated. In the ER, Dr. Greene retrieves information from the repository using a biometric identifier.
The implanted device reports that it is unableto terminate the arrhythmia. The EMTs deactivate his internal defibrillator and externally resuscitate him. The Medstat Reasoning Assistant has collected data from all the available sources and says the patient’s blood pressure is dangerously low. Surgical intervention is recommended; the patient is taken to surgery.
All of this happens within 13 minutes of the fan’s arrival in the E.R.
We can do this today, almost! But we are burdened with tempting technologies, squandered solutions, perplexed patients and cynicism in the C-suite because it’s not just about the technology. We haven’t discovered a way to change the way we work and leverage our investments.
Using information to improve outcomes is a complex process, requiring interpretation, collaboration and intervention. Coupling knowledge to opportunity requires a recognition and response system.
We need the ability to pull the right teams of people together quickly, virtually, joining a problem with a solution, a diagnosis with an intervention, and feedback with a response. Emerging technologies must remove the barriers to health care and education, whether they are geographic, temporal, linguistic or financial.
We can imagine a new generation of biomaterials and nanotechnologies, which will be ingested, injected and implanted so we might revolutionize health care, diagnostics and education. But the presence of information is insufficient.
Visualization of information, and its relationship to our challenges, must be understood and imbedded into the work flow of the overwhelmed professional. We must share best practices and evidence-based outcomes to create knowledge for the world.
So, what do we need? My top four technologies include predictive, preventive, personalized solutions to support increased productivity.
» Predictive: Virtual-reality simulation centers where we can learn, teach, explore, discover and create new knowledge. Simulation tools and technologies will promote teaching and learning around the world, while improving the knowledge and skills of the best and brightest students. Virtual patients will encourage creative thinking; virtual interventions will extend our reach and improve the quality of education and healthcare.
» Preventive: Environmental sensors and alerts, to help us understand the impact of our behaviors, and reverse the toxic affect of these behaviors. We need technology for managing the effects of humankind on our planet, as well as technologies to reverse the effects of our behaviors on our bodies. Preventive medicine will begin in the womb with gene therapy.
Continuous prevention will require intelligent sensors. The information from these sensors must be interpreted and aggregated to allow us to become more proactive. Collections of minimally invasive physiologic sensors in concert with expert systems can empower individuals to play more active roles in their own health care, while readily identifying the first signs of disease, when interventions are most beneficial.
» Personalized: A national standard for a secure universal portal to a person’s image/data/genetic profile, populated by network-agnostic devices. To achieve the promise of an efficient and effective healthcare delivery system, access to integrated information is critical, and elusive.
An interoperable (or unified) personal record is a threatening concept, due to privacy and confidentiality concerns. And yet it is an important component of a safe (and affordable) care model. We must invent, identify or embrace solutions that will promote secure access and integration of personal health records.
» Productive: A pervasive, ubiquitous, device-agnostic communications network; with network-agnostic presence-aware devices, capable of leveraging the full spectrum of communication and messaging modalities, including voice and speech recognition.
We must improve productivity of the workforce. No where is this more critical than in health care, and nowhere have we struggled more. But it may not be about the technology!
Stephanie Reel is vice president for information technology at Johns Hopkins in Baltimore.
