Total Body Scanning

Longitudinal Health Record

Total Body Scanning

Longitudinal Health Record

Richard M. Satava, MD FACSProfessor of Surgery

University of Washingtonand

Senior Science AdvisorUS Army Medical Research and Materiel Command

Richard M. Satava, MD FACSProfessor of Surgery

University of Washingtonand

Senior Science AdvisorUS Army Medical Research and Materiel Command

National Forum on the Future of the Defense Health Information System ASD(HA) and Georgetown University

Arlington, VAMarch 26, 2008

National Forum on the Future of the Defense Health Information System ASD(HA) and Georgetown University

Arlington, VAMarch 26, 2008

and theand the

Disruptive Visions

http://depts.washington.edu/biointel

“The Future is not what it used to be !”

- Yogi Berra

“The Future is here …

. . . it’s the Information Age”

“The Future is here …

. . . it’s the Information Age”

Current Visions

SATAVA 7 July, 1999DARPA

The Information Age is NOT the Future

The Information Age is the Present ...

There is something else out there . . . .

Scientific Method . . .. . . is DEAD?

HISTORYObservation, PhenomenonExperimentScientific method, …?

Not all science is explainable using scientific methodIntuitionCreativityQuantum mechanicsEMERGENT PROPERTIES

What comes BEFORE the hypothesis?

Observation, phenomenon, experiment, scientific method, …?

A new “science” may need to be invented

THE STRUCTURE

OF SCIENTIFIC

REVOLUTIONS

THOMAS S. KUHN

SCIENTIFIC METHODControlled, randomized, double-blind trial

Control GroupNo Parachute

Test GroupParachute

Still looking for volunteers for the control groupStill looking for volunteers for the control group

Scientific MethodA Paradigm Change in Evolution

Hypothesis Study Design Experiment Results Reporting

Hypothesis Study Design Modeling & Experiment Results Reporting Simulation

Modeling & Simulation

New technologies that are emerging from Information Age discoveries are driving our basic approach in all areas of healthcare

. . . For example, the LHR

New technologies that are emerging from Information Age discoveries are driving our basic approach in all areas of healthcare

. . . For example, the LHR

Fundamental Concept

Preventive Acute/chronic Proactive Reactive Predictive Retrospective Parametric Qualitative Point of care Centralized .

Visual Text

Preventive Acute/chronic Proactive Reactive Predictive Retrospective Parametric Qualitative Point of care Centralized .

Visual Text

The Five Ps of Precision Healthcare

It’s Time to TransitionHow we populate the LHR - the ContentHow we populate the LHR - the Content

The Fundamental Change

What do these have in common with the LHR?

Venus of Willendorf 24,000 BC

Visual Cortes

It’s Time to Transition

Healthcare has only begun to realize the potentialof high performance computing

By 2015 a laptop will compute at 1 TeraHz - today’s supercomputer

Atari 1977 Mac 1984 ? 2015

Courtesy A. TsiarasAnatomic Travelogue

How we view the LHR - the InterfaceHow we view the LHR - the Interface

Why modeling & simulation, imaging and robotics• Healthcare is the only industry without a computer representation of its “product”

•A robot is not a machine . . .it is an information system with arms . . .

• A CT scanner is not an imaging system it is an information system with eyes . . .

thus

• An operating room is an information system with . . . * “The Information Age is about changing from objects and atoms to bits & bytes”

Nicholas Negroponte “Being Digital” - 1995

Information basis for Medicine

Borrow from Industry – eg,CAD/CAM

Information basis for Medicine

Borrow from Industry – eg,CAD/CAM

The Fundamental Change

Healthcare has only begun to realize the potential

The Industry StandardCAD/CAM

Virtual Prototyping

Virtual Medical Design

Virtual Testing

HolomerTotal body-scan

for total knowledge

Satava March, 2004Virtual Soldier Program

Information Representation of a PatientInformation Representation of a PatientMedical equivalent of CAD/CAMMedical equivalent of CAD/CAM

Multi-modal total body scan on every trauma patient in 15 seconds

* Battlefield Medical Information System – Tactical - deployed to 3000 medics in IraqReal time data display from demo in which data drives image and prediction July, 2005

The Virtual Soldier

The Media PerceptionSeattle Times

By Brier Dudley, Seattle Times Mar. 17, 2008-A few years from now, when you drive into a McDonald's parking lot, your dashboard computer will start beeping. The computer is synced to your phone, and both deviceshave geographic location services. They know where you are and, based on your credit-card activity, they guess you're about to order another burger and supersized fries. But because you've subscribed to Microsoft Personal Trainer 2015, a premium feature of the online health-management system you've been using since 2012, technology intervenes. The services are gathering information on your behalf, using a new software platform that began taking shape in 2008. When your car stops moving, the phone projects your image on the windshield, similar to R2D2 played the holographic image of Princess Leia in "Star Wars."

Mar. 17, 2008-A few years from now, when you drive into a McDonald's parking lot, your dashboard computer will start beeping. The computer is synced to your phone, and both deviceshave geographic location services. They know where you are and, based on your credit-card activity, they guess you're about to order another burger and supersized fries. But because you've subscribed to Microsoft Personal Trainer 2015, a premium feature of the online health-management system you've been using since 2012, technology intervenes. The services are gathering information on your behalf, using a new software platform that began taking shape in 2008. When your car stops moving, the phone projects your image on the windshield, similar to R2D2 played the holographic image of Princess Leia in "Star Wars."

On the windshield, you're looking chubbier than you do in the rear-view mirror, because the image shows what you'll look like if you keep eating this way. Superimposed on the image is your current weight, the cholesterol reading from your last checkup and -- highlighted in red -- a notation that you haven't used your Web-connected treadmill for over a month. The image flickers and zooms ahead two years, showing how you'll appear after gaining an extra 30 pounds and being diagnosed with diabetes. With the ka-ching sound of a slot machine, it starts calculating what will happen to your health and life-insurance premiums. Somewhere in the background, it sends an update to your physician. The image on your windshield is more than virtual. It's reality, based on the

On the windshield, you're looking chubbier than you do in the rear-view mirror, because the image shows what you'll look like if you keep eating this way. Superimposed on the image is your current weight, the cholesterol reading from your last checkup and -- highlighted in red -- a notation that you haven't used your Web-connected treadmill for over a month. The image flickers and zooms ahead two years, showing how you'll appear after gaining an extra 30 pounds and being diagnosed with diabetes. With the ka-ching sound of a slot machine, it starts calculating what will happen to your health and life-insurance premiums. Somewhere in the background, it sends an update to your physician. The image on your windshield is more than virtual. It's reality, based on the

Microsoft's Future Vision (Healthcare)Microsoft's Future Vision (Healthcare)

Virtual Autopsy . . .

Wound Tract

Less than 2% of hospital deaths have autopsy

Statistics from autopsy drive national policies

. . . is a SIMULATED Autopsy. . . is a SIMULATED Autopsy

Total Integration of Surgical Care

Courtesy of Joel Jensen, SRI International, Menlo Park, CA

Minimally Invasive& Open Surgery

Pre-operative planningSurgical Rehearsal

Intra-operative navigation

Remote Surgery

Simulation & TrainingPre-operative Warmup

C:\Documents and Settings\rsatava\Desktop\SATAVA - 0712\Mimic - Anastomosis - Short.avi

Endovascular Simulators(Surgical rehearsal)

Graphicoverlay

Patient specific image

From tissue and instruments

to

Information and energy*

From tissue and instruments

to

Information and energy*

* “The Information Age is about changing from objects and atoms to bits & bytes”Nicholas Negroponte “Being Digital” - 1995

The Fundamental Change

Information and computersCornerstone of Systems Integration

Single instrument which

- performs both diagnosis & therapy - in real time - can be autonomous - feedback from data in the EHR

Single instrument which

- performs both diagnosis & therapy - in real time - can be autonomous - feedback from data in the EHR

What possible importance does LHR have for technical proceduresWhat possible importance does LHR have for technical procedures

Smart Surgical ToolsInstrumented ScalpelInstrumented ScalpelXACTIX

XACTIX

CONVENTIONAL

MEMS SharpsMEMS Sharps

Courtesy: E.C. Benzel, L.A. Ferrara, A.J. Fleischman, S.Roy

Information on the Battlefield

BMIS-T

Holomer on battlefield video click hereHolomer on battlefield video click here

The LSTATLife Support for Trauma and Transport

Courtesy of Integrated Medical Systems, Signal Hill, CA

“ . . . with a fully functional ICU ”

• Defibrillator

• Ventilator

• Suction

• Monitoring

• Blood Chemistry

Analysis

• 3-Channel Fluid/Drug

Infusion

•Data Storage and

Transmission

• On-board Battery

• On-board Oxygen

• Accepts Off-Board

Power and Oxygen

Total Patient Awareness

Bring the hospital to the casualty, not the casualty to the hospital . . .

212th MASH Deployed with LSTAT - Combat Support Hospital

LSTAT Deployment to Kosovo - March 2000

Courtesy of Integrated Medical Systems, Signal Hill, CA

Confidential

If you are not making mistakesyou are not working hard enough … … and that’s a big mistake! Anonymous

Experience is the name everyone gives to their mistakes - Oscar Wilde

Be careful ofunintendedconsequences

Do Robots Dream ?http://depts.washington.edu/biointel