Foreword to Electronic Reporting in the Digital Medical Enterprise
Doctors in the year 2012 will have access to full-immersion virtual-reality training and surgical systems, microchip-based protein and gene analysis systems, knowledge-based systems providing automated guidance and access to the most recent medical research, and always-present visual displays of patient data for instant interaction via voice.
Published in KurzweilAI.net November 1, 2002
Foreword
Ray Kurzweil, one of the foremost pioneers in the field of artificial
intelligence, has been called “the ultimate thinking machine”
by Forbes magazine. As early as 1974, he led the development of
the first “omni-font” optical character recognition (OCR)
technology, which made it possible for computers to recognize printed
and typed documents. In 1976, he adapted this technology for use
in the Kurzweil Reading Machine, which reads documents aloud to
the blind and visually impaired. His OCR technology also provided
the capability for Lexus and Nexus to build their online legal and
news information services. He also developed the first commercially
marketed large-vocabulary speech recognition devices.
In 1999, Kurzweil received the National Medal of Technology,
the nation’s highest honor in technology, from President Clinton
in a White House ceremony. He has received hundreds of other national
and international awards and is the author of The Age of Intelligent
Machines (1990) and The Age of Spiritual Machines, When Computers
Exceed Human Intelligence (1999).
This speech recognition pioneer shared his thoughts on the future
of computers in medicine with the editors and readers of this SCAR
Primer.
The last time I brought my car in for a check-up, the dealer had
a comprehensive history of all of its repairs and tests up on his
screen as I pulled in. The last time I brought my body in for a
check-up, my doctor had a thick folder of dog-eared paper records
on his desk. If we wanted to plot one of my health variables—cholesterol,
say—this would require a time-consuming project of thumbing
through many disparate records in varied formats, assuming the data
could be found at all.
Medicine is perhaps the most knowledge-intensive profession one
can pursue, so it may seem surprising that we are not further along
in the use of computation, which is the most powerful technology
we have for containing and controlling knowledge. The reasons for
this state of affairs are many: medical knowledge is extremely complex
and, therefore, difficult to represent in rigid tabular databases,
and there are no clear authorities to set and enforce standards
for electronic medical records.
But this is now starting to change rapidly. Because of its complexity,
medicine has been slower than some other fields to fully embrace
the computer. By the end of the decade, however, I believe we will
find medicine as the profession taking best advantage of knowledge-based
technology. There are many factors for this impending transformation:
the Internet, the ubiquity of inexpensive computers, the advent
of portable computing, and a broad array of advances in computerized
systems that affect all phases of medicine.
The Internet is already a powerful force changing the relationship
between doctors and patients. Patients are increasingly knowledgeable
about medical issues as a result of the thousands of medical Web
sites and discussion groups, although the reliability of much of
the information is a legitimate concern. Increasingly, patients
come into their visits armed with information that they want to
review. Although dealing with misinformation is an issue, most doctors
I’ve talked to find that increased patient knowledge results
in greater compliance with treatment and lifestyle recommendations,
because the patients have a greater understanding of the implications
of their condition. Many doctors are using the Web and e-mail as
means of communicating with their patients. Although these new modalities
of communication can be very effective, they can also create new
dilemmas (e.g., how should a doctor handle the potential for an
e-mail being sent by a patient complaining of chest pain at 3 a.m.?)
We are in the early stages of many other salient trends. Telemedicine
is used as doctors share imaging data over the Internet and engage
in videoconferencing to access expertise in other geographical areas.
Automated pattern recognition is starting to be used in identifying
areas of interest in electrocardiograms (particularly the lengthy
24-hour Holter tapes) and blood cell analyses. Databases that provide
information on drug interactions are coming into general use. The
human genome project has revealed the basic genetic data needed
to launch an almost limitless number of inquiries and practical
applications. Microchip technology is being used to analyze biological
samples for specific proteins and strands of DNA. Viable electronic
medical records are emerging. Virtual reality systems, which include
haptic (i.e., tactile) interfaces are used in training surgeons
and even in certain types of surgery.
Let’s consider how these trends will manifest themselves over
the next decade: it is now the year 2012.
Computers have essentially disappeared and are no longer contained
in little rectangular boxes. Personal computers have become, well,
very personal. The computer “display” is now built into
the user’s eyeglasses and contact lenses, which paint images
directly onto the retina. Similarly discreet devices provide two-way
auditory communication. We are plugged into the Web at all times
through very high bandwidth wireless connections. And all of the
electronics required are built into our eyeglasses and woven into
our clothing.
Virtual displays (created by the “direct eye” displays)
hover in the air (and can be seen through) as we walk around. Alternatively,
these display lenses allow users to enter full-immersion virtual
reality environments, where they can interact with other people:
patients, other doctors involved in a case, and remote medical experts,
none of whom need to be physically proximate. Specialized haptic
devices even allow physical examinations from afar. It’s now
possible for medical technicians with relatively inexpensive equipment
to bring health care to remote areas.
Doctors routinely train in virtual reality environments that simulate
the visual, auditory, and tactile experience of medical procedures,
including surgery. The virtual environments allow interacting with
physically remote patients, but simulated patients are also available.
With a simulated patient, a medical student (or a physician taking
a continuing medical education course, or even a high school student
learning what it’s like to be a doctor) can engage in a complete
simulated doctor–patient encounter, diagnose a condition, and
recommend a treatment. He or she can then fast forward to the next
encounter with that patient (which can be a few—simulated—hours
or months later) and see how things turned out.
Microchip-based protein and gene analysis systems allow thousands
of tests to be rapidly administered in a doctor’s office as
well as at home. Computer-based pattern recognition is routinely
used to interpret imaging data and blood cell analysis. The resolution
and bandwidth of noninvasive imaging technologies have greatly improved
and are used ubiquitously, with diagnosis involving a collaboration
between the human physician and a pattern-recognition–based
expert system.
Lifetime patient records are maintained in computer databases,
and trend analyses for critical medical variables (e.g., blood pressure,
hormone levels) are readily available. Privacy concerns about access
to these records (as with many other databases of personal information)
continue to be a major issue.
Doctors routinely consult knowledge-based systems, which provide
automated guidance, access to the most recent medical research,
and practice guidelines. Practice guidelines are implemented as
expert systems that provide automated suggestions and not just as
written documents.
As a doctor examines a patient (who may be hundreds or thousands
of miles away), he or she views well-organized displays of relevant
information on always present visual displays. All of the currently
relevant examination and test data are displayed (and seen hovering
in the air), as are all relevant trends. The doctor interacts with
this invisible computer either by speaking to it or by manipulating
a special handheld device. In addition to patient data, the doctor
can see tentative diagnoses and treatment recommendations from the
automated diagnostic and practice guideline systems. If the doctor
wants to share certain information with the patient (e.g., “look
at how your blood pressure has improved over the past week”),
a relevant graph or other display can be sent to the patient’s
own computerized display. Commands to the computerized systems to
accomplish these tasks can be given in natural language voice commands
(e.g., “send blood pressure graph to Sally”), or, when
the doctor wants to communicate with his or her own computer display
discreetly, a handheld communicator could be used.
The bioengineering revolution, which was only coming into its own
in 2002, is now in full swing. The toll from the major killers of
2002—heart disease, cancer, stroke, diabetes—have been
greatly reduced, and these diseases are becoming manageable chronic
conditions. Anti-aging treatments are becoming available, and bioengineering
now appears to be extending the human life span by more than a year
every year.
Surgery now typically uses a virtual reality system that allows
the surgeon to view a site of surgery that is inside the patient
from outside the patient. The virtual reality system can also greatly
increase the apparent size of the surgery site. For example, tiny
nerves and blood vessels can be made to appear tens or even hundreds
of times larger, so that the surgeon can use large physical movements
to control very small precise movements of robotic manipulators
that are in contact with the patient’s tissues.
Neural implants for sensory disorders (e.g., improved cochlear,
auditory cortex, and retinal implants) are widely used, as are neural
implants for certain neurological diseases such as Parkinson’s
disease and a variety of tremor-causing conditions. Using the robotic
virtual reality surgical systems, these implants can be introduced
using minimally invasive procedures.
Patients who share medical conditions and concerns frequently meet
with each other in virtual reality meetings. Patients are increasingly
knowledgeable about their own health conditions. There has been
a great deal of consolidation of health-related Web sites, and authoritative
sites that have the confidence of both doctors and patients have
emerged. This allows patients to take increasing responsibility
for their own health and lifestyle choices and allows physicians
to take the role of knowledgeable guides to an increasingly complex
world of medical technology.
@ 2002 Ray Kurzweil.
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