By
Dr Geeta Asthana
Senior Consultant
Fortis Escorts Heart Institute
Okhla, New Delhi 110025
and
Dr. RGS Asthana
Senior
Member IEEE
Figure
1: Health and Technology in 2030 [33]
Summary
Health and technology 2030 [1] refers to healthcare approach at not only exploring
but also exploiting the potential of new technologies useful for improving health of patients by providing best diagnosis and treatment by encouraging
research, education and services in all relevant disciplines of health (See
Figure 1 [33]). Devices to monitor personal health and robot-assisted surgery and
regenerative technologies are hints of things to come provided research in
Artificial Intelligence field progresses in ways that increases the belief of healthcare
players, i.e., doctors, nurses, patients and regulators [2, 11].
mHealth
[28] has great potential to reduce the costs of healthcare, while improving the
quality. The mobile may chime alarms to all relevant people after identifying
disease(s) based on parameters monitored by either directly by it or the healthcare
apps connected to it. It may also advise
treatment and provide all help in ordering medicine or arranging ambulance or
managing doctor’s appointment or admission in hospital based on the seriousness
of the case of the individual.
We describe in some detail use of technology in healthcare,
e.g., 3D Printing; Big data analytics; impact of Artificial Intelligence; Clinical
workflow and pathways changes causing changes in hospital design; use of nanobots
in changing shape of surgery; and exploitation of potential of wearable techs.
A
brief review of status of healthcare in the year 2030 and even beyond (see
conclusion section) is presented.
Keywords
Digital connectivity, Communications, Internet of things, 3D-Printing, Artificial Intelligence, Big Data, Robotics and nanobots, Wearable Technologies , Genomics, mhealth, regenerative medicine, exo-skeletons,
Stem Cell Technology, NanoTechnology,
Prelude
The world has seen an exponential growth in
connectivity over the last five years, and the next five years will bring further
and faster expansion of communication [19]. In fact, today first thing you need
is connectivity to do anything and in next decade connectivity will be taken as
given.
Until
recently, researchers have had only limited success in extending healthcare into
the home environment, yet there seems to be a huge demand for this service. The increasing cost of hospitalization is
making home care more viable and with advent of technology and growth in
connectivity it’s even becoming cheaper as well as effective.
Here
is a possible scenario of how medicine will be practiced in future right from
the birth of a child? At birth (and
later even before birth), a child’s blood will be sampled, put in a gene
sequencer and DNA is analyzed to find out any potential health issues. Future
pediatricians will then calculate a “healthcare roadmap” for the child for next
20-50 years, detailing the exact custom vaccines, gene therapies and surgeries the
child will need to undergo at specific times of life to avoid serious health
complications later on [14].
As
child grows older, the phones, wearable and implants he carries around will
monitor his health always. Meanwhile, implants will analyze his blood for
levels of toxins, viruses, and bacteria and alarm will be raised if any
parameters go outside permissible limits.
All
health data so generated will be shared with patient’s personal health apps,
online health monitoring subscription service, or by local HIE. These services will provide over-the-counter
medication and personal care recommendations to block illness before it fully
sets in.
Review of Healthcare
According
to Cisco [20], Internet
of things (IoT) will have over 500 billion devices connected to the Internet by 2030 and majority
of these are likely be health related devices.
The
following is taken from a list of many of the emerging health information
technologies (HIT) and changes in healthcare practices that may materialize in
time to come [6]. A brief review on the progress in this area is presented
below:
- Electronic
Health Record (EHR), Personal Health Record (PHR), and Mobile Health
(mHealth) will be connected via Health Information Exchange (HIE)
networks. HIE networks will be connected
with other related Industries, e.g. Banking, Security, Manufacturing,
Pharma, etc. mHealth is expected to reach 1.158 billion users by 2020 [28].
Large quantities of data collected by EHR systems will automatically be transferred
to public health data repositories using HIE networks, resulting in
improved public health as well as medical research. The big data technologies
will play major role in developing analytics [18].
·
Healthcare
will not only become ubiquitous but Healthcare information technologies (HIT)
will enable patients to use the healthcare resources & services on a
'7x24x365' basis.
·
The
cost of healthcare will be reduced by using technology [41] e.g.
o
Use of Healthcare Transparency
Tools for comparison shopping by providing meaningful
cost and quality information for healthcare on
an online platform will become popular therefore patients will
make value-based healthcare decisions;
o
Remote Monitoring Systems will generate real-time
data which will be swiftly accessed by all healthcare providers including
nurses, doctors and even patients,;
o
“Virtual Doctor Visits” through Tele-health and telemedicine will be common as these enable two-way
interactions between a patient and a physician by live video conferencing
technology;
- On-line Health Condition Management
Programs will use online tools that help you manage your medical
condition from home; such
solutions already exist in some countries to enable monitoring of health
of old or immobile people; Home healthcare and self-care will grow dramatically
over the coming decade;
- The length of stay (LOS) in the hospital will become shorter with time. The hospitals will become smaller and specialized. There will be larger area for handling emergencies and less area for patients staying. All this will happen as cost of hospitalization will become very high and thus home care will grow and development of new clinical workflows and pathways; and
o Medical Billing
Management Apps will exploit technology to make aggregatingand viewing health claims, insurance information, and medical data easier than
ever before.
·
New User
Interface (UI) will be offered, e.g. Wearable Systems and Google Glass. These
devices could have a major effect on the daily clinical routine and business
practices of clinicians.
·
Personal
health applications fixed to clothes or beneath the skin sending back constant
streams of data to medical centers and providing for real-time alerts or
diagnoses. New wearable body sensors that capture continuous physiological data
streams will become widely available for use by 2020. This market will continue
to grow substantially through 2030.
·
There
will be a wide range of major advances in biotechnology as both Singapore and China
are doing massive investments in this area besides US; Nanotechnology (which deals with dimensions and tolerances of less
than 100 nanometers [26], especially the manipulation of individual atoms and
molecules.); diagnostics, health information
technologies, stem cell treatments [27], genomics, human augmentation solutions
and much more. We’ve already seen enormous impacts from genomics in
medicine, especially cancer treatment, where we’ve started to treat
tumors based on their genetic makeup rather than the organ in which they are found, like the breast or the prostate. By 2031,
these techniques, along with other new treatments, like immune-therapies which help the body’s own defense to fight tumors, will
make cancer a highly treatable disease [23].
- Neuro-pharmaceuticals [7] (a drug used
to treat neuro-psychiatric, neuro-psychological or nervous-system
disorders) will allow people to maintain concentration for longer periods
of time or enhance their learning abilities.
·
By 2030,
medical decisions and treatment will continually improve as they become
based on greater access to better data and health information.
·
Nanotechnology
& Implantable Health IT Systems interfaced to EHR and PHR Systems will
become a reality by 2030 or even earlier.
·
A range
of new medical Robotic devices will be interfaced to Health IT (HIT) systems by
2030. The 'Internet of Things' [20] is the network of all the devices
including these. There will be trend to embed
intelligent processors into almost every possible device, will continue to
proliferate – especially in a wide range of devices related to health and
fitness.
- The utilization of the
enhanced clinical pathways [21], in managing care, will be an effective
method to monitor the process of acute clinical care in patients
undergoing primary total joint replacement surgery.
- Today in India when a surgeon
opens up a patient for surgery he may find more complications then he has
envisaged earlier. These situations will become things of past as surgeons
will have better and intelligent diagnosis.
- Synergistic
technologies such as computer processing power and big data storage and
analysis will be important for managing the huge amounts of data gathered
by genome sequencing. The field of
'predictive medicine' – an emerging area where we will know the diseases
to which an individual is utmost susceptible [15] – will grow as the
development of new genomic information systems spread and evolve. When the human genome was first decoded in 2003, the cost was $3 billion.
By 2030, we can expect sequencing of a full human genome to cost under
$100 [23] as on date it is about $1000 [22]. That exponential reduction in
cost will create new worlds of possibility.
- Germline [30] genetic modification is
a form of genetic engineering which involves changing genes in
eggs, sperm, or very early embryos. This type of engineering is
inheritable, meaning that the modified genes would
appear not only in any children that resulted from the procedure, but in
all succeeding generations. The
other similar technologies like cloning and stem cell research will raise the possibility of a new
class system, discriminated only by those possessing the ability to
“enhance themselves and their offspring” versus those who can't do so.
- The
field of Regenerative medicine which deals
with the "process of replacing, engineering or regenerating human
cells, tissues or organs to restore or establish normal function”, in fact, is a
branch of translational
research in tissue
engineering and molecular
biology [8, 29]. It
will advance rapidly and complete
organ replacements grown from stem cells, e.g., replacement organs, such
as kidneys and livers, may be developed by 2030 and humans may get these
implants. 3-D organ printing is a major possibility besides many new
scenarios including teeth regeneration; cures for hearing loss; limb
replacement, biomedical devices, nanobots [16] may also materialize.
- Research in Medicine will enable doctors to
customize drugs for their patients based on their genetic make-up in next
5 years.
·
Use of
'Social Media' in healthcare will also be one of the other major growth
areas for the healthcare industry in the coming decade.
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Status of Major Technologies
A carpenter or an architect may have a standard
toolset but what he does with it depends
on individual’s expertise. Similarly, technology only provides tools to process
but the domain knowledge restricts the use of technology toolset (which also is
improving day by day) but as and when the right domain knowledge is developed,
we will get wonderful results by use of technology. We describe here a few major technologies
which are likely to have major impact on the medicine and healthcare as it is
practiced today.
3D printing [3, 4]
The price of the cheapest 3D printer today is about $400 which
used to be $18,000 say, 10 years before. It not only became cheaper but also 100 times
faster during this period. Physical objects are “printed” from raw
materials via additive, or 3D – printing: It allows for printing products at
home and creates a whole set of human health opportunities.
One
day, 3D printers may create not only things, but also human organs – looks like
a difficult preposition today. The material used to print an organ would
obviously be different from what is used to print a bike, and one needs to find
out what kinds of materials will work, such as, titanium powder for making
bones. The process is called
“bio-printing [3, 4].” However,
all bio-printers output cells from a bio-print head that moves left and right,
back and forth, and up and down, in order to place the cells exactly where
required. Over a period of several hours, this permits an organic object to be
built up in a great many very thin layers. In addition to outputting cells,
most bio-printers also output a dissolvable gel to support and protect cells
during printing. 3D printing has
great potential to service custom design needs. It is true that there is
nothing more custom than a human body.
Artificial Intelligence or AI
An AI intelligent system using natural language
processing, ontologies and reasoning can be effective in gathering and
extracting information from large data sources and has the ability to identify
the cause and effect within data. Computers become exponentially better in understanding
the world.
However,
along with advances in technology, the latest strategy for AI developers has
become [5], “Don’t model the world but model the mind.”
Since 2012, a specific machine learning technique called “Deep Learning”
has permeated the AI world. Researchers have abandoned the classical
programming tricks-style of AI and switched to deep learning, because it works
far better than any previous methodologies. Thus, we have made progress on several
key AI problems, viz., image understanding, signal processing, vocal
comprehension, and understanding text.
Although, “Deep Learning” is far from true AI as it does not take us
even close to adaptable intelligence human’s show, but it certainly is a step towards
getting there.
IBM
researchers with U.S. military funding developed a new computer chip based on
neural computing that could revolutionize everything from smartphones to smart cars and also approach the
computing capabilities of the human brain someday [34]. AI inspired films such as Blade Runner and
The Terminator, were in limelight again and as per Dr. Kurzweil [35] - one of
18 maverick thinkers, ”Machines will rapidly overtake humans in their
intellectual abilities and will soon be able to solve some of the most
intractable problems of the 21st century.”
More recently, Apple
developed SIRI – a personal assistant - for its iPhone followed by Google in
developing its own assistant for it’s Android OS. Looking ahead, we can expect our personal
assistants accessible to us 24/7 and capable of fully responding to natural
language, including colloquialisms and our personal idiosyncrasies as well as
you can have conversations with them. In
short they will be tuned to our habits so they can write as well as read our
emails, book appointments, perform menial thought tasks, and even anticipate
our needs and last but not the least analyze our health data collected in
health apps of the mobile and make prediction about possible diseases as well
as solution thereof and even order medicines from the chemist. Of course, we
will be able to assign the degree of autonomy we give our mind clones.
The Human Brain Project (HBP) has successfully overcome its initial difficulties [36] after
getting major funding from European commission. Scientists have developed the first high-definition 3D
model of a complete human brain - it is called BIG BRAIN and is part of HBP. Just imagine being able to surf through the
brain and its 86 billion neurons - well now you can!
The
key difference between Europe's HBP and the U.S.'s BRAIN Initiative is that the
latter does not depend on a single scientific vision. Instead many teams will
compete for grants and lead innovation into different, unplanned
directions. Use of Big Data techniques may make Europe's
HBP a perfect complement to ‘BRAIN’ initiative of United States - a well-funded neuroscience initiatives - focusing
on techniques development. China and Japan also
started a brain-mapping project mainly for Disease Studies [37, 38].
Our brains will be directly connected to the Internet
in the next 15 years, making us, “hybrids,” one artificial intelligence pioneer
predicts [16]. An
environment can be planned in the future where AI based tools replace a range
of functions performed today by the people.
Big Data and Analytics [18, 25]
Big data is a term for data sets that are very large or complex that traditional data
processing applications are insufficient to deal with. Big data analytics is the process of examining large data sets to
uncover hidden patterns, unknown correlations, market trends, customer
preferences and other useful business information.
The sources for data in healthcare are mainly EHR, Genomics (include DNA
sequences), behavioural (includes Social
net and Mobile sensor data) and public health resources; Big data tech enable
doctors to get a better evidence and insights at not only at a cheaper cost but
also enables improved outcomes through smarter decision making. Based on
analytics, healthcare
providers can develop new strategies for care of patients, reduce the number of
unnecessary hospitalizations and improve the health of patients while
decreasing the costs of care.
The consequence of not
using right technology to analyze data results in hospital re-admissions within
30 days of a previous discharge which happens in 20% of all cases in US. This
is not only expensive but are also potentially harmful, and most importantly,
they are often preventable. Identifying patients at risk of re-admission
can guide efficient resource utilization and save
millions of healthcare dollars each year. Making meaningful predictions from complex
hospitalization data through information extraction, feature selection and
predictive modeling will only be possible by using Big Data and analytics.
Healthcare
Industry is generating massive quantities of data and big data technologies
have potential of supporting a wide range of medical and healthcare functions,
including among others clinical decision support, disease surveillance, and
population health management.
Robotics and
Services
Robotics
is beginning to influence many jobs, from manufacturing to agriculture, and
retail to services. According to the International Federation of Robotics, the
world now includes 1.1 million working robots, and machines account for 80% of
the work in manufacturing a car. 22 Robots are streamlining supply chains to
deliver more efficient and predictable business results. Robotics could make the surgeon’s
scalpel a thing of the past by 2030 [12]. This will reduce by a great margin in
future almost 5,000 injuries and more than 300 deaths in the year 2013 which
happened mainly due to faulty instrumentation. Figure 2 shows a robot covered with
sterile material in a operation theatre.
The first robotic pharmacist in the US is expected to be available by
2021. An i.v.-compounding robot [see figure 2] was
successfully implemented in a cancer center and has been integrated into the
pharmacy’s workflow at the Taussig Cancer Center of the Cleveland Clinic [13].
Nano-robots or Nanobots are becoming more popular now
as scientists now put them inside living organism. Nanobots injected into humans could yield a
possible cure to leukaemia. International team of scientists is working on nanobots that
could unclog arteries [17]. It’s a surgery
performed by tiny micro-surgeons. The surgeons, called Nanobots, are really
tiny groups of magnetically charged particles that band together to break up
clogged arteries. The surgery is planned in two steps the first being delivery
of drugs to soften the blockage and second is nanobots charging into battle,
drilling in to blast heart blockages apart. These nanobots could be
biodegradable so will disappear with time. Besides the above nanobots may do a
lot more.
Figure
2: A robot covered with sterile material in a operation theatre
If you think only about above it is sufficient to change the
complete picture of heart treatment including medicine, surgery and
angioplasty.
Wearable Technology
With the growing aging population [9], dominance of
chronic diseases, and rising healthcare costs, the healthcare system worldwide
going through a major change, from the hospital-centered system to an
individual-centered system. This is mainly brought through recent developments
in wearable medical technology enabling not only the accessibility but also the
affordability of healthcare so that critical parameters as well as the biochemical
variables of the patient can be monitored continuously for extended periods of
time, making early disease detection and timely response to health threats
possible. The wearable technology will be available in form of intelligent
biomedical clothing forming body area networks for communication of the data to
the healthcare providers.
As per SNS research report [10, 11] wearable device
shipments is likely to grow at a compound annual growth rate (CAGR) of 29%
between 2016 and 2020. By 2018 and 2020, wearable devices market will be worth
$12 and $40 billion respectively. Leading
smartphone OEMs, Apple and Samsung are already in smart watch market with a
combined share of nearly 75%. New business models will emerge, particularly, in
the enterprise space. More than 56 million Health and fitness related wearable
devices will be used by people by 2018. The key emphasis in smart watch and
medical bands is on health applications only.
Status of Healthcare beyond 2030 in brief
Given below is a brief scenario of health beyond 2030:
- Medical science will one day solve the mystery of common
chronic diseases like cancer, atherosclerosis causing heart disease and
stroke, diabetes, and age-related dementias like Alzheimer's disease [32].
·
Regenerative medicine is one of the fastest
growing biomedical industries in the world [8] because
patients are being cured of diseases that were once incurable [29]. Regenerated
organ's cells would be derived from the patient's own tissue or cells and this
approach will easily circumvent the problem of organ transplant rejection.
·
Body-worn
technologies will be popular but will have potential for serious misuse. Human augmentation covers a wide range of
technologies from implants and prosthetics to powered skeletons. Elderly people as well as disabled people
could ultimately benefit from powered exoskeletons that assist wearers with
simple walking and lifting activities. There are number of companies making
exoskeletons and a list of manufacturers is given in [24]. Improvement in battery technology will make
it possible to develop longer-lasting batteries which will improve viability
and practicality of use of exoskeletons [31].
·
Prosthetic
limbs have now reached the stage where they offer equivalent or slightly
improved functionality to human limbs even today. Prosthetics will eventually
be directly integrated with the user’s body.
As replacement limb technology advances, people may choose to enhance
their physical selves, much as they do with cosmetic surgery today.
·
Progress in the neurosciences will be critical for the
development of future brain-machine interfaces. And advances in flexible
biocompatible electronics will enable improved integration with cybernetic
implants [31]. There is
possibility of transplant of head and its implications could be very
interesting.
Conclusion
Global population is expected to
even out at around 10 billion people by 2050. It is expected that approximately
70% of the world's population will live in cities by 2050 primarily due to
better healthcare support and availability of jobs. This will put significant
pressure on the infra including energy, food, water resources and also
healthcare.
This paper does not discuss the
environment issues mainly like clean air or clean water or climate changes in
the world by 2030 which may cause major health concerns.
Detection
of diseases at early stage will be thinkable by use of Big Data technologies in
healthcare, so diseases will be treated easily and efficiently. Numerous
questions regarding healthcare can be addressed with big data analytics
[18]. With time, Big data analytics in
healthcare is evolving into a promising field for providing insight from very
large data sets and improving outcomes while reducing costs [25].
SNS
Research estimates that by the end of 2016, mHealth could represent up to $340
Billion in annual healthcare cost savings worldwide [28]. Think of mhealth gaining
more spread as well as popularity with many more new apps and potential savings
by end 2030?
It is worthwhile knowing that social media and public domain
data can also sense public health. Patients will need to carry responsibility
to improve their health by taking keen interest. Similarly, every health professional
must have strong performance records and be capable of achieving the best
outcomes. Use of 'Social Media' in healthcare will also be one of the other
major growth areas for the healthcare industry in the coming decade.
AI today has potential to gently,
gradually and ubiquitously redefine our association with technology to enhance
human capacity, longevity and, primarily, how we live [40]. By 2030, we will have right and relevant technology solutions
to develop new approaches to health-care and also its delivery at reasonable
cost maintaining quality. Use of
'Social Media' in healthcare will also be one of the other major growth
areas for the healthcare industry in the coming decade.
References
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[2]
Stanford-hosted study examines how AI might affect urban life in 2030
[3] Bio printing
[4] Organ Printing
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Artificial Intelligence Improve Democracy or Destroy It?
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hold for Healthcare and Health IT – From 2015 thru 2030 and Beyond
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Verticals and Forecasts
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RGS Asthana, Senior Member, IEEE
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i.v.-compounding robot in a hospital-based cancer center pharmacy
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Avoiding a Medical Meltdown
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Kurzweil: Human Brains to Fuse with Nanobots, Become 'Hybrids' by 2030
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Stop the No. 1 Killer in America
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data analytics in healthcare: promise and potential
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Worlds
[23] 5
Technologies For 2031 http://www.forbes.com/sites/gregsatell/2016/08/12/5-technologies-for-2031/#79f933bf543b
[24] Exoskeleton report
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[26] Nanotechnology
[27] What Is Stem Cell Therapy And
Why Is It The Future of Personalized Healthcare?
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Ecosystem: 2015 - 2030 - Opportunities, Challenges, Strategies & Forecasts
[29]
Regenerative Medicine: Could This Be Healthcare's Saving Grace?
[30] Germline
[32] Health: Charting New Plagues Like Predicting the Weather
[33] Image
in Figure 1
[34] IBM's Brain-Inspired Computer
Chip Comes from the Future
[35] Computers 'to match human brains by 2030'
[36] The Human Brain Project and the
Graphene Flagships are moving ahead to the next stage of their 10-Year Voyage
[37] Why the Human Brain Project
Went Wrong—and How to Fix It
[38] Brain/MINDS: brain-mapping project in Japan
[39] The Cancer Surgeon’s Latest Tool: Quantum Dots
http://spectrum.ieee.org/biomedical/imaging/the-cancer-surgeons-latest-tool-quantum-dots?utm_source=Tech+Alert&utm_medium=Email&utm_campaign=TechAlert_10-13-16&bt_ee=czXGaEkc6KRkANFlsDcZ+DOwIWdquudsu/6jX4ZXHLL+3xzU0Kdgc0J77SIha78S&bt_ts=1476367339517
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