The future of hospitals, medicine - and the health of all of us

The patient was rushed in a wheelchair to the emergency room at the hospital, with her eyes wide open in terror and struggling to breathe. A few weeks before she was hospitalized and diagnosed with pneumonia. Doctor David H. Newman, the attending physician, described her in the following words in a published article in the New York Times -

"Her arms were covered in red and purple bruises, the product of daily blood tests; Her face was emaciated; Her lips were dry. According to her husband, while she was in the hospital she rarely slept and did not eat well. She lost weight.”

When the patient arrived at the hospital's emergency room, Newman examined her and discovered that the pneumonia was long gone. Her lungs sounded clean, but the suffering and difficulties she experienced in the hospital clearly affected her. Newman believes that they led to a new type of syndrome - "post-hospital syndrome".

Doctor Harlan M. Krumholtz, a professor of medicine and public health at Yale University, first recognized the syndrome and gave it its name In a study published in 2013 In the prestigious New England Journal of Medicine (NEJM). According to Krumholz, the patients are unable to sleep well in their rooms, do not enjoy the food they are used to in their homes, are unable to engage in physical activity and suffer from isolation from their loved ones, acquaintances and workplace. Although the hospitals provide great physical proximity to the doctor and emergency medical services, they also make it difficult for the hospitalized to recover from the disease.

What is good, then, that the hospitals are reduced in their roles and in the number of hospitalized patients they receive. The trend can already be seen today: Report of the Medicare Payments Advisory Committee From the last year reveals that between 2008 and 2014, the number of hospitalized patients in the United States decreased by eight percent, while the number of visitors to outpatient clinics increased by 32.9 percent.

In the prediction I will describe in this entry, it seems that as a result of several technological trends that will integrate and reinforce each other, hospitals will become less and less relevant for the majority of patients in the coming decades. They will not disappear completely, but most citizens will be able to avoid visiting them, or at least being hospitalized for a long time.

In the rest of the post I will briefly review the various technological trends that will affect the future of hospitals. If they seem familiar to you, it's for a good reason: these trends are so powerful and significant that they affect every area of ​​our lives, so you must have been exposed to them in other places as well, and certainly in previous entries on this blog. It is precisely for this reason that we need to take them seriously, because they will surely also affect the future of medicine and hospitals. I will show how they can influence in these areas and further some of the functions of the hospital, and finally I will ask what will be left for these institutions in the future.

First technological trend: connectivity and sensing (the Internet of Things)

The world is getting filled with sensors of all kinds, big and small (mostly small), and many of them are linked to what is known as the "Internet of Things". The Internet of Things connects all these sensors and allows us easy access to them and a quick way to cross-reference information that did not exist before.

How big is the Internet of Things? There are assumptions that by 2020 we will reach a number of 200 billion objects to be connected to the Internet of Things. Even under the lowest assumptions, by 2020 each person is expected to own 6.3 connected objects on average. Most people, especially in developed countries, will own even more connected objects.

But what kinds?

The most important health-related objects will surely be those that fall into the category of wearable computing. We will carry them wherever we go. These include Smart shirts, Smart Watches, smart rings, smart shoes, Smart belts, smart glasses and even Smart hats. And when I write "intelligence" I mean it in the full sense of the word: we are going to embed sensing capability, connectivity and limited artificial intelligence in many of the objects we carry on our bodies. In fact, we are about to instill "wisdom" in them and give them the ability to alert us to any future changes in our physiological state.

The second important category will be that of ingestible and skin computing. This category includesProteus company's balls, which include a sensor and a transmitter and are able to report the state of the drug inside the stomach and intestine, and the tattooed sensors (don't worry, this is a tiny transparent sticker attached to the skin, not a tattoo etched into the skin) that can transmit messages about what is happening in the body.

The third main category will be the home sensors, and especially those that are starting to appear in homes for other general uses, such as the Kinect (a smart camera connected to the Internet), Amazon Echo and Google Assistant (a smart microphone connected to the Internet), home robots and more.

All these sensors will provide a level of surveillance that can only be found today in the most sophisticated hospitals. But beyond that, they will open a window to a new model of medical monitoring that will include all human beings.

At this point, the skeptics and wearable computing experts usually respond, explaining that young people and healthy people are not enthusiastic about buying devices that will monitor their health. That's true, but those experts miss the point: in the Internet of Things world, All objects will be smart. Every young person will carry a smartphone in their pocket, an electronic tattoo on their skin, and will enjoy the services of computerized assistants and robots in their homes. And all of these will listen to him all the time and assess his health status automatically. The big question is not whether people will purchase health monitoring devices, but what is the marketing and economic model through which the insurance and medical companies will be able to get people to volunteer the information read on those devices.

We can learn about the future economic model of these companies from the story of Nokia and Wise in the first decade of the 21st century. Nokia tried to gain control over the information market coming from the roads by placing large, expensive and sophisticated sensors at every intersection. Wise tried to do the exact same thing, but she assumed that in a few years everyone would have smart phones with portable GPS receivers, and would want to share every incident on the road with each other. In other words, Wise realized that when everyone is purchasing end devices - even if for other purposes - it can take advantage of them and concentrate on software development and service provision, rather than purchasing, installing and maintaining the expensive and cumbersome physical hardware.

The story of Wise and Nokia is about to repeat itself also in the context of the hospitals. Many of the services provided by these expensive, slow and outdated institutions will not be able to compete with similar services that will be provided by medical companies and information to citizens, and that will rely on the devices they already have in their homes and on the body: small, cheap sensors, and most importantly - that the customer has already purchased and uses them for various needs.

The trend of artificial intelligence development

We are, therefore, about to enter a world full of sensors. These will flood us with information - more information than today's doctors can use. Fortunately for us and for them, they will not be responsible for analyzing, processing and drawing conclusions from this wealth of information. This role will be played by Watson-type artificial intelligence engines and the like. Already today, Watson is able to diagnose and provide medical recommendations that match those of talented and experienced human doctors in the field of cancer - but it reaches these conclusions in a matter of seconds, while they need long hours of reading medical literature and medical documents to reach the most successful determination (we think).

We are seeing Watson's successes begin to reach the awareness of the medical community. In August 2016, he was able to correctly diagnose an unusual type of cancer in a Japanese woman, which had eluded doctors. He did it in just ten minutes, and while he relies on the twenty million medical studies he has gone through, and at the same time offers an appropriate treatment plan. In Germany, Watson is currently being used to diagnose rare diseases, in a medical institute designed to treat patients for whom the normal medical system is unable to decipher the causes of their illnesses. Some of the lucky patients who come to the institute have already gone through forty previous doctors who could not understand what they are sick with. The doctors at the institute have to go through thousands of pages of medical records of each patient and try to solve the mystery. Is it any wonder that the waiting list for the institute's services reaches the length of 6,000 patients? But now the institute is starting to use Watson's services - and initial tests already show that it is manages to reach similar conclusions Like those reached by entire committees of doctors at the institute.

I am not trying to claim that Watson - or any other artificial intelligence engine that provides diagnostic and medical consulting services - does not make mistakes. Of course he is wrong, just as human doctors are confused, wrong, or simply not exposed to the most up-to-date medical information on the same level as Watson. And anyway, human doctors areDear: You have to teach and train them for decades, provide them with an office and a secretary, pay them high salaries and more. But even more than that, they are limited in time. By virtue of being human, they can go through a limited amount of documents and patients per day. The artificial intelligence is not expected to have similar limitations, and the meaning is that any of us who agree to link the sensors on it to the Internet of Things and give the artificial intelligence access to them, will be able to benefit from constant and regular monitoring and medical advice - every minute, in fact.

https://www.youtube.com/watch?time_continue=116&v=_kH5iXm8P5I

The artificial intelligence known as Vi: contacts the user through headphones, monitors his health condition and provides him with recommendations regarding the best physical activity for him. Of the company LifeBeam (with a development center in Israel)

Artificial intelligence, therefore, will bring us to a world where medicine is no longer a service separated from our daily lives. We will not have to make an appointment at a health fund or wait for a doctor to diagnose us. Instead, the computerized medical advisors will provide us with an opinion every morning regarding our medical condition - and this without us having to waste time at all visiting the clinic or the hospital.

The trend of robotics in homes

Home robots have turned from science fiction into reality in the form of the Roomba and the iRobot - the small robotic vacuum cleaners that run around in many homes today. Now, thanks to the impressive developments in the field of artificial intelligence and sensors, we are starting to see new and impressive types of home robots. From robots equipped with a projector with which they can add meaning and color to walls, surfaces and even objects in the house, to 'sensitive' robots that are able to understand the emotional state of their owners and react accordingly.

The most important robots for medical purposes are those that can treat patients in their homes. Molly is one of these, for example, which is based on two human-looking arms and hands, and is able to cook thousands of different dishes with maximum precision. Molly should reach the market in 2017, with an estimated cost of about 15,000 dollars, and you can prepare even patients with disabilities their favorite dishes. Another impressive robot recently demonstrated was Boston Dynamics' Spot-Mini, which looks like a friendly little dog - with a robotic arm coming out of its back. Spot-mini can go up and down the stairs, walk around the house, and even put the dishes in the dishwasher using the arm. And of course, even robots that will carry the patients around the house are now in advanced stages of development.

When the robots in homes will be developed enough, there will no longer be a need for one of the central important functions of the hospital: providing constant care for the physical needs of those hospitalized who cannot take care of themselves. Robots will not reach a high level in the next five years, but in ten or fifteen years we are expected to see really sophisticated robots arriving in almost every home.

The trend of rapid production

In the previous post, I touched on the future possibility of producing medicines at home. This activity is still far away, and more importantly - it will be limited in terms of the law, so it will be forced to take place under the spotlight for a large part of the drugs. However, machines (and possibly robots) will be able to produce cookies, creatives and sweets containing different combinations of active substances in different doses, depending on the patient's physiological condition. The machines will operate using cartridges of food and medicinal substances, and will combine them together according to doses determined and controlled by the doctor.

Such machines are especially important for chronic patients who have to take dozens of different pills a day. Since they will also be connected to the Internet of Things, they will be able to balance the required doses automatically every hour, and without the involvement of human doctors. The meaning, in practice, is that giving pills in the usual way will become primitive and crude medicine, which does not adapt itself optimally to the patient's needs. Basically, exactly as she is today, without a choice.

The trend of fast transportation

If you've been reading the blog for a long time, you've probably noticed the constant improvement in the capabilities of autonomous vehicles. When the autonomous vehicles reach the roads in large numbers, we will see a new type of public transportation: cheap, efficient, and requiring a much smaller number of vehicles to meet the needs of the residents. Beyond that, everyone will be able to comfortably use this public transportation, including the elderly and people with disabilities.

Along with autonomous public transportation, we are expected to see two more developments in the next two decades: the entry of drones into the delivery market, and the use of flying taxis. As you probably remember from one of the previous entries, Uber Develops plans to use flying taxis (and more precisely as VTOL - Vertically Take-Off and Landing aircraft) that will be cheaper to use than regular taxis. The flying taxis operate thanks to advanced artificial intelligence that will provide them with autonomy, batteries and electric motors that should provide them with enough power to cross the entire city, and a large number of blades to make sure that even if several systems fail together - the blades that will continue to function will be able to land the vehicle without casualties.

All these tools will start to be used for medical purposes as well. we You can already see the drones today are used for efficient, safe and fast transportation of Medicines and blood samples for hospitals or to isolated villages. Other drones are able to fly at speeds of one hundred km/h and function at the scene as a defibrillator monitor With remote activation by a doctor.

What all these developments mean, when they come to fruition, is that distances in the physical world become less important. Or more precisely, the only distance that changes is the one measured "as the crow flies" - that is, in a straight line stretching between two points on the map. Obstacles, roads, buildings, traffic jams - all of these can be ignored in calculating the estimated arrival time. As a result, services that could previously only be provided effectively when they were held in the same building, will be possible to start providing in the next decade even when they are located in different buildings dozens of kilometers apart. That is, we can start to 'decentralize' the hospital services in the area. Of course, we will not be able to provide all patients with the same level of care in their homes, as they would receive in the hospital, but at least some of them will no longer be obliged to be admitted to the hospital in order to receive emergency treatment quickly and efficiently.

The trend of accurate forecasting

In the last twenty years, the costs of sequencing the genetic code - that is, reading the programming and operating instructions of the human body - have decreased at a dramatic rate. If in the early XNUMXs sequencing the genetic code of one person cost almost one hundred million dollars, then the price dropped to one hundred thousand dollars in only eight years, and today it stands atA thousand dollars only. It appears that the costs will continue to decrease as the number of people who undergo the procedure increases. 23andMe, which provides partial genetic sequencing, already has 1.2 million registered customers, myself among them. Each of us received certain estimates from society - at least before the United States Food and Drug Administration forced it to stop giving medical diagnoses - about the statistical consequences of our genetic code on our health.

In the coming years, anyone who wants to will be able to know what information exists in their genetic code, and accordingly we will be able to provide better predictions regarding their chances of developing certain diseases in the future and prepare for them.

Our forecasting abilities will not be limited only to the long term. Thanks to the Internet of Things and artificial intelligence that is always watching over us, we can accurately predict when people need emergency medical care - in many cases before the catastrophe. We know, for example, for algorithms that receive information from sensors on the patient's body can warn of an impending heart attack Four whole hours before the event. Artificial intelligence engines running on all the data coming from the monitored people will probably be able to report ahead of time on a multitude of other emergency cases.

Given such advanced forecasting capabilities, it seems likely that in the not-too-distant future we will be able to predict accurately and in advance when a person is going to experience a health crisis that will require him to go to the hospital and receive treatments that only the large institution can provide. Other cases could be treated in smaller clinics near the patient's home, or in his own home.

A future without hospitals?

All these trends lead me to formulate a prediction according to which in the next twenty years the role of hospitals will be reduced, and the number of patients in them will decrease significantly. Many chronic patients will receive home care, and will come to the hospital only in extreme emergencies. Others will be able to visit smaller clinics that, thanks to sophisticated robotics and advanced artificial intelligence, will be able to provide medical services at a level that rivals that of hospitals today.

But what will be left for the hospitals to do?

The future hospitals

Even assuming that all the trends I described will mature together, we will still see the hospitals providing a number of services that will be very difficult to replace. I divide these services into several different categories -

1. high cost: Any examination or treatment that involves particularly expensive equipment, such as an MRI, will still be left within the limits of the hospital that can afford to purchase and maintain them.
2. special preparation: The hospital will continue to perform examinations and treatments that require special preparation of the kind that is difficult to achieve in a normal home - for example, surgery that must be performed in a high-level sterile environment.
3. Trauma care centers: In any situation where people are unexpectedly injured - for example, as a result of a car accident - they will surely be sent to the hospital for initial treatment until their condition stabilizes.
4. Fear of immediate deterioration: In cases where there is a fear of deterioration requiring immediate treatment, hospitalization will continue in the hospital.

These, then, will be the hospitals of the future: institutions containing the most sophisticated laboratories and the most advanced medical equipment, but with a much smaller number of patients who will have to leave the comfort of their homes and endure the difficult living conditions in the hospital.

And to tell the truth, this is a future I can hardly wait for.

—

Additional assessments regarding the future of medicine, monitoring, and the way in which part of the medical responsibility will pass to the patients themselves, can be found in my soon-to-be-published book - "The Rulers of the Future: Capital-Government, Technology, Hope" published by Kinneret Zamora. If you want to be updated when the book is published, you can subscribe to the blog in the box on the right.