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Much has been said about the impact of emerging technology on modern healthcare. Many entrepreneurs and investors alike are intent on developing disruptive innovations that significantly improve clinical workflows, enable predictive analytics or enable widescale interoperability. While any of these would represent a significant medical advancement, several factors suggest that an even more far reaching disruption may be coming to healthcare for which these advances cannot prevent. I refer to the ultimate demise of hospitals themselves. Consider for example the following facts. First economic factors, policy and regulatory forces are already leading to less care being provided in the hospital and more care provision in the home and community.  Secondly, retail healthcare outlets are rapidly growing in popularity. They exhibit high levels of patient satisfaction, shorter waiting times, lower costs and care quality that is on par or better than similar care provided in hospital emergency departments. Thirdly, hospitals are dangerous places! It has been well documented in the medical literature that many people who go to the hospital, get sick from illnesses they did not bring to the hospital.  In fact, a recent study found that such hospital acquired problems are so common that they are actually the third leading cause of death! Fourth, advances in the computer sciences and broadband networks are fueling a revolution in medical device innovation that is enabling once large bedside and hospital confined medical devices to become miniaturized, handheld, ingestible, wearable, mobile and operable anywhere there is a broadband connection. In fact, some people who 20 years ago required stays in the Intensive Care Unit followed by lengthy hospitalizations prior to discharge are now are able to go home with small portable devices that do the work the ICU based machines did just 2 decades ago! Fifth, advances in robotics are now enabling surgeons located in one place to operate on patients located across town or across the globe. The spectrum of surgeries performed this way will likely increase in the future. Sixth, advances in telemedicine and telehealth are enabling physicians to see, talk to, examine and monitor their patients remotely, lowering the need for inconvenient visits to the doctor’s office or unnecessary visits to the ER or hospital. Seventh, hospitals were in part developed to centralize resources thereby reducing financial costs or improving opportunity costs. In the future, it may do neither. Finally, the emergence of artificial intelligence, and cognitive computing is providing unprecedented levels of data tracking and analytic capacity enabling the generation of insights that are instantly available to medical providers, patients and caregivers alike.

Given these realities then, why would patients, in the future, ever choose, to stay in a hospital? Why would payors insist that covered beneficiaries obtain care in high risk hospitals when lower risk and lower cost options with comparable outcomes are available? Obviously, they wouldn’t. While we are not there yet, it will not likely take 20 years for us to get there. It may not even take 10 years. There is a coming bloodbath for hospitals, as we currently know them. Only those systems that proactively embrace the opportunities these realities portend and innovate on the very notion of what a hospital is and does, will ultimately be able to survive.

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Recently a group of researchers from Microsoft and the University of Cambridge announced the development of a program called DeepCoder. Deep Coder is a combination of an Artificial Intelligence System and machine learning system that can write its own code. Currently, the system is only able to write relatively simple programs, but the developers envision a day when anyone can simply tell DeepCoder what they want and it will then write the code to accomplish the requested task within seconds and without error!

The implications of this technology are simply profound and absolutely disruptive!

Today, much has been said about the potential of using IBM’s Watson supercomputer to solve challenging societal problems across diverse sectors such as security, finance and healthcare. However, to get the benefit of Watson, you have to be able to pay IBM to use the platform. According to recent reports, you will likely have to be able to pay a huge amount of money! (See MD Anderson benches IBM Watson…) Microsoft’s DeepCoder on the other hand, offers the potential, if placed in the hands of consumers, for almost anyone, anywhere and at anytime, to recognize a need or problem and have a working solution developed for it “On Demand”. As the authors point out, this is not meant to replace current infrastructure or personnel, but to augment and enhance current abilities.

In the health sector, the opportunities are almost endless, particularly if we think across the entire care continuum from wellness, to diagnostics and therapeutics, through recovery, chronic disease management and end of life care. Through this system, every problem essentially becomes a “Big Data” problem for which the appropriate code can be written to address the problem!

For busy clinicians trying to understand the potential implications of a new drug for a patient in the office, rather than scheduling a second visit with the patient, prior to which he/she would review a number of textbooks and other digital/print resources in order to make an evidence based opinion, DeepCoder could, write a program that searches the over 26 million research studies available in the National Library of Medicine’s PubMed database, determine which studies apply most closely to the current patient, synthesize the findings from the most relevant studies and print a one page synopsis and recommendations for the patient regarding the best initial dose, on the desktop printer sitting next to the doctor, for his review, faster than the patient can get undressed.

For the aging senior who is diabetic, hypertensive and lives alone, her adult son, who lives in another state, could tell DeepCoder to find the highest quality senior care day program, that offers door to door transportation, meals and is willing to dispense medications, that has an immediate opening and fits within his budget. Since both he and his mother have an Amazon Echo, he could simply tell Alexa what he needs and she then tells DeeepCoder.  A few seconds later, once the program is written, Alexa could then use it as a new personalized “skill”, execute the task, complete the online application after her son’s approval, schedule the in-person interview and send the required down payment to the Senior Care center in advance of the meeting.

While these examples are exciting, they are not yet possible. However it is also true, that is likely only a matter of time before these or something even better become reality in healthcare!

 

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For some, the idea of technology helping to improve healthcare is exciting, to others not so much. Robotics in surgery is one exciting (or scary) area in medicine where technology has been advancing very quickly. In the past, robots have assisted surgeons in performing complex operations, helping to minimize pain and recovery time while improving satisfaction and outcomes. Now, surgeons in Washington DC have demonstrated that robots may soon, operate by themselves, without any human assistance! Look Mom, No Humans involved in my surgery!  This is both exciting and daunting. Think about the possibilities for increasing access to surgical procedures, in areas were there are not enough surgeons. Wide spread use of autonomous surgical robots could significantly reduce wait times to obtain critical operations or by combining the robots with telehealth infrastructure, potentially enable anyone, anywhere to receive surgeries they need, any time of day or night! In the future, these robots might even be cheap enough and small enough to fit into ever single home. Imagine, going to your bathroom, bedroom or man cave to have your next surgery! Right now the AAMC is projecting huge physician shortages of up to 90,000 physicians overall and specifically 31,600 surgeons in less than 10 years!

But what about the down sides?  What happens when something goes wrong and there is no surgeon involved in the operation? Even if it happens in a hospital rather than a home, who is responsible for the problem or fixing the problem? What if the problem is caused by an electrical failure or intermittent broadband service? Should the public utilities companies or telecommunications providers and ISP’s be at least partially liable? If you believe these problems are so significant that we should not go down this road, then how will we fix the base line problem of significant surgeon shortages in the next decade and beyond? We can’t build medical schools or increase the number of medical school graduates fast enough to compensate for those currently retiring, much less to make up for projected deficits! No matter what we feel about the potential risks associated with advances in medical and health technologies, it is certain that they will be a part of the future of health in America and across the globe. The Robot will see you now!