Walker Land, Dave Schaffer, Michael Hultner

1. Topic 1: Overcoming Massive Cost, Complexity, and Non-Coordination Problems in Current Health Care Systems—the Serious Challenge We FaceTopic 2: Discussion of important futuristic health care problems Walker Land, Dave Schaffer, Michael Hultner

2. Content • 50 years ago • What we had 50 years ago • How about today? • Patient treatment today • How modern “system” may break down • How might CAS help? • Serious cost problem+ futuristic health care question- Dr. Michael Hultner • Serious complexity problem+ futuristic health care question- Dr. J. David Schaffer • Q and A period

3. 50 years ago • Approximately 50 years or so ago, health care was much simpler than it is today. • Today, irrespective of the medical discipline or level or location around the world, health care is • more (1.) costly, (2.) complex, and (3.) uncoordinated.

4. What we had 50 years ago • Most general practitioners were male • Mainly diagnosed diseases among their patients based on experience • Then dispensed pills themselves and /or wrote prescriptions to pharmacies • Generally conducted their practice from their home • Did not have a support staff beyond a wife/husband, who was generally the nurse, bookkeeper, mail clerk and the office staff • Worked long hours • Totality of problems described totally in terms learned in medical school many years earlier

5. How about today? • Today patient may well find himself / herself in a clinic, a “walk-in” surgi-center, or emergency room • Only because a computer driven admissions system, or a nurse practitioner, a care coordinator, a physician’s assistant and maybe even a real doctor said he or she should be there • Based simply on the patient’s answers to a form questionnaire during a current and/or previous visit.

6. Patient’s Treatment Today • Treatment: Treatment today dictated by the “evidence” • Evidence: This evidence is a shared management decision regarding the patient’s particular illness. • Solution: “Solution” to patient’s problem is less likely to come from a prescription bottle, but may well come, instead, in the form of highly disciplined services of a multidisciplinary team

7. Modern “system” can break down • Regrettably modern “system” often breaks down. • Experience of ever-increasing (1.) cost, (2.) complexity, and (3.) non-coordination • In both practical and personal terms ( in today’s health care delivery systems) leads to frustration and, in more extreme cases, disillusionment.

8. How might CAS help? • How might complex adaptive systems (CASs) help address these challenges in the ever increasing :(1.) cost, (2.) complexity, and (3.) non-coordination of health care? • Let’s summarize some of the possible ways as stipulated the following three categories described as follows:

9. How might CAS help? • (1) CASs provide important concepts, as well as tools, for responding to many of today’s health care challenges by using them as the foundations for developing highly precise decision-support-systems (DSS), • (2) CASs also provide new and adaptable frameworks, which incorporate “dynamic,” “emergent,” “intuitive and non-intuitive,” and “creative” methodologies to replace traditional methods based primarily on “experience” and “educated-guesswork”, • (3) CASs also provide an “integration methodology” for combining the use of all kinds of data, including clinical practice, organization, information sharing and management • (4.)CDSS research translated into clinical practice (in terms of operational second openiondiagnostic aids) , as well as professional development data (all of which are unique but interdependent), that are produced around self-adaptive systems that learn from environment adaption.

10. Question: • How can CAS’s help in reducing the ever increasing (1.) cost, (2.) complexity, and (3.) non-coordination problems of today’s health care systems?

11. Serious Cost Problem+ “futuristic health care question” • This “serious cost problem” will be addressed “head-on “ using a CAS-based decision-support-system (DSS). • And will be presented by Dr. Michael Hultner • Michael will also address the following question:Assuming that efforts to create new life forms are successful, how will these new life forms effect humanity • He will also integrate these two topics

12. Serious Complexity Problem+ “futuristic health care question” • The “serious complexity problem” will also be addressed “head-on” using a CAS-based decision-support-system (DSS). • This topic shall be presented by Dr. J. David Schaffer as well as addressing the topic : How can, say, medical research transition from the current defensive based medical approaches to validated outcome based approaches? • He will also integrate these two topics.

13. Q and A Period • In the early 20th century the average life span was around 31 years [Wikipedia,]. • Today, it is almost triple with many countries have citizens living to 100 and over. At the same time, many developing and under-developed countries cannot adequately feed their growing populations. • There are great variations in life expectancy between different parts of the world, mostly caused by differences in public health, medical care, and diet. The impact of AIDS is particularly notable on life expectancy in many African countries [Wikipedia]. • With all the advances made and being made in medicine and health care practice, it is a reasonable assumption the at the beginning of the 22nd century, the average life span may well be between 200-250 years ( I have heard estimates of up to 500 years), leading to a significant worldwide over population. • These collective conditions, given that they might occur, leads, again, to the following question: How do we balance medical advances with the cost of an aging global population?