UTURE

1. F Richard M. Satava, MD FACS Professor of Surgery University of Washington and Senior Science Advisor US Army Medical Research and Materiel Command UTURE Total Body Scanning Longitudinal Health Record and the National Forum on the Future of the Defense Health Information System ASD(HA) and Georgetown University Arlington, VA March 26, 2008

2. Disruptive Visions “The Future is not what it used to be !” - Yogi Berra http://depts.washington.edu/biointel

3. “The Future is here … . . . it’s the Information Age” Current Visions

4. R The Information Age is NOT the FutureThe Information Age is the Present ... There is something else out there . . . . EAL F UTURE SATAVA 7 July, 1999 DARPA

5. THE STRUCTURE OF SCIENTIFIC REVOLUTIONS THOMAS S. KUHN Scientific Method . . . . . . is DEAD? HISTORY Observation, Phenomenon Experiment Scientific method, …? Not all science is explainable using scientific method Intuition Creativity Quantum mechanics EMERGENT PROPERTIES What comes BEFORE the hypothesis? Observation, phenomenon, experiment, scientific method, …? A new “science” may need to be invented

6. SCIENTIFIC METHOD Controlled, randomized, double-blind trial Control GroupNo Parachute Test GroupParachute Still looking for volunteers for the control group

7. Scientific Method A Paradigm Change in Evolution Hypothesis Study Design Experiment Results Reporting Modeling & Simulation Hypothesis Study DesignModeling &Experiment Results Reporting Simulation

8. New technologies that are emerging from Information Age discoveries are driving our basic approach in all areas of healthcare . . . For example, the LHR Fundamental Concept

9. It’s Time to Transition How we populate the LHR - the Content The Five Ps of Precision Healthcare Preventive Acute/chronic Proactive Reactive Predictive Retrospective Parametric Qualitative Point of care Centralized . Visual Text

10. The Fundamental Change Venus of Willendorf 24,000 BC Visual Cortes What do these have in common with the LHR?

11. It’s Time to Transition How we view the LHR - the Interface Atari 1977 Mac 1984 ? 2015 Healthcare has only begun to realize the potential of high performance computing By 2015 a laptop will compute at 1 TeraHz - today’s supercomputer Courtesy A. Tsiaras Anatomic Travelogue

12. Why modeling & simulation, imaging and robotics • Healthcare is the only industry without a • computer representation of its “product” • A robot is not a machine . . . • it is an information system with arms . . . • A CT scanner is not an imaging system • it is an information system with eyes . . . • thus • An operating room is an information system with . . . * “The Information Age is about changing from objects and atoms to bits & bytes” Nicholas Negroponte “Being Digital” - 1995

13. Information basis for Medicine Borrow from Industry – eg,CAD/CAM The Fundamental Change Healthcare has only begun to realize the potential

14. The Industry Standard CAD/CAM Virtual Prototyping Virtual Medical Design Virtual Testing

15. Multi-modal total body scan on every trauma patient in 15 seconds Information Representation of a Patient Medical equivalent of CAD/CAM Holomer Total body-scan for total knowledge Virtual Soldier Program Satava March, 2004

16. The Virtual Soldier * Battlefield Medical Information System – Tactical - deployed to 3000 medics in Iraq Real time data display from demo in which data drives image and prediction July, 2005

17. Seattle Times By Brier Dudley, Seattle Times Microsoft's Future Vision (Healthcare) On the windshield, you're looking chubbier than you do in the rear-view mirror, because the image shows what you'll look like if you keep eating this way. Superimposed on the image is your current weight, the cholesterol reading from your last checkup and -- highlighted in red -- a notation that you haven't used your Web-connected treadmill for over a month. The image flickers and zooms ahead two years, showing how you'll appear after gaining an extra 30 pounds and being diagnosed with diabetes. With the ka-ching sound of a slot machine, it starts calculating what will happen to your health and life-insurance premiums. Somewhere in the background, it sends an update to your physician. The image on your windshield is more than virtual. It's reality, based on the Mar. 17, 2008-A few years from now, when you drive into a McDonald's parking lot, your dashboard computer will start beeping. The computer is synced to your phone, and both deviceshave geographic location services. They know where you are and, based on your credit-card activity, they guess you're about to order another burger and supersized fries. But because you've subscribed to Microsoft Personal Trainer 2015, a premium feature of the online health-management system you've been using since 2012, technology intervenes. The services are gathering information on your behalf, using a new software platform that began taking shape in 2008. When your car stops moving, the phone projects your image on the windshield, similar to R2D2 played the holographic image of Princess Leia in "Star Wars." The Media Perception

18. Wound Tract Virtual Autopsy . . . . . . is a SIMULATED Autopsy Less than 2% of hospital deaths have autopsy Statistics from autopsy drive national policies

21. Total Integration of Surgical Care Minimally Invasive & Open Surgery Remote Surgery Pre-operative planning Surgical Rehearsal Simulation & Training Pre-operative Warmup Intra-operative navigation Courtesy of Joel Jensen, SRI International, Menlo Park, CA

23. Endovascular Simulators(Surgical rehearsal) Patient specific image Graphic overlay

24. From tissue and instruments to Information and energy* The Fundamental Change * “The Information Age is about changing from objects and atoms to bits & bytes” Nicholas Negroponte “Being Digital” - 1995

25. Information andcomputers Cornerstone of Systems Integration What possible importance does LHR have for technical procedures Singleinstrument which - performs both diagnosis & therapy - in real time - can be autonomous - feedback from data in the EHR

26. XACTIX XACTIX CONVENTIONAL Smart Surgical Tools MEMS Sharps Instrumented Scalpel Courtesy: E.C. Benzel, L.A. Ferrara, A.J. Fleischman, S.Roy

27. Information on the Battlefield BMIS-T Holomer on battlefield video click here

28. Total Patient Awareness • Defibrillator • Ventilator • Suction • Monitoring • Blood Chemistry • Analysis • 3-Channel Fluid/Drug • Infusion • Data Storage and • Transmission • On-board Battery • On-board Oxygen • Accepts Off-Board • Power and Oxygen Bring the hospital to the casualty, not the casualty to the hospital . . . The LSTATLife Support for Trauma and Transport “ . . . with a fully functional ICU ” Courtesy of Integrated Medical Systems, Signal Hill, CA

29. LSTAT Deployment to Kosovo - March 2000 212th MASH Deployed with LSTAT - Combat Support Hospital Courtesy of Integrated Medical Systems, Signal Hill, CA

30. Confidential

31. Be careful of unintended consequences Experience is the name everyone gives to their mistakes - Oscar Wilde If you are not making mistakes you are not working hard enough … … and that’s a big mistake!Anonymous

32. Planet Earth Represented as a 4-D structure Do Robots Dream ? http://depts.washington.edu/biointel