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

D isruptive V isions “The Future is not what it used to be !” - Yogi Berra

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

SATAVA 7 July, 1999 DARPA The Information Age is NOT the Future The Information Age is the Present... There is something else out there....

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 THE STRUCTURE OF SCIENTIFIC REVOLUTIONS THOMAS S. KUHN

SCIENTIFIC METHOD Controlled, randomized, double-blind trial Control Group No Parachute Test Group Parachute Still looking for volunteers for the control group

Scientific Method A Paradigm Change in Evolution Hypothesis Study DesignExperimentResults Reporting Hypothesis Study Design Modeling & ExperimentResults Reporting Simulation Modeling & Simulation

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

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

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

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

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”

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

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

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

* 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 The Virtual Soldier

The Media Perception Seattle Times By Brier Dudley, Seattle Times 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 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." 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 Microsoft's Future Vision (Healthcare)

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

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

Endovascular Simulators (Surgical rehearsal) Graphic overlay Patient specific image

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

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

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

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

The LSTAT Life Support for Trauma and Transport Courtesy of Integrated Medical Systems, Signal Hill, CA “... with a fully functional ICU ” 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 Total Patient Awareness Bring the hospital to the casualty, not the casualty to the hospital...

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

Confidential

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

Do Robots Dream ?