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Posts Tagged health care

Mythical magic munitions Robert Hickson Mar 11

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There may be still a few discoveries and technologies out there, or yet to see the light of day, that will be “magic bullets” which will solve a pressing problem. As, for example, penicillin once did. In parts of Silicon Valley that hope probably still springs eternal, at least if you can develop an app from it.

Think of all the problems that would be “eliminated” if we could upload your mind to a robot, or take a pill to live longer.

But as we develop a better understanding of the complexities of our world, that seems like a mythical, more simpler place.

This is well illustrated in a poignant article in the New Yorker about children with complex life-threatening medical conditions [Subscription required to read whole article]. Jerome Groopman notes that as medicines get better in prolonging lives, there is a need to change how healthcare operates to meet the increasingly complex needs of the patients and their families.

The article describes the role that Pediatric Advanced Care Teams are now playing in helping coordinate healthcare for a patient, but also the way in which they help the family better navigate the health and social systems and assist the family in making difficult decisions about treatments.

The last point is the most important. It’s not just about coordinating and wrapping around services, but enabling the patient or family to have some control and choice. In many cases there isn’t a simple linear path from surgery/medicines to a fully healthy life.

Just providing more health-care robots and simple brain fitness apps won’t be enough to handle the potential senile tsunamis many developed countries may face as their post-retirement populations metastasize.

The bringing together of multidisciplinary teams of broader groups of interested parties to solve problems is becoming more common outside of medicine too. We are starting to see examples in water (or other resource) allocation, in some areas of social services, and energy supply. We’ll need many more of them.

They can appear slow, chaotic (at times), and the benefits can be slow to appear. Not a situation that sells itself to impatient policy makers of technocrats. But as the New Yorker article notes, the new approach can not only improve the quality of life of the patients and their families, but also provide big savings to the healthcare system by reducing readmissions and ineffective surgery or other treatments.

Deloitte is promoting a similar approach to government in their “GovCloud” report on the future of government work. Once many bureaucratic processes are automated you can, in Deloitte’s view, radically cut back the public service and have diverse teams of creative bureaucrats coalesce around particular policy problems, provide a solution, dissolve and reform into new teams for the next problem.

This is being done, at a small scale at least, in some places. Notably the UK’s “nudge” unit. [I don't think nudging is a panacea, and much still needs to be done to demonstrate long term effectiveness. Paul Walker earlier this week at The Dismal Science blog linked to a libertarian critique  about nudging]

While aspects of Deloitte’s proposal appeal, I can see it going badly wrong if you just bring in a bunch of general policy wonks and consultants who have little understanding of the particular issue, propose a simplistic solution, and then move on without any accountability. We’ve all seen that before.

But the notion that we need to approach issues and problems differently now is critical. Magical thinking shouldn’t continue when we don’t have magic bullets anymore.

 

Robots and the elderly Robert Hickson Jun 26

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There is much optimism in some quarters that health-care robots and other advanced technologies will help meet the anticipated demand for more health-care workers as the proportion of old folks increases [NZ data here].

Rodney Brooks of  Rethink Robotics talks about this with the BBC, along with the need to think about designing robots from the users point of view rather than the engineer’s.

 

Droid

 

[As an aside he also makes the good point that current industrial robots will not meet the needs of small manufacturers, who require cheaper, safer and more versatile robots - like Baxter]

However, Rebecca Mead in an enlightening and compassionate article in the New Yorker, describes a more human-centred approach in some US dementia-care units. These have reduced the reliance on medication and rigid hospital rules. They are getting some wonderful and more dignified results with patients, as well as reducing the stress and frustrations of nursing staff and doctors. Similar to Rodney Brooks’ approach, they have considered care from the patients perspective. This has involved redesigning the facilities, as well as retraining staff. It can also reduce costs (or at least not blow them out) because of the lower use of medicines, so seems likely to be able to applicable more widely.

This illustrates that while new technologies can help, we shouldn’t just jump straight to technological solutions for pressing needs. Robots may play an important role in aged care in the future, but they’ll need to be much more than replacement manual labourers. If the type of care Mead describes is the objective, then robots will also need to be great communicators and able to modify their behaviour for different individuals and situations. That will be a big challenge, but artificial intelligence seems to be moving slowly in that direction.

 

 

 

The Future of Healthcare Robert Hickson Dec 16

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I’m still preparing my end of year trend posting, so for now I’ll just point you in the direction of a short article on the future of healthcare that I wrote for  Pharmac’s (the New Zealand government’s pharmaceutical purchasing agency) Annual Review (PDF, 1.5 MB).

The Pharmaceutical industry is in an interesting period of change. About US$100 Billion “patent dividend” is anticipated over the next few years as some major blockbuster drugs come off patent, so pharmaceutical companies are looking to where they could generate new income. Some companies are big on mergers and acquisitions, others are trying out more open innovation models. Some Big Pharma companies are moving into generic medicines, others are heading upstream to become more involved in diagnostics, and some may transform into healthcare management companies. Smaller pharmaceutical firms and biotechnology companies are producing more of the pharmaceuticals now.

Meanwhile regulators and pharmaceutical purchasers around the world are demanding more information on the comparative effectiveness of new medicines. Better outcomes, not just more pills is what they are looking for.  Generating that information adds more time and money to developing new treatments. Some patient lobby groups though are wanting access to drugs quicker, even if critical clinical data is lacking.

“Electronic medicine” is being viewed as a means to help reduce (or at least better contain) healthcare costs, through better management and smarter use of patient medical records (NZ doctors are already good users of electronic records). The amount of information about patients is set to skyrocket, so there is going to be a lot more information to manage, and mine for better treatment options. IBM, though, has noted that doctors now often have more information than they know what to do with [PDF, 0.9 MB].

Lots of applications for smart phones and tablet computers are appearing. These are intended to help folks better manage their own health. However, the  health apps field has been called the “wild west” because many of the apps have not demonstrated clinical validity or sought FDA approval.

The future will be interesting. Patients will be  expecting more personalised care, while major healthcare providers will be ever more involved in number crunching and analytics to determine the treatment options that best meet their performance requirements.

Where’s my Robot? [Part 1] Robert Hickson Sep 14

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Robots have been a promise and a fear for the last century. Up till now robots have been used for what have been called the 3 D’s — Dull, Dirty and Dangerous work. Things like building cars, vacuuming, mining, chopping up carcasses, search & rescue, and joining the armed forces. But there are also robotic footballers, pool sharks, penguins, spiders (yay!) and kung fu fighters. Robots are also starting to drive around town or do experiments (thankfully not yet on us). There may be over 8 million robots already out there.

We haven’t yet got to Rosie the Robot Maid, positronic brains, or Skynet, but we seem to be heading towards at least some of them. Robotic office workers are on the way – oh, here was I thinking some of them had infiltrated our work spaces long ago.

In this blog posting I’m introducing Aridane’s webshot; an overview of the drivers, trends, challenges and opportunities covered by the post:

  • Drivers (influencers of change): demographics (aging populations), technology, defence (warfare), economics (labour costs & productivity)
  • Trends: robots being used for more types of applications and in more complex situations; moving from programmed machines to learning machines
  • Challenges: creating versatile and fully autonomous safe robots, what types of robots will we accept safety, making robots affordable for the middle classes
  • Opportunities: improved productivity and safety, filling workforce gaps

 This post (Part 1) covers the trends, Part 2 looks at some of the challenges.

Current situation

The last few years have seen steady development and deployment or robots in a variety of settings. Industrial robots are making a comeback after two years of slow growth following the global financial crisis. The latest forecast from World Robotics concludes that there will be 1.3 million robots working away in factories by 2014. Current numbers are just over 1 million. Most of the industrial robots are employed in the electronics and automotive sectors, with Asia being where most of them reside. The US is concerned that it is falling behind [PDF, 1.32 MB] in the field of industrial robots.

Robots used in other settings — what World Robotics call ‘service’ robots — are also increasing. These are predominantly military (6,000 sold last year) and surprisingly (to me) milking applications (just over 4,000 sold). The latter are big in Europe, with New Zealand and Australia just starting to get interested in similar machines. Future farmers may need advanced degrees in engineering. More on military robots later.

Service robots for medical and logistical (such as moving freight around) applications each sold about 1,000 units in 2010. The World Robotics report notes only small sales of cleaning bots, but iRobot states that more than 6 million home cleaning robots have been sold. However, World Robotics predicts that over 14 million service robots will be sold over the next 4-5 years.

 

Drivers for Robotics

Key drivers (or influencers of change) in the field of robotics are ageing populations (leading to fewer human workers and more older people to look after), rising labour costs, reducing combat losses and increasing combat effectiveness, and technological developments (in mechatronics, materials science, sensing technologies, and of course faster cheaper computing power).

 

Trends

World Robotics notes that there are a growing number of more versatile industrial robots — ones able to do several tasks rather than just one. This is being driven by the increasing flexibility of some manufacturing processes, where product lines change quickly and products are personalised for individual customers.

So when will we get a versatile domestic robot, be able to call up ‘Ms Green Robot’ to work in our garden, or get ‘Hire a Botty’ to come over and do some home maintenance?

Not for some time. But just getting robots away from a factory floor or lab is a big achievement. And home and medical care robots don’t seem too far away.

We shouldn’t just be imagining a single house robot either. Robots swarms are likely to become more common in the near future. These can help map environments, as well as undertake surveillance. And with more things getting connected to the internet (see my previous post on the Internet of Things) your future Roomba may be conversing with other small autonomous devices to organise cleaning the home and other tedious tasks.

While the increasing dexterousness of robots and their sensory capabilities are impressive, the more significant trend in robotics is the changing approach to programming. Software is moving away from coding simple stimulus-response actions to more evolutionary behaviours, enabling robots to learn in new environments. Advances in artificial intelligence are likely to result in more sophisticated robot behaviours in the next few years. The August edition of National Geographic provides an overview of some recent advances in making robots more sociable.

There is also a move (as in other areas of ICT) for robotics to adopt an open source software approach to stimulate developments and new applications.

The larger underlying trend is of increasing automation in our lives. Dishwashers, microwave ovens, smart phones, robot vacuum cleaners, robotic genome sequencers, and computer assisted driving (and flying) are all now common. They free us from some activities or help us do others better. In the short to medium term it seems that robots will simply continue this trend. Some consider that a popular future robot could be a self propelling equivalent of a smart phone or tablet computer that acts like a personal assistant.

There will be further blurring of the boundaries between humans and machines as bionic prosthetics become more common. See this video on TED about human exoskeletons.

There are of course fears that robots will take the jobs of humans, but will this be any different from other technologies (think of ATMs, shipping containers, the internet). New types of jobs for humanoids usually emerge.

A transformation will occur when robots start making complex decisions and actions that can’t be pre-programmed. Then perhaps we’ll stop considering them as just devices and start thinking of them as creatures. (Roomba owners can get very attached to them, but it’s not quite the same thing). The goal of the RoboCup is to have a robot team beat humans by 2050. That will be a significant turning point.

Part 2 gives a brief overview of challenges facing robotics, and more on military robots.

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