Health care: Information tech must catch up to medical marvels
Michael Dowling, Northwell Health's CEO, believes we're entering the age of smart medicine.
- The United States health care system has much room for improvement, and big tech may be laying the foundation for those improvements.
- Technological progress in medicine is coming from two fronts: medical technology and information technology.
- As information technology develops, patients will become active participants in their health care, and value-based care may become a reality.
In his book Health Care Reboot, Michael Dowling, Northwell Health's CEO, argues that "[the United States] is constructing a solid foundation upon which the new American health care is being erected." To those steeped in news of health care's administrative bloat, under-performing primary care, and low levels of insurance coverage, such a thesis may seem bold, wishful, or downright delusional.
But Dowling does not ignore the health care system's need for improvement. Rather, he believes that contemporary trends can foster such improvement if we recognize their value. He cites advances and disruptions in areas such as consolidation, education, payment reform, and mental health to support his progressive view that "better, safer, and more accessible care" is coming.
Among those trends is big tech's move into health care, or as Dowling puts it, technology may soon move us into the age of smart medicine.
Medical tech marvels
Dowling sees big tech's stride into health care as coming from two fronts: medical technology and information technology. On the medical technology front, the technology available to doctors has accelerated at an unprecedented pace, resulting in tools and techniques that are "the stuff of Star Wars."
"Some of the most advanced technology tools ever developed in any field are in use to care for patients. Look at any modern operating room or intensive care unit, and the technology to treat patients and keep them alive is remarkable," writes Dowling.
To pick one of many examples, Northwell Health's Cohen Children's Medical Center was the first pediatric program on Long Island to institute ROSA, a "robotic operating surgical assistant." Before ROSA, children suffering epilepsy would have to undergo a full craniotomy to target and monitor areas of seizure activity. With ROSA's assistance, surgeons can get the same results through a minimally invasive procedure, reducing the risk of infection and strain on the patient.
Even technology not designed for therapy has been co-opted to play small, yet supportive, roles in quotidian treatment. A study out of the Children's Hospital Los Angeles found that virtual reality can help reduce a child's anxiety and stress during basic procedures such as a blood draw.
Information tech plays catch up
Photo: Sisacorn / Shutterstock
Dowling characterizes the information technology front as "less impressive," pointing to the well-known difficulties of onboarding electronic health records. Beyond concerns of cybersecurity and interoperability, such systems have caused widespread burnout and dissatisfaction among practitioners thanks to their time consumption and complicated workflows.
But progress is being made. Apple recently added a Health Records app to its iPhone, giving patients from 39 health systems access to their medical records.
"This existing new reality is that a fat file, that until recently was stored away unavailable to the patient, now sits in its entirety on the patient's phone," writes Dowling. "For patients with chronic conditions who make frequent use of medical services, this leap forward enables them, whether a mile from their doctor's office or a thousand miles, to track and share with their doctor essential data on blood pressure, heart rate, glucose levels, and scores of other important clinical markers."
But to succeed, this information must be gatherable, accessible, and understandable to any patient. Big tech will need to streamline such systems for maximum user-friendliness, all while keeping operations on a device with which patients and practitioners are intimately familiar.
That device will be the smartphone and tablet. 77 percent of Americans own smartphones. Among Americans over 65 years of age — the demographic most in need of such advancements — 46 percent own a smartphone, a number that is likely to climb.
Big tech's vision of integrating information technology with health care is some ways off. Much experimenting must be done, and big tech needs to better collaborate with traditional health care stakeholders. Even so, these incipient steps may lead to a framework where practitioners can gather more data more quickly and with greater ease, while patients become partners, not passive recipients, of their health care team.
Accelerating value-based care
In the United States, value-based health care exists today as a should-we, could-we debate topic. Big tech's entry into the field could push value-based care closer to practice. As noted on the health care blog Tech Prescribed, integrating improved data acquisition with AI-powered platforms could turn value-based care into a manageable venture.
"As a result, we will see the move to VBC accelerate even further as more firms turn a profit through this business model. Good news for docs — this will make you the primary customer for provider technology and really improve your user experience as a side effect," writes Colton Ortolf of Tech Prescribed.
The Northwell Health entity Pharma Ventures was created both in response to collaborating with big pharma and as a means to promote value-based care. Pharma Ventures was designed "to link drug prices to drug performance" and "to serve as a super-site for clinical trials." The goal is to drive down costs while simultaneously improving patient experience. Such an initiative is only possible due to Northwell's integrated systems and system-wide electronic health records.
Entering the smart age of medicine
For Dowling, health care in the United States is laying an important foundation for the medicine of tomorrow. We're moving away from the view that health care is something the patient receives at a medical facility. Soon, health care will see the patient take an active role alongside a team of health care providers.
"The new American medicine is proactive and has physicians working in teams with nurses and other caregivers to reach out to patients and guide them along a pathway to health and wellbeing," writes Dowling.
By creating new machines, proliferating information, and making that information easier to obtain, big tech's dive into health care will be a fundamental element in this upcoming paradigm shift.
A study finds that baby mammals dream about the world they are about to experience to prepare their senses.
- Researchers find that babies of mammals dream about the world they are entering.
- The study focused on neonatal waves in mice before they first opened their eyes.
- Scientists believe human babies also prime their visual motion detection before birth.
Imagine opening your eyes for the first time as a brand new baby. The world is so mysterious, full of obstacles and strange shapes. And yet it does not take babies all that long to get their bearings, to latch on to their parents, and to start interacting. How do they do this so quickly? A new study published in Science proposes that babies of mammals dream about the world they are about to enter before being born, developing important skills.
The team, led by professor Michael Crair, who specializes in neuroscience, ophthalmology, and visual science, wanted to understand why when mammals are born, they are already somewhat prepared to interact with the world.
"At eye opening, mammals are capable of pretty sophisticated behavior," said Craig, "But how do the circuits form that allow us to perceive motion and navigate the world? It turns out we are born capable of many of these behaviors, at least in rudimentary form."
Unusual retinal activity
The scientists observed waves of activity radiating from the retinas of newborn mice before their eyes first open. Imaging shows that soon after birth, this activity disappears. In its place matures a network of neural transmissions that carries visual stimuli to the brain, as explained by a Yale press release. Once it reaches the brain, the information is encoded for storage.
What's particularly unusual about this neonatal activity is that it demonstrates a pattern that would happen if the animal was moving forward in its environment. As the researchers write in the study, "Spontaneous waves of retinal activity flow in the same pattern as would be produced days later by actual movement through the environment."
Crair explained that this "dream-like activity" makes sense from an evolutionary standpoint, as it helps the mouse get ready for what will happen to it after it opens its eyes. It allows the animal to "respond immediately to environmental threats," Crair shared.
What is creating the waves?
The scientists also probed what is responsible for creating the retinal waves that mimic forward motion. They turned on and off the functionality of starburst amacrine cells — retinal cells that release neurotransmitters — and discovered that blocking them stopped the retinal waves from flowing, which hindered the mouse from developing the ability to react to visual motion upon birth. These cells are also important to an adult mouse, affecting how it reacts to environmental stimuli.
Graphic showing the origin and functionality of directional retinal waves.Michael C. Crair et al, Science, 2021.
What about human babies?
While the study focused on mice, human babies also seem to be able to identify objects and motion right after birth. This suggests the presence of a similar phenomenon in babies before they are born.
"These brain circuits are self-organized at birth and some of the early teaching is already done," Crair stated. "It's like dreaming about what you are going to see before you even open your eyes."
The non-contact technique could someday be used to lift much heavier objects — maybe even humans.
- Since the 1980s, researchers have been using sound waves to move matter through a technique called acoustic trapping.
- Acoustic trapping devices move bits of matter by emitting strategically designed sound waves, which interact in such a way that the matter becomes "trapped" in areas of particular velocity and pressure.
- Acoustic and optical trapping devices are already used in various fields, including medicine, nanotechnology, and biological research.
Sound can have powerful effects on matter. After all, sound strikes our world in waves — vibrations of air molecules that bounce off of, get absorbed by, or pass through matter around us. Sound waves from a trained opera singer can shatter a wine glass. From a jet, they can collapse a stone wall. But sound can also be harnessed for delicate interactions with matter.
Since the 1980s, researchers have been using sound to move matter through a phenomenon called acoustic trapping. The method is based on the fact that sound waves produce an acoustic radiation force.
"When an acoustic wave interacts with a particle, it exerts both an oscillatory force and a much smaller steady-state 'radiation' force," wrote the American Physical Society. "This latter force is the one used for trapping and manipulation. Radiation forces are generated by the scattering of a traveling sound wave, or by energy gradients within the sound field."
When tiny particles encounter this radiation, they tend to be drawn toward regions of certain pressure and velocity within the sound field. Researchers can exploit this tendency by engineering sound waves that "trap" — or suspend — tiny particles in the air. Devices that do this are often called "acoustic tweezers."
Building a better tweezer
A study recently published in the Japanese Journal of Applied Physics describes how researchers created a new type of acoustic tweezer that was able to lift a small polystyrene ball into the air.
Tweezers of Sound: Acoustic Manipulation off a Reflective Surface youtu.be
It is not the first example of a successful "acoustic tweezer" device, but the new method is likely the first to overcome a common problem in acoustic trapping: sound waves bouncing off reflective surfaces, which disrupts acoustic traps.
To minimize the problems of reflectivity, the team behind the recent study configured ultrasonic transducers such that the sound waves that they produce overlap in a strategic way that is able to lift a small bit of polystyrene from a reflective surface. By changing how the transducers emit sound waves, the team can move the acoustic trap through space, which moves the bit of matter.
Move, but don't touch
So far, the device is only able to move millimeter-sized pieces of matter with varying degrees of success. "When we move a particle, it sometimes scatters away," the team noted. Still, improved acoustic trapping and other no-contact lifting technologies — like optical tweezers, commonly used in medicine — could prove useful in many future applications, including cell separation, nanotechnologies, and biological research.
Could future acoustic-trapping devices lift large and heavy objects, maybe even humans? It seems possible. In 2018, researchers from the University of Bristol managed to acoustically trap particles whose diameters were larger than the sound wavelength, which was a breakthrough because it surpassed "the classical Rayleigh scattering limit that has previously restricted stable acoustic particle trapping," the researchers wrote in their study.
In other words, the technique — which involved suspending matter in tornado-like acoustic traps — showed that it is possible to scale up acoustic trapping.
"Acoustic tractor beams have huge potential in many applications," Bruce Drinkwater, co-author of the 2018 study, said in a statement. "I'm particularly excited by the idea of contactless production lines where delicate objects are assembled without touching them."
Australian parrots have worked out how to open trash bins, and the trick is spreading across Sydney.
- If sharing learned knowledge is a form of culture, Australian cockatoos are one cultured bunch of birds.
- A cockatoo trick for opening trash bins to get at food has been spreading rapidly through Sydney's neighborhoods.
- But not all cockatoos open the bins; some just stay close to those that do.
Dumpster-diving trash parrots
In a study about these smart birds just published in Science, researchers define animal culture as "population-specific behaviors acquired via social learning from knowledgeable individuals."
Co-lead author of the study Barbara Klump of the Max Planck Institute of Animal Behavior in Konstanz, Germany says, "[C]ompared to humans, there are few known examples of animals learning from each other. Demonstrating that food scavenging behavior is not due to genetics is a challenge."
An opportunity presented itself in a video that co-author Richard Major of the Australian Museum shared with Klump and the other co-authors. In the video, a sulphur-crested cockatoo used its beak to pull up the handle of a closed garbage bin — using its foot as a wedge — and then walked back the lid sufficiently to flip it open, exposing the bin's edible contents.
Major has been studying Cacatua galerita for 20 years and says, "Like many Australian birds, sulphur-crested cockatoos are loud and aggressive." The study describes them as a "large-brained, long-lived, and highly social parrot." Says Major, "They are also incredibly smart, persistent, and have adapted brilliantly to living with humans."(Research regarding some of the ways in which wild animals adapt to the presence of humans has already produced some fascinating results and is ongoing.)
Clever cockie opens bin - 01 youtu.be
The researchers became curious about how widespread this behavior might be and saw a research opportunity. After all, says John Martin, a researcher at Taronga Conservation Society, "Australian garbage bins have a uniform design across the country, and sulphur-crested cockatoos are common across the entire east coast."
Martin continues, "In 2018, we launched an online survey in various areas across Sydney and Australia with questions such as, 'What area are you from, have you seen this behavior before, and if so, when?'"
Word gets around
Credit: magspace/Adobe Stock
Although the cockatoos' maneuver was reported in only three suburbs before 2018, by the end of 2019, people in 44 areas reported observing the behavior. Clearly, more and more cockatoos were learning how to successfully dumpster dive.
As further proof, says Klump, "We observed that the birds do not open the garbage bins in the same way, but rather used different opening techniques in different suburbs, suggesting that the behavior is learned by observing others." One individual bird in north Sydney invented its own method, and the scientists saw it grow in popularity throughout the local population.
To track individual birds, the researchers marked 500 cockatoos with small red dots. Subsequent observations revealed that not all cockatoos are bin-openers. Only about 10 percent of them are, and they are mostly males. The other cockatoos apparently restrict their education to a different lesson: hang around with a bin-opener, and you will get supper.
Thanks to the surveys, the researchers consider the entire project to be a valuable citizen-science experiment. "By studying this behavior with the help of local residents, we are uncovering the unique and complex cultures of their neighborhood birds."
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