Health IT: Exploring the Role of Technology in Healthcare - Episode 3
Simon D. Murray, MD: In terms of applications in medicine, what do you think is holding us back, what are some of the problems that you see that are keeping us from moving forward? You mentioned earlier a lack of collaboration sometimes between the providers and the software engineers, but what other things are holding us back?
Eric Daimler, PhD, MS: We talked a little bit about the things that are holding us back from the adoption of modern technologies, that's how I had phrased this, modern technologies, in the healthcare system. You know it's worth repeating that the issue of data integration has historically been a very big problem to do proper analysis. I was on participating with this team with a non-governmental organization they gave a lot of money to address this issue of child mortality. I had not been aware that in the United States there was this community that had child mortality rates that would rival a developing country. It's really tragic and then so this NGO was spending millions of dollars to try to address this problem, they had some first-rate physicians from UPenn from UPMC and from Vanderbilt working to address this issue. And they start with data, they spend some amount of money trying to collect data to then do analysis, they spent about 18 months, 2 years, a couple of million dollars of the grant money, on this database integration and I asked the physicians why did you do that? And they said well that's just what the IT people said. I asked the IT people why did you do that and they say well we used the best technology available at the time. But they spent a couple of million dollars you know 18 to 24 months and they integrated three databases. The new world you're going to see is being able to integrate 30 databases in a fraction of the time at a fraction of the money. That literally will save lives because the outcomes from those sort of research projects will come to the public sooner that's it that's a huge innovation, but it's not terribly telegenic to talk about data integration.
SM: It’s an amazing innovation, how's it going to happen though? How are we going to go from where we are then in that hospital system to where you're talking about?
ED: That particular innovation will come from innovations in mathematics. So in the same way that we have had innovations in physics that allow for new semiconductor approaches to emerge in that industry, this is an innovation in mathematics that will augment maybe even fork off from calculus, and enable a new digital way of thinking about these sort of problems.
SM: Do you think we need more processing power to do that? Are our processors powerful enough to do that?
ED: It's a great question. So in the totality of the planning part of “sense plan act” you have the storage, computation, and networking. And in the computation part of that that has improved sufficient to allow that mathematical innovation to take root and be applied into computer science. That will continue to improve but that's not a limiting factor for this particular application, regardless of the size of the database.
SM: I agree that the databases that we have, that we have to do better, integrating them. That's really a real slow down in drug technology and patient care and patient records.
What do you think about privacy issues when it comes to medicine and electronic records and data gathering, with our watches that measure our heart rates and report to Apple, you know and stuff like that, do you have any concerns about that?
ED: I do, I have many concerns about that and I would say many of our reactions are misapplied so we currently have this restriction about applying Social Security numbers to patients the problem or phone numbers, now those laws should be repealed. Because engineers have to somehow connect a patient to data and if they can't do Social Security numbers they'll do a workaround and that workaround very well may be worse. This gets to the sort of systems intelligence that I would ask everybody to participate in which thinks about the data acquisition, the data collection ,and storage, and then the resulting actions. The acquisition of data is certainly a place around which we need to be very concerned and the metadata problem the description about the data remains a bigger problem than many people appreciate but if people can participate in the holistic systems intelligence systems view of AI, they can participate in the conversation to see whether this is appropriate.
Because I don't have an answer and no one really has an answer and our understanding of this problem is very different than today, 2019 2020, than it was in 2016 2015, and therefore it's probably going to be different in 2020 to 2023, so we need to be continuing experimenting about how our reactions feel relative to the technology. And the data available it's very concerning if the data that's collected is say stored for all time and somehow carelessly distributed. You know there was an example recently where some 50,000 MRI images were on a public hospital computer right? This is tragic, it's because often people have this myopic view of what their job is in relation to data security. “Oh that's ITs problem” you know this particular problem, IT thought it was the hospital, the hospital thought that was the IT department, they're kind of pointing back and forth to each other. Each has their own little point solution instead of people constantly reflecting on what's the total solution here, double-checking “hey do we have the security protocols in place?” at multiple steps.
You know we do these sort of guardrails in other parts of our lives, in transportation we talked about this a little bit you know, we've put up sidewalks to separate from cars, we've put up bollards on sidewalks increasingly to make sure we keep cars separate, and that allows for new experiments, allows for autonomous vehicles to go down the street with a little more assurance that they're not going to be crossing over to the sidewalk. Because these cars will fail but they fail in different ways that we don't really appreciate. And so guardrails guidelines, that's far more effective right now than regulation in helping shape the conversation, because regulations necessarily are overreach just by the nature of it. So us having a conversation, physicians are very well placed to be part of this conversation, can help put in the structure that allows for new tools, new innovations, could come and just be placed in and applied with patient.
Transcript edited for clarity.