Computers in the Operating Room: A Patient/Customer and Computer Person

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Computers in the Operating Room A
Patient/Customer and Computer Persons View

• The 3rd Congress on Computers Robotics in the
  Operating Room 2000
• July 14, 1999
• Gordon Bell
• Microsoft Corporation

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Abstract

• The computing and communications industry are on
  a quest to put "everything into Cyberspace. Our
  ability to carry out this quest evolves in three
  dimensions the computers (including robotic
  computers with hands, arms, legs, eyes, etc.)
  networks to connect the global computing
  hierarchy that will eventually include "on body"
  nets and finally, cyberization.
• Cyberization is the technology to interface
  information bearing entities (cars, physical
  networks, people) to computer platforms. For
  the "information-based" world, Nicholas
  Negroponte characterizes the quest as the
  transition from a massy world made up of atoms to
  a mass-less world of bits or more precisely,
  electrons, photons, magnetization that hold bits.
  By going massless, then time and distance can be
  shifted as in telepresence, the overall framework
  for telemedicine. By looking at cyberization
  opportunities, one might speculate how Operating
  Rooms might look.

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Outline

• Computing Technology Basics
• Everything cyberizable is in Cyberspace
• Cyber Personal Assistants
• Electrons replace atoms for presenceTelepresen
  ce being there, while being here and maybe
  some other time
• Guardian Angels, an on-body assistant
• Turing tests ... When will computers be able
  to fool some of the people some of the time?

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Caveat

• Discuss where computing is going and by analogy
• Spark your imagination about how computing and
  other technology will impact life outside (and
  within) the OR
• no income
• The speakers understanding of the OR is from a
  patient and web-visitor perspective
• no sight, no blood, no pulse

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The two great inventions

• The computer (1946 realised in 1948). Computers
  supplement and substitute for all other info
  processors, including humans
• The Transistor (1946) and subsequent Integrated
  Circuit (1957).
• Moores Law The integrated circuit evolves at
  the rate of 60 per year as measured by the
  number of transistors per chip.
• Storage evolves at this rate
• Optical transmission lines do too
• Phone lines behave Morons Law

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LINC Laboratory Instrument Computer c1964
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Extrapolation from 1950s 20-30 growth per year
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Growth of Microprocessor Performance
10000
Cray T90
Cray C90
1000
Cray 2
Cray Y-MP
Alpha
RS6000/590
Cray X-MP
Alpha
100
RS6000/540
Cray 1S
i860
2X transistors/Chip Every 1.5 years Moores
Law Microprocessors have become smaller,
denser, and more powerful.
Performance in Mflop/s
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R2000
1
80387
0.1
6881
80287
8087
0.01
1998
1980
1982
1986
1988
1990
1992
1994
1996
Year
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Desktop Supercomputing
3/20/89 Electronic News
www.dell.com
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Bells Nine Computer Price Tiers

• 1 embeddables e.g. greeting
  card
• 10 wrist watch wallet computers
• 100 pocket/ palm computers
• 1,000 portable computers
• 10,000 personal computers (desktop)
• 100,000 departmental computers
  (closet)
• 1,000,000 site computers (glass house)
• 10,000,000 regional computers (glass
  castle)
• 100,000,000 national centers en route to
• 1,000,000,000

Super server costs more than 100,000Mainframe
costs more than 1 million an array of
processors, disks, tapes, comm ports
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Platform evolution What do they do thats
useful? How do they communicate?
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In a decade we can/will have

• more powerful personal computers
• processing 10-100x
• 4x resolution (2K x 2K) large displays
• storage of one terabyte
• adequate networking
• ubiquitous access todays fast LANs
• One chip, networked platforms
• more cyberizationThe challenge interfacing
  platforms and people.

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Outline

• Computing Technology Basics
• Everything cyberizable is in Cyberspace
• Cyber Personal Assistants
• Electronics replace atoms for presenceTelepres
  ence being there, while being here and maybe
  some other time
• Guardian Angels
• Turing tests ... When will computers be able
  to fool some of the people some of the time?

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Everything cyberizable will be in Cyberspace!
Body
Continent
Car
Region/ Intranet
Home
Campus, including SANs
World
Fractal Cyberspace a network of networks of
platforms
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Everything will be in Cyberspace

• Is this a challenge? goal? quest? fate? or
• Cyberization enables new computing platforms
  thatrequire new networks to connect them
• Infrastructure supports the content
• Three evolutionary dimensions

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Cyberization interface to all bits and process
information

• Coupling to all information and information
  processors
• Pure bits e.g. paper, newspapers, video
• Bit tokens e.g. money, stock
• State of
• places like the OR,
• things e.g. robots, instrumentation, especially
  people

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OR 2000 Implications when everything is in
cyberspace

• IP on everything
• Delivered by some standard wire or fiber e.g.
  Ethernet or Firewire or USB
• HTML accessible
• Even the robots have to be connected so they can
  feedback!

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Atoms a.k.a. massy vs. massless bits
Atoms (mass) Electrons, etc. (massless) people
know computers also know bricks mortar anywhere
(personnel/clients) office hours anytime radio
nets gt anwhere reports databases web access
for all documents! letter fax email web
access phone email, voice video mail personal
visits videophone / videomail signature authentica
ted images envelopes digital envelopes / store
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New or old money its just bits
Credit
ATM /
Prepaid
Check
Cash
Prepaid
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Put those checks statements in Cyberspace or
eliminate them!
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Paperless transactions put them all in Cyberspace
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Http//wwww.medicalogic.com

• Internet-based service for keeping medical
  records electronically EMR
• No on site or in office equipment except a
  browser
• Facilities
• rapid input and record retrieval
• accessible anywhere at anytime
• patient accessible
• prescription drug interaction, advice, etc.

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Especially cyber-ready images
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Sensors, actuators/emitters, sensor-actuators,
and wireless

• Medical P, T (body), blood gas, ECG, etc.
• Mobile location (GPS, compass), ambient (P,T),
  acceleration,
• Personal A/V (and eyes) including IR, body
  head position (6 degrees),
• Speech and glasses
• Radar, sonar, beacons,
• Spectrum, chemical, etc. analyzers
• Connected without cables

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Outline

• Computing Technology Basics
• Everything cyberizable is in Cyberspace
• Cyber Personal Assistants
• Electronics replace atoms for presenceTelepres
  ence being there, while being here and maybe
  some other time
• Guardian Angels
• Turing tests ... When will computers be able
  to fool some of the people some of the time?

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The Cyber Admin or the prosthetic memoryWhen
we can store everything weve read/written,
heard/said, seen/acted, plusphysical
parameters.
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What does Cyber Admin do?

• Captures the creation of all personal/professional
  information
• Everything that happens in the OR
• Stores and organizes
• Retrieval is the challenge
• recalling readings, conversations, presentations,
  images
• helps the guardian angel
• What are the apps?
• when we can do this?

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My project putting my legacy and future bits in
Cyberspacehttp//www.research.microsoft/

• Personal paper documents
• Books (encoded by CMU), papers, articles, memos,
  notes, email, notebooks, drawings
• Encode video and audio lectures
• Current electronic media
• email, files, papers, photos (now digital)
• voice notes and records
• Would like to capture photos and slides

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Capture and encoding
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HP Digital Sender color document scanner
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Sony voice notes recorder
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Evolving cameras to capture images and voice notes
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A word about storage CDs hold 6 near VHS
quality videos (300 Kbps)
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Book page
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Now how do you find or use the rich information
The system must locate, retrieve, visualize,
order, up load the organizations IP assets
(text, proposals, images, videos, presentations,
experiments, procedures, etc.) with
appropriate controls.
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Thumbnails to aid retrieval
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Virage Video Cataloger
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Outline

• Computing Technology Basics
• Everything cyberizable is in Cyberspace
• Cyber Personal Assistants
• Electronics replace atoms for presenceTelepres
  ence being there, while being here and maybe
  some other time
• Guardian Angels
• Turing tests ... When will computers be able
  to fool some of the people some of the time?

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Telepresence being there while being here, at
another time, and with time scaling

• Telepresentations
• Telemeetings and telecollaboration
• The work

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MotivationTelepresentations

• Presenter and/or audience telepresent

NOT meeting or collaboration settings Forget the
nasty social issues!
Mostly one-way
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TelepresentationElements

• Slides
• Audio
• Video
• Script, text comments, hyperlinks,etc.

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TelepresentationsThe Essentials

• Slide and audio a must
• Add some video (low quality) to make us feel
  good
• Storage and transmission costs low

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TelepresentationsThe Killer App

• Increased attendance lower travel costs
• Practical and low-cost NOW
• e.g. ACM97 - 2,000 visitors in real space, 20,000
  visitors on Internethttp//research.microsoft.com
  /acm97

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What about telecollaboration? working together
at a distance
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Conference Rooms with Teleconferencing
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Telework its the sound, screens, and bandwidth,
stupid
http//research.microsoft.com/barc/GBell/
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CMU wearable computers
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Future OR
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Current OR
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(No Transcript)
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Telepresence Reflection terminal
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(No Transcript)
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Mobile videophone
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Honda Robot
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Hospital robots...
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Telemedical CollaborationTelementoring is
probably the killer app

• Surprisingly little used currently
• 1 in 1000 radiograms, 1 in 2000 home visits
• Saves time and money no money
• Robotics more useful for precision and routine
  than remotely
• Inhibitors are network speed, delays, etc.
• Remote diagnostics a promising use of VR
• Will be able to have anyone, anywhere with you at
  anytime...

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Webcam of Hospital in Sweden
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What happens when there are webcam(eras)
everywhere (e.g. a dozen or so in the OR) instead
of the 100,000 out there now?
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Living in Cyberspace the infrastructurebeing
always connected is essential
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Infrastructure
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MilliBill

• Large, general purpose panel
• Paintings, photos, videos, a new art medium, and
• even TV
• Becomes a true window to anywhere
• Voice interface
• Evolves to cover entire wall so that everyone can
  be by a window

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Fujitsu 42 plasma panel
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Attending simultaneous meetings
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Outline

• Computing Technology Basics
• Everything cyberizable is in Cyberspace
• Cyber Personal Assistants
• Electronics replace atoms for presenceTelepres
  ence being there, while being here and maybe
  some other time
• Guardian Angels
• Turing tests ... When will computers be able
  to fool some of the people some of the time?

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The Guardian AngelKnows about your state of
health.Has the latest medical knowledge.
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Your husband just died, heres his black box
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Steve ManninCyberspace
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Not shown ECG GPS
Compass altimeter
PCS Pilot
Libretto, .5mm pencil
Libretto PS, Ricoh Camera Swiss Army Knife
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Moores law is less important than MEMS
micro-electro mechanical systems
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4 Experts Predict BionicsWired, February 1997

• Hi-Fi Cochlear Implants 2005
• Bionic Limbs 2013
• Artificial Vision 2040
• Bionic Person (unlikely)

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A device that would have saved me from a heart
attack
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BAN, PAN or whatever for people networks

• Temperature monitoring with the flu
• Saved me from a heart attack
• Where is the person, exactly a baby sitter
• Lets interact ala Barney

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MedtronicsImplantedCardioplasticstimulatorcard
io- recorder
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Pump
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(No Transcript)
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Audio, pix, T, P, ECG, location, physiological
parameters1 GB
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Outline

• Computing Technology Basics
• Everything cyberizable is in Cyberspace
• Cyber Personal Assistants
• Electronics replace atoms for presenceTelepres
  ence being there, while being here and maybe
  some other time
• Guardian Angels
• Turing tests ... When will computers be able
  to fool some of the people some of the time?

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Turing test you cant tell whether you are
communicating with a person or a machine using

• Text limited context
• Voice
• context
• speech to text and text to speed
• Visual image and voice
• more context
• synthesis of dynamic, human images
• A simulator to carry out a procedure on any
  person, anywhere

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People surrogatesmodels you can touch and feel
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Simulation with physical models
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Visualizing modeling...
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What is Medical VR?http//www.informatik.umu.se/
jwworth/execsum.html

• Visualisation of data (usually anatomical)
• Interaction with visualised data
• Simulated behaviors of simulated realities
• increasingly as a result of interactions
• "Realisation" in modalities other than vision
• sound, force, touch, smell

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Virtual augmentation connecting the images with
reality
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Models you touch feel
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Everything must work together! Medical
industry based on proprietary standards
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Health Number one market need must be open!
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Standards and Standards Processes

• HL7 application-level messages e.g. admission,
  discharge, transfers results clinical
  observations.
• DICOM images e.g. ultrasound, MRI, and X-rays or
  PACS, Picture Archiving and Comm. System.
• IEEE 1073 bedside devices e.g. patient monitors,
  ventilators, and infusion pumps standards.
• X12 forms for insurance transactions.
• ASTM laboratory information systems standards
  plus the content and security of electronic
  medical records
• HIBCC healthcare bar codes standards e.g. labels
• ADA dental informatics standards

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Impediments

• Standards caused by companies trying to gain
  proprietary advantages that lock in their
  customers!
• User Interface
• Just doing it people, time, training
• Threat no income

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The end