The Promise and Peril of. Connected Future


Raj M. Khandwalla, MD, MS, FACC

Director of Cardiovascular Education, Cedars Sinai Care Foundation

Assistant Professor of Medicine

Attending Cardiologist

Cedars-Sinai Medical Group

Cedars-Sinai Heart Institute 

The advent of Digital Medicine owes its meteoric rise to 4 factors:

·         Accelerating computing power, to understand complex biological permutations

·         A rise in Biosensors

·         An explosion in available data, with 39% of the population on Social Media and 60% using Smart Phones

·         An inefficient healthcare delivery system with mediocre outcome.

 There has been a paradigm shift in the way healthcare is delivered, with a greater weightage paid to value over volume.

Thus, there is now a shift away from fee for service with an outcome-based reimbursement structure.

The future portends that care will move away from the Office/Hospital setting to a Home based one. 

The manufacturers of the “Fitbit” postulated that the provision of a device that measures daily activity would incentivize the users to increase their daily step count to a healthy one. This was a result of the findings that an increased level of physical activity prevented cardiac disease. Conversely, a sedentary life style led to an increased level of disease.

Various studies using “fitbit” concluded that the device per se was of no help, but a cash incentive was effective.

A US study found that there had to be “artificial intelligence” incorporated into the devices for them to act as an incentive to losing weight. The more the activity, the lesser the onset of cardiac disease. Other devices have found their way into the market, including a necklace that measures thoracic impedance, and other finger-tip devices that creates a single lead EKG pattern to detect any arrhythmias and impending crises in real time. 

The military technology of having devices that visually penetrated walls, has led to the process of Deep Learning as a technique to master standard measures. Thus, computers are based on how the human brain functions at various, independent levels. 

In an experiment, computer systems were exposed to thousands of images of melanomas. These computers with this artificial intelligence were able to outdo the  human beings in diagnosing multiple myelomas. 

Similarly, there are artificial algorhythms that out-performed dermatologists. 

Physicians may feel threatened that AI devices would replace them, but those who turn adversity into opportunity, would always be there at the cutting edge of technology.

Pablo Picasso said words to the effect that computers were only good at providing answers. Physicians just HAVE to ask the questions, and create the Artificial Intelligence to address their issues. This Deep Learning by AI would be supervised by physicians who would train the machines to react like the human brain. 

The industry is in its infancy with various entrepreneurs divesting into different aspects of machines and medicine. Once a structure evolves, dot com related medicine will not only be a reality but a norm in the provision of health care.

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