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Computers in the Operating Room: A Patient/Customer and Computer Person’s View
The 3rd Congress on Computers & Robotics in the Operating Room 2000
July 14, 1999
Gordon Bell
Microsoft Corporation
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OutlineComputing Technology: BasicsEverything “cyberizable” is in Cyberspace Cyber Personal Assistants Electrons replace atoms for “presence”
“Telepresence” … 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 speaker’s 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).– Moore’s 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 Moron’s Law
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LINC: Laboratory Instrument Computer c1964
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Tera
Giga
Mega
Kilo
11947 1957 1967 1977 1987 1997 2007
Extrapolation from 1950s: 20-30% growth per year
StorageStorageBackboneBackbone
MemoryMemoryProcessingProcessing
Telephone ServiceTelephone Service17% / year17% / year
????
0.010.1
110
1001000
10000
1980
1982
1986
1988
1990
1992
1994
1996
Per
form
ance
in M
flop
/s
Micros
Supers
8087 802876881
80387
R2000
i860
RS6000/540Alpha
RS6000/590Alpha
Cray 1S
Cray X-MP
Cray 2 Cray Y-MP Cray C90Cray T90
Growth of Microprocessor Performance
1998
2X transistors/Chip Every 1.5 years
“Moore’s Law”
Microprocessors have become smaller, denser,
and more powerful.
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Desktop Supercomputing
> $13M< $15KCost
> 5,000 lbs< 50 lbsWeight
1 GB2 GBMax RAM
4 166MHz2 Xeon 550MHzCPUs
13331333Peak Mflops
1989 Cray Y-MP8/4128
Dell Precision610 Workstation
3/20/89 Electronic Newswww.dell.com
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•
Bell’s Nine Computer Price Tiers
Super server: costs more than $100,000“Mainframe”: costs more than $1 million
an array of processors, disks, tapes, comm ports
1$: 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$:
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Platform evolution: What do they do that’s 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 = today’s fast LANs
One chip, networked platforms more cyberization
The challenge… interfacing platforms and people.
OR 2000OR 2000
OutlineComputing Technology: BasicsEverything “cyberizable” is in Cyberspace Cyber Personal Assistants Electronics replace atoms for “presence”
“Telepresence” … 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?
OR 2000OR 2000
Region/Region/IntranetIntranet
Campus,Campus,including SANsincluding SANs
HomeHome
BodyBody
WorldWorld
ContinentContinent
Everything cyberizable will be in Cyberspace!
Fractal Cyberspace: a network of … networks of … platforms
CarCar
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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 knowbricks & mortar anywhere
(personnel/clients)office hours anytime
radio nets => anwherereports & databases web access for all
documents!letter & fax email & web accessphone email, voice & video mailpersonal visits videophone / videomailsignature authenticated imagesenvelopes digital envelopes / store
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New or old money… it’s just bits
Prepaid
Credit
Cash
Check
ATM /
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
OR 2000OR 2000
OutlineComputing Technology: BasicsEverything “cyberizable” is in Cyberspace Cyber Personal Assistants Electronics replace atoms for “presence”
“Telepresence” … 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 memory…
When we can store everything we’ve: 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 Cyberspace
http://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 organization’s 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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OutlineComputing Technology: BasicsEverything “cyberizable” is in Cyberspace Cyber Personal Assistants Electronics replace atoms for “presence”
“Telepresence” … 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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TelepresentationElements
Slides Audio Video Script,
text comments, hyperlinks,etc.
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Telepresentations:The 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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What about telecollaboration?
… working together at a distance
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Conference Rooms with Teleconferencing
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Telework: it’s the sound, screens, and bandwidth, stupid
http://research.microsoft.com/barc/GBell/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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Telepresence: Reflection terminal
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Mobile videophone
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Honda Robot
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Hospital robots...
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Telemedical Collaboration…Telementoring 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?
OR 2000OR 2000
OutlineComputing Technology: BasicsEverything “cyberizable” is in Cyberspace Cyber Personal Assistants Electronics replace atoms for “presence”
“Telepresence” … 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 Angel
Knows about your state of health.
Has the latest medical knowledge.
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Your husband just died, … here’s his black box
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Steve ManninCyberspace
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Libretto, .5mm pencil
PCS; Pilot
Libretto PS, Ricoh Camera; Swiss Army Knife
Compass; altimeter
Not shown: ECG; GPS;
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Moore’s 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 Let’s interact… ala Barney
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MedtronicsImplanted
Cardioplasticstimulator
cardio- recorder
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Pump
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Audio, pix, T, P, ECG, location, physiological parameters…1 GB
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OutlineComputing Technology: BasicsEverything “cyberizable” is in Cyberspace Cyber Personal Assistants Electronics replace atoms for “presence”
“Telepresence” … 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?
OR 2000OR 2000
Turing test: you can’t 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 surrogates:models 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