Thursday, November 19, 2015

End of Year Predictions

During the last decade we have seen enormous changes in clinical medicine, and it's business workings. Some of  it has been very good, and much of it has been disruptive. Much of life is letting go. In order to move forward each year, something  gets left behind.

It began with bronze, then iron, then nano-technology. Horse power was replaced by steam engines, then combustion engines, now being replaced by electric engines.

In health care much the same is occurring. Few would recognize or remember the technology used to  perform lab tests, diagnostic testing and treatments from 20 years ago. We are now passing through the first  stages of information technology and the digital language that makes today's medical care possible.  As we traverse each iteration a new one appears and we cast off the old reluctantly. Learning new techniques are  time consuming until mastered.

My own story as an ophthalmologist beginning in 1978 mirrors what is now occurring  in health information technology.

In 1977 it was common for a cataract removal to take over one hour or more. The recovery period required sandbags and a three day hospital stay. Numerous advances in material design, and operative technique created a nexus.  The addition of micro surgery, intraocular lenses and a revolutionary method of dissolving the crystalline lens made for a major change, including better outcomes fewer complications, creating the ability to have a fifteen minute surgery and an outpatient encounter of less than two hours door to door. In 1977 in order to see clearly it required special thick lenses or a custom contact lens. Today in 2015 we have intraocular lenses which are placed in the eye at the time of cataract removal.  Vision is  restored within several hours following surgery, and not infrequently there is no eye patch !

Mine was not a  unique experience. Other specialists, in orthopedic surgery, neurosurgery, abdominal surgery, have gained from what I like to call "scopology",  endoscopes, laparoscopes, small incision back surgery, even small incision heart surgery.

What is coming next will effect not only medicine, it will effect almost every industry, from entertainment to retail sales, travel, and home.

By chance I happened to receive an email, one of those that takes you to a lengthy video that you  cannot stop, but are drawn to remain by it[s content and promise of some special  deal with a money-back guarantee if dissatisfied.  This was no different.  However, buried within the presentation were the facts that a new device  would soon be entering the market.  The smart watch and other wearable are a brief pit stop on the way to a device akin to  Mr Clean's all in one magic  sponge.  It is predicted that over 500 million will be purchased in the initial two years of production. What it is will revolutionize our lives in medicine, at the store, and in the home or wherever you may be. It is a device that is worn and works passively with little, if no input from the user.

Like most mobile devices, at first, they will be very expensive. However in a relatively short period of time they will become ubiquitous and available in inexpensive material such as rubberized neoprene, or plastic material. They will be available as expensive jewelry, embedded with gems in a variety of metals.  The electronics will be in a removable cartridge to be transferred from your daytime wear to evening apparel.

Daytime Wear


 Evening Wear
 Special Occasions


Apple, LG, Nokia and Samsung are all waiting to capitalize on this development.  The journey from tablet PC to  handheld phones, smart watches are all development tools to design and produce the Smart Band. The inner workings of this band contain some proprietary components that will make some companies and people very rich. It includes GPS, RFID, connectivity, and considerable computing power. The device will have a  relatively short half-life....designed to be replaced with new technology every year or so, just as Apple and Android smart phone manufacturers release new iterations each year with new functionality.  The driving force is to  be able to do more with less.  This innovation cycle is what drives our economy.  It has for a very long time in consumer devices, cars, appliances. We see now that fewer and fewer gadgets can be repaired, it is now a throw away market place. Labor has become more expensive than parts.

Think of all the occurrences during  your day from arising in the  morning, eating breakfast, driving to the office or hospital, waiting for your first patient, travelling to the hospital, making rounds and more. Messaging  has become commonplace but requires active participation.  Imagine a wearable that would calculate  your location and signal whoever is waiting for you where you are and how long it will be until your arrive. No more calls from the O.R. the floor, your partners, or anyone expecting to meet with you that day. All of this without the wearer lifting a finger. If you planned to meet someone for lunch the device will notify your favorite eatery and have  your selection hot and waiting for you. After your meal it will automatically pay your bill.

The only choice will be which wrist do you want to wear it on? Oh yes...color and do you want it engraved?

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