Q&A: Dr. Nick van Terheyden forecasts the future of health care (video)

By Brian T. Horowitz, Editor and Contributing Writer

We’ve seen the development of wearables and electronic health records (EHRs), but what other future technologies might we see in health care?

Carmakers such as Jaguar Land Rover are experimenting with sensors that could be embedded in a steering wheel to measure brain waves. Including these types of sensors in a vehicle could also help change a driver’s behavior and improve health, according to Dr. Nick van Terheyden, Dell’s chief medical officer.

“That’s actually useful information, especially if you have cardiac disease or some form of diabetes,” van Terheyden told Power More.

Big data provides pivotal insights for physicians in health care, and telemedicine kiosks allow patients to see doctors remotely in a ***, but what will the future of health care look like? We spoke with van Terheyden to find out.

Power More: In the future, how will wearables integrate with mobile apps, the cloud and sensors? How far away are we from it becoming a reality?

Dr. Nick: We’re on the cusp of this emerging into so many parts of our lives. I’m currently wearing the latest Fitbit, which includes GPS as well as constant and recurring pulse rate data that records over a five-day period without having to recharge the battery. To me that’s fascinating and provides real insights. Wearables are starting to open up that data. We see patients with multiple arrhythmias and can be associated with cardiac dysfunction. There are indications of that in the preceding 12 months of EKG rhythm in the patient. If you’re not recording the rhythm on a regular basis, you miss that.

I have a Hexoskin device. It records my EKG, my breathing and using this data and my activity will calculate your maximum VO2 (one of the best measures of cardiac fitness) based on those parameters. It allows you to tailor your fitness and health program based on dynamic data collection. We’re going to see it built into all sorts of fabrics and capturing data in many unexpected places. And providing actionable health insights to patients and consumers all the time.

I think we’re going to see an explosion of wearables in the next 18 months to two years.

Power More: Let’s talk about implantables. Where do we stand with those? When will they become adopted?

Dr. Nick: I’ve seen dermal tags that sample the interstitial fluids, much like putting a Band-Aid on your skin, and they are starting to offer real-time insights into levels of electrolytes, glucose and other molecules in our blood. The company was still in stealth mode as they hadn’t gone public, but the implication was a noninvasive implantable that you can tear off afterwards but that it would sync with your device to provide real-time analysis of your blood, electrolytes and your liver function. I don’t think it has quite reached the point of delivery, but that’s a noninvasive version of implantables and more acceptable given the ease with which you can elect to stop and tear off the strip.

The other version is the permanent implantable — for example implantable defibrillators. [Former Vice President] Dick Cheney has one. These are life-saving devices that can be challenging for patients because when they activate you’re essentially getting a jolt of electricity. It’s not very pleasant, but it can be lifesaving. I think we’re going to see more of these devices implanted to monitor and provide real-time alerts and potentially treatments to patients.

Power More: What will the future of EHRs look like in terms of how they’re connected to the cloud, big data and other aspects of health care?

Dr. Nick: There’s a bit of buyer’s remorse. [Health care providers] bought EHRs to help solve problems because they were going to offer all this value. What they did was capture information, but in many cases they have been challenging to access to gain insights into patients and help guide treatments. Part of that was the user experience. Part of that was the user design, the interface. I think the next wave of this is going to be building value on top of these EHRs. I think they’re going to be a lot more interactive, offering real-time insights to support the workflow of the clinicians as they assemble the knowledge about the patient and the latest data on treatments and help guide the delivery of personalized medicine.

If you were to describe the ultimate EHR in its simplest form for a physician, it would just be something that lives in the fabric of my office. It’s built into the devices. It listens to what’s being said. It’s tracking all the activity, test, investigations and results. It assembles all of that information in an automated way and then presents it to the clinicians and the patient as an actionable insight that we can review and decide on the best course of treatment.

Power More: What are the key trends shaping the future of health care? What’s coming down the pike?

Dr. Nick: Genomics and proteomics are huge eye-openers. When I went to medical school we looked at the genome, and 95 percent of it was described as “junk” because we didn’t understand it. Of course it turns out that that’s not the case. This complex genome has so many elements to it, and we are only just starting to unlock the code. Our capacity to fully sequence a human is down below $1,000 and takes less than 24 hours. Now suddenly you’ve got huge amounts of data that will become part of the medical record and extensive genetic details about our patients. It will play an increasing role in our treatment of our patients.

Artificial intelligence — the ability to teach computers or have computers learn and understand and be intelligent — opens up new processes because it enables discovery of insights and identification of information that we as humans can’t possibly discern because of the volume of data and the complexity of multiple factors. We’re dealing with such large amounts of data and data sets and the tying of all of that together. I think that’s going to be a huge expansion as we see more artificial insights and automated learning.

Artificial organs. Some people talk about it as transhumanism because you’re creating artificial things. [Scientists] conceptually create organs from stem cells or grow them in petri dishes. We have a big donor organ availability problem. If you can replace some of these patients’ failing kidneys, you can turn their world around from being tied to a dialysis machine to being completely free with a new artificial kidney. When we think about knees, could you create a custom knee that’s not made of metal — made of tissue that’s self-healing. We will see more in the way of artificial organs that will meet the current shortage of donor organs and offer tremendous opportunities for improving quality of life as we age and some of our organs stop working so well — it could be a simple as *** implants or intraocular lenses.

Virtual reality. There has been a lot of advances in virtual reality but the next wave of augmented reality is more interesting and applicable in health care with the ability to overlay imaging data on an existing operating field. The simplest example is a surgical field that takes an MRI and a CT scan and projects it as an overlay before the surgeon makes any skin incisions. So now he’s cutting based on that patient’s individual anatomy and not based on generalized details of anatomy that varies by individual. We’ve seen some of that with the Microsoft HoloLens. They’ve got a game where you’re sitting in your living room and you start to see aliens emerge from the wall. It’s really fascinating, and no doubt will be developed in gaming first. But it will quickly find applications in health care.

3-D printing. Now we’re no longer dependent on a supply chain. You’ve got a 3-D printer that will print devices. I can print a custom tool for a surgical operation or procedure that is customized to my particular design. We’ve seen some early work where they have modeled real patient anatomy and data and used this for complex reconstructive surgery, creating templates customized just for that procedure for that patient. They create examples and print pieces used as templates to help them do a perfect job. This will probably expand to 3-D printing of replacement custom organs. Why would you not 3-D print an organ if you can print the cells? We can print pieces of chemical. Now we can extend that to the cellular level.

Check out the video below as Dr. Nick demonstrates the latest medical devices and discusses what will shape the future of health care.

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