Foreword to Electronic Reporting in the Digital Medical Enterprise

June 6, 2003

Published in November 1, 2002


Ray Kurzweil, one of the foremost pioneers in the field of artificial intelligence, has been called “the ultimate thinking machine” by Forbes magazine. As early as 1974, he led the development of the first “omni-font” optical character recognition (OCR) technology, which made it possible for computers to recognize printed and typed documents. In 1976, he adapted this technology for use in the Kurzweil Reading Machine, which reads documents aloud to the blind and visually impaired. His OCR technology also provided the capability for Lexus and Nexus to build their online legal and news information services. He also developed the first commercially marketed large-vocabulary speech recognition devices.

In 1999, Kurzweil received the National Medal of Technology, the nation’s highest honor in technology, from President Clinton in a White House ceremony. He has received hundreds of other national and international awards and is the author of The Age of Intelligent Machines (1990) and The Age of Spiritual Machines, When Computers Exceed Human Intelligence (1999).

This speech recognition pioneer shared his thoughts on the future of computers in medicine with the editors and readers of this SCAR Primer.

The last time I brought my car in for a check-up, the dealer had a comprehensive history of all of its repairs and tests up on his screen as I pulled in. The last time I brought my body in for a check-up, my doctor had a thick folder of dog-eared paper records on his desk. If we wanted to plot one of my health variables&#8212cholesterol, say&#8212this would require a time-consuming project of thumbing through many disparate records in varied formats, assuming the data could be found at all.

Medicine is perhaps the most knowledge-intensive profession one can pursue, so it may seem surprising that we are not further along in the use of computation, which is the most powerful technology we have for containing and controlling knowledge. The reasons for this state of affairs are many: medical knowledge is extremely complex and, therefore, difficult to represent in rigid tabular databases, and there are no clear authorities to set and enforce standards for electronic medical records.

But this is now starting to change rapidly. Because of its complexity, medicine has been slower than some other fields to fully embrace the computer. By the end of the decade, however, I believe we will find medicine as the profession taking best advantage of knowledge-based technology. There are many factors for this impending transformation: the Internet, the ubiquity of inexpensive computers, the advent of portable computing, and a broad array of advances in computerized systems that affect all phases of medicine.

The Internet is already a powerful force changing the relationship between doctors and patients. Patients are increasingly knowledgeable about medical issues as a result of the thousands of medical Web sites and discussion groups, although the reliability of much of the information is a legitimate concern. Increasingly, patients come into their visits armed with information that they want to review. Although dealing with misinformation is an issue, most doctors I’ve talked to find that increased patient knowledge results in greater compliance with treatment and lifestyle recommendations, because the patients have a greater understanding of the implications of their condition. Many doctors are using the Web and e-mail as means of communicating with their patients. Although these new modalities of communication can be very effective, they can also create new dilemmas (e.g., how should a doctor handle the potential for an e-mail being sent by a patient complaining of chest pain at 3 a.m.?)

We are in the early stages of many other salient trends. Telemedicine is used as doctors share imaging data over the Internet and engage in videoconferencing to access expertise in other geographical areas. Automated pattern recognition is starting to be used in identifying areas of interest in electrocardiograms (particularly the lengthy 24-hour Holter tapes) and blood cell analyses. Databases that provide information on drug interactions are coming into general use. The human genome project has revealed the basic genetic data needed to launch an almost limitless number of inquiries and practical applications. Microchip technology is being used to analyze biological samples for specific proteins and strands of DNA. Viable electronic medical records are emerging. Virtual reality systems, which include haptic (i.e., tactile) interfaces are used in training surgeons and even in certain types of surgery.

Let’s consider how these trends will manifest themselves over the next decade: it is now the year 2012.

Computers have essentially disappeared and are no longer contained in little rectangular boxes. Personal computers have become, well, very personal. The computer “display” is now built into the user’s eyeglasses and contact lenses, which paint images directly onto the retina. Similarly discreet devices provide two-way auditory communication. We are plugged into the Web at all times through very high bandwidth wireless connections. And all of the electronics required are built into our eyeglasses and woven into our clothing.

Virtual displays (created by the “direct eye” displays) hover in the air (and can be seen through) as we walk around. Alternatively, these display lenses allow users to enter full-immersion virtual reality environments, where they can interact with other people: patients, other doctors involved in a case, and remote medical experts, none of whom need to be physically proximate. Specialized haptic devices even allow physical examinations from afar. It’s now possible for medical technicians with relatively inexpensive equipment to bring health care to remote areas.

Doctors routinely train in virtual reality environments that simulate the visual, auditory, and tactile experience of medical procedures, including surgery. The virtual environments allow interacting with physically remote patients, but simulated patients are also available. With a simulated patient, a medical student (or a physician taking a continuing medical education course, or even a high school student learning what it’s like to be a doctor) can engage in a complete simulated doctor–patient encounter, diagnose a condition, and recommend a treatment. He or she can then fast forward to the next encounter with that patient (which can be a few&#8212simulated&#8212hours or months later) and see how things turned out.

Microchip-based protein and gene analysis systems allow thousands of tests to be rapidly administered in a doctor’s office as well as at home. Computer-based pattern recognition is routinely used to interpret imaging data and blood cell analysis. The resolution and bandwidth of noninvasive imaging technologies have greatly improved and are used ubiquitously, with diagnosis involving a collaboration between the human physician and a pattern-recognition–based expert system.

Lifetime patient records are maintained in computer databases, and trend analyses for critical medical variables (e.g., blood pressure, hormone levels) are readily available. Privacy concerns about access to these records (as with many other databases of personal information) continue to be a major issue.

Doctors routinely consult knowledge-based systems, which provide automated guidance, access to the most recent medical research, and practice guidelines. Practice guidelines are implemented as expert systems that provide automated suggestions and not just as written documents.

As a doctor examines a patient (who may be hundreds or thousands of miles away), he or she views well-organized displays of relevant information on always present visual displays. All of the currently relevant examination and test data are displayed (and seen hovering in the air), as are all relevant trends. The doctor interacts with this invisible computer either by speaking to it or by manipulating a special handheld device. In addition to patient data, the doctor can see tentative diagnoses and treatment recommendations from the automated diagnostic and practice guideline systems. If the doctor wants to share certain information with the patient (e.g., “look at how your blood pressure has improved over the past week”), a relevant graph or other display can be sent to the patient’s own computerized display. Commands to the computerized systems to accomplish these tasks can be given in natural language voice commands (e.g., “send blood pressure graph to Sally”), or, when the doctor wants to communicate with his or her own computer display discreetly, a handheld communicator could be used.

The bioengineering revolution, which was only coming into its own in 2002, is now in full swing. The toll from the major killers of 2002&#8212heart disease, cancer, stroke, diabetes&#8212have been greatly reduced, and these diseases are becoming manageable chronic conditions. Anti-aging treatments are becoming available, and bioengineering now appears to be extending the human life span by more than a year every year.

Surgery now typically uses a virtual reality system that allows the surgeon to view a site of surgery that is inside the patient from outside the patient. The virtual reality system can also greatly increase the apparent size of the surgery site. For example, tiny nerves and blood vessels can be made to appear tens or even hundreds of times larger, so that the surgeon can use large physical movements to control very small precise movements of robotic manipulators that are in contact with the patient’s tissues.

Neural implants for sensory disorders (e.g., improved cochlear, auditory cortex, and retinal implants) are widely used, as are neural implants for certain neurological diseases such as Parkinson’s disease and a variety of tremor-causing conditions. Using the robotic virtual reality surgical systems, these implants can be introduced using minimally invasive procedures.

Patients who share medical conditions and concerns frequently meet with each other in virtual reality meetings. Patients are increasingly knowledgeable about their own health conditions. There has been a great deal of consolidation of health-related Web sites, and authoritative sites that have the confidence of both doctors and patients have emerged. This allows patients to take increasing responsibility for their own health and lifestyle choices and allows physicians to take the role of knowledgeable guides to an increasingly complex world of medical technology.

@ 2002 Ray Kurzweil.