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  1. F UTURE FUTURE ofHEALTHCARE Impact upon Architecture and the Richard M. Satava, MD FACS Professor of Surgery University of Washington and Senior Science Advisor US Army Medical Research and Materiel Command Future of Healthcare Design AIA Seattle/AHP Healthcare Design Conference Seattle, WA February 14, 2008

  2. Greetings from Monterey California

  3. “The Future is not what it used to be” ….Yogi Berra Disruptive Visions

  4. “The Future is here … . . . it’s the Information Age” Current Visions

  5. New technologies that are emerging from Information Age discoveries are driving our basic approach in all areas of healthcare education . . . EXAMPLES Fundamental Concept

  6. Why Robots? The Touch Lab, MIT Movie: Alien

  7. Holomer Total body-scan for total diagnosis Virtual Soldier Program Multi-modal total body scan on every trauma patient in 15 seconds Satava March, 2004

  8. Wound Tract Virtual Autopsy . . . . . . is a SIMULATED Autopsy Less than 2% of hospital deaths have autopsy Statistics from autopsy drive national policies

  9. Why modeling & simulation, imaging and robotics • Healthcare is the only industry without a • computer representation of its “product” • A robot is not a machine . . . • it is an information system with arms . . . • A CT scanner is not an imaging system • it is an information system with eyes . . . • thus • An operating room is an information system with . . .

  10. Total Integration of Surgical Care Minimally Invasive & Open Surgery Remote Surgery Pre-operative planning Surgical Rehearsal Simulation & Training Pre-operative Warmup Intra-operative navigation Courtesy of Joel Jensen, SRI International, Menlo Park, CA

  11. XACTIX XACTIX CONVENTIONAL Surgical MEMS - Smart Surgical Tools MEMS Sharps Instrumented Scalpel Courtesy: E.C. Benzel, L.A. Ferrara, A.J. Fleischman, S.Roy

  12. Mechanics to energy “TriCorder” Point-of-care noninvasive therapy HIFU High Intensity Focused Ultrasound for Non-invasive Acoustic hemostasis Courtesy Larry Crum, Univ Washington Applied Physics Lab

  13. Courtesy Larry Crum, Univ Washington Applied Physics Lab 2003

  14. From tissue and instruments to Information and energy* The Fundamental Changes * “The Information Age is about changing from objects and atoms to bits & bytes” Nicholas Negroponte “Being Digital” - 1995

  15. Total Patient Awareness • Defibrillator • Ventilator • Suction • Monitoring • Blood Chemistry • Analysis • 3-Channel Fluid/Drug • Infusion • Data Storage and • Transmission • On-board Battery • On-board Oxygen • Accepts Off-Board • Power and Oxygen Bring the hospital to the casualty, not the casualty to the hospital . . . The LSTATLife Support for Trauma and Transport “ . . . with a fully functional ICU ” Courtesy of Integrated Medical Systems, Signal Hill, CA

  16. LSTAT Deployment to Kosovo - March 2000 212th MASH Deployed with LSTAT - Combat Support Hospital Courtesy of Integrated Medical Systems, Signal Hill, CA

  17. Aeromedical evacuation Nightingale UAVGoal • Identify “optimum” VTOL UAV design • Create a new VTOL UAV tailored to the operational need LSTAT

  18. VTOL UAV technology is maturing rapidly enough to minimize risk. Why now?

  19. LSTAT Lite LSTAT – Back pack version LSTAT for far-forward battlefield – less than 50 lbs

  20. + TRAUMA PORTAL + Emergency Room Trauma Portal

  21. Opportunities for LSTAT • Pre-hospital transport, treatment & continuity of care • In-hospital transport • Room Flexibility • Surge Capability • Disaster Response – local • Disaster Response – national & transport

  22. Trans Oral Intra-peritoneal Surgery - Future Courtesy of N Reddy, Hyperbad India 20005

  23. Early Luminal Malignancies - Robotic Endoscopic Mucosal Resection - EMR Courtesy of N Reddy, Hyperbad India 20005

  24. Trans-gastric appendectomy Courtesy of N Reddy, Hyperbad India 20005

  25. So What ?

  26. Future EndoscopicWorkstation? Conventional colonoscopy Tele-endoscopy. Controlling micro-robot (which has been inserted into the rectum) from endoscope workstation [ Courtesy R Satava, GI Clinics North America, 1983] Endo-vascular work station – by Hansen Medical, Inc URL http://hansenmedical.com Feb, 2007

  27. Classic Education and Examination What is the REVOLUTION in surgical education?

  28. Mannequin-based Simulator - Realistic physiologic response Individual and Team Training The Realization The Dream Human Patient Simulator 2005 Courtesy METI, Inc Sarasota, FL 2006 First Mannequin VR Simulator – David Gaba 1984 Courtesy MedSim, Inc - 1991

  29. Simulation Incorporates Training and Objective Assessment Surgical Simulators Laparoscopic hysterectomy Courtesy Michael vanLent, ICT, Los Angeles, CA LapSim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000 Laparoscopic Simulator with tactile feedback Courtesy Murielle Launay, Xitact, Lausanne Switzerland

  30. Virtual Reality Suturing Simulator Computer-based wound planning Dermatology SimulatorsPre-operative planning • Strong collaborative environment • UW Dermatology • Daniel Berg • Human Interface Technology Laboratory (HIT lab) • Suzanne Weghorst • Peter Oppenheimer

  31. Endovascular Simulators(Surgical rehearsal) Patient specific image Graphic overlay

  32. Harborview VA ISIS University Washington of Madigan AMC Children’s Seattle Pacific Northwest Simulation Consortium WWAMI: Washington, Wyoming, Alaska, Montana, Idaho University of British Columbia, Vancouver, BC Oregon University of Health Sciences, Portland, OR Anchorage Vancouver Spokane Billings Portland Boise Cheyenne WWAMI Represents 27% of entire land mass of USA

  33. Over 500,000 operations performed … …in foreign countries in 2007 Medical Tourism Another Concern Opportunity

  34. Objective Assessment of Technical Skills Objective Structured Assessment of Technical Skills – OSATS Richard Reznick, Univ of Toronto

  35. “Red Dragon” “Blue Dragon” passive recording device Courtesy Blake Hannaford, PhD University of Washington, Seattle

  36. Objective Assessment Novice Intermediate Expert MEMS based tracking, RFID, etc Hand motion tracking patternsAra Darzi, MD. Imperial College, London, 2000

  37. New Concepts for OR of the Future “The OR Without Lights” Eric LaPorta, Barcelona, Spain 2005

  38. ROBOT SURGICAL TECHNOLOGIES, INC “Penelope” – robotic scrub nurse Michael Treat MD, Columbia Univ, NYC. 2003 Currently in Clinical Trials

  39. Integrating Surgical Systems for Autonomy The Operating Room (personnel) of the Future 100,000 Surgeon Assistant Scrub Nurse Circulating nurse Borrowing from the standard practices of other industries

  40. Demonstration of Phase 1 Operating Room with no People SRI International, Menlo Park, CA January, 2007

  41. Demonstration of Phase 1 Operating Room with no People SRI International, Menlo Park, CA January, 2007

  42. Predator 2003 Fighter Pilots – until 2002 Fighter Pilots – Beyond 2003 SATAVA 7 July, 1999 DARPA

  43. “Remote Pilots” A last bastion of guts-and-glory aviation is falling, as the U.S. Air Force prepares to unveil a new breed of unmanned aircraft pilots. Known as “remote pilots”, they’ll wear wings. They’ll fly aircraft. But chances are many will never climb into a cockpit. . Senior leaders have yet to approve the new Undergraduate Remote Pilot Training (URT), but Air Force officers familiar with the project expect approval by the end of the year. Instead of sticking reluctant manned aviators behind a console, the Air Force will groom remote pilots from the start to fly what the service now calls unmanned aerial systems 28 Training & Simulation Journal August/September 2006