Who cares? P Cochrane, D Heatley and I D Pearson
The first world is moving towards higher concentrations of older people and fewer carers. Just 20 years ago there were 30 potential carers for each person needing care. By 2010 this will have reduced to only three potential carers. National economies will not be able to sustain the levels of care enjoyed to date and a potential crisis looms. Fortunately the technological advances that have extended lifetimes are also spawning the means of caring through information technology (IT). The demands placed on telecommunications networks will dictate wide-band services, with human scale delays and interfaces.
1.
Aging populations
J
ust 20 years ago there were 30 potential carers for each person needing care in the first world. By 2010 this will have reduced to only three. National economies will not sustain the levels of care enjoyed to date and a potential crisis looms. Fortunately the technologies that have extended our lifetimes are also spawning the means of caring, and the demands placed on networks will dictate wide-band services with human scale delays and interfaces. 2.
Remote care
T
he technologies are already with us to allow surgeons at remote locations to ‘be’ with or even inside a patient’s body, and robots are being used in hip replacement, brain and eye surgery. Remote surgery with a team in California operating on a patient in London using tele-robotics may soon become commonplace. As further developments include the remote monitoring of patients through electronic interfaces mounted on, and in, the body, drug-dependent people can be monitored by computers administering and optimising dosage. 3.
Info-medical advances
W
hile IT can be used to give people independence for as long as possible, and informal health care can be transformed to self-care, the question nevertheless arises: ‘Is it possible to more effectively utilise finite medical resources?’
• •
Can nursing practitioners take some of the load off GPs? Can GPs and nursing practitioners work together more effectively?
•
Can consultants and specialists be more accessible?
•
Could the social services be more effective?
•
Could help be on tap when required?
These are all feasible through the use of networked PCs equipped with video cameras and high-resolution displays. Consultants, GPs and nurse practitioners can share images and data via fixed and mobile communications, and thus effect remote diagnosis and treatment. 4.
Networked medicine
W
hen doctor and patient meet, in the flesh or on-line, medical records could be instantly accessed, symptoms recorded, and computer-aided treatment initiated. At the point when a doctor might normally decide to refer a patient to a specialist, remote access to the specialist’s own expert system may prove sufficient. If the diagnosis remains unclear, electronic agents could search global databases for a match, and provide help from any medical facility connected to the network. In essence, doctors will then be cybernauts. 5.
Information
M
edicine involves large amounts of subjective analysis and specialist knowledge. Diagnostic process can thus be long and complex, needing referrals and tests, which may result in uncertain conclusions. It is not unusual for medics to spend more than 85% of their time trying to find information, roughly 10% putting it into the right format, and approximately 5% making critical decisions. BT Technol J Vol 18 No 1 January 2000
105
TODAY Help is required to navigate through the growing field of information, to find, access and manipulate data, and, finally, to make decisions and to take action. Artificial intelligence (AI) systems for navigation and location can go some way to solving all of this. 6.
Smart copier — dumb pacemaker
W
hen smart copiers break down they automatically log the failure, call the service engineer, and present readout of likely causes. The same technology is finding its way into vending machines and automatic bank tellers. Soon it will reside in washing machines, tumble dryers, microwave ovens, TVs, and PCs. As the number of artificial body parts increases there will be a logical necessity to monitor both the outside and inside of humans with caring computers. Preventative maintenance is always preferable to curative medicine! 7.
Real-time drugs administration
V
ast amounts of hospital time is currently devoted to people requiring periodic monitoring and basic medication, and a modest level of instrumentation and AI could obviate this. Technologies already exist to monitor and administer the correct dosage of drugs, optimised through real-time bio-feedback matched to an individual’s metabolism. To take a specific example, an artificial pancreas is already at the research stage, and some hospitals in the USA are experimenting with the dispensing of drugs by such mechanisms. The next step is obvious — networked patients can remain at home to be remotely monitored and advised. 8.
Probably the greatest challenge will be the design and engineering of interfaces that can be successfully mastered by an old, infirm, and sometimes confused, population. The emphasis has to be a human one as increasingly it will be the machine that cares.
The machine as doctor
Peter Cochrane joined the British Post Office in 1962 and is a graduate of Trent Polytechnic and Essex University. He is a fellow of the IEE, IEEE, and Royal Academy of Engineering, a visiting professor to Essex, Kent and University College, London. He joined Adastral Park in 1973 and has worked on a variety of analogue and digital switching and transmission studies. He has been a consultant to numerous international companies on projects concerned with systems, networks, and test equipment development. He received the Queen’s Award for Technology in 1990 as manager for the production of optical receivers for TAT-8 and the PTAT-1 undersea cable systems. In 1993 he was appointed head of the Advanced Applications and Technologies Department with 620 staff.
David Heatley obtained BSc (Hons 1st Class) and MSc degrees in electronics in 1978 and 1981 respectively, and a doctorate in Optical Communications Systems in 1989. He joined BT in 1978 to work on the development of analogue and digital optical fibre systems designed for video and broadband services. In 1985 he was appointed to head a group responsible for the development of optical receivers for terrestrial and undersea fibre systems. In this capacity, he was a member of the team that received the Queen’s Award for Technology in 1990. He is presently with the Advanced Media Unit and heads a team with special responsibility for mobile telecommunications, future studies and telemedicine. He is a Member of the IEE and a Chartered Engineer.
M
any patients find talking to a computer about personal issues less embarrassing and more acceptable. They can be more candid, and thus provide better quality of information, leading to a more accurate diagnosis. Machines can also be more accurate than humans in this preliminary diagnostic phase. Soon, machines will outpace humans as the amount of information available increases through the use of improved biometrics. In this situation, AI could reduce diagnostic errors, as it will consider all previous case histories. 9.
Conclusions
W
hile our society will become much older, the technologies to help the older members are already being developed. Travel substitution will allow us to work, play and socialise from anywhere. Telemedicine will revolutionise the way doctors work and communicate with each other and their patients. The same technology will allow experts in all fields to share expertise world-wide without having to travel. 106
BT Technol J Vol 18 No 1 January 2000
Ian Pearson graduated in 1981 in Applied Mathematics and Theoretical Physics from Queens University, Belfast. He spent four years in Shorts Missile Systems, in many different disciplines from mechanical engineering to battlefield strategy simulation. He joined BT in 1985, analysing the performance of computer networks and protocols, and after two years, moved to the Local Access Division where he helped develop ATM transmission over optical networks. From 1990 to 1992 he worked in the Network Studies Unit, on the evolution of broadband networks and services, and then in 1992, he moved to the Systems Research Department where he became a full time futurologist. He still works as BT’s futurologist in C2G, the Communications Consultancy Group. From day to day, he maps the future impact of developments throughout technology, considering both their business and social implications, and then travels globally to share his conclusions with both external groups and other parts of BT.
