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OR 2000 Computers in the Operating Room: A Patient/Customer and Computer Persons View The 3rd Congress on Computers & Robotics in the Operating Room 2000.

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Presentation on theme: "OR 2000 Computers in the Operating Room: A Patient/Customer and Computer Persons View The 3rd Congress on Computers & Robotics in the Operating Room 2000."— Presentation transcript:

1 OR 2000 Computers in the Operating Room: A Patient/Customer and Computer Persons View The 3rd Congress on Computers & Robotics in the Operating Room 2000 July 14, 1999 Gordon Bell Microsoft Corporation

2 OR 2000 Abstract The computing and communications industry are on a quest to put "everything into Cyberspace. Our ability to carry out this quest evolves in three dimensions: the computers (including robotic computers with hands, arms, legs, eyes, etc.); networks to connect the global computing hierarchy that will eventually include "on body" nets; and finally, cyberization. Cyberization is the technology to interface information bearing entities (cars, physical networks, people) to computer platforms. For the "information-based" world, Nicholas Negroponte characterizes the quest as the transition from a massy world made up of atoms to a mass-less world of bits or more precisely, electrons, photons, magnetization that hold bits. By going massless, then time and distance can be shifted as in telepresence, the overall framework for telemedicine. By looking at cyberization opportunities, one might speculate how Operating Rooms might look.

3 OR 2000 Outline Computing Technology: Basics Everything cyberizable is in Cyberspace Cyber Personal Assistants Electrons replace atoms for presence Telepresence … being there, while being here and maybe some other time Guardian Angels, an on-body assistant Turing tests... When will computers be able to fool some of the people some of the time?

4 OR 2000 Caveat Discuss where computing is going … and by analogy Spark your imagination about how computing and other technology will impact life outside (and within) the OR… no income The speakers understanding of the OR is from a patient and web-visitor perspective… no sight, no blood, no pulse

5 OR 2000 The two great inventions The computer (1946… realised in 1948). Computers supplement and substitute for all other info processors, including humans The Transistor (1946) and subsequent Integrated Circuit (1957). – Moores Law: The integrated circuit evolves at the rate of 60% per year as measured by the number of transistors per chip. – Storage evolves at this rate – Optical transmission lines do too – Phone lines behave Morons Law

6 OR 2000 LINC: Laboratory Instrument Computer c1964

7 OR 2000 Tera Giga Mega Kilo Extrapolation from 1950s: 20-30% growth per yearStorage Backbone Memory Processing Telephone Service 17% / year ??

8 Year Performance in Mflop/s Micros Supers R2000 i860 RS6000/540 Alpha RS6000/590 Alpha Cray 1S Cray X-MP Cray 2Cray Y-MP Cray C90 Cray T90 Growth of Microprocessor Performance X transistors/Chip Every 1.5 years Moores Law Microprocessors have become smaller, denser, and more powerful.

9 OR 2000 Desktop Supercomputing > $13M< $15KCost > 5,000 lbs< 50 lbsWeight 1 GB2 GBMax RAM 4 166MHz2 Xeon 550MHzCPUs 1333 Peak Mflops 1989 Cray Y-MP8/4128 Dell Precision 610 Workstation 3/20/89 Electronic News

10 OR 2000 Bells Nine Computer Price Tiers Super server: costs more than $100,000 Mainframe: costs more than $1 million an array of processors, disks, tapes, comm ports 1$: embeddables e.g. greeting card 10$: wrist watch & wallet computers 100$:pocket/ palm computers 1,000$:portable computers 10,000$: personal computers (desktop) 100,000$: departmental computers (closet) 1,000,000$:site computers (glass house) 10,000,000$:regional computers (glass castle) 100,000,000$:national centers… en route to 1,000,000,000$:

11 OR 2000 Platform evolution: What do they do thats useful? How do they communicate?

12 OR 2000 In a decade we can/will have: more powerful personal computers – processing x – 4x resolution (2K x 2K); large displays – storage of one terabyte adequate networking – ubiquitous access = todays fast LANs One chip, networked platforms more cyberization The challenge… interfacing platforms and people.

13 OR 2000 Outline Computing Technology: Basics Everything cyberizable is in Cyberspace Cyber Personal Assistants Electronics replace atoms for presence Telepresence … being there, while being here and maybe some other time Guardian Angels Turing tests... When will computers be able to fool some of the people some of the time?

14 OR 2000 Region/Intranet Campus, including SANs Home Body World Continent Everything cyberizable will be in Cyberspace! Fractal Cyberspace: a network of … networks of … platforms Car

15 OR 2000 Everything will be in Cyberspace Is this a challenge? goal? quest? fate?… or Cyberization enables new computing platforms that require new networks to connect them – Infrastructure supports the content – Three evolutionary dimensions

16 OR 2000 Cyberization: interface to all bits and process information Coupling to all information and information processors Pure bits e.g. paper, newspapers, video Bit tokens e.g. money, stock State of: – places like the OR, – things e.g. robots, instrumentation, especially people…

17 OR 2000 OR 2000: Implications when everything is in cyberspace IP on everything Delivered by some standard wire or fiber e.g. Ethernet or Firewire or USB HTML accessible… Even the robots have to be connected so they can feedback!

18 OR 2000 Atoms a.k.a. massy vs. massless bits Atoms (mass)Electrons, etc. (massless) people knowcomputers also know bricks & mortaranywhere (personnel/clients) office hoursanytime radio nets => anwhere reports & databasesweb access for all documents! letter & fax & web access phone , voice & video mail personal visitsvideophone / videomail signatureauthenticated images envelopesdigital envelopes / store

19 OR 2000 New or old money… its just bits Prepaid Credit Cash Check ATM / Prepaid

20 OR 2000 Put those checks & statements in Cyberspace or eliminate them!

21 OR 2000 Paperless transactions: put them all in Cyberspace

22 OR Internet-based service for keeping medical records electronically …EMR No on site or in office equipment except a browser Facilities – rapid input and record retrieval – accessible anywhere at anytime – patient accessible – prescription drug interaction, advice, etc.

23 OR 2000 Especially cyber-ready images

24 OR 2000 Sensors, actuators/emitters, sensor-actuators, and wireless Medical: P, T (body), blood gas, ECG, etc. Mobile: location (GPS, compass), ambient (P,T), acceleration, Personal: A/V (and eyes) including IR, body & head position (6 degrees), Speech and glasses Radar, sonar, beacons, Spectrum, chemical, etc. analyzers Connected without cables

25 OR 2000 Outline Computing Technology: Basics Everything cyberizable is in Cyberspace Cyber Personal Assistants Electronics replace atoms for presence Telepresence … being there, while being here and maybe some other time Guardian Angels Turing tests... When will computers be able to fool some of the people some of the time?

26 OR 2000 The Cyber Admin or the prosthetic memory… When we can store everything weve: read/written, heard/said, seen/acted, plus physical parameters.

27 OR 2000 What does Cyber Admin do? Captures the creation of all personal/professional information Everything that happens in the OR Stores and organizes Retrieval is the challenge – recalling readings, conversations, presentations, images – helps the guardian angel What are the apps? when we can do this?

28 OR 2000 My project … putting my legacy and future bits in Cyberspace Personal paper documents – Books (encoded by CMU), papers, articles, memos, notes, , notebooks, drawings Encode video and audio lectures Current electronic media – , files, papers, photos (now digital) – voice notes and records Would like to capture photos and slides

29 OR 2000 Capture and encoding

30 OR 2000 HP Digital Sender… color document scanner

31 OR 2000 Sony voice notes recorder…

32 OR 2000 Evolving cameras to capture images and voice notes

33 OR 2000 A word about storage… CDs hold 6 near VHS quality videos (300 Kbps)

34 OR 2000 Book page

35 OR 2000 Now how do you find or use the rich information The system must: locate, retrieve, visualize, order, up load the organizations IP assets (text, proposals, images, videos, presentations, experiments, procedures, etc.) … with appropriate controls.

36 OR 2000 Thumbnails to aid retrieval

37 OR 2000 Virage Video Cataloger

38 OR 2000 Outline Computing Technology: Basics Everything cyberizable is in Cyberspace Cyber Personal Assistants Electronics replace atoms for presence Telepresence … being there, while being here and maybe some other time Guardian Angels Turing tests... When will computers be able to fool some of the people some of the time?

39 OR 2000 Telepresence … being there while being here, at another time, and with time scaling Telepresentations Telemeetings and telecollaboration The work

40 OR 2000 Motivation: Telepresentations Presenter and/or audience telepresent NOT: meeting or collaboration settings Forget the nasty social issues! Mostly one-way

41 OR 2000 Telepresentation Elements è Slides è Audio Video Script, text comments, hyperlinks, etc.

42 OR 2000 Telepresentations: The Essentials Slide and audio a must Add some video (low quality) to make us feel good Storage and transmission costs low

43 OR 2000 Telepresentations: The Killer App Increased attendance & lower travel costs Practical and low-cost NOW e.g. ACM97 - 2,000 visitors in real space, 20,000 visitors on Internet

44 OR 2000 What about telecollaboration? … working together at a distance

45 OR 2000 Conference Rooms with Teleconferencing

46 OR 2000 Telework: its the sound, screens, and bandwidth, stupidhttp://research.microsoft.com/barc/GBell/

47 OR 2000 CMU wearable computers

48 OR 2000 Future OR

49 OR 2000 Current OR

50 OR 2000

51 Telepresence: Reflection terminal

52 OR 2000

53 Mobile videophone

54 OR 2000 Honda Robot

55 OR 2000 Hospital robots...

56 OR 2000 Telemedical Collaboration… Telementoring is probably the killer app Surprisingly little used currently: – 1 in 1000 radiograms, 1 in 2000 home visits – Saves time and money; no money Robotics more useful for precision and routine than remotely Inhibitors are network speed, delays, etc. – Remote diagnostics a promising use of VR – Will be able to have anyone, anywhere with you at anytime...

57 OR 2000 Webcam of Hospital in Sweden

58 OR 2000 What happens when there are webcam(eras) everywhere (e.g. a dozen or so in the OR) instead of the 100,000 out there now?

59 OR 2000 Living in Cyberspace … the infrastructure being always connected is essential

60 OR 2000 Infrastructure

61 OR 2000 MilliBill Large, general purpose panel – Paintings, photos, videos, a new art medium, and – even TV – Becomes a true window to anywhere Voice interface Evolves to cover entire wall so that everyone can be by a window

62 OR 2000 Fujitsu 42 plasma panel

63 OR 2000 Attending simultaneous meetings

64 OR 2000 Outline Computing Technology: Basics Everything cyberizable is in Cyberspace Cyber Personal Assistants Electronics replace atoms for presence Telepresence … being there, while being here and maybe some other time Guardian Angels Turing tests... When will computers be able to fool some of the people some of the time?

65 OR 2000 The Guardian Angel Knows about your state of health. Has the latest medical knowledge.

66 OR 2000 Your husband just died, … heres his black box

67 OR 2000 Steve Mann in Cyberspace

68 OR 2000 Libretto,.5mm pencil PCS; Pilot Libretto PS, Ricoh Camera; Swiss Army Knife Compass; altimeter Not shown: ECG; GPS;

69 OR 2000 Moores law is less important than MEMS micro-electro mechanical systems

70 OR Experts Predict Bionics Wired, February 1997 Hi-Fi Cochlear Implants 2005 Bionic Limbs 2013 Artificial Vision 2040 Bionic Person (unlikely)

71 OR 2000 A device that would have saved me from a heart attack

72 OR 2000 BAN, PAN or whatever for people networks Temperature monitoring with the flu Saved me from a heart attack Where is the person, exactly… a baby sitter Lets interact… ala Barney

73 OR 2000 Medtronics Implanted Cardioplastic stimulator cardio- recorder

74 OR 2000 Pump

75 OR 2000

76 Audio, pix, T, P, ECG, location, physiological parameters… 1 GB

77 OR 2000 Outline Computing Technology: Basics Everything cyberizable is in Cyberspace Cyber Personal Assistants Electronics replace atoms for presence Telepresence … being there, while being here and maybe some other time Guardian Angels Turing tests... When will computers be able to fool some of the people some of the time?

78 OR 2000 Turing test: you cant tell whether you are communicating with a person or a machine using: Text… limited context Voice – context – speech to text and text to speed Visual image and voice – more context – synthesis of dynamic, human images A simulator to carry out a procedure on any person, anywhere

79 OR 2000 People surrogates: models you can touch and feel

80 OR 2000 Simulation with physical models

81 OR 2000 Visualizing & modeling...

82 OR 2000 What is Medical VR? Visualisation of data (usually anatomical) Interaction with visualised data Simulated behaviors of simulated realities: – increasingly as a result of interactions "Realisation" in modalities other than vision: – sound, force, touch, smell

83 OR 2000 Virtual augmentation: connecting the images with reality

84 OR 2000 Models you touch & feel

85 OR 2000 Everything must work together! Medical industry based on proprietary standards

86 OR 2000 Health: Number one market need… must be open!

87 OR 2000 Standards and Standards Processes HL7 application-level messages e.g. admission, discharge, transfers; results; clinical observations. DICOM images e.g. ultrasound, MRI, and X-rays… or PACS, Picture Archiving and Comm. System. IEEE 1073 bedside devices e.g. patient monitors, ventilators, and infusion pumps standards. X12 forms for insurance transactions. ASTM laboratory information systems standards plus the content and security of electronic medical records HIBCC healthcare bar codes standards e.g. labels ADA dental informatics standards

88 OR 2000 Impediments Standards… caused by companies trying to gain proprietary advantages that lock in their customers! User Interface Just doing it… people, time, training Threat: no income

89 OR 2000 The end


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