In today's health care system, high tech and high cost often go together, usually in the waning years of life and often in a hospital. The latest technology — CT and MRI scanners, pacemakers and the like —usually doesn't reach the patient's bedside until he or she is already ill or injured.
The University of Rochester is out to change that. The University has launched its Center for Future Health, whose mission is to create new, portable technologies for use by people in their own homes to prevent disease before it strikes. A melanoma monitor, an interactive digital assistant, wearable computers, memory glasses — engineers are already developing these and other devices in collaboration with physicians. The goal is to make technology affordable and easy to use, so that the home, not a hospital or a doctor's office, becomes the location where patients maintain their health.
"We're developing new technology with the goal of shifting the focus of medicine from treating and curing patients, to preventing disease," says Philippe Fauchet, center director. "There are groups left and right developing devices for individual applications, but we're talking about a fundamental change in the health care system. We will create new medical technology, but on a personal scale. It will be technology you can trust and use everyday without being bothered."
The center is conducting about 20 research projects, including several with the Media Lab at Massachusetts Institute of Technology. Most involve taking a new technology — pattern recognition, DNA computing, artificial intelligence software — and using it as the seed of a low-cost, portable health care device. Pattern and motion recognition software might be the basis of a "gait monitor" that would give early warning of a stroke, or of "memory glasses" to remind the elderly of the names of relatives. Artificial intelligence algorithms are being studied as the basis of a communication aid that might be helpful in curbing marital disputes. DNA could provide the computing power necessary to identify bacterial strains almost immediately. University officials know of no other effort where the focus is on developing new technologies for everyday use by large numbers of people for the prevention of disease.
"This is a whole new vision for the health care system," says Provost Charles Phelps. "The Center for Future Health offers one of the most interesting and vital opportunities for research and teaching that has emerged from the University in years. At its heart, the center will develop new uses of computing technologies, applied at a personal level, to help improve people's health. But the central idea is even more revolutionary: Returning control of people's own health care to them through immediately available and highly personalized information, collected routinely throughout the day in the normal course of their lives."
In each project engineers and scientists are working closely with physicians from the outset, making sure the health-care goals are realistic and appropriate. About two dozen core faculty members come from the University, which is the lead institution. The MIT Media Lab is a long-term partner, with about half a dozen faculty participants. There are also a few faculty participants from the Georgia Institute of Technology and the University of Toronto, as well as dozens of graduate students.
The center is the brainchild of Fauchet, professor and chair of the Department of Electrical and Computer Engineering, and physician Alice Pentland, James H. Sterner Professor and Chair of the Department of Dermatology. Fauchet serves as director and Pentland serves as medical director. Sandy Pentland, academic head of the MIT Media Lab and adjunct professor at Rochester, is external director.
The engineers and physicians come from a variety of areas: computer science, neurology, electrical and computer engineering, chemistry, psychiatry, community and preventive medicine, and others. The center also includes anthropologists and faculty from departments like religion and classics, to help analyze the social implications of the center's research. There is a host of factors to spur creation of such a center at the University, organizers say. Both the medical and engineering schools are highly ranked, and the campuses are right across the street, making collaboration convenient. Its researchers have already formed alliances with interested engineers at other universities. And the University has expertise in licensing its technology, regularly ranking among the top 25 universities nationwide in patent royalties.
Several companies have expressed interest in the center, which is currently pursuing funding from large agencies like the National Institutes of Health and the National Science Foundation, as well as private foundations. Most of the projects build on research currently being done and funded through grants to individual investigators. As projects progress they will be tested and demonstrated in a "medically smart home" before commercialization.
While it's tempting to think of the center as just another medical research center, its focus will not be on "big medicine," says Alice Pentland.
"Medicine is about treating disease. This center is about maintaining health," she says. "Currently medicine is centered around big machines in doctors' offices or in hospitals, and it's not friendly for consumers to access. Your quality of life degrades before expensive technology is brought to bear on the illness, and information about your health is dispersed among many different providers. And the physician is in control. We have a new vision of medicine, where people can assess their health in their own home, and consumers have more control over their own health." Last year more than $25 billion was spent by people on out-of-pocket costs not currently included as part of the "medical system," Pentland says, a sure sign that people want more say in their health care.
Adds Fauchet: "The current health care system is under tremendous stress. Now there are tools to keep you alive the last few years of your life, at tremendous cost. What about maintaining your quality of life, at a minimum of cost? We want to give you the tools to be good to yourself."
A question the organizers hear often is whether people are ready and willing to use such technology. To help address this issue, the center has joined the LINCOS project, a collaboration initially set up between MIT, the University, and Costa Rican officials led by former president Jose Maria Figueres Olsen. LINCOS is a kind of "digital town center," providing isolated rural communities with a box of technology that offers information and links to the outside world. The center is developing the health component of the digital center, with information to assess one's health as well as instruments like stethoscopes and thermometers. The first box will be placed in a remote Costa Rican village later this summer, and several more are planned for Costa Rica, at least 20 in the United States, and dozens more throughout Latin America.
"It's a prototype for the integration of communities worldwide," says Alice Pentland. "It's vital that we understand the needs of each individual community. This component will help us understand a culture's decision-making on health, traditions, perceptions of computers, and a variety of issues. We don't want our inventions sitting in a laboratory. We intend these technologies to be used not just nationwide but worldwide."
A PARTIAL LIST OF PROJECTS
The projects being pursued by researchers at the Center for Future Health are designed to address health issues that affect many people. Most are being done at the University of Rochester, while several are the result of a collaboration with the MIT Media Laboratory. Some also include colleagues at Georgia Institute of Technology and the University of Toronto, and it's likely that other institutions will join as the center grows.
Some of these projects are just beginning, while several are in progress, and creation of a few prototype devices is expected soon. Among the tools in development:
"Memory glasses" that a person with early dementia or memory problems might wear which automatically detect certain patterns (loved ones, street signs, grocery items, for example) and then offers audio instructions such as "The person you're looking at is your brother Bill"; "You have bought milk and eggs, but you forgot the bread"; "This is Oak Street; turn left if you want to go home." One goal: Allowing such patients to live independently longer.
A "melanoma monitor," a passive system that takes an image of your body, perhaps each week in the bathroom, and compares each image to the last one. When a mole starts growing, you receive an alert to see a doctor, and you bring along a computer printout with details of the mole's size and how it has changed.
A "smart bandage" that could quickly identify a tiny amount of bacteria through powerful computing and determine which antibiotics it's resistant to and which could be used to treat the patient, cutting the amount of time necessary between illness and treatment.
Convenient monitoring tools, such as a wristwatch-type device that monitors pulse, respiration and temperature constantly. This might be handy after a patient leaves the hospital and is prone to infection (fever), or for an older person who often has difficulty breathing. Such sensors could also be part of a "smart bed" that takes in this information during sleep.
A "gait monitor" that would pick up subtle signs of stroke or early signs of diseases like Parkinson's. Oftentimes an impaired gait is the first symptom and goes unnoticed for months or even years.
A "digital assistant" that is as easy to speak with, in plain English, as the "Star Trek computer," which people could turn to with many of their health-care questions. A conversation might be about ear infections, for instance: "I think my son has an ear infection." The computer then converses with the person. "What is his temperature?" "Has he vomited?" The outcome might be: "The last four times your son had these symptoms, it turned out to be nothing. Let him sleep through the night, then check his symptoms again in the morning."
A communication aid equipped with artificial-intelligence software that recognizes certain phrases and tones of voice and lets the speaker know, gently and unobtrusively, that his emotion level is rising, and suggests alternate phrases or actions.
An array of sensors based on new types of materials under development at the University. Such sensors might be used to detect tiny amounts of bacteria on food, to check whether water is safe to drink, or to check one's breath or sweat for electrolyte levels, monitor breathing, or send an early warning when dehydration is possible.
A "rehab trainer," a program that watches one's movements during rehabilitation, then compares them to the way the exercises should really be done and offers advice such as, "You're dropped your shoulder too much" or "Stretch your left leg for 10 seconds, not just five." It's based on the "Tai Chi Trainer" recently developed by the MIT Media Lab.
"Smart socks," being developed in collaboration with Sundaresan Jayaraman of Georgia Tech, that automatically detect the amount of pressure within a person's foot and then alert the wearer when an ulcer is imminent. Foot ulcers affect the majority of people with spinal-cord injuries and are a constant threat to people with diabetes.
A "Digital Town Center," a high-tech box that will be dropped in rural areas of the United States and Latin America to give isolated people access to health and other information. The first box will be tested this summer in a remote area of Costa Rica.
"Smart clothing" equipped with optical fibers, developed by Georgia Tech researchers. Such a shirt might be able to detect an injury like a bullet wound and then send that information back to a triage center, where medics could decide which patients are most severely injured and to retrieve that patient immediately without checking several healthier patients first.