A Technological Revolution in Healthcare
by Manish Chand, Consultant Colorectal and Endometriosis Surgeon MBA PhD, Senior Lecturer, Director MS Advanced MIS University College London
There is no doubt we are entering a new phase of surgical evolution, influenced by the uptake of increasingly complex technology. What is less clear is whether this represents a further ‘evolution’ or indeed a ‘revolution’.
When compared to other industries, healthcare has historically lagged behind, with an underlying reluctance to adopt innovative and disruptive technologies. This is mainly due to a combination of resources, safety concerns, regulation and a lack of imagination. The only major change in surgery in the last 25 years has been the introduction of minimally-invasive surgery, which still struggles to effectively penetrate many parts of the world — including parts of the US.
Fortunately, this mindset is now changing with a new generation of surgical leaders who better understand how technologies used routinely and successfully in other industries can benefit patient outcomes and make current processes in healthcare safer and more efficient. Embracing collaboration with industry partners rather than shunning them has enabled a greater acceleration in development, with clinicians engaged earlier in the process and in a more integrated manner.
The idea that a ‘magic wand’ or ‘silver bullet can singularly solve the problem (whatever that problem or disease entity may be) is inaccurate and unfeasible. However, there is widespread acceptance that we must seek an aggregation of marginal gains, which together will lead to significant improvements. One area includes imaging, fluorescence and advanced instrumentation amongst others. It has always struck me as perverse that the television I watch at home has a vastly better image resolution than the laparoscopic screens I have been operating on for years – and indeed comes at a fraction of the price. It is only now we are beginning to see the introduction of comparable resolution in the OR, but the sad fact is that rather than demand better resolution screens, most will excuse their obvious benefit stating there is little to be gained by investing in such technology – but technology they are unwilling to forego in their homes. The concept of ‘marginal gains’ relies on these small wins, which when put together create a significantly improved outcome.
Being able to identify anatomy, physiological processes and pathology more clearly and accurately can only be of benefit. With improved camera technology it is now possible to incorporate filters within the ‘lens’ so the visual spectrum visible by the surgeon can be expanded. Novel software allows overlapping of these images, providing surgeons with an unparalleled view of the patient’s anatomy and physiology. The field of fluorescence guided surgery is gaining huge momentum, and the adoption of this technology will bring about important changes in our traditional approach to surgery in the coming years.
Of all the disruptive technologies, the most exciting, but least understood are probably virtual and augmented reality (VR and AR), and Artificial Intelligence (AI). These technologies have only a small footprint in the healthcare space, and are virtually absent in surgery. The use cases for these technologies at the moment are primarily consumer-focused, from Pokemon Go and Snapchat filters to understanding movie preferences on Netflix and computer vision-enhanced autonomous driving. But their applications to healthcare, in meaningful ways, have been few and far between. Because of the confusion that VR/AR and AI cause physicians and administrators, they will require intrepid entrepreneurs who are fluent in both technology and medicine to meld these worlds in order to find the most useful applications for these emerging technologies.
VR is unlikely to be a tool used during a surgical procedure, but could find its role in simulated teaching, surgical planning, patient information and consenting, and other such pre-operative activities. It is beginning to be used in some ways already for surgical training. AR is more exciting when it comes to real-time use in the OR. AR models of patients undergoing surgery are highly useful for surgeons who require a reference point. If there is some ambiguity in understanding the patient’s anatomy as presented during the surgery, the surgeon can use the model as a highly accurate reference to continue the procedure with confidence. When combined with access to patient investigations and cross-sectional imaging, AR headsets provide the surgeon with a complete picture of the patient, thus empowering the surgeon further.
Working with Touch Surgery, my team at University College London has created and tested one of the first AR models used during a procedure for colorectal cancer. Whilst this model can be improved further, it is evidence that adoption of innovative technology can and will make a direct impact on patient outcomes. It is important to remember that as we develop these technologies, we keep in mind surgical benefit, and not get carried away with gimmickry.
Machine learning techniques also have huge potential to revolutionise our healthcare systems. Most technology companies are combining with respected healthcare institutions to create, deliver and test these concepts, which all rely on immense troves of data. The perfection of ML algorithms requires data and the continual feeding of such data. Often single institutions researching these concepts are unable to generate or acquire sufficient data. We have already seen the successful reports of CheXNet and a machine’s ability to read chest X-rays with greater accuracy than a physician. Pathology will likely soon follow, and then perhaps endoscopy, with surgery, proving the greatest challenge.
We, along with other select groups and institutions around the world, are working on it. We hope if researched and implemented in a safe and responsible manner we will see a complete revolution in the surgical space rather than a further evolution. Maybe there is a ‘magic wand’ after all!