TED@Intel
Eric Dishman: Health care should be a team sport
Filmed:
Readability: 4.1
1,053,887 views
When Eric Dishman was in college, doctors told him he had 2 to 3 years to live. That was a long time ago. Now, Dishman puts his experience and his expertise as a medical tech specialist together to suggest a bold idea for reinventing health care -- by putting the patient at the center of a treatment team.
Eric Dishman - Social scientist
Eric Dishman does health care research for Intel -- studying how new technology can solve big problems in the system for the sick, the aging and, well, all of us. Full bio
Eric Dishman does health care research for Intel -- studying how new technology can solve big problems in the system for the sick, the aging and, well, all of us. Full bio
Double-click the English transcript below to play the video.
00:13
I want to share some personal friends and stories with you
0
1243
3952
00:17
that I've actually never talked about in public before
1
5195
2037
00:19
to help illustrate the idea
2
7232
2360
00:21
and the need and the hope
3
9592
1919
00:23
for us to reinvent our health care system around the world.
4
11511
3282
00:26
Twenty-four years ago, I had -- a sophomore in college,
5
14793
3387
00:30
I had a series of fainting spells. No alcohol was involved.
6
18180
2822
00:33
And I ended up in student health,
7
21002
2931
00:35
and they ran some labwork and came back right away,
8
23933
2169
00:38
and said, "Kidney problems."
9
26102
2173
00:40
And before I knew it, I was involved and thrown into
10
28275
3450
00:43
this six months of tests and trials and tribulations
11
31725
3220
00:46
with six doctors across two hospitals
12
34945
2684
00:49
in this clash of medical titans
13
37629
2696
00:52
to figure out which one of them was right
14
40325
2044
00:54
about what was wrong with me.
15
42369
2464
00:56
And I'm sitting in a waiting room some time later for an ultrasound,
16
44833
3273
01:00
and all six of these doctors actually show up in the room at once,
17
48106
2823
01:02
and I'm like, "Uh oh, this is bad news."
18
50929
4352
01:07
And their diagnosis was this:
19
55281
1563
01:08
They said, "You have two rare kidney diseases
20
56844
1910
01:10
that are going to actually destroy your kidneys eventually,
21
58754
2681
01:13
you have cancer-like cells in your immune system
22
61435
2537
01:15
that we need to start treatment right away,
23
63972
1917
01:17
and you'll never be eligible for a kidney transplant,
24
65889
2457
01:20
and you're not likely to live more than two or three years."
25
68346
3419
01:23
Now, with the gravity of this doomsday diagnosis,
26
71765
2964
01:26
it just sucked me in immediately,
27
74729
2400
01:29
as if I began preparing myself as a patient
28
77129
2642
01:31
to die according to the schedule that they had just given to me,
29
79771
4097
01:35
until I met a patient named Verna in a waiting room,
30
83868
2640
01:38
who became a dear friend, and she grabbed me one day
31
86508
2058
01:40
and took me off to the medical library
32
88566
1994
01:42
and did a bunch of research on these diagnoses and these diseases,
33
90560
2934
01:45
and said, "Eric, these people who get this
34
93494
2520
01:48
are normally in their '70s and '80s.
35
96014
1948
01:49
They don't know anything about you. Wake up.
36
97962
3111
01:53
Take control of your health and get on with your life."
37
101073
3122
01:56
And I did.
38
104195
1542
01:57
Now, these people making these proclamations to me
39
105737
2360
02:00
were not bad people.
40
108097
1326
02:01
In fact, these professionals were miracle workers,
41
109423
2561
02:03
but they're working in a flawed, expensive system that's set up the wrong way.
42
111984
4066
02:08
It's dependent on hospitals and clinics for our every care need.
43
116050
3255
02:11
It's dependent on specialists who just look at parts of us.
44
119305
3667
02:14
It's dependent on guesswork of diagnoses and drug cocktails,
45
122972
3915
02:18
and so something either works or you die.
46
126887
2600
02:21
And it's dependent on passive patients
47
129487
4208
02:25
who just take it and don't ask any questions.
48
133695
3762
02:29
Now the problem with this model
49
137457
1562
02:31
is that it's unsustainable globally.
50
139019
2486
02:33
It's unaffordable globally.
51
141505
1954
02:35
We need to invent what I call a personal health system.
52
143459
3487
02:38
So what does this personal health system look like,
53
146946
2323
02:41
and what new technologies and roles is it going to entail?
54
149269
5041
02:46
Now, I'm going to start by actually sharing with you
55
154310
2153
02:48
a new friend of mine, Libby,
56
156463
1896
02:50
somebody I've become quite attached to over the last six months.
57
158359
2714
02:53
This is Libby, or actually, this is an ultrasound image of Libby.
58
161073
3876
02:56
This is the kidney transplant I was never supposed to have.
59
164949
2871
02:59
Now, this is an image that we shot a couple of weeks ago for today,
60
167820
3851
03:03
and you'll notice, on the edge of this image,
61
171671
1940
03:05
there's some dark spots there, which was really concerning to me.
62
173611
2909
03:08
So we're going to actually do a live exam
63
176520
2529
03:11
to sort of see how Libby's doing.
64
179049
1375
03:12
This is not a wardrobe malfunction. I have to take my belt off here.
65
180424
2718
03:15
Don't you in the front row worry or anything.
66
183142
2134
03:17
(Laughter)
67
185276
1282
03:18
I'm going to use a device from a company called Mobisante.
68
186558
3727
03:22
This is a portable ultrasound.
69
190285
1474
03:23
It can plug into a smartphone. It can plug into a tablet.
70
191759
2543
03:26
Mobisante is up in Redmond, Washington,
71
194302
2130
03:28
and they kindly trained me to actually do this on myself.
72
196432
3650
03:32
They're not approved to do this. Patients are not approved to do this.
73
200082
2205
03:34
This is a concept demo, so I want to make that clear.
74
202287
2811
03:37
All right, I gotta gel up.
75
205098
1087
03:38
Now the people in the front row are very nervous. (Laughter)
76
206185
4451
03:42
And I want to actually introduce you to Dr. Batiuk,
77
210636
4045
03:46
who's another friend of mine.
78
214681
1447
03:48
He's up in Legacy Good Samaritan Hospital in Portland, Oregon.
79
216128
3886
03:52
So let me just make sure. Hey, Dr. Batiuk. Can you hear me okay?
80
220014
3494
03:55
And actually, can you see Libby?
81
223508
2176
03:57
Thomas Batuik: Hi there, Eric.
82
225684
1178
03:58
You look busy. How are you?
83
226862
1245
04:00
Eric Dishman: I'm good. I'm just taking my clothes off
84
228107
2728
04:02
in front of a few hundred people. It's wonderful.
85
230835
2569
04:05
So I just wanted to see, is this the image you need to get?
86
233404
4657
04:10
And I know you want to look and see if those spots are still there.
87
238061
3737
04:13
TB: Okay. Well let's scan around a little bit here,
88
241798
2729
04:16
give me a lay of the land.
89
244527
1275
04:17
ED: All right.TB: Okay. Turn it a little bit inside,
90
245802
3516
04:21
a little bit toward the middle for me.
91
249318
2400
04:23
Okay, that's good. How about up a little bit?
92
251718
4796
04:28
Okay, freeze that image. That's a good one for me.
93
256514
3050
04:31
ED: All right. Now last week, when I did this,
94
259564
2687
04:34
you had me measure that spot to the right.
95
262251
2801
04:37
Should I do that again?
96
265052
1687
04:38
TB: Yeah, let's do that.
97
266739
1044
04:39
ED: All right. This is kind of hard to do
98
267783
3304
04:43
with one hand on your belly and one hand on measuring,
99
271087
2171
04:45
but I've got it, I think,
100
273258
1255
04:46
and I'll save that image and send it to you.
101
274513
2551
04:49
So tell me a little bit about what this dark spot means.
102
277064
2472
04:51
It's not something I was very happy about.
103
279536
2105
04:53
TB: Many people after a kidney transplant
104
281641
1943
04:55
will develop a little fluid collection around the kidney.
105
283584
3268
04:58
Most of the time it doesn't create any kind of mischief,
106
286852
3281
05:02
but it does warrant looking at,
107
290133
2408
05:04
so I'm happy we've got an opportunity to look at it today,
108
292541
2975
05:07
make sure that it's not growing, it's not creating any problems.
109
295516
2928
05:10
Based on the other images we have,
110
298444
2216
05:12
I'm really happy how it looks today.
111
300660
2384
05:15
ED: All right. Well, I guess we'll double check it when I come in.
112
303044
2397
05:17
I've got my six month biopsy in a couple of weeks,
113
305441
2565
05:20
and I'm going to let you do that in the clinic,
114
308006
1709
05:21
because I don't think I can do that one on myself.
115
309715
2440
05:24
TB: Good choice.ED: All right, thanks, Dr. Batiuk.
116
312155
2645
05:26
All right. So what you're sort of seeing here
117
314800
2131
05:28
is an example of disruptive technologies,
118
316931
2108
05:31
of mobile, social and analytic technologies.
119
319039
3196
05:34
These are the foundations of what's going to make personal health possible.
120
322235
2911
05:37
Now there's really three pillars
121
325146
2585
05:39
of this personal health I want to talk to you about now,
122
327731
1897
05:41
and it's care anywhere, care networking and care customization.
123
329628
3792
05:45
And you just saw a little bit of the first two
124
333420
1683
05:47
with my interaction with Dr. Batiuk.
125
335103
1541
05:48
So let's start with care anywhere.
126
336644
2880
05:51
Humans invented the idea of hospitals and clinics
127
339524
2728
05:54
in the 1780s. It is time to update our thinking.
128
342252
3900
05:58
We have got to untether clinicians and patients
129
346152
3494
06:01
from the notion of traveling to a special
130
349646
2618
06:04
bricks-and-mortar place for all of our care,
131
352264
2580
06:06
because these places are often the wrong tool,
132
354844
2301
06:09
and the most expensive tool, for the job.
133
357145
2466
06:11
And these are sometimes unsafe places to send our sickest patients,
134
359611
3552
06:15
especially in an era of superbugs
135
363163
2137
06:17
and hospital-acquired infections.
136
365300
2116
06:19
And many countries are going to go brickless from the start
137
367416
2882
06:22
because they're never going to be able to afford
138
370298
1966
06:24
the mega-medicalplexes that a lot of the rest of the world has built.
139
372264
4520
06:28
Now I personally learned that hospitals
140
376784
2756
06:31
can be a very dangerous place at a young age.
141
379540
2516
06:34
This was me in third grade.
142
382056
1840
06:35
I broke my elbow very seriously, had to have surgery,
143
383896
2416
06:38
worried that they were going to actually lose the arm.
144
386312
2327
06:40
Recovering from the surgery in the hospital, I get bedsores.
145
388639
2936
06:43
Those bedsores become infected,
146
391575
2233
06:45
and they give me an antibiotic which I end up being allergic to,
147
393808
2936
06:48
and now my whole body breaks out,
148
396744
1951
06:50
and now all of those become infected.
149
398695
2560
06:53
The longer I stayed in the hospital, the sicker I became,
150
401255
2547
06:55
and the more expensive it became,
151
403802
1585
06:57
and this happens to millions of people around the world every year.
152
405387
3345
07:00
The future of personal health that I'm talking about
153
408732
2343
07:03
says care must occur at home as the default model,
154
411075
4458
07:07
not in a hospital or clinic.
155
415533
1480
07:09
You have to earn your way into those places
156
417013
1560
07:10
by being sick enough to use that tool for the job.
157
418573
3566
07:14
Now the smartphones that we're already carrying
158
422139
2106
07:16
can clearly have diagnostic devices like ultrasounds plugged into them,
159
424245
3726
07:19
and a whole array of others, today,
160
427971
2171
07:22
and as sensing is built into these,
161
430142
1522
07:23
we'll be able to do vital signs monitor
162
431664
2030
07:25
and behavioral monitoring like we've never had before.
163
433694
2839
07:28
Many of us will have implantables that will actually look
164
436533
2552
07:31
real-time at what's going on with our blood chemistry
165
439085
2737
07:33
and in our proteins right now.
166
441822
2247
07:36
Now the software is also getting smarter, right?
167
444069
2695
07:38
Think about a coach, an agent online,
168
446764
3097
07:41
that's going to help me do safe self-care.
169
449861
2136
07:43
That same interaction that we just did with the ultrasound
170
451997
2305
07:46
will likely have real-time image processing,
171
454302
2223
07:48
and the device will say, "Up, down, left, right,
172
456525
2145
07:50
ah, Eric, that's the perfect spot to send that image
173
458670
2656
07:53
off to your doctor."
174
461326
1849
07:55
Now, if we've got all these networked devices
175
463175
2207
07:57
that are helping us to do care anywhere,
176
465382
2380
07:59
it stands to reason that we also need a team
177
467762
1795
08:01
to be able to interact with all of that stuff,
178
469557
1987
08:03
and that leads to the second pillar I want to talk about,
179
471544
2621
08:06
care networking.
180
474165
1572
08:07
We have got to go beyond this paradigm
181
475737
3146
08:10
of isolated specialists doing parts care
182
478883
3651
08:14
to multidisciplinary teams doing person care.
183
482534
4219
08:18
Uncoordinated care today is expensive at best,
184
486753
3396
08:22
and it is deadly at worst.
185
490149
2095
08:24
Eighty percent of medical errors are actually caused
186
492244
2403
08:26
by communication and coordination problems
187
494647
1948
08:28
amongst medical team members.
188
496595
2321
08:30
I had my own heart scare years ago in graduate school,
189
498916
2239
08:33
when we're under treatment for the kidney,
190
501155
2114
08:35
and suddenly, they're like, "Oh, we think you have a heart problem."
191
503269
2614
08:37
And I have these palpitations that are showing up.
192
505883
1885
08:39
They put me through five weeks of tests --
193
507768
2506
08:42
very expensive, very scary -- before the nurse finally notices
194
510274
3499
08:45
the piece of the paper, my meds list
195
513773
2096
08:47
that I've been carrying to every single appointment,
196
515869
1522
08:49
and says, "Oh my gosh."
197
517391
2186
08:51
Three different specialists had prescribed
198
519577
1969
08:53
three different versions of the same drug to me.
199
521546
2039
08:55
I did not have a heart problem. I had an overdose problem.
200
523585
4275
08:59
I had a care coordination problem.
201
527860
2813
09:02
And this happens to millions of people every year.
202
530673
2766
09:05
I want to use technology that we're all working on and making happen
203
533439
3634
09:09
to make health care a coordinated team sport.
204
537073
3732
09:12
Now this is the most frightening thing to me.
205
540805
2302
09:15
Out of all the care I've had in hospitals and clinics around the world,
206
543107
4258
09:19
the first time I've ever had a true team-based care experience
207
547365
3347
09:22
was at Legacy Good Sam these last six months
208
550712
2771
09:25
for me to go get this.
209
553483
1058
09:26
And this is a picture of my graduation team from Legacy.
210
554541
2969
09:29
There's a couple of the folks here. You'll recognize Dr. Batiuk.
211
557510
2510
09:32
We just talked to him. Here's Jenny, one of the nurses,
212
560020
2616
09:34
Allison, who helped manage the transplant list,
213
562636
2312
09:36
and a dozen other people who aren't pictured,
214
564948
2144
09:39
a pharmacist, a psychologist, a nutritionist,
215
567092
2536
09:41
even a financial counselor, Lisa,
216
569628
2242
09:43
who helped us deal with all the insurance hassles.
217
571870
2727
09:46
I wept the day I graduated.
218
574597
2599
09:49
I should have been happy, because I was so well
219
577196
1627
09:50
that I could go back to my normal doctors,
220
578823
1653
09:52
but I wept because I was so actually connected to this team.
221
580476
3295
09:55
And here's the most important part.
222
583771
1596
09:57
The other people in this picture are me and my wife, Ashley.
223
585367
3039
10:00
Legacy trained us on how to do care for me at home
224
588406
4102
10:04
so that they could offload the hospitals and clinics.
225
592508
2744
10:07
That's the only way that the model works.
226
595252
2464
10:09
My team is actually working in China
227
597716
1816
10:11
on one of these self-care models
228
599532
1739
10:13
for a project we called Age-Friendly Cities.
229
601271
2373
10:15
We're trying to help build a social network
230
603644
1794
10:17
that can help track and train the care of seniors
231
605438
2484
10:19
caring for themselves
232
607922
1507
10:21
as well as the care provided by their family members
233
609429
2405
10:23
or volunteer community health workers,
234
611834
2482
10:26
as well as have an exchange network online,
235
614316
2256
10:28
where, for example, I can donate three hours of care a day to your mom,
236
616572
3328
10:31
if somebody else can help me with transportation to meals,
237
619900
2870
10:34
and we exchange all of that online.
238
622770
2658
10:37
The most important point I want to make to you about this
239
625428
2390
10:39
is the sacred and somewhat over-romanticized
240
627818
3314
10:43
doctor-patient one-on-one
241
631132
2774
10:45
is a relic of the past.
242
633906
2116
10:48
The future of health care is smart teams,
243
636022
2452
10:50
and you'd better be on that team for yourself.
244
638474
3569
10:54
Now, the last thing that I want to talk to you about
245
642043
2292
10:56
is care customization,
246
644335
1240
10:57
because if you've got care anywhere and you've got care networking,
247
645575
2925
11:00
those are going to go a long way towards improving our health care system,
248
648500
2808
11:03
but there's still too much guesswork.
249
651308
3033
11:06
Randomized clinical trials were actually invented in 1948
250
654341
4088
11:10
to help invent the drugs that cured tuberculosis,
251
658429
3382
11:13
and those are important things, don't get me wrong.
252
661811
2297
11:16
These population studies that we've done have created
253
664108
1865
11:17
tons of miracle drugs that have saved millions of lives,
254
665973
2579
11:20
but the problem is that health care
255
668552
2435
11:22
is treating us as averages, not unique individuals,
256
670987
4080
11:27
because at the end of the day,
257
675067
1547
11:28
the patient is not the same thing as the population
258
676614
3255
11:31
who are studied. That's what's leading to the guesswork.
259
679869
3278
11:35
The technologies that are coming,
260
683147
1838
11:36
high-performance computing, analytics,
261
684985
2089
11:39
big data that everyone's talking about,
262
687074
1917
11:40
will allow us to build predictive models for each of us
263
688991
2919
11:43
as individual patients.
264
691910
1954
11:45
And the magic here is, experiment on my avatar
265
693864
4459
11:50
in software, not my body in suffering.
266
698323
4801
11:55
Now, I've had two examples I want to quickly share with you
267
703124
2483
11:57
of this kind of care customization on my own journey.
268
705607
2559
12:00
The first was quite simple. I finally realized some years ago
269
708166
3177
12:03
that all my medical teams were optimizing my treatment for longevity.
270
711343
3877
12:07
It's like a badge of honor to see how long they can get the patient to live.
271
715220
2754
12:09
I was optimizing my life for quality of life,
272
717974
3067
12:13
and quality of life for me means time in snow.
273
721041
4380
12:17
So on my chart, I forced them to put, "Patient goal:
274
725421
2830
12:20
low doses of drugs over longer periods of time,
275
728251
3766
12:24
side effects friendly to skiing."
276
732017
3246
12:27
And I think that's why I achieved longevity.
277
735263
2652
12:29
I think that time-in-snow therapy was as important
278
737915
2232
12:32
as the pharmaceuticals that I had.
279
740147
2133
12:34
Now the second example of customization -- and by the way,
280
742280
2315
12:36
you can't customize care if you don't know your own goals,
281
744595
1896
12:38
so health care can't know those until you know your own health care goals.
282
746491
3369
12:41
But the second example I want to give you is,
283
749860
1712
12:43
I happened to be an early guinea pig,
284
751572
1787
12:45
and I got very lucky to have my whole genome sequenced.
285
753359
3604
12:48
Now it took about two weeks of processing
286
756963
2322
12:51
on Intel's highest-end servers to make this happen,
287
759285
2124
12:53
and another six months of human and computing labor
288
761409
3032
12:56
to make sense of all of that data.
289
764441
2562
12:59
And at the end of all of that, they said, "Yes,
290
767003
3050
13:02
those diagnoses of that clash of medical titans
291
770053
2438
13:04
all of those years ago were wrong,
292
772491
2384
13:06
and we have a better path forward."
293
774875
2274
13:09
The future that Intel's working on now is to figure out
294
777149
2385
13:11
how to make that computing for personalized medicine
295
779534
2197
13:13
go from months and weeks to even hours,
296
781731
3753
13:17
and make this kind of tool available,
297
785484
1671
13:19
not just in the mainframes of tier-one research hospitals around the world,
298
787155
3818
13:22
but in the mainstream -- every patient, every clinic
299
790973
2806
13:25
with access to whole genome sequencing.
300
793779
2149
13:27
And I tell you, this kind of care customization
301
795928
2343
13:30
for everything from your goals to your genetics
302
798271
2826
13:33
will be the most game-changing transformation
303
801097
1765
13:34
that we witness in health care during our lifetime.
304
802862
3582
13:38
So these three pillars of personal health,
305
806444
2934
13:41
care anywhere, care networking, care customization,
306
809378
2858
13:44
are happening in pieces now,
307
812236
1247
13:45
but this vision will completely fail if we don't step up
308
813483
3783
13:49
as caregivers and as patients to take on new roles.
309
817266
4001
13:53
It's what my friend Verna said:
310
821267
1653
13:54
Wake up and take control of your health.
311
822920
2121
13:57
Because at the end of the day these technologies
312
825041
1589
13:58
are simply about people caring for other people
313
826630
3897
14:02
and ourselves in some powerful new ways.
314
830527
3411
14:05
And it's in that spirit that I want to introduce you
315
833938
1560
14:07
to one last friend, very quickly.
316
835498
2551
14:10
Tracey Gamley stepped up to give me the impossible kidney
317
838049
3867
14:13
that I was never supposed to have.
318
841916
4681
14:18
(Applause)
319
846597
15679
14:34
So Tracey, just tell us a little bit quickly about what the donor experience was like with you.
320
862992
4357
14:39
Tracey Gamley: For me, it was really easy.
321
867349
1884
14:41
I only had one night in the hospital.
322
869233
1951
14:43
The surgery was done laparoscopically,
323
871184
1704
14:44
so I have just five very small scars on my abdomen,
324
872888
3206
14:48
and I had four weeks away from work
325
876094
2039
14:50
and went back to doing everything I'd done before
326
878133
1883
14:52
without any changes.
327
880016
1516
14:53
ED: Well, I probably will never get a chance to say this to you
328
881532
2986
14:56
in such a large audience ever again.
329
884518
2459
14:58
So "thank you" feel likes a really trite word,
330
886977
2787
15:01
but thank you from the bottom of my heart for saving my life.
331
889764
2462
15:04
(Applause)
332
892226
5883
15:10
This TED stage and all of the TED stages
333
898109
2449
15:12
are often about celebrating innovation
334
900558
2726
15:15
and celebrating new technologies,
335
903284
1109
15:16
and I've done that here today,
336
904393
2285
15:18
and I've seen amazing things coming from TED speakers,
337
906678
2329
15:21
I mean, my gosh, artificial kidneys, even printable kidneys, that are coming.
338
909007
4033
15:25
But until such time that these amazing technologies
339
913040
3181
15:28
are available to all of us, and even when they are,
340
916221
3038
15:31
it's up to us to care for, and even save, one another.
341
919259
4427
15:35
I hope you will go out and make personal health happen
342
923686
2438
15:38
for yourselves and for everyone. Thanks so much.
343
926124
3928
15:42
(Applause)
344
930052
4647
ABOUT THE SPEAKER
Eric Dishman - Social scientistEric Dishman does health care research for Intel -- studying how new technology can solve big problems in the system for the sick, the aging and, well, all of us.
Why you should listen
Eric Dishman is an Intel Fellow and general manager of Intel's Health Strategy & Solutions Group. He founded the product research and innovation team responsible for driving Intel’s worldwide healthcare research, new product innovation, strategic planning, and health policy and standards activities.
Dishman is recognized globally for driving healthcare reform through home and community-based technologies and services, with a focus on enabling independent living for seniors. His work has been featured in The New York Times, Washington Post and Businessweek, and The Wall Street Journal named him one of “12 People Who Are Changing Your Retirement.” He has delivered keynotes on independent living for events such as the annual Consumer Electronics Show, the IAHSA International Conference and the National Governors Association. He has published numerous articles on independent living technologies and co-authored government reports on health information technologies and health reform.
He has co-founded organizations devoted to advancing independent living, including the Technology Research for Independent Living Centre, the Center for Aging Services Technologies, the Everyday Technologies for Alzheimer’s Care program, and the Oregon Center for Aging & Technology.
Eric Dishman | Speaker | TED.com