TEDMED 2009
Eric Dishman: Take health care off the mainframe
埃里克 迪什曼:让医保脱离主体
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在TEDMED上，埃里克迪什曼发表了一个大胆的争论：美国医保系统就像是1959年的计算机，捆绑到繁冗、笨重的中央系统：医院，医生，护理之家。就在我们老龄化日趋严重的时候，解决这个问题更加刻不容缓，他说道：要建立个人的，联网的，以家庭为中心的医疗保健制度。
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.
00:15
If you think about the phone --
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如果你想想电话-
00:17
and Intel has tested
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正如英特尔（intel）已经测试过的
00:19
a lot of the things I'm going to show you,
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我将向你展示
00:21
over the last 10 years,
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最近10年间的很多东西
00:23
in about 600 elderly households --
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在大约600个老年家庭中-
00:25
300 in Ireland, and 300 in Portland --
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其中300个在爱尔兰，300个在波兰
00:28
trying to understand: How do we measure
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正在尝试理解我们如何用一种
00:30
and monitor behavior
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和观察行为
00:32
in a medically meaningful way?
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并以一种医学上有意义的方式？
00:34
And if you think about the phone, right,
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如果你考虑一下电话，好
00:36
it's something that we can use for some incredible ways
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我们可以用一些不可思议的方式使用它
00:38
to help people actually take the right medication at the right time.
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（比如）帮助人们在正确的时间服用正确的药物
00:41
We're testing these kinds of simple
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我们正在测试这些简单的
00:43
sensor-network technologies in the home
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在家里使用的传感网络技术
00:45
so that any phone that a senior is already comfortable with
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任何与传感器适应良好的电话
00:47
can help them deal with their medications.
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都可以帮助他们处理药物
00:49
And a lot of what they do is they pick up the phone,
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很多情况下他们做的就是拿起电话
00:51
and it's our system whispering to them which pill they need to take,
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然后我们的系统就会轻声对他们说，他们该吃那些药了
00:54
and they fake like they're having a conversation with a friend.
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让他们觉得就像在跟朋友聊天
00:57
And they're not embarrassed by a meds caddy that's ugly,
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而不用对着一个厨房的桌子上的丑陋的药箱子
00:59
that sits on their kitchen table and says,
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为难地说：
01:01
"I'm old. I'm frail."
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"我老了，我很脆弱。”
01:03
It's surreptitious technology
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这项技术具有保密性
01:05
that's helping them do a simple task
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帮助他们完成一项简单的任务
01:07
of taking the right pill at the right time.
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即按时服药
01:09
Now, we also do some pretty amazing things with these phones.
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目前，我们还在电话上做了一些非常惊人事情
01:12
Because that moment when you answer the phone
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因为当你在接电话的时候
01:15
is a cognitive test every time that you do it.
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每次做的都是一个认知的测试
01:18
Think about it, all right? I'm going to answer the phone three different times.
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想一下，好吗？我正在要接这三个不同的电话
01:21
"Hello? Hey."
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“喂？是你啊。”
01:23
All right? That's the first time.
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行吧？这是第一次
01:26
"Hello? Uh, hey."
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“喂？噢，是你啊”
01:30
"Hello? Uh, who?
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“喂？哦，谁？”
01:34
Oh, hey."
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“哦，是你啊”
01:37
All right? Very big differences
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对吧？非常大的差别
01:40
between the way I answered the phone the three times.
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在我三次接电话中
01:43
And as we monitor phone usage
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由于我们观测电话的使用
01:45
by seniors over a long period of time,
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通过传感器，已经有很长时间了
01:48
down to the tenths of a microsecond,
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（甚至观测细致到）数十微秒的程度
01:50
that recognition moment
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还有认出的时刻
01:52
of whether they can figure out that person on the other end
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他们是否能认出电话那头的对方是谁
01:54
is a friend and we start talking to them immediately,
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是朋友的话，他们就立刻开始跟他们聊天
01:56
or they do a lot of what's called trouble talk,
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或者（没认出来），他们就会做很多被称作麻烦对话的问话
01:58
where they're like, "Wait, who is this? Oh." Right?
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都像这个样子，“等等，是谁呀？哦。”
02:01
Waiting for that recognition moment
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今天临床显示，
02:03
may be the best early indicator of the onset of dementia
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等待认知时刻或许是最好的老年痴呆症发病早期显示器，
02:05
than anything that shows up clinically today.
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比什么都好。
02:07
We call these behavioral markers.
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我们称这些是行为的记录者。
02:09
There's lots of others. Is the person going to the phone
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还有很多其它的方式。这个人是否跟原先一样，
02:11
as quickly, when it rings, as they used to?
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电话一响就接了呢？
02:14
Is it a hearing problem or is it a physicality problem?
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是听觉上的问题还是行动不便？
02:17
Has their voice gotten more quiet? We're doing a lot of work with people
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还是声音变的轻了呢？我们研究了很多
02:19
with Alzheimer's and particularly with Parkinson's,
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患有阿尔茨海默氏症，特别是帕金森症的病人，
02:22
where that quiet voice that sometimes shows up with Parkinson's patients
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轻声可能是最好的
02:25
may be the best early indicator
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发现前期帕金森症的征兆，
02:28
of Parkinson's five to 10 years before it shows up clinically.
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比临床显现的要早5年到10年。
02:31
But those subtle changes in your voice over a long period of time
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但是你声音的那些长时间的微妙改变
02:34
are hard for you or your spouse to notice until it becomes so extreme
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对于你和你的配偶来说是很难发现的，直到它恶化，
02:37
and your voice has become so quiet.
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你的声音变得完全轻微的时候。
02:39
So, sensors are looking at that kind of voice.
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所以说，传感器就监视这种声音。
02:41
When you pick up the phone,
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当你接电话的时候，
02:43
how much tremor are you having,
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你的声带震动了多少，
02:45
and what is that like, and what is that trend like over a period of time?
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那是怎么样的，你以前又是什么状况的？
02:48
Are you having more trouble dialing the phone than you used to?
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你打电话时是否感到比以前费劲儿？
02:50
Is it a dexterity problem? Is it the onset of arthritis?
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是灵活性的问题？还是关节炎的问题？
02:53
Are you using the phone? Are you socializing less than you used to?
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你在打电话么？你是否比以前联系朋友的次数少了？
02:57
And looking at that pattern. And what does that decline in social health
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看那个模型。社交健康降低意味着什么呢，
03:00
mean, as a kind of a vital sign of the future?
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是否算是一种来自未来的至关重要的信号呢？
03:03
And then wow, what a radical idea,
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哇，这是什么先进的想法，
03:06
we -- except in the United States --
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我们，除了在美国，
03:08
might be able to use this newfangled technology
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可能能够使用这种新奇的科技
03:11
to actually interact with a nurse or a doctor on the other end of the line.
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来与另一端的护士或医生们交流。
03:14
Wow, what a great day that will be
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当我们真的能这么做的时候，
03:16
once we're allowed to actually do those kinds of things.
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该是多么美好的一天呀。
03:19
So, these are what I would call behavioral markers.
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这就是我们所说的行为记录者。
03:23
And it's the whole field that we've been trying to work on
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这是我们过去十年
03:26
for the last 10 years at Intel.
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在Intel公司所努力的。
03:28
How do you put simple disruptive technologies,
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你如何将简单的全新技术用一句话讲出来，
03:30
and the first of five phrases that I'm going to talk about in this talk?
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我这次总共才打算说五句话？
03:32
Behavioral markers matter.
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行为记录者很重要。
03:34
How do we change behavior?
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我们怎样才能改变行为呢？
03:36
How do we measure changes in behavior
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当它能帮助我们预防疾病，
03:38
in a meaningful way that's going to help us with
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早期疾病的爆发，记录疾病的长期进展，
03:40
prevention of disease, early onset of disease,
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我们怎样量化这样的行为
03:42
and tracking the progression of disease over a long period of time?
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所带来的重大意义上的改变呢？
03:45
Now, why would Intel let me
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现在，为什么Intel公司
03:48
spend a lot of time and money, over the last 10 years,
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让我花费无数的实践和金钱，数十年来，
03:51
trying to understand the needs of seniors
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试图了解老人的需要，
03:53
and start thinking about these kinds of behavioral markers?
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并试图了解这些行为记录者呢？
03:55
This is some of the field work that we've done.
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这是我们已经了解的一些领域。
03:58
We have now lived with 1,000 elderly households
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过去十年中，我们同20个国家的
04:01
in 20 countries over the last 10 years.
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1000多户老人生活在一起。
04:03
We study people in Rochester, New York.
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我们研究纽约州罗切斯特市的人们。
04:05
We go live with them in the winter
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我们一冬天都跟他们生活在一起，
04:07
because what they do in the winter,
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因为他们在冬天的所作所为，
04:09
and their access to healthcare, and how much they socialize,
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他们的医保，他们的社交
04:11
is very different than in the summer.
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都跟他们在夏天的完全不一样。
04:13
If they have a hip fracture we go with them
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如果他们髋部骨折了，我们会跟随着他们，
04:15
and we study their entire discharge experience.
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研究他们的整个过程。
04:17
If they have a family member who is a key part of their care network,
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如果他们有家庭成员是他们医保网络的重要部分，
04:19
we fly and study them as well.
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我们就飞过去，研究他们。
04:21
So, we study the holistic health experience
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所以说，在过去的10年中，
04:24
of 1,000 seniors over the last 10 years
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20多个不同的国家，
04:26
in 20 different countries.
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我们进行了1000多个传感器的整体健康试验。
04:28
Why is Intel willing to fund that?
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为什么Intel公司愿意资助我们呢？
04:31
It's because of the second slogan that I want to talk about.
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原因也正是我要讲到的第二个口号。
04:33
Ten years ago, when I started trying to convince Intel
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10年前，当我刚刚开始向Intel公司游说
04:35
to let me go start looking at disruptive technologies
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让我实施这个
04:37
that could help with independent living,
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能够帮助单独个体家庭的新奇的技术时，
04:39
this is what I called it: "Y2K + 10."
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我使用了“Y2K+10”这个口号。
04:42
You know, back in 2000,
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你知道，在2000年的时候，
04:44
we were all so obsessed with paying attention
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我们都着迷于
04:46
to the aging of our computers,
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计算机的千年虫问题，
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and whether or not they were going to survive
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看他们是否能够
04:50
the tick of the clock from 1999 to 2000,
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随着时钟从1999到2000的滴答声中幸存下来，
04:52
that we missed a moment that only demographers were paying attention to.
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但我们却错过了人口学家所关注的时刻。
04:57
It was right around New Years.
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那就在新年夜前后。
04:59
And that switchover,
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那是个大转变，
05:01
when we had the larger number of older people on the planet,
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这个星球上第一次
05:04
for the first time than younger people.
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老年人比年轻人多。
05:06
For the first time in human history -- and barring aliens landing
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也是人类历史上的第一次，禁止外国人登陆
05:08
or some major other pandemic,
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或者其他一些主要瘟疫，
05:10
that's the expectation from demographers, going forward.
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那就是人口统计学的期望，又向前了一步。
05:13
And 10 years ago it seemed like I had a lot of time
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10年前，看起来好像我有很多时间
05:15
to convince Intel to work on this. Right?
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劝说Intel公司研究这个。对吧？
05:17
Y2K + 10 was coming,
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Y2K+10正来临，
05:19
the baby boomers starting to retire.
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婴儿潮也正开始退却。
05:22
Well folks, it's like we know these demographics here.
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大伙看看，这就好像我们知道这些人口统计学似的。
05:26
This is a map of the entire world.
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这是张世界地图。
05:28
It's like the lights are on,
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这就像灯是亮着的，
05:30
but nobody's home on this demographic
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却没有人思考着人口统计学的
05:32
Y2K + 10 problem. Right?
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Y2K+10问题。对吧？
05:34
I mean we sort of get it here, but we don't get it here,
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我的意思是，我们好像是了解了，但是我们却没有真正了解。
05:38
and we're not doing anything about it.
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我们没解决任何问题。
05:40
The health reform bill is largely ignoring
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医保改革大体上忽视了
05:42
the realities of the age wave that's coming,
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正来临的老龄化
05:44
and the implications for what we need to do to change
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和我们需要做些什么来改变
05:46
not only how we pay for care,
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不仅仅是我们如何支付医疗保健，
05:49
but deliver care in some radically different ways.
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更是用一些完全不同的方式来实施医疗保健的影响。
05:52
And in fact, it's upon us.
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实际上，这取决于我们。
05:54
I mean you probably saw these headlines. This is Catherine Casey
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我的意思是，你可能读到过这些头条新闻。这是凯瑟琳凯西，
05:57
who is the first boomer to actually get Social Security.
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她是第一位实际上得到社会保障的婴儿潮出生的孩子。
06:00
That actually occurred this year. She took early retirement.
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其实是今年发生的事。她选择提前退休。
06:02
She was born one second after midnight in 1946.
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她在1946年的午夜1秒钟后出生的。
06:06
A retired school teacher,
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她是一位退休的学校老师。
06:08
there she is with a Social Security administrator.
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这是她同她的社保人员在一起，
06:10
The first boomer actually, we didn't even wait till 2011, next year.
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第一位婴儿潮出生的人，我们还没等到2011年，也就是明年。
06:13
We're already starting to see early retirement occur this year.
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我们已经看到了今年提前退休的人们。
06:16
All right, so it's here. This Y2K + 10 problem is at our door.
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好，现在。这个Y2K+10问题就在我们家门口。
06:19
This is 50 tsunamis scheduled on the calendar,
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日历上记录着50个海啸。
06:24
but somehow we can't sort of marshal our government
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但是不知何故，我们没能够鼓舞我们的政府，
06:27
and innovative forces to sort of get out in front of it
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没能够激发出力量
06:29
and do something about it. We'll wait until
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来做点什么。我们只是等待着，
06:31
it's more of a catastrophe, and react,
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直到发生更多的灾难后才有反应，
06:33
as opposed to prepare for it.
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而不是提前准备好。
06:35
So, one of the reasons it's so
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所以说，备战Y2K问题很富有挑战性的
06:37
challenging to prepare for this Y2K problem
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众多原因之一是，
06:39
is, I want to argue, we have what I would call
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我想争辩一下，我们有我称之为
06:41
mainframe poisoning.
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主体中毒的东西。
06:43
Andy Grove, about six or seven years ago,
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安迪 格鲁夫，大约在六到七年前，
06:46
he doesn't even know or remember this, in a Fortune Magazine article
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他甚至都不知道或不记得这个了，在一期财富杂志的文章中
06:48
he used the phrase "mainframe healthcare,"
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他用到了“主体医保”的词语，
06:51
and I've been extending and expanding this.
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我就一直在扩展这个词语。
06:53
He saw it written down somewhere. He's like, "Eric that's a really cool concept."
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他看到这个词语出现在一些地方。 他说了类似这样的话“埃里克，那个点子真棒。”
06:56
I was like, "Actually it was your idea. You said it in a Fortune Magazine article.
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我就说了类似这样的话“实际上那是你的点子。是你在一期财富杂志的文章中说过的。
06:58
I just extended it."
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而我只是将它扩展了。”
07:00
You know, this is the mainframe.
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你知道，这也是个主体。
07:02
This mentality of traveling to
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旅游和
07:05
and timesharing large, expensive healthcare systems
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分期巨额的医保系统的想法
07:08
actually began in 1787.
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实际开始于1787年。
07:10
This is the first general hospital in Vienna.
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第一个普通医院建立在维也纳。
07:13
And actually the second general hospital in Vienna,
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实际上维也纳的第二个普通议员
07:15
in about 1850, was where we started to build out
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是在大约1850年，也是在我们准备扩建
07:18
an entire curriculum for teaching med students specialties.
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医药学生的整个课程的地方。
07:22
And it's a place in which we started developing
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我们开始发展
07:24
architecture that literally divided the body,
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人体构造建筑学的地方，
07:26
and divided care into departments and compartments.
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将保健分散到不同的部门和机构中。
07:29
And it was reflected in our architecture,
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我们的建筑学也受其影响。
07:31
it was reflected in the way that we taught students,
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我们教学生的方式也受其影响。
07:33
and this mainframe mentality persists today.
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这个主体在精神上持续到今天。
07:36
Now, I'm not anti-hospital.
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我并不是反对医院。
07:39
With my own healthcare problems, I've taken drug therapies,
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我使用药物疗法的医保问题是，
07:41
I've traveled to this hospital and others, many, many times.
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我的从一个医院到另一个医院，许多许多次。
07:44
But we worship the high hospital on a hill. Right?
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但是我们把医院放在一个很高的位置上。对吧？
07:48
And this is mainframe healthcare.
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这个就是主体的医保。
07:50
And just as 30 years ago
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就在30年前，
07:52
we couldn't conceive that we would have the power
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我们还不能够想象到我们能够有一台
07:55
of a mainframe computer that took up a room this size
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具有主体计算机的能力，却只有
07:58
in our purses and on our belts,
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我们的钱包和皮带大小，
08:00
that we're carrying around in our cell phone today,
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我们今天可以随时随地用手机带着它。
08:02
and suddenly, computing,
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突然间，计算机化，
08:04
that used to be an expert driven system,
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原先只是个专家驱动系统，
08:06
it was a personal system that we all owned as part of our daily lives --
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是一个个人系统，我们把它作为我们日常生活的一部分。
08:09
that shift from mainframe to personal computing
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那个从主体到个人化的转变
08:12
is what we have to do for healthcare.
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是我们需要在医保改革中做的。
08:14
We have to shift from this mainframe mentality of healthcare
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我们需要从这个主体医保的想法转变到
08:17
to a personal model of healthcare.
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以个人为模型的医保。
08:19
We are obsessed with this way of thinking.
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我们对这个想法着迷。
08:22
When Intel does surveys all around the world and we say,
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当Intel公司对全世界做调研时，我们说，
08:24
"Quick response: healthcare."
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“快速回复，医保。”
08:26
The first word that comes up is "doctor."
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出现的第一个词就是医生。
08:28
The second that comes up is "hospital." And the third is "illness" or "sickness." Right?
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出现的第二个词就是医院。第三个是疾病。对吧？
08:31
We are wired, in our imagination, to think about healthcare
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我们被束缚着，在我们的想象中，生了病联想到到医保
08:35
and healthcare innovation as something
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和医保创新,就好像是件
08:37
that goes into that place.
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理所应当的事。
08:39
Our entire health reform discussion right now,
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我们现在的整个医疗改革争论，
08:41
health I.T., when we talk with policy makers,
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健康I.T.，当我们同制度的制定者谈话时
08:44
equals "How are we going to get doctors using
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等于我们如何要医生使用
08:46
electronic medical records in the mainframe?"
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主体电子医药记录？
08:48
We're not thinking about
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我们没有想过
08:50
how do we shift from the mainframe to the home.
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如果将主体转变到家庭。
08:52
And the problem with this is
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这个的问题是
08:54
the way we conceive healthcare. Right?
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我们想到医保的方式。对吧？
08:56
This is a very reactive, crisis-driven system.
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这是个多反应，危机驱动的系统。
08:58
We're doing 15-minute exams with patients.
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我们对患者做了15分钟的试验。
09:00
It's population-based.
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基于人口。
09:02
We collect a bunch of biological information in this artificial setting,
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我们集合了一些生物学的信息。
09:05
and we fix them up, like Humpty-Dumpty all over again,
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将它们整合，就像玩Humpty-Dumpty一样，
09:07
and send them home,
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然后送他们回家，
09:09
and hope -- we might hand them a brochure, maybe an interactive website --
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再希望，我们给他们一本小册子，或许还有一个交互式的网站，
09:12
that they do as asked and don't come back into the mainframe.
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通过网站，他们按照所要求的行动，不再回到主体中来。
09:16
And the problem is we can't afford it today, folks.
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问题是，大伙们，我们今天还无法担负这个系统。
09:19
We can't afford mainframe healthcare today to include the uninsured.
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我们担负不起要求现在的主体医保包括那些没有保险的。
09:23
And now we want to do a double-double
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现在我们希望能有双重保险
09:25
of the age wave coming through?
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在老龄化来的时候？
09:27
Business as usual in healthcare is broken and we've got to do something different.
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做医保生意同以往一样不景气，我们需要做些不同的事情。
09:30
We've got to focus on the home.
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我们需要关注家庭。
09:32
We've got to focus on a personal healthcare paradigm
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我们需要关注个人医保例子
09:34
that moves care to the home. How do we be more proactive,
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那些将保健带到家的例子。我们如何变得更积极主动，
09:36
prevention-driven?
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更加保护驱动呢？
09:38
How do we collect vital signs and other kinds of information 24 by 7?
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我们如何24小时一周7天的不间断地收集重要信号和其他的信息呢？
09:42
How do we get a personal baseline about what's going to work for you?
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我们如何知晓如何为你工作的个人底线呢？
09:45
How do we collect not just biological data
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我们如何收集不仅仅是生物学数据
09:47
but behavioral data, psychological data,
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还有行为数据，心理学数据，
09:49
relational data, in and on and around the home?
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人际关系数据，跟整个家庭相关的方方面面的数据呢？
09:52
And how do we drive compliance to be a customized care plan
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我们如何驱动个人化的保健方案
09:55
that uses all this great technology that's around us
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来改变我们的行为，
09:57
to change our behavior?
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这个保健方案使用了我们周围的伟大科技？
09:59
That's what we need to do for our personal health model.
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这就是我们自身的医保模式所需要的。
10:02
I want to give you a couple of examples. This is Mimi
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我来给你们一些例子。这是咪咪-
10:04
from one of our studies --
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我们研究对象之一-
10:06
in her 90s, had to move out of her home
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她90岁的时候，离开了家
10:08
because her family was worried about falls.
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因为她的家人担心她会摔倒。
10:10
Raise your hand if you had a serious fall
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如果在你家，有过严重的摔倒，
10:12
in your household, or any of your loved ones,
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不论是你，还是你的爱人，
10:14
your parents or so forth. Right?
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你的父母还是其他人，请举起你的手。对吧？
10:16
Classic. Hip fracture often leads to institutionalization of a senior.
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太经典了。髋部骨折通常导致老年人的日常生活。
10:20
This is what was happening to Mimi; the family was worried about it,
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这就是发生在咪咪身上的事情，她全家都很担心，
10:22
moved her out of her own home into an assisted living facility.
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所以将她搬了出来，搬到一所养老院。
10:25
She tripped over her oxygen tank.
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她的氧气罐绊倒了她。
10:28
Many people in this generation won't press the button,
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这代人中的大多数人都不会按下按钮，
10:30
even if they have an alert call system, because they don't want to bother anybody,
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即便他们有报警系统，因为他们不想麻烦别人，
10:32
even though they've been paying 30 dollars a month.
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即便他们每月支付30美金。
10:34
Boomers will press the button. Trust me.
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婴儿潮出生的人会按下按钮。相信我。
10:36
They're going to be pressing that button non-stop. Right?
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他们会不停的按下按钮的。对吧?
10:40
Mimi broke her pelvis, lay all night, all morning,
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咪咪的骨盆骨折了，她就那样躺了一整天，一整夜，
10:44
finally somebody came in and found her,
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终于有人进来发现了她，
10:46
sent her to the hospital.
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将她送进了医院。
10:48
They fixed her back up. She was never going to be able to move back
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他们固定住了她的背部。她永远也不能够搬回
10:50
into the assisted living. They put her into the nursing home unit.
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养老院了。他们将她送进了护理之家。
10:52
First night in the nursing home unit where she had been
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在护理之家的第一个夜晚，
10:54
in the same assisted living facility, moved her from one bed to another,
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也是她原先呆过的养老院，他们将她从一张床移到另一张床，
10:57
kind of threw her, rebroke her pelvis,
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动作大了点，结果造成她的骨盆再次骨折。
10:59
sent her back to the hospital that she had just come from,
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她又被送到她刚刚出院的那家医院，
11:02
no one read the chart, put her on Tylenol,
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没有人看过病历，就给她泰诺，
11:04
which she is allergic to, broke out, got bedsores,
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可是她对泰诺过敏，过敏症爆发后，她得了褥疮，
11:06
basically, had heart problems, and died
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基本上，还有心脏的问题，最后她在摔倒后和并发症以及种种错误下
11:09
from the fall and the complications and the errors that were there.
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去世了。
11:12
Now, the most frightening thing about this is
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现在，这个最可怕的是，
11:16
this is my wife's grandmother.
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这是我妻子的祖母。
11:19
Now, I'm Eric Dishman. I speak English,
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我是埃里克迪什曼。我讲英语。
11:21
I work for Intel, I make a good salary,
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我为Intel公司工作。我挣的钱不少。
11:23
I'm smart about falls and fall-related injuries --
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对于跟摔倒相关的损伤我很注意。
11:26
it's an area of research that I work on.
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这是我工作的研究领域。
11:28
I have access to senators and CEOs.
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我能接触到参议员和CEO。
11:31
I can't stop this from happening.
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我不能够阻止这样的事情继续发生。
11:33
What happens if you don't have money, you don't speak English
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如果你没有钱，也不会英语，
11:35
or don't have the kind of access
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或者也没有什么人能接触
11:37
to deal with these kinds of problems that inevitably occur?
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来解决这样不可避免发生的问题，又会发生些什么呢？
11:40
How do we actually prevent the vast majority of falls
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我们实际上如何首先阻止
11:43
from ever occurring in the first place?
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绝大多数摔倒的发生？
11:45
Let me give you a quick example of work that we're doing
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让我给你们一个简短的例子，来展示给你们
11:47
to try to do exactly that.
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我们正在从事的工作。
11:49
I've been wearing a little technology that we call Shimmer.
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一种我们成为Shimmer的科技。
11:52
It's a research platform.
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它是一个研究平台。
11:54
It has accelerometry. You can plug in a three-lead ECG.
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它有个加速器。你能插入一个3导联心电图。
11:57
There is all kinds of sort of plug-and-play
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那里有所有种类的即插即用的
11:59
kind of Legos that you can do to capture, in the wild,
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像乐高一样的装置，你可以捕获，野生的，
12:01
in the real world,
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现实世界的，
12:03
things like tremor, gait,
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像震颤，步态，
12:05
stride length and those kinds of things.
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步幅，以及那类的信息。
12:07
The problem is, our understanding of falls today,
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问题是，我们对摔倒的理解，在今天，
12:11
like Mimi, is get a survey in the mail three months after you fell,
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像咪咪，就是在你摔到三个月后收到一封调查邮件，
12:14
from the State, saying, "What were you doing when you fell?"
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它来自于州政府，上面写着“你跌倒的时候在干什么？”
12:17
That's sort of the state of the art.
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这也算是一种州政府的艺术。
12:19
But with something like Shimmer, or we have something called the Magic Carpet,
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但是，当有了像Shimmer一类，或者我们称之为神奇地谈的帮助，
12:22
embedded sensors in carpet, or camera-based systems
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将监控器放入地毯中，或者一个从运动医学借鉴来的
12:24
that we borrowed from sports medicine,
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基于摄像头的系统，
12:26
we're starting for the first time in those 600 elderly households
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我们第一次向600个老年住户
12:29
to collect actual kinematic motion data
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收集实际的运动学移动数据
12:32
to understand: What are the subtle changes that are occurring
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来了解正在发生的微妙变化是什么
12:36
that can show us that mom has become risk at falls?
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这也向我们显示了妈妈也存在摔倒的风险。
12:39
And most often we can do two interventions,
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最多的，我们能做两种干预，
12:41
fix the meds mix.
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修复医药合剂。
12:43
I'm a qualitative researcher, but when I look at these data streams coming in
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我是一名定性的研究人员，但是当我看到这些来自于
12:46
from these homes, I can look at the data and tell you the day
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这些家庭的数据时，我能够通过这些数据告诉你有一天
12:49
that some doctor prescribed them something that nobody else
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医生会给他们开处方，
12:51
knew that they were on, because we see the changes
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没有人能够察觉。因为我们看到的改变
12:53
in their patterns in the household. Right?
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就发生在他们的家中。对吧?
12:56
These discoveries of behavioral markers,
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这些行为记录者的发明，
12:59
and behavioral changes
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和行为的改变
13:01
are game changing, and like the discovery of the microscope
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改变了游戏规则，就像显微镜的发明一样
13:03
because of our collecting data streams that we've actually never done before.
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因为我们收集数据的方法是我们从来没有使用过的。
13:06
This is an example in our TRIL Clinic in Ireland
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这是一个发生在爱尔兰的Trill诊所的例子
13:08
of -- actually what you're seeing is
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是关于...你们自己看吧，
13:10
she's looking at data,
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她在读取
13:12
in this picture, from the Magic Carpet.
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照片里的数据，来自于神奇地毯。
13:14
So, we have a little carpet that you can look at your amount of postural sway,
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所以，一块小地毯你可以看到你自己的状态，
13:17
and look at the changes in your postural sway over many months.
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还能看到数月中你自己状态的改变。
13:20
Here's what some of this data might look like.
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这里是一些数据可能出现的样子。
13:22
This is actually sensor firings.
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这个实际上是传感器
13:24
These are two different subjects in our study.
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我们的研究有两个不同的主题。
13:26
It's about a year's worth of data.
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大约是一年的数据。
13:28
The color represents different rooms they are in the house.
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颜色代表了房屋中不同的房间。
13:31
This person on the left is living in their own home.
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左边的这个人住在他们自己的屋子里。
13:33
This person on the right is actually living in an assisted living facility.
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右边的这个人实际上住在养老院。
13:36
I know this because look at how punctuated meal time is
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我知道这些是因为当他们不住在自己的屋子时，
13:39
when they are no longer in their particular rooms here. Right?
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他们的吃饭时间都很准。对吧？
13:42
Now, this doesn't mean that much to you.
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现在，这些对你并不重要。
13:45
But when we look at these cycles of data
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但是，当你看到长时间的
13:47
over a longer period of time -- and we're looking at everything from
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整体数据时，我们能从
13:49
motion around different rooms in the house,
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房屋中不同房间的动态看出任何信息，
13:51
to sort of micro-motions that Shimmer picks up,
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像Shimmer收集的微观动态，
13:54
about gait and stride length -- these streams of data
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关于步态和步幅，这些数据
13:56
are starting to tell us things about behavioral patterns
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告诉我们行为模式，
13:58
that we've never understood before.
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一些我们从来不知道的模式。
14:00
You can go to ORCATech.org --
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你可以查看ORCATech.org-
14:02
it has nothing to do with whales, it's the Oregon Center for Aging and Technology --
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这跟鲸鱼没有关系，这是俄勒冈州的老龄化技术中心-
14:05
to see more about that.
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得知更多的信息。
14:07
The problem is, Intel is still one of the largest
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问题是，Intel公司仍然是
14:09
funders in the world
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世界上独立生活技术研发的
14:11
of independent living technology research.
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最大的资助者之一。
14:14
I'm not bragging about how much we fund;
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我没有吹牛我们有多少资金，
14:16
it's how little anyone else actually pays attention
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其他人实际注意到的
14:18
to aging and funds innovation on aging,
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老龄化和用于老龄化的资金很少，
14:21
chronic disease management and independent living in the home.
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慢性疾病管理，独立生活在家。
14:24
So, my mantra here, my fourth slogan is:
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所以，我的咒语，我第四个口号是：
14:26
10,000 households or bust.
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要么是10，000户家人或者是一无所有。
14:29
We need to drive
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我们需要驱使
14:31
a national, if not international, Framingham-type heart study
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整个国家，即使不是国际间的，像弗雷明汉式心脏研究一样的
14:35
of independent living technologies,
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做对独立生活技术的研究，
14:37
where we have 10,000 elderly connected households
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这样10000连在一起的老年住户
14:40
with broadband, full medical characterization,
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有着宽带，全套的医疗设施，
14:43
and a platform by which we can start to experiment
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一个我们可以开始试验的平台
14:45
and turn these from 20-household anecdotal studies
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将大学基金资助的
14:48
that the universities fund,
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20位住户研究，
14:50
to large clinical trials that prove out the value of these technologies.
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变成大型的临床试验来证明这些科技的价值。
14:53
So, 10,000 households or bust.
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所以说，要么是10000住户，要么是一无所有。
14:55
These are just some of the households that we've done in the Intel studies.
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这只是我们在Intel研究中所研究的一些住户。
14:59
My fifth and final phrase:
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我的第五个，也是最后一个口号是：
15:01
I have tried for two years,
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我试了两年，
15:03
and there were moments when we were quite close,
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有过几次我们离
15:06
to make this healthcare reform bill be about reform
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改革医保非常近了
15:09
from something and to something,
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就是将一些事改革成另一些事。
15:11
from a mainframe model
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从主体模型
15:13
to a personal health model,
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到个人健康模型，
15:15
or to mean something more than just a debate
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或者不仅仅是一场关于
15:17
about the public option and how we're going to finance.
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公众选择和我们将如果投资的辩论。
15:19
It doesn't matter how we finance healthcare.
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我们如何投资医保其实并不重要。
15:22
We're going to figure something out
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我们只是想把事情弄明白
15:24
for the next 10 years, and try it.
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在接下来的10年内，然后试验。
15:26
No matter who pays for it,
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谁来支付这个并不重要，
15:28
we better start doing care in a fundamentally different way
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我们最好以一种根本不同的方式开始关心
15:30
and treating the home and the patient
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和对待家庭和病人
15:33
and the family member and the caregivers
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以及家庭成员，和护理人员
15:35
as part of these coordinated care teams
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把他们当作互相协调的团队
15:37
and using disruptive technologies that are already here
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用这里已经有的全新技术
15:41
to do care in some pretty fundamental different ways.
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以完全不同的方式来护理。
15:44
The president needs to stand up and say,
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领导人应该站起来说，
15:47
at the end of a healthcare reform debate,
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这是医保改革争论的结尾，
15:50
"Our goal as a country is to move 50 percent of care
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“我们作为一个国家的目标是将百分之五十的保健
15:53
out of institutions, clinics, hospitals and nursing homes,
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从机构，诊所，医院和护理之家分离，
15:56
to the home, in 10 years."
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移到家庭，在未来的10年内。”
15:58
It's achievable. We should do it economically,
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我们可以做到的。我们要从经济上这么做。
16:00
we should do it morally,
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我们要从道义上这么做。
16:02
and we should do it for quality of life.
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从生活品质上这么做。
16:04
But there is no goal within this health reform.
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但是，这项医保改革是没有目标的。
16:06
It's just a mess today.
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今天只是一团乱。
16:08
So, you know, that's my last message to you.
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你知道，这是我给你们的最后的讲话。
16:10
How do we set a going-to-the-moon goal
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我们要如何完成这个像去月球一样的
16:13
of dealing with the Y2K +10 problem that's coming?
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解决即将来临的Y2K+10的问题的目标？
16:17
It's not that innovation and technology is going to be the
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创新和技术不会成为
16:19
magic pill that cures all, but it's going to be part of the solution.
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万灵药，但是却是解决方法的一部分。
16:22
And if we don't create a personal health movement,
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如果我们不创造出一个个人健康运动，
16:25
something that we're all aiming towards in reform,
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一个我们改革的方向，
16:27
then we're going to move nowhere.
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我们将无所去处。
16:29
So, I hope you'll turn this conference into that kind of movement forward.
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所以，我希望你把这场会议看成一种运动。
16:31
Thanks very much.
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谢谢大家
16:33
(Applause)
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（鼓掌）
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