TEDMED 2009
Eric Dishman: Take health care off the mainframe
艾瑞克·迪許曼：將健康照護從主體移開
Filmed:
Readability: 4
439,060 views
在TEDMED, 艾瑞克·迪許曼提出大膽的論調：美國健康照護系統就像約1959年的電腦系統，拴著龐大、難以移動的中央系統：醫院、醫師、護理之家。當我們的老年人口暴漲，他說，為全部的人創造個人的、網絡性的、以居家為主的健康系統，是很重要的。
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 --
0
0
2000
如果你想想看，電話
00:17
and Intel has tested
1
2000
2000
美商英特爾已經測試過
00:19
a lot of the things I'm going to show you,
2
4000
2000
很多東西是我馬上要表演給你們看的
00:21
over the last 10 years,
3
6000
2000
在過去的十年
00:23
in about 600 elderly households --
4
8000
2000
約600戶年長者家裡
00:25
300 in Ireland, and 300 in Portland --
5
10000
3000
有300戶是在愛爾蘭，300戶是在波特蘭
00:28
trying to understand: How do we measure
6
13000
2000
試著去理解我們要如何測量
00:30
and monitor behavior
7
15000
2000
及監測行為
00:32
in a medically meaningful way?
8
17000
2000
以一個在醫療上有意義的方式？
00:34
And if you think about the phone, right,
9
19000
2000
而且，如果你想想看電話，對
00:36
it's something that we can use for some incredible ways
10
21000
2000
它就是能讓我們以一些不可思議的方式
00:38
to help people actually take the right medication at the right time.
11
23000
3000
來幫助人們，準確的在對的時間吃對的藥。
00:41
We're testing these kinds of simple
12
26000
2000
我們正在測試這類簡單的
00:43
sensor-network technologies in the home
13
28000
2000
在家裡的偵測網絡科技
00:45
so that any phone that a senior is already comfortable with
14
30000
2000
所以只要任何電話是一位年長者已能自在使用的
00:47
can help them deal with their medications.
15
32000
2000
就能幫助他們處理他們的用藥。
00:49
And a lot of what they do is they pick up the phone,
16
34000
2000
而他們所要作的只是接起電話，
00:51
and it's our system whispering to them which pill they need to take,
17
36000
3000
而且是我們的系統在私底下悄悄告訴他們應該吃哪一種藥，
00:54
and they fake like they're having a conversation with a friend.
18
39000
3000
假裝他們正在和朋友對話。
00:57
And they're not embarrassed by a meds caddy that's ugly,
19
42000
2000
他們不必為藥物像醜陋的桿弟感到尷尬
00:59
that sits on their kitchen table and says,
20
44000
2000
佔在他們的廚房桌上而說
01:01
"I'm old. I'm frail."
21
46000
2000
『我老了、我很虛弱。』
01:03
It's surreptitious technology
22
48000
2000
它可以是暗地裡的科技
01:05
that's helping them do a simple task
23
50000
2000
來幫助他們處理一簡單的任務
01:07
of taking the right pill at the right time.
24
52000
2000
在對的時間吃對的藥丸。
01:09
Now, we also do some pretty amazing things with these phones.
25
54000
3000
現在，我們還用這些電話來作一些很了不起的事。
01:12
Because that moment when you answer the phone
26
57000
3000
因為，就在你接起電話的那一刻
01:15
is a cognitive test every time that you do it.
27
60000
3000
，你接起的每一次都是一個認知測試。
01:18
Think about it, all right? I'm going to answer the phone three different times.
28
63000
3000
想想看，好吧？我現在就來接三次不同的電話。
01:21
"Hello? Hey."
29
66000
2000
『哈囉？嗨～』
01:23
All right? That's the first time.
30
68000
3000
好了嗎？那是第一次。
01:26
"Hello? Uh, hey."
31
71000
4000
『哈囉？痾，嗨～』
01:30
"Hello? Uh, who?
32
75000
4000
『哈囉？痾，是哪位？
01:34
Oh, hey."
33
79000
3000
喔，嘿。』
01:37
All right? Very big differences
34
82000
3000
可以嗎？相當大的差別。
01:40
between the way I answered the phone the three times.
35
85000
3000
在我三次接電話的方式。
01:43
And as we monitor phone usage
36
88000
2000
所以當我們監測電話使用的方式
01:45
by seniors over a long period of time,
37
90000
3000
由年長者經過很長的一段時間。
01:48
down to the tenths of a microsecond,
38
93000
2000
不到十分之一微秒，
01:50
that recognition moment
39
95000
2000
那辨認的當下，
01:52
of whether they can figure out that person on the other end
40
97000
2000
看他們是否能辨認電話另一頭
01:54
is a friend and we start talking to them immediately,
41
99000
2000
的那個人是朋友，而馬上開始和他們聊起天來，
01:56
or they do a lot of what's called trouble talk,
42
101000
2000
還是他們會有很多所謂的困惑對話，
01:58
where they're like, "Wait, who is this? Oh." Right?
43
103000
3000
像是『等一下，你是誰？喔。』對吧？
02:01
Waiting for that recognition moment
44
106000
2000
等待辨認的那一刻
02:03
may be the best early indicator of the onset of dementia
45
108000
2000
也許就會是最好的早期失智開始的指標，
02:05
than anything that shows up clinically today.
46
110000
2000
勝過任何現今臨床上的徵兆。
02:07
We call these behavioral markers.
47
112000
2000
我們稱這些作行為指標。
02:09
There's lots of others. Is the person going to the phone
48
114000
2000
還有很多其它的行為。這個人去接電話時，
02:11
as quickly, when it rings, as they used to?
49
116000
3000
當電話響起時，接電話的速度，是否和他之前一樣？
02:14
Is it a hearing problem or is it a physicality problem?
50
119000
3000
這是有聽覺障礙，還是有行動障礙？
02:17
Has their voice gotten more quiet? We're doing a lot of work with people
51
122000
2000
他們發聲是否變得比較安靜？我們正在和很多人進行合作
02:19
with Alzheimer's and particularly with Parkinson's,
52
124000
3000
患有阿滋海默症的，還有特別是帕金森氏症
02:22
where that quiet voice that sometimes shows up with Parkinson's patients
53
127000
3000
，當漸趨安靜的發聲，有些時候表現在帕金森氏患者身上，
02:25
may be the best early indicator
54
130000
3000
有可能是最好的早期指標
02:28
of Parkinson's five to 10 years before it shows up clinically.
55
133000
3000
比帕金森氏症臨床症狀的出現，還要早個五到十年。
02:31
But those subtle changes in your voice over a long period of time
56
136000
3000
而這些你聲音裡細微的、長時間的改變
02:34
are hard for you or your spouse to notice until it becomes so extreme
57
139000
3000
對你或你的配偶來說，可能很難去注意，直到它變得很極端
02:37
and your voice has become so quiet.
58
142000
2000
而你的聲音也已經變得很安靜。
02:39
So, sensors are looking at that kind of voice.
59
144000
2000
所以，偵測器就是在監測那種訊號。
02:41
When you pick up the phone,
60
146000
2000
當你拿起話筒時，
02:43
how much tremor are you having,
61
148000
2000
你有多麼顫抖？
02:45
and what is that like, and what is that trend like over a period of time?
62
150000
3000
還有那是甚麼樣子，經過一段時間，那是一個怎樣的趨勢？
02:48
Are you having more trouble dialing the phone than you used to?
63
153000
2000
你撥電話的按鍵時、是否比之前有更多的困難？
02:50
Is it a dexterity problem? Is it the onset of arthritis?
64
155000
3000
是靈活度的問題？是關節炎的前兆？
02:53
Are you using the phone? Are you socializing less than you used to?
65
158000
4000
你有在使用電話嗎？你社交的是否比之前來得少？
02:57
And looking at that pattern. And what does that decline in social health
66
162000
3000
看著那個模式，那減少的趨勢，在社交健康上，代表的
03:00
mean, as a kind of a vital sign of the future?
67
165000
3000
意義是甚麼？能否代表將來的一種生命徵象？
03:03
And then wow, what a radical idea,
68
168000
3000
接著，哇，這是個多麼創新的點子！
03:06
we -- except in the United States --
69
171000
2000
我們，除了在美國，
03:08
might be able to use this newfangled technology
70
173000
3000
說不定還可以利用這項新穎的科技，
03:11
to actually interact with a nurse or a doctor on the other end of the line.
71
176000
3000
確實與一位護士或醫師在電話的另一端互動。
03:14
Wow, what a great day that will be
72
179000
2000
那世界將會變得多麼美好！
03:16
once we're allowed to actually do those kinds of things.
73
181000
3000
等到有一天我們真的能夠完成這樣的事情時，
03:19
So, these are what I would call behavioral markers.
74
184000
4000
所以，這些就是我所謂的行為指標。
03:23
And it's the whole field that we've been trying to work on
75
188000
3000
而且，這是整個領域，我們已經試著要做的
03:26
for the last 10 years at Intel.
76
191000
2000
在過去十年，在英特爾。
03:28
How do you put simple disruptive technologies,
77
193000
2000
你要如何把一個簡單的破壞性科技，
03:30
and the first of five phrases that I'm going to talk about in this talk?
78
195000
2000
放在我接下來將要在這個演講裡討論到的五個階段中的第一個階段？
03:32
Behavioral markers matter.
79
197000
2000
行為指標很重要。
03:34
How do we change behavior?
80
199000
2000
我們要如何改變行為？
03:36
How do we measure changes in behavior
81
201000
2000
我們要如何去測量行為的改變，
03:38
in a meaningful way that's going to help us with
82
203000
2000
以有意義的的方式，那是可以用來幫助我們
03:40
prevention of disease, early onset of disease,
83
205000
2000
預防疾病，疾病的早期發現，
03:42
and tracking the progression of disease over a long period of time?
84
207000
3000
進而追蹤疾病在經過一段長時間的發展？
03:45
Now, why would Intel let me
85
210000
3000
只是，為什麼英特爾願意讓我
03:48
spend a lot of time and money, over the last 10 years,
86
213000
3000
花這麼多的時間跟金錢，在過去的十年，
03:51
trying to understand the needs of seniors
87
216000
2000
試著要了解年長者的需求
03:53
and start thinking about these kinds of behavioral markers?
88
218000
2000
且開始考慮這幾種行為指標？
03:55
This is some of the field work that we've done.
89
220000
3000
這是一些我們已經做過的田野訪查。
03:58
We have now lived with 1,000 elderly households
90
223000
3000
我們現在已經住進一千戶年長者家裡
04:01
in 20 countries over the last 10 years.
91
226000
2000
在過去十年、在20個國家中。
04:03
We study people in Rochester, New York.
92
228000
2000
我們研究在紐約州羅徹斯特市的人。
04:05
We go live with them in the winter
93
230000
2000
我們在冬天時，和他們住在一起，
04:07
because what they do in the winter,
94
232000
2000
因為他們在冬天作的事，
04:09
and their access to healthcare, and how much they socialize,
95
234000
2000
和他們使用醫療資源，以及他們參與社交活動的程度，
04:11
is very different than in the summer.
96
236000
2000
是和夏天很不同的。
04:13
If they have a hip fracture we go with them
97
238000
2000
如果他們髖關節骨折，我們就跟著他們，
04:15
and we study their entire discharge experience.
98
240000
2000
研究他們整個出院的經驗。
04:17
If they have a family member who is a key part of their care network,
99
242000
2000
如果其中有位家庭成員是他們健康照護網絡很重要的一員，
04:19
we fly and study them as well.
100
244000
2000
那我們也會飛去並一起研究他們。
04:21
So, we study the holistic health experience
101
246000
3000
所以我們研究整體的健康觀感。
04:24
of 1,000 seniors over the last 10 years
102
249000
2000
一千位年長者在過去的十年，
04:26
in 20 different countries.
103
251000
2000
二十個不同的國家裡，
04:28
Why is Intel willing to fund that?
104
253000
3000
為什麼英特爾願意贊助這研究？
04:31
It's because of the second slogan that I want to talk about.
105
256000
2000
這是因為我將要討論的第二個口號。
04:33
Ten years ago, when I started trying to convince Intel
106
258000
2000
十年前，當我開始試著要說服英特爾，
04:35
to let me go start looking at disruptive technologies
107
260000
2000
讓我著手尋找破壞性科技，
04:37
that could help with independent living,
108
262000
2000
可以幫助獨立生活的
04:39
this is what I called it: "Y2K + 10."
109
264000
3000
這是我給它取的名字：『Y2K + 10』
04:42
You know, back in 2000,
110
267000
2000
你也知道，回到2000年
04:44
we were all so obsessed with paying attention
111
269000
2000
我們都著魔似的將注意力集中
04:46
to the aging of our computers,
112
271000
2000
於我們電腦的老化，
04:48
and whether or not they were going to survive
113
273000
2000
及它們是否能逃過
04:50
the tick of the clock from 1999 to 2000,
114
275000
2000
時鐘滴答從1999到2000年
04:52
that we missed a moment that only demographers were paying attention to.
115
277000
5000
我們也錯過一刻只有人口統計學家有在關心。
04:57
It was right around New Years.
116
282000
2000
那差不多是新年的時候。
04:59
And that switchover,
117
284000
2000
那個大轉變，
05:01
when we had the larger number of older people on the planet,
118
286000
3000
也正是在這個星球上，我們的老年人人口數目大於
05:04
for the first time than younger people.
119
289000
2000
年輕人人數的第一次。
05:06
For the first time in human history -- and barring aliens landing
120
291000
2000
那也是第一次在人類歷史上，除了外星人登入
05:08
or some major other pandemic,
121
293000
2000
或是其它重大的流行性疾病，
05:10
that's the expectation from demographers, going forward.
122
295000
3000
人口統計學家預期要往前看。
05:13
And 10 years ago it seemed like I had a lot of time
123
298000
2000
且十年前我似乎有很多的時間
05:15
to convince Intel to work on this. Right?
124
300000
2000
去說服英特爾去做這。對吧？
05:17
Y2K + 10 was coming,
125
302000
2000
Y2K+10就要來了，
05:19
the baby boomers starting to retire.
126
304000
3000
嬰兒潮那一代也開始要退休。
05:22
Well folks, it's like we know these demographics here.
127
307000
4000
只是大家，這就像我們知道這些人口統計資料在這，
05:26
This is a map of the entire world.
128
311000
2000
這裡是一張全世界的地圖。
05:28
It's like the lights are on,
129
313000
2000
這就像燈是亮的，
05:30
but nobody's home on this demographic
130
315000
2000
但沒有人在這人口統計學的家
05:32
Y2K + 10 problem. Right?
131
317000
2000
Y2K + 10的問題裡。對吧？
05:34
I mean we sort of get it here, but we don't get it here,
132
319000
4000
我的意思是，我們好像到了，可是我們沒有到這，
05:38
and we're not doing anything about it.
133
323000
2000
而且我們沒有對它作任何事。
05:40
The health reform bill is largely ignoring
134
325000
2000
健康改革法案是幾乎完全忽略，
05:42
the realities of the age wave that's coming,
135
327000
2000
那將要來的高齡潮的事實，
05:44
and the implications for what we need to do to change
136
329000
2000
以及它隱含著，不單只是我們該如何做，才能改變
05:46
not only how we pay for care,
137
331000
3000
我們支付健康照護費用的方式，
05:49
but deliver care in some radically different ways.
138
334000
3000
而是如何將照護以截然不同的方式傳遞。
05:52
And in fact, it's upon us.
139
337000
2000
講白一點，它與我們息息相關。
05:54
I mean you probably saw these headlines. This is Catherine Casey
140
339000
3000
我的意思是你大概看過這些頭條。這是凱瑟琳凱西，
05:57
who is the first boomer to actually get Social Security.
141
342000
3000
她是第一位得到社會福利的嬰兒潮。
06:00
That actually occurred this year. She took early retirement.
142
345000
2000
這件事其實是在今年發生的。她及早退休。
06:02
She was born one second after midnight in 1946.
143
347000
4000
她是在1946年凌晨十二點後一秒出生的。
06:06
A retired school teacher,
144
351000
2000
一位退休的學校老師。
06:08
there she is with a Social Security administrator.
145
353000
2000
那裡，她和社會福利的行政官一起，
06:10
The first boomer actually, we didn't even wait till 2011, next year.
146
355000
3000
確實是第一位嬰兒潮，我們還不必等到明年，2011年。
06:13
We're already starting to see early retirement occur this year.
147
358000
3000
我們已經漸漸在今年看到提早退休的發生。
06:16
All right, so it's here. This Y2K + 10 problem is at our door.
148
361000
3000
好吧，所以它來了。這Y2K+10的問題就在我們門口。
06:19
This is 50 tsunamis scheduled on the calendar,
149
364000
5000
這是50個海嘯安插在行事暦上。
06:24
but somehow we can't sort of marshal our government
150
369000
3000
但不知怎麼的，我們就不大能整頓我們的政府，
06:27
and innovative forces to sort of get out in front of it
151
372000
2000
或以創新的力量，好像，走出去站在它前面
06:29
and do something about it. We'll wait until
152
374000
2000
並對它做點什麼事。我們會等到它
06:31
it's more of a catastrophe, and react,
153
376000
2000
已經一發不可收拾，才做出反應，
06:33
as opposed to prepare for it.
154
378000
2000
而不是做好準備等著它。
06:35
So, one of the reasons it's so
155
380000
2000
所以，其中一個為問題它之所以
06:37
challenging to prepare for this Y2K problem
156
382000
2000
為Y2K作準備，這麼具挑戰性的原因
06:39
is, I want to argue, we have what I would call
157
384000
2000
在於，我要提出的，我們有我稱它作所謂的
06:41
mainframe poisoning.
158
386000
2000
主體中毒。
06:43
Andy Grove, about six or seven years ago,
159
388000
3000
安迪郭夫，約六、七年前，
06:46
he doesn't even know or remember this, in a Fortune Magazine article
160
391000
2000
他可能也不知道或不記得這件事，在一篇財富雜誌的文章裡
06:48
he used the phrase "mainframe healthcare,"
161
393000
3000
他用了這個詞『主體的健康照護』，
06:51
and I've been extending and expanding this.
162
396000
2000
而我將它延伸、擴大。
06:53
He saw it written down somewhere. He's like, "Eric that's a really cool concept."
163
398000
3000
當他看到這被寫在某個地方時，他就像這樣說『艾瑞克，這是一個很酷的概念。』
06:56
I was like, "Actually it was your idea. You said it in a Fortune Magazine article.
164
401000
2000
我就像這樣『其實這原本是你的想法。你在財富雜誌裡說過的。
06:58
I just extended it."
165
403000
2000
我不過是延伸它而已。』
07:00
You know, this is the mainframe.
166
405000
2000
你也知道，這就是所謂的主體。
07:02
This mentality of traveling to
167
407000
3000
這個跋涉前往的想法
07:05
and timesharing large, expensive healthcare systems
168
410000
3000
而且分時大型昂貴的健康照護系統，
07:08
actually began in 1787.
169
413000
2000
其實是開始於1787年。
07:10
This is the first general hospital in Vienna.
170
415000
3000
這是維也納第一個大眾醫院。
07:13
And actually the second general hospital in Vienna,
171
418000
2000
而實際上維也納的第二個公共醫院，
07:15
in about 1850, was where we started to build out
172
420000
3000
在約1850年，也正是我們開始打造
07:18
an entire curriculum for teaching med students specialties.
173
423000
4000
整套課程來訓練醫學生專業的地方。
07:22
And it's a place in which we started developing
174
427000
2000
另外，那也正是我們開始發展出
07:24
architecture that literally divided the body,
175
429000
2000
架構將身體分區的地方，並
07:26
and divided care into departments and compartments.
176
431000
3000
將照護分成部門及科部。
07:29
And it was reflected in our architecture,
177
434000
2000
同時，這也反應在我們的架構上，
07:31
it was reflected in the way that we taught students,
178
436000
2000
它也反應在我們教學生的方式。
07:33
and this mainframe mentality persists today.
179
438000
3000
這套主體的想法一直持續到今天。
07:36
Now, I'm not anti-hospital.
180
441000
3000
現在，我不是反對醫院。
07:39
With my own healthcare problems, I've taken drug therapies,
181
444000
2000
以我自己的健康問題，我曾經接受藥物治療，
07:41
I've traveled to this hospital and others, many, many times.
182
446000
3000
我也拜訪這間和其它家醫院很多很多次。
07:44
But we worship the high hospital on a hill. Right?
183
449000
4000
只是我們崇拜那高高在斜坡上的醫院，對吧？
07:48
And this is mainframe healthcare.
184
453000
2000
而這就是主體健康照護系統。
07:50
And just as 30 years ago
185
455000
2000
也不過30多年前，
07:52
we couldn't conceive that we would have the power
186
457000
3000
我們不會去設想到，我們有能力
07:55
of a mainframe computer that took up a room this size
187
460000
3000
將房間大小的電腦主機，
07:58
in our purses and on our belts,
188
463000
2000
縮到我們的皮包和皮帶的大小，
08:00
that we're carrying around in our cell phone today,
189
465000
2000
讓我們今天能攜帶在手機裡帶著到處走。
08:02
and suddenly, computing,
190
467000
2000
加上忽然，電腦的使用，
08:04
that used to be an expert driven system,
191
469000
2000
那曾經是專家引導的系統，
08:06
it was a personal system that we all owned as part of our daily lives --
192
471000
3000
已是我們都擁有且成為我們日常生活一部份的個人系統。
08:09
that shift from mainframe to personal computing
193
474000
3000
那個從大主機到個人電腦的轉變，
08:12
is what we have to do for healthcare.
194
477000
2000
正是我們必須對健康照護系統做的事。
08:14
We have to shift from this mainframe mentality of healthcare
195
479000
3000
我們必須將主體的健康照護概念，
08:17
to a personal model of healthcare.
196
482000
2000
轉換成健康照護的個人模式。
08:19
We are obsessed with this way of thinking.
197
484000
3000
我們是執著於這種思考方式的。
08:22
When Intel does surveys all around the world and we say,
198
487000
2000
當英特爾在作全世界問卷調查，我們說
08:24
"Quick response: healthcare."
199
489000
2000
『聯想健康照護。』
08:26
The first word that comes up is "doctor."
200
491000
2000
第一個冒出來的字是醫師。
08:28
The second that comes up is "hospital." And the third is "illness" or "sickness." Right?
201
493000
3000
第二個冒出來的是醫院。然後第三個是疾病或患病。對吧？
08:31
We are wired, in our imagination, to think about healthcare
202
496000
4000
我們聯想，在我們的想像裡，把健康照護
08:35
and healthcare innovation as something
203
500000
2000
及健康照護的創意想成是某個東西
08:37
that goes into that place.
204
502000
2000
會進去那個地方。
08:39
Our entire health reform discussion right now,
205
504000
2000
我們目前整個健康改革的討論，
08:41
health I.T., when we talk with policy makers,
206
506000
3000
當我們和政策決策者談，
08:44
equals "How are we going to get doctors using
207
509000
2000
等於我們要如何讓醫師在主體裡使用
08:46
electronic medical records in the mainframe?"
208
511000
2000
電子醫療紀錄？
08:48
We're not thinking about
209
513000
2000
我們不是在想
08:50
how do we shift from the mainframe to the home.
210
515000
2000
要如何從主體轉移到家裡。
08:52
And the problem with this is
211
517000
2000
而這個問題的本身就在於這是
08:54
the way we conceive healthcare. Right?
212
519000
2000
我們設想健康照護的方式，對吧？
08:56
This is a very reactive, crisis-driven system.
213
521000
2000
這是一個非常具反應性，危機導向的系統。
08:58
We're doing 15-minute exams with patients.
214
523000
2000
我們正在和病人作15分鐘的測試。
09:00
It's population-based.
215
525000
2000
這是以人口為根據的。
09:02
We collect a bunch of biological information in this artificial setting,
216
527000
3000
我們在這人為的佈置裡收集一堆生物性資料。
09:05
and we fix them up, like Humpty-Dumpty all over again,
217
530000
2000
接著我們把他們修理回去，像是從頭到尾把杭弟唐帝（兒歌中從牆上跌下摔破的蛋）再做一次，
09:07
and send them home,
218
532000
2000
然後把他們送回家，
09:09
and hope -- we might hand them a brochure, maybe an interactive website --
219
534000
3000
接著希望，我們能發傳單給他們，或是一個能互動的網頁，
09:12
that they do as asked and don't come back into the mainframe.
220
537000
4000
好讓他們能照著要求作，就不會回到主體裡。
09:16
And the problem is we can't afford it today, folks.
221
541000
3000
但問題是，各位，我們今天付不起。
09:19
We can't afford mainframe healthcare today to include the uninsured.
222
544000
4000
我們不能支付今天主體醫療去涵括沒保險的部份。
09:23
And now we want to do a double-double
223
548000
2000
而且我們要做的是一個雙倍再加倍
09:25
of the age wave coming through?
224
550000
2000
即將要來的高齡潮？
09:27
Business as usual in healthcare is broken and we've got to do something different.
225
552000
3000
健康照護產業和往常一樣是破產的所以我們必須作點甚麼是不一樣的。
09:30
We've got to focus on the home.
226
555000
2000
我們必須要把焦點放在家裡。
09:32
We've got to focus on a personal healthcare paradigm
227
557000
2000
我們必須聚焦在個人的健康照護模式，
09:34
that moves care to the home. How do we be more proactive,
228
559000
2000
把照顧移到家裡。我們要如何才能變得比較積極、
09:36
prevention-driven?
229
561000
2000
預防性導向？
09:38
How do we collect vital signs and other kinds of information 24 by 7?
230
563000
4000
我們要怎麼收集每天24小時的生命徵象和其它資訊？
09:42
How do we get a personal baseline about what's going to work for you?
231
567000
3000
我們要怎麼取得一個個人的基準資料才知道哪一樣資料對你有用？
09:45
How do we collect not just biological data
232
570000
2000
我們要如何收集不單單是生物性資料，
09:47
but behavioral data, psychological data,
233
572000
2000
但行為資料、心理狀況的資料
09:49
relational data, in and on and around the home?
234
574000
3000
在家裡、屬於家裡以及在家裡附近的相關性的資料？
09:52
And how do we drive compliance to be a customized care plan
235
577000
3000
還有我們要怎麼引導配合度，成為量身定做的照護計畫
09:55
that uses all this great technology that's around us
236
580000
2000
那是利用在我們周遭的這些高級科技，
09:57
to change our behavior?
237
582000
2000
來改變我們的行為？
09:59
That's what we need to do for our personal health model.
238
584000
3000
那正是我們必須為我們的個人健康模式做的。
10:02
I want to give you a couple of examples. This is Mimi
239
587000
2000
我要給你幾個例子。這是米咪
10:04
from one of our studies --
240
589000
2000
從我們當中一個研究出來—
10:06
in her 90s, had to move out of her home
241
591000
2000
在她九十幾歲時，必須搬出她家，
10:08
because her family was worried about falls.
242
593000
2000
因為她的家人擔心她會跌倒。
10:10
Raise your hand if you had a serious fall
243
595000
2000
如果你曾有嚴重的摔跤發生，請舉手。
10:12
in your household, or any of your loved ones,
244
597000
2000
在你家裡，或任何你愛的人
10:14
your parents or so forth. Right?
245
599000
2000
你的父母等人。對吧？
10:16
Classic. Hip fracture often leads to institutionalization of a senior.
246
601000
4000
很典型的。髖關節骨折常會導致年長者住進安養院。
10:20
This is what was happening to Mimi; the family was worried about it,
247
605000
2000
這就在米咪身上發生，家人擔心這件事，
10:22
moved her out of her own home into an assisted living facility.
248
607000
3000
把她從自己家裡請出去，搬進輔助生活的機構。
10:25
She tripped over her oxygen tank.
249
610000
3000
她被她的氧氣鋼筒絆倒。
10:28
Many people in this generation won't press the button,
250
613000
2000
很多在這個世代的人不會按下那個急救鈕，
10:30
even if they have an alert call system, because they don't want to bother anybody,
251
615000
2000
就算他們有緊急呼叫系統，因為他們不想要打擾到其他人，
10:32
even though they've been paying 30 dollars a month.
252
617000
2000
儘管他們已經支付一個月30美元。
10:34
Boomers will press the button. Trust me.
253
619000
2000
嬰兒潮的人會按下那個鈕。相信我。
10:36
They're going to be pressing that button non-stop. Right?
254
621000
4000
他們將會不停的按這那個鈕。對吧？
10:40
Mimi broke her pelvis, lay all night, all morning,
255
625000
4000
米咪摔斷她的髖骨，整個晚上躺著，整個早上，
10:44
finally somebody came in and found her,
256
629000
2000
直到終於有人走進來找到她，
10:46
sent her to the hospital.
257
631000
2000
把她送到醫院。
10:48
They fixed her back up. She was never going to be able to move back
258
633000
2000
他們把她修理好。她再也不能夠搬回
10:50
into the assisted living. They put her into the nursing home unit.
259
635000
2000
那個輔助生活的機構。他們將她送到照護之家。
10:52
First night in the nursing home unit where she had been
260
637000
2000
在照護之家的第一晚，就在她曾待過的同一個輔助生活機構，
10:54
in the same assisted living facility, moved her from one bed to another,
261
639000
3000
把她從一張床搬到另一張床，
10:57
kind of threw her, rebroke her pelvis,
262
642000
2000
大概丟到她，又摔到她的髖骨，
10:59
sent her back to the hospital that she had just come from,
263
644000
3000
把她送回她才離開的醫院，
11:02
no one read the chart, put her on Tylenol,
264
647000
2000
沒人讀過她的病歷，給她泰諾（止痛藥），
11:04
which she is allergic to, broke out, got bedsores,
265
649000
2000
是她會過敏的，過敏發作，得到褥瘡，
11:06
basically, had heart problems, and died
266
651000
3000
基本上有心臟問題，接著就死了
11:09
from the fall and the complications and the errors that were there.
267
654000
3000
原因是摔倒和病發症以及那存在著的錯誤。
11:12
Now, the most frightening thing about this is
268
657000
4000
現在，這件事最驚人的部份在於，
11:16
this is my wife's grandmother.
269
661000
3000
這是我太太的祖母。
11:19
Now, I'm Eric Dishman. I speak English,
270
664000
2000
現在，我是艾瑞克．迪許曼。我說英文。
11:21
I work for Intel, I make a good salary,
271
666000
2000
我為英特爾工作。我的收入優渥。
11:23
I'm smart about falls and fall-related injuries --
272
668000
3000
我對跌倒及跌倒相關的傷害很有辦法。
11:26
it's an area of research that I work on.
273
671000
2000
這是我在研究的領域。
11:28
I have access to senators and CEOs.
274
673000
3000
我能接近參議員及主要執行長們（CEOs）
11:31
I can't stop this from happening.
275
676000
2000
但我卻沒法停止這件事。
11:33
What happens if you don't have money, you don't speak English
276
678000
2000
如果你沒有錢，那會怎麼樣，如果你不說英文，
11:35
or don't have the kind of access
277
680000
2000
或是沒有辦法接觸到
11:37
to deal with these kinds of problems that inevitably occur?
278
682000
3000
能處理這種難以避免問題的資源？
11:40
How do we actually prevent the vast majority of falls
279
685000
3000
我們到底該如何預防大多數
11:43
from ever occurring in the first place?
280
688000
2000
在第一時間摔跤的發生？
11:45
Let me give you a quick example of work that we're doing
281
690000
2000
讓我給你一個簡單的例子，是我們正在試著
11:47
to try to do exactly that.
282
692000
2000
去做的這件事。
11:49
I've been wearing a little technology that we call Shimmer.
283
694000
3000
我已隨時帶戴著一個小型我們稱做訊門的科技。
11:52
It's a research platform.
284
697000
2000
這是一個研究的平台。
11:54
It has accelerometry. You can plug in a three-lead ECG.
285
699000
3000
他有加速度計。你可以插進一個三插的心電圖。
11:57
There is all kinds of sort of plug-and-play
286
702000
2000
它有各種不同的轉接頭和玩法
11:59
kind of Legos that you can do to capture, in the wild,
287
704000
2000
有點像樂高，讓你可以在自然的情況、
12:01
in the real world,
288
706000
2000
在真實的世界
12:03
things like tremor, gait,
289
708000
2000
追蹤像是顫抖、步態、
12:05
stride length and those kinds of things.
290
710000
2000
步長，還有這一類的東西。
12:07
The problem is, our understanding of falls today,
291
712000
4000
問題是，我們對跌倒的了解，在今天，
12:11
like Mimi, is get a survey in the mail three months after you fell,
292
716000
3000
就像米咪，是在你跌倒的三個月後收到寄來的問卷，
12:14
from the State, saying, "What were you doing when you fell?"
293
719000
3000
來自州政府問說『在你跌倒的時候你在做甚麼？』
12:17
That's sort of the state of the art.
294
722000
2000
那已經是現有最好的情形。
12:19
But with something like Shimmer, or we have something called the Magic Carpet,
295
724000
3000
但是如果有類似訊門這樣的東西，或是我們有什麼像是神奇地毯的東西，
12:22
embedded sensors in carpet, or camera-based systems
296
727000
2000
能埋偵測器在地毯裡或是以相機為基礎的系統，
12:24
that we borrowed from sports medicine,
297
729000
2000
那是我們從運動醫學借來的
12:26
we're starting for the first time in those 600 elderly households
298
731000
3000
我們開始可以第一次在六百戶年長者家裡，
12:29
to collect actual kinematic motion data
299
734000
3000
蒐集實際的力學運動資料，
12:32
to understand: What are the subtle changes that are occurring
300
737000
4000
以了解到底有什麼細微的改變，是正在發生的，
12:36
that can show us that mom has become risk at falls?
301
741000
3000
且可以告訴我們媽媽已經成為會跌倒的高危險群。
12:39
And most often we can do two interventions,
302
744000
2000
還有，更常見的，我們可以做兩種介入，
12:41
fix the meds mix.
303
746000
2000
處理醫療的混亂。
12:43
I'm a qualitative researcher, but when I look at these data streams coming in
304
748000
3000
我是一位質性的研究員，但是，當我看著這些加進來的資料庫，
12:46
from these homes, I can look at the data and tell you the day
305
751000
3000
那是從這些家裡出來的，我能看著那資料並告訴你是哪一天
12:49
that some doctor prescribed them something that nobody else
306
754000
2000
某醫師開了某些藥，那是沒有其他人
12:51
knew that they were on, because we see the changes
307
756000
2000
知道他們正在服用的。因為我們看到改變
12:53
in their patterns in the household. Right?
308
758000
3000
的趨勢是在那家裡。對吧？
12:56
These discoveries of behavioral markers,
309
761000
3000
這些行為指標的發現，
12:59
and behavioral changes
310
764000
2000
和行為改變
13:01
are game changing, and like the discovery of the microscope
311
766000
2000
都是改變的遊戲，好比顯微鏡的發明，
13:03
because of our collecting data streams that we've actually never done before.
312
768000
3000
因為我們收集的資料庫是我們之前都從來沒做過的。
13:06
This is an example in our TRIL Clinic in Ireland
313
771000
2000
這是我們在愛爾蘭喜爾診所的一個例子
13:08
of -- actually what you're seeing is
314
773000
2000
...其實你真正看到的是，
13:10
she's looking at data,
315
775000
2000
她正在看資料
13:12
in this picture, from the Magic Carpet.
316
777000
2000
在這張照片裡從神奇地毯來的。
13:14
So, we have a little carpet that you can look at your amount of postural sway,
317
779000
3000
所以，我們有一張小地毯讓你可以看你自己姿勢晃動的程度，
13:17
and look at the changes in your postural sway over many months.
318
782000
3000
再看你姿勢晃動程度經過幾個月的改變。
13:20
Here's what some of this data might look like.
319
785000
2000
這裡是一些資料大概的樣子。
13:22
This is actually sensor firings.
320
787000
2000
這是實際上偵測器在發送訊號。
13:24
These are two different subjects in our study.
321
789000
2000
這是我們實驗中的兩位不同的個案。
13:26
It's about a year's worth of data.
322
791000
2000
差不多是累積一整年的資料。
13:28
The color represents different rooms they are in the house.
323
793000
3000
顏色代表著他們現在所在房子裡不同的房間。
13:31
This person on the left is living in their own home.
324
796000
2000
這個左邊的人正住在他自己的房子裡。
13:33
This person on the right is actually living in an assisted living facility.
325
798000
3000
這在右邊的人正實際住在一個輔助生活機構。
13:36
I know this because look at how punctuated meal time is
326
801000
3000
我之所以知道這，是因為你看用餐時間是多麼的準時
13:39
when they are no longer in their particular rooms here. Right?
327
804000
3000
當他們不再住在自己特定的房間時，對吧？
13:42
Now, this doesn't mean that much to you.
328
807000
3000
現在，這可能對你來說沒有很大的意義，
13:45
But when we look at these cycles of data
329
810000
2000
但是當我們看這些週期性的資料
13:47
over a longer period of time -- and we're looking at everything from
330
812000
2000
經過一段較長的時間，而且我們看的是所有的東西，
13:49
motion around different rooms in the house,
331
814000
2000
從在房子裡不同房間的動作，
13:51
to sort of micro-motions that Shimmer picks up,
332
816000
3000
到一些訊門偵測到的微動作，
13:54
about gait and stride length -- these streams of data
333
819000
2000
像是步態及步長，這些大量的資料
13:56
are starting to tell us things about behavioral patterns
334
821000
2000
漸漸在告訴我們像是關於行為模式的東西
13:58
that we've never understood before.
335
823000
2000
一些我們以前從來都不懂。
14:00
You can go to ORCATech.org --
336
825000
2000
你可以進ORCATech.org網站—
14:02
it has nothing to do with whales, it's the Oregon Center for Aging and Technology --
337
827000
3000
它和鯨魚一點都沒關係，它是奧勒岡州的老年人及科技中心—
14:05
to see more about that.
338
830000
2000
去看看更多東西。
14:07
The problem is, Intel is still one of the largest
339
832000
2000
只是問題是，英特爾還是其中之一最大
14:09
funders in the world
340
834000
2000
在世界上的贊助者
14:11
of independent living technology research.
341
836000
3000
在研究獨立生活科技的。
14:14
I'm not bragging about how much we fund;
342
839000
2000
我不是在吹牛我們贊助了多少，
14:16
it's how little anyone else actually pays attention
343
841000
2000
而是其實其他人是多麼漠視
14:18
to aging and funds innovation on aging,
344
843000
3000
與老年化及花極少的基金在改革老年化、
14:21
chronic disease management and independent living in the home.
345
846000
3000
慢性疾病的管理、和獨立的居家。
14:24
So, my mantra here, my fourth slogan is:
346
849000
2000
所以，我的信念在這，我的第四個口號是：
14:26
10,000 households or bust.
347
851000
3000
10,000戶或破壞。
14:29
We need to drive
348
854000
2000
我們必須要引導
14:31
a national, if not international, Framingham-type heart study
349
856000
4000
全國性的，不然就國際性的，像弗明翰一類的心臟研究
14:35
of independent living technologies,
350
860000
2000
的獨立居住科技，
14:37
where we have 10,000 elderly connected households
351
862000
3000
當中我們讓10,000家老年人連接在一起
14:40
with broadband, full medical characterization,
352
865000
3000
靠的是寬頻、完整的醫療特徵
14:43
and a platform by which we can start to experiment
353
868000
2000
，及平台，其中我們可以開始作實驗，
14:45
and turn these from 20-household anecdotal studies
354
870000
3000
並將這20戶個別案例研究，
14:48
that the universities fund,
355
873000
2000
由大學贊助的
14:50
to large clinical trials that prove out the value of these technologies.
356
875000
3000
變成大型臨床試驗來發揮這些科技的價值。
14:53
So, 10,000 households or bust.
357
878000
2000
所以，10,000戶或破壞。
14:55
These are just some of the households that we've done in the Intel studies.
358
880000
4000
這些只是一些我們已經在英特爾實驗過的家庭。
14:59
My fifth and final phrase:
359
884000
2000
我的第五個也是最後一點：
15:01
I have tried for two years,
360
886000
2000
我已經試了兩年，
15:03
and there were moments when we were quite close,
361
888000
3000
有些時候我們也很接近，
15:06
to make this healthcare reform bill be about reform
362
891000
3000
在讓這健康改革法案能改革
15:09
from something and to something,
363
894000
2000
從這東西到另一種東西。
15:11
from a mainframe model
364
896000
2000
從一個主體模式
15:13
to a personal health model,
365
898000
2000
到個人健康模式、
15:15
or to mean something more than just a debate
366
900000
2000
或是能代表不單單只是眾人意見下的討論串
15:17
about the public option and how we're going to finance.
367
902000
2000
或是我們要如何去籌措資金。
15:19
It doesn't matter how we finance healthcare.
368
904000
3000
不管我們怎麼去籌措健康照護的資金，
15:22
We're going to figure something out
369
907000
2000
我們總要試著想到些什麼
15:24
for the next 10 years, and try it.
370
909000
2000
為未來十年，並試試看。
15:26
No matter who pays for it,
371
911000
2000
不論是誰要買單，
15:28
we better start doing care in a fundamentally different way
372
913000
2000
我們最好能開始以完全不同的方式來執行健康照護，
15:30
and treating the home and the patient
373
915000
3000
而且將他的家、病人、
15:33
and the family member and the caregivers
374
918000
2000
他的家庭成員、及照護者
15:35
as part of these coordinated care teams
375
920000
2000
都看成是互相合作的一個照護團隊，
15:37
and using disruptive technologies that are already here
376
922000
4000
再用現有的破壞性科技
15:41
to do care in some pretty fundamental different ways.
377
926000
3000
以一些很基本不同的方式來作照護。
15:44
The president needs to stand up and say,
378
929000
3000
總統可能需要站起來並說，
15:47
at the end of a healthcare reform debate,
379
932000
3000
在健康照護改革討論的最後，
15:50
"Our goal as a country is to move 50 percent of care
380
935000
3000
『我們國家的目標是要，移走百分之五十
15:53
out of institutions, clinics, hospitals and nursing homes,
381
938000
3000
在機構、診所、醫院和照護之家的照護
15:56
to the home, in 10 years."
382
941000
2000
在未來的十年移到家裡。』
15:58
It's achievable. We should do it economically,
383
943000
2000
這是可以達成的。我們應該做得合乎經濟效益。
16:00
we should do it morally,
384
945000
2000
我們應該要做得合乎道德。
16:02
and we should do it for quality of life.
385
947000
2000
而且我們應該為了生活品質而作。
16:04
But there is no goal within this health reform.
386
949000
2000
但現有的健康改革是沒有目標的，
16:06
It's just a mess today.
387
951000
2000
在今天是亂成一團的。
16:08
So, you know, that's my last message to you.
388
953000
2000
所以你知道，這是我要給你最後的一個訊息。
16:10
How do we set a going-to-the-moon goal
389
955000
3000
我們怎麼去設定一個將要通往月球
16:13
of dealing with the Y2K +10 problem that's coming?
390
958000
4000
處理這將要來的Y2K+10問題的目標？
16:17
It's not that innovation and technology is going to be the
391
962000
2000
這其實沒那麼創新或是科技是那
16:19
magic pill that cures all, but it's going to be part of the solution.
392
964000
3000
治百病的神奇藥丸，但是它至少會是答案的一部份。
16:22
And if we don't create a personal health movement,
393
967000
3000
而且如果我們不創造一個我們個人的健康運動
16:25
something that we're all aiming towards in reform,
394
970000
2000
那是我們都邁向要改革的，
16:27
then we're going to move nowhere.
395
972000
2000
那我們哪裡也走不了。
16:29
So, I hope you'll turn this conference into that kind of movement forward.
396
974000
2000
所以，我希望你們能把這個會議轉而推進這類的運動。
16:31
Thanks very much.
397
976000
2000
非常謝謝大家。
16:33
(Applause)
398
978000
3000
（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