Digital Medicine: “O Brave New World”
Recently, I participated in an international meeting in Nanjing, China on digital medicine. The meeting was sponsored by the Chinese Society of Digital Medicine and the newly formed International Society of Digital Medicine, both under the leadership of the remarkably energetic and effective professor, Shaoxiang Zhang from Chongqing, China. For my part of the meeting, I reviewed the experience of our health care system with the Epic electronic medical record (Epic Systems Corporation, Verona, Wis.), contrasted with published reports cited in PubMed.
A wide array of topics was covered during this 3-day meeting, ranging from 3-dimensional (3D) creation of various skeletal replacement parts, to big data research projects, to new imaging techniques involving magnetic resonance imaging (MRI), to robot-assisted care of frail, elderly patients, as well as many other interesting digital technologies. This “buffet” of multiple components for the health care systems of the future was both fascinating and a bit daunting. I was particularly impressed with the many presentations on 3D medicine.
Chinese orthopedic surgeons and a small number of their European colleagues have been implanting artificial bones and joints to replace those damaged by trauma or degenerative processes. These surgeons have been using 3D bony replacements for over a year for the repair of a variety of osseous structures, including the femur, the humerus, one or more vertebrae, parts of the skull, and pieces of the rib cage. These replacement parts are designed and manufactured in the hospital utilizing sophisticated digital software that takes information from the patient’s own computed tomography scan to create a bony structure that is exactly like the patient’s original bone. The bony structure itself is created by a 3D printer from a sophisticated mixture of chemical components that, in many cases, includes titanium in a liquid form. The required bone or joint is then hardened and placed into the patient during orthopedic surgery. Recently, an Australian surgeon replaced 2 cervical vertebrae that had been destroyed by a malignancy with a 3D composite vertebral prosthesis.
At this point, the overall clinical experience with these 3D prostheses has been very positive, but many questions remain, such as long-term durability, repair, and resistance to infection. Nevertheless, the fact that the artificial bone is exactly the same shape, length, and volume as the patient’s original bone is truly remarkable. I certainly hope that these futuristic bony replacements will eventually prove to be durable and highly functional. There was even talk at the meeting about the possibility of creating heart valves and internal organs such as the kidney with 3D components that would contain functioning renal tissue fabricated in the laboratory from the patient’s own stem cells. This latter futuristic replacement organ is still only in the earliest stage of development.
Other topics that were discussed during the meeting included the newly created field of “big data” investigation in which medical information from huge numbers of patients is examined and compiled. Such data are available in large national or insurance databases, and potentially important diagnostic or therapeutic comparisons can be made utilizing this digitally stored information. Also of interest was the employment of robots to assist with patient care. Japanese investigators have been working hard at developing robots that could be used for a variety of clinical purposes such as helping to care for elderly and frail individuals. Here, too, the work is in an early stage of development but does appear to be something, like the electronically driven automobile, that will almost certainly become commonplace.
Other speakers reported on new, highly sophisticated MRI protocols that would enable physicians to routinely measure metabolic function and viability of a variety of tissues. A number of presentations involved personal health care products to assist in the care of patients by collecting, saving, or transmitting important clinical data, for example, electrocardiographic information or chronic blood pressure measurements. I came away from this meeting with the sense that in the relatively near future, we will utilize a variety of these new digital devices, some of which will be embedded in patients or in their clothing. Surely, in health care, we are about to face “a brave new world.”
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-Joseph S. Alpert, MD (Editor in Chief, The American Journal of Medicine)
This article originally appeared in the March 2017 issue of The American Journal of Medicine.