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  • Translator: Joseph Geni Reviewer: Morton Bast

  • I want to share some personal friends and stories with you

  • that I've actually never talked about in public before

  • to help illustrate the idea

  • and the need and the hope

  • for us to reinvent our health care system around the world.

  • Twenty-four years ago, I had -- a sophomore in college,

  • I had a series of fainting spells. No alcohol was involved.

  • And I ended up in student health,

  • and they ran some labwork and came back right away,

  • and said, "Kidney problems."

  • And before I knew it, I was involved and thrown into

  • this six months of tests and trials and tribulations

  • with six doctors across two hospitals

  • in this clash of medical titans

  • to figure out which one of them was right

  • about what was wrong with me.

  • And I'm sitting in a waiting room some time later for an ultrasound,

  • and all six of these doctors actually show up in the room at once,

  • and I'm like, "Uh oh, this is bad news."

  • And their diagnosis was this:

  • They said, "You have two rare kidney diseases

  • that are going to actually destroy your kidneys eventually,

  • you have cancer-like cells in your immune system

  • that we need to start treatment right away,

  • and you'll never be eligible for a kidney transplant,

  • and you're not likely to live more than two or three years."

  • Now, with the gravity of this doomsday diagnosis,

  • it just sucked me in immediately,

  • as if I began preparing myself as a patient

  • to die according to the schedule that they had just given to me,

  • until I met a patient named Verna in a waiting room,

  • who became a dear friend, and she grabbed me one day

  • and took me off to the medical library

  • and did a bunch of research on these diagnoses and these diseases,

  • and said, "Eric, these people who get this

  • are normally in their '70s and '80s.

  • They don't know anything about you. Wake up.

  • Take control of your health and get on with your life."

  • And I did.

  • Now, these people making these proclamations to me

  • were not bad people.

  • In fact, these professionals were miracle workers,

  • but they're working in a flawed, expensive system that's set up the wrong way.

  • It's dependent on hospitals and clinics for our every care need.

  • It's dependent on specialists who just look at parts of us.

  • It's dependent on guesswork of diagnoses and drug cocktails,

  • and so something either works or you die.

  • And it's dependent on passive patients

  • who just take it and don't ask any questions.

  • Now the problem with this model

  • is that it's unsustainable globally.

  • It's unaffordable globally.

  • We need to invent what I call a personal health system.

  • So what does this personal health system look like,

  • and what new technologies and roles is it going to entail?

  • Now, I'm going to start by actually sharing with you

  • a new friend of mine, Libby,

  • somebody I've become quite attached to over the last six months.

  • This is Libby, or actually, this is an ultrasound image of Libby.

  • This is the kidney transplant I was never supposed to have.

  • Now, this is an image that we shot a couple of weeks ago for today,

  • and you'll notice, on the edge of this image,

  • there's some dark spots there, which was really concerning to me.

  • So we're going to actually do a live exam

  • to sort of see how Libby's doing.

  • This is not a wardrobe malfunction. I have to take my belt off here.

  • Don't you in the front row worry or anything.

  • (Laughter)

  • I'm going to use a device from a company called Mobisante.

  • This is a portable ultrasound.

  • It can plug into a smartphone. It can plug into a tablet.

  • Mobisante is up in Redmond, Washington,

  • and they kindly trained me to actually do this on myself.

  • They're not approved to do this. Patients are not approved to do this.

  • This is a concept demo, so I want to make that clear.

  • All right, I gotta gel up.

  • Now the people in the front row are very nervous. (Laughter)

  • And I want to actually introduce you to Dr. Batiuk,

  • who's another friend of mine.

  • He's up in Legacy Good Samaritan Hospital in Portland, Oregon.

  • So let me just make sure. Hey, Dr. Batiuk. Can you hear me okay?

  • And actually, can you see Libby?

  • Thomas Batuik: Hi there, Eric.

  • You look busy. How are you?

  • Eric Dishman: I'm good. I'm just taking my clothes off

  • in front of a few hundred people. It's wonderful.

  • So I just wanted to see, is this the image you need to get?

  • And I know you want to look and see if those spots are still there.

  • TB: Okay. Well let's scan around a little bit here,

  • give me a lay of the land.

  • ED: All right.TB: Okay. Turn it a little bit inside,

  • a little bit toward the middle for me.

  • Okay, that's good. How about up a little bit?

  • Okay, freeze that image. That's a good one for me.

  • ED: All right. Now last week, when I did this,

  • you had me measure that spot to the right.

  • Should I do that again?

  • TB: Yeah, let's do that.

  • ED: All right. This is kind of hard to do

  • with one hand on your belly and one hand on measuring,

  • but I've got it, I think,

  • and I'll save that image and send it to you.

  • So tell me a little bit about what this dark spot means.

  • It's not something I was very happy about.

  • TB: Many people after a kidney transplant

  • will develop a little fluid collection around the kidney.

  • Most of the time it doesn't create any kind of mischief,

  • but it does warrant looking at,

  • so I'm happy we've got an opportunity to look at it today,

  • make sure that it's not growing, it's not creating any problems.

  • Based on the other images we have,

  • I'm really happy how it looks today.

  • ED: All right. Well, I guess we'll double check it when I come in.

  • I've got my six month biopsy in a couple of weeks,

  • and I'm going to let you do that in the clinic,

  • because I don't think I can do that one on myself.

  • TB: Good choice.ED: All right, thanks, Dr. Batiuk.

  • All right. So what you're sort of seeing here

  • is an example of disruptive technologies,

  • of mobile, social and analytic technologies.

  • These are the foundations of what's going to make personal health possible.

  • Now there's really three pillars

  • of this personal health I want to talk to you about now,

  • and it's care anywhere, care networking and care customization.

  • And you just saw a little bit of the first two

  • with my interaction with Dr. Batiuk.

  • So let's start with care anywhere.

  • Humans invented the idea of hospitals and clinics

  • in the 1780s. It is time to update our thinking.

  • We have got to untether clinicians and patients

  • from the notion of traveling to a special

  • bricks-and-mortar place for all of our care,

  • because these places are often the wrong tool,

  • and the most expensive tool, for the job.

  • And these are sometimes unsafe places to send our sickest patients,

  • especially in an era of superbugs

  • and hospital-acquired infections.

  • And many countries are going to go brickless from the start

  • because they're never going to be able to afford

  • the mega-medicalplexes that a lot of the rest of the world has built.

  • Now I personally learned that hospitals

  • can be a very dangerous place at a young age.

  • This was me in third grade.

  • I broke my elbow very seriously, had to have surgery,

  • worried that they were going to actually lose the arm.

  • Recovering from the surgery in the hospital, I get bedsores.

  • Those bedsores become infected,

  • and they give me an antibiotic which I end up being allergic to,

  • and now my whole body breaks out,

  • and now all of those become infected.

  • The longer I stayed in the hospital, the sicker I became,

  • and the more expensive it became,

  • and this happens to millions of people around the world every year.

  • The future of personal health that I'm talking about

  • says care must occur at home as the default model,

  • not in a hospital or clinic.

  • You have to earn your way into those places

  • by being sick enough to use that tool for the job.

  • Now the smartphones that we're already carrying

  • can clearly have diagnostic devices like ultrasounds plugged into them,

  • and a whole array of others, today,

  • and as sensing is built into these,

  • we'll be able to do vital signs monitor

  • and behavioral monitoring like we've never had before.

  • Many of us will have implantables that will actually look

  • real-time at what's going on with our blood chemistry

  • and in our proteins right now.

  • Now the software is also getting smarter, right?

  • Think about a coach, an agent online,

  • that's going to help me do safe self-care.

  • That same interaction that we just did with the ultrasound

  • will likely have real-time image processing,

  • and the device will say, "Up, down, left, right,

  • ah, Eric, that's the perfect spot to send that image

  • off to your doctor."

  • Now, if we've got all these networked devices

  • that are helping us to do care anywhere,

  • it stands to reason that we also need a team

  • to be able to interact with all of that stuff,

  • and that leads to the second pillar I want to talk about,

  • care networking.

  • We have got to go beyond this paradigm

  • of isolated specialists doing parts care

  • to multidisciplinary teams doing person care.

  • Uncoordinated care today is expensive at best,

  • and it is deadly at worst.

  • Eighty percent of medical errors are actually caused

  • by communication and coordination problems

  • amongst medical team members.

  • I had my own heart scare years ago in graduate school,

  • when we're under treatment for the kidney,

  • and suddenly, they're like, "Oh, we think you have a heart problem."

  • And I have these palpitations that are showing up.

  • They put me through five weeks of tests --

  • very expensive, very scary -- before the nurse finally notices

  • the piece of the paper, my meds list

  • that I've been carrying to every single appointment,

  • and says, "Oh my gosh."

  • Three different specialists had prescribed

  • three different versions of the same drug to me.

  • I did not have a heart problem. I had an overdose problem.

  • I had a care coordination problem.

  • And this happens to millions of people every year.

  • I want to use technology that we're all working on and making happen

  • to make health care a coordinated team sport.

  • Now this is the most frightening thing to me.

  • Out of all the care I've had in hospitals and clinics around the world,

  • the first time I've ever had a true team-based care experience

  • was at Legacy Good Sam these last six months

  • for me to go get this.

  • And this is a picture of my graduation team from Legacy.

  • There's a couple of the folks here. You'll recognize Dr. Batiuk.

  • We just talked to him. Here's Jenny, one of the nurses,

  • Allison, who helped manage the transplant list,

  • and a dozen other people who aren't pictured,

  • a pharmacist, a psychologist, a nutritionist,

  • even a financial counselor, Lisa,

  • who helped us deal with all the insurance hassles.

  • I wept the day I graduated.

  • I should have been happy, because I was so well

  • that I could go back to my normal doctors,

  • but I wept because I was so actually connected to this team.

  • And here's the most important part.

  • The other people in this picture are me and my wife, Ashley.

  • Legacy trained us on how to do care for me at home

  • so that they could offload the hospitals and clinics.

  • That's the only way that the model works.

  • My team is actually working in China

  • on one of these self-care models

  • for a project we called Age-Friendly Cities.

  • We're trying to help build a social network

  • that can help track and train the care of seniors

  • caring for themselves

  • as well as the care provided by their family members

  • or volunteer community health workers,

  • as well as have an exchange network online,

  • where, for example, I can donate three hours of care a day to your mom,

  • if somebody else can help me with transportation to meals,

  • and we exchange all of that online.

  • The most important point I want to make to you about this

  • is the sacred and somewhat over-romanticized

  • doctor-patient one-on-one

  • is a relic of the past.

  • The future of health care is smart teams,

  • and you'd better be on that team for yourself.

  • Now, the last thing that I want to talk to you about

  • is care customization,

  • because if you've got care anywhere and you've got care networking,

  • those are going to go a long way towards improving our health care system,