A brief summary of the Future of Medicine in 15 trends.

1. THE FUTURE OF MEDICINE:
We are the last generation to know so little about our health
Barcelona, 10 de Marzo de 2015

2. Director E-Health
Innovation Department
jfernandez@hsjdbcn.org
@HSJDBCN
Jorge Juan FERNÁNDEZ
@jorgejuan
Director
MOEBIO / d·HEALTH
jjfernandez@biocat.cat
@moebiobarcelona

4. Generations do differ,
but less because people differ
than because opportunities do.
Clay Shirky was right…
“Cognitive Surplus” (2010)

5. FOOD FOR THOUGHTTRENDS
A WORLD THAT IS
CHANGING:
IMPLICATIONS

6. FOOD FOR THOUGHTTRENDS
A WORLD THAT
IS CHANGING:
IMPLICATIONS

7. The Second Age Machine
The 1st Machine Revolution was about augmenting physical power.
The 2nd Machine Revolution will be about augmenting mental power.
SOURCE: “The Second Machine Age”, Erik Brynjolfsson and Andrew McAfee (2014)

8. MEDICINE is becoming an information technology
SOURCE: Kairos Future, 2013
1850 1950 2000
Hygiene
revolution
Pharma
revolution
Data
revolution
If data is the currency of the new system,
trust is the central bank.

10. FOOD FOR THOUGHTTRENDS
A WORLD THAT IS
CHANGING:
IMPLICATIONS

11. It is very important to know “what is coming”

12. What is happening in the industry/market?
Smartphone = PlatformEmpowered Patients
Synthetic Biology
Portable Diagnostics
3D printingOnline care
Big Data Precision Medicine
Hacking Life’s Code
Artificial Intelligence
Sensors
Medical Tricoder
Human augmentation
Fighting AgingBrain Computer Interface

13. http://bionicly.com/digital-health-hype-cycle/

14. Virtual visits on the rise:
Telemedicine will expand healthcare
into our homes and beyond
#1

15. Within the Kaiser Permanente Northern California system,
the number of virtual physician visits grew from 4.1 million
in 2008 to 10.5 million in 2013
SOURCE: http://content.healthaffairs.org/content/33/2/251.abstract
These trends suggest dramatically increasing comfort among
both patients and physicians with health care provided virtually

16. Touchpoints in Patient Experience are mainly digital

17. Telepresence robots:
Allowing top physicians to beam into locations around the world
for consultation and rounds at the hospital

18. Patient-to-Patient interactions
will strongly outpace
Provider-to-Patient interactions
#2

19. Citizens are becoming the CEOs of their own health
Smart Patients is an online community where
patients and caregivers learn from each other
about treatments, clinical trials, the latest science,
and how it all fits into the context of their
experience.
Crohnology is a Patient-Powered Research
Network, currently focused on Crohn's & Colitis
that allows any patient to contribute to research
for the cure.

20. SOURCE: http://curetogether.com/blog/2011/09/26/acid-reflux//
The closest we have to a Michelin Guide…
At CureTogether, 2,826 people who experience Acid Reflux came together to rate 39 treatments.

21. SOURCE: http://www.patient-innovation.com
Not only information, also product innovation

22. The smartphone is the healthcare
platform of today and the future
#3

23. www.cardiio.com http://www.medisafeproject.com
/
https://www.socialdiabetes.com/ InShape Moms
A B
C D
Cell phones becoming the health platform of today & future
The center of gravity of the Internet is shifting: from fixed access
(computers) to ubiquitous access (smartphones & tablets)

24. Digital Therapies: EU reimbursed apps

25. Prescribing more than medicine:
Apps & Peripherals (Apps & Adds)
Themometer (Kinsa Smart) GeckoCap: improving medication
adherence in pediatric asthma
NETRA (MIT) Peek Vision
iBGStar

26. Nurses-in-an-iPhone (49,95$ a month)

27. DermatologistOnCall ($59 virtual visits)
SOURCE: https://www.dermatologistoncall.com/
DermatologistOnCall®
A virtual health solution
that makes accessibility
to a board-certified
dermatologist easier,
faster and more
convenient than ever.

28. FirstDerm ($40 virtual visits)
SOURCE: https://www.firstderm.com/
FirstDerm.
Your online
Dermatologist.
Send a picture of your
skin concern
anonymously and
receive an answer
from a board certified
dermatologist in under
24 hours.

29. Printing Pixels:
Before the 3D Printing (hardware)
comes the 3D Modeling (software)
#4

30. 3D Printing works with any material (glass, titanium,…) and
any scale (micro scale, building scale,…)

31. 3D Printing: Medicine #1 area of application
 Tissues with blood vessels
 Low–Cost Prosthetic Parts
 Drugs
 Tailor–made sensors
 Tumor Models
 Bone
 Heart Valve
 Ear cartilage
 Medical equipment
 Cranium Replacement
 Synthetic skin
 Organs
WARNING: 3D printing will cause an intellectual property
nightmare. 10x worse than what we’re seeing with digital files.
12 Things We Can 3D Print in Medicine Now

32. 3D Printing at HSJD

33. 3D Electronics Printing
http://www.voxel8.co/

34. Bioprinting: instead of using ink, using cells
http://www.organovo.com/
When we can regrow a heart, liver, lung or kidney when we need
it instead of waiting for the donor to die.

35. The Medical Tricorder: from Medical
Devices to Consumer Devices
The most disruptive thing in the market is
not technology, but rather the customer
#5

36. The Robot Will See You Now

37. A different type of future…

38. $10M Qualcomm Tricorder XPRIZE
http://tricorder.xprize.org/

39. The Medical Tri-Corder: consumers are in charge
(from B2B to B2C)
http://tytocare.com/http://www.scanadu.com/
In the near future, we’ll be able to do a lot of basic health care for ourselves.

40. SCANADU:
Check your health as easily as your email

41. SCANADU: First release
https://www.linkedin.com/pulse/scouting-your-health-lucien-engelen

42. TYTO: Conducting a physical examination
from the comfort of your home!
SOURCE: http://www.businessweek.com/articles/2014-05-01/tyto-care-device-enables-personal-health-exams

43. Portable Diagnostics:
Devices that are becoming our go-to
diagnostic centers
#6

44. Portable Diagnostics
DISEASE DECODED
Imagine a simple blood test that can tell
you, at the molecular level, the exact
type of disease you have and its severity
before presenting any symptoms.
Imagine using the same test to monitor
the success of the treatment.
http://miroculus.com/
By January 2013, Kahol’s team had
incorporated 33 diagnostic tests, including for
HIV, syphilis, pulse oximetry, and troponin
(relating to heart attack) into the Swasthya
Slate and reduced its cost to $800 per unit.
In high volumes, the Swasthya Slate can be
produced for as little as $150 per unit.
http://www.swasthyaslate.org/

45. Portable Diagnostics
http://www.wired.com/2015/02/hiv-diagnostic-tool/

46. Doctors or Algorithms?
Healthcare will move from “Human-to-
Human” to “Machine-to-Human”
#7

47. Watson? The new Deep Blue (chess, Kasparov, 1997)

48. Dr. Watson: a new Doc in town
“In the next 10 years,
data science and
software will do more
for medicine than all
of the biological
sciences together”
“IBM Watson can go through literature
the same way we do now in two
weeks, and do that in two seconds”

49. “80% of what doctors do today will be replaced by
technology in 10 years” (Vinod Khosla)

50. Some interesting results
After only one year, Watson’s
successful diagnostic rate for
lung cancer is 90%, compared
to 50% for human doctors.
One such Watson system
contains 40 million documents,
ingests an average of 27.000
new documents per day, and
provides insights for thousands
of users.

51. A number of scientists are concerned:
“artificial intelligence could end mankind”
http://futureoflife.org/

52. Big Data in Healthcare:
Big data growth is accelerating as more of
the world’s activity is expressed digitally
#8

53. Healthcare is one of the most intensive sectors in knowledge,
which comes from the scientific publications, and in data obtained
from the patients’ real information
KNOWLEDGE
BIOMEDICAL LITERATURE:
 Medical information is doubling every
5 years.
 PubMed comprises more than 24
million citations for biomedical
literature from MEDLINE, life science
journals, and online books.
 More than 700.000 added each year.
 6-12 months: publishing the latest
medical research information can be
delayed up to one year.
 15 years: the time it can take for the
latest evidence to be put into practice.

54. Healthcare is one of the most intensive sectors in knowledge,
which comes from the scientific publications, and in data obtained
from the patients’ real information
DATA
Clinical Data
Biomedical
Imaging
‘Omics &
Systems
Biology
Biometric
Data
Medical
devices
mHealth /
Apps
Social Media
Online
communities
Environment
 By 2011, U.S. healthcare
organizations had generated 150
exabytes -- that's 150 billion gigabytes
-- of data.
 Kaiser Permanente alone might have
as much as 44 petabytes of patient
data just from its electronic health
record (EHR) system, or 4,400 times
the amount of information held at the
Library of Congress.
Source: IHT2 consultancy

55. Humans can’t compete with computers

56. The 4 Vs of Big Data
VOLUME
Scale of data
90% of the data in
the world today was
created within the
last two years
5x more data being
created than stored
Global size of data
in healthcare
estimated in 2011
to be 150 Exabytes
VARIETY
Different
forms &
sources of
data
VELOCITY
Analysis of
streaming
data
VERACITY
Uncertainty
of data
People-to-People
(Social Media, online
communities)
People-to-Machine
(computers, mobile,
medical devices)
Machine-to-Machine
(sensors, GPS,
barcode scanners)
136M emails sent
every minute
306 hours of
YouTube video
uploaded every
minute
433.000 tweets per
minute
1 in 3 business
leaders don’t trust
the information
they use to make
decisions

57. Big Data & Advanced Analytics: The 7 trillion piece puzzle
DNA / RNA Proteins Metabolites
Cells /
Tissues
25.000
genes
100.000
proteins
2.400
compounds
7 trillion
human cells
Organs
9
organ-
systems
29
organs
Body Society
4
basic types
of tissues
1
human body
7 billion
people
SOURCE: Siemens AG 2012

58. HCE
Información clínica de
asistencia especializada
Genética
Información genética
(full exome)
Internet of
Things
Medical
devicesInformación clínica de
asistencia primaria
Apps Brain
Data
Texto
eCAP
?????
SIRE
Receta electrónica
Data
Data
Cuestionarios
web
Redes
Sociales
Comunidades
online
Big Data: Volumen, Variedad, Velocidad
10 11 12
Adherencia
terapéutica
1 2 3 4 5 6
7
8 9
ASÍNCRONO
REAL-TIME
Data
Texto
Data
Texto
Texto Texto Data

59. Data will transform…
Medicine (as a Science)
Healthcare (as an Industry)
Care delivery (as a Service)
#1
#2
#3

60. Precision Medicine:
Discovering unique therapies that treat an
individual’s condition based on the specific
abnormalities of their disease
#9

61. Precision Medicine
http://nih.gov/precisionmedicine/

62. Human augmentation
&
Exoskeletons
#10

63. Amputees can now control limbs with their thoughts
http://www.jhuapl.edu/newscenter/pressreleases/2014/141216.asp

64. Human Augmentation

65. Exoskeletons

66. Brain Computer Interface (BCI):
Technology will help us understand the
brain (the last human frontier)
#11

67. These discoveries and cutting-edge tools will allow us to access brain
information in noninvasive ways, opening up new spectrums of
science and human understanding
http://emotiv.com/

68. OpenBCI
http://www.openbci.com/
We are a community of
researchers, engineers, artists,
scientists, designers, makers,
and more. The one thing we all
have in common? We share an
unfaltering passion for
harnessing the electrical
signals of the human brain
and body to further understand
and expand who we are.

69. MUSE: improve your mental fitness, no gym membership required
http://www.openbci.com/

70. MUSE: improve your mental fitness, no gym membership required
http://www.choosemuse.com/

71. The Human Brain: the last frontier

72. Large-scale Brain Mapping projects: US (apr 2013) vs EU (nov 2013)
Dr. Henry Markram’s Human Brain Project recently got 1
billion worth of funding from the European Union. The
money will be spread in 100 million dollar payments over
the next 10 years and is aimed at scaling up Markram’s
past research in simulating parts of a rat brain to the first
and most comprehensive attempt to reverse-engineer
and simulate the complete human brain.
https://www.humanbrainproject.eu/
112 Partners in 24 countries in
Europe and around the world
BRAIN Initiative
(Brain Research through Advancing
Innovative Neurotechnologies)
http://braininitiative.nih.gov/

73. Web 3.0 (The Sensors’ Web):
From Wearables to Insideables and the
human body as the next computer
interface
#12

74. WEARABLES everywhere…

75. Almost 40% of the 153 “Internet of Things” deals in 2013 raising
$1 billion from VC were healthcare businesses (ranging from
ingestible sensors to smartphone-enabled devices)
SOURCE: http://www.businessweek.com/articles/2014-05-01/tyto-care-device-enables-personal-health-exams

76. WEARABLE SENSORS:
Google + Novartis: developing a smart contact lens that can
monitor the wearer’s blood sugar level for diabetic patients

77. WEARABLE SENSORS:
SENSIMED Triggerfish
http://www.sensimed.ch/

78. You are the interface: The screen is out and the skin is IN
The human body is the next computer interface
New 'electronic skin' patches monitor health wirelessly

79. IMPLANTABLE SENSORS: Implants will enhance, or
in some cases, replace exoskeletons
https://wtvox.com/2015/02/elastic-spinal-implant-could-help-paralysed-walk-again/

80. INSIDEABLES: The Next Sensor Will Be IN You
Proteus's focus is about
getting people to take their
medication as prescribed
Tech is moving from
the outside to the
inside of our bodies

81. Synthetic Biology
The creation of living systems from non-
living chemicals designed on a computer
#13

82. Reprogramming life

83. Reprogramming life
(2010)

84. MIT iGem Competition
http://www.bioglowtech.com/http://www.igem.org/

85. Hacking Life’s Code
#14

86. Hacking Life’s Code
http://www.genome.gov/images/content/cost_megabase_.jpg

87. Hacking Life’s Code
http://www.genome.gov/images/content/cost_genome.jpg
In both graphs, note the sudden and profound out-pacing of Moore's Law beginning in January 2008. This
represents the time when the sequencing centers transitioned from Sanger-based (dideoxy chain
termination sequencing) to 'second generation' (or 'next-generation') DNA sequencing technologies.

88. Sequencing and mapping will lead to our greatest
advancements

89. Do you really want to know YOUR future?

90. Fighting aging
Some of the greatest minds
are exploring ways to end death
#15

91. Making 100 Years Old the “New 60”
http://peterdiamandis.tumblr.com/post/96726741373/evidence-of-abundance-10-living-longer

92. The Palo Alto Longevity Prize (1M $)
http://paloaltoprize.com/

93. Can a COMPANY solve death?
Google Ventures: 36% of $2 Billion invested in healthcare companies that will slow aging, reverse disease, and extend life

94. Companies fighting aging
http://www.calicolabs.com/
CALICO (California Life Company) Human Longevity Inc. (HLI)
http://www.humanlongevity.com/

95. Experts are not reaching a consensus
120
Aging is not equivalent to the aberrant process of Alzheimer’s
disease; it is in fact a distinctly different neurological process.

96. No stakeholder of healthcare is ready for what is
coming.
In 10 years, you will trust your computer more than
your doctor.
AI in Medicine will enable better dianoses and
personalized medical recommendations.
Technology might change us more in a generation
than evolution has done over million of years.
We are moving from “evolution by natural
selection” to “evolution by intelligent decision”.
It’s not “Human Touch” OR “Technology” but AND.
#1
#2
#3
#4
#5
#6

97. FOOD FOR
THOUGHT
TRENDS
A WORLD THAT IS
CHANGING:
IMPLICATIONS

98. 5MIN
CONSUMER GOODS
12MIN
HEALTH
30
MIN
10MIN

100. CONCLUSION: A tornado more than a tsunami