Eric Dishman: Take health care off the mainframe

36,920 views ・ 2010-03-16

TED


请双击下面的英文字幕来播放视频。

翻译人员: Xu Jiang 校对人员: Zhu Jie
00:15
If you think about the phone --
0
15260
2000
如果你想想电话-
00:17
and Intel has tested
1
17260
2000
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,
2
19260
2000
我将向你展示
00:21
over the last 10 years,
3
21260
2000
最近10年间的很多东西
00:23
in about 600 elderly households --
4
23260
2000
在大约600个老年家庭中-
00:25
300 in Ireland, and 300 in Portland --
5
25260
3000
其中300个在爱尔兰,300个在波兰
00:28
trying to understand: How do we measure
6
28260
2000
正在尝试理解我们如何用一种
00:30
and monitor behavior
7
30260
2000
和观察行为
00:32
in a medically meaningful way?
8
32260
2000
并以一种医学上有意义的方式?
00:34
And if you think about the phone, right,
9
34260
2000
如果你考虑一下电话,好
00:36
it's something that we can use for some incredible ways
10
36260
2000
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.
11
38260
3000
(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
12
41260
2000
我们正在测试这些简单的
00:43
sensor-network technologies in the home
13
43260
2000
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
14
45260
2000
任何与传感器适应良好的电话
00:47
can help them deal with their medications.
15
47260
2000
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,
16
49260
2000
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,
17
51260
3000
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.
18
54260
3000
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,
19
57260
2000
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,
20
59260
2000
为难地说:
01:01
"I'm old. I'm frail."
21
61260
2000
"我老了,我很脆弱。”
01:03
It's surreptitious technology
22
63260
2000
这项技术具有保密性
01:05
that's helping them do a simple task
23
65260
2000
帮助他们完成一项简单的任务
01:07
of taking the right pill at the right time.
24
67260
2000
即按时服药
01:09
Now, we also do some pretty amazing things with these phones.
25
69260
3000
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
26
72260
3000
因为当你在接电话的时候
01:15
is a cognitive test every time that you do it.
27
75260
3000
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.
28
78260
3000
想一下,好吗?我正在要接这三个不同的电话
01:21
"Hello? Hey."
29
81260
2000
“喂?是你啊。”
01:23
All right? That's the first time.
30
83260
3000
行吧?这是第一次
01:26
"Hello? Uh, hey."
31
86260
4000
“喂?噢,是你啊”
01:30
"Hello? Uh, who?
32
90260
4000
“喂?哦,谁?”
01:34
Oh, hey."
33
94260
3000
“哦,是你啊”
01:37
All right? Very big differences
34
97260
3000
对吧?非常大的差别
01:40
between the way I answered the phone the three times.
35
100260
3000
在我三次接电话中
01:43
And as we monitor phone usage
36
103260
2000
由于我们观测电话的使用
01:45
by seniors over a long period of time,
37
105260
3000
通过传感器,已经有很长时间了
01:48
down to the tenths of a microsecond,
38
108260
2000
(甚至观测细致到)数十微秒的程度
01:50
that recognition moment
39
110260
2000
还有认出的时刻
01:52
of whether they can figure out that person on the other end
40
112260
2000
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,
41
114260
2000
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,
42
116260
2000
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?
43
118260
3000
都像这个样子,“等等,是谁呀?哦。”
02:01
Waiting for that recognition moment
44
121260
2000
今天临床显示,
02:03
may be the best early indicator of the onset of dementia
45
123260
2000
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.
46
125260
2000
比什么都好。
02:07
We call these behavioral markers.
47
127260
2000
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
48
129260
2000
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?
49
131260
3000
电话一响就接了呢?
02:14
Is it a hearing problem or is it a physicality problem?
50
134260
3000
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
51
137260
2000
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,
52
139260
3000
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
53
142260
3000
轻声可能是最好的
02:25
may be the best early indicator
54
145260
3000
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.
55
148260
3000
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
56
151260
3000
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
57
154260
3000
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.
58
157260
2000
你的声音变得完全轻微的时候。
02:39
So, sensors are looking at that kind of voice.
59
159260
2000
所以说,传感器就监视这种声音。
02:41
When you pick up the phone,
60
161260
2000
当你接电话的时候,
02:43
how much tremor are you having,
61
163260
2000
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?
62
165260
3000
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?
63
168260
2000
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?
64
170260
3000
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?
65
173260
4000
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
66
177260
3000
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?
67
180260
3000
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,
68
183260
3000
哇,这是什么先进的想法,
03:06
we -- except in the United States --
69
186260
2000
我们,除了在美国,
03:08
might be able to use this newfangled technology
70
188260
3000
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.
71
191260
3000
来与另一端的护士或医生们交流。
03:14
Wow, what a great day that will be
72
194260
2000
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.
73
196260
3000
该是多么美好的一天呀。
03:19
So, these are what I would call behavioral markers.
74
199260
4000
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
75
203260
3000
这是我们过去十年
03:26
for the last 10 years at Intel.
76
206260
2000
在Intel公司所努力的。
03:28
How do you put simple disruptive technologies,
77
208260
2000
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?
78
210260
2000
我这次总共才打算说五句话?
03:32
Behavioral markers matter.
79
212260
2000
行为记录者很重要。
03:34
How do we change behavior?
80
214260
2000
我们怎样才能改变行为呢?
03:36
How do we measure changes in behavior
81
216260
2000
当它能帮助我们预防疾病,
03:38
in a meaningful way that's going to help us with
82
218260
2000
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,
83
220260
2000
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?
84
222260
3000
所带来的重大意义上的改变呢?
03:45
Now, why would Intel let me
85
225260
3000
现在,为什么Intel公司
03:48
spend a lot of time and money, over the last 10 years,
86
228260
3000
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
87
231260
2000
试图了解老人的需要,
03:53
and start thinking about these kinds of behavioral markers?
88
233260
2000
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.
89
235260
3000
这是我们已经了解的一些领域。
03:58
We have now lived with 1,000 elderly households
90
238260
3000
过去十年中,我们同20个国家的
04:01
in 20 countries over the last 10 years.
91
241260
2000
1000多户老人生活在一起。
04:03
We study people in Rochester, New York.
92
243260
2000
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
93
245260
2000
我们一冬天都跟他们生活在一起,
04:07
because what they do in the winter,
94
247260
2000
因为他们在冬天的所作所为,
04:09
and their access to healthcare, and how much they socialize,
95
249260
2000
他们的医保,他们的社交
04:11
is very different than in the summer.
96
251260
2000
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
97
253260
2000
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.
98
255260
2000
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,
99
257260
2000
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.
100
259260
2000
我们就飞过去,研究他们。
04:21
So, we study the holistic health experience
101
261260
3000
所以说,在过去的10年中,
04:24
of 1,000 seniors over the last 10 years
102
264260
2000
20多个不同的国家,
04:26
in 20 different countries.
103
266260
2000
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?
104
268260
3000
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.
105
271260
2000
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
106
273260
2000
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
107
275260
2000
让我实施这个
04:37
that could help with independent living,
108
277260
2000
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."
109
279260
3000
我使用了“Y2K+10”这个口号。
04:42
You know, back in 2000,
110
282260
2000
你知道,在2000年的时候,
04:44
we were all so obsessed with paying attention
111
284260
2000
我们都着迷于
04:46
to the aging of our computers,
112
286260
2000
计算机的千年虫问题,
04:48
and whether or not they were going to survive
113
288260
2000
看他们是否能够
04:50
the tick of the clock from 1999 to 2000,
114
290260
2000
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.
115
292260
5000
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.
116
297260
2000
那就在新年夜前后。
04:59
And that switchover,
117
299260
2000
那是个大转变,
05:01
when we had the larger number of older people on the planet,
118
301260
3000
这个星球上第一次
05:04
for the first time than younger people.
119
304260
2000
老年人比年轻人多。
05:06
For the first time in human history -- and barring aliens landing
120
306260
2000
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,
121
308260
2000
或者其他一些主要瘟疫,
05:10
that's the expectation from demographers, going forward.
122
310260
3000
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
123
313260
2000
10年前,看起来好像我有很多时间
05:15
to convince Intel to work on this. Right?
124
315260
2000
劝说Intel公司研究这个。对吧?
05:17
Y2K + 10 was coming,
125
317260
2000
Y2K+10正来临,
05:19
the baby boomers starting to retire.
126
319260
3000
婴儿潮也正开始退却。
05:22
Well folks, it's like we know these demographics here.
127
322260
4000
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.
128
326260
2000
这是张世界地图。
05:28
It's like the lights are on,
129
328260
2000
这就像灯是亮着的,
05:30
but nobody's home on this demographic
130
330260
2000
却没有人思考着人口统计学的
05:32
Y2K + 10 problem. Right?
131
332260
2000
Y2K+10问题。对吧?
05:34
I mean we sort of get it here, but we don't get it here,
132
334260
4000
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.
133
338260
2000
我们没解决任何问题。
05:40
The health reform bill is largely ignoring
134
340260
2000
医保改革大体上忽视了
05:42
the realities of the age wave that's coming,
135
342260
2000
正来临的老龄化
05:44
and the implications for what we need to do to change
136
344260
2000
和我们需要做些什么来改变
05:46
not only how we pay for care,
137
346260
3000
不仅仅是我们如何支付医疗保健,
05:49
but deliver care in some radically different ways.
138
349260
3000
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.
139
352260
2000
实际上,这取决于我们。
05:54
I mean you probably saw these headlines. This is Catherine Casey
140
354260
3000
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.
141
357260
3000
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.
142
360260
2000
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.
143
362260
4000
她在1946年的午夜1秒钟后出生的。
06:06
A retired school teacher,
144
366260
2000
她是一位退休的学校老师。
06:08
there she is with a Social Security administrator.
145
368260
2000
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.
146
370260
3000
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.
147
373260
3000
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.
148
376260
3000
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,
149
379260
5000
日历上记录着50个海啸。
06:24
but somehow we can't sort of marshal our government
150
384260
3000
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
151
387260
2000
没能够激发出力量
06:29
and do something about it. We'll wait until
152
389260
2000
来做点什么。我们只是等待着,
06:31
it's more of a catastrophe, and react,
153
391260
2000
直到发生更多的灾难后才有反应,
06:33
as opposed to prepare for it.
154
393260
2000
而不是提前准备好。
06:35
So, one of the reasons it's so
155
395260
2000
所以说,备战Y2K问题很富有挑战性的
06:37
challenging to prepare for this Y2K problem
156
397260
2000
众多原因之一是,
06:39
is, I want to argue, we have what I would call
157
399260
2000
我想争辩一下,我们有我称之为
06:41
mainframe poisoning.
158
401260
2000
主体中毒的东西。
06:43
Andy Grove, about six or seven years ago,
159
403260
3000
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
160
406260
2000
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,"
161
408260
3000
他用到了“主体医保”的词语,
06:51
and I've been extending and expanding this.
162
411260
2000
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."
163
413260
3000
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.
164
416260
2000
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."
165
418260
2000
而我只是将它扩展了。”
07:00
You know, this is the mainframe.
166
420260
2000
你知道,这也是个主体。
07:02
This mentality of traveling to
167
422260
3000
旅游和
07:05
and timesharing large, expensive healthcare systems
168
425260
3000
分期巨额的医保系统的想法
07:08
actually began in 1787.
169
428260
2000
实际开始于1787年。
07:10
This is the first general hospital in Vienna.
170
430260
3000
第一个普通医院建立在维也纳。
07:13
And actually the second general hospital in Vienna,
171
433260
2000
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
172
435260
3000
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.
173
438260
4000
医药学生的整个课程的地方。
07:22
And it's a place in which we started developing
174
442260
2000
我们开始发展
07:24
architecture that literally divided the body,
175
444260
2000
人体构造建筑学的地方,
07:26
and divided care into departments and compartments.
176
446260
3000
将保健分散到不同的部门和机构中。
07:29
And it was reflected in our architecture,
177
449260
2000
我们的建筑学也受其影响。
07:31
it was reflected in the way that we taught students,
178
451260
2000
我们教学生的方式也受其影响。
07:33
and this mainframe mentality persists today.
179
453260
3000
这个主体在精神上持续到今天。
07:36
Now, I'm not anti-hospital.
180
456260
3000
我并不是反对医院。
07:39
With my own healthcare problems, I've taken drug therapies,
181
459260
2000
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.
182
461260
3000
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?
183
464260
4000
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.
184
468260
2000
这个就是主体的医保。
07:50
And just as 30 years ago
185
470260
2000
就在30年前,
07:52
we couldn't conceive that we would have the power
186
472260
3000
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
187
475260
3000
具有主体计算机的能力,却只有
07:58
in our purses and on our belts,
188
478260
2000
我们的钱包和皮带大小,
08:00
that we're carrying around in our cell phone today,
189
480260
2000
我们今天可以随时随地用手机带着它。
08:02
and suddenly, computing,
190
482260
2000
突然间,计算机化,
08:04
that used to be an expert driven system,
191
484260
2000
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 --
192
486260
3000
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
193
489260
3000
那个从主体到个人化的转变
08:12
is what we have to do for healthcare.
194
492260
2000
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
195
494260
3000
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.
196
497260
2000
以个人为模型的医保。
08:19
We are obsessed with this way of thinking.
197
499260
3000
我们对这个想法着迷。
08:22
When Intel does surveys all around the world and we say,
198
502260
2000
当Intel公司对全世界做调研时,我们说,
08:24
"Quick response: healthcare."
199
504260
2000
“快速回复,医保。”
08:26
The first word that comes up is "doctor."
200
506260
2000
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?
201
508260
3000
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
202
511260
4000
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
203
515260
2000
和医保创新,就好像是件
08:37
that goes into that place.
204
517260
2000
理所应当的事。
08:39
Our entire health reform discussion right now,
205
519260
2000
我们现在的整个医疗改革争论,
08:41
health I.T., when we talk with policy makers,
206
521260
3000
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
207
524260
2000
等于我们如何要医生使用
08:46
electronic medical records in the mainframe?"
208
526260
2000
主体电子医药记录?
08:48
We're not thinking about
209
528260
2000
我们没有想过
08:50
how do we shift from the mainframe to the home.
210
530260
2000
如果将主体转变到家庭。
08:52
And the problem with this is
211
532260
2000
这个的问题是
08:54
the way we conceive healthcare. Right?
212
534260
2000
我们想到医保的方式。对吧?
08:56
This is a very reactive, crisis-driven system.
213
536260
2000
这是个多反应,危机驱动的系统。
08:58
We're doing 15-minute exams with patients.
214
538260
2000
我们对患者做了15分钟的试验。
09:00
It's population-based.
215
540260
2000
基于人口。
09:02
We collect a bunch of biological information in this artificial setting,
216
542260
3000
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,
217
545260
2000
将它们整合,就像玩Humpty-Dumpty一样,
09:07
and send them home,
218
547260
2000
然后送他们回家,
09:09
and hope -- we might hand them a brochure, maybe an interactive website --
219
549260
3000
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.
220
552260
4000
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.
221
556260
3000
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.
222
559260
4000
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
223
563260
2000
现在我们希望能有双重保险
09:25
of the age wave coming through?
224
565260
2000
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.
225
567260
3000
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.
226
570260
2000
我们需要关注家庭。
09:32
We've got to focus on a personal healthcare paradigm
227
572260
2000
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,
228
574260
2000
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?
229
576260
2000
更加保护驱动呢?
09:38
How do we collect vital signs and other kinds of information 24 by 7?
230
578260
4000
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?
231
582260
3000
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
232
585260
2000
我们如何收集不仅仅是生物学数据
09:47
but behavioral data, psychological data,
233
587260
2000
还有行为数据,心理学数据,
09:49
relational data, in and on and around the home?
234
589260
3000
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
235
592260
3000
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
236
595260
2000
来改变我们的行为,
09:57
to change our behavior?
237
597260
2000
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.
238
599260
3000
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
239
602260
2000
我来给你们一些例子。这是咪咪-
10:04
from one of our studies --
240
604260
2000
我们研究对象之一-
10:06
in her 90s, had to move out of her home
241
606260
2000
她90岁的时候,离开了家
10:08
because her family was worried about falls.
242
608260
2000
因为她的家人担心她会摔倒。
10:10
Raise your hand if you had a serious fall
243
610260
2000
如果在你家,有过严重的摔倒,
10:12
in your household, or any of your loved ones,
244
612260
2000
不论是你,还是你的爱人,
10:14
your parents or so forth. Right?
245
614260
2000
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.
246
616260
4000
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,
247
620260
2000
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.
248
622260
3000
所以将她搬了出来,搬到一所养老院。
10:25
She tripped over her oxygen tank.
249
625260
3000
她的氧气罐绊倒了她。
10:28
Many people in this generation won't press the button,
250
628260
2000
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,
251
630260
2000
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.
252
632260
2000
即便他们每月支付30美金。
10:34
Boomers will press the button. Trust me.
253
634260
2000
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?
254
636260
4000
他们会不停的按下按钮的。对吧?
10:40
Mimi broke her pelvis, lay all night, all morning,
255
640260
4000
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,
256
644260
2000
终于有人进来发现了她,
10:46
sent her to the hospital.
257
646260
2000
将她送进了医院。
10:48
They fixed her back up. She was never going to be able to move back
258
648260
2000
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.
259
650260
2000
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
260
652260
2000
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,
261
654260
3000
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,
262
657260
2000
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,
263
659260
3000
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,
264
662260
2000
没有人看过病历,就给她泰诺,
11:04
which she is allergic to, broke out, got bedsores,
265
664260
2000
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
266
666260
3000
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.
267
669260
3000
去世了。
11:12
Now, the most frightening thing about this is
268
672260
4000
现在,这个最可怕的是,
11:16
this is my wife's grandmother.
269
676260
3000
这是我妻子的祖母。
11:19
Now, I'm Eric Dishman. I speak English,
270
679260
2000
我是埃里克迪什曼。我讲英语。
11:21
I work for Intel, I make a good salary,
271
681260
2000
我为Intel公司工作。我挣的钱不少。
11:23
I'm smart about falls and fall-related injuries --
272
683260
3000
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.
273
686260
2000
这是我工作的研究领域。
11:28
I have access to senators and CEOs.
274
688260
3000
我能接触到参议员和CEO。
11:31
I can't stop this from happening.
275
691260
2000
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
276
693260
2000
如果你没有钱,也不会英语,
11:35
or don't have the kind of access
277
695260
2000
或者也没有什么人能接触
11:37
to deal with these kinds of problems that inevitably occur?
278
697260
3000
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
279
700260
3000
我们实际上如何首先阻止
11:43
from ever occurring in the first place?
280
703260
2000
绝大多数摔倒的发生?
11:45
Let me give you a quick example of work that we're doing
281
705260
2000
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.
282
707260
2000
我们正在从事的工作。
11:49
I've been wearing a little technology that we call Shimmer.
283
709260
3000
一种我们成为Shimmer的科技。
11:52
It's a research platform.
284
712260
2000
它是一个研究平台。
11:54
It has accelerometry. You can plug in a three-lead ECG.
285
714260
3000
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
286
717260
2000
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,
287
719260
2000
像乐高一样的装置,你可以捕获,野生的,
12:01
in the real world,
288
721260
2000
现实世界的,
12:03
things like tremor, gait,
289
723260
2000
像震颤,步态,
12:05
stride length and those kinds of things.
290
725260
2000
步幅,以及那类的信息。
12:07
The problem is, our understanding of falls today,
291
727260
4000
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,
292
731260
3000
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?"
293
734260
3000
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.
294
737260
2000
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,
295
739260
3000
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
296
742260
2000
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,
297
744260
2000
基于摄像头的系统,
12:26
we're starting for the first time in those 600 elderly households
298
746260
3000
我们第一次向600个老年住户
12:29
to collect actual kinematic motion data
299
749260
3000
收集实际的运动学移动数据
12:32
to understand: What are the subtle changes that are occurring
300
752260
4000
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?
301
756260
3000
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,
302
759260
2000
最多的,我们能做两种干预,
12:41
fix the meds mix.
303
761260
2000
修复医药合剂。
12:43
I'm a qualitative researcher, but when I look at these data streams coming in
304
763260
3000
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
305
766260
3000
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
306
769260
2000
医生会给他们开处方,
12:51
knew that they were on, because we see the changes
307
771260
2000
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?
308
773260
3000
就发生在他们的家中。对吧?
12:56
These discoveries of behavioral markers,
309
776260
3000
这些行为记录者的发明,
12:59
and behavioral changes
310
779260
2000
和行为的改变
13:01
are game changing, and like the discovery of the microscope
311
781260
2000
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.
312
783260
3000
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
313
786260
2000
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
314
788260
2000
是关于...你们自己看吧,
13:10
she's looking at data,
315
790260
2000
她在读取
13:12
in this picture, from the Magic Carpet.
316
792260
2000
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,
317
794260
3000
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.
318
797260
3000
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.
319
800260
2000
这里是一些数据可能出现的样子。
13:22
This is actually sensor firings.
320
802260
2000
这个实际上是传感器
13:24
These are two different subjects in our study.
321
804260
2000
我们的研究有两个不同的主题。
13:26
It's about a year's worth of data.
322
806260
2000
大约是一年的数据。
13:28
The color represents different rooms they are in the house.
323
808260
3000
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.
324
811260
2000
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.
325
813260
3000
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
326
816260
3000
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?
327
819260
3000
他们的吃饭时间都很准。对吧?
13:42
Now, this doesn't mean that much to you.
328
822260
3000
现在,这些对你并不重要。
13:45
But when we look at these cycles of data
329
825260
2000
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
330
827260
2000
整体数据时,我们能从
13:49
motion around different rooms in the house,
331
829260
2000
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,
332
831260
3000
像Shimmer收集的微观动态,
13:54
about gait and stride length -- these streams of data
333
834260
2000
关于步态和步幅,这些数据
13:56
are starting to tell us things about behavioral patterns
334
836260
2000
告诉我们行为模式,
13:58
that we've never understood before.
335
838260
2000
一些我们从来不知道的模式。
14:00
You can go to ORCATech.org --
336
840260
2000
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 --
337
842260
3000
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.
338
845260
2000
得知更多的信息。
14:07
The problem is, Intel is still one of the largest
339
847260
2000
问题是,Intel公司仍然是
14:09
funders in the world
340
849260
2000
世界上独立生活技术研发的
14:11
of independent living technology research.
341
851260
3000
最大的资助者之一。
14:14
I'm not bragging about how much we fund;
342
854260
2000
我没有吹牛我们有多少资金,
14:16
it's how little anyone else actually pays attention
343
856260
2000
其他人实际注意到的
14:18
to aging and funds innovation on aging,
344
858260
3000
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.
345
861260
3000
慢性疾病管理,独立生活在家。
14:24
So, my mantra here, my fourth slogan is:
346
864260
2000
所以,我的咒语,我第四个口号是:
14:26
10,000 households or bust.
347
866260
3000
要么是10,000户家人或者是一无所有。
14:29
We need to drive
348
869260
2000
我们需要驱使
14:31
a national, if not international, Framingham-type heart study
349
871260
4000
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,
350
875260
2000
做对独立生活技术的研究,
14:37
where we have 10,000 elderly connected households
351
877260
3000
这样10000连在一起的老年住户
14:40
with broadband, full medical characterization,
352
880260
3000
有着宽带,全套的医疗设施,
14:43
and a platform by which we can start to experiment
353
883260
2000
一个我们可以开始试验的平台
14:45
and turn these from 20-household anecdotal studies
354
885260
3000
将大学基金资助的
14:48
that the universities fund,
355
888260
2000
20位住户研究,
14:50
to large clinical trials that prove out the value of these technologies.
356
890260
3000
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.
357
893260
2000
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.
358
895260
4000
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:
359
899260
2000
我的第五个,也是最后一个口号是:
15:01
I have tried for two years,
360
901260
2000
我试了两年,
15:03
and there were moments when we were quite close,
361
903260
3000
有过几次我们离
15:06
to make this healthcare reform bill be about reform
362
906260
3000
改革医保非常近了
15:09
from something and to something,
363
909260
2000
就是将一些事改革成另一些事。
15:11
from a mainframe model
364
911260
2000
从主体模型
15:13
to a personal health model,
365
913260
2000
到个人健康模型,
15:15
or to mean something more than just a debate
366
915260
2000
或者不仅仅是一场关于
15:17
about the public option and how we're going to finance.
367
917260
2000
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.
368
919260
3000
我们如何投资医保其实并不重要。
15:22
We're going to figure something out
369
922260
2000
我们只是想把事情弄明白
15:24
for the next 10 years, and try it.
370
924260
2000
在接下来的10年内,然后试验。
15:26
No matter who pays for it,
371
926260
2000
谁来支付这个并不重要,
15:28
we better start doing care in a fundamentally different way
372
928260
2000
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
373
930260
3000
和对待家庭和病人
15:33
and the family member and the caregivers
374
933260
2000
以及家庭成员,和护理人员
15:35
as part of these coordinated care teams
375
935260
2000
把他们当作互相协调的团队
15:37
and using disruptive technologies that are already here
376
937260
4000
用这里已经有的全新技术
15:41
to do care in some pretty fundamental different ways.
377
941260
3000
以完全不同的方式来护理。
15:44
The president needs to stand up and say,
378
944260
3000
领导人应该站起来说,
15:47
at the end of a healthcare reform debate,
379
947260
3000
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
380
950260
3000
“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,
381
953260
3000
从机构,诊所,医院和护理之家分离,
15:56
to the home, in 10 years."
382
956260
2000
移到家庭,在未来的10年内。”
15:58
It's achievable. We should do it economically,
383
958260
2000
我们可以做到的。我们要从经济上这么做。
16:00
we should do it morally,
384
960260
2000
我们要从道义上这么做。
16:02
and we should do it for quality of life.
385
962260
2000
从生活品质上这么做。
16:04
But there is no goal within this health reform.
386
964260
2000
但是,这项医保改革是没有目标的。
16:06
It's just a mess today.
387
966260
2000
今天只是一团乱。
16:08
So, you know, that's my last message to you.
388
968260
2000
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
389
970260
3000
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?
390
973260
4000
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
391
977260
2000
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.
392
979260
3000
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,
393
982260
3000
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,
394
985260
2000
一个我们改革的方向,
16:27
then we're going to move nowhere.
395
987260
2000
我们将无所去处。
16:29
So, I hope you'll turn this conference into that kind of movement forward.
396
989260
2000
所以,我希望你把这场会议看成一种运动。
16:31
Thanks very much.
397
991260
2000
谢谢大家
16:33
(Applause)
398
993260
3000
(鼓掌)
关于本网站

这个网站将向你介绍对学习英语有用的YouTube视频。你将看到来自世界各地的一流教师教授的英语课程。双击每个视频页面上显示的英文字幕,即可从那里播放视频。字幕会随着视频的播放而同步滚动。如果你有任何意见或要求,请使用此联系表与我们联系。

https://forms.gle/WvT1wiN1qDtmnspy7