Eric Dishman: Take health care off the mainframe

譯者: Chih Ying (Naomi) Chuang 審譯者: Shelley Krishna Tsang

If you think about the phone --

如果你想想看，電話

and Intel has tested

美商英特爾已經測試過

a lot of the things I'm going to show you,

很多東西是我馬上要表演給你們看的

over the last 10 years,

在過去的十年

in about 600 elderly households --

約600戶年長者家裡

300 in Ireland, and 300 in Portland --

有300戶是在愛爾蘭，300戶是在波特蘭

trying to understand: How do we measure

試著去理解我們要如何測量

and monitor behavior

及監測行為

in a medically meaningful way?

以一個在醫療上有意義的方式？

And if you think about the phone, right,

而且，如果你想想看電話，對

it's something that we can use for some incredible ways

它就是能讓我們以 一些 不可思議的方式

to help people actually take the right medication at the right time.

來幫助人們，準確的在對的時間吃對的藥。

We're testing these kinds of simple

我們正在測試這類簡單的

sensor-network technologies in the home

在家裡的偵測網絡科技

so that any phone that a senior is already comfortable with

所以只要任何電話是一位年長者已能自在使用的

can help them deal with their medications.

就能幫助他們處理他們的用藥。

And a lot of what they do is they pick up the phone,

而他們所要作的只是接起電話，

and it's our system whispering to them which pill they need to take,

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，

and they fake like they're having a conversation with a friend.

假裝他們正在和朋友對話。

And they're not embarrassed by a meds caddy that's ugly,

他們不必為藥物像醜陋的桿弟感到尷尬

that sits on their kitchen table and says,

佔在他們的廚房桌上而說

"I'm old. I'm frail."

『我老了、我很虛弱。』

It's surreptitious technology

它可以是暗地裡的科技

that's helping them do a simple task

來幫助他們處理一簡單的任務

of taking the right pill at the right time.

在對的時間吃對的藥丸。

Now, we also do some pretty amazing things with these phones.

現在，我們還用這些電話來作一些很了不起的事。

Because that moment when you answer the phone

因為，就在你接起電話的那一刻

is a cognitive test every time that you do it.

，你接起的每一次都是一個認知測試。

Think about it, all right? I'm going to answer the phone three different times.

想想看，好吧？我現在就來接三次不同的電話。

"Hello? Hey."

『哈囉？嗨～』

All right? That's the first time.

好了嗎？那是第一次。

"Hello? Uh, hey."

『哈囉？痾，嗨～』

"Hello? Uh, who?

『哈囉？痾，是哪位？

Oh, hey."

喔，嘿。』

All right? Very big differences

可以嗎？相當大的差別。

between the way I answered the phone the three times.

在我三次接電話的方式。

And as we monitor phone usage

所以當我們監測電話使用的方式

by seniors over a long period of time,

由年長者經過很長的一段時間。

down to the tenths of a microsecond,

不到十分之一微秒，

that recognition moment

那辨認的當下，

of whether they can figure out that person on the other end

看他們是否能辨認電話另一頭

is a friend and we start talking to them immediately,

的那個人是朋友，而馬上開始和他們聊起天來，

or they do a lot of what's called trouble talk,

還是他們會有很多所謂的困惑對話，

where they're like, "Wait, who is this? Oh." Right?

像是『等一下，你是誰？喔。』對吧？

Waiting for that recognition moment

等待辨認的那一刻

may be the best early indicator of the onset of dementia

也許就會是最好的早期失智開始的指標，

than anything that shows up clinically today.

勝過任何現今臨床上的徵兆。

We call these behavioral markers.

我們稱這些作行為指標。

There's lots of others. Is the person going to the phone

還有很多其它的行為。這個人去接電話時，

as quickly, when it rings, as they used to?

當電話響起時，接電話的速度，是否和他之前一樣？

Is it a hearing problem or is it a physicality problem?

這是有聽覺障礙，還是有行動障礙？

Has their voice gotten more quiet? We're doing a lot of work with people

他們發聲是否變得比較安靜？我們正在和很多人進行合作

with Alzheimer's and particularly with Parkinson's,

患有阿滋海默症的，還有特別是帕金森氏症

where that quiet voice that sometimes shows up with Parkinson's patients

，當漸趨安靜的發聲，有些時候表現在帕金森氏患者身上，

may be the best early indicator

有可能是最好的早期指標

of Parkinson's five to 10 years before it shows up clinically.

比帕金森氏症臨床症狀的出現，還要早個五到十年。

But those subtle changes in your voice over a long period of time

而這些你聲音裡細微的、長時間的改變

are hard for you or your spouse to notice until it becomes so extreme

對你或你的配偶來說，可能很難去注意，直到它變得很極端

and your voice has become so quiet.

而你的聲音也已經變得很安靜。

So, sensors are looking at that kind of voice.

所以，偵測器就是在監測那種訊號。

When you pick up the phone,

當你拿起話筒時，

how much tremor are you having,

你有多麼顫抖？

and what is that like, and what is that trend like over a period of time?

還有那是甚麼樣子，經過一段時間，那是一個怎樣的趨勢？

Are you having more trouble dialing the phone than you used to?

你撥電話的按鍵時、是否比之前有更多的困難？

Is it a dexterity problem? Is it the onset of arthritis?

是靈活度的問題？是關節炎的前兆？

Are you using the phone? Are you socializing less than you used to?

你有在使用電話嗎？你社交的是否比之前來得少？

And looking at that pattern. And what does that decline in social health

看著那個模式，那減少的趨勢，在社交健康上，代表的

mean, as a kind of a vital sign of the future?

意義是甚麼？能否代表將來的一種生命徵象？

And then wow, what a radical idea,

接著，哇，這是個多麼創新的點子！

we -- except in the United States --

我們，除了在美國，

might be able to use this newfangled technology

說不定還可以利用這項新穎的科技，

to actually interact with a nurse or a doctor on the other end of the line.

確實與一位護士或醫師在電話的另一端互動。

Wow, what a great day that will be

那世界將會變得多麼美好！

once we're allowed to actually do those kinds of things.

等到有一天我們真的能夠完成這樣的事情時，

So, these are what I would call behavioral markers.

所以，這些就是我所謂的行為指標。

And it's the whole field that we've been trying to work on

而且，這是整個領域，我們已經試著要做的

for the last 10 years at Intel.

在過去十年，在英特爾。

How do you put simple disruptive technologies,

你要如何把一個簡單的破壞性科技，

and the first of five phrases that I'm going to talk about in this talk?

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？

Behavioral markers matter.

行為指標很重要。

How do we change behavior?

我們要如何改變行為？

How do we measure changes in behavior

我們要如何去測量行為的改變，

in a meaningful way that's going to help us with

以有意義的的方式，那是可以用來幫助我們

prevention of disease, early onset of disease,

預防疾病，疾病的早期發現，

and tracking the progression of disease over a long period of time?

進而追蹤疾病在經過一段長時間的發展？

Now, why would Intel let me

只是，為什麼英特爾願意讓我

spend a lot of time and money, over the last 10 years,

花這麼多的時間跟金錢，在過去的十年，

trying to understand the needs of seniors

試著要了解年長者的需求

and start thinking about these kinds of behavioral markers?

且開始考慮這幾種行為指標？

This is some of the field work that we've done.

這是一些我們已經做過的田野訪查。

We have now lived with 1,000 elderly households

我們現在已經住進一千戶年長者家裡

in 20 countries over the last 10 years.

在過去十年、在20個國家中。

We study people in Rochester, New York.

我們研究在紐約州羅徹斯特市的人。

We go live with them in the winter

我們在冬天時，和他們住在一起，

because what they do in the winter,

因為他們在冬天作的事，

and their access to healthcare, and how much they socialize,

和他們使用醫療資源，以及他們參與社交活動的程度，

is very different than in the summer.

是和夏天很不同的。

If they have a hip fracture we go with them

如果他們髖關節骨折，我們就跟著他們，

and we study their entire discharge experience.

研究他們整個出院的經驗。

If they have a family member who is a key part of their care network,

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，

we fly and study them as well.

那我們也會飛去並一起研究他們。

So, we study the holistic health experience

所以我們研究整體的健康觀感。

of 1,000 seniors over the last 10 years

一千位年長者在過去的十年，

in 20 different countries.

二十個不同的國家裡，

Why is Intel willing to fund that?

為什麼英特爾願意贊助這研究？

It's because of the second slogan that I want to talk about.

這是因為我將要討論的第二個口號。

Ten years ago, when I started trying to convince Intel

十年前，當我開始試著要說服英特爾，

to let me go start looking at disruptive technologies

讓我著手尋找破壞性科技，

that could help with independent living,

可以幫助獨立生活的

this is what I called it: "Y2K + 10."

這是我給它取的名字：『Y2K + 10』

You know, back in 2000,

你也知道，回到2000年

we were all so obsessed with paying attention

我們都著魔似的將注意力集中

to the aging of our computers,

於我們電腦的老化，

and whether or not they were going to survive

及它們是否能逃過

the tick of the clock from 1999 to 2000,

時鐘滴答從1999到2000年

that we missed a moment that only demographers were paying attention to.

我們也錯過一刻只有人口統計學家有在關心。

It was right around New Years.

那差不多是新年的時候。

And that switchover,

那個大轉變，

when we had the larger number of older people on the planet,

也正是在這個星球上，我們的老年人人口數目大於

for the first time than younger people.

年輕人人數的第一次。

For the first time in human history -- and barring aliens landing

那也是第一次在人類歷史上，除了外星人登入

or some major other pandemic,

或是其它重大的流行性疾病，

that's the expectation from demographers, going forward.

人口統計學家預期要往前看。

And 10 years ago it seemed like I had a lot of time

且十年前我似乎有很多的時間

to convince Intel to work on this. Right?

去說服英特爾去做這。對吧？

Y2K + 10 was coming,

Y2K+10就要來了，

the baby boomers starting to retire.

嬰兒潮那一代也開始要退休。

Well folks, it's like we know these demographics here.

只是大家，這就像我們知道這些人口統計資料在這，

This is a map of the entire world.

這裡是一張全世界的地圖。

It's like the lights are on,

這就像燈是亮的，

but nobody's home on this demographic

但沒有人在這人口統計學的家

Y2K + 10 problem. Right?

Y2K + 10的問題裡。對吧？

I mean we sort of get it here, but we don't get it here,

我的意思是，我們好像到了，可是我們沒有到這，

and we're not doing anything about it.

而且我們沒有對它作任何事。

The health reform bill is largely ignoring

健康改革法案是幾乎完全忽略，

the realities of the age wave that's coming,

那將要來的高齡潮的事實，

and the implications for what we need to do to change

以及它隱含著，不單只是我們該如何做，才能改變

not only how we pay for care,

我們支付健康照護費用的方式，

but deliver care in some radically different ways.

而是如何將照護以截然不同的方式傳遞。

And in fact, it's upon us.

講白一點，它與我們息息相關。

I mean you probably saw these headlines. This is Catherine Casey

我的意思是你大概看過這些頭條。這是凱瑟琳凱西，

who is the first boomer to actually get Social Security.

她是第一位得到社會福利的嬰兒潮。

That actually occurred this year. She took early retirement.

這件事其實是在今年發生的。她及早退休。

She was born one second after midnight in 1946.

她是在1946年凌晨十二點後一秒出生的。

A retired school teacher,

一位退休的學校老師。

there she is with a Social Security administrator.

那裡，她和社會福利的行政官一起，

The first boomer actually, we didn't even wait till 2011, next year.

確實是第一位嬰兒潮，我們還不必等到明年，2011年。

We're already starting to see early retirement occur this year.

我們已經漸漸在今年看到提早退休的發生。

All right, so it's here. This Y2K + 10 problem is at our door.

好吧，所以它來了。這Y2K+10的問題就在我們門口。

This is 50 tsunamis scheduled on the calendar,

這是50個海嘯安插在行事暦上。

but somehow we can't sort of marshal our government

但不知怎麼的，我們就不大能整頓我們的政府，

and innovative forces to sort of get out in front of it

或以創新的力量，好像，走出去站在它前面

and do something about it. We'll wait until

並對它做點什麼事。我們會等到它

it's more of a catastrophe, and react,

已經一發不可收拾，才做出反應，

as opposed to prepare for it.

而不是做好準備等著它。

So, one of the reasons it's so

所以，其中一個為問題它之所以

challenging to prepare for this Y2K problem

為Y2K作準備，這麼具挑戰性的原因

is, I want to argue, we have what I would call

在於，我要提出的，我們有我稱它作所謂的

mainframe poisoning.

主體中毒。

Andy Grove, about six or seven years ago,

安迪郭夫，約六、七年前，

he doesn't even know or remember this, in a Fortune Magazine article

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

he used the phrase "mainframe healthcare,"

他用了這個詞『主體的健康照護』，

and I've been extending and expanding this.

而我將它延伸、擴大。

He saw it written down somewhere. He's like, "Eric that's a really cool concept."

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。』

I was like, "Actually it was your idea. You said it in a Fortune Magazine article.

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。

I just extended it."

我不過是延伸它而已。』

You know, this is the mainframe.

你也知道，這就是所謂的主體。

This mentality of traveling to

這個跋涉前往的想法

and timesharing large, expensive healthcare systems

而且分時大型昂貴的健康照護系統，

actually began in 1787.

其實是開始於1787年。

This is the first general hospital in Vienna.

這是維也納第一個大眾醫院。

And actually the second general hospital in Vienna,

而實際上維也納的第二個公共醫院，

in about 1850, was where we started to build out

在約1850年，也正是我們開始打造

an entire curriculum for teaching med students specialties.

整套課程來訓練醫學生專業的地方。

And it's a place in which we started developing

另外，那也正是我們開始發展出

architecture that literally divided the body,

架構將身體分區的地方，並

and divided care into departments and compartments.

將照護分成部門及科部。

And it was reflected in our architecture,

同時，這也反應在我們的架構上，

it was reflected in the way that we taught students,

它也反應在我們教學生的方式。

and this mainframe mentality persists today.

這套主體的想法一直持續到今天。

Now, I'm not anti-hospital.

現在，我不是反對醫院。

With my own healthcare problems, I've taken drug therapies,

以我自己的健康問題，我曾經接受藥物治療，

I've traveled to this hospital and others, many, many times.

我也拜訪這間和其它家醫院很多很多次。

But we worship the high hospital on a hill. Right?

只是我們崇拜那高高在斜坡上的醫院，對吧？

And this is mainframe healthcare.

而這就是主體健康照護系統。

And just as 30 years ago

也不過30多年前，

we couldn't conceive that we would have the power

我們不會去設想到，我們有能力

of a mainframe computer that took up a room this size

將房間大小的電腦主機，

in our purses and on our belts,

縮到我們的皮包和皮帶的大小，

that we're carrying around in our cell phone today,

讓我們今天能攜帶在手機裡帶著到處走。

and suddenly, computing,

加上忽然，電腦的使用，

that used to be an expert driven system,

那曾經是專家引導的系統，

it was a personal system that we all owned as part of our daily lives --

已是我們都擁有且成為我們日常生活一部份的個人系統。

that shift from mainframe to personal computing

那個從大主機到個人電腦的轉變，

is what we have to do for healthcare.

正是我們必須對健康照護系統做的事。

We have to shift from this mainframe mentality of healthcare

我們必須將主體的健康照護概念，

to a personal model of healthcare.

轉換成健康照護的個人模式。

We are obsessed with this way of thinking.

我們是執著於這種思考方式的。

When Intel does surveys all around the world and we say,

當英特爾在作全世界問卷調查，我們說

"Quick response: healthcare."

『聯想健康照護。』

The first word that comes up is "doctor."

第一個冒出來的字是醫師。

The second that comes up is "hospital." And the third is "illness" or "sickness." Right?

第二個冒出來的是醫院。然後第三個是疾病或患病。對吧？

We are wired, in our imagination, to think about healthcare

我們聯想，在我們的想像裡，把健康照護

and healthcare innovation as something

及健康照護的創意想成是某個東西

that goes into that place.

會進去那個地方。

Our entire health reform discussion right now,

我們目前整個健康改革的討論，

health I.T., when we talk with policy makers,

當我們和政策決策者談，

equals "How are we going to get doctors using

等於我們要如何讓醫師在主體裡使用

electronic medical records in the mainframe?"

電子醫療紀錄？

We're not thinking about

我們不是在想

how do we shift from the mainframe to the home.

要如何從主體轉移到家裡。

And the problem with this is

而這個問題的本身就在於這是

the way we conceive healthcare. Right?

我們設想健康照護的方式，對吧？

This is a very reactive, crisis-driven system.

這是一個非常具反應性，危機導向的系統。

We're doing 15-minute exams with patients.

我們正在和病人作15分鐘的測試。

It's population-based.

這是以人口為根據的。

We collect a bunch of biological information in this artificial setting,

我們在這人為的佈置裡收集一堆生物性資料。

and we fix them up, like Humpty-Dumpty all over again,

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，

and send them home,

然後把他們送回家，

and hope -- we might hand them a brochure, maybe an interactive website --

接著希望，我們能發傳單給他們，或是一個能互動的網頁，

that they do as asked and don't come back into the mainframe.

好讓他們能照著要求作，就不會回到主體裡。

And the problem is we can't afford it today, folks.

但問題是，各位，我們今天付不起。

We can't afford mainframe healthcare today to include the uninsured.

我們不能支付今天主體醫療去涵括沒保險的部份。

And now we want to do a double-double

而且我們要做的是一個雙倍再加倍

of the age wave coming through?

即將要來的高齡潮？

Business as usual in healthcare is broken and we've got to do something different.

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。

We've got to focus on the home.

我們必須要把焦點放在家裡。

We've got to focus on a personal healthcare paradigm

我們必須聚焦在個人的健康照護模式，

that moves care to the home. How do we be more proactive,

把照顧移到家裡。我們要如何才能變得比較積極、

prevention-driven?

預防性導向？

How do we collect vital signs and other kinds of information 24 by 7?

我們要怎麼收集每天24小時的生命徵象和其它資訊？

How do we get a personal baseline about what's going to work for you?

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？

How do we collect not just biological data

我們要如何收集不單單是生物性資料，

but behavioral data, psychological data,

但行為資料、心理狀況的資料

relational data, in and on and around the home?

在家裡、屬於家裡以及在家裡附近的相關性的資料？

And how do we drive compliance to be a customized care plan

還有我們要怎麼引導配合度，成為量身定做的照護計畫

that uses all this great technology that's around us

那是利用在我們周遭的這些高級科技，

to change our behavior?

來改變我們的行為？

That's what we need to do for our personal health model.

那正是我們必須為我們的個人健康模式做的。

I want to give you a couple of examples. This is Mimi

我要給你幾個例子。這是米咪

from one of our studies --

從我們當中一個研究出來—

in her 90s, had to move out of her home

在她九十幾歲時，必須搬出她家，

because her family was worried about falls.

因為她的家人擔心她會跌倒。

Raise your hand if you had a serious fall

如果你曾有嚴重的摔跤發生，請舉手。

in your household, or any of your loved ones,

在你家裡，或任何你愛的人

your parents or so forth. Right?

你的父母等人。對吧？

Classic. Hip fracture often leads to institutionalization of a senior.

很典型的。髖關節骨折常會導致年長者住進安養院。

This is what was happening to Mimi; the family was worried about it,

這就在米咪身上發生，家人擔心這件事，

moved her out of her own home into an assisted living facility.

把她從自己家裡請出去，搬進輔助生活的機構。

She tripped over her oxygen tank.

她被她的氧氣鋼筒絆倒。

Many people in this generation won't press the button,

很多在這個世代的人不會按下那個急救鈕，

even if they have an alert call system, because they don't want to bother anybody,

就算他們有緊急呼叫系統，因為他們不想要打擾到其他人，

even though they've been paying 30 dollars a month.

儘管他們已經支付一個月30美元。

Boomers will press the button. Trust me.

嬰兒潮的人會按下那個鈕。相信我。

They're going to be pressing that button non-stop. Right?

他們將會不停的按這那個鈕。對吧？

Mimi broke her pelvis, lay all night, all morning,

米咪摔斷她的髖骨，整個晚上躺著，整個早上，

finally somebody came in and found her,

直到終於有人走進來找到她，

sent her to the hospital.

把她送到醫院。

They fixed her back up. She was never going to be able to move back

他們把她修理好。她再也不能夠搬回

into the assisted living. They put her into the nursing home unit.

那個輔助生活的機構。他們將她送到照護之家。

First night in the nursing home unit where she had been

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，

in the same assisted living facility, moved her from one bed to another,

把她從一張床搬到另一張床，

kind of threw her, rebroke her pelvis,

大概丟到她，又摔到她的髖骨，

sent her back to the hospital that she had just come from,

把她送回她才離開的醫院，

no one read the chart, put her on Tylenol,

沒人讀過她的病歷，給她泰諾（止痛藥），

which she is allergic to, broke out, got bedsores,

是她會過敏的，過敏發作，得到褥瘡，

basically, had heart problems, and died

基本上有心臟問題，接著就死了

from the fall and the complications and the errors that were there.

原因是摔倒和病發症以及那存在著的錯誤。

Now, the most frightening thing about this is

現在，這件事最驚人的部份在於，

this is my wife's grandmother.

這是我太太的祖母。

Now, I'm Eric Dishman. I speak English,

現在，我是艾瑞克．迪許曼。我說英文。

I work for Intel, I make a good salary,

我為英特爾工作。我的收入優渥。

I'm smart about falls and fall-related injuries --

我對跌倒及跌倒相關的傷害很有辦法。

it's an area of research that I work on.

這是我在研究的領域。

I have access to senators and CEOs.

我能接近參議員及主要執行長們（CEOs）

I can't stop this from happening.

但我卻沒法停止這件事。

What happens if you don't have money, you don't speak English

如果你沒有錢，那會怎麼樣，如果你不說英文，

or don't have the kind of access

或是沒有辦法接觸到

to deal with these kinds of problems that inevitably occur?

能處理這種難以避免問題的資源？

How do we actually prevent the vast majority of falls

我們到底該如何預防大多數

from ever occurring in the first place?

在第一時間摔跤的發生？

Let me give you a quick example of work that we're doing

讓我給你一個簡單的例子，是我們正在試著

to try to do exactly that.

去做的這件事。

I've been wearing a little technology that we call Shimmer.

我已隨時帶戴著一個小型我們稱做訊門的科技。

It's a research platform.

這是一個研究的平台。

It has accelerometry. You can plug in a three-lead ECG.

他有加速度計。你可以插進一個三插的心電圖。

There is all kinds of sort of plug-and-play

它有各種不同的轉接頭和玩法

kind of Legos that you can do to capture, in the wild,

有點像樂高，讓你可以在自然的情況、

in the real world,

在真實的世界

things like tremor, gait,

追蹤像是顫抖、步態、

stride length and those kinds of things.

步長，還有這一類的東西。

The problem is, our understanding of falls today,

問題是，我們對跌倒的了解，在今天，

like Mimi, is get a survey in the mail three months after you fell,

就像米咪，是在你跌倒的三個月後收到寄來的問卷，

from the State, saying, "What were you doing when you fell?"

來自州政府問說『在你跌倒的時候你在做甚麼？』

That's sort of the state of the art.

那已經是現有最好的情形。

But with something like Shimmer, or we have something called the Magic Carpet,

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，

embedded sensors in carpet, or camera-based systems

能埋偵測器在地毯裡或是以相機為基礎的系統，

that we borrowed from sports medicine,

那是我們從運動醫學借來的

we're starting for the first time in those 600 elderly households

我們開始可以第一次在六百戶年長者家裡，

to collect actual kinematic motion data

蒐集實際的力學運動資料，

to understand: What are the subtle changes that are occurring

以了解到底有什麼細微的改變，是正在發生的，

that can show us that mom has become risk at falls?

且可以告訴我們媽媽已經成為會跌倒的高危險群。

And most often we can do two interventions,

還有，更常見的，我們可以做兩種介入，

fix the meds mix.

處理醫療的混亂。

I'm a qualitative researcher, but when I look at these data streams coming in

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，

from these homes, I can look at the data and tell you the day

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

that some doctor prescribed them something that nobody else

某醫師開了某些藥，那是沒有其他人

knew that they were on, because we see the changes

知道他們正在服用的。因為我們看到改變

in their patterns in the household. Right?

的趨勢是在那家裡。對吧？

These discoveries of behavioral markers,

這些行為指標的發現，

and behavioral changes

和行為改變

are game changing, and like the discovery of the microscope

都是改變的遊戲，好比顯微鏡的發明，

because of our collecting data streams that we've actually never done before.

因為我們收集的資料庫是我們之前都從來沒做過的。

This is an example in our TRIL Clinic in Ireland

這是我們在愛爾蘭喜爾診所的一個例子

of -- actually what you're seeing is

...其實你真正看到的是，

she's looking at data,

她正在看資料

in this picture, from the Magic Carpet.

在這張照片裡從神奇地毯來的。

So, we have a little carpet that you can look at your amount of postural sway,

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，

and look at the changes in your postural sway over many months.

再看你姿勢晃動程度經過幾個月的改變。

Here's what some of this data might look like.

這裡是一些資料大概的樣子。

This is actually sensor firings.

這是實際上偵測器在發送訊號。

These are two different subjects in our study.

這是我們實驗中的兩位不同的個案。

It's about a year's worth of data.

差不多是累積一整年的資料。

The color represents different rooms they are in the house.

顏色代表著他們現在所在房子裡不同的房間。

This person on the left is living in their own home.

這個左邊的人正住在他自己的房子裡。

This person on the right is actually living in an assisted living facility.

這在右邊的人正實際住在一個輔助生活機構。

I know this because look at how punctuated meal time is

我之所以知道這，是因為你看用餐時間是多麼的準時

when they are no longer in their particular rooms here. Right?

當他們不再住在自己特定的房間時，對吧？

Now, this doesn't mean that much to you.

現在，這可能對你來說沒有很大的意義，

But when we look at these cycles of data

但是當我們看這些週期性的資料

over a longer period of time -- and we're looking at everything from

經過一段較長的時間，而且我們看的是所有的東西，

motion around different rooms in the house,

從在房子裡不同房間的動作，

to sort of micro-motions that Shimmer picks up,

到一些訊門偵測到的微動作，

about gait and stride length -- these streams of data

像是步態及步長，這些大量的資料

are starting to tell us things about behavioral patterns

漸漸在告訴我們像是關於行為模式的東西

that we've never understood before.

一些我們以前從來都不懂。

You can go to ORCATech.org --

你可以進ORCATech.org網站—

it has nothing to do with whales, it's the Oregon Center for Aging and Technology --

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—

to see more about that.

去看看更多東西。

The problem is, Intel is still one of the largest

只是問題是，英 特爾還是其中之一最大

funders in the world

在世界上的贊助者

of independent living technology research.

在研究獨立生活科技的。

I'm not bragging about how much we fund;

我不是在吹牛我們贊助了多少，

it's how little anyone else actually pays attention

而是其 實其他人是多麼漠視

to aging and funds innovation on aging,

與老年化及花極少的基金在改革老年化、

chronic disease management and independent living in the home.

慢性疾病的管理、和獨立的居家。

So, my mantra here, my fourth slogan is:

所以，我的信念在這，我的第四個口號是：

10,000 households or bust.

10,000戶或破壞。

We need to drive

我們必須要引導

a national, if not international, Framingham-type heart study

全國性的，不然就國際性的，像弗明翰一類的心臟研究

of independent living technologies,

的獨立居住科技，

where we have 10,000 elderly connected households

當中我們讓10,000家老年人連接在一起

with broadband, full medical characterization,

靠的是寬頻、完整的醫療特徵

and a platform by which we can start to experiment

，及平台，其中我們可以開始作實驗，

and turn these from 20-household anecdotal studies

並將這20戶個別案例研究，

that the universities fund,

由大學贊助的

to large clinical trials that prove out the value of these technologies.

變成大型臨床試驗來發揮這些科技的價值。

So, 10,000 households or bust.

所以，10,000戶或破壞。

These are just some of the households that we've done in the Intel studies.

這些只是一些我們已經在英特爾實驗過的家庭。

My fifth and final phrase:

我的第五個也是最後一點：

I have tried for two years,

我已經試了兩年，

and there were moments when we were quite close,

有些時候我們也很接近，

to make this healthcare reform bill be about reform

在讓這健康改革法案能改革

from something and to something,

從這東西到另一種東西。

from a mainframe model

從一個主體模式

to a personal health model,

到個人健康模式、

or to mean something more than just a debate

或是能代表不單單只是眾人意見下的討論串

about the public option and how we're going to finance.

或是我們要如何去籌措資金。

It doesn't matter how we finance healthcare.

不管我們怎麼去籌措健康照護的資金，

We're going to figure something out

我們總要試著想到些什麼

for the next 10 years, and try it.

為未來十年，並試試看。

No matter who pays for it,

不論是誰要買單，

we better start doing care in a fundamentally different way

我們最好能開始以完全不同的方式來執行健康照護，

and treating the home and the patient

而且將他的家、病人、

and the family member and the caregivers

他的家庭成員、及照護者

as part of these coordinated care teams

都看成是互相合作的一個照護團隊，

and using disruptive technologies that are already here

再用現有的破壞性科技

to do care in some pretty fundamental different ways.

以一些很基本不同的方式來作照護。

The president needs to stand up and say,

總統可能需要站起來並說，

at the end of a healthcare reform debate,

在健康照護改革討論的最後，

"Our goal as a country is to move 50 percent of care

『我們國家的目標是要，移走百分之五十

out of institutions, clinics, hospitals and nursing homes,

在機構、診所、醫院和照護之家的照護

to the home, in 10 years."

在未來的十年移到家裡。』

It's achievable. We should do it economically,

這是可以達成的。我們應該做得合乎經濟效益。

we should do it morally,

我們應該要做得合乎道德。

and we should do it for quality of life.

而且我們應該為了生活品質而作。

But there is no goal within this health reform.

但現有的健康改革是沒有目標的，

It's just a mess today.

在今天是亂成一團的。

So, you know, that's my last message to you.

所以你知道，這是我要給你最後的一個訊息。

How do we set a going-to-the-moon goal

我們怎麼去設定一個將要通往月球

of dealing with the Y2K +10 problem that's coming?

處理這將要來的Y2K+10問題的目標？

It's not that innovation and technology is going to be the

這其實沒那麼創新或是科技是那

magic pill that cures all, but it's going to be part of the solution.

治百病的神奇藥丸，但是它至少會是答案的一部份。

And if we don't create a personal health movement,

而且如果我們不創造一個我們個人的健康運動

something that we're all aiming towards in reform,

那是我們都邁向要改革的，

then we're going to move nowhere.

那我們哪裡也走不了。

So, I hope you'll turn this conference into that kind of movement forward.

所以，我希望你們能把這個會議轉而推進這類的運動。

Thanks very much.

非常謝謝大家。

(Applause)

（鼓掌）