A temporary tattoo that brings hospital care to the home | Todd Coleman

譯者: Ann Chen 審譯者: 易帆 余

Please meet Jane.

這是珍，

She has a high-risk pregnancy.

她患有高危險妊娠。

Within 24 weeks,

她現在懷孕 24 週，

she's on bed rest at the hospital,

在醫院臥床，

being monitored for her preterm contractions.

接受早產性宮縮的監測。

She doesn't look the happiest.

她看起來並不快樂，

That's in part because it requires technicians and experts

部分是因為技術員和專科醫師

to apply these clunky belts on her to monitor her uterine contractions.

需將笨重的腰帶戴在她身上， 以監測子宮收縮。

Another reason Jane is not so happy is because she's worried.

珍不快樂的另一原因 是因為她擔心，

In particular, she's worried about what happens

特別是擔心在醫院 臥床 10 天後會發生什麼事，

after her 10-day stay on bed rest at the hospital.

What happens when she's home?

她回家後會發生什麼事？

If she were to give birth this early it would be devastating.

假如她這麼早就分娩，那將會很慘。

As an African-American woman,

她是位非裔美國女性，

she's twice as likely to have a premature birth

有比一般人高兩倍發生 早產或死產的機率。

or to have a stillbirth.

So Jane basically has one of two options:

所以基本上珍只能二選一：

stay at the hospital on bed rest,

留在醫院臥床，

a prisoner to the technology until she gives birth,

成為被科技囚禁的犯人，直到生產，

and then spend the rest of her life paying for the bill;

然後終其餘生去償付賬單；

or head home after her 10-day stay and hope for the best.

或者住院 10 天後回家， 祈求有最好的結果。

Neither of these two options seems appealing.

這兩種選擇似乎都不是很理想。

As I began to think about stories like this

當我開始想到及聽到這些故事時，

and hear about stories like this,

I began to ask myself and imagine:

我自問並想像：

Is there an alternative?

是否有替代的方式？

Is there a way we could have the benefits of high-fidelity monitoring

不但病人能從醫院可靠人士 得到高傳真度監測的這種優點，

that we get with our trusted partners in the hospital

while someone is at home living their daily life?

同時又可在家過正常生活？

With that in mind,

基於這樣的想法，

I encouraged people in my research group

我鼓勵我的研究團隊人員

to partner with some clever material scientists,

去和一些聰明的材料科學家合作，

and all of us came together and brainstormed.

然後我們在一起腦力激盪。

And after a long process,

經過一段漫長的歷程，

we came up with a vision, an idea,

我們萌生一個願景，一個想法：

of a wearable system that perhaps you could wear like a piece of jewelry

就是一種可佩戴式裝置， 或許能像戴珠寶般戴著它，

or you could apply to yourself like a Band-Aid.

或是像 OK 繃可自己黏貼。

And after many trials and tribulations and years of endeavors,

經過許多實驗與艱難 以及多年的努力，

we were able to come up with this flexible electronic patch

我們研發出這種柔軟的電子貼片，

that was manufactured using the same processes

它是運用製造 電腦晶片的方法製作而成，

that they use to build computer chips,

except the electronics are transferred from a semiconductor wafer

只不過此電子裝置是將半導體晶片

onto a flexible material that can interface with the human body.

換成能和身體相互作用的柔軟材質。

These systems are about the thickness of a human hair.

這裝置大約是人類頭髮的厚度。

They can measure the types of information that we want,

它們可以檢測我們所需的各種資訊，

things such as:

例如：

bodily movement,

身體的移動、

bodily temperature,

體溫、

electrical rhythms of the body

身體的電位節律

and so forth.

等等。

We can also engineer these systems,

我們也能設計這些裝置，

so they can integrate energy sources,

讓它們能結合能源

and can have wireless transmission capabilities.

且具有無線傳輸的能力。

So as we began to build these types of systems,

當我們開始建構這種裝置時，

we began to test them on ourselves in our research group.

先在自己的研究團隊裡進行測試。

But in addition, we began to reach out to some of our clinical partners

此外也開始延伸到 在聖地亞哥的臨床合作者，

in San Diego,

and test these on different patients in different clinical conditions,

並且針對各種不同 臨床狀況的病人進行測試，

including moms-to-be like Jane.

包括即將為人母的人，例如珍。

Here is a picture of a pregnant woman in labor at our university hospital

這是在我們大學附設醫院 一位待產的孕婦的照片，

being monitored for her uterine contractions with the conventional belt.

使用傳統的腰帶 進行子宮收縮的監測。

In addition,

此外，

our flexible electronic patches are there.

我們的柔軟電子貼片也貼在那裡。

This picture demonstrates waveforms pertaining to the fetal heart rate,

這張照片顯示胎兒心率的波形圖，

where the red corresponds to what was acquired

紅色波是使用傳統的腰帶記錄所得，

with the conventional belts,

and the blue corresponds to our estimates

而藍色波是用我們的柔軟電子裝置 和演算法估算的。

using our flexible electronic systems and our algorithms.

At this moment,

此時，

we gave ourselves a big mental high five.

給予了我們極大的精神鼓舞。

Some of the things we had imagined were beginning to come to fruition,

我們過去想像的事情 已開始有了成果，

and we were actually seeing this in a clinical context.

我們也能在真正的 臨床背景下看到進展。

But there was still a problem.

但仍有一個問題，

The problem was, the way we manufactured these systems

就是我們製造這些裝置的方法

was very inefficient,

非常沒有效率，

had low yield

產量低，

and was very error-prone.

且非常容易出錯。

In addition,

再者，

as we talked to some of the nurses in the hospital,

當我們和醫院的護士交流時，

they encouraged us to make sure

他們建議我們確保

that our electronics worked with typical medical adhesives

我們的電子裝置能與 醫院的醫療用貼布搭配使用。

that are used in a hospital.

We had an epiphany and said, "Wait a minute.

我們靈光乍現，說道：「等一下！

Rather than just making them work with adhesives,

與其只是將它們搭配貼布使用，

let's integrate them into adhesives,

不如將它們整合入貼布，

and that could solve our manufacturing problem."

那就能解決我們製造的問題了。」

This picture that you see here

你們現在看到的照片

is our ability to embed these censors inside of a piece of Scotch tape

是我們已能把檢測裝置 嵌入一片 Scotch 膠布裡面，

by simply peeling it off of a wafer.

只需將膠布 從晶片上撕下來就可以了。

Ongoing work in our research group allows us to, in addition,

研究團隊持續地研發， 讓我們進一步能夠

embed integrated circuits into the flexible adhesives

將集成電路嵌入柔軟的貼布裡，

to do things like amplifying signals and digitizing them,

使它能做像放大訊號、數據數位化、

processing them

處理數據

and encoding for wireless transmission.

以及編碼，以便無線傳輸。

All of this integrated into the same medical adhesives

這全都整合入 醫院使用的醫療貼布中。

that are used in the hospital.

So when we reached this point,

但當研發至此，

we had some other challenges,

我們面臨一些來自工程學 及實用領域的其他挑戰，

from both an engineering as well as a usability perspective,

to make sure that we could make it used practically.

我們需要確保它能實際運用。

In many digital health discussions,

在許多數位化健康研討中，

people believe in and embrace the idea that we can simply digitize the data,

人們相信並接受這樣的想法： 我們只需將數據數位化，

wirelessly transmit it,

無線傳輸它，

send it to the cloud,

將它送到雲端，

and in the cloud,

而在雲端裡，

we can extract meaningful information for interpretation.

就能取出有用的資料來進行判讀。

And indeed, you can do all of that,

事實上，這些你都能做到，

if you're not worried about some of the energy challenges.

假如你不擔憂 電能耗費的挑戰的話。

Think about Jane for a moment.

考慮一下珍。

She doesn't live in Palo Alto,

她既不住在帕洛阿爾托，

nor does she live in Beverly Hills.

也不住在比佛利山。

What that means is,

這意思就是

we have to be mindful about her data plan and how much it would cost

我們必須注意她的手機上網方案， 以及她要花費多少錢

for her to be sending out a continuous stream of data.

才能送出連續的數據流。

There's another challenge

另外還有一個挑戰，

that not everyone in the medical profession is comfortable talking about.

這並非每位醫療專業人員 都願意談論的，

And that is, that Jane does not have the most trust

也就是說，珍對醫療機構 並不完全信任。

in the medical establishment.

She, people like her, her ancestors, have not had the best experiences

她、像她一樣的人、她的祖先 對醫生、醫院或保險公司

at the hands of doctors and the hospital

以往的印象並不好，

or insurance companies.

That means that we have to be mindful of questions of privacy.

這意謂我們必須注意隱私的問題。

Jane might not feel that happy

珍可能不太樂意

about all that data being processed into the cloud.

將所有數據都傳送到雲端。

And Jane cannot be fooled;

而且珍會閱讀新聞，不容易被騙；

she reads the news.

She knows that if the federal government can be hacked,

她知道如果聯邦政府能被駭客入侵，

if the Fortune 500 can be hacked,

財富美國 500 強公司能被駭客入侵，

so can her doctor.

那她的醫生也有可能。

And so with that in mind,

考慮到這一點，

we had an epiphany.

我們又靈光乍現：

We cannot outsmart all the hackers in the world,

既然無法比世上所有的駭客更聰明，

but perhaps we can present them a smaller target.

或許我們就做個 他們興趣缺缺的小目標。

What if we could actually,

假如我們真的能夠

rather than have those algorithms that do data interpretation

不是在雲端進行數據判讀的演算，

run in the cloud,

what if we have those algorithms run on those small integrated circuits

而是在那些嵌入貼布的 小型集成電路執行呢？

embedded into those adhesives?

And so when we integrate these things together,

所以當我們將這些都整合在一起，

what this means is that now we can think about the future

現在你就能夠想像，在未來，

where someone like Jane can still go about living her normal daily life,

像珍一樣的病人 仍能繼續過著日常的生活，

she can be monitored,

同時又能被監測，

it can be done in a way where she doesn't have to get another job

她可以不需要找第二份工作 來支付她的上網方案，

to pay her data plan,

and we can also address some of her concerns about privacy.

而且我們也能解決 她所憂慮的隱私問題。

So at this point,

所以此時此刻，

we're feeling very good about ourselves.

我們對自己感覺很滿意。

We've accomplished this,

我們已經完成這件事，

we've begun to address some of these questions about privacy

也已開始解決一些 有關隱私的問題，

and we feel like, pretty much the chapter is closed now.

我們覺得差不多大工告成了。

Everyone lived happily ever after, right?

從此大家都過得幸福快樂，對吧？

Well, not so fast.

沒那麼快！

(Laughter)

（笑聲）

One of the things we have to remember, as I mentioned earlier,

稍早我曾提到有件事必須記住，

is that Jane does not have the most trust in the medical establishment.

就是珍對醫療機構並不完全信賴。

We have to remember

我們必須記住，

that there are increasing and widening health disparities,

醫療公平性差距不斷地增加與擴大，

and there's inequity in terms of proper care management.

在適當的照護處置方面仍不公平。

And so what that means is that this simple picture

也就是說，這張 珍和她的數據的簡單圖片

of Jane and her data --

even with her being comfortable being wirelessly transmitted to the cloud,

──即使她願意將傳輸數據至雲端，

letting a doctor intervene if necessary --

必要時讓醫師介入參與──

is not the whole story.

那並不代表全部。

So what we're beginning to do

所以我們現在開始在做的是

is to think about ways to have trusted parties serve as intermediaries

想出一些方式，讓可信賴的團體

between people like Jane and her health care providers.

成為像珍這樣的病患 與健康照護者間的中間人。

For example, we've begun to partner with churches

例如，我們已開始與教會合作，

and to think about nurses that are church members,

以來自可靠社群的教會護理人員

that come from that trusted community,

as patient advocates and health coaches to people like Jane.

來擔任像珍一樣病患的 代言人和健康指導員。

Another thing we have going for us

另一項對我們有利的

is that insurance companies, increasingly,

是保險公司逐漸對這種構想感興趣。

are attracted to some of these ideas.

They're increasingly realizing

他們漸漸了解，

that perhaps it's better to pay one dollar now

或許最好現在花一點錢

for a wearable device and a health coach,

在可佩戴裝置和健康指導員身上，

rather than paying 10 dollars later,

而不是事後花更多的錢補貼

when that baby is born prematurely

早產且之後還要住進 新生兒加護病房的嬰兒，

and ends up in the neonatal intensive care unit --

one of the most expensive parts of a hospital.

──那是醫院花費最昂貴的部門之一。

This has been a long learning process for us.

我們經歷了一段漫長的學習過程。

This iterative process of breaking through and attacking one problem

這種突破、奮力解決問題

and not feeling totally comfortable,

以及不完全自信

and identifying the next problem,

和找出下一個問題的反覆過程，

has helped us go along this path

幫助了我們

of actually trying to not only innovate with this technology

不只是真正嘗試用科技來創新，

but make sure it can be used for people who perhaps need it the most.

並且確保它能使用在 可能最需要的人身上。

Another learning lesson we've taken from this process

從這過程中，我們學到 讓自己很謙卑的另一課，

that is very humbling,

is that as technology progresses and advances at an accelerating rate,

就是當科技在發展 並以加速度在進步，

we have to remember that human beings are using this technology,

我們必須銘記， 使用這些科技的是人類，

and we have to be mindful

我們必須銘記，

that these human beings -- they have a face,

這些人──他們有血有肉、

they have a name

他們有自己的名字

and a life.

和自己的生活。

And in the case of Jane,

至於珍， 順利的話，

hopefully, two.

會有兩個寶寶。

Thank you.

謝謝大家。

(Applause)

（掌聲）