Transcript Computer Classes: Why they form, and what`s new

Computers in the Operating Room:
A Patient/Customer and
Computer Person’s View
The 3rd Congress on Computers &
Robotics in the Operating Room 2000
July 14, 1999
Gordon Bell
Microsoft Corporation
OR 2000
Outline
Computing Technology: Basics
Everything “cyberizable” is in Cyberspace
Cyber Personal Assistants
Electrons replace atoms for “presence”
“Telepresence” … being there, while
being here and maybe some other time
Guardian Angels, an on-body assistant
Turing tests ...
When will computers be able to fool
some of the people some of the time?
OR 2000
Caveat


Discuss where computing is going …
and by analogy
Spark your imagination about how
computing and other technology will
impact life outside (and within)
the OR…
“no income”

The speaker’s understanding of the
OR is from a patient and web-visitor
perspective…

“no sight, no blood, no pulse”
OR 2000
The two great inventions


The computer (1946… realised in 1948).
Computers supplement and substitute
for all other info processors, including
humans
The Transistor (1946) and subsequent
Integrated Circuit (1957).
–
–
–
–
Moore’s Law:
The integrated circuit evolves at the rate of
60% per year as measured by the number
of transistors per chip.
Storage evolves at this rate
Optical transmission lines do too OR 2000
Phone lines behave Moron’s Law
LINC: Laboratory Instrument
Computer c1964
OR 2000
Extrapolation from 1950s:
20-30% growth per year
Tera
Giga
Storage
Backbone
Processing
Memory
??
Mega
Kilo
1
1947
Telephone Service
17% / year
1957
1967
1977
1987
2000
1997OR 2007
Performance in Mflop/s
Growth of Microprocessor Performance
10000
Cray T90
Supers
Cray 2
Cray Y-MP Cray C90
Alpha
1000
RS6000/590
Cray X-MP
Alpha
Micros
RS6000/540
100 Cray 1S
i860
2X transistors/Chip Every 1.5
years
R2000
10
“Moore’s Law”
1
80387
Microprocessors have
6881
0.1
become smaller, denser,
80287
8087
and more powerful.
0.01
Desktop Supercomputing
Dell Precision
610 Workstation
1989 Cray
Y-MP8/4128
CPUs
2 Xeon 550MHz
4 166MHz
Max RAM
2 GB
1 GB
Peak Mflops
1333
1333
Weight
Cost
< 50 lbs
< $15K
> 5,000 lbs
> $13M
www.dell.com
3/20/89 Electronic News
OR 2000
Bell’s Nine Computer Price Tiers
1$:
10$:
100$:
1,000$:
10,000$:
100,000$:
1,000,000$:
10,000,000$:
100,000,000$:
1,000,000,000$:
embeddables e.g. greeting card
wrist watch & wallet computers
pocket/ palm computers
portable computers
personal computers (desktop)
•
departmental computers (closet)
site computers (glass house)
regional computers (glass castle)
national centers… en route to
Super server: costs more than $100,000
“Mainframe”: costs more than $1 million
OR 2000
an array of processors, disks, tapes, comm ports
Platform evolution:
What do they do that’s useful?
How do they communicate?
OR 2000
In a decade we can/will have:

more powerful personal computers
–
–
–

adequate networking
–


processing 10-100x
4x resolution (2K x 2K); large displays
storage of one terabyte
ubiquitous access = today’s fast LANs
One chip, networked platforms
more cyberization
The challenge… interfacing platforms
OR 2000
and people.
Outline
Computing Technology: Basics
Everything “cyberizable” is in Cyberspace
Cyber Personal Assistants
Electronics replace atoms for “presence”
“Telepresence” … being there, while
being here and maybe some other time
Guardian Angels
Turing tests ...
When will computers be able to fool
some of the people some of the time?
OR 2000
Everything cyberizable will be
in Cyberspace!
Continent
Body
Car
Region/
Intranet
Home
Campus,
World
including SANs
Fractal Cyberspace: a
network of … networks
of … platforms OR 2000
“Everything will be in
Cyberspace”


Is this a challenge? goal?
quest? fate?… or
Cyberization enables
new computing platforms that
require new networks to connect
them
–
–
Infrastructure supports the content
Three evolutionary dimensions
OR 2000
Cyberization: interface to all bits
and process information




Coupling to all information and
information processors
Pure bits e.g. paper, newspapers, video
Bit tokens e.g. money, stock
State of:
– places like the OR,
– things e.g. robots, instrumentation,
especially people…
OR 2000
OR 2000: Implications when
everything is in cyberspace




IP on everything
Delivered by some standard wire or
fiber e.g. Ethernet or Firewire or USB
HTML accessible…
Even the robots have to be
connected so they can feedback!
OR 2000
Atoms a.k.a. massy vs. massless bits
Atoms (mass)
people know
bricks & mortar
office hours
reports & databases
letter & fax
phone
personal visits
signature
envelopes
Electrons, etc. (massless)
computers also know
anywhere
(personnel/clients)
anytime
radio nets => anwhere
web access for all
documents!
email & web access
email, voice & video mail
videophone / videomail
authenticated images
OR 2000
digital envelopes / store
New or old money… it’s just bits
Credit
ATM /
Prepaid
Check
Cash
OR 2000
Prepaid
Put those checks & statements in
Cyberspace or eliminate them!
OR 2000
Paperless transactions: put them all
in Cyberspace
OR 2000
Http://wwww.medicalogic.com



Internet-based service for keeping
medical records electronically …EMR
No on site or in office equipment except
a browser
Facilities
–
–
–
–
rapid input and record retrieval
accessible anywhere at anytime
patient accessible
prescription drug interaction, advice, etc.
OR 2000
Especially cyber-ready images
OR 2000
Sensors, actuators/emitters,
sensor-actuators, and wireless







Medical: P, T (body), blood gas, ECG,
etc.
Mobile: location (GPS, compass),
ambient (P,T), acceleration,
Personal: A/V (and eyes) including IR,
body & head position (6 degrees),
Speech and glasses
Radar, sonar, beacons,
Spectrum, chemical, etc. analyzers
OR 2000
Connected without cables
Outline
Computing Technology: Basics
Everything “cyberizable” is in Cyberspace
Cyber Personal Assistants
Electronics replace atoms for “presence”
“Telepresence” … being there, while
being here and maybe some other time
Guardian Angels
Turing tests ...
When will computers be able to fool
some of the people some of the time?
OR 2000
The Cyber Admin or
the prosthetic memory…
When we can store
everything we’ve:
read/written,
heard/said,
seen/acted, plus
physical parameters.
OR 2000
What does Cyber Admin do?

Captures the creation of all
personal/professional information

Everything that happens in the OR

Stores and organizes
Retrieval is the challenge

–
–


recalling readings, conversations,
presentations, images
helps the “guardian angel”
What are the apps?
when we can do this?
OR 2000
My project … putting my legacy
and future bits in Cyberspace
http://www.research.microsoft/

Personal paper documents
–


Encode video and audio lectures
Current electronic media
–
–

Books (encoded by CMU), papers, articles,
memos, notes, email, notebooks, drawings
email, files, papers, photos (now digital)
voice notes and records
Would like to capture photos and slides
OR 2000
Capture and encoding
OR 2000
HP Digital Sender…
color document scanner
OR 2000
Sony voice notes recorder…
OR 2000
Evolving cameras to capture
images and voice notes
OR 2000
A word about storage… CDs
hold 6 “near VHS quality”
videos (300 Kbps)
OR 2000
Book
page
OR 2000
Now how do you find or
use the rich information
The system must:
locate,
retrieve,
visualize,
order,
up load the organization’s IP assets
(text, proposals, images, videos,
presentations, experiments,
procedures, etc.) …
OR 2000
with appropriate controls.
Thumbnails to aid retrieval
OR 2000
Virage Video Cataloger
OR 2000
Outline
Computing Technology: Basics
Everything “cyberizable” is in Cyberspace
Cyber Personal Assistants
Electronics replace atoms for “presence”
“Telepresence” … being there, while
being here and maybe some other time
Guardian Angels
Turing tests ...
When will computers be able to fool
some of the people some of the time?
OR 2000
Telepresence
… being there while being here,
at another time, and
with time scaling



Telepresentations
Telemeetings and telecollaboration
The “work”
OR 2000
Telepresentation
Elements
 Slides
 Audio


Video
Script,
text
comments,
hyperlinks,
etc.
OR 2000
Telepresentations:
The Essentials



Slide and audio a must
Add some video
(low quality)
to make us feel good
Storage and transmission
costs low
OR 2000
What about telecollaboration?
… working together at a
distance
OR 2000
Conference Rooms with
Teleconferencing
OR 2000
Telework: it’s the sound,
screens, and bandwidth, stupid
OR 2000
http://research.microsoft.com/barc/GBell/
CMU wearable computers
OR 2000
Future
OR
OR 2000
Current OR
OR 2000
OR 2000
Telepresence: Reflection terminal
OR 2000
OR 2000
Mobile
videophone
OR 2000
Honda
Robot
OR 2000
Hospital robots...
OR 2000

Telemedical Collaboration…
Telementoring is probably the
“killer app”
Surprisingly little used currently:
–
–


1 in 1000 radiograms, 1 in 2000 home visits
Saves time and money; “no money”
Robotics more useful for precision and
routine than remotely
Inhibitors are network speed, delays, etc.
–
–
Remote diagnostics a promising use of VR
Will be able to have anyone, anywhereOR
with
2000
you at anytime...
Webcam of Hospital in Sweden
OR 2000
What happens when there are
webcam(eras) everywhere
(e.g. a dozen or so in the OR)
instead of the 100,000 out
there now?
OR 2000
Outline
Computing Technology: Basics
Everything “cyberizable” is in Cyberspace
Cyber Personal Assistants
Electronics replace atoms for “presence”
“Telepresence” … being there, while
being here and maybe some other time
Guardian Angels
Turing tests ...
When will computers be able to fool
some of the people some of the time?
OR 2000
The Guardian Angel
Knows about your state of
health.
Has the latest medical
knowledge.
OR 2000
Your
husband
just died,
… here’s
his black
box
OR 2000
Steve Mann
in
Cyberspace
OR 2000
Not shown:
ECG; GPS;
Compass;
altimeter
PCS; Pilot
Libretto,
.5mm
pencil
Libretto PS,
Ricoh Camera;
Swiss Army
OR 2000
Knife
Moore’s law is less important
than MEMS micro-electro
mechanical systems
OR 2000
4 Experts Predict Bionics
Wired, February 1997

Hi-Fi Cochlear Implants 2005

Bionic Limbs 2013

Artificial Vision 2040

Bionic Person (unlikely)
OR 2000
A device that would have
saved me from a heart attack
OR 2000
BAN, PAN or whatever for
people networks




Temperature monitoring with the flu
Saved me from a heart attack
Where is the person, exactly… a baby
sitter
Let’s interact… ala Barney
OR 2000
Medtronics
Implanted
Cardioplastic
stimulator
cardiorecorder
OR 2000
Pump
OR 2000
OR 2000
Audio, pix, T, P, ECG,
location, physiological
parameters…
1 GB
OR 2000
Outline
Computing Technology: Basics
Everything “cyberizable” is in Cyberspace
Cyber Personal Assistants
Electronics replace atoms for “presence”
“Telepresence” … being there, while
being here and maybe some other time
Guardian Angels
Turing tests ...
When will computers be able to fool
some of the people some of the time?
OR 2000
Turing test: you can’t tell whether
you are communicating with a
person or a machine using:


Text… limited context
Voice
–
–

Visual image and voice
–
–

context
speech to text and text to speed
more context
synthesis of dynamic, human images
A simulator to carry out a procedure
on any person, anywhere
OR 2000
People
surrogates:
models you
can touch
and feel
OR 2000
Simulation with physical models
OR 2000
Visualizing & modeling...
OR 2000
What is Medical VR?
http://www.informatik.umu.se/~jwworth/execsum.html



Visualisation of data (usually anatomical)
Interaction with visualised data
Simulated behaviors of simulated
realities:
–

increasingly as a result of interactions
"Realisation" in modalities other than
vision:
–
sound, force, touch, smell
OR 2000
Virtual augmentation:
connecting the images with reality
OR 2000
Models you touch & feel
OR 2000
Everything must work together!
Medical industry based on
“proprietary standards”
OR 2000
Health:
Number
one
market
need…
must
be
open!
OR 2000
Standards and Standards Processes
•HL7 application-level messages e.g. admission,
discharge, transfers; results; clinical observations.
•DICOM images e.g. ultrasound, MRI, and X-rays…
or PACS, Picture Archiving and Comm. System.
•IEEE 1073 bedside devices e.g. patient monitors,
ventilators, and infusion pumps standards.
•X12 forms for insurance transactions.
•ASTM laboratory information systems standards
plus the content and security of electronic medical
records
•HIBCC healthcare bar codes standards e.g. labels
•ADA dental informatics standards
OR 2000
Impediments




Standards… caused by companies
trying to gain proprietary advantages
that lock in their customers!
User Interface
Just doing it… people, time, training
Threat: “no income”
OR 2000
The end
OR 2000