By Atam Dhawan
What are the emerging medical and healthcare technologies of the next decade? A new report provides a view of 10 areas to watch. We present part 1 of the report in this issue. Part 2 will follow next month.
(Editor’s note) This article is drawn from a report to the IEEE Engineering in Medicine and Biology Society’s Emerging Technology Committee.
1. Medical Informatics: Medical and Health Care Information Management
With the inclusion of Electronic Health Care, Point-of-Care technologies, E-Health and M-Health protocols, and personalized healthcare/medicine, the medical informatics area is entering into another era of massive amount of information. The medical and health care information databases would lead to new knowledge bases, discoveries in medical research, engineering oriented developments and clinical translational research and practices. Information mining, security and management along with multi-facet analyses would be a critical challenge in almost every area of biomedical research and clinical applications. Perhaps this is the era that would redefine clinical engineering and applications specifically in personalized medicine.
uHealth – ubiquitous Health – is growing as a terminology for the right healthcare, to the right person, in the right location at the right time, seamlessly, securely and reliably.
Health monitoring and informatics including home monitoring using Point-Of-Care technologies that acquire, record, transmit and analyze adaptively sampled healthcare data would provide specific modeling capabilities for better healthcare and preventive as well as personalized medicine. However, the enormous data analysis from genome to physiome levels and associated environmental and population based studies should lead to better understanding of risk factors and protocols for better clinical healthcare management protocols. There is a need for standardized platforms of real-time patient analytics that incorporate complex correlation and analysis of physiological streams in real-time followed by translational protocols for clinical implementation.
There are new challenging opportunities for researches and experts in computer science, multi-disciplinary engineering areas, biology (and related domains of biosciences) and medical sciences to collaborate with industry and clinicians towards developing new paradigms of modeling, simulation and analysis for clinical/translational applications.
2. Point-of-Care Health Care Technologies
The rapidly approaching crisis in health care costs will demand the development of high effectiveness, low cost means of delivery health care. The nation’s investment in electronic communications technologies as well as biomolecular technologies will be exploited to effect a generation of point-of-care sensors and therapeutics permitting patients to remain longer at home and multiply the effectiveness of physicians. Targeted technologies for disaster sites and developing technologies also will be developed. Closely joined will be e-Health and medical informatics initiatives.
The “Point-of-Care Health Care Technologies” including e-health and m-health technologies could provide remote health monitoring and telemedicine but will require efficient health care information management. The overall challenge has moved up to another level with increased complexity to provide selective prioritized health care in emergency situations such as during a natural disaster or terrorist outbreak. In addition, probably a new area, “Nursing Engineering” is about to be explored.
Specific globally significant areas include POC monitoring technologies for diabetes, hypertension, cancer, premature childbirth and neonatal care, obesity and virus related diseases such as HIV.
There is a significant global concern of prematurity (and associated infections during the premature and neonatal stage) that cause death in low income populatons. However, of greater concern is the national rising statistic that 10% of babies are born prematurely internationally. Prematurity can lead to lifelong morbidities such as chronic lung disease and ADHD.
3. Neural Prostheses and Neural Engineering
The recent technological advancements in engineering and biosciences have set up the stage for next generation invasive and non-invasive interfaces with biological neural systems. Neural prostheses that are adaptive to the biological neural systems have already emerged as exciting possibilities in neural rehabilitation and neural engineering to discover and explore highly complex multi-scale models. Neural engineering will continue to be a major area of research and clinical translational research to impact upon neuroscience and the way neurological diseases and disorders will be treated in the future.
Neurovascular diseases and disorders such as Strokes, Epilepsy, Depression, Alzheimer’s and Parkinson’s Diseases account for more than 1/3 rd of the health care costs and are considered as a major global health care concern. More than 50 million people in European Union are expected to be suffering from neurological disorders for health care costs reaching 400 million Euro per year. The health care costs in United States for neurological disease and disorders are expected to exceed $750 million per year. Neuro-nano-sensors based regulatory devices and neurostimulators would allow better interfacing with cortical and neural structures along with intelligent prosthetic devices would make a significant impact in therapy and rehabilitation related to neurological diseases and disorders.
The potential spectrum of neural engineering spans over almost all physiological systems in addition to neural prosthesis, neurobiosensing and neural interfacing for clinical applications. As neuromodulation plays a major role in regulating cardiovascular functions in the autonomous nervous systems, recent research has demonstrated a potential application of neuromodulation in treating refractory (or incurable) cardiovascular diseases. This is particularly true in hypertension and heart failure. Since there are more than one billion patients with hypertension worldwide, one tenth of them are refractory, hypertension is the most common risk factor of cardiovascular diseases and the number one killer of human being is the cardiovascular diseases, controlling refractory hypertension is extremely important. It has been shown that neuromodulation is extremely effective in lowering blood pressure in those patients.
4. Cardiovascular and Respiratory Systems
Cardiovascular diseases (CVDs) are the number one cause of death globally in both men and women: more people die annually from CVDs than from any other cause representing about 30% of all global deaths. According to WHO report, “By 2030, almost 23.6 million people will die from CVDs, mainly from heart disease and stroke. These are projected to remain the single leading causes of death. The largest percentage increase will occur in the Eastern Mediterranean Region. The largest increase in number of deaths will occur in the South-East Asia Region”. Since 82% of CVD deaths take place in low- and middle-income countries, low-cost point-of-care technologies with information networks and effective treatment protocols are essential to improve global health. Cardiovascular diseases are closed linked with other major health issues such as cerebrovascular (strokes), hypertension and respiratory diseases. This leads the CVDs and related diseases in underdeveloped and developing countries to a new alarming level and have to be studied in conjunction with genomic and environmental variables in additional to effective diagnosis, screening and treatment protocols.
The estimated cost of health care services for patients with heart disease exceeded $316.4 billion in United States. This total includes the cost of health care services, medications, and lost productivity. However, physicians trained in cardiology are far less required to treat all cardiovascular patients. Since the survival rate of cardiovascular diseases, in particular heart attack, clearly depends on who takes care of those patients (either cardiologists or non-cardiologists), Computer-aided and assisted diagnosis and treatment systems would create a major impact in effectively dealing the global issue of cardiovascular diseases.
5. Neurosensors and Nanosystems on a Chip
Fast emerging technological advances in bioelectronics and bio-nano-sensor-technologies have created exciting applications in clinical neurosciences as and related areas. Advanced technological developments are critical to address challenges of improving our basic knowledge of the nervous system, neurophysiology and neurological disorders, and to develop devices to interface with neural tissue. The neural information gathered can be used to design more effective technologies (for example by exploiting the potentialities related to bioinspiration) and also to develop systems to help disabled people to deal with neurological disorders. New bio-nano-sensor electronic devices and interfacing systems would have a significant impact in neuro-scientific and clinical applications.
Nanosystems or nanolabs on a chip have started to provide a critical foundation to diagnostics biomarkers and point-of-care technologies including pathogen detection. There is a growing interest in BME and medical communities to construct artificial organs on a chip to implement or replace organ functions. Some achievements include Kidney chips, Lung chips, and Blood vessels on chips. These potential technologies can offer testbeds/models for biological development and screening, not as replacements for organ function.
(End of Part 1. Part 2 of this article will appear in next month’s Newsletter.)
I would like to acknowledge and thank the EMBS Emerging Technology Committee members for their contributions. The committee is:
Atam P Dhawan, NJIT, USA: Chair
Jean Louis Coatrieux, Universite de Rennes, France
Alexander Frangi, University of Sheffield, UK
Peter Hunter, University of Auckland, New Zealand
Silvestro Micera, University of Zurich, Swtizerland
Kenji Sunagawa, Kyushu University, Japan
Bruce Wheeler, University of Florida, USA
Metin Akay, University of Houston, USA
Semahat Demir, National Science Foundation, USA
Yantian Zhang,, National Institutes of Health, USA