Please meet Jane. She has a high-risk pregnancy. Within 24 weeks, she's on bed rest at the hospital, being monitored for her preterm contractions.
Upoznajte Džejn. Ona ima trudnoću visokog rizika. U 24. nedelji, ona je u bolničkoj postelji, na posmatranju zbog prevremenih kontrakcija.
She doesn't look the happiest. That's in part because it requires technicians and experts to apply these clunky belts on her to monitor her uterine contractions. Another reason Jane is not so happy is because she's worried. In particular, she's worried about what happens after her 10-day stay on bed rest at the hospital. What happens when she's home? If she were to give birth this early it would be devastating. As an African-American woman, she's twice as likely to have a premature birth or to have a stillbirth. So Jane basically has one of two options: stay at the hospital on bed rest, a prisoner to the technology until she gives birth, and then spend the rest of her life paying for the bill; or head home after her 10-day stay and hope for the best. Neither of these two options seems appealing.
Ne izgleda baš najsrećnije. To je delom zato što je potrebno da tehničari i stručnjaci postavljaju ove teške kaiševe na nju kako bi merili kontrakcije materice. Drugi razlog što Džejn nije srećna je zato što brine. Posebno brine šta će se desiti nakon njenog desetodnevnog boravka u bolničkoj postelji. Šta će se desiti kada se vrati kući? Kada bi se porodila ovako rano, to bi bila katastrofa. Kao Afroamerikanka, ona ima dva puta veće šanse za prevremeni porođaj ili da rodi mrtvorođenče. Džejn praktično ima jednu od dve opcije: da ostane u bolničkoj postelji, kao zarobljenik tehnologije dok se ne porodi, a da onda provede ostatak života plaćajući bolnički račun, ili da izađe kući nakon 10 dana i nada se najboljem. Nijedna od ove dve opcije ne zvuči privlačno.
As I began to think about stories like this and hear about stories like this, I began to ask myself and imagine: Is there an alternative? Is there a way we could have the benefits of high-fidelity monitoring that we get with our trusted partners in the hospital while someone is at home living their daily life?
Razmišljajući o ovakvim pričama i slušajući o njima, počeo sam da se pitam i razmišljam da li postoji neka alternativa. Da li postoji način da imamo prednosti preciznog nadgledanja koje dobijamo kod naših pouzdanih partnera u bolnici, dok je pacijent kod kuće i vodi normalan život?
With that in mind, I encouraged people in my research group to partner with some clever material scientists, and all of us came together and brainstormed. And after a long process, we came up with a vision, an idea, of a wearable system that perhaps you could wear like a piece of jewelry or you could apply to yourself like a Band-Aid. And after many trials and tribulations and years of endeavors, we were able to come up with this flexible electronic patch that was manufactured using the same processes that they use to build computer chips, except the electronics are transferred from a semiconductor wafer onto a flexible material that can interface with the human body.
Sa tim na umu, ohrabrio sam ljude u svom istraživačkom timu da se udruže sa izvesnim naučnicima u oblasti pametnih materijala, i svi smo se skupili i iznosili ideje. Nakon dugog procesa, došli smo do jedne vizije, ideje, mobilnog sistema kojeg možda možete nositi poput nakita ili možete staviti kao flaster. Posle dosta testiranja, problema i godina napornog rada, uspeli smo da osmislimo ovu fleksibilnu elektronsku nalepnicu koja je proizvedena korišćenjem istih procesa koji se koriste da se naprave kompjuterski čipovi, osim što se elektronika prenosi iz poluprovodničke pločice na fleksibilni materijal koji se može povezati sa ljudskim telom.
These systems are about the thickness of a human hair. They can measure the types of information that we want, things such as: bodily movement, bodily temperature, electrical rhythms of the body and so forth. We can also engineer these systems, so they can integrate energy sources, and can have wireless transmission capabilities.
Ovi sistemi su debljine ljudske dlake. Oni mogu izmeriti vrste informacija koje želimo, stvari kao što su: pokreti tela, temperatura tela, električna ritmika tela i tako dalje. Takođe možemo dizajnirati ove sisteme, tako da mogu da integrišu izvore energije i da imaju mogućnosti bežičnog prenosa.
So as we began to build these types of systems, we began to test them on ourselves in our research group. But in addition, we began to reach out to some of our clinical partners in San Diego, and test these on different patients in different clinical conditions, including moms-to-be like Jane.
Kako smo počeli da pravimo ove vrste sistema, počeli smo da ih testiramo na sebi u istraživačkom timu. Uz to, počeli smo da se obraćamo nekim našim kliničkim partnerima u San Dijegu i da ovo testiramo na različitim pacijentima u različitim kliničkim uslovima, uključujući buduće mame, poput Džejn.
Here is a picture of a pregnant woman in labor at our university hospital being monitored for her uterine contractions with the conventional belt. In addition, our flexible electronic patches are there. This picture demonstrates waveforms pertaining to the fetal heart rate, where the red corresponds to what was acquired with the conventional belts, and the blue corresponds to our estimates using our flexible electronic systems and our algorithms.
Evo fotografije jedne trudnice na porođaju u našoj univerzitetskoj bolnici kojoj se posmatraju kontrakcije materice sa uobičajenim pojasom. Uz to, tu su naše fleksibilne elektronske nalepnice. Ova slika pokazuje oblike talasa vezane za otkucaje srca fetusa, gde crveno odgovara onome što se dobija sa uobičajenim pojasevima, a plavo odgovara našim procenama korišćenjem naših fleksibilnih elektronskih sistema i algoritama.
At this moment, we gave ourselves a big mental high five. Some of the things we had imagined were beginning to come to fruition, and we were actually seeing this in a clinical context.
U tom trenutku, uputili smo sebi čestitku. Neke od stvari koje smo zamislili počele su da se ostvaruju, i to zapravo vidimo u kliničkom kontekstu.
But there was still a problem. The problem was, the way we manufactured these systems was very inefficient, had low yield and was very error-prone. In addition, as we talked to some of the nurses in the hospital, they encouraged us to make sure that our electronics worked with typical medical adhesives that are used in a hospital. We had an epiphany and said, "Wait a minute. Rather than just making them work with adhesives, let's integrate them into adhesives, and that could solve our manufacturing problem."
Ipak, i dalje smo imali problem. Problem je što je način na koji smo proizvodili ove sisteme bio veoma neefikasan, imao nisku proizvodnju i bio podložan greškama. Uz to, dok smo u bolnici pričali sa nekim medicinskim sestrama, ohrabrivale su nas da obezbedimo da naša elektronika radi sa tipičnim medicinskim lepljivim materijalima koji se koriste u bolnici. Tad nam je sinulo: „Čekaj malo. Umesto da samo napravimo da elektronika radi sa lepljivim materijalima, hajde da je integrišemo u njih, i to bi rešilo naš problem proizvodnje.“
This picture that you see here is our ability to embed these censors inside of a piece of Scotch tape by simply peeling it off of a wafer. Ongoing work in our research group allows us to, in addition, embed integrated circuits into the flexible adhesives to do things like amplifying signals and digitizing them, processing them and encoding for wireless transmission. All of this integrated into the same medical adhesives that are used in the hospital.
Ova fotografija koju vidite prikazuje našu sposobnost da ubacimo ove senzore unutar lepljive trake, jednostavno odlepljujući je sa podmetača. Rad koji nastavlja naš tim istraživača omogućava nam da, uz to, uključimo integrisana kola u fleksibilne lepljive materijale da bismo mogli da dobijemo jači signal i da ih digitalizujemo, obradimo i dekodiramo za bežičan prenos. Sve ovo je integrisano u iste medicinske lepljive materijale koji se koriste u bolnici.
So when we reached this point, we had some other challenges, from both an engineering as well as a usability perspective, to make sure that we could make it used practically.
Kada smo došli do ove tačke, imali smo neke druge izazove, kako iz perspektive inženjeringa, tako i upotrebljivosti, da bismo bili sigurni da mogu praktično da se koriste.
In many digital health discussions, people believe in and embrace the idea that we can simply digitize the data, wirelessly transmit it, send it to the cloud, and in the cloud, we can extract meaningful information for interpretation. And indeed, you can do all of that, if you're not worried about some of the energy challenges. Think about Jane for a moment. She doesn't live in Palo Alto, nor does she live in Beverly Hills. What that means is, we have to be mindful about her data plan and how much it would cost for her to be sending out a continuous stream of data.
U mnogim digitalnim diskusijama vezanim za zdravlje, ljudi veruju u ideju da prosto možemo da digitalizujemo podatke, bežično ih prenesemo, pošaljemo ih na „oblak“, a u oblaku izdvojimo bitne informacije za obradu. Zaista, sve to može da se uradi, ako vas ne brinu neki energetski izazovi. Pomislite na Džejn na trenutak. Ona ne živi u Palo Altu, niti živi na Beverli Hilsu. To znači da moramo da uzmemo u obzir njen plan podataka i koliko bi nju koštalo da šalje stalne nizove podataka.
There's another challenge that not everyone in the medical profession is comfortable talking about. And that is, that Jane does not have the most trust in the medical establishment. She, people like her, her ancestors, have not had the best experiences at the hands of doctors and the hospital or insurance companies. That means that we have to be mindful of questions of privacy. Jane might not feel that happy about all that data being processed into the cloud. And Jane cannot be fooled; she reads the news. She knows that if the federal government can be hacked, if the Fortune 500 can be hacked, so can her doctor.
Postoji još jedan izazov o kome nisu svi u medicinskoj profesiji spremni da razgovaraju. A to je da Džejn nema bezuslovno poverenje u medicinske ustanove. Ona, ljudi poput nje, njeni preci, nisu imali najbolja iskustva kod lekara, u bolnici ili osiguravajućim kućama. To znači da moramo biti obazrivi prema pitanjima privatnosti. Džejn možda ne bi bila najsrećnija da se svi njeni podaci obrađuju u oblaku. Ne možete prevariti Džejn; ona čita vesti. Ona zna da, ako federalna vlada može biti žrtva hakera, ako jedna od najuspešnijih kompanija može biti žrtva hakera, može i njen lekar.
And so with that in mind, we had an epiphany. We cannot outsmart all the hackers in the world, but perhaps we can present them a smaller target. What if we could actually, rather than have those algorithms that do data interpretation run in the cloud, what if we have those algorithms run on those small integrated circuits embedded into those adhesives?
Imajući to u vidu, sinula nam je ideja. Ne možemo nadmudriti sve hakere na svetu, ali možda im možemo predstaviti jednu manju metu. Šta ako bismo zapravo, umesto ovih algoritama za obradu podataka koja se odvija u oblaku, šta ako bismo ove algoritme pustili na ovim malim integrisanim kolima ugrađenim u lepljive materijale?
And so when we integrate these things together, what this means is that now we can think about the future where someone like Jane can still go about living her normal daily life, she can be monitored, it can be done in a way where she doesn't have to get another job to pay her data plan, and we can also address some of her concerns about privacy.
Tako kada integrišemo ove stvari, to znači da sada možemo da razmišljamo o budućnosti gde neko poput Džejn može i dalje da vodi normalan svakodnevni život, možemo da je pratimo, to može da se uradi tako da ona ne mora da radi još jedan posao da bi platila prenos podataka, i takođe možemo da se osvrnemo na neke njene brige o privatnosti.
So at this point, we're feeling very good about ourselves. We've accomplished this, we've begun to address some of these questions about privacy and we feel like, pretty much the chapter is closed now. Everyone lived happily ever after, right? Well, not so fast.
Tako u ovom trenutku, mislimo da smo uradili nešto dobro. Ostvarili smo ovo, počeli smo da se osvrćemo na neka od ovih pitanja o privatnosti i smatramo da smo praktično sada zatvorili jedno poglavljle. I svi su živeli srećno do kraja života, je l' da? Pa, ne tako brzo.
(Laughter)
(Smeh)
One of the things we have to remember, as I mentioned earlier, is that Jane does not have the most trust in the medical establishment. We have to remember that there are increasing and widening health disparities, and there's inequity in terms of proper care management. And so what that means is that this simple picture of Jane and her data -- even with her being comfortable being wirelessly transmitted to the cloud, letting a doctor intervene if necessary -- is not the whole story.
Jedna od stvari koje moramo da zapamtimo, kao što sam spomenuo, je da Džejn nema potpuno poverenje u medicinske ustanove. Moramo zapamtiti da sve više nastaju i povećavaju se razlike u zdravstvu, i da postoje nejednakosti u pogledu valjanog sprovođenja nege. To znači da ova jednostavna slika Džejn i njenih podataka - čak i da je njoj u redu da se oni bežično prenesu na oblak i dopusti lekarima da reaguju ako zatreba - nije cela priča.
So what we're beginning to do is to think about ways to have trusted parties serve as intermediaries between people like Jane and her health care providers. For example, we've begun to partner with churches and to think about nurses that are church members, that come from that trusted community, as patient advocates and health coaches to people like Jane.
Ono što počinjemo da radimo je da razmišljamo o načinima da imamo učesnike od poverenja kao posrednike između ljudi poput Džejn i njenih zdravstvenih radnika. Primera radi, počeli smo da se povezujemo sa crkvama i da razmišljamo o medicinskim sestrama koje su članovi crkve, koje dolaze iz krugova od poverenja, kao o zastupnicima pacijenata i zdravstvenim trenerima za ljude poput Džejn.
Another thing we have going for us is that insurance companies, increasingly, are attracted to some of these ideas. They're increasingly realizing that perhaps it's better to pay one dollar now for a wearable device and a health coach, rather than paying 10 dollars later, when that baby is born prematurely and ends up in the neonatal intensive care unit -- one of the most expensive parts of a hospital.
Još jedna stvar koja nam ide na ruku je da osiguravajuće kuće sve više i više privlače neke od ovih ideja. One sve više i više shvataju da je možda bolje sada platiti jedan dolar za mobilni uređaj i zdravstvenog trenera, nego platiti 10 dolara kasnije, kada se ta beba prevremeno rodi i završi na neonatalnoj intezivnoj nezi - jednom od najskupljih delova bolnice.
This has been a long learning process for us. This iterative process of breaking through and attacking one problem and not feeling totally comfortable, and identifying the next problem, has helped us go along this path of actually trying to not only innovate with this technology but make sure it can be used for people who perhaps need it the most.
Ovo je bio dug proces učenja za nas. Ovaj učestali proces napretka i rešavanja jednog problema, pri čemu nemate skroz dobar osećaj, a već prepoznajete sledeći problem, pomogao nam je da idemo putem gde ne samo da ćemo pokušati da inoviramo sa ovom tehnologijom, već da ćemo obezbediti da je koriste ljudi kojima je možda najviše potrebna.
Another learning lesson we've taken from this process that is very humbling, is that as technology progresses and advances at an accelerating rate, we have to remember that human beings are using this technology, and we have to be mindful that these human beings -- they have a face, they have a name and a life. And in the case of Jane, hopefully, two.
Još nešto što smo naučili iz ovog procesa, što je vrlo utešno, je da, kako tehnologija napreduje vrlo brzo, moramo zapamtiti da ljudska bića koriste ovu tehnologiju, i moramo imati na umu da ova ljudska bića imaju lice, imaju ime i imaju život. A u slučaju Džejn, nadamo se, dva.
Thank you.
Hvala vam.
(Applause)
(Aplauz)