St Vincent’s Health Australia

Professor Erwin Loh

For those of us interested in futurology, the study of possible, probable, and preferable futures, it is an exciting time to be in the healthcare sector. Healthcare is facing potentially seismic changes in the way business is done, with disruptive changes happening so quickly on different fronts that keeping up is almost impossible. Most of us are just trying to stay afloat on top of the giant wave of new technologies that are constantly being introduced into the clinical space.

The changes in health technologies have been exponential in pace. It was only fifty years ago that we discovered the double helix structure of DNA, and today we are able to edit genes to change the fundamental foundations of life itself. Right now, there is an unprecedented acceleration in the investment and development of artificial intelligence, genetic engineering, wearables, 3D printing, augmented and virtual reality, and brain-computer interfaces. All of these emerging technologies are already being used at St Vincent’s Health Australia facilities, and in this article, I will touch on each of them in turn.

I will not spend too much time discussing the rise of artificial intelligence (AI) and the use of machine learning in health. We are beginning to see algorithms automating and replacing many duties carried out by health professionals, including doctors. The Food and Drug Administration (FDA) in the US has already approved AI devices in radiology, ophthalmology, and other areas of medicine. On the other hand, the Therapeutic Goods Administration (TGA) in Australia has only just started consultation on a new proposal to regulate software as a medical device. At St Vincent’s Hospital Melbourne, trials are already underway in the use of AI in radiology, and in the diagnosis of diabetic retinopathy in our diabetes clinics. Without doubt, AI will be game-changer in medicine, especially in diagnostic specialties like pathology and radiology.

"Clinicians need to continually keep up-to-date with the latest emerging technologies, and work with technologists to ensure that as new devices are created, they are designed with both the health providers and the patients in mind"

The genetic engineering of human DNA is now undergoing a revival with the discovery of the CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) tool. CRISPR allows us to edit our actual genetic code in order to treat hereditary diseases. Scientists have successfully treated neuromuscular diseases like Duchenne muscular dystrophy in animal models and human trials have commenced in the treatment of inherited disorders like beta thalassemia and cystic fibrosis. At the St Vincent’s Institute, research is underway to improve CRISPR’s gene-editing ability to increase its therapeutic potential.

Wearables are achieving critical mass in the consumer market, and their current and future impact in how care can be delivered should not be underestimated. Most of us carry smartphones and an increasing number of people have smartwatches and other fitness trackers to monitor their own health. Wearable and connected devices can serve as biosensors that measure vital signs and other biometrics in real-time to add to the repository of data that can not only warn us of current health issues but have predictive value as well, especially with the support of AI. For example, at St Vincent’s Hospital Sydney, cardiologists have partnered with Samsung to develop a wearable device that can be used by patients at risk of heart rhythm disorders, with monitoring done by AI in the cloud.

Additive manufacturing, or 3D printing, is another emerging technology that is being applied in healthcare. St Vincent’s Hospital Melbourne, as part of the Aikenhead Centre for Medical Discovery, has been involved in the development of the BioPen, a hand-held 3D printer pen filled with stem cell ink that allows orthopedic surgeons to ‘draw’ new cartilage into damaged joints. Also, St Vincent’s Private Hospital in Sydney in collaboration with the Victor Chang Cardiac Research Institute has for the first time this year used a 3D printer to make a replica of a patient’s heart to foster better planning for surgery and treatment. Similar developments have also occurred with 3D printed kidneys and other organs, which may lead to an exciting future where there may no longer be waiting lists for organ transplant recipients.

Augmented reality (AR) and virtual reality (VR) devices have already hit the consumer market, both for gaming and for commercial applications in different industries, including health, where they are used in surgical training, patient education, and diagnostic specialties. An example is the use of VR at St Vincent’s Hospital Sydney, in stroke rehabilitation patients so that they can visualize what is happening to their own bodies, and in pain management for the treatment of acute pain. The ability to superimpose data onto the clinician’s visual field in AR will provide a new user interface to access information, and big tech is already working on new devices in this arena.

Brain-computer interfaces (BCI) are also an emerging technology that may potentially revolutionize the way patients with neuromuscular conditions and paralysis communicate with the world. The modern multi-channel cochlear implant, invented by an ENT surgeon from Melbourne, is an example of a neuroprosthetic device that converts sounds into nerve signals. Researchers have been developing interfaces that range from direct electrodes implanted in the brain to devices that are able to interpret brainwaves and convert them into actions. At St Vincent’s Health Melbourne, neuroscientists have been developing brain-computer interfaces that interpret EEG brainwaves to allow them to control a robotic hand and support the treatment of epilepsy.

More recently, Elon Musk’s Neuralink Company has suggested that their brain implant device could be ready for human clinical trials as early as the end of 2020. Musk has widely supported the idea of human-machine interfaces that he believes is necessary for humankind to keep up with the rise of artificial intelligence. Putting aside the therapeutic potential, a direct connection between computers and our brain provides the ultimate data input device, which also opens up ethical issues and gives a whole new meaning to the issues of cybersecurity, privacy, hacking, and computer viruses.

In summary, clinicians need to continually keep up-to-date with the latest emerging technologies, and work with technologists to ensure that as new devices are created, they are designed with both the health providers and the patients in mind. Governance frameworks need to be established in hospitals so that new technologies are introduced safely. As Malcolm X, the human rights activist once said, “Education is the passport to the future, for tomorrow belongs to those who prepare for it today.” So let us prepare today for the future, by ensuring that we are educated in medical futurology, the science of what is possible and preferable in healthcare.