MIS2018: “Top 10” Medical Innovations: 2019



the top ten is selected by a group of 40 physicians in a double-elimination set of run offs we interview about a hundred and fifty physicians from every field at the Cleveland Clinic about twenty investors of venture capitalists and ten from the media on three main criteria what will make a clinical difference in the next year what will make a large clinical difference in the next year and what's important for patient care the group meets that is 20 physicians meet they take the 250 or so suggestions that the staff led by Susan Burnett has whittled into great paragraphs and summaries in eliminate and get down to about 25 so their to 20 groups then there's a single elimination after that to get the top ten things that will make a major difference for critical care in the next year I think we've done this for more than 13 years the results of the prior ones are on our website you can see in 10 years we've only really missed one if you will so it's a tremendous record of success by this method today we will reveal the top 10 things that we think will change patient care in a major way next year and there's a major difference this year compared to prior years in prior years it seemed like there was always a device or a drug in this year most of the suggestions were at the interface of specialties that is two things combining as you'll see to make major differences for next year so let's go ahead and get started we'll do it on a fairly tight timeframe number 10 number ten RNA based therapies a code of genetic information ribonucleic acid has become a popular target for therapeutics interfering with that code gives scientists the ability to intercept a patient's genetic abnormality before it is translated into non functioning proteins anta sense nucleotide therapy prevents the production of proteins encoded by a disease and is being explored in several conditions such as age-related retinitis familial hypercholesterolemia and Huntington's disease RNA interference a mechanism for gene silencing is currently being explored for use in cancer and neurological diseases with RNA interference RNA molecules either micro RNA mi RNA or short interfering RNA si RNA inhibit gene expression by neutralizing targeted mRNA sequences FDA approved in 2018 the most successful RNA interference therapy is for the treatment of hereditary transtheoretical a dose Asst feeding off the success of DNA based gene therapy RNA based therapy puts a twist on treatment sparking progress and innovation in therapeutics dr. Olga Stan inna from the staff and molecular cardiology at the Werner Institute will discuss this by the way when you ask questions if you can't ask questions put the number that is a ten nine eight seven six before your question which will make it easier for me to figure out who the call on well I would like to stress how important and how amazing was this discovery of RNA interference the whole new class of molecules of regulatory molecules the whole new level of regulation inside the cell was discovered and that's not something that happens every year or even every ten years so it's really big discovery but what is even more important about this discovery is it's absolutely unprecedented therapeutic potential and actually that was very quickly appreciated the Nobel Prize was given to create mellow and angry fire who did not discover the first micro RNA but they showed that it's a general mechanism that can be used as a tool that can be used to create new therapeutics so this oligonucleotides the therapeutic agents they are based on the sequence of DNA on the sequence of mRNA and it's very easy to design them because we know the sequence of every gene in our genome human genome has been sequenced and many other genome skeleton so it's easy to design it's relatively easy to deliver in the lab we actually just inject The Naked Toledo nucleotide and it goes where it's supposed to be and gets taken up by the cells and also it can be very very specific because it's sequence based of course it has but it needs to be tested but the potential of being very very specific is very high and that's why it's taking off and that's why we see the new drugs appearing and there are very many oligonucleotides in trials in preclinical trials and clinical trials and I think it's not just for the next year but for many years to come and one of the things mentioned was that you can stop the production of proteins you don't want to like avoid in MOA doses you say a little more about that yes so this micro rna's they bind to the mRNA which is used to produce the protein so they bind to mRNA and they stop the production of proteins so by designing artificial small oligonucleotides that will bind to your mRNA of choice you can stop the production of specific protein and it's easy to design because we know all the sequences for each gene that results in the protein eventually thank you number nine number nine mitral and tricuspid valve percutaneous replacement it beats in your chest it pounds with anxiety the heart is one of the most vital organs in the body and prone to an array of problems surgery on the heart has become less invasive and many cardiac procedures are now conducted percutaneously via a catheter through the skin percutaneous surgery has been game-changing in aortic valve intervention and has now expanded to include replacement of the mitral and tricuspid valves to remedy mitral valve insufficiency such as prolapse regurgitation or stenosis a replacement valve stem is inserted in a percutaneous manner performed for the first time in 2016 the world's first implantation of a tricuspid valve stent has shown excellent maintenance of valvular function the exploration of this technology is ongoing but with promising results the innovation lowers risk and rubes care for cardiac patients dr. Samir Kapadia who is director of the cath labs in the Heart and Vascular Institute at the Cleveland Clinic will discuss this thank you very much for snowfall thank you for recognizing the heart is very important and we all are very very excited about the fact that for the first time we are able to treat not just the ORAC wall but the mitral and tricuspid valve percutaneously we replace and repair both have seen the advancement in the last year and the most important fact that we understood is that patients who come with heart failure where the heart is failing and the mitral and tricuspid valves are leaking not because the valves are abnormal because heart is dilated and the walls are leaking treating the mitral and tricuspid valve in these patients not only saves life but also makes them feel better they do not have hospital admissions and this is a very crucial part so this is going to improve our abilities to expand the indications to all these patients and now there are several therapies including the first one we did in the for the first time not in the world done in Cleveland Clinic because this is unusual that FDA allows us to do the first valve replacement so the tricuspid valve replacement was done first time in Cleveland Clinic 2016 patients still doing well and this is now done in 30 more patients and it is going to be available for patient use in the near future the tricuspid valve replacement and the mitral valve repair as you know the mitral clip is now also at a level where it is routinely used we do two or three cases every week and it may get FDA approval for the indications for heart failure so this is a big advancement for the patient care and for the international cardiologists treating valve disease heart failure is an expensive thing to treat they keep coming back and back many more times will this just add to the cost actually it may help with the cost because although all the therapies of course is done for business so people want to make money so we'll be some costs initially involved with the with the care but only three patients if we treat we prevent a hospitalization in two years so we have to treat only three patients for mitral clip to prevent the hospitalization so is these therapies become more effective safe and without risks we will probably be able to decrease the cost and also make people feel better so this is a huge improvement for patients who are looking for options when they have heart failure so fewer hospitalizations for heart failure patients because of this exactly you're free to send in questions at any time you don't have to wait to the end number eight number eight innovation in robotic surgery an extension of the physicians hands robotic surgery provides pinpoint accuracy advances in the field range from the development of more accurate planning tools and software to increased automation of tasks during surgery precision surgical arms designed for proper instrument positioning and implantation during spinal surgery increase surgeon precision automating the bronchoscopy process avoids incisions with the insertion of flexible tubes through the body's natural openings using a controller like interface this advancement increases accuracy and safety while decreasing invasiveness and cost robotize ation is also reaching endovascular procedures like percutaneous coronary intervention PCI and peripheral vascular intervention P VI which traditionally require the surgeon to wear leg using robotics now lowers risk for patients and the surgeon while improving outcomes robotic surgery provides precision flexibility and control paired with shortened recovery time and limited pain patients benefit from the continued advancements in the field dr. dr. jehad kyuk who is the director of robotic and imaging surgery and part of the clock Glickman institute euro Adric institute will discuss this thank you dr. Reisen robotics by itself is not new to medicine it's been there since the year 2000 and applied frequently every day all over the country what's new is really the spread of robotics spread all over the subspecialties you saw several examples today and the movie presented it moved from being in the operating room mostly for urology and cardiology and to feels that we're not there before like pulmonary doing endoscopy or for stereo tactics and orthopedic surgery as you saw in the clip there so really that's what's new it's opening new dimensions for caregivers to explore and I think we're still in the early phase of robotics we're just touching into this vast field and I'm not talking about technologies that are science fiction I'm talking about technologies that are available some of them on your phone some of them on many aspects that you deal with every day and the first task would be obviously to put some of these applications together to enhance what we have in robotics today the robot today is just an extension of the surgeons hands and eyes what we want to reach is a level where the robot helps the surgeon and the surgical team to explore and and deliver more precise procedures so you saw a robot that have multiple arms to do a procedure just few weeks ago the Cleveland Clinic received the first in the country robot that allows these multiple cuts needed to enter the patient and do the surgery now we can do through one small incision and get all these instruments through that small incision and spread inside the patient to do the same surgery so obviously we're going into less and less reserved ways that mean less pain quicker recovery and less hospital stay for our patients so we're just starting and hopefully we'll be able to present more and more of this and more innovations to come so one of the things you told me right before we went on is that you're in fact able to do things faster with the Augmented robot can you describe a little bit of that yes so there are definite aspects that we can add to that current robotic surgery one of them is for us to know exactly where are we inside the patient where where is the instrument in relation to the tumor you're trying to remove so stereo tactics and having the importing of a previous image into the field where you are can guide you better so you can do faster procedures and more precise procedures but also there's another dimension dimension I can tell you that you can print for example an organ and get that replica of that print put it on a bench and rehearse your surgery a day before or so and get your best performance to give to the patient the next day for example number seven number seven Visor for pre-hospital stroke diagnosis the timing of stroke intervention is crucial those seconds hinge on the importance of a rapid diagnosis utilizing ambulance drive time engineers have designed a visor for pre-hospital stroke diagnosis a non-invasive bioimpedance spectroscopy device that detects changes in distribution of cerebral fluids the visor is able to reveal pathologies in the brain during neurologic assessment when on a patient's head the visor emits low energy frequency waves through the hemispheres of the brain detecting changes in frequency between the two if the frequencies are different they indicate the occurrence of a stroke the greater the difference the greater the stroke severity studies show the visor has a 92 accuracy rate the device received FDA 510 K clearance in January and is expected to be commercially distributed and used next year with stroke they say time is brain an implementation of the visor is poised to save both dr. mark Bain who's director of cerebral vascular surgery in the neurology Institute will discuss this mark yeah thanks dr. Rosen I'd also like to say the brain is pretty important too so I'd like to just give a little perspective here you know we all in this room know that stroke you know affects probably around 800,000 people per year in this country and we in 2015 have had multiple randomized trials that have shown that when we do procedures to take blood clots out of arteries in the brain or do surgery to remove blood clots in the brain people do better in fact it's some of the strongest data that we have in medicine basically it's a two to one needed to treat to help a patient that's having a stroke one of the frustrations we have as physicians and probably as hospital systems are that we're not getting all the patients and one of the reasons for that is it's hard to diagnose stroke in the field in Cleveland we're lucky we have a mobile stroke unit that attempts to do that and it does that very well we can get imaging on an ambulance and tell if somebody's having a stroke but in a lot of communities a lot of rural centers we can't do that this visor I've actually talked to the people that are working with it now there's some group in New York City that's working with it and it's pretty amazing 92% accuracy rate can tell if you're having a large stroke or a large bleed in the brain and the nice thing about that is and we can organize our stroke systems that we can get patients to hospitals faster so that we can treat the patients so I think over the next you know definitely a year or two you're gonna be seeing this the Spy's are on ambulance units that are going out into the field and treating patients will it replace the ambulance in other words will you need mobile stroke units if you have this visor and if the Weiser going to be inexpensive enough to put in every police car every first responder yeah I don't think it's gonna replace mobile stroke units I mean that's really the Holy Grail is getting an ambulance with imaging capabilities to the patient but obviously there's limitations to that you can't you know take an ambulance everywhere in Cleveland or everywhere in America and so the the goal of this is to get this is inexpensive as possible and to have this just like an EKG for the heart or to have it on all ambulances have it in shopping plazas so if someone Falls or has symptoms you can put that on so it's absolutely intense so maybe you and the defibrillator group in heart will join and them together they're both important number six number six virtual and mixed reality for medical education imagine peering inside the human body without an incision or a skull turning the heart without touching it using a headset controllers an innovative technology it's possible to navigate human anatomy through virtual and mixed reality these realities can provide medical training in procedures techniques and equipment use as well as simulate patient interactions in a more immersive and realistic way as the vr mr trend grows pilot programs involving these technologies for the education of medical students are being implemented worldwide though not a replacement for hands-on practice virtual and mixed reality are increasing situational experience giving students an opportunity to practice with computer simulation is a low-risk alternative and in extreme cases can prevent patient harm the technologies new applications have many dubbing virtual and mixed reality the new reality dr. Neil Maeda a physician in the education Institute will discuss this it looks like from the pictures you've already been doing this yeah we've been doing this for almost two years now first of all let me reassure you I'm not a hologram I'm real right here so you know as you treat medical problems or you do various procedures that we have looked at you can easily understand that understanding the 3d relationship between various structures in the human body down to the microscopic level is critical and this becomes very important as the structures are often difficult to see for example the neural pathways or the inside of the year or down to microscopic levels like the structure of drugs and the receptors what mixed reality and virtual reality really lets you do this in a very unique way medical education like my mentor dr. young tells me has not changed and he's a historian who has studied this it has not changed in 300 years we usually wait here to see there so we have a lot of physicians that the audience will probably be nodding so we usually spend two years studying books in classrooms trying to understand why we are learning what we are learning and then the next two years trying to apply remember what we learned two years ago and apply it to real patients can you imagine that if you're trying to understand page case of Parkinson's and again I'm using dr. Young's example you are sitting in a classroom with a group of patients you actually see a virtual patient with the typical gait and the typical tremor now you want to dig down deeper you can see the structures in the basal ganglia and you dig down deeper you can actually see the structure of the various chemicals and the receptors and the 3d anatomy all of it working together with a facilitator in the same classroom or remotely you can do this the other thing I'd like to stress is all of us who have seen patients or beam patients know the importance of imaging nothing happens in the hospital it seems like without a CD and x-ray and MRI and ultrasound and echo what have you and our students instead of learning radiology right from day one have to wait till they get to the clinics to learn this what we can do now is when you're seeing a patient you can take their actual CT scan superimpose it on the patient so the patient's complaining of pain in the right upper quadrant you can actually see the cat scan of the right upper quadrant at the same time as seeing the patient so as we trained the physicians of tomorrow I really strongly believe that there is seriously a chance that we are an mr may actually help us prepare them for the medicine of tomorrow like we have not done for the past 300 years one of the things that we enjoyed if you will in first-year medical school was the formaldehyde smell of the anatomy lab is that going to be done away with a great question I think that's what we are looking at right now is what is the role of the actual physical cadaver and the experience clearly most of us remember it as our initiation into medicine and you know there's a lot of things you can discuss besides Anatomy when you're doing a dissection on a real human body do you need to do that for two years can that experience be customized to meet the learning objectives that are best taught with a cadaver with – the formaldehyde because we use fresh cadavers as dr. Drake would stress and then can you actually think about what do physicians of the tomorrow need most of us who have done a surgery residency or helped in surgery will tell you most of what you learned about anatomy that was relevant was done on the human body that was living and you know our previous CEO used to say everything he learned about cardiac surgery and valvular surgery was learned during fellowship and so what does the cadaver training actually give us I don't think we have the answer number five number five patient specific products achieved with 3d printing secondary operations and poor patient outcomes result in millions of wasted dollars each year the use of incorrectly sized implant devices has been linked to a host of problems ranging from general irritation to migration low function and complications to remedy some of the disappointing results Healthcare is investing in three-dimensional or 3d printing utilizing this technology medical devices are now matched to the exact specifications of a patient showing greater acceptance by the body increased comfort for the patient and improved performance outcomes some new and noteworthy work includes customized airway stents external prosthetics and cranial and orthopedic implants another application of 3d printing in healthcare is the printing of a patient's Anatomy as a visual aid for surgical planning the ability to hold a physical model gives surgeons the ability to conceptualize the ideal course of action prior to operating with its widening healthcare applications 3d printing has become a trendsetter in customizing patient care dr. Tom gildo who is head of the or director of the bronchoscopy unit in pulmonary medicine will discuss this yes dr. Roizen thank you 3d printing as a tool as a remarkable tool and for that are part of 20 years we've been looking at figuring out ways to use it in healthcare and healthcare delivery systems looking at everything from drug deliveries to replacement parts even to organic creating new organs the work that we've done in my section was really related to addressing probably the most common problem on patients is that everybody tends to be different and when we're facing problems related to anatomic structures where the diseases they manifest differently in every different human being we've been able to take that patients cats can generate a 3-dimensional prescription based on what we think the right outcome of this patient should be and replace it with a device that was made specifically for that person the patient's specific implant in doing so we've certainly relevant eyes the way we take care of these patients so where we used to spend a lot of time dealing with the complications of airway implants and dealing with the complications related to infection and migration and granulation and the like changing out that device one that was specifically made for that patient has been remarkable we've had enormous support from the FDA and the FDA has begun to understand and appreciate how to work with patient specific products and we're looking forward to taking this further now one of the things you told me right beforehand was that instead of putting a stent in if you will every 40 days of 44 days I think it was you went 400 days so that must be a great benefit to you and the patient helping that patient that way exactly so the the complication ranges that we deal with now again dealing just with the stents that we have that were mass-produced I would have to take them and cut them and sew them and fashion them for that patient and in doing so we were able to take what was a repeated procedure general Opera anesthesia operation with rigid instrumentation and changed that device and a major procedure major procedure every month and then we found a device we used the 3d printing to make a device specifically for that patient it lasted over a year and again the only reason we took it out is because we told the FDA we'd take it out in a year and plan for a new one so this this ability to impact patient live directly with technologies specifically designed for them certainly is gonna have great hope going forward in many different specialties number four number four advances in immunotherapy for cancer treatment using the body's own immune system to fight cancer isn't something new but its advancement towards a cure for cancer is the market for immunotherapy – cancer therapies has seen an unprecedented number of FDA approvals one of the most notable advancements is joint therapy the integration of immunotherapy and chemotherapy in a sample of patients with metastases non-small-cell lung cancer joint therapy has been incredibly effective more than doubling the cancer response rate from its rate with chemotherapy alone other innovations on the immunotherapy front involve therapies derived from t-cells new forms of engineered t-cells have exhibited enhanced anti-tumor activity targeting antigens on tumor cells allowing the body's immune defenses to attack the cancers within a patient the agent with the most promise in 2019 is that of a t-cell receptor TCR t-cell therapy developed for use in liver cancer the world's third most deadly with a near-daily discovery of new immunotherapy utak targets it is the hope that effective therapies will soon exist for all tumour profiles dr. Hedy care away from our Towson Cancer Institute will discuss this thank you so much for allowing us to be here today and to talk about this type of therapy for our patients is incredibly meaningful as many of you know lung cancer is a horrible diagnosis for any patient and this type of therapy has and will continue to transform the treatment not only for lung cancer but for many of the cancers that are out there I think this therapy in particular has been important for renal for bladder for melanoma and of course liver cancer a disorder that we really have not had much headway in for decades so this type of therapy really pushes the envelope and helping us understand how a patient's immune system can help eradicate cancers this is pretty exciting to be a part of and to actually witness so it is joint therapies rather than one we gave in fact the first immunotherapy I think as a top 10 probably five or six years ago I am reminded on Rolling Stone magazine in 2001 there was a picture on the cover of a the head of immunotherapy at UC Berkeley at the time who had failed their drugs all the immunotherapy drugs had failed because they were only given one year trials his company was going belly-up if you will he he had a company as well as being at UC Berkeley and so he said well let's just continue it but he was on the cover singing the immunotherapy blues if you will on rolling stone he recently said the joint therapy are going to take for example malignant melanoma from a chronic from a chronic disease cancers a chronic disease to a totally curable disease in 80 or 90 percent talk to us a little bit about joint gosh I hope so I think we have some refinement yet to still do not only in the way that we want to deliver these agents the ordering of these agents and even the subpopulations that matter with regard to genomic information expression of particular ligands like PD PD l1 EGFR and other mutations that then target a totally different pathway so I think genomic information selecting the appropriate patients to give them the right therapy and equally important to spare them therapy that's going to add toxicity and not benefit the ability to eradicate minimal residual disease I am optimistic that are the patient's own immune system probably is poised best to harness that desire and we hope that that will happen in the future I'm just going to add one more point he said in fact because of the the differences in genetics and the way drugs are approved in the United States we're running out of patience for trials and we need all of you and all of us if we god forbid get these diseases to sign up for clinical trials because that's important in advancing the field thank you for that point I couldn't agree more especially in the world of oncology clinical trials are paramount number three number three expanded window for acute stroke intervention slurred speech arm weakness these are signs your loved one is having a stroke then you think with a death rate of two million brain cells per minute prolonged lack of blood flow can cause irreversible damage resulting in loss of brain function and disability until now the six hours after stroke onset were thought to be the period of time during which intervention was most effective however new research suggests that the window for intervention may be longer new guidelines released by the American Heart Association and American Stroke Association in January 2018 recommend an increased treatment window for clot removal expanding eligibility for this intervention the recommendations came in light of results of the dawn and diffused three trials which Illustrated the benefit of mechanical intervention up to 24 hours after onset of stroke this expanded window for acute stroke therapy is changing practice and benefiting patients around the world dr. suzanne hassan from who the senator director and cerebral vascular interventions in the neurologic institute will discuss this score that's two for the brain and one for the hearts no and as was already discussed again we do recognize of course that again that mantra and stroke has been time is brain certainly we want to treat people very very quickly and get them to medical attention as soon as possible but we do run into situations where unfortunately the patients don't at presenting the short time windows we have for some of our acute stroke therapies for example if someone's found down they went to sleep the night before and had their stroke while they were sleeping we may not be within those time windows and unfortunately the time windows were limiting the ability for us to treat a lot of patients so we used to have this six hour window which was what the original clinical trials that proved the thrombectomy therapy did however now with this these new trials that have shown we've actually now been able to expand this window and it really it comes down to selection of patients using advanced imaging techniques with CT as well as MRI we're able to select those patients that really even out further have brain to save so now we can go 1224 even after after 24 to 36 three more hours picking out those patients that really can benefit from the therapy and as dr. Bain had mentioned we're talking about you know a number needed to treat up to which this is probably the most effective treatment in medicine short of the medication to treat lice the one of the things was TPA was advanced for those of you who don't know the person who pushed TPA to the brain justin's even doctors even died this year but he had to fight with both the FDA and NIH to move it from the heart to the brain it's also been a fight to use both TPA and if you will mechanical interventions for the brain do you see is there an advantage of the mechanical over the TPA or are they used together how do they fit together we've learned a by the way is a clot dissolver sorry right correct a clot buster medication we've largely viewed the two therapy as complementary so when you're within the window for IV TPA which is a you know recommended in the guidelines up to four hours after symptom onset we do like to give that TPA medication but we have to recognize its limitations as well that for very very large clots which these elbow or emergent large vessel occlusion type strokes are the TPA if you give it to the intravenous it's hard for that medication through the intravenous to really eat away at that clot and dissolve it up fully and so thrombectomy really has come along and allowed us now to be able to treat these most severe of strokes getting those claws removed out of the blood vessels and it's really nice to see now that we can really move this therapy and and treat patients well further out than we could ever treat with IV TPA and so this changes the disability rates from strokes absolutely out again with these number needed a tree we're seeing a lot more patients you know improvement in their functional outcome their ability to return to home to work and to function we're talking about patients that normally would end up with a really large stroke that would either kill them it'd be fatal or you leave you with severe severe disability remember that stroke is the number one cause of disability medical disability around the world and so to be able to have this treatment that can prevent that severe severe outcomes that we see from stroke is really a big step forward number two number two the advent of AI in health care in this age of technology artificial intelligence knows no bounds once thought a futuristic threat to humankind AI is changing and saving lives not intended to replace clinicians or clinical judgment ai serves the purpose to enhance and complement the very human interaction a provider and patient in healthcare AI is changing the game with its applications in decision support image analysis and patient triage with their ability to reduce variation and duplicate testing decision support systems quickly decipher large amounts of data within the electronic medical record AI technology is also taking the uncertainty out of viewing patient scans by highlighting problem areas on images aiding in the screening and diagnosis process artificial intelligence helps with the issue of physician burnout by collecting patient data via an app or text messaging chat BOTS now ask patients a series of questions regarding their symptoms taking the guesswork out of self diagnosis and saving both the patient and provider time and money with the AI integration working smarter enables solutions to a variety of issues for patients hospitals and the health care industry dr. ed Marx the chief information officer the Cleveland Clinic will discuss this created it may not be hearts or brains but a I will help max Lewis has a value of all the different innovations we've been speaking about what's great about AI it has the opportunity it's Cleveland Clinic to really impact all four areas that are so important to us whether it's the caregiver experience the patient experience the community or the organization but what's really exciting is what we can do for the patient experience so this morning I was with our development team as along with our our epic development team and we're talking about the patient triage so the patient can self triage and it's all powered by AI and to the point that they may be directed to come in for a consult and then everything is automated so the system knows what kind of physician they need to see maybe who by specialty by a very specific subspecialty who they need to see in what tests do they need to have before they even make a phone call and so the time to treatment is much quicker the patient is more engaged and then on the clinician side make everything easier for the clinician to help bring together information ahead of time so that the clinician doesn't have to spend their time digging for information but it's presented to them and then assists them along the way as they go through the diagnosis themselves and for the treatment so from a quality perspective from a pure patient experience perspective and from a caregiver burnout perspective a i''k is really a game changer now one of the things we were promised with the electronic medical record it was going to give us more time to help be with the patient and motivate instead what it's given us is more time to spend on a keyboard and it's said to be the leading cause of burnout whether that's true or not before we get into that argument the will this improve our time will would make us physicians more efficient I believe it will we've seen sound results early on with pathology and in radiology and dermatology where through the utilization of AI we can help prioritize use cases that need the most attention ahead so we can be more efficient in our workflow and then some of the things that would have you know we talked about operating on top of license some things can be handled by the AI but we call it an important differentiation for us is we call it augmented intelligence not artificial intelligence because we will never replace the the clinician the empathy the touch that we give to our patients because that's what differentiates us here at the clinic now one of the things you just mentioned was image it is an image reading which is so difficult to pick out cancers etc where are we in that with us yeah so we work very closely with our imaging Institute talking about a lot of different strategies that we're planning on employing definitely there's other examples in the industry where there's been a lot of success good track record so we continue to work together to start doing our own rollout of that and we believe that through the literature that we've seen and through others experience that we have a great opportunity so you'll see that coming here shortly so that's detection of images by a machine and then read reread by a physician rather than a couple physician right and then it would be reprioritized so we we have 24/7 coverage and we some things that are low acuity that we don't think require immediate attention those would be prioritized lower than things that require immediate immediate attention because today we might look at all we get all these inputs at the same time and we go through sequentially but that's probably not the best method in terms of caregiver burnout nor from a patient experience so it automatically prioritizes those that need to be read quicker than others number one number one alternative therapy for pain fighting the opioid crisis nationally the opioid crisis claims a hundred and sixteen lives a day the death rate from the opioid-related overdoses has been declared a health emergency twenty to thirty percent of patients prescribed opioids for chronic pain misuse the drugs with potentially detrimental consequences given the human suffering and economic costs every incremental solution to the opioid crisis is welcome one important element to consider is genetics just as one's genetics influence for example high skin and hair color so to do genetics determine an individual's ability to metabolize drugs effectively pharmacogenomics the study of how genes affect a person's response to drugs is an excellent tool to individualize prescription pain medications with pharmacogenomics prescribers will be able to determine how a patient metabolizes their prescription and guard against potentially dangerous adverse drug reactions free prescription testing can also be used to determine which patients won't respond due to their genetics to some opioid based drugs and point toward a more effective treatment for each patient's pain in 2019 with increased access to genetic testing pharmacogenomics is poised to make significant inroads into precision medicine and a solution to the crisis dr. Jennifer Hawking's a pharmd in the genomic Medical Institute in Lerner will discuss the this application of pharmacogenetics thank you first of all for having me up here it's an honor to be up here with such distinguished individuals pharmacogenomics essentially uses a patient's genetic makeup to predict response to medications and by having this information before a prescription is written we can predict and select who may have adverse effects to certain medications who may not respond to certain pain medications that gives us the unique opportunity to select a medication that the patient will respond well to and what's important to note about pharmacogenomics is that this information can be used for a lifetime and it can be used not just to help with pain management but also can be used in medications are used to treat it depression nausea and certain infections in other words the way I kind of see pharmacogenomics is this is about getting the right drug at the right dose to the right patient so we had a number of submissions over the years of 3d printing of advances in robotic surgery for example and in pharmacogenomics the group felt that this was the year that it was going to take off is that right yes I think that we have to be careful and because in that pharmacogenomics by saying that it could potentially solve or cure the opioid crisis might be a little bit of an oversimplification but I think what pharmacogenomics can really do is predict who will experience severe adverse effects to certain pain medications and who may not have pain relief from certain pain medications that allows us to prescribe medications for that particular patient and minimize and potentially eliminate unnecessary or ineffective prescriptions out there in conversely if someone requires more pain medication you may know that yes and so one of the points that you know it I always emphasize is that for patients who are not responding to their pain medication and they go through their medication very quickly they may return sooner than expected asking for a new one and unfortunately sometimes we ascribe unfairly to these patients that they may be drug seeking when in fact their genetic makeup may not allow them to respond to that particular pain medication we've given them and this allows us that unique opportunity to then select a different medication that would work better for that patient there are other things that the group looked at combined in this area of helping to solve the opioid crisis including food choices other medications aromatherapy stress management shared medical appointments all were grouped together because it is felt that the intensity of effort plus the pharmacogenomics will in fact help solve this or at least turn this problem and that's out of it in one year but turn the problem into a solvable one soon please do submit questions so the first one if you will goes to number eight robotic surgery and I wanted to get your attention dr. cave which is how do you see the advancement of autonomous robotic surgery versus tell a manipulation the analogous to self-driving cars versus driver assist I think both ideas are a step forward I think that automation is coming because you know the day of having the surgery done just by bare hands and bare eyes if I might say may not be acceptable in the future so automation allows the machine to help the human during it doing a task and you see it all around us with what we do during our days so it's coming to an operating room and the procedure room soon and the visor where is it this stand for working with the DoD and is this related to can you relate this to wartime injuries did it develop there yeah yeah I mean I think it has great potential for that anywhere that there can be a difference in fluid in the brain this has a potential t to work so trauma hemorrhages stroke brain tumor I think you know stroke is a hot topic right now so that's why it's been focused in the stroke space but I think it has a for military use for soldiers for anywhere you get this device which it's gonna be widely applicable I think it's a great idea I'm going to ask the final question unless there are more but this one relates to a model so is it possible to do a 3d model of for example a prostate with a tumor and our expert dr. Kyle you practicing on that model and then making it our autonomous robot that makes the surgery faster so I'll take that but I think the urologists are right here next to me so essentially almost if you think about imaging what we do is take 3d images with cat scans and MRIs but to look at them we are actually slicing them and then displaying them on a 2d screen but the image is actually 3d so what we can do quite easily now for things that have high contrast like cats cats or studies with contrast bones those are relatively I can do it in a few minutes myself you would not get the software that will help you do that MRIs are trickier because of the multiple gray scales but yes people do that the same thing with Neurology MRIs of brain tumors you can create models once you have the model you have two options one you can 3d print them but that is a slower process right now expensive slow but you can just visualize it in a we are or mr and save time okay I think that that the 3d printing will compete with simulation and education so now sometimes we train our residents and fellows by having a simulation and it's all virtual they're doing the surgery through like a game like a video game that you see well now we can actually print the organ put it on the bench and the trainee will sense the robotic instrument or the endoscope or whatever you're using in more reality-based to teach them so I think that's going to be a competition with simulation in the educational field I want to thank you I also want to especially thank the staff of the innovation Institute that did the preparation of all 250 summaries and has gathered the group here and especially you for staying so long and helping us motivate ourselves to do better so thank you very much [Applause]

20 Comments

  1. murphy Momoh said:

    Yes

    June 29, 2019
    Reply
  2. Night Knight said:

    Thanks!

    June 29, 2019
    Reply
  3. CIS News Network said:

    nice video #CIS_News_Netwok

    June 29, 2019
    Reply
  4. COMMANDER FLAME Gaming said:

    that guy reminds me of the short guy in incredibles the boss. and harry osborn mixed

    June 29, 2019
    Reply
  5. ilmas ashraf said:

    by the time ur fucking innovations will work millions more will be dead

    June 29, 2019
    Reply
  6. AnastasiaRoo said:

    Fundraising Medical Community Service www.gofundme.com/brightislandoutreach in the Dominican Republic.

    June 29, 2019
    Reply
  7. onlythewise1 said:

    twenty years from now were all most curing something ,only need another 100 billion of tax money

    June 29, 2019
    Reply
  8. onlythewise1 said:

    say ,we cant cure much of anything but we can make you feel better for a price , why cure anyone when you can make billions off of making you feel better and only millions curing someone

    June 29, 2019
    Reply
  9. Baka The Genius said:

    Can someone please read this and see if it’s a good idea … yk how cars have code scanners? How the check engine light comes on and then someone can hook up a code scanner and see what the problem is… what if someone invented something (idk maybe nanobots to reside in the bloodstream) that monitored how the body was behaving and then doctors could just hook up a device (kinda like a code scanner) , read the information from the nano bots and if not know exactly what’s happening to a person .. then at least have a general idea

    June 29, 2019
    Reply
  10. Patrik said:

    AI in healthcare is #1 but they downplayed the implications – it will eliminate so much waste and redundancy in the system. Everyone will have a personal AI doctor available 100% of the time – always responsive with no waiting time. It will be constantly updated with the latest research and data. Sensors and test-equipment will not only be able to diagnose you when you're ill, you'll be made aware of issues in real-time well before they break out – so illness can be prevented.

    Also if there is an flu epidemic in your local area, you'll be made aware of it, and outbreaks can be contained. There will be much less travelling to a physical building to visit a doctor, no more waiting for care – there will be physical labs for more advanced testing, but much of that will be automated as well.

    Now there isn't really much preventing this from happening today – the knowledge, AI, sensors and equipment is already out there… but the implication for the industry is enormous as is the benefit to people.

    June 29, 2019
    Reply
  11. Dr. Christian Hirsch said:

    Sounds great. Thanks for sharing!

    June 29, 2019
    Reply
  12. charles kidney said:

    It is very important to realize, medical error is the 3rd leading cause of death in the US. People need to do their own research and really be their own doctor, Google really gives better diagnosis than most doctors. Also people need to focus on preventing themselves getting sick 80 percent of cardio vascular disease is preventable as is 2/3 of cancers. Focus on prevention and if you do get sick, do your own research and be prepared to see a few doctors before you find a good one

    June 29, 2019
    Reply
  13. Kester Gascoyne said:

    Thank you for hosting and publishing this online!!!

    June 29, 2019
    Reply
  14. Denarius Wright said:

    These innovations will no doubt change the game, but I think they also prove that healthcare in The US should never be under full government control, we need independent private insurance companies that could cope with the cost of these uber expensive advances -DW (04.18.2019)

    June 29, 2019
    Reply
  15. ucha10 said:

    #7 👀

    June 29, 2019
    Reply
  16. Dr. Shokhrukh said:

    the 6th is just super. i love that one in advance

    June 29, 2019
    Reply
  17. Shimul hossain Shimul hossain said:

    Medicine is use for curing sick people and trillion Dollar fund are investing for curing Cancer,Diabetics,HIV Disease patent It is ok.On the other hand trillion trillion Dollar are using for killing Sound Health people if Healthy people died by using Nuclear weapon what is the benefit of invention of new medicine for living sick people. Medicine is betterment for human being nuclear weapon is harmful for human being So Destroying of mass killing weapon is necessary beside invention of new medicine if doctors want to sustain their achievement they should invention some medicine against nuclear weapons reaction to save the innocent people.

    June 29, 2019
    Reply
  18. Not Me said:

    Hey thank you for this ❤️

    June 29, 2019
    Reply
  19. Ryan Syme said:

    10: RNA interference – 2:20

    9: Mitral & tricuspid valve percutaneous replacement – 7:00

    8: Innovation in robotic surgery – 11:00

    7: Visor for pre-hospital stroke diagnosis – 15:53

    6: Virtual and mixed reality for medical education – 19:48

    5: Patient specific products achieved with 3d printing – 25:47

    4: Advances in immunotherapy for cancer treatment –29:54

    3: Expanded window for acute stroke intervention –34:54

    2: The advent of AI in healthcare – 39:40

    1: Alternative therapy for pain: fighting the opioid crisis – 45:00

    June 29, 2019
    Reply
  20. Nick Soma said:

    Very informative and effective presentation. Thanks!

    June 29, 2019
    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *