All over the world, healthcare experts worry about the seemingly unstoppable proliferation of healthcare technologies. Their budgets are already bursting; how can they afford yet more? Richard Kitney's answer is - easily! New technologies are not a resource drain; they're the only affordable hope for global medical care. Trained as an engineer, he is now Professor for Biomedical Systems Engineering at Imperial College in London and runs the Centre for Biological and Medical Systems, which is devoted to pushing the boundaries of information technology in healthcare.
Wired: What are the main failings of medical technology?
Kitney: None of it knows how to talk. Ultrasound scanners don't talk to magnetic resonance scanners; MR scanners don't talk to computers. Dicom 3 [the standard for medical information systems] is pretty comprehensive, but much of it is still on paper - 3,000 pages of it. Our group, together with MIT, have spent a long time developing a high-level toolbox to put Dicom 3 into action. What we're creating is an overall medical IT infrastructure that will cover all the internal workings of a hospital, but also stretch much further afield.
Is there a way of testing it all out without throwing a working hospital into chaos?
Yes. Imperial College's new medical school opens in October 1998, and we're designing its IT infrastructure from scratch.
What differences will that make?
IT can offer the site real-time imaging for students: you might be sitting in the main lecture theatre here in South Kensington, watching operations being performed worldwide. A ground-breaking operation in Los Angeles, watched 7,000 miles away in real time, with room on the band for questions and free conversation. This would have been inconceivable even five years ago.
And outside the classroom?
It's two in the morning in London. We're junior doctors, and we're in a situation where we want help. The hospital's consultant is fast asleep; if we wake him up he'll probably make the wrong decision. What do we do? With the "University of Southern California" we're developing a 24-hour global healthcare demonstration network. For the pilot we will have sites in London, Los Angeles and probably Bangkok - the Thais are extremely interested in all aspects of medical IT. All three sites will have resident experts across a wide spectrum of specialities. Doctors needing assistance will call up across the network to the resident team in Bangkok.
Aren't expert systems a more cost-effective solution?
In certain areas expert systems are already very effective. In the interpretation of electrocardiograms, there are one or two systems which throw up the correct diagnosis 99 times out of 100. US-based agencies, to which you can transmit an electrocardiogram over telecoms or the Internet, will process that ECG through knowledge-based systems and give you a diagnosis. Knowledge-based systems are also particularly good at throwing up alternative diagnoses. After a long day a GP is presented with a patient whose symptoms they will probably only interpret one way, but a knowledge-based system may take that information and throw up two or three alternatives. They can be very useful because they encourage lateral thinking. But we're nowhere near the point where we can replace the judgement of clinicians with IT.
And how much is all this connectivity going to cost?
Some say healthcare is expensive enough without the addition of more expensive technology. My argument would be that healthcare is hugely expensive, about 10% of gross domestic product, and that to cap or reduce that figure, you need a radical revision of healthcare as a whole. All over the world, healthcare policy is converging onto a common model: the purchaser-provider model that is now used by the NHS. Using this model, IT actually reduces the cost of healthcare - it brings savings in time and resources because it gives people the information they want when they want it. That in turn leads to a better use of human resources; GPs in particular will play a much bigger role than ever before.
Some people worry about becoming mere numbers in such a system. Won't medical IT homogenise the way patients are treated?
Quite the opposite. Take a patient in an intensive care unit. Their physiology - heart-rate, respiration and so on - may be very different from your own, but that's not the point; what really matters is whether it's drifting from what it was an hour ago. The next generation of monitors will check the patient's current physiological state against an evolving model of what it was one, ten or a hundred hours before.
And will those machines be able to respond to changes in a patient's state?
Not yet, but soon. For instance, we've been developing a new technique which allows a nurse to see extremely easily whether a baby on a ventilator is distressed or not. The next stage is to design feedback systems so the ventilator itself knows what's going on. The machine adjusts to the baby, and the baby adjusts to the machine.
It sounds like you're making cyborgs. What are the chances of IT helping to create artificial body parts?
For organs, tissue engineering will get there first. Tissue engineering is moving by leaps and bounds. It can do more than create different tissues - we're now able to recreate the geometry of those tissues. Where medical IT comes in is in imaging and interpretation - making sure cells and structures are growing properly. Very soon now - within the next year or so - you'll see cultivated cartilage entering the market. Linking tissue engineering to genetic engineering, it then becomes feasible to consider growing replacement organs.
Will developments in fast-moving areas like tissue engineering revolutionise your work, or make it redundant?
Our work will be revolutionised by nanotechnology in the next 20 or 30 years, but nobody really knows how. On the other hand, it will be only 5 years before microsurgery becomes a cost-effective possibility. We'll then be able to repair nervous tissue a nerve at a time. The imaging and modelling associated with that kind of surgery is extremely exciting.
Simon Ings is a freelance editor and the author of several novels, including Hothead and Hotwire.