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Wednesday, May 30, 2018

eHealth forever or technology forever?

I have been writing this "ehealth enabled browser" blog on eHealth since after I graduated with a M.Sc. in eHealth in 2012. I will probably be spending a lot less time blogging here. I still enjoy following the various topics and points of interest that I have encountered in digital health.  Recently one of the great health informatics bloggers, Dr. John Halamka - the Geek Doctor - has decided to wind down his blog. Looks like he is taking more to the twitter sphere. I highly recommend you check that out if you are interested in Health Informatics (or life in general).

A little while ago something I read inspired me to think about writing the ebook version of the "ehealth enabled browser" that I have run here on the earthspiritendless URL at blogspot.ca  Turns out I may have received more inspiration than the perspiration necessary to do that. For the time being, I will settle for writing this post. This will try to encapsulate what I think I have learned by following digital health during this blog experience. To start off  - let me try to explain the significance of the title of this post - eHealth forever or technology forever?

I saw a TED talk where I heard that essentially "technology lives forever" (Kevin Kelly - How Technology Evolves). To illustrate this point the presenter used the example of a steel plow, the kind our ancestors not so long ago pulled behind horses or oxen. A schematic or blueprint of this technology would allow anyone with the technology to replicate it - in essence, bringing it back to life. The technology will last many hundreds of years and would still exist in some less than functional form even after the warranty expires. When it is totally broken, you create another one. Maybe the most difficult thing is just preserving the knowledge and information to manufacture it.  Well, biological beings might appear to be in the same category - cloning DNA - but let's face it, we break down more permanently than the technology we have created. Which leads me to the URL name for this blog - earthspiritendless. The final word is going to be that none of this matters and that only the Earth abides. Nothing lasts forever.

I can't remember why I named this blog URL earthspiritendless when it was supposed to be about digital health and the study of health informatics. The title of the blog - "an ehealth enabled browser" - suggests a blog about someone "browsing" or reading about ehealth.  The URL name actually comes from the English translation for a Tibetan name a Tibetan Rinpoche (reincarnated Lama) gave me in Bodhgaya, India. It is not a riff on the sports wear company that makes earthspirit brand running shoes. I always did have some fear that the company would track me down and accuse me of infringing on their brand or something. The fact of the matter is that there is no connection between ehealth and the Tibetan "nom de religion".

Since eHealth has a computer science focus there is always going to be an attraction to future technologies - for as we know - technology evolves. If you want to try to follow where computer technology is going in the future, there would be no better futurologist to consult than Ray Kurzweil, currently Chief Engineer at Google. It was by reading his books and starting this blog that I began to see a convergence in the ideas of transhumanism, the singularity, and health informatics - a future where we need to learn how about the role of the health care system along with life extension concepts and technologies. I also read his weekly Accelerating Intelligence reports on new discoveries in science and technology, and have a link to it on the blog.

In the field of eHealth itself one of my overall impressions is the continual need for research and systematic reviews on the efficacy of eHealth for improving health and quality of life, as well as a return on investment. The latter just means an improvement in the quality of life. This is where the great service of such academic venues as the Journal of Medical Internet Research is focused. If I was to go back 7 years with a serious intent to study eHealth - toward a PhD for example - I would be busy reading, saving and studying journal articles. eHealth is a business, computer science, and health science interdisciplinary work, and it is always important to keep that in mind when reading and assessing journal articles.

I suppose if I was to generalize about what I have reviewed in digital health into categories of most interest to me and this blog, I could come up with something like this:
  1. Careers
  2. Ethics of Technology
  3. Life Extension
  4. Personal Health Records - Toward the Quantified Self
  5. Spiritual machines

A spiritual master was once asked what is man's greatest need and the answer was "having work to do". Sorry I don't have a reference for that or even if I have reworded that correctly, but it really means that we find no real meaning in life unless we do work.  Health Informatics as an educational program is an applied field where internships are developed, so it is career oriented from the beginning. One reason I studied it was the possibility of making a career change into what I perceived was an exciting field that had many new developments on the horizon. This blog was never going to provide me with an income from the google ads ( I made enough to buy a few cups of coffee so thanks for those clicks!). I once thought of extending it as a possible business and I secured an URL called ehealthenabled.ca with the intent of developing a site/service for ways of empowering people to use ehealth technology.

That ehealthenabled.ca site didn't run for longer than a year, and I used it mostly to explore again web development in the suite of web hosting software one finds in Control Panel. I learned that WordPress is better than blogspot for creating content. My problem was that I didn't really know what kind of content to bring to market. I had a vague sort of idea that what we need for public and preventative health were ehealth technology "garages" in every neighbourhood. When cars were mechanically breaking down all the time, every neighbourhood had a repair garage - all gone now as pumping stations have consolidated and cars no longer break down as frequently.  These self-service or consultant oriented ehealth stations would also have exercise equipment and all kinds of mobile ehealth technology available, including DIY ultrasound, tDCS etc - after working through the health, safety and privacy concerns of course. We know now how important exercise is for health and having access to resistance training equipment -and/or health coaches - is a fundamental health technology.

The other and perhaps most interesting aspect about an eHealth career is the current potential for entrepeneurship, start-ups, and innovation. eHealth is an applied field, an application of ideas and technologies to solve ever changing and challenging problems in healthcare. I have participated in several Health Hackathons and it would have been great to get involved in some of these types of activities a lot earlier. I would also like to turn the clock back a few more years so I wouldn't miss the mobile app programming bus! Knew that one was coming - did nothing much about it.

Ethics of Technology

Since I work professionally in an ethics related career ( university research ethics) I naturally have had an interest in technology and ethics. For many years I was more interested in bioethics generally and have some courses and conferences under my belt (including a conference presentation on RFID privacy and security concerns in Healthcare). In the past several years there has been a strong shift towards just focusing on the ethics of new technologies and I trace this back when Demi Hassabis sold his DeepMind artificial intelligence gaming software company to Google. Forming an ethics technology committee was a condition of the sale to Google. There is relevance to eHealth a lot here because at Google, Deep Mind went on to develop Alpha-Go the AI that defeated the best Go players in the world. Alpha-Go is also being used in Healthcare, much like IBM's Watson.

There is a really comprehensive research group that also has an open source journal called the Institute for Ethics and Emerging Technologies -  https://ieet.org/. It is interesting to follow this group. I once tried to interest them in publishing an essay I wrote about Steve Mann but I ended up posting it on my Linkedin page - a version of it at least.

Life Extension

I think I only seriously became interested in how life extension related to eHealth by reading Ray Kurzweil. Medicine is more and more becoming an information science apparently. I think the corner was turned on that once medical reference libraries went digital. Living forever is a serious science fiction theme but if Ray is right and exponential changes is happening in computer power, discoveries in science are going to accelerate.  The idea that we should be trying to stay healthy to live longer is not new, but the idea that we should seriously try to stay healthy in order to possibly benefit by new life extension technologies that will be available after the singularity - in 2030? - certainly is a new deck of cards.  The movie Elysium, one of probably a thousand or so that explore life extension ideas in science fiction had a credible healthcare technology that could cure any disease.

Is this something I personally want and help strive to attain? Something like this is a foundational and massively transformational (thank you Peter Diamandis for that concept)  movement and revolution in healthcare where the ethics of maintaining quality of life is so vital. What if we as individuals don't have a choice for how long we are going to live if even the dictates of healthcare ethics say we have to be preserved in some form of silicon based artificial intelligence while our biological DNA is being reprogrammed for cellular regeneration. Maybe it will just come down to a duty to care?

Another spiritual master was asked what was the secret to his longevity and health and he replied "Living off the interest of my investments". Sorry - no reference for that anywhere on the Internet at the moment. Maybe I heard that before the internet.

Personal Health Records - Toward the Quantified Self

The ehealth enabled blog explored a lot studies about personal health records. An aspect tangential to that is a concept called the "quantified self". Will collecting a lot of health data in a "do it yourself" sort of way help save us? I found it interesting to read about experiences with fitbit heart rate data, facebook posts on personal health issues, and other such patient lead data collecting activities, that have resulted in some life saving measures.

The really protracted issues that never seem to go away are the problems with data interoperability. It is hard to join an HL7 committee and help advance the work of interoperability (tried that).  Not everyone is cut out to help write standards. New standards then emerge - FHIR for example. Now there is talk about how the blockchain will be used for the "provenance" of information. Who owns my health data, me, my doctor, or the data miners?

My own conclusion here is mostly about usability.  Collecting our own personal health data should be like an ongoing construction or renovation project where the tools are easily accessible.  Are we not building the virtual self? Log ins to health records are cumbersome - so is typing up the data. Just let the healthcare system do it? We have to be able to better track and record our ongoing health concerns - with or without the healthcare system. I also think we need artificial intelligence in the health record in our social media to tell us when to do things, based on our profiles and our precision medicine disposition. Out of nowhere, we should get a suggestion to get a shingles vaccination!

Spiritual Machines

Meditation to me is a form of health technology, and my teachers were like physicians who prescribed the daily practices for my own benefit, and the benefit of all sentient beings. Experimenting with the Muse EEG headband which is designed to induce or teach one how to enter a meditative state was a highlight not only of my blog posting, but of my own meditation experiences. Though I learned meditation in a long, hard, and traditional kind of way, I truly value the potential for technologies like the Muse. Talking AI or virtual doctors aside, exploring our own calm states of mind is going to make us better people in the long run. For then, we will known what we know, and what we don't know.