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By Design

January 1, 1998
by Terry Monahan
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Executive Summary

Who: Kenneth L. Kaplan
Architect and Principal Research Scientist
Department of Architecture and Planning
Massachusetts Institute of Technology, Cambridge, Mass.

What:Scientific Director of the National Healthcare Project.The project’s research committee conducted its first meeting with industry in September; plans are under way to establish technology test beds within the U.S. military healthcare system later this year.

How:By partnering with civilian test beds and the Department of Defense, which through its Advanced Research Projects Agency has prototyped some of the most sophisticated and practical healthcare technologies in the world, the NHP plans to identify and test practical, available technologies that are ready to deploy in the near future.


Four years ago Kenneth L. Kaplan, an architect and researcher at Harvard and MIT, received a grant from the U.S. Department of Defense Advanced Research Projects Agency to research the surgical room of the future. The project began as an investigation into improving the outcome of front-line battlefield casualties which, because of the difficulty in locating and diagnosing injured soldiers, has not improved significantly since the Civil War. But time spent in mega-hospitals like Massachusetts General in Boston convinced him that if he intended to redo the surgical room, he’d have to take on the whole hospital--and by extension, the whole healthcare environment.

A year later he was asked to testify about his research before the House Science Committee’s subcommittee on technology, which under U.S. House of Representatives Speaker Newt Gingrich was interested in how advanced medical technologies could help improve the population’s health status. From biosensors in diagnostic monitoring to a telemedicine-based home healthcare network, Kaplan cited the cost and quality-of-life advantages of various current technologies--many of them being developed by the Department of Defense, academia and industry. He concluded that advanced healthcare could be delivered to soldiers and citizens alike--anywhere in the world.

With the encouragement of Congress and the technology subcommittee, Kaplan, a former social worker in New York City, has expanded the Surgical Room of the Future Project to an ambitious National Healthcare Project. Under the auspices of the Potomac Institute for Policy Studies, a nonprofit technology and policy research organization in Arlington, Va., the project’s research council held its first industry meeting last fall with representatives from Wang Healthcare Systems, 3M, Honeywell, Inc., Overture Prime Inc., CVS and GE Medical. This year the project intends to develop several advanced concepts for technology application in healthcare delivery--and to test them within the vast and comparatively well integrated U.S. military healthcare system.


How did research into surgical-suite design mushroom into reinventing healthcare?
In looking at using advanced simulation computer tools, I spent a lot of time visiting with doctors, watching surgeries, walking around the hospitals. Mass. General had 45 operating rooms for various surgeries. Why wasn’t there one basic room? Why when a new procedure came along did there have to be a new room built? I walked the hallways, came across rooms and the way people worked in them didn’t make sense--they were even dangerous, with an enormous assortment of wires, cables and stuff everywhere.

The system of healthcare is simply unsystematized compared to other industries. There’s an irrational aggregate of buildings that you have to go to to get treatment. It was a research question: If you started with a blank slate what would you do?

I went from enthusiasm to despair. I’m an architect. Most of the buildings’ designs haven’t changed in 40 to 50 years. And if you’re going to design a building, the facility has to last 40 to 50 years. How can a room of furniture and equipment be integrated better? McDonald’s kitchen has been completely thought through. It’s foolish to design a hospital today based on paradigms of 20 to 30 years ago.

So what’s today’s paradigm?
The focus of investment in healthcare today is not wellness, it’s later-stage disease. It’s on the surgeries. That’s where care is being delivered; that’s where the money is leaking.

Everyone agrees we want optimal care, but the costs are extravagant. How do we integrate high-quality with low-cost delivery--and get wonderful service? If you have your major investment on prevention, nothing’s to say you’re going to lower costs and people are going to live longer. But there’s certainly a lot of evidence now that diseases once restricted to Western culture are expanding to the global culture--heart disease and cancer are growing, and now in the Far East we’re building new hospitals for later-stage disease--literally duplicating what we have here. How do we turn a large ship around toward prevention? That’s really the challenge now.

The model we develop will reverse some of the irritating and disturbing elements that are causing the turbulence in the field. Two major problems are enormous cost and how little you get in value for that cost.

What gives a project this ambitious a chance for success?
The National Healthcare Project brings together designers, engineers, technology developers, doctors and healthcare providers. What we’re doing is concurrent engineering. Traditional engineering is linear: You design something, build it, and then ask people to comment on it. Concurrent engineering came through aerospace design--that’s what healthcare needs. You don’t want to design something and then ask the doctors: Is this what you want?

Combining architects and engineers with doctors and the traditional provider brings a unique approach, and even the traditionalists understand the need for these new perspectives. The content here that’s come out of the project is the notion of working with government agencies like the Department of Defense where you can try out new systems in environments where you can study and work with real patients and doctors in real conditions, and introduce challenges and problems that stand to be proven. Most clinical trials have narrow focuses--nothing’s wrong with that, but if they’re not integrated with a broader focus they’re not going to relate to the broader issues. What NHP is at best is the broad focus--the sweeping rethinking of healthcare delivery with a focus on improving access, quality and lowering cost.

Within the NHP, projects will focus on different aspects of the system, but what’s important is that the projects relate to the larger vision. There’s got to be a long-term vision as well as a short-term strategy. Particularly today, if you’re going to have a long-term strategy, you have to be thinking technology.

This isn’t to say that there won’t be naysayers or people who aren’t overly enthusiastic. The field is so chaotic right now, there really isn’t strong leadership on which way to go. In that kind of social or political environment people get mistrustful of someone taking the lead. On the other hand, what’s going in our favor is a growing recognition by all the stakeholders that something’s gotta give, because it’s not working.

What’s the ultimate NHP vision?
In the future, there are two worlds that would be very different--work and home. In the home would be an enormous access to medical information. The home would have unassuming devices with medical capability. Sensors would read your life signs and respond. The home would be your first line of defense; rarely would you have to go into a healthcare facility for "maintenance."

What would be radically different would be access to powerful resources of medical information, unassuming medical devices in the kitchen or bedroom or bathroom allowing you to eat, sleep and deal with stress in an educated way. Every one of us would have a care counselor or a care broker who with the information available in your house could help you automate your microenvironment, prevent accidents, help you develop behaviors toward a healthy lifestyle.

There’s a technology revolution going on. Healthcare is the one industry that’s least exploiting it.


The National Healthcare Project

Objectives

  • Partner industry with leading experts in medical specialty fields
  • Define areas of advanced technology based on clinical specialty problems
  • Identify how healthcare research and development consortiums can provide the best alternatives with near-term results and long-term strategy
  • Define an alternative system development method to address medical specialty clinical objectives, in contrast to conventional medical research and development avenues
  • Identify solutions through advanced technology for early detection of disease
  • Develop a focus for consumer-driven products for medicine that targets wellness and empowers patients to share in managing their care
  • Mold a 21st century cost-effective healthcare model based on early detection and preventive medicine
  • Influence (and benefit from) technology research and development policy

For more information about the National Healthcare Proejct, contact:

Wayne Martin, Project Manager
National Healthcare Project
1600 Wilson Blvd., Suite 1200
Arlington, VA 22209
(703) 525-0770
fax: (703) 525-0299


Terry Monahan is editorial director of Healthcare Informatics.



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