Digital Doctors: The Future of Medicine | Derek O'Keefe | TEDxGalway

Summary

Dr. Derrick, a physician-engineer, discusses the convergence of medicine and engineering for healthcare innovation. He shares his experience with NASA's NEEMO mission, where he used physiological data to make mission decisions. Derrick also explores the future of medicine with wearable tech, AI, and telemedicine, emphasizing how these technologies can transform chronic disease management and deliver personalized healthcare.

Takeaways

• 👨‍⚕️ Derrick is a physician-engineer with a background in biomedical engineering and endocrinology, focusing on the intersection of medicine and engineering for innovative solutions.
• 🚀 In 2007, Derrick worked with NASA to develop a bio vest for monitoring astronaut sleep in space, using ECG and heart rate variability to deduce sleep stages and quality.
• 🦾 He has been involved in creating exoskeletons with electrical stimulation to help stroke patients with paralysis walk more efficiently.
• 🩺 Derrick has been developing technologies for people with type 1 diabetes to deliver insulin automatically, aiming to improve treatment and quality of life.
• 📊 The talk emphasizes the importance of using data and technology to make informed decisions in healthcare, rather than relying solely on subjective feelings.
• 🧠 Artificial intelligence (AI) is becoming more integrated into healthcare, with the potential to predict health outcomes and personalize treatment plans.
• 🏥 The future of medicine involves telemedicine and remote monitoring, which can reduce the need for physical hospital visits and improve patient care.
• 🤖 AI can analyze wearable technology data to provide personalized health insights and potentially influence insurance premiums based on health behaviors.
• 👕 Smart fabrics are an upcoming technology that will allow clothing to monitor physiological signals, leading to a more integrated approach to health monitoring.
• 🌐 The talk concludes with a vision where the patient is at the center of healthcare, empowered by technology to manage their health more effectively.

Q & A

What does the term 'physician engineer' mean?

A physician engineer is someone who has training in both engineering and medicine, allowing them to approach problems analytically and logically while also understanding the complexities and nuances of clinical practice.

How does the speaker describe the difference between engineering and medicine?

Engineering is described as black and white, analytical, and problem-solving, while medicine is seen as a spectrum of color where nothing is ever black and white, indicating its complexity and variability.

What was the challenge NASA faced in 2007 regarding astronaut sleep?

NASA needed to monitor how astronauts sleep in space due to the rapid succession of sunrises and sunsets causing severe jet lag, which affected their sleep quality.

How did the speaker's team address the sleep monitoring issue for astronauts?

They developed a bio vest that astronauts could wear to monitor their ECG and heart rate variability, allowing them to deduce sleep stages and assess sleep quality.

What is the significance of the NEEMO mission mentioned in the script?

The NEEMO (NASA Extreme Environment Mission Operations) mission is significant as it simulates space exploration conditions on Earth, allowing for the development of protocols and technology that can be used in actual space missions.

Why was the speaker invited to participate in the NEEMO mission?

The speaker was invited due to his experience with telemedicine and the mission's focus on making decisions based on physiological data.

How does the speaker envision the future of wearable technology in sports?

The speaker sees wearable technology being used not just during training but also during games and potentially being worn all the time to monitor and improve athlete performance.

What is the potential impact of AI on health insurance policies?

AI could analyze data from wearable technology to predict health risks and adjust insurance premiums accordingly, rewarding those with healthier lifestyles and penalizing those with unhealthy behaviors.

What is the concept of 'predictive purchasing' as mentioned in the script?

Predictive purchasing is an AI-driven service where online shopping platforms predict and deliver products that customers are likely to want before they even realize it, based on their past purchasing patterns and behaviors.

How does the speaker propose to improve the delivery of healthcare for chronic diseases?

The speaker suggests using remote monitoring and AI to manage chronic diseases, allowing for virtual clinics and reducing the need for physical hospital visits, thus improving efficiency and patient care.

What is the potential benefit of telemedicine in managing chronic diseases?

Telemedicine can reduce the need for patients to travel to clinics, provide more frequent check-ins, and allow healthcare providers to monitor patient data remotely, leading to more effective management of chronic conditions.

Outlines

00:00

👨‍⚕️ The Fusion of Medicine and Engineering

Derrick, a physician with a background in biomedical engineering, discusses the synergy between clinical medicine and engineering. He highlights his involvement in innovative projects, such as developing a bio vest for NASA to monitor astronauts' sleep in space, creating exoskeletons for stroke patients, and working on technologies for type 1 diabetes. He emphasizes the importance of combining clinical problems with engineering solutions for innovation and shares his experience of being invited by NASA for a mission involving telemedicine.

05:01

🚀 Advancing Medicine with Space Exploration

In this section, Derrick talks about his collaboration with NASA on the NEEMO mission, where he was involved in making mission decisions based on physiological data from astronauts living underwater in the Aquarius habitat. He describes how this technology is being adapted for elite sports to monitor player health and performance, and how it will soon be integrated into consumer wearable technology, leading to a future where smart fabrics in our clothing monitor our health and make decisions about our well-being.

10:01

🤖 The Role of Artificial Intelligence in Predicting Behavior

Derrick explores the potential of artificial intelligence in recognizing patterns in human behavior and predicting future actions. He gives examples of how AI is used in car insurance to reward good driving behavior and how it could be applied to health insurance. He also discusses the concept of predictive purchasing, where AI algorithms predict consumer needs before they realize them, and how this technology could be used to analyze health data to predict and prevent chronic diseases.

15:03

🏥 The Future of Telemedicine and Chronic Disease Management

In the final paragraph, Derrick envisions a future where telemedicine and remote monitoring play a significant role in managing chronic diseases. He criticizes the inefficiency of traditional healthcare systems and suggests that virtual clinics could reduce the need for physical hospital visits. He describes how AI could help schedule virtual appointments based on patients' health data, allowing healthcare providers to monitor and adjust treatment plans remotely, thus improving the delivery of healthcare.

Keywords

💡Physician Ear

A physician ear is a term used to describe someone who has dual training in both medicine and engineering. In the video, Derrick, the speaker, identifies himself as a physician ear, highlighting his unique background that allows him to bridge the gap between clinical problems and engineering solutions. This dual expertise is central to the theme of innovation in healthcare.

💡Endocrinology

Endocrinology is a branch of medicine that deals with the disorders of the endocrine system, including hormones and diabetes. Derrick mentions his training in endocrinology, emphasizing his specialization in hormonal imbalances and their treatment, which is relevant to the development of technologies for conditions like diabetes.

💡Heart Rate Variability (HRV)

Heart Rate Variability (HRV) refers to the variation in time between successive heartbeats. It is an indicator of the overall health of the cardiovascular system and is used in the context of monitoring astronaut sleep quality in the video. Derrick explains how HRV was utilized to assess the sleep stages of astronauts, illustrating the application of biomedical engineering in space exploration.

💡Exoskeletons

Exoskeletons are wearable robotic frameworks that can enhance or restore the abilities of their users. In the video, Derrick discusses projects involving exoskeletons with electrical stimulation to help stroke patients with paralysis walk more efficiently. This showcases the integration of engineering and medicine to improve mobility and quality of life.

💡Telemedicine

Telemedicine is the remote delivery of healthcare services, such as consultations and treatment, using telecommunications technology. Derrick talks about his involvement with NASA's NEEMO mission, where telemedicine was used to make mission decisions based on physiological data. This concept is central to the future of healthcare, as it can reduce the need for physical hospital visits and improve patient care.

💡Aquarius Habitat

The Aquarius Habitat is an underwater research laboratory used by NASA to simulate space missions. Derrick was invited to participate in a mission there, which is used as an example of extreme environment training for space exploration. The habitat serves as a testbed for technologies and protocols that could be used on lunar or Martian bases.

💡Artificial Intelligence (AI)

Artificial Intelligence refers to the simulation of human intelligence in machines that are programmed to think like humans and mimic their actions. In the video, Derrick discusses the role of AI in analyzing data from wearable technology to predict health outcomes and personalize healthcare. AI is portrayed as a key driver in the future of personalized medicine.

💡Smart Fabrics

Smart fabrics are textiles that incorporate electronic components or sensors to monitor physiological signals. Derrick mentions the development of smart fabrics that can send text messages about health indicators, such as temperature. This technology is part of the broader theme of wearable technology and its potential to revolutionize healthcare monitoring.

💡Chronic Diseases

Chronic diseases are long-term health conditions that require ongoing management. Derrick discusses the increasing prevalence of chronic diseases and the need for new approaches to their management. The video suggests that remote monitoring and AI can play a significant role in managing these conditions more effectively, reducing the burden on healthcare systems.

💡Telehealth

Telehealth encompasses a range of healthcare services delivered remotely using digital technologies. Derrick argues for the adoption of telehealth to improve the efficiency of healthcare delivery, particularly for chronic disease management. Telehealth is presented as a solution to reduce unnecessary hospital visits and enhance patient care.

💡Wearable Technology

Wearable technology includes devices like smartwatches and fitness trackers that can monitor health metrics. Derrick discusses the evolution of wearable technology from simple step counters to sophisticated devices that can analyze a wide range of physiological data. These devices are integral to the vision of a future where health monitoring is continuous and integrated into daily life.

Highlights

Introduction to Derrick, a physician-engineer with expertise in biomedical engineering and endocrinology.

The potential for innovation by combining clinical problems faced by doctors with engineering solutions.

In 2007, NASA faced challenges monitoring astronaut sleep patterns in space due to rapid day-night cycles.

Development of a bio vest to monitor astronauts' ECG and heart rate variability for sleep quality assessment.

Collaboration on projects involving exoskeletons and electrical stimulation for stroke patients with paralysis.

Recent work on technologies for type 1 diabetes management, including insulin delivery systems.

The importance of data in making mission-critical decisions, illustrated by NASA's telemedicine practices.

Involvement in NASA's NEEMO mission, which focuses on extreme environment simulations for space exploration.

The Aquarius habitat, an underwater laboratory used to simulate space mission conditions.

Use of physiological data to make mission decisions, a concept being adopted in elite sports.

The rise of wearable technology and its potential impact on consumer health and wellness.

The future of smart fabrics that can monitor physiological signals and interact with users.

The role of artificial intelligence in analyzing data from wearable tech and making health predictions.

The potential for AI to personalize health insurance premiums based on individual health data.

The ethical considerations of AI and data in healthcare, including privacy and decision-making autonomy.

The transformation of healthcare delivery through telemedicine and remote patient monitoring.

The vision for a future where patients are at the center of healthcare, empowered by technology.

Encouragement to embrace technology's potential to improve healthcare delivery and patient outcomes.

Transcripts

[Music]

[Music]

my name is Derrick you've heard a bit

about me from the intro and I'm a

physician ear so what that term means is

is that I've trained as an engineer so

I've done an electronic computer

electronic computer biomedical

engineering and I've also trained as a

physician or a doctor so I've done my

medical training and my clinical

training in general medicine and an

endocrinology and in diabetes and as an

engineer half my brain is in black and

white so it's analytical problem-solving

very logical and as a clinician well

anyone who knows medicine knows it's a

spectrum of color nothing's ever black

and white in medicine and the

interesting thing is is that doctors

have a lot of clinical problems and

engineers have lots of solutions so if

you put the two of them together you

have great opportunity for innovation

and I've been lucky in the last 20 years

or so to be involved with some of some

very innovative projects so back in 2007

and NASA had a problem with monitoring

how astronauts sleep in space because if

you're in orbit and you're going around

the earth 16 times a day that's 16

sunrises and sunsets that's really bad

jet lag so they had to figure out how

they're sleeping rather than just saying

are you sleeping okay subjectively

so we came up with an idea where we put

a bio vest on the astronauts and we

looked at their ECG and what's called

our heart rate variability and from that

we could deduce their sleep stage and

see the quality of sleep they were

getting so when you do an intervention

then you can see if it's effective or

not we've done projects where we've

worked with patients who have had

strokes and I've had paralysis

afterwards we've built exoskeletons with

electrical stimulation to allow them to

walk more efficiently

and more recently we've done work with

people with type 1 diabetes developing

technologies to deliver instant

automatically so the idea of a clinical

problem and an engineer being at the

table and being involved with the

solution is a very very innovative mix

and tonight I'm going to hopefully talk

to you about that where that mix of

engineering and medicine is going in the

future with the talk about digital

doctors the future of medicine so this

story starts actually here in Galway

about four years ago I was a doctor on a

ward round in the hospital and when

you're on a ward round you go out to see

all your patients in the morning so you

see the patient and you ask them how

their how their

how the treatment is working you check

their vital signs you look at the Bloods

you look at the radiology and then

during the ward round I get a phone call

and I answered the phone because it

could be radiology ringing me with an

updated report and the patient or it

could be the labs ringing me about an

updated blood result so I took the phone

call and somebody said hi is this dr.

O'Keefe and I said yes

is this you dad and they said oh this is

actually NASA we have a Nemo mission

next summer and we're wondering if you'd

like to be part of it because part of

the mission brief is telemedicine and

you did things with telemedicine with as

few years ago and I was like okay I'm in

the middle of something at the moment

can I ring you back later and they were

like yeah sure no problem so I hung up

the phone and I turned back to the team

and they were like who was on the phone

I was like it was NASA they were like

yeah sure was yeah but it actually was

NASA and and for those who don't know

who NASA is if you haven't watched any

movies or being involved with society in

the last 50 years NASA is the u.s.

federal agency that's kind of tasked

with manned spaceflight and they have a

big year this year this year is the 50th

anniversary of putting a man on the moon

this July so you're gonna hear a lot

about NASA and their achievements this

year and they've done some phenomenal

stuff over the last 50 years of manned

spaceflight you're aware of see of the

of the shuttle program and the robotic

missions and so on but what NASA really

have done for us as society is develop

new technologies and new protocols for

us as as humans and push the boundaries

of science and one thing they do really

well at NASA and the one of the reasons

of their success is what's called the

three P's so that's practice practice

practice

very good so what they asked me to do

with NASA is they asked me to get

involved with one of their practice

sessions so they have these facilities

around planet Earth whereby they take a

habitat which we're going to hopefully

put on the lunar surface of the Martian

surface and they take this habitat and

they put it in what's called an extreme

environment and those extreme

environments are in the High Arctic

where there's snow and you know for high

winds they're on the lava fields of

Hawaii they're in the deserts of the

Mojave and the one that I was invited to

be involved with was underwater off the

coast of Florida it's called the

Aquarius habitat it's about 60 feet down

which is double the height of a

two-story house it's about 10 kilometers

off the coast of Florida and this pretty

much both sized sunken laboratory is

where four astronauts live for a month

every year in what's called Nemo the

NASA extreme environment mission

operation and the idea of these four

astronauts living there are aquanauts as

they're called underwater for the month

is that during that month they can do

science and engineering experiments and

they can develop the protocols here on

earth before we put that base on the

moon and Mars and you might say well why

do they want to put in such an

inhospitable environment but that's the

key that makes the simulation high

fidelity because if something is wrong

you can't just pop outside and leave the

habitat if you forget something you

can't just pop outside

historian get it you really have to plan

the mission and you have to be in the

moment in the mission so it allows us to

test protocols and techniques and

technology in a high fidelity scenario

so why did they want me that was the

question I guess so I rang them back and

I said yeah I'm actually available next

summer what's the what's the mission and

they said we have this idea you know

we've been doing telemedicine and remote

monitoring for a while at NASA but the

NEEMO mission this year we have an

interesting idea we want to make mission

decisions based on physiological data

and I was like all right that sounds

interesting so usually there's a flight

surgeon which is the physician that

looks after the health of the astronauts

or aquanauts but this was the flight

surgeon actually inputting into Mission

decisions so the idea would be is that

the aquanauts under water would wear

something like a bio vest that would

measure their heart rate their ECG their

respire to rate their movement and so on

and then with that activity then we

could actually make decisions so for

example I was able to talk to one of the

the crew dr. Marc or Eva and I'd say to

me you know you're planning today on the

mission schedule to go outside the

habitat today to do extra vehicular

activity and there's a choice of four

people that you can pick but I've been

looking at the physiological data for

the last 24 hours and I think you should

pick Aquanaut number two because

Aquanaut number one they haven't slept

so well the last three nights an

Aquanaut number three they're developing

a temperature so they're probably gonna

get a flu so we made a mission decision

based on physiological objective data

and that's a very interesting concept

and it's kind of a tease of where we're

going to go in medicine so as I said

when you're outside their habitat you

have to be at your physical and mental

best and that's why it's really

important that you use data to make the

decisions and not just ask somebody how

they feel and this technology was 2015

this kind of concept and it's starting

to creep in now to what we call elite

sports so elite you know soccer in the

Premiership or football basketball all

the top sports of the world what you're

starting to see now is a lot of the

players in the training ground wearing

this kind of technology both to assess

how they're performing and then also on

the day when they're playing sports the

next level of course which is going to

become more common if it's not there

already is that a lot of these elite

athletes will be expected to wear this

equipment all the time not just where

they're in training not just one

they're playing the game so now on a

Friday night when a coach makes a

decision about a big international the

next day he says okay not only is this

player playing well during the week in

training I can see that they've been in

bed every night at ten o'clock they've

got the radar asleep they haven't gone

to too many night clubs so that's what's

going to be expected of the elite sports

person because what's going to happen is

on the Friday night when you're picking

your team you want to pick the best at

the best eleven does that make sense

yeah so let's just take that idea and go

forward it again another five years and

then you're coming into the world of us

to consumers so you're all familiar with

wearable technology most of us here

probably have some intelligent band on

our wrist that measures our step counter

tells us our calories we have

smartwatches we have phones in our

pockets that are computers a thousand

times more powerful than that Apollo

mission in 1969 but the big game changer

in the next few years is going to be

smart fabrics this has already been

developed in some research labs but it

just hasn't hit widespread consumer

market yet and what that basically means

is your t-shirt will have fibers in it

that will be measuring your

physiological signals so you'll be

sitting there and you'll get a text

message from your t-shirt

and it'll say hey John you're getting

your temperature I see you've got

tickets booked tomorrow night for the

cinema I'd probably pass in it so this

is this is interesting this is where the

technology is going the idea of wearable

tech ultimately making decisions with

our lives and then the important thing

and all of that discussion is the engine

behind those decisions because all this

variable technology is just data that

doesn't do anything what you need is

information and from the information

then you get knowledge and that's the

second part of the talk so the first

part is remote monitoring which I hope

you've followed me on the journey the

next part is the artificial intelligence

so we've all heard this term artificial

intelligence we're familiar with that I

hope in our lives whereby you're

watching a music video on the internet

and maybe it makes a suggestion of what

video you should watch next and then you

watch it you kind of go oh that was

pretty cool I didn't know that artist so

it's kept you in the same steam attic

area but it's going to get stronger and

it's going to make our lives more

interesting so for example in the United

States at the moment and indeed in

Ireland more recently if you imagine

young drivers they get penalized a lot

with insurance policies because

typically young drivers you know they

tend to have more accidents because they

may not understand the risks involved

with their behaviors but now you can get

an electronic device that you can plug

into your actual car so any car built

since the mid 90s has a diagnostic port

for mechanics this device plugs into it

and it monitors your behavior as a

driver so if you turn rice and you

indicate rice that's a good thing

if you drive between the hours of 8:00

and 8:00 and it's daylight that's good

if you obey the speed limits that's good

so if you have good behaviors you get

10% off your premium brilliant so

rewards people who have good driving

behaviors and therefore have a lower

chance of accidents now imagine the flip

of that so all that wearable technology

I've just told you about that we'll all

be wearing in five years time or so

imagine if all that technology is

harnessed and now it's a life insurance

company or a health insurance companies

looking at it and it says you know what

Jack you're doing a fantastic job you're

going to bed every night at 10:00 you're

getting up every morning at 8:00 you're

getting a great sleep

you're not going to the pub you're going

to salad bars you are living your best

life 10% off your health insurance

policy

now Mary you're going to bed every night

at 10 o'clock but you're watching Game

of Thrones for three hours you're

falling asleep at one o'clock you're

waking up at 6:00 and then you're

wondering why you're tired the next day

and you don't have time to prepare the

food so you're going to a fast-food

joint and then you're so tired you can't

go to the gym you're going to get a 10%

loading on your premium so do we really

want that as a society because these are

the kind of questions were going to have

to ask

it's creeping in already with the car

insurance but as society do we want to

give that kind of access I guess to

artificial intelligence now we are

creatures of habit we know this it's

part of probably an evolutionary biology

mechanism whereby we do things in

patterns and that's where artificial

intelligence is really powerful is when

pattern recognition it sees behaviors

and it predicts the future based on

patterns so a payton was taken out last

year by one of the large online shopping

companies called predictive purchasing

and the idea is you can say $10 $20 or

$50 and you can select once a week once

a month or once a year so we'll just say

you say $50 once a month and they're so

confident with their artificial

intelligence algorithms that they know

what you want before you've even thought

of it that they'll give you free

shipping if you don't want it and I know

what everyone's saying here in their

brain they're saying there's no way a

computer knows what I want I am a

multi-faceted special sentient human

being

we are all creatures of passions and as

I said it's probably something to do

with with our evolution whereby if we

used to walk a certain way back to the

cave every night and we didn't get

killed or attacked

we probably kept walking to the cave the

same way every day most of us here

probably drive the same way to work

every day we go to the same supermarket

we buy the same twenty things so this

new predictive purchasing software

that's gonna come online pretty soon

you've selected $50 you've selected once

a month you look at the calendar and you

see it's the first of the month and

you're gonna go home and you're gonna

see this package on the table and you're

gonna think to yourself oh yeah this is

brilliant now I'm going to show that

artificial intelligence how special I am

and you're gonna walk over to the table

you're gonna pick up the box open it and

say there's no way a computer oh my

goodness this is amazing this is exactly

what I wanted how did it know so it knew

because it got you a guidebook for

France on the holidays and it's all in

your calendar that you're going to

France this summer and it also saw in

your calendar that last year you were in

Spain and you bought a guidebook in the

same thematic style and you gave it a

five-star rating so it predicted that

you'd want a guidebook for this year's

holiday Wow maybe computers do know us

better than we know ourselves so this is

the kind of artificial intelligence

that's going to be making big decisions

not only about our purchases but also

about our health so imagine all that

wearable technology I spoke to you about

and the computer is analyzing it and

it's saying you know what Jack you have

a 50% of getting diabetes based on your

current health patterns and then you go

when you change your behavior and maybe

you can drop it to 30% because the

artificial intelligence is able to look

at the patterns and given your level of

activity and your dietary input and so

on it's able to make an accurate

prediction of your chance of developing

different chronic diseases and that can

change behaviors but data gives us the

chance to make better decisions and

ultimately what we want to do is change

the way we deliver health care that's

going to be the future of medicine or by

the patient is at the center of the

health care equation not the institution

or the healthcare network so is there a

way to take that remote monitoring mix

it with the artificial intelligence and

deliver health care and

way especially for chronic diseases

because as we know we're all getting

older and medicine is doing a really

great job of keeping everyone alive so

there's far more people alive now and

living longer and healthier into their

older age and so we have this plethora

of chronic diseases that now need

management which is a good thing

we just need to change the way we're

managing it so hospitals as you know

that might have been built 50 years ago

which had 30 seats in the waiting room

which was enough for that population

that's completely redundant now where

you have people standing because you

need double the amount of seats so there

must be better way of doing it and there

is traditionally centralized things like

shopping go to a department store that's

been changed to online banking going to

a bank that's been changed to online

health has been a bit slower to catch up

with the idea of ICT information

communication technology because we're

afraid about our data being shared and

being been leaked but as we know if we

can trust the internet for our banking

and so on that there's some really good

encryption methods there so is there a

way to take the remote monitoring the

artificial intelligence and to actually

deliver better health care and there is

this is telemedicine and it's already

being used around the world and being

used for a long time but not really in

the area of chronic diseases so why is a

patient coming from Clifton or from the

Aran Islands or even from across Galway

and spending an hour and a half coming

to the clinic 20 minutes parking where

he to hours in a waiting room to see me

for 10 minutes that's a waste of

everyone's resources and you don't need

to be an engineer to figure out that's a

pretty wasteful process for the

environment for the person's time it's

much better if for example the

artificial intelligence can figure out

which patients need to be seen maybe

they're having a lot of low blood

Sugar's if they're diabetic and it

schedules them to have a virtual clinic

with me so at 2 p.m. in the afternoon

they get a link to log on to the clinic

I said in your pockets you have phones

that have audio-visual equipment like

FaceTime and Skype that are encrypted

so I can see you on the computer and

then I can see all your data because all

these meters these glucose meters now

when you take a value it goes to the

cloud so I can see your sugar data I can

see your activity data and I can see

your your your medication administration

and then we can have a very rich

conversation and I can say as you would

if you were beside me I see every

Tuesday afternoon you're going low

but also I noticed on Tuesday afternoon

your activity goes up what's going on

and then you might say I've joined a way

of walking Club every Tuesday and I say

oh that makes sense you better pull back

on your your mealtime insulin so we can

have rich conversations remotely and it

prevents people having to come in to a

physical hospital now you'll still have

to come in at least once a year for a

chronic disease to get you know the

general medical exam but a lot of the

care can be delivered remotely and if

these visits throughout here which will

keep people on track with their targets

for chronic diseases

so in summary two things I hope you

learned tonight from my talk one if your

phone rings always answer it it could be

NASA and to the power of technology to

improve the way that we deliver health

care that's the future of Medicine thank

you