Introduction.
The worlds of InfoTec and BioTech are fusing leading to a quantum leap in MedTec innovation. This innovation is leading to a lot of speculation on the future of medicine. I personally believe that medicine will disseminate from an institutional service to a network of services.
There are many reasons for this. Professor Chris Berg, Professor Jason Potts, and Professor Sinclair Davidson from RMIT’s Blockchain Innovation Hub have proposed that the blockchain will replace institutional trust leading to a new type of institution, a V-Form institution.
I believe that the hospital as an institution will suffer the same fate, however, more innovation is required if a network of services is to facilitate patients’ needs for surgeries and other interventional procedures. Surgeons have successfully carried out remote surgeries over the Internet, so you may think the job done? Absolutely NOT!!
The medical deep fake is a reality, researchers have already shown how hackers can access radiology systems and alter images at the point of capture; resulting in aberrant images being saved to the patient’s record. If it can happen to a real- time radiology scan, then it can happen to a real-time remote surgery. Researchers will have to look to novel systems to guarantee the integrity of the system. I propose the blockchain as a solution, in the following paragraphs I describe the benefits of blockchain and describe its application in a real-life situation.
Enjoy!!!
What does a spacecraft have to do with remote surgery, remote robotics, blockchain, and the metaverse?
It comes down to autopilot and consensus. A spacecraft depends on autopilot to navigate the solar system but being outside the earth’s atmosphere it is vulnerable to disruption and downtime caused by the sun’s solar mass ejections. These ejections throw out plumes of solar radiation which knock out electronics including a spacecraft’s autopilot.
To counter this risk spacecraft don’t just have one autopilot they have many. But this redundancy is not without its risks! What if different autopilots are telling the spacecraft different things, which autopilot does the spacecraft believe? Well, the spacecraft employs a consensus algorithm to determine its true navigational state, (or at least the state that is least likely to be wrong). If 99% of the autopilots agree on one state, then the opinion of the other 1% is considered erroneous and discarded.
A blockchain is a network of computers, called nodes, that like the autopilot are operating with a shared purpose, due to the need for operational integrity it requires the redundancy of many nodes and therefore shares the problem of forming consensus. However, the ability to form a consensus among thousands of independent computers is the core strength of the blockchain. It not only gives us redundancy but also trust by default and immutability. But what has all this got to do with robotics and remote surgeries?
Sir I’m going to remove your prostate. Well, not actually me, I’ll be instructing my robot ‘Da Vinci’ on how to do it!
So, this is actually a thing! Robots called Da Vinci Machines do remove prostates with the surgeon operating it remotely. The first time I saw one of these machines I was a medical student on a placement in the Galway Clinic, Ireland.
When I walked into the theatre the surgery had already begun, there were five large robotic arms hovering over the patient and were each operating instrumentation or a camera within the patient’s abdomen. The surgeon was sitting in a Pac-Man machine in the corner, (no joke this thing looked like something from a 1980’s arcade!). The screen was 3D allowing the surgeon to see depth, he had two joysticks and two pedals which he used to control the robotic arms.
But if the cable was long enough could the surgeon be in the next theatre?
Yes. In fact, with a long enough cable he could have done the operation remotely from his office.
But how remote can we go? How long until a cable becomes unfeasible, and can we then use the internet to link the two?
The answer to this question is how much you are willing to trust the internet. What if the connection between the two dropped? What if the connection got hacked? What if a malicious actor hacked the system and instructed the robot not to cut the prostate but instead to cut the nerve plexus around it, (bye bye boner!!!).
Realistically we would need a lot of redundancy, trust, and immutability in our system… sound like a job for a blockchain? Yes!
With a blockchain the surgeon has not just one connection with her robot, she’s got thousands. She can tolerate a large proportion of her network failing and still maintain a reliable connection with her robot. But will each of the remaining nodes tell the robot the same thing? Probably not but the consensus algorithm, in establishing truth, will disregard the erroneous instructions and give the trustworthy and correct instructions to the robot.
So, do we even need a hospital?
In time no! There’s definitely a time coming when we’ll have Robotics as a Service, (RaaS), and Surgery as a Service (SaaS), and blockchain connecting the two.
When explaining this concept to colleagues, this is the point where all the surgery bros lose their minds and retort with “You need a surgeon on site in case there’s a complication” which is an extremely valid point, but it’s nothing that time & technology (tnt), won’t solve. And sorry surgery bros but with the rate of innovation and the rate of convergence of emerging technologies in medical services, change is coming a hell of a lot faster than you think!
So, let’s look at applying this concept to a less risky surgery which also has profound benefits to patients, say a cataract operation. Cataracts are the leading cause of blindness in the third world and the fix is a low-risk day procedure, the patient does not need to be put under a full anaesthetic. Just numb their eyes and change their lenses, (OK, a little bit more complex but doable). The obstacle is connecting remote communities, specialists, and facilities.
Enter our 3D augmented internet aka the Metaverse…
Imagine Médecins Sans Frontières decided to open their headquarters in a hospital in the metaverse! The hospital complete with blockchain-based medical records and digital identities of all their volunteers, could function with Everything-Else as a Service, (EEaaS).
MSF decided to launch ‘Operation Satoshi’s Vision’, they charter a RaaS company to airlift a container fitted out with robotics to function as an ophthalmology theatre to a remote community somewhere in the third world. A SaaS provider has located an ophthalmologist in Perth, Australia who has kindly agreed to perform cataract procedures for the day. Tomorrow the container is airlifted to another community where a Fellow from Shanghai University
The hospital has also agreed to donate his time and expertise. With their HQ functioning as the blockchain linking the two MSF will have successfully engineered a trustworthy and cost-effective way of bringing the gift of sight to marginalised and otherwise forgotten peoples.
A bit farfetched?
Yes, but will it happen? I believe so…
About Author.
Did you know that Colm McCourt, who’s not only a brilliant mind but also an RMIT alum, shared some of his wisdom on Medium back on July 15, 2022?
The post just got an upgrade and is now shining bright over at Spektrumlab.io