Emerging Healthcare Delivery Paradigm for the 21st Century

The current U.S. healthcare system faces serious challenges on multiple fronts. Although the United States is considered the best place for patients to obtain accurate diagnoses and high-quality treatment, nearly 45 million Americans do not have health insurance. Healthcare expenditure in the U.S. has more than doubled from $966 billion in 1994 to $2.2 trillion in 2007. New and increased use of prescription drugs, imaging, and other therapeutics has contributed to a substantial rise in healthcare expenses in the last several decades. These expanding costs, along with the rapidly increasing number of retirees and people with chronic disease, make the current healthcare system unsustainable. Thus, transformation is direly needed. New technology and advances must not only improve care but also be cost-efficient. The delivery system must increase its emphasis on prevention and screening rather than end-of-term care.

Distributed Diagnosis and Home Healthcare (D2H2) is a new delivery framework to transform healthcare from a central, hospital-based system to one that is more patient-centered, distributed, and home-based. The vision is that D2H2 will benefit patients and society by improving the quality and convenience of care—controlling healthcare costs and increasing access to affordable and effective healthcare.

Technology will be the pulling force into this new era of healthcare and its delivery. How to address key non-technical challenges in D2H2 (e.g., stakeholder’s resistance and insurance reimbursement) and manage the process of unleashing technological advances will be critical to its success. Moreover, success is dependent on bridging the “valley of death” in technologies for D2H2 and creating a dynamic and entrepreneurial environment and support system for translational research, and closer ties and collaboration between researchers, engineers, industry, clinicians, and healthcare organizations.

Point-of-care diagnostics is one of the key technologies that will enable the realization of D2H2. Its benefits include its portable nature and use of smaller volumes of reagents as well as shorter wait time and the possibility of home use. To fully support the new healthcare vision, the point-of-care diagnostic technology must be accurate and economical, both in production and use. Also, a necessary feature of these point-of-care testing devices will be their interoperability with electronic health records (EHRs).

Another enabling technology at the forefront of the new era of distributed healthcare is home devices. Home monitoring is becoming a necessity today (and increasingly more so in the future) partly due to the aging population and the rising number of patients with chronic conditions. Home devices should be designed to help in prevention of unhealthy behaviors as well as crisis detection and monitoring the health of chronically ill patients outside of the clinical setting. In order to be used by the consumer effectively and correctly (e.g., patient, home nurse and relative of patient), these devices should be easy to operate and robust against environmental variations, operator dependencies and errors.

The Internet is another enabling technology that is critical. It is sometimes seen as the link between

Author: Yongmin Kim

Dr. Yongmin Kim received the B.S. degree in electronics engineering from Seoul National University, Seoul, Korea, in 1975, and the M.S. and Ph.D. degrees in electrical engineering from the University of Wisconsin (Madison), in 1979 and 1982, respectively. From 1982 to 1986, he was Assistant Professor of the Department of Electrical Engineering at the University of Washington, Seattle. From 1986 to 1990, he was Associate Professor of Electrical Engineering and Adjunct Associate Professor of Bioengineering and Computer Science. From 1990, he was Professor of Electrical Engineering, and Adjunct Professor of Bioengineering, Radiology, and Computer Science and Engineering. From March 1999 to June 2007, he was Professor and Chair of Bioengineering. Currently, he is Professor of Bioengineering, Professor of Electrical Engineering, and Adjunct Professor of Radiology and Computer Science and Engineering. From 2004 to 2007, he was the W. Hunter and Dorothy L. Simpson Endowed Chair in Bioengineering. He has taught parallel computers, digital electronics and computer design, advanced microcomputer system design, digital image processing and applications, multimedia algorithms and systems, mediaprocessors, computer image generation, technology innovation and commercialization, and weekly seminar series on image computing, medical imaging and bioengineering. Also, he has offered various continuing education courses on image computing and multimedia, mediaprocessors, and advanced digital systems to many engineers around the world. His research interests include medical imaging and computing, ultrasound systems, electronic medicine, distributed diagnosis and home healthcare, and molecular imaging. He has participated heavily in the architecture definition and optimization as well as algorithm and system development for Texas Instruments TMS320C80 Multimedia Video Processor (MVP) and Hitachi/Equator Technologies Media Accelerated Processor (MAP). He has supervised 36 Ph.D. dissertations and 102 Masters theses, and currently is working with 15 Ph.D. students in Electrical Engineering, Bioengineering, and Computer Science & Engineering. Dr. Kim and his research group have made 85 inventions that have led to 70 patents, transferred the invented technologies to industry with 25 licenses, and helped commercialization of these technologies. He edited a book, Handbook of Medical Imaging (SPIE Press, 2000) and is a contributing author to many books. He has more than 450 research publications, and he is the editor of 13 Conference Proceedings. He was a member of the Advisory Board for IEEE Transactions on Pattern Analysis and Machine Intelligence from 1985 to 1994 and has been a member (Chairman during 1993-1994) of the Steering Committee of the IEEE Transactions on Medical Imaging from 1990 to 1996 and again from 2007. He has been a member of the Editorial Board of Proceedings of the IEEE, the IEEE Transactions on Biomedical Engineering, the IEEE Transactions on Information Technology in Biomedicine, the IEEE Press series, and the Annual Reviews of Biomedical Engineering. He is the director of the Image Computing Systems Laboratory at the University of Washington. He was awarded the 1988 Early Career Achievement Award of the IEEE Engineering in Medicine and Biology Society for his contributions to medical imaging and the 2003 Ho-Am Prize in Engineering. In 2005, he received a Distinguished Achievement Award from the University of Wisconsin-Madison College of Engineering. He was the Program Chairman of the 1989 IEEE EMBS Conference and Conference Chair of the SPIE Medical Imaging Image Display Conference from 1990 to 1999. Also, he was Symposium Chair of the SPIE Medical Imaging consisting of seven conferences from 1998 to 2001. He organized and chaired the first conference on Distributed Diagnosis and Home Healthcare on April 2006 in Washington, D.C., which was sponsored by IEEE, ASME, AMA, RSNA, HIMSS and other organizations. He has been a consultant to NIH, NSF, U.S. Army, MITRE, Texas Instruments, Intel, Siemens, Hitachi, Fujitsu, Canon, Samsung, Micron, and many other companies. He has served on the Board of Directors and the Technical Advisory Board of several companies. He is a member of the Department of Biomedical Engineering External Advisory Board for the Cleveland Clinic Foundation, University of Wisconsin, University of Utah and KAIST and an external reviewer for many academic programs. He has been an IEEE/EMBS distinguished lecturer since 1991 and Chair of the Distinguished Lecturer Committee in 1997 and 1998 and the Awards Committee in 2001 and 2002. From 1992 to 2006, he was an ABET (Accreditation Board for Engineering and Technology) program evaluator for computer engineering and bioengineering. He was a member of the IEEE Fellow Committee from 1998 to 2001. He was the Chair of the IEEE/EMBS Fellows Committee in 2003 and 2004. He was a member of the IEEE Awards Board and the IEEE TAB Periodicals Committee in 2005 and 2006. He was the President-Elect of the IEEE EMBS in 2004, the President of the IEEE EMBS in 2005 and 2006, and the Past President of the IEEE EMBS in 2007. Dr. Kim is a Fellow of the IEEE and a Fellow of the American Institute for Medical and Biological Engineering. He is a member of Tau Beta Pi and Eta Kappa Nu.