In this month’s letter, Dr. Rick Valachovic highlights digital technologies that are transforming the way we live and the way we provide clinical care.
The hype around IBM’s Watson and the computer’s failure to revolutionize medical diagnosis since making its debut on the game show Jeopardy! have left many observers reluctant to jump on the next big technological bandwagon. You may be among them, and with good reason. Acquiring new technology can be costly and time-consuming, and it can take fortitude to persevere through the pain that often comes with learning to use it properly, especially when you have to bring others along for the ride.
Does that mean we should shrink from the opportunities before us? Hardly. We just need to do more to prepare for what lies ahead.
That’s why Mary Truhlar, D.D.S., M.S., Dean of the Stony Brook University School of Dental Medicine and Chair of the ADEA Council of Deans, chose to focus this year’s ADEA Deans’ Conference on the technological challenges faced by dental schools. Over the course of several days in California, deans and their colleagues learned from one another about successfully integrating new technologies in the past and heard from outside experts about what’s coming down the road.
“There is so much going on in the clinical realm that is absolutely breathtaking,” said Bruce Lieberthal, Chief Innovation Officer at Henry Schein, Inc., who spoke about health care technology at the conference.
Since 2015, Bruce has headed the innovation group at Henry Schein, an ADEA Corporate Member and a distributor of dental equipment and supplies. He shared descriptions of what’s taking place in the health care innovation landscape and explained the role that artificial intelligence (AI) is playing as a facilitator of this progress.
The dream of getting computers to think has been around since the 1950s, but the ability to realize that dream has only been possible in the wake of six recent developments.
- The dramatic increase in computing power. Today’s desktop computers have 1.3 million times more brute computing power than the computer that took NASA’s Apollo 11 mission to the moon and back.
- The increase in communication speed and the decrease in latency, the delay before a transfer of data begins. With the introduction of 5G communications, that speed will increase to the point where a surgeon guiding an operation remotely and the robot making incisions act at essentially the same time.
- The ability to miniaturize computer chips to embed powerful processors in smaller and smaller devices.
- The creation of artificial neural networks that simulate how the human mind works.
- The accumulation of sufficient data sets to facilitate computer learning.
- The advent of deep learning, the process by which computers apply neural networks to the analysis of diverse data to solve complex problems.
AI has been key to the development of the Internet of Things (IOT). I suspect you are familiar with IOT through the boom in smart devices for the home. With 5 billion IOT devices in the world today, many of us are regulating our thermostats or operating home security systems through our smartphones. I’ve noticed many of you wearing devices that track your steps and other data, and these “wearables” become more sophisticated every year. The latest Apple Watch can generate an electrocardiogram in just 40 seconds. Meanwhile, in the realm of dentistry, smart toothbrushes are tracking how long and how well people brush.
These devices represent just the most visible manifestations of the use of IOT in the health care arena. Implantable devices, such as electrodes that stimulate the brain, and ingestible sensors aimed at tracking medication use are the next frontier in remotely managing chronic conditions. More than 40% of Americans have one or more of chronic diseases, which account for an estimated 75% of all health care spending. Being able to monitor these conditions outside of health care settings—before they become acute—is a crucial strategy for keeping people healthy and keeping down costs.
What will these technologies mean for the dental office? Imagine walking into a practice and activating the lights, the computers and the compressor by simply saying, “Good morning.” The thermostat setting moves up or down depending on the time of year, and music starts to flow through the sound system. During your first appointment, your assistant returns from the supply closet with the materials you will be using that day, and before you even employ them, your inventory control program, thanks to sensor technology, has already placed orders for those that are running low.
IOT technologies also have the potential to substantially improve the patient experience. As individuals are ushered into separate operatories, music can put them at ease by changing in accordance with the preferences stored in their health records. As patients exit from the practice, postoperative instructions can appear on their smartphones along with coupons for the drugs they need to purchase.
Another ADEA Deans’ Conference speaker, Larry Emmott, D.D.S., also anticipates advances in genetics and big data playing a growing role in diagnosis, with digital lab-on-a-chip devices taking center stage. Larry writes about digital technology in his Emmott on Technology blog, and he has made it his mission to help dental professionals make good technology choices. Larry attributes much of the expanded use of digital technologies in diagnosis to what he calls “these little miracles in our pockets,” our smartphones. One example he told us about: a $5 test for the human immunodeficiency virus made from a specialized chip and a 3D printed interface that can be attached to a smartphone.
On the treatment side, Larry foresees advances in dentistry that are “just mind-boggling.” He expects that robotic surgery and the use of lasers will improve the precision and the experience of care. So will 3D printing, which is already transforming the construction of dental restorations. Others are using bio-plotters to custom build teeth and pieces of bone from human cells. And Bruce knows of at least one company that is seeking FDA approval for the use of nanotechnology to embed antimicrobial properties in dental restorative materials. Mind-boggling, indeed!
These tools could be revolutionary—in part because they may ultimately allow people to diagnose and treat many conditions themselves well before entering a dental office or other health care setting.
“Eventually, a professional dentist will have to intervene to do some things,” Larry believes, “but 50 years down the road, these technologies will enable us to deliver health care quickly and cheaply at a very high degree of quality.”
While clearly enthusiastic about the power of the digital revolution, Larry is also well aware of the barriers that may continue to impede progress in these areas for some time to come. For starters, he notes that a lack of data security and privacy concerns are holding back the spread of technologies that rely on the Internet to store and share data. Second, he says that dentistry is “plagued by proprietary systems,” which prevent information sharing in ways that would allow for significant advances in research and clinical care. Third, the absence of standards for interoperability that stakeholders honor and adhere to—not just in dentistry but in medicine as well—continues to stymie progress. Fourth, state licensure requirements and other regulations stand in the way of innovations such as telehealth. Finally, our own dental culture is likely holding many of us back.
As Larry rightly points out, dental professionals as a group are rule-oriented, and we value precision. We are taught to follow step-by-step procedures and are loath to deviate from what we know. Too often, when we do embrace a new technology, we don’t adapt our practices to take full advantage of its capabilities. “If dentists don’t have a vision of what they’re trying to accomplish, they can spend a lot of money on technology and get very little benefit,” Larry observed.
Too often this has been the case, but informative programs, such as the conference the deans enjoyed this fall, can do a great deal to inform our vision of the future and help us successfully integrate technology into our schools and practices. Ultimately, smart devices are about much more than convenience. When creatively deployed, these groundbreaking technologies can also make people healthier, and they might even reduce preventable morbidity and mortality.
I have no doubt that technological advances in health care have a bright future, but the challenge we face now as dental educators is to prepare our students for a more digitally assisted clinical environment while also teaching them to function in the world as it currently exists. Truly, there is much to ponder about how we meet this challenge.