Name: How Cleveland Clinic Is Disrupting Medicine With Microsoft HoloLens
Uploaded: 2017-05-12
Duration: 20 min 6 s
Description: Watch full interview with Toby Cosgrove, CEO of Cleveland Clinic.

Well I'm here with Doctor Toby Cosgrove who is the CEO and it seems like you're the founder of the Cleveland Clinic. I've been here that long? No, it just seems like it's having its kinda renaissance since you took the helm. And there's so much exciting stuff. You're partnering with the Case Western Medical Reserve Very new cool technology that we're gonna talk about today, the Hololens, tell me a little bit about that .>> Well it's terrific it's augmented reality and I initially saw it now almost three years ago when Microsoft was working on it and it hadn't really gotten the commercial product yet. And, we saw the potential of it for education .>> But, you were looking, you were looking at a Mars Rover, right? I mean you weren't actually thinking about anatomy at the time. No, actually they, we weren't thinking about anatomy. They put us in a room, and, and they had a relationship with the Jet Propulsion Laboratory, and the Jet Propulsion Laboratory has got a Rover on Mars. And I put the goggles on and I am on Mars. It's amazing and so they use this to decide where they are going to drive the Rover, every day. And we said" my goodness, this is a game changer ." And can you image all of the things that you have to learn and be able to visually see them at the same time and emerse yourself in to [ UNKNOWN ]. It was really stunning. Augmented reality, you're in a real world setting, but then there's a super imposition of another world, right? Exactly, exactly what it is, for example You see a hologram. You can work around the hologram it's in your room. It's incredible. And so you imagine what it would be like for anatomy, and creating this sort of virtual anatomy idea. And you talked to your colleague Dr. Mark Ritzwald and you say get on the plane, right. We saw this and I was out there with President Snyder, and the two of us talked about it, and we saw the potential. And we said Mark, get out there, and we sent him out the next week. And he got involved, and you'll see the fruits of his labors, which are really quite stunning. [ LAUGH ] And so when you're a medical student, now you and I talked about this. You're a Of course a famous heart surgeon. You've- Used to be. Used to be. But you've invented different procedures. And you said to me if I had had this when I was a medical student, I would have been a better surgeon. So you were one of the best In the world. Well, you know, we started out when I was in medical school with a cold cadaver. And I remember the first, Are there warm cadavers, by the way? No, they're not warm cadavers. Okay, okay, just checking cuz I'd be worried [ UNKNOWN ] Okay. But we spent the first, I think, ten days just dissecting the nerves to the skin of the arm. I mean, what an incredible waste of time. I never even thought about subsequently. [ COUGH ] But we couldn't see the big picture of things. You couldn't walk around and look at them from different directions. They were just, there they were. And it was and though, then when I got to be a heart surgeon I had to learn the anatomy of the heart all over again. Learn it by actually seeing it as you were taking apart parts, and cutting and paste? Well, some of that but also books. And Frank Netter's drawings of the heart. And multiple publications and different things. And people study different parts of the heart. I'd be willing to go back to Leonardo Da Vinci's works, drawings of the heart which were really incredibly [ CROSSTALK ] What's the man called the, yeah [ LAUGH ]. And so his drawings by the way are spectacular and very accurate and very interesting. So I went back and so I just pieced it all together, a piece at a time but you never got sort of a three dimensional view of it. You never [ UNKNOWN ] over here and over here You look straight at a drawing and now you have the ability to understand the body as you walk around it. And you see where things fit into the program a bit at a time. You see the context of the body and you actually see the relative sizes and proportions of things and The way they shape and being able to see how those shapes bend as you move around. Exactly. So it's a much more dynamic understanding of what's going on, and you could put it in context of the whole body, not just some little thing that you're studying at that particular time. It's actually fascinating. And I think it will give people greater understanding. And I think what the next step is it will clearly move into the clinical arena. I mean, guys are already starting to use and say how can we use this when we start to think about face transplants, and what will this mean as how we reconstruct the face? So and I think that's just the beginning of our understanding of the uses of this sort of technology. So when we talk about what you can see in this virtual anatomy, you can see these schematics not just of bones, and ligaments, and tissue. But You can actually see, say, the white matter in the brain coming through different pathways. That's- The nerves, right. That's astounding, to see the various pathways in the brain. Very hard to understand. You certainly can't see them as you look at them in a cadaver. You certainly can, cuz he stood in my pathway, I know that, cuz yeah, [ LAUGH ] those are challenging. No, but you can't see them in a dissection. Right. And you're taking the material from a functional MRI and beginning to look at these pathways in the brain. And so you can walk around them and look at them from different directions and understand them in a way that you never could before. Now we're at the point right now where we're seeing these schematics essentially. And very well informed, based on real life human biology. But we are not at a point of understanding the pathology yet, so where we have an individual's disease. So you're a heart surgeon. It'd be great if one day, you could see, say, a patient's faulty valve that was particularly tricky, and be able to upload that through, say, a CT scan or other energy. And then see that in the hollow lens. I think absolutely we'll be able to do that. Yeah. I don't have any question about that and that will add the next dimension of how we use this and clinical understanding. What about at the cellular level? Coming down, right now we can see tissues and we can see linings of organs, but can we actually see the cells? I think I'm frankly I'm not sure whether we're gonna be able to do or not. I'm sure that with the proper microscopic picture you can load those in and figure out how you do it. But I mean it just happen thinking you gotta look at the The pharmaceuticals, the structure of a drug. You can see it out in the middle of the air, you can walk around it and see the various covalent bonds [ INAUDIBLE ]. It's pretty exciting stuff. And I think it just going to add another dimension to how we began to understand the anatomic and the medical world. And when students are going into this hollow lens you see their hands moving, they're actually moving the parts around and they're looking. It's a kind of a hands on learning, and it changes the way they learn, right? Well, I think it's going to change the way they learn, and it's part of the bigger picture of what we're trying to do with this building we're building across the way. Yeah, tell me about that. So what this building is It's quite unique. It's bringing medical students, dental students, physician and nurses, physician's assistants all in one building. To begin to talk about team work. Because healthcare has gotten so big and so complicated That the guy with the black bag who used to come to your house. Yeah, I like that guy. Yeah, we all like that guy, but he can't manage it all anymore. He can't have all the cures and all the diagnosis and all the knowledge in that black bag. So, it takes a whole team of people. And so what we're trying to do is teach teamwork now from the get go and then to begin to incorporate the technology that is now becoming available to us in a different sort of a way. Watson, for example, is going to move into there. And Watson has been going to medical school here. For the last three years and Watson has learned now to read the history, the physical and the lab studies. And give you a problem list as well as a doctor can do. Pretty exciting stuff. How good a student was Watson? Watson? Watson's a very good student. Not very much fun on saturday night though. Not much personnel. Yeah. Not with the rat cellar. No No. No no not too much. But watching his, able to read 40 million documents in 15 seconds and remember it all. Now when you stop and think about what's going on now with the explosion and knowledge, the total amount of knowledge in healthcare is now doubling every 73 days. There are 5600 journals And there are, turning out 900, 000 journal articles a year. Nobody can keep up with all that. Right. And then you look at the place of the human genome coming along, which has got 3 billion data points in every human genome. So the amount of data you've got to handle is just enormous. So Watson's gonna come in. HoloLens is gonna come in. We're looking at MOOCs to begin to help teach. We wanna take the technology that's now available. And being it to bear in education in a new way, teaching teams how to work together. And you're teaching not just with technology, but changing the human behavior. Because you're noticing the way that people interact in a different way and how they internalize knowledge after Being in something like the HoloLens or being exposed to these interdisciplinary teams. Absolutely, this is about teams, and this is about how people interact, both with each other and with the patient, which is gonna change how physicians Think about interacting in the greater universal people. Yeah. Do you remember the first time that you actually at the anatomy on the home runs. What you're reaction was? I want, My God, I can't believe this on the first and just recently I have the Hollands on and I'm walking around a A, money that's floating out here in space. And they say, Toby, stick your head in. And so I go like this, stick my head in. And my head's in the chest cavity, and I'm looking down at the diaphragm. My god. Now for the first, that's the first time I've ever looked down on the diaphragm. Because as a chest surgeon, You can't see the diaphragm all in one slug because there's a funny thing called lungs that get in the way. So this was an opportunity for me to understand this portion of the anatomy in a different way than I'd ever seen it before in 40 years as a chest surgeon. That's incredible. Now as somebody who understands the heart probably better than 99. 9 % of the people on the planet, or more, what did you learn about the heart? Anything, from looking at this? Well you could see the interaction. For example, you could see the interaction of the muscles that support the mitral valve, and how the valve opens and closes. Yeah. And You can understand that. I mean it took me forever to understand that as not [ UNKNOWN ] for the other. But all of a sudden you can see it actually happening, then you say, I understand that. Now these little muscles contract and the valve opens. And when they don't open you get the pro laps or you get those. And you can see how that happens. Wait a minute, do you have some medical training? [ LAUGH ] I've been listening to you for a while, yeah. [ LAUGH ] So, and so you can actually start to understand where break down a little bit better because you're seeing the actual movement. The mechanical movement. Yeah. In a way. Yeah. So, students have Have you talked to any of them about this, about your experiences? The students really see this thing as a way to understand what's going on much better than they could just the anatomy. When I think about the nerves, the nervous system Yeah. I mean, the second endeavour. You can't figure out how it goes from here to here. There's no way you can see it. I mean, it just doesn't travel in something anatomically in dissect, but you can understand it by looking at a schematic that shows it and how it happens. Right. It's incredible. And then, you can actually As we get better at programming these, we can program in failure in the system. So we can see, for example, if you've got a severed nerve here, how it would affect. Absolutely. It's just a matter of programming what you want to put into this. No, that's not a simple process and it's a big effort. But you can program all kinds of things into, that is the teaching aid. If you're looking at, for example, something The process of cancer and understanding cell signaling, we'll be able to look at that one day. I can only imagine the potential of this. I mean, it is huge to begin to understand this. And we saw a very nice example the other day of if you put a tumor on a location on the brain what it affects And what it will affect in the various pathways in the brain that it'll affect. Are we in a revolution? Are we in a healthcare revolution right now? I think we are right now going through the biggest change in healthcare that's happened in a century. Wow. And we are moving now To multiple different areas I mean we're changing right now from how we get paid for looking at for people to how we begin to look out after populations. And we're trying to keep people well and out of the hospital instead they're just trying to fix someone so get into the hospital. We're changing our understanding of Genomics, which is a huge issue. And the more we study, the more we understand the influence of genomics. We're understanding the influence of everything in the environment and how they affect you. By everything you put in your mouth and how it affects the rest of your body, which is the biggest environmental influence on your life So, and, we're also have this explosion of knowledge and. Mm- hm. With artificial intelligence begin to try and understand how we can take this knowledge and begin to look for early signaling of problems. Mm- hm. Of people that we never had before. We recently put together a company called Explore us. Which I had the collected 50 million patient records. And you can imagine you can go to that and say, I want to know how many people where 43 years old Who have diabetes or taking this drug and two nano seconds you [ SOUND ] have them. Wow. [ CROSSTALK ] With this potential side effects they have or adverse affects from taking them. In that drug, or if there's some relationship with another morbidity or disease [ CROSSTALK ]. Exactly, and so you start to see connections that you never could pick up just from looking at the 100 patients. See, you've talked about this explosion of knowledge, all these new technologies How much is there also a change in mindset? And what I mean by that is, is there a sense of a disruptive restlessness? A sense that we're just tired of doing things the old way, the old traditional hide down ways and particularly in an industry that is pretty hide bound. Yeah. And healthcare clearly is very high bone. And I think one of the things that's being very disruptive is all the social media that has come to effect that. And if you look at where venture capitalists are putting their money. They used to put it in devices and pharmaceuticals. Now it's going into IT. And there are more new companies being spun up that are looking at ways to take care of patients, to facilitate care, how to change the way we understand the pathologic processes. So the whole process is changing. Right now, for example, I can get on my cellphone any place in the world, and get a consult from the Cleveland Clinic and talk to them on my cellphone. It's incredible, yeah. I mean, think about what that means. Think about the fact that we can do virtual medicine. I can make sure that Mrs. Jones at home Is taking, I can talk to her on her Skype or in her cellphone and make sure she's taking the blue pills instead of the green ones and so she's right. I can look after people in nursing homes without every going to visit them, I can get a [ UNKNOWN ] consult with, from home, just by taking, holding up the cellphone to the [ UNKNOWN ] and asking what it is We're looking now at, we're reading x- rays from Abu Dhabi. Right. We're looking at pathology slides from China. This is an incredible change that technology is bringing us. And with it comes the mind set of millennials who wanna have. Mm- hm. Instant access to care any place, any where, any time. People feel frustrated. When you say health care, in fact, we were thinking about what word to put on our cover, whether health care had such bad connotations now. But you don't sound like you're that frustrated. You sound pretty optimistic. Well I am, I'm excited. I'm excited because I think we're moving from the time of sick care to time of well care in trying to keep people well and out of the hospital. And if you look at the financial ramification of all of this for our country. The big issue that we have is the exploding cost of health. And that's the root cause of all this discussion about what we're gonna do about coverage. And so, but The root cause of the problem is the exploding cost. And the cost has gone up for two reasons. One, more older people, and secondly, more things we can do for them. Right. Now, and this is not just the United States, this is all over the world. Everybody is concerned about this rising cost to healthcare. So, what we have to do is, we have to look at how we can, A, keep people well and keep them outta the, getting sick. I mean just think for example, 10 percent of the healthcare costs in the United States is from obesity. Yeah. And so, keep them well, and then if they do get sick, get them into the most efficient healthcare delivery system that we can. Hopefully keep them outta the hospital. And that is a major change in our thinking. [ UNKNOWN ] it's an honor and a pleasure to talk to America's doctor. I enjoyed it. Always. Thank you.

Watch full interview with Toby Cosgrove, CEO of Cleveland Clinic.