��������ο

As a former astronaut, now assistant professor in the University of Toronto's department of surgery and hospital chief executive officer, Dr. Dave Williams has a unique perspective on health care.

Today, Williams is using lessons he learned in space to transform care as president and CEO of Southlake Regional Heath Centre. He spoke to writer Suniya Kukaswadia about the promise of Big Data, the future of medicine and the intersection of science and science fiction.

Do you think big data will change medical research in the future?

Big data presents opportunities for using large databases of information to provide diagnostic support to clinicians. The ICU is a good example. We can monitor patients using physiologic sensors to record heart rate, urine output and blood pressure as opposed to relying on one-on-one interactions between the health care professional and patient to gather the data and make decisions.

Imagine if we can use computers to do this in the future instead of people. It sounds like something out of Star Trek or 2001: A Space Odyssey.

In the aerospace world, for example, aircraft have on-board data monitoring systems that help the crew ensure everything is working properly. The clinical data is there but now we have the opportunity through analytics to apply this information to health care.

What inspired you to become an astronaut and a physician?

It goes back to 1961 when Alan Shepard went to space. I remember watching it on TV and thinking ‘that’s incredible! That’s what I want to do.’ But at that time Canada didn’t have an astronaut program. I decided to focus on the underwater world instead, and became passionate about scuba diving.

At age 12 I was considered young for the course and I had to pass both the physical and theoretical tests to get my scuba certificate. The theory involved advanced physics and a lot of physiology. I became interested in looking at how the body adapted to functioning in extreme environments – whether it was underwater or in space. That’s one of the reasons why I became a physician.

While many see me as an astronaut, an aquanaut and a physician, I would actually characterize myself as an exploration scientist who is passionate about how the body performs in a wide-range of environments. My passion is helping people working in those environments optimize their performance.

How does one role inform the other?

Both working in space and in health care requires understanding how teams work together in environments that are intolerant of error. The consequences of a mistake in space can be catastrophic. The same is true in clinical practice. If you were going in for surgery you would want to know that the operating room is a zero-fault-tolerant environment where your clinical team achieves success and avoids errors.

Both careers are also data driven and science-enabled. Our understanding of scientific principles has helped us explore space, and the same is true for medicine. We’re using science and engineering to drive the development of new technology to deliver state-of-the-art health care in space. Similarly, technological innovation is transforming the way in which medical care is delivered on Earth. There have been remarkable changes in the treatment of a number of different diseases over the course of my career, all driven by research and innovation. For instance, it is exciting to see how the application of space robotics to the development of surgical robots is transforming modern surgery.

One of the reasons why I became a hospital CEO was to see whether we could take the lessons learned from aerospace about the importance of innovation, safety and quality and bring them into health care.

Have you been able to apply any of those lessons at Southlake?

Yes, very much so. One of the elements of high reliability organizations is creating a culture of safety. At Southlake we have a very vibrant culture called the Southlake Way. It is defined by our core values of putting patients first, honouring our commitments, pushing the envelope and giving a damn. We just added a new core value called ‘speak up’ which is an extrapolation of what we do in the aerospace program. During a space flight we want crew members to speak up if they see something that they are concerned about. The same applies to health care, where we are seeing the concept integrated into the use of surgical checklists.

How do you think science fiction influences medical devices?

I think science fiction is a driver that challenges us to consider what might be possible. It is based on science portrayed from a fictional perspective. If you think back to the SciFi from the 1960s, you’ll recognize some of the devices that are in use today such as body-worn sensors that collect physiologic data and stream it to hand-held devices. Metaphorically it’s very similar to the Tricorder from Star Trek.

During my first space flight in 1998, I had to take a pill that was actually an AM frequency radio hooked up to a temperature sensor. It was used to monitor my core body temperature. The data was then sent via radio signals to a receiver I wore on the outside of my body and then downloaded to a research team in mission control.

SciFi is great at getting us to think about biocompatible devices. Currently, we’re seeing glimpses of the fictional ‘bionic person’ with people who have artificial implants. Take ventricular assist devices. In the 1950s and 60s those would be considered science fiction, but they are a reality today. I’m interested to see where biocompatible devices will take us in the future.

What are some of the big challenges facing health care today in your opinion?

I think we need to transition from a health and disease model to a wellness model. I trained as a physician when rest and recovery was a routine part of a hospital stay. Patients were admitted to the hospital to be treated and then rest and recover. That’s now evolving into a system where patients are admitted to the hospital when they need access to sophisticated technology to diagnose or treat a condition followed by early mobilization. Where possible I think care needs to be transferred back to the community with supports to help patients return to their optimum level of function.

How can the health care model shift towards a wellness-focused approach?

We’re already seeing the shift in my opinion. Patients and their families are better engaged in individualized care plans developed by interprofessional teams. We’re also creating new technologies to help empower patients to get more involved in their care. Technology will definitely speed up the transition to a more wellness-focused approach. I think this model will also help us confront some of the economic factors we face in health care today.

What are some unique health issues faced by astronauts?

Astronauts in space face the same challenges we face while we age. Their rate of bone loss can be anywhere from one to two per cent per month. This becomes problematic if an astronaut has been in space for an extended period of time. They also face issues with muscle wasting and aerobic deconditioning. We don’t use our legs much while in space. After a space flight it takes some time to adapt to a gravitational environment and regain your terrestrial legs.

NASA uses bed rest when it does research to understand the impact of these changes on an astronaut’s body. When some elderly patients are admitted to the hospital, we may keep them in bed for extended periods of time depending on their condition and need for care in the community. That’s like sending someone to Mars.

On my first space flight we wore a wrist device that monitored our activity levels. Imagine if we monitored activity levels of patients in hospitals, and physicians started prescribing minimum levels of activity to make sure people weren’t becoming deconditioned. We’re much more aware of the need for early mobilization in health care. I’m very excited to see our physiotherapists working together with respiratory therapists to help recovering ICU patients on ventilators walk around.

We know physical activity is crucial in the space program, but that’s something that’s fallen off the radar in the traditional health and disease model of care. Activity, diet and sleep are all critical in the wellness model.

Where do you see health care going?

Our imagination will be the limit, but I think we will use more and more technology in the delivery of innovative community-based care. However, one thing to consider is whether or not humans will remain an earth-living species, or will we be a space faring species. We know people want to go to Mars. Our ability to live on Mars will be based on us developing technology to drive biologic sustainability. Biologic change is measured in centuries whereas technologic growth is much faster. I think health care in the future will be based on technology optimizing physiologic function.

What do you think humans in 100 years will look like?

I think fundamentally the human form will continue to look the way it does today. But I wouldn’t be surprised if people continued to grow taller and have better physical conditioning. I also think we’ll see more bionics. We have some interesting advancements even now. In the past we haven’t been able to do much for adults who lose their sight. But now we’re seeing the emergence of light sensors that interact with the central nervous system to give people a rudimentary pattern of light recognition.

Suniya Kukaswadia  is a writer with the Faculty of Medicine at the University of Toronto.