A rare innovator in a field that is struggling to be innovative, Dr Homero Rivas gives us his views on the place of digital tools in the field of medicine today and talks about the techniques that have the potential to revolutionise the work of physicians and surgeons.

[Health 2.0] Google Glass and 3D Printing the Future of Surgery?

Interview with Homero Rivas, a bariatric surgery specialist and Professor at Stanford University, on the sidelines of the Health 2.0 event held in Barcelona on 18 - 20 May.

L’Atelier: You’re an enthusiastic user of Google Glass during surgical operations. Why is that? Do you think this device will become more widespread in the medical field in the near future?

Homero Rivas: I’m an academic, a university teacher. So it’s my duty to assess the new tools that are becoming available to physicians. This doesn’t mean that everything I use will necessarily bring added value to my work.  Google Glass still has plenty of limitations, especially as regards the battery but also as to what you can do with the device.  However, this is a real computer that you can wear on your person, which enables you to access the Web, take photos and videos and share them – all inside an operating theatre, which is a very limited space where everything has to be sterile.

I’m not so sure that all clinicians will adopt this practice in the near future, though. It’s always difficult to predict with certainty what tomorrow’s practices will be, especially since technology in the medical field is constantly evolving.

Are there any other techniques already available but not much used by doctors today which you think have the potential to transform the way they work?

3D printing is one of the techniques which could transform physicians’ work.  For instance, 3D printing could enable clinicians to ‘customise’ a plaster for a straightforward fracture and even produce tailor-made prostheses, such as artificial hips. Surgeons could also use this technology to avoid making mistakes when preparing to perform a complicated operation such as for instance removing a brain tumour. The surgeon could ‘print out’ a 3D copy of the patient’s skull and practice on it ahead of the real intervention.  Here again, it will take some time to educate the practitioners. Meanwhile, patients are becoming much keener on the use of this type of technology, and they are today much better informed. After all, patients are the ones who have the greatest interest in safeguarding their own health.

L’Atelier recently interviewed Richard Brady, a surgeon who expressed his concern at the growing number of so-called ‘medical’ apps launched every year without any regulation. Do you share his views on this?

Well, there’s no doubt that there is today a large range of medical apps available. In 2017, there will be an estimated 1.8 billion users of apps for medical purposes. However, the fact is that the United States body responsible for the oversight of everything to do with Health [Editor’s Note: the FDA] did not until very recently have a unit in charge of regulating Digital Health products. This is why the vast majority of apps that claim to have medical benefits are not subject to any controls at the present time.

I wouldn’t go so far as to say that these apps are dangerous, because most users are not fools. The main problem with medical apps designed today is that they’re built either by individual developers who don’t have a real understanding of the medical world or by physicians who don’t know enough about software development. And there‘s a wide disconnect between these two worlds.  So, yes, at this moment in time there are a large number of ‘medical’ apps, but I wouldn’t worry too much because this indicates a great interest in medicine and those that are of ‘poor quality’ won’t survive the pressures of the market.

In any case, I myself am a keen user of apps, which I wouldn’t describe as ‘medical’ so much as ‘well-being’ tools – especially those that enable you to keep track of your weight, monitor your heart rate, your sleep quality, and so on. But I do in fact have a great belief in the potential of medical apps and even more so of ‘wearable’ devices, which in my view are still under-used today. Of course the main reason why they aren’t yet as widespread as medical apps is a purely financial one, but they are capable of having a definite effect. That could be a preventative effect, anticipating blood clots, heart attacks, strokes and such attacks or alternatively for post-operative follow-up and monitoring of the patient’s condition to avoid having to call on a nurse every time. All this will happen eventually.  However, neither apps nor wearables will survive in the market unless they’re patient-driven and patient-centric.  

What are, in your view, the main obstacles to incorporating all these innovations into the Health field?

Well, most of the barriers are purely technical, but there are also economic obstacles. The fact is that the technology is advancing at a crazy pace and most clinicians simply can’t keep up with this rapid progress. I also sense some resistance in the doctors’ mindset. Some physicians find it hard to believe that digital will bring them any real benefits, whether we’re talking about communication methods, ways of obtaining information, or as a means of actually delivering care.

Nevertheless, I think the education process for doctors will come about of its own accord. Take email for example: there was no need for a major publicity campaign to get people to use emails. Changes arising from the use of digital tools are going to happen, whether physicians like it or not. Moreover, these changes are being driven by the next generation, who are already prepared to adopt the new approaches.  And the older generation will simply have to adapt to these innovations if they don’t want to risk getting out of touch with the times. 

By Anthéa Delpuech