Complex Adaptive Healthcare

My wife Betsy and I attended a very interesting lecture last night hosted at the Santa Fe Institute by Dr. Tim Buchman, Ph.D., M.D., who is an external professor at SFI. (NOTE: This lecture is now on video online here)

Dr. Buchman’s day job is Founding Director of Emory Center for Critical Care and Professor of Surgery at Emory School of Medicine. The title of of Dr. Buchman’s lecture was: Secrets of the Heart: The Electrocardiogram, Complex Systems Science and Fundamental Laws of Biology.

As is often the case at SFI, the lecture brought together several pathways of interest that reminded me of the Arc de Triomphe de l’Étoile that so fascinated me as a child, where every type of vehicle comes together at variable speeds, volume and noise levels, carrying all types of cargo, yet despite the chaos and occasional fender bender, traffic flows and life continues.

The Arc de Triomphe network analogy works well for the mega-disciplinary approach required of my work with Kyield—including our semantic healthcare platform, as well as the complexity of human biology, with the Arc serving nicely to visually simulate the cellular traffic (blood), even if lacking in muscular pump function. The beauty of complexity research at SFI is that researchers are increasingly able to confirm theory with mathematics and evidence from testing in real world environments like an ICU.

Those who have studied complexity and chaos may already be aware of the importance of nonlinear dynamics in healthcare, although confirmation of research in this area is fascinating. For example, the old assumption in medicine that the ‘normal’ heart and respiratory rhythms regulated by devices in the ICU is the most beneficial turns out to be false. The lecture revealed compelling evidence that heart patterns are to a surprising degree predictive of mortality, and that after two weeks in the ICU with a ‘regular’ rhythm (synchronized), patients have an EKG pattern that is less than optimal for longevity, which is one reason why extended stays in ICU are best avoided when possible.

Dr. Buchman reports that to date research shows that the human body performs much better over time, to include quality of life and duration, with ‘irregular’ rhythms, or lack of synchronicity. To date it appears that forecasting optimum variations have failed—important lesson being that variables in exercise, or cardiorespiratory rhythms, is essential—the body appears equipped to adapt to variable activity much better than synchronization. For this reason, in Dr. Buchman’s ICU, the respirators now intentionally represent an asynchronous system. It’s probably a safe assumption that intentional asynchronism will play an increasingly important role in medicine moving forward.

This lecture was timely for me as it reinforced the importance of providing our rationally designed semantic healthcare platform to optimize care in real-time, as well as improve the quality of data for predictive medicine and future discovery. Mobile health aligns very well with the needs of patients, payers, and researchers in many ways, not least of which is providing anonymous data for prevention, which is key to driving costs lower and improving quality of life—potentially on a massive scale.

I spoke to David Krakauer after the lecture—chair of faculty at SFI and brilliant guy, who said that the lecture will be up on their web site soon. I will share on Twitter when it becomes available. Professor Krakauer reminded me of another good resource on this topic at ReyLab (Institute for Nonlinear Dynamics in Medicine) run by Ary Goldberger, M.D. at Harvard.