Luis Kun
Center for Hemispheric Defense Studies (CHDS)
National Defense University                             
Abraham Lincoln Hall                                          
260 5th Avenue, Room 3109                                
Fort McNair, DC 20319-5066                    
USA
Phone: +1 202 685 9452
Email: KunL@ndu.edu

DVP term expires December 2013

Luis Kun is founding chair of the IEEE-USA Electronic Health Record and High Performance Computers and Communications WG; and the Bioterrorism / Homeland Security WG, and the Critical Infrastructure Protection Committee. He received a BSEE, MSEE, and PhD in biomedical engineering from UCLA and spent 14 years at IBM. As senior IT advisor to the Agency for Health Care Policy and Research, Kun led HPCC and Telehealth efforts. As a distinguished Fellow at CDC, he wrote the IT vision for the National Immunization Program.  A Fellow of the IEEE and the American Institute for Medical and Biological Engineering, Kun received AIMBE’s first-ever Fellow Advocate Award in 2009. His IEEE-USA Citation of Honor Award reads, “For exemplary contributions in the inception and implementation of a health care IT vision in the US.” He sits in many professional and journal Boards and is the Editor in Chief of the (Springer) new journal on Health and Technology.

Transforming Healthcare through Interoperability
For over 40 years researchers have written about applying computer technologies to improve daily medical care, and in the past decade, the goal of using genomic data to truly personalize care has been woven into those concepts. Since 2004, the US has focused on creating a complete personal health record for each citizen by 2015, and great strides have been made in developing the technical standards to allow near-real-time health data acquisition either directly from medical devices, health practitioners, caregivers, and/or patients themselves.  In this period  government and private agencies have also been separately collecting and organizing vast quantities of scientific data regarding agriculture, society, and many other facets of science the environment we live in. It has become clear that many illnesses and injuries are directly caused or are significantly influenced by the environment. Further, as human lifetimes are extended around the globe, environmental factors simply have more years damage to human health and wellness.   The cost of treating illnesses and injuries in the US is rapidly approaching 20% GDP, and other countries are experiencing significant medical cost increases as well. These increases have far outstripped other industries, and is made worse by the growing percentages of elder citizens.  Older populations also shift the cost and burden of healthcare onto a decreasing percentage of young and health workers, too.  Not only are the costs unsustainable, but the escalation of human suffering for old and young alike is unacceptable and unnecessary. 

Ultimately, scientists, engineers, and information specialists will have to work to “engineer health and wellness INTO each person’s life” as consistently and as effectively as possible, because that is simply more efficient, effective, affordable, and ethical than treating the symptoms of illnesses and injuries. Health and wellness is not a “one size fits all” process, however.  Our genetic makeup and our lifelong history of nutrition, exercise, education, illnesses and injuries all interact with the environment in very complex ways.  Over many centuries of evolution, humans have adapted to widely different chemical, climactic, nutritional, and other challenges.  The ideal sustenance for health and wellness of each person and community can be considerably different through seasonal, regional, social, and other changes. Matching health and wellness solutions to each person’s current and projected needs will require integrating vast amounts of sometimes dissimilar information, careful and thoughtful analysis of these data warehouses, and skillful interpretation and application of that data to meet each person’s actual needs.

Evolucion y Transformacion del sistema sanitario y de la salud publica: un gran desafío del Siglo XXI
La sociedad actual esta siendo afectada, en formas impensables para muchos, por una combinacion de factores que no solo estan revolucionando la forma en que trabajamos, estudiamos (aprendemos y ensenamos), leemos y escribimos, nos divertimos o nos enteramos de noticias, compramos y vendemos y en general en la forma que nos comunicamos sino la forma total en que vivimos.  La globalizacion y el constante uso de tecnologias que convergen tanto en el ambito academico, como en el industrial o en el de gobierno ha ido generando una nueva generacion de dilemas socio-económicos y tecnologicos que estan asociados no solo con la ingenieria biomedica, la ingenieria clínica y la electromedicina sino con un gran gama de otras áreas.  Desde el aspecto profesional los nuevos requisitos han abierto y abriran oportunidades laborales para aquellos que tengan conocimiento en un espectro de nuevas areas que incluyen biosensores, sistemas geograficos de informacion, la nanotecnologia, “intelligent agents”, y muchos otros.  Los expertos en medicina y salud publica deberan incorporar dentro de sus equipos individuos que puedan desarrollar, mantener e incorporar las nuevas tecnologías dentro de los respectivos campos.  En muchos casos las soluciones usadas en un campo distinto han permitido resolver problemas en otro, lo cual ayuda a mejorar el costo-efectividad de las soluciones propuestas.  NOTA: Esta charla abarcara temas que pueden ser de mucho interes para audiencias heterogeneas que incluyan no solo a los expertos en computación sino a ingenieros: biomedicos, de sistemas, de comunicaciones, tecnologos, medicos, enfermeras, personas asociadas con la salud publica y epidemias, agencias o departamentos encargados de proteger los alimentos, el agua potable, el medio ambiente, las fronteras, etc.

The National Health Information Infrastructure, Bioterrorism and Public Health

La gripe aviar, el SARS, la vaca loca, el SIDA, la tuberculosis y la Malaria son algunas de las enfermedades emergentes del siglo 21.
Estas amenazas a la salud constituyen una nueva forma de normalidad: donde las caracteristicas de las amenazas pueden ser descriptas como amenazas globales con impacto local o amenazas locales con impacto global. El impacto de estas enfermedades se refleja no solo en el terreno del cuidado de la salud o de la salud publica, sino también en la seguridad nacional  y la economia de las naciones afectadas. Pequenas redes mundiales de grupos locales muestran como, a traves de una veloz transmision,  estos portadores pueden desbastar regiones enteras. Esta nueva “normalidad” tiene requerimientos de respuesta que exigen una rapida deteccion, una rapida y efectiva comunicación, una rapida y efectiva integración y una rapida y efectiva accion. Las claves para abordar estos aspectos de la globalizacion son : conectividad, velocidad e integracion. La visión de red de Informacion de Salud Pública puede transformar la salud pública por medio de la coordinación de sus funciones y la organizacion por medio de sistemas de información que permitan: flujo de datos en tiempo real, analisis asistido por computadora, soporte a las decisiones, colaboración profesional y rapida diseminacion de información a los hospitales, clinicas y al publico. Sistemas de deteccion temprana que usan informacion en tiempo real de ventas, así como tambien de el ausentismo en los trabajos y en las escuelas, combinados con sistemas de información geografica pueden proveer una ventana de tiempo unica para que los funcionarios de la salud pública puedan actuar rápidamente y prevenir futuras complicaciones a sistemas que , de otra forma, colapsarían a causa de su falta de capacidad de respuesta. El cuidado del ambiente del hogar del siglo 21 puede otorgar a los ciudadanos del mundo desarrollado una oportunidad unica de efectuar una cuarentena en el hogar mientras continuan recibiendo servicios a través de la información de infraestructura del hogar.

Hurdles in the Information Age on Public Health Practice and Health Care Delivery
The implementation of Electronic Health Records (EHR) and a Health Information Infrastructure both at the National and Global levels has been a lot slower than many estimated just a few decades ago.  Although “Costs & Privacy” seem to be two of the reasons most commonly attributed to these delays, few people focus on the potential savings that could occur by having both the EHR and a National Health Information Infrastructure (NHII).  Health care costs are the fastest growing segment of government and personal expenditures. One of the attempts to control these escalating costs is managed care. So far the data on effectiveness of managed care in controlling these costs is mixed. Life expectancy on the other hand, has increased. The over-65 population is increasing with the over-85 group increasing the most rapidly. From an economic point of view the "elderly" represents by far the biggest expense and as this group increases so do the expenses.  Most of the talk in terms of the benefits of telemedicine has been mainly in the area of "rural health" since it affects 55 million lives in this country alone. Telehealth and in particular telemedicine however offer some unique opportunities for the elderly and as such its economic, cultural, social and technological impacts can be phenomenal. Nursing homes and in particular home care will become much more cost and clinically effective by utilization of these technologies.  In the Information Age implementation and support of the National and Global Health Information Infrastructures (NHII/GHII) strategic plan will occur through the utilization of High Performance Computing and Communications [HPCC] and Intelligent Agents . HPCC technology provides a potentially huge payoff in health care.  From tele-consultations to availability of health-related databases, the effect of using HPCC will enhance patient care, improve drug design, and broaden access to medical information. With the incorporation of these technologies to genome-map related discovery we are at the verge of doing true disease prevention.  Geographic distance, time to accomplish tasks, separation of people from resources, and outdated organizational structures are impediments that inhibit the ultimate achievement of all these goals. Information technology has a pervasive and unprecedented ability to remove these barriers to progress.