and Intel has tested

如果你想想看，電話

a lot of the things I'm going to show you,

美商英特爾已經測試過

over the last 10 years,

很多東西是我馬上要表演給你們看的

in about 600 elderly households --

在過去的十年

300 in Ireland, and 300 in Portland --

約600戶年長者家裡

trying to understand: How do we measure

有300戶是在愛爾蘭，300戶是在波特蘭

and monitor behavior

試著去理解我們要如何測量

in a medically meaningful way?

及監測行為

And if you think about the phone, right,

以一個在醫療上有意義的方式？

it's something that we can use for some incredible ways

而且，如果你想想看電話，對

to help people actually take the right medication at the right time.

它就是能讓我們以 一些 不可思議的方式

We're testing these kinds of simple

來幫助人們，準確的在對的時間吃對的藥。

sensor-network technologies in the home

我們正在測試這類簡單的

so that any phone that a senior is already comfortable with

在家裡的偵測網絡科技

can help them deal with their medications.

所以只要任何電話是一位年長者已能自在使用的

And a lot of what they do is they pick up the phone,

就能幫助他們處理他們的用藥。

and it's our system whispering to them which pill they need to take,

而他們所要作的只是接起電話，

and they fake like they're having a conversation with a friend.

而且是我們的系統在私底下悄悄告訴他們應該吃哪一種藥，

And they're not embarrassed by a meds caddy that's ugly,

假裝他們正在和朋友對話。

that sits on their kitchen table and says,

他們不必為藥物像醜陋的桿弟感到尷尬

"I'm old. I'm frail."

佔在他們的廚房桌上而說

It's surreptitious technology

『我老了、我很虛弱。』

that's helping them do a simple task

它可以是暗地裡的科技

of taking the right pill at the right time.

來幫助他們處理一簡單的任務

Now, we also do some pretty amazing things with these phones.

在對的時間吃對的藥丸。

Because that moment when you answer the phone

現在，我們還用這些電話來作一些很了不起的事。

is a cognitive test every time that you do it.

因為，就在你接起電話的那一刻

Think about it, all right? I'm going to answer the phone three different times.

，你接起的每一次都是一個認知測試。

"Hello? Hey."

想想看，好吧？我現在就來接三次不同的電話。

All right? That's the first time.

『哈囉？嗨～』

"Hello? Uh, hey."

好了嗎？那是第一次。

"Hello? Uh, who?

『哈囉？痾，嗨～』

Oh, hey."

『哈囉？痾，是哪位？

All right? Very big differences

喔，嘿。』

between the way I answered the phone the three times.

可以嗎？相當大的差別。

And as we monitor phone usage

在我三次接電話的方式。

by seniors over a long period of time,

所以當我們監測電話使用的方式

down to the tenths of a microsecond,

由年長者經過很長的一段時間。

that recognition moment

不到十分之一微秒，

of whether they can figure out that person on the other end

那辨認的當下，

is a friend and we start talking to them immediately,

看他們是否能辨認電話另一頭

or they do a lot of what's called trouble talk,

的那個人是朋友，而馬上開始和他們聊起天來，

where they're like, "Wait, who is this? Oh." Right?

還是他們會有很多所謂的困惑對話，

Waiting for that recognition moment

像是『等一下，你是誰？喔。』對吧？

may be the best early indicator of the onset of dementia

等待辨認的那一刻

than anything that shows up clinically today.

也許就會是最好的早期失智開始的指標，

We call these behavioral markers.

勝過任何現今臨床上的徵兆。

There's lots of others. Is the person going to the phone

我們稱這些作行為指標。

as quickly, when it rings, as they used to?

還有很多其它的行為。這個人去接電話時，

Is it a hearing problem or is it a physicality problem?

當電話響起時，接電話的速度，是否和他之前一樣？

Has their voice gotten more quiet? We're doing a lot of work with people

這是有聽覺障礙，還是有行動障礙？

with Alzheimer's and particularly with Parkinson's,

他們發聲是否變得比較安靜？我們正在和很多人進行合作

where that quiet voice that sometimes shows up with Parkinson's patients

患有阿滋海默症的，還有特別是帕金森氏症

may be the best early indicator

，當漸趨安靜的發聲，有些時候表現在帕金森氏患者身上，

of Parkinson's five to 10 years before it shows up clinically.

有可能是最好的早期指標

But those subtle changes in your voice over a long period of time

比帕金森氏症臨床症狀的出現，還要早個五到十年。

are hard for you or your spouse to notice until it becomes so extreme

而這些你聲音裡細微的、長時間的改變

and your voice has become so quiet.

對你或你的配偶來說，可能很難去注意，直到它變得很極端

So, sensors are looking at that kind of voice.

而你的聲音也已經變得很安靜。

When you pick up the phone,

所以，偵測器就是在監測那種訊號。

how much tremor are you having,

當你拿起話筒時，

and what is that like, and what is that trend like over a period of time?

你有多麼顫抖？

Are you having more trouble dialing the phone than you used to?

還有那是甚麼樣子，經過一段時間，那是一個怎樣的趨勢？

Is it a dexterity problem? Is it the onset of arthritis?

你撥電話的按鍵時、是否比之前有更多的困難？

Are you using the phone? Are you socializing less than you used to?

是靈活度的問題？是關節炎的前兆？

And looking at that pattern. And what does that decline in social health

你有在使用電話嗎？你社交的是否比之前來得少？

mean, as a kind of a vital sign of the future?

看著那個模式，那減少的趨勢，在社交健康上，代表的

And then wow, what a radical idea,

意義是甚麼？能否代表將來的一種生命徵象？

we -- except in the United States --

接著，哇，這是個多麼創新的點子！

might be able to use this newfangled technology

我們，除了在美國，

to actually interact with a nurse or a doctor on the other end of the line.

說不定還可以利用這項新穎的科技，

Wow, what a great day that will be

確實與一位護士或醫師在電話的另一端互動。

once we're allowed to actually do those kinds of things.

那世界將會變得多麼美好！

So, these are what I would call behavioral markers.

等到有一天我們真的能夠完成這樣的事情時，

And it's the whole field that we've been trying to work on

所以，這些就是我所謂的行為指標。

for the last 10 years at Intel.

而且，這是整個領域，我們已經試著要做的

How do you put simple disruptive technologies,

在過去十年，在英特爾。

and the first of five phrases that I'm going to talk about in this talk?

你要如何把一個簡單的破壞性科技，

Behavioral markers matter.

放在我接下來將要在這個演講裡討論到的五個階段中的第一個階段？

How do we change behavior?

行為指標很重要。

How do we measure changes in behavior

我們要如何改變行為？

in a meaningful way that's going to help us with

我們要如何去測量行為的改變，

prevention of disease, early onset of disease,

以有意義的的方式，那是可以用來幫助我們

and tracking the progression of disease over a long period of time?

預防疾病，疾病的早期發現，

Now, why would Intel let me

進而追蹤疾病在經過一段長時間的發展？

spend a lot of time and money, over the last 10 years,

只是，為什麼英特爾願意讓我

trying to understand the needs of seniors

花這麼多的時間跟金錢，在過去的十年，

and start thinking about these kinds of behavioral markers?

試著要了解年長者的需求

This is some of the field work that we've done.

且開始考慮這幾種行為指標？

We have now lived with 1,000 elderly households

這是一些我們已經做過的田野訪查。

in 20 countries over the last 10 years.

我們現在已經住進一千戶年長者家裡

We study people in Rochester, New York.

在過去十年、在20個國家中。

We go live with them in the winter

我們研究在紐約州羅徹斯特市的人。

because what they do in the winter,

我們在冬天時，和他們住在一起，

and their access to healthcare, and how much they socialize,

因為他們在冬天作的事，

is very different than in the summer.

和他們使用醫療資源，以及他們參與社交活動的程度，

If they have a hip fracture we go with them

是和夏天很不同的。

and we study their entire discharge experience.

如果他們髖關節骨折，我們就跟著他們，

If they have a family member who is a key part of their care network,

研究他們整個出院的經驗。

we fly and study them as well.

如果其中有位家庭成員是他們健康照護網絡很重要的一員，

So, we study the holistic health experience

那我們也會飛去並一起研究他們。

of 1,000 seniors over the last 10 years

所以我們研究整體的健康觀感。

in 20 different countries.

一千位年長者在過去的十年，

Why is Intel willing to fund that?

二十個不同的國家裡，

It's because of the second slogan that I want to talk about.

為什麼英特爾願意贊助這研究？

Ten years ago, when I started trying to convince Intel

這是因為我將要討論的第二個口號。

to let me go start looking at disruptive technologies

十年前，當我開始試著要說服英特爾，

that could help with independent living,

讓我著手尋找破壞性科技，

this is what I called it: "Y2K + 10."

可以幫助獨立生活的

You know, back in 2000,

這是我給它取的名字：『Y2K + 10』

we were all so obsessed with paying attention

你也知道，回到2000年

to the aging of our computers,

我們都著魔似的將注意力集中

and whether or not they were going to survive

於我們電腦的老化，

the tick of the clock from 1999 to 2000,

及它們是否能逃過

that we missed a moment that only demographers were paying attention to.

時鐘滴答從1999到2000年

It was right around New Years.

我們也錯過一刻只有人口統計學家有在關心。

And that switchover,

那差不多是新年的時候。

when we had the larger number of older people on the planet,

那個大轉變，

for the first time than younger people.

也正是在這個星球上，我們的老年人人口數目大於

For the first time in human history -- and barring aliens landing

年輕人人數的第一次。

or some major other pandemic,

那也是第一次在人類歷史上，除了外星人登入

that's the expectation from demographers, going forward.

或是其它重大的流行性疾病，

And 10 years ago it seemed like I had a lot of time

人口統計學家預期要往前看。

to convince Intel to work on this. Right?

且十年前我似乎有很多的時間

Y2K + 10 was coming,

去說服英特爾去做這。對吧？

the baby boomers starting to retire.

Y2K+10就要來了，

Well folks, it's like we know these demographics here.

嬰兒潮那一代也開始要退休。

This is a map of the entire world.

只是大家，這就像我們知道這些人口統計資料在這，

It's like the lights are on,

這裡是一張全世界的地圖。

but nobody's home on this demographic

這就像燈是亮的，

Y2K + 10 problem. Right?

但沒有人在這人口統計學的家

I mean we sort of get it here, but we don't get it here,

Y2K + 10的問題裡。對吧？

and we're not doing anything about it.

我的意思是，我們好像到了，可是我們沒有到這，

The health reform bill is largely ignoring

而且我們沒有對它作任何事。

the realities of the age wave that's coming,

健康改革法案是幾乎完全忽略，

and the implications for what we need to do to change

那將要來的高齡潮的事實，

not only how we pay for care,

以及它隱含著，不單只是我們該如何做，才能改變

but deliver care in some radically different ways.

我們支付健康照護費用的方式，

And in fact, it's upon us.

而是如何將照護以截然不同的方式傳遞。

I mean you probably saw these headlines. This is Catherine Casey

講白一點，它與我們息息相關。

who is the first boomer to actually get Social Security.

我的意思是你大概看過這些頭條。這是凱瑟琳凱西，

That actually occurred this year. She took early retirement.

她是第一位得到社會福利的嬰兒潮。

She was born one second after midnight in 1946.

這件事其實是在今年發生的。她及早退休。

A retired school teacher,

她是在1946年凌晨十二點後一秒出生的。

there she is with a Social Security administrator.

一位退休的學校老師。

The first boomer actually, we didn't even wait till 2011, next year.

那裡，她和社會福利的行政官一起，

We're already starting to see early retirement occur this year.

確實是第一位嬰兒潮，我們還不必等到明年，2011年。

All right, so it's here. This Y2K + 10 problem is at our door.

我們已經漸漸在今年看到提早退休的發生。

This is 50 tsunamis scheduled on the calendar,

好吧，所以它來了。這Y2K+10的問題就在我們門口。

but somehow we can't sort of marshal our government

這是50個海嘯安插在行事暦上。

and innovative forces to sort of get out in front of it

但不知怎麼的，我們就不大能整頓我們的政府，

and do something about it. We'll wait until

或以創新的力量，好像，走出去站在它前面

it's more of a catastrophe, and react,

並對它做點什麼事。我們會等到它

as opposed to prepare for it.

已經一發不可收拾，才做出反應，

So, one of the reasons it's so

而不是做好準備等著它。

challenging to prepare for this Y2K problem

所以，其中一個為問題它之所以

is, I want to argue, we have what I would call

為Y2K作準備，這麼具挑戰性的原因

mainframe poisoning.

在於，我要提出的，我們有我稱它作所謂的

Andy Grove, about six or seven years ago,

主體中毒。

he doesn't even know or remember this, in a Fortune Magazine article

安迪郭夫，約六、七年前，

he used the phrase "mainframe healthcare,"

他可能也不知道或不記得這件事，在一篇財富雜誌的文章裡

and I've been extending and expanding this.

他用了這個詞『主體的健康照護』，

He saw it written down somewhere. He's like, "Eric that's a really cool concept."

而我將它延伸、擴大。

I was like, "Actually it was your idea. You said it in a Fortune Magazine article.

當他看到這被寫在某個地方時，他就像這樣說『艾瑞克，這是一個很酷的概念。』

I just extended it."

我就像這樣『其實這原本是你的想法。你在財富雜誌裡說過的。

You know, this is the mainframe.

我不過是延伸它而已。』

This mentality of traveling to

你也知道，這就是所謂的主體。

and timesharing large, expensive healthcare systems

這個跋涉前往的想法

actually began in 1787.

而且分時大型昂貴的健康照護系統，

This is the first general hospital in Vienna.

其實是開始於1787年。

And actually the second general hospital in Vienna,

這是維也納第一個大眾醫院。

in about 1850, was where we started to build out

而實際上維也納的第二個公共醫院，

an entire curriculum for teaching med students specialties.

在約1850年，也正是我們開始打造

And it's a place in which we started developing

整套課程來訓練醫學生專業的地方。

architecture that literally divided the body,

另外，那也正是我們開始發展出

and divided care into departments and compartments.

架構將身體分區的地方，並

And it was reflected in our architecture,

將照護分成部門及科部。

it was reflected in the way that we taught students,

同時，這也反應在我們的架構上，

and this mainframe mentality persists today.

它也反應在我們教學生的方式。

Now, I'm not anti-hospital.

這套主體的想法一直持續到今天。

With my own healthcare problems, I've taken drug therapies,

現在，我不是反對醫院。

I've traveled to this hospital and others, many, many times.

以我自己的健康問題，我曾經接受藥物治療，

But we worship the high hospital on a hill. Right?

我也拜訪這間和其它家醫院很多很多次。

And this is mainframe healthcare.

只是我們崇拜那高高在斜坡上的醫院，對吧？

And just as 30 years ago

而這就是主體健康照護系統。

we couldn't conceive that we would have the power

也不過30多年前，

of a mainframe computer that took up a room this size

我們不會去設想到，我們有能力

in our purses and on our belts,

將房間大小的電腦主機，

that we're carrying around in our cell phone today,

縮到我們的皮包和皮帶的大小，

and suddenly, computing,

讓我們今天能攜帶在手機裡帶著到處走。

that used to be an expert driven system,

加上忽然，電腦的使用，

it was a personal system that we all owned as part of our daily lives --

那曾經是專家引導的系統，

that shift from mainframe to personal computing

已是我們都擁有且成為我們日常生活一部份的個人系統。

is what we have to do for healthcare.

那個從大主機到個人電腦的轉變，

We have to shift from this mainframe mentality of healthcare

正是我們必須對健康照護系統做的事。

to a personal model of healthcare.

我們必須將主體的健康照護概念，

We are obsessed with this way of thinking.

轉換成健康照護的個人模式。

When Intel does surveys all around the world and we say,

我們是執著於這種思考方式的。

"Quick response: healthcare."

當英特爾在作全世界問卷調查，我們說

The first word that comes up is "doctor."

『聯想健康照護。』

The second that comes up is "hospital." And the third is "illness" or "sickness." Right?

第一個冒出來的字是醫師。

We are wired, in our imagination, to think about healthcare

第二個冒出來的是醫院。然後第三個是疾病或患病。對吧？

and healthcare innovation as something

我們聯想，在我們的想像裡，把健康照護

that goes into that place.

及健康照護的創意想成是某個東西

Our entire health reform discussion right now,

會進去那個地方。

health I.T., when we talk with policy makers,

我們目前整個健康改革的討論，

equals "How are we going to get doctors using

當我們和政策決策者談，

electronic medical records in the mainframe?"

等於我們要如何讓醫師在主體裡使用

We're not thinking about

電子醫療紀錄？

how do we shift from the mainframe to the home.

我們不是在想

And the problem with this is

要如何從主體轉移到家裡。

the way we conceive healthcare. Right?

而這個問題的本身就在於這是

This is a very reactive, crisis-driven system.

我們設想健康照護的方式，對吧？

We're doing 15-minute exams with patients.

這是一個非常具反應性，危機導向的系統。

It's population-based.

我們正在和病人作15分鐘的測試。

We collect a bunch of biological information in this artificial setting,

這是以人口為根據的。

and we fix them up, like Humpty-Dumpty all over again,

我們在這人為的佈置裡收集一堆生物性資料。

and send them home,

接著我們把他們修理回去，像是從頭到尾把杭弟唐帝（兒歌中從牆上跌下摔破的蛋）再做一次，

and hope -- we might hand them a brochure, maybe an interactive website --

然後把他們送回家，

that they do as asked and don't come back into the mainframe.

接著希望，我們能發傳單給他們，或是一個能互動的網頁，

And the problem is we can't afford it today, folks.

好讓他們能照著要求作，就不會回到主體裡。

We can't afford mainframe healthcare today to include the uninsured.

但問題是，各位，我們今天付不起。

And now we want to do a double-double

我們不能支付今天主體醫療去涵括沒保險的部份。

of the age wave coming through?

而且我們要做的是一個雙倍再加倍

Business as usual in healthcare is broken and we've got to do something different.

即將要來的高齡潮？

We've got to focus on the home.

健康照護產業和往常一樣是破產的所以我們必須作點甚麼是不一樣的。

We've got to focus on a personal healthcare paradigm

我們必須要把焦點放在家裡。

that moves care to the home. How do we be more proactive,

我們必須聚焦在個人的健康照護模式，

prevention-driven?

把照顧移到家裡。我們要如何才能變得比較積極、

How do we collect vital signs and other kinds of information 24 by 7?