She has a high-risk pregnancy.

這是珍，

Within 24 weeks,

她患有高危險妊娠。

she's on bed rest at the hospital,

她現在懷孕 24 週，

being monitored for her preterm contractions.

在醫院臥床，

She doesn't look the happiest.

接受早產性宮縮的監測。

That's in part because it requires technicians and experts

她看起來並不快樂，

to apply these clunky belts on her to monitor her uterine contractions.

部分是因為技術員和專科醫師

Another reason Jane is not so happy is because she's worried.

需將笨重的腰帶戴在她身上， 以監測子宮收縮。

In particular, she's worried about what happens

珍不快樂的另一原因 是因為她擔心，

after her 10-day stay on bed rest at the hospital.

特別是擔心在醫院 臥床 10 天後會發生什麼事，

What happens when she's home?

她回家後會發生什麼事？

If she were to give birth this early it would be devastating.

假如她這麼早就分娩，那將會很慘。

As an African-American woman,

她是位非裔美國女性，

she's twice as likely to have a premature birth

有比一般人高兩倍發生 早產或死產的機率。

or to have a stillbirth.

所以基本上珍只能二選一：

So Jane basically has one of two options:

留在醫院臥床，

stay at the hospital on bed rest,

成為被科技囚禁的犯人，直到生產，

a prisoner to the technology until she gives birth,

然後終其餘生去償付賬單；

and then spend the rest of her life paying for the bill;

或者住院 10 天後回家， 祈求有最好的結果。

or head home after her 10-day stay and hope for the best.

這兩種選擇似乎都不是很理想。

Neither of these two options seems appealing.

當我開始想到及聽到這些故事時，

As I began to think about stories like this

我自問並想像：

and hear about stories like this,

是否有替代的方式？

I began to ask myself and imagine:

不但病人能從醫院可靠人士 得到高傳真度監測的這種優點，

Is there an alternative?

同時又可在家過正常生活？

Is there a way we could have the benefits of high-fidelity monitoring

基於這樣的想法，

that we get with our trusted partners in the hospital

我鼓勵我的研究團隊人員

while someone is at home living their daily life?

去和一些聰明的材料科學家合作，

With that in mind,

然後我們在一起腦力激盪。

I encouraged people in my research group

經過一段漫長的歷程，

to partner with some clever material scientists,

我們萌生一個願景，一個想法：

and all of us came together and brainstormed.

就是一種可佩戴式裝置， 或許能像戴珠寶般戴著它，

And after a long process,

或是像 OK 繃可自己黏貼。

we came up with a vision, an idea,

經過許多實驗與艱難 以及多年的努力，

of a wearable system that perhaps you could wear like a piece of jewelry

我們研發出這種柔軟的電子貼片，

or you could apply to yourself like a Band-Aid.

它是運用製造 電腦晶片的方法製作而成，

And after many trials and tribulations and years of endeavors,

只不過此電子裝置是將半導體晶片

we were able to come up with this flexible electronic patch

換成能和身體相互作用的柔軟材質。

that was manufactured using the same processes

這裝置大約是人類頭髮的厚度。

that they use to build computer chips,

它們可以檢測我們所需的各種資訊，

except the electronics are transferred from a semiconductor wafer

例如：

onto a flexible material that can interface with the human body.

身體的移動、

These systems are about the thickness of a human hair.

體溫、

They can measure the types of information that we want,

身體的電位節律

things such as:

等等。

bodily movement,

我們也能設計這些裝置，

bodily temperature,

讓它們能結合能源

electrical rhythms of the body

且具有無線傳輸的能力。

and so forth.

當我們開始建構這種裝置時，

We can also engineer these systems,

先在自己的研究團隊裡進行測試。

so they can integrate energy sources,

此外也開始延伸到 在聖地亞哥的臨床合作者，

and can have wireless transmission capabilities.

並且針對各種不同 臨床狀況的病人進行測試，

So as we began to build these types of systems,

包括即將為人母的人，例如珍。

we began to test them on ourselves in our research group.

這是在我們大學附設醫院 一位待產的孕婦的照片，

But in addition, we began to reach out to some of our clinical partners

使用傳統的腰帶 進行子宮收縮的監測。

in San Diego,

此外，

and test these on different patients in different clinical conditions,

我們的柔軟電子貼片也貼在那裡。

including moms-to-be like Jane.

這張照片顯示胎兒心率的波形圖，

Here is a picture of a pregnant woman in labor at our university hospital

紅色波是使用傳統的腰帶記錄所得，

being monitored for her uterine contractions with the conventional belt.

而藍色波是用我們的柔軟電子裝置 和演算法估算的。

In addition,

此時，

our flexible electronic patches are there.

給予了我們極大的精神鼓舞。

This picture demonstrates waveforms pertaining to the fetal heart rate,

我們過去想像的事情 已開始有了成果，

where the red corresponds to what was acquired

我們也能在真正的 臨床背景下看到進展。

with the conventional belts,

但仍有一個問題，

and the blue corresponds to our estimates

就是我們製造這些裝置的方法

using our flexible electronic systems and our algorithms.

非常沒有效率，

At this moment,

產量低，

we gave ourselves a big mental high five.

且非常容易出錯。

Some of the things we had imagined were beginning to come to fruition,

再者，

and we were actually seeing this in a clinical context.

當我們和醫院的護士交流時，

But there was still a problem.

他們建議我們確保

The problem was, the way we manufactured these systems

我們的電子裝置能與 醫院的醫療用貼布搭配使用。

was very inefficient,

我們靈光乍現，說道：「等一下！

had low yield

與其只是將它們搭配貼布使用，

and was very error-prone.

不如將它們整合入貼布，

In addition,

那就能解決我們製造的問題了。」

as we talked to some of the nurses in the hospital,

你們現在看到的照片

they encouraged us to make sure

是我們已能把檢測裝置 嵌入一片 Scotch 膠布裡面，

that our electronics worked with typical medical adhesives

只需將膠布 從晶片上撕下來就可以了。

that are used in a hospital.

研究團隊持續地研發， 讓我們進一步能夠

We had an epiphany and said, "Wait a minute.

將集成電路嵌入柔軟的貼布裡，

Rather than just making them work with adhesives,

使它能做像放大訊號、數據數位化、

let's integrate them into adhesives,

處理數據

and that could solve our manufacturing problem."

以及編碼，以便無線傳輸。

This picture that you see here

這全都整合入 醫院使用的醫療貼布中。

is our ability to embed these censors inside of a piece of Scotch tape

但當研發至此，

by simply peeling it off of a wafer.

我們面臨一些來自工程學 及實用領域的其他挑戰，

Ongoing work in our research group allows us to, in addition,

我們需要確保它能實際運用。

embed integrated circuits into the flexible adhesives

在許多數位化健康研討中，

to do things like amplifying signals and digitizing them,

人們相信並接受這樣的想法： 我們只需將數據數位化，

processing them

無線傳輸它，

and encoding for wireless transmission.

將它送到雲端，

All of this integrated into the same medical adhesives

而在雲端裡，

that are used in the hospital.

就能取出有用的資料來進行判讀。

So when we reached this point,

事實上，這些你都能做到，

we had some other challenges,

假如你不擔憂 電能耗費的挑戰的話。

from both an engineering as well as a usability perspective,

考慮一下珍。

to make sure that we could make it used practically.

她既不住在帕洛阿爾托，

In many digital health discussions,

也不住在比佛利山。

people believe in and embrace the idea that we can simply digitize the data,

這意思就是

wirelessly transmit it,

我們必須注意她的手機上網方案， 以及她要花費多少錢

send it to the cloud,

才能送出連續的數據流。

and in the cloud,

另外還有一個挑戰，

we can extract meaningful information for interpretation.

這並非每位醫療專業人員 都願意談論的，

And indeed, you can do all of that,

也就是說，珍對醫療機構 並不完全信任。

if you're not worried about some of the energy challenges.

她、像她一樣的人、她的祖先 對醫生、醫院或保險公司

Think about Jane for a moment.

以往的印象並不好，

She doesn't live in Palo Alto,

這意謂我們必須注意隱私的問題。

nor does she live in Beverly Hills.

珍可能不太樂意

What that means is,

將所有數據都傳送到雲端。

we have to be mindful about her data plan and how much it would cost

而且珍會閱讀新聞，不容易被騙；

for her to be sending out a continuous stream of data.

她知道如果聯邦政府能被駭客入侵，

There's another challenge

財富美國 500 強公司能被駭客入侵，

that not everyone in the medical profession is comfortable talking about.

那她的醫生也有可能。

And that is, that Jane does not have the most trust

考慮到這一點，

in the medical establishment.

我們又靈光乍現：

She, people like her, her ancestors, have not had the best experiences

既然無法比世上所有的駭客更聰明，

at the hands of doctors and the hospital

或許我們就做個 他們興趣缺缺的小目標。

or insurance companies.

假如我們真的能夠

That means that we have to be mindful of questions of privacy.

不是在雲端進行數據判讀的演算，

Jane might not feel that happy

而是在那些嵌入貼布的 小型集成電路執行呢？

about all that data being processed into the cloud.

所以當我們將這些都整合在一起，

And Jane cannot be fooled;

現在你就能夠想像，在未來，

she reads the news.

像珍一樣的病人 仍能繼續過著日常的生活，

She knows that if the federal government can be hacked,

同時又能被監測，

if the Fortune 500 can be hacked,

她可以不需要找第二份工作 來支付她的上網方案，

so can her doctor.

而且我們也能解決 她所憂慮的隱私問題。

And so with that in mind,

所以此時此刻，

we had an epiphany.

我們對自己感覺很滿意。

We cannot outsmart all the hackers in the world,

我們已經完成這件事，

but perhaps we can present them a smaller target.

也已開始解決一些 有關隱私的問題，

What if we could actually,

我們覺得差不多大工告成了。

rather than have those algorithms that do data interpretation

從此大家都過得幸福快樂，對吧？

run in the cloud,

沒那麼快！

what if we have those algorithms run on those small integrated circuits

（笑聲）

embedded into those adhesives?

稍早我曾提到有件事必須記住，

And so when we integrate these things together,

就是珍對醫療機構並不完全信賴。

what this means is that now we can think about the future

我們必須記住，

where someone like Jane can still go about living her normal daily life,

醫療公平性差距不斷地增加與擴大，

she can be monitored,

在適當的照護處置方面仍不公平。

it can be done in a way where she doesn't have to get another job

也就是說，這張 珍和她的數據的簡單圖片

to pay her data plan,

──即使她願意將傳輸數據至雲端，

and we can also address some of her concerns about privacy.

必要時讓醫師介入參與──

So at this point,

那並不代表全部。

we're feeling very good about ourselves.

所以我們現在開始在做的是

We've accomplished this,

想出一些方式，讓可信賴的團體

we've begun to address some of these questions about privacy

成為像珍這樣的病患 與健康照護者間的中間人。

and we feel like, pretty much the chapter is closed now.

例如，我們已開始與教會合作，

Everyone lived happily ever after, right?

以來自可靠社群的教會護理人員

Well, not so fast.

來擔任像珍一樣病患的 代言人和健康指導員。

(Laughter)

另一項對我們有利的

One of the things we have to remember, as I mentioned earlier,

是保險公司逐漸對這種構想感興趣。

is that Jane does not have the most trust in the medical establishment.

他們漸漸了解，

We have to remember

或許最好現在花一點錢

that there are increasing and widening health disparities,

在可佩戴裝置和健康指導員身上，

and there's inequity in terms of proper care management.

而不是事後花更多的錢補貼

And so what that means is that this simple picture

早產且之後還要住進 新生兒加護病房的嬰兒，

of Jane and her data --

──那是醫院花費最昂貴的部門之一。

even with her being comfortable being wirelessly transmitted to the cloud,

我們經歷了一段漫長的學習過程。

letting a doctor intervene if necessary --

這種突破、奮力解決問題

is not the whole story.

以及不完全自信

So what we're beginning to do

和找出下一個問題的反覆過程，

is to think about ways to have trusted parties serve as intermediaries

幫助了我們

between people like Jane and her health care providers.

不只是真正嘗試用科技來創新，

For example, we've begun to partner with churches

並且確保它能使用在 可能最需要的人身上。

and to think about nurses that are church members,

從這過程中，我們學到 讓自己很謙卑的另一課，

that come from that trusted community,

就是當科技在發展 並以加速度在進步，

as patient advocates and health coaches to people like Jane.

我們必須銘記， 使用這些科技的是人類，

Another thing we have going for us

我們必須銘記，

is that insurance companies, increasingly,

這些人──他們有血有肉、

are attracted to some of these ideas.

他們有自己的名字

They're increasingly realizing

和自己的生活。

that perhaps it's better to pay one dollar now

至於珍， 順利的話，

for a wearable device and a health coach,

會有兩個寶寶。

rather than paying 10 dollars later,

謝謝大家。

when that baby is born prematurely

（掌聲）

and ends up in the neonatal intensive care unit --

one of the most expensive parts of a hospital.

This has been a long learning process for us.

This iterative process of breaking through and attacking one problem

and not feeling totally comfortable,

and identifying the next problem,

has helped us go along this path

of actually trying to not only innovate with this technology

but make sure it can be used for people who perhaps need it the most.

Another learning lesson we've taken from this process

that is very humbling,

is that as technology progresses and advances at an accelerating rate,

we have to remember that human beings are using this technology,

and we have to be mindful

that these human beings -- they have a face,

they have a name

and a life.

And in the case of Jane,

hopefully, two.

Thank you.

(Applause)