Nanotechnology, Nanomedicine, and Health IT Systems
Shepherdstown 21 November 2006Nanotechnology has the potential to revolutionize almost every industry including health care, pharmaceuticals, communication, computers, manufacturing, materials, energy, and security. Biologists, physicists, chemists, materials scientists, computational scientists, and mechanical and electronic engineers are all collaborating to share knowledge of tools and techniques and information on the physics of atomic and molecular interactions. This article attempts to pull together relevant information about the development of nanotechnology in health care to date, draw a relationship between nanotechnology and electronic health record (EHR) systems, highlight selected major issues, and offer a set of recommendations to health care organizations on possible next steps to take. In the coming decades, cheaper and high-performance nanotechnology solutions with much greater functionality than we are just starting to see today will dramatically change the daily business practices of health care provider organizations and the lives of their patients they treat.
Federal funding for nanotechnology research and development (R&D) has increased substantially since inception of the National Nanotechnology Initiative (NNI) in 2001. NNI is a federal R&D program established to coordinate multi-agency efforts in nanoscale science, engineering, and technology. Twenty-three federal agencies are participating in the initiative including the DoD, NIST, HHS, DOE, EPA, and Commerce (see http://www.nano.gov/index.html). Nanotechnology federal funding increased from $464 million in 2001 to an estimated $1,24 billion in 2005 and continues to grow. The United States, Asian countries (e.g. Japan, China, and Korea), and several European countries recognize the tremendous economic potential of nanotechnology. While difficult to measure accurately, it is estimated that world-wide government funding has increased to about five times what it was in 1997, exceeding $2 billion in 2002 (NNI Web site: http://www.nano.gov/html/facts/faqs.html) and still increasing.
The term "nanotechnology" was first used in 1974 by a Japanese researcher at the University of Tokyo to refer to the ability to engineer materials precisely at the nanometer (nm) level. The primary driving force for miniaturization at that time came from the electronics industry's attempt to develop tools to create smaller electronic devices on silicon chips. The definition of nanotechnology continues to evolve.
The NNI calls something "nanotechnology" if it involves the following criteria:
- Research and technology development at the atomic, molecular or macromolecular levels, in the length scale of approximately 1 - 100 nanometer range
- Creating and using structures, devices and systems that have novel properties and functions because of their small and/or intermediate size
- Ability to control or manipulate on the atomic scale
Nanomedicine deals with comprehensive monitoring, control, construction, repair, defense and improve human biological system at molecular level using engineered nanostructures and nanodevices.
The National Science and Technology Council Committee on Technology (NSTC) and the Interagency Working Group on Nanoscience, Engineering, and Technology (IWGN) has produced an informative brochure entitled "Nanotechnology: Shaping the World Atom by Atom". It explains nanotechnology and its potential in laypersons terms. See
The literature highlights two different approaches to nanotechnology - "top down" and "bottom up". "Top-down involves starting with a block of material, and etching or milling it down to the desired shape. Bottom-up, or molecular nanotechnology, involves the assembly of smaller sub-units (atoms or molecules) to make a larger structure. These two methods have evolved separately and have now reached the point where the best achievable feature size for each technique is approximately the same, leading to novel hybrid ways of manufacture." (The Royal Society & The Royal Academy of Engineering Nanoscience and Nanotechnologies; July 2004.) A breakthrough for the "bottom-up" stage has been the discovery of spinning molecular structures, which has huge applications for medicine and information technology.
The ability to build and control engineered objects on the scale of nanometers (one-billionth of a meter) has been an essential element in the "Information Revolution" with the development of ever-faster and more powerful electronic devices to manipulate, transmit, and store data. Numerous products featuring the unique properties of nanoscale materials are available today including magnetoresistance (GMR) heads in computers to increase storage capacity; non-volatile magnetic memory; automotive sensors; and solid-state compasses.
In this rapidly growing field of nanotechnology, it is difficult to keep pace with developments, especially since much of the R&D is proprietary information. Some of the examples listed on the Nanotechnology Now
http://www.nanotech-now.com/current-uses.htm and other nanotechnology web sites are presented here to give some idea of the far-reaching effects of nanotechnology applications:
Nanocomposites are constituents that are mixed on a nanometer-length scale, often resulting in properties that are superior to conventional microscale composites and can be synthesized using surprisingly simple and inexpensive techniques. (University of Cornell Web site -
http://www.mse.cornell.edu/materials_science_discovering/nanocomposites.html) One example is a coating process to make sponge-like silica latch onto toxic metals in waters. Metals such as lead and mercury are captured and then recovered for reuse or contained in-place forever. A plastic nanocomposite, currently being used in some automobiles, is scratch-resistant, light-weight, rust-proof, and stronger, resulting in fuel savings and increased longevity.
Nanocrystals absorb and then re-emit the light in a different color - the size of the nanocrystal determines the color. Examples include an antimicrobial dressing covered with nanocrystalline silver that rapidly kills a broad spectrum of bacteria in as little as 30 minutes; and semi-conducting nanocrystals (Quantum dots) that, when illuminated with ultraviolet light, emit a vast spectrum of bright colors that can be used to identify and locate cells and other biological activities (e.g., MRSs).
Nanoparticles of a material behave differently than bulk amounts of the same material. At the nanoscale, a material may be stronger, lighter, more water-soluble, more heat-resistant, or a better conductor of electricity. It takes only small amounts of a nanoparticle, precisely placed, to change a material's physical properties. Adding nanoparticles of clay to a polymer used to wrap power lines increases strength and reduces flammability, for example. Other examples involve nanoscale cloth treatment currently used to repel stains; sunscreens that utilize nanoparticles that effectively absorb light in the UV range (due to particle size, they spread more easily, cover better, and save money because you use less); and vitamins that are formulated as nanoparticles so they can be mixed with cold water and absorbed by the body.
Nanocomposite coatings extend the shelf life of a variety of products. Examples include tennis balls that bounce twice as long and automobile tires that are lighter (better mileage) and last longer (better cost performance).
All-carbon nanotubes (1.2 nanometers in diameter) are promising for applications ranging from new structural materials that are stronger and lighter weight to electronic components for new supercomputers to drug delivery systems.
Nanotechnology Activities in Health Care
Nanobot medical devices that know when to release their pharmaceutical intervention, illustrate the evolving logic and intelligence embedded into medical devices. Health and medical care is a knowledge business, and professionals of the future will operate surrounded with "ubiquitous computing" options from standalone sensing and computing devices to embedded intelligence in the hardware and software of PDAs, eyeglasses, walls, and so on.
Early nanomedicine applications include: focused pharmaceutical delivery systems; "laboratories on a chip" that perform multiple medical tests invitro or invivo; health related imaging nanodevices; nanosurgical tools; and nanotechnology implants and tissue scaffolds. Currently available health-related products using nanotechnology include burn and wound dressings, water filtration, a dental-bonding agent, and sunscreens and cosmetics.
Within two to five years, advanced drug delivery systems are expected to become commercially available, including implantable devices that automatically administer drugs and sensor drug levels and medical diagnostic tools, such as cancer tagging mechanisms, and "lab-on-a-chip" real time diagnostics for physicians. Also expected are sensors for airborne chemicals or other toxins; nanoimaging devices; nanosurgical tools; nanorobots or nanomedibots; super-conductive circuits and ultra-fast computers.
It is widely accepted that R&D in nanotechnology requires an inter-disciplinary collaborative approach. The following are just a few specific examples of the many nanotechnology initiatives in the health care arena:
Massachusetts Institute of Technology (MIT)
A chemical engineer and professor at MIT was awarded the Albany (N.Y.) Medical Center Prize in Medicine and Biomedical Research, America's top tribute in medicine, for his research on polymer-based drug-delivery systems that allow clinicians to control the release of large molecules in a steady, controlled manner through surgically implanted plastic devices. His work has spawned revolutionary advances in cancer treatment (Modern Physician MP Stat, May 3, 2005).
U.S. Army & MIT
The U.S. Army Institute of Soldier Nanotechnologies (
http://web.mit.edu/isn/), a research unit devoted to developing military applications for nanotechnology, is working with MIT to incorporate wound detection and treatment systems within uniforms made of "smart" materials, such as a responsive system that provides an instant splint for a broken bone.
University of North Carolina and Real-Time Virtual Laboratories
The University of North Carolina at Chapel Hill and the Center for Computer Integrated Systems for Microscopy and Manipulation are collaborating on the Distributed nanoManipulator (
http://www.cs.unc.edu/Research/nano/cismm/nm/) project. They are using virtual laboratories to offer real-time access to remote instruments.
Researchers at Purdue University, the University of Alberta, and Canada's National Institute for Nanotechnology have discovered that bone cells called osteoblasts attach better to nanotube-coated titanium than they do to conventional titanium used to make artificial joints. Purdue University researchers have shown that extremely thin carbon fibers called nanotubes might be used to create brain probes and implants to study and treat neurological damage and disorders. These nanotubes not only caused less scar tissue but also stimulated neurons to grow 60 percent more fingerlike extensions, called neurites, which are needed to regenerate brain activity in damaged regions (Purdue News, Jan 2004).
The Purdue Research Foundation has partnered with Theron Research Technologies to develop and market technology discovered at Purdue University that provides doctors with a more advanced way to take the vital signs of premature infants and monitor blood in a non-invasive manner. Because premature babies have such small veins, doctors must use a technique called direct umbilical artery catheterization (threading a catheter through the baby's umbilical cord) to measure aortic pressure (Purdue News, Jan 2003).
Northwestern University Institute for Nanotechnology
Northwestern University developed the "Bio-Barcode Assay", a highly sensitive diagnostic test that could revolutionize the detection of disease. The technique involves nanotechnology and the use of magnets, gold, DNA and antibodies. Experts are already exploring ways of using it to spot early markers of Alzheimer's disease and in the future it could also be used to diagnose the earliest signs of cancer, HIV infection, or the human form of Mad Cow disease. (News.scotsman.com; Nov 2004).
Prosthetic & Medical Implants: Nanotechnology will lead to new generations of prosthetic and medical implants designed to interact with the body, fundamentally altering the management of illnesses, patient-doctor relationships, and medical culture in general. As written in According to The Royal Society and The Royal Academy of Engineering Nanoscience and Nanotechnologies, July 2004, three major areas in which nanotechnology applications (see
http://www.nanotec.org.uk/report/chapter2.pdf) will be valuable to health care organizations include:
Implants and prosthetics - "With the advent of new materials, and the synergy of nanotechnologies and biotechnologies, it could be possible to create artificial organs and implants that are more akin to the original, through cell growth on artificial scaffolds or biosynthetic coatings that increase biocompatibility and reduce rejection. These could include retinal, cochlear, and neural implants, repair of damaged nerve cells, and replacements of damaged skin, tissue, or bone."
Diagnostics - "Within microelectromechanical (MEMS), laboratory-on-a-chip technology for quicker diagnosis, which requires less of the sample, is being developed in conjunction with microfluidics. In the medium term, it could be expected that general personal health monitors may be available. Developments in both genomics and nanotechnology are likely to enable sensors that can determine genetic make-up quickly and precisely, enhancing knowledge of people's predisposition to genetic-related diseases."
The following noteworthy news items were contained in recent 2006 issues of BioMedical Nanoscience News - See
Magnetic Field Acts as "Remote Control" to Deliver Nanomedicine
Jun. 7, 2006, Physorg/Univ of Buffalo - A nanoparticle-based drug delivery concept in which an applied magnetic field directs the accumulation in tumor cells of custom-designed, drug-filled nanocarriers has been demonstrated by University at Buffalo researchers. The new approach, recently published in Molecular Pharmaceutics, may lead to treatments that exploit the advantages of photodynamic therapy (PDT) and that have the potential to reduce drug accumulation in normal tissues. See
New Approaches Target Nanoparticles to Cancer Cells
May 23, 2006, Physorg - One of the major goals of cancer nanotechnology research is to develop nanoparticles that deliver cancer imaging agents and anticancer drugs specifically to tumors. Two new reports in the literature highlight new approaches to creating targeted nanoscale devices for diagnostic and therapeutic applications in cancer. See http://www.physorg.com/news67534690.html
Nanotechnology Shows Early Promise to Treat Cardiovascular Disease
May 10, 2006, Physorg/Rutgers, the State University of New Jersey - A new tactic in the battle against cardiovascular disease - employing nanoengineered molecules called "nanolipoblockers" as frontline infantry against harmful cholesterol - is showing promise in early laboratory studies at Rutgers, The State University of New Jersey. See http://www.physorg.com/news66485379.html
A quick listing of some areas that are converging on the field of nanomedicine includes: Biotechnology, Genomics, Genetic Engineering, Cell Biology, Stem Cells, Cloning, Prosthetics, Cybernetics, Neural Medicine, Dentistry, Cryonics, Veterinary Medicine, Biosensors, Biological Warfare, Cellular Reprogramming, Diagnostics, Drug Delivery, Gene Therapy, and Clinical Imaging. Looking forward to the next decade, the linkage of these nanotechnology diagnostic, drug delivery, or implant devices to a patient care information system and personal health record become very real possibilities.
Nanotechnology & Electronic Health Records (EHR)
The primary focus of most health care provider organizations today is on the acquisition and continued deployment of interoperable EHR systems across the country and around the world. As of 2006, it appears that less than 20 percent of health care provider organizations have acquired and implemented a comprehensive electronic health record (EHR) system with physician order entry capabilities. A 2006 HIMSS survey indicated that more than 80 percent of hospital and health systems in the United States plan on installing clinical information systems over the next five years.
While nanotechnology is playing a significant role, making computing and communications systems microscopic in size and more conducive to on-body usage, as noted above, nanotechnology solutions in medicine are still in the early stages of development and deployment. Integration of nanomedicine technology solutions with EHR systems will not begin to truly emerge until the end of the next decade.
The authors project that by the year 2020 implantable medical sensors feeding data to EHR systems will be more widely utilized. Advanced drug delivery systems are expected to become commercially available, including implantable nanomedicine devices that automatically sense drug levels and administer medication. Medical diagnostic tools, such as cancer tagging mechanisms, and "lab-on-a-chip" real time diagnostics for physicians will become available and will be interfaced to EHR systems. Nanoimaging devices will be used to record clinical images that will then be stored in a patient's personal electronic medical record.
Goal: Off to Mars
Picture a solar-powered, wearable, health intelligent information system used by astronauts on the planned mission to Mars in 2020. The wearable systems are connected wirelessly to the onboard eHealth Advisor Live, which includes many self-care and supported self-care procedures and treatments along with an electronic health record (EHR) system, which in turn is interfaced to the master medical advisor and EHR system back on Earth. The master system is a state-of-the-art virtual doctor that includes a robust real-time health data repository, as well as a genomic biorepository. The system is continuously being fed data by nanotechnology biosensors that are embedded in the wearable systems used by the international crew of NASA astronauts. Nanotechnology will also be implanted inside the team. A micro chemical laboratory on a chip will also control the creation and rate of delivery of drugs or the repairing of tissues as needed. Other nano-particle, molecule-sized sensors inside a person's cells would warn of the health impacts from space radiation. An onboard robotic surgical system will also be available for use as needed.
These types of systems, based on current research directions, could be used by NASA in 2020 and beyond on its future Lunar and Mars missions. Spin-offs of these emerging medical informatics solutions will also improve the quality of medical care on Earth.
Government Funding Considerations
The challenge for interested health care organizations is to help governments to formulate long-term strategies that promote the cost effective development of nanotechnology that meets as many needs as possible, especially with regards to health care. Early involvement by health care provider organizations might prove useful in providing guidance about funding efforts to link nanotechnology solutions to electronic health record (EHR) systems of the future.
Major long-term cost-benefits related to investments in nanotechnology for health care include:
- Significant investment must be made over time before achieving major benefits
- Potential for radical advances in medical diagnosis and treatment are high
- Powerful capabilities built into future health IT systems will utilize nanotechnology
- Improvements in personal health information and personal care products
- Early involvement and investment should lead to standards, interoperability, etc.
Other Concerns - Privacy, Security, Patient Safety, and Ethics
The public is very concerned about safety, privacy and ethical issues. For example:
- With computing expected to be so cheap and powerful, it is possible that nanotechnology products will be able to process, sense and transmit information without our consent or knowledge.
- The values of natural human life and what society is and is not willing to accept lack current definitions in the realm of applied nanotechnology (e.g. replacing living body parts with man-made mechanisms).
The evolution of nanotechnology will likely involve extensive testing of solutions coupled with consideration of the social and ethical consequences of deploying them. "Like any powerful new technology", says National Science Foundation (NSF) Director Rita Colwell, "nanotech also has the potential for unintended consequences - which is precisely why we can't allow the societal implications to be an afterthought." In March 2005, a European Commission was launched to promote international dialogue on the social, ethical and legal benefits and potential impacts of nanotechnology.
Other challenges or issues that need to be addressed include the need for standards, overcoming legal barriers, collaborative research, development of interfaces to health information systems, patient safety, and interoperability to name just a few.
Cheaper and higher performing nanotechnology solutions, combined with convenience and greater functionality, will revolutionize health care in the coming decade(s) and will change the daily business practices of health care organizations and how they provide patient care. The following set of recommendations is presented on possible next steps for large health care provider organizations to take:
- Establish Nanotech Monitoring as Part of Technology Early Warning Systems: Obtain lessons learned from existing nanotechnology projects, especially as they relate to health care IT systems.
- Consider becoming involved in the NNI Initiative or other research and development efforts in nanotechnology that relate to the delivery of patient-centric healthcare and health information systems.
- Identify potential nanotechnology pilot projects involving health care related product development and implementation that may benefit your patients in the future (e.g., drug delivery, gene therapy, diagnostics).
- Conduct a Cost-Benefit Analysis and Return on Investment for this type of initiative for your organization.
- Investigate changes in clinical practices and business processes that your organization may need to make in anticipation of implementing nanotechnology applications/devices.
- Conduct a cost benefit analysis and return on investment for these type of initiatives so you can better determine when to move forward in this arena.
- Obtain lessons learned from existing nanotechnology projects, especially as they relate to health care and IT systems.
Other Key References
The authors delve deeper into this area and further elaborate on nanotechnolgies in health care in their upcoming book entitled "Medical Informatics 2020" to be published in December 2006 by Jones & Bartlett. See
Peter J. Groen is on the faculty of the Computer & Information Science Department at Shepherd University in West Virginia and is one of the founders of the Shepherd University Research Corporation - see www.shepherd.edu/surc.
Marc Wine is a coordinator for Intergovermental Health IT within the Office of Intergovernmental Solutions at the U.S. General Services Administration (GSA). He also is a guest lecturer on Medical Informatics at the George Washington University in Washington, D.C.
Douglas Goldstein is a "Practical Futurist", author, guest speaker, and CEO of Medical Alliances, Inc. See www.medicalalliance.com.
Peter Groen, Marc Wine, Douglas Goldstein
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