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JoelSelanikio_2013X-_令人惊讶的医疗保健大数据革新开端_
There's an old joke about a cop who's walking his beat in the middle of the night, and he comes across a guy under a street lamp who's looking at the ground and moving from side to side, and the cop asks him what he's doing. [00:13]
cop:v.遭受;忍受;注意到;n.警察; lamp:n.灯;台灯;(理疗用的)发热灯;
The guys says he's looking for his keys. [00:23]
So the cop takes his time and looks over and kind of makes a little matrix and looks for about two, three minutes. [00:25]
matrix:n.[数]矩阵;模型;[生物][地质]基质;母体;子宫;[地质]脉石;
No keys. [00:31]
The cop says, "Are you sure? [00:32]
Hey buddy , are you sure you lost your keys here?" [00:35]
buddy:n.伙伴,好朋友;密友;小男孩;v.做好朋友,交朋友;
And the guy says, "No, actually I lost them down at the other end of the street, but the light is better here." [00:37]
(Laughter) [00:42]
There's a concept that people talk about nowadays called "big data." [00:46]
And what they're talking about is all of the information that we're generating through our interaction with and over the Internet, everything from Facebook and Twitter [00:49]
generating:v.产生;引起;(generate的现在分词) interaction:n.[计]交互,相互作用;相互交流;干扰;
to music downloads, movies, streaming, all this kind of stuff , the live streaming of TED. [00:57]
stuff:n.东西:物品:基本特征:v.填满:装满:标本:
And the folks who work with big data, for them, they talk about that their biggest problem is we have so much information. [01:02]
The biggest problem is: how do we organize all that information? [01:09]
organize:v.组织;安排;处理;分配;管理;
I can tell you that, working in global health, that is not our biggest problem. [01:13]
global:adj.全球的;总体的;球形的;
Because for us, even though the light is better on the Internet, the data that would help us solve the problems we're trying to solve is not actually present on the Internet. [01:18]
So we don't know, for example, how many people right now are being affected by disasters or by conflict situations. [01:28]
disasters:n.灾难(disaster的复数); conflict:n.冲突;矛盾;争执;抵触;v.抵触;
We don't know for, really, basically , any of the clinics in the developing world, which ones have medicines and which ones don't. [01:35]
basically:adv.主要地,基本上; clinics:n.诊所(clinic的复数形式);
We have no idea of what the supply chain is for those clinics. [01:42]
supply chain:n.供应链;
We don't know -- and this is really amazing to me -- we don't know how many children were born -- or how many children there are -- in Bolivia or Botswana or Bhutan. [01:46]
We don't know how many kids died last week in any of those countries. [01:58]
We don't know the needs of the elderly , the mentally ill. [02:01]
elderly:adj.上了年纪的;过了中年的;稍老的; mentally:adv.精神上,智力上;心理上;
For all of these different critically important problems or critically important areas that we want to solve problems in, we basically know nothing at all. [02:04]
critically:adv.精密地;危急地;批评性地;用钻研眼光地;
And part of the reason why we don't know anything at all is that the information technology systems that we use in global health to find the data to solve these problems is what you see here. [02:15]
information technology:n.信息技术;
This is about a 5,000-year-old technology. [02:27]
Some of you may have used it before. [02:29]
It's kind of on its way out now, but we still use it for 99 percent of our stuff. [02:31]
This is a paper form. [02:35]
And what you're looking at is a paper form in the hand of a Ministry of Health nurse in Indonesia , who is tramping out across the countryside in Indonesia on, I'm sure, a very hot and humid day, [02:38]
Ministry:n.(政府的)部门; Indonesia:n.印尼,印度尼西亚(东南亚岛国); tramping:v.重步行走,踏,踩;(tramp的现在分词)
and she is going to be knocking on thousands of doors over a period of weeks or months, knocking on the doors and saying, "Excuse me, we'd like to ask you some questions. [02:49]
Do you have any children? Were your children vaccinated ?" [02:58]
vaccinated:v.给…接种疫苗;(vaccinate的过去分词和过去式)
Because the only way we can actually find out how many children were vaccinated in the country of Indonesia, what percentage were vaccinated, is actually not on the Internet, but by going out and knocking on doors, sometimes tens of thousands of doors. [03:02]
percentage:n.百分比;百分率;利润的分成;提成;
Sometimes it takes months to even years to do something like this. [03:15]
You know, a census of Indonesia would probably take two years to accomplish . [03:19]
census:vt.实施统计调查;n.人口普查,人口调查; accomplish:v.完成;实现;达到;
And the problem, of course, with all of this is that, with all those paper forms -- and I'm telling you, we have paper forms for every possible thing: [03:23]
We have paper forms for vaccination surveys . [03:30]
vaccination:n.接种疫苗;种痘; surveys:n.调查(survey的复数);
We have paper forms to track people who come into clinics. [03:32]
track:n.小道;足迹;车辙;轨道;v.追踪;跟踪;
We have paper forms to track drug supplies, blood supplies -- all these different paper forms for many different topics, they all have a single, common endpoint , and the common endpoint looks something like this. [03:36]
endpoint:n.端点;末端,终结点;
And what we're looking at here is a truckful of data. [03:48]
This is the data from a single vaccination coverage survey in a single district in the country of Zambia from a few years ago, that I participated in. [03:53]
coverage:n.覆盖,覆盖范围; participated:v.参加;参与;(participate的过去式和过去分词)
The only thing anyone was trying to find out is what percentage of Zambian children are vaccinated, and this is the data, collected on paper over weeks, from a single district, which is something like a county in the United States. [04:01]
paper over:隐瞒;掩饰; county:n.郡,县; United:adj.联合的; v.联合,团结; (unite的过去分词和过去式)
You can imagine that, for the entire country of Zambia, answering just that single question ... [04:14]
looks something like this. [04:20]
Truck after truck after truck, filled with stack after stack after stack of data. [04:23]
stack:n.堆栈;一摞;大量;许多;v.(使)放成整齐的一叠(或一摞,一堆);
And what makes it even worse is that's just the beginning. [04:28]
Because once you've collected all that data, of course, someone -- some unfortunate person -- is going to have to type that into a computer. [04:31]
When I was a graduate student, [04:38]
I actually was that unfortunate person sometimes. [04:40]
I can tell you, I often wasn't really paying attention. [04:42]
I probably made a lot of mistakes when I did it that no one ever discovered, so data quality goes down. [04:45]
But eventually that data, hopefully, gets typed into a computer, and someone can begin to analyze it, and once they have an analysis and a report, hopefully, then you can take the results of that data collection and use it to vaccinate children better. [04:50]
eventually:adv.最后,终于; analyze:v.对…进行分析,分解(等于analyse); analysis:n.分析;分解;验定;
Because if there's anything worse in the field of global public health -- [05:03]
in the field of:在…方面,在…领域;
I don't know what's worse than allowing children on this planet to die of vaccine-preventable diseases -- diseases for which the vaccine costs a dollar. [05:08]
diseases:n.[医]病(disease的复数);[医]疾病;[植保]病害;疾病种类; vaccine:n.疫苗;牛痘苗;adj.疫苗的;牛痘的;
And millions of children die of these diseases every year. [05:17]
And the fact is, millions is a gross estimate , because we don't really know how many kids die each year of this. [05:21]
gross:adj.总共的;粗野的;恶劣的;显而易见的;v.总共收入;n.总额,总数; estimate:v.估计;估算;估价;n.估价;(对大小、数量、成本等的)估计;估计的成本;
What makes it even more frustrating is that the data-entry part, the part that I used to do as a grad student, can take sometimes six months. [05:27]
frustrating:adj.令人沮丧的;v.使沮丧;(frustrate的现在分词) grad:n.毕业生;校友;
Sometimes it can take two years to type that information into a computer, [05:34]
And sometimes, actually not infrequently , it actually never happens. [05:38]
infrequently:adv.很少发生地;稀少地;
Now try and wrap your head around that for a second. [05:42]
wrap:v.缠绕;隐藏;掩护;包起来;缠绕;穿外衣;n.外套;围巾;
You just had teams of hundreds of people. [05:44]
They went out into the field to answer a particular question. [05:47]
You probably spent hundreds of thousands of dollars on fuel and photocopying and per diem . [05:50]
photocopying:n.复印,照相复制;v.复印;影印(photocopy的ing形式); per diem:adj.每日的;n.日补贴;
And then for some reason, momentum is lost or there's no money left, and all of that comes to nothing, because no one actually types it into the computer at all. [05:56]
momentum:n.势头;[物]动量;动力;冲力;
The process just stops. [06:04]
process:v.处理;加工;列队行进;n.过程,进行;方法,adj.经过特殊加工(或处理)的;
Happens all the time. [06:05]
This is what we base our decisions on in global health: little data, old data, no data. [06:07]
So back in 1995, [06:15]
I began to think about ways in which we could improve this process. [06:17]
improve:v.改进;改善;
Now 1995 -- obviously, that was quite a long time ago. [06:20]
It kind of frightens me to think of how long ago that was. [06:23]
frightens:v.使惊吓;使惊恐;(frighten的第三人称单数)
The top movie of the year was " Die Hard with a Vengeance ." [06:26]
Die Hard:na.壮烈牺牲;难断气;难绝灭; with a Vengeance:猛烈地,激烈地;
As you can see , Bruce Willis had a lot more hair back then. [06:29]
As you can see:正如你所看到的;你是知道的;
I was working in the Centers for Disease Control and I had a lot more hair back then as well. [06:31]
But to me, the most significant thing that I saw in 1995 was this. [06:37]
significant:adj.重大的;有效的;有意义的;值得注意的;意味深长的;n.象征;有意义的事物;
Hard for us to imagine, but in 1995, this was the ultimate elite mobile device . [06:42]
ultimate:adj.最终的;极限的;根本的;n.终极;根本;基本原则; elite:n.精英;精华;杰出人物; mobile:n.手机;汽车;移动电话;adj.活跃的;可动的; device:n.装置;策略;图案;
It wasn't an iPhone. It wasn't a Galaxy phone. [06:48]
Galaxy:n.银河;[天]星系;银河系;一群显赫的人;
It was a PalmPilot. [06:50]
And when I saw the PalmPilot for the first time, I thought, "Why can't we put the forms on these PalmPilots? [06:52]
And go out into the field just carrying one PalmPilot, which can hold the capacity of tens of thousands of paper forms? [06:58]
capacity:n.能力;容量;资格,地位;生产力;
Why don't we try to do that? [07:05]
Because if we can do that, if we can actually just collect the data electronically , digitally , from the very beginning, we can just put a shortcut right through that whole process of typing, of having somebody type that stuff into the computer. [07:06]
electronically:adv.电子地; digitally:adv.数位; shortcut:n.近路;捷径;快捷方式(图标);
We can skip straight to the analysis and then straight to the use of the data to actually save lives." [07:21]
So that's what I began to do. [07:26]
Working at CDC, I began to travel to different programs around the world and to train them in using PalmPilots to do data collection, instead of using paper. [07:29]
And it actually worked great. [07:39]
It worked exactly as well as anybody would have predicted . [07:41]
as well as:也;和…一样;不但…而且; predicted:v.预言;预告;预报;(predict的过去分词和过去式)
What do you know? [07:44]
Digital data collection is actually more efficient than collecting on paper. [07:45]
efficient:adj.有效率的;有能力的;生效的;
While I was doing it, my business partner, [07:49]
Rose, who's here with her husband, Matthew, here in the audience, [07:51]
Rose was out doing similar stuff for the American Red Cross. [07:54]
The problem was, after a few years of doing that, [07:57]
I realized -- I had been to maybe six or seven programs -- and I thought, you know, if I keep this up at this pace, over my whole career , maybe I'm going to go to maybe 20 or 30 programs. [07:59]
career:n.职业;事业;生涯;经历;
But the problem is, 20 or 30 programs, like, training 20 or 30 programs to use this technology, that is a tiny drop in the bucket . [08:10]
bucket:n.大桶状物; v.拼命划桨;
The demand for this, the need for data to run better programs just within health -- not to mention all of the other fields in developing countries -- is enormous . [08:19]
not to mention:更不必说;不必提及; enormous:adj.庞大的,巨大的;凶暴的,极恶的;
There are millions and millions and millions of programs, millions of clinics that need to track drugs, millions of vaccine programs. [08:27]
There are schools that need to track attendance . [08:35]
attendance:n.出席;到场;出席人数;
There are all these different things for us to get the data that we need to do. [08:38]
And I realized if I kept up the way that I was doing, [08:42]
I was basically hardly going to make any impact by the end of my career. [08:46]
impact:n.影响;效果;碰撞;冲击力;v.挤入,压紧;撞击;对…产生影响;
And so I began to rack my brain, trying to think about, what was the process that I was doing? [08:51]
How was I training folks, and what were the bottlenecks and what were the obstacles to doing it faster and to doing it more efficiently ? [08:56]
bottlenecks:n.[包装]瓶颈(bottleneck的复数); obstacles:n.障碍;障碍物;阻碍;(obstacle的复数形式) efficiently:adv.有效地;效率高地(efficient的副词形式);
And, unfortunately , after thinking about this for some time, [09:03]
unfortunately:adv.不幸地;
I identified the main obstacle. [09:06]
identified:v.确认;认出;找到;发现;说明身份;(identify的过去式和过去分词)
And the main obstacle, it turned out -- and this is a sad realization -- the main obstacle was me. [09:10]
realization:n.实现;领悟;
So what do I mean by that? [09:16]
I had developed a process whereby I was the center of the universe of this technology. [09:18]
whereby:adv.凭借;通过…;借以;与…一致;
If you wanted to use this technology, you had to get in touch with me. [09:26]
in touch with:同…有联系,和…有接触;
That means you had to know I existed. [09:29]
Then you had to find the money to pay for me to fly out to your country and the money to pay for my hotel and my per diem and my daily rate. [09:31]
So you could be talking about 10- or 20- or 30,000 dollars, if I actually had the time or it fit my schedule and I wasn't on vacation. [09:38]
schedule:工作计划,日程安排
The point is that anything, any system that depends on a single human being or two or three or five human beings -- it just doesn't scale . [09:45]
scale:n.规模;比例;鳞;刻度;天平;数值范围;v.衡量;攀登;剥落;生水垢;
And this is a problem for which we need to scale this technology, and we need to scale it now. [09:53]
And so I began to think of ways in which I could basically take myself out of the picture . [09:58]
out of the picture:不相干的;不合适;不在画面里的;
And, you know, I was thinking, "How could I take myself out of the picture?" [10:06]
for quite some time. [10:09]
I'd been trained that the way you distribute technology within international development is always consultant-based. [10:11]
distribute:v.分发;分配;分销;分散;
It's always guys that look pretty much like me, flying from countries that look pretty much like this to other countries with people with darker skin. [10:18]
And you go out there, and you spend money on airfare and you spend time and you spend per diem and you spend for a hotel and all that stuff. [10:26]
airfare:n.飞机票价;
As far as I knew, that was the only way you could distribute technology, and I couldn't figure out a way around it. [10:34]
As far as:至于…;
But the miracle that happened -- [10:40]
miracle:n.奇迹,奇迹般的人或物;惊人的事例;
I'm going to call it Hotmail for short. [10:42]
Hotmail:n.微软提供的免费电子邮件服务;
You may not think of Hotmail as being miraculous , but for me it was miraculous , because I noticed, just as I was wrestling with this problem -- [10:45]
miraculous:adj.不可思议的,奇迹的; wrestling:n.摔跤运动;v.摔跤;奋力对付;全力解决;(wrestle的现在分词)
I was working in sub-Saharan Africa, mostly, at the time -- [10:52]
sub-Saharan:撒哈拉以南地区;
I noticed that every sub-Saharan African health worker that I was working with had a Hotmail account. [10:56]
And it struck me, "Wait a minute -- [11:03]
I know the Hotmail people surely didn't fly to the Ministry of Health in Kenya to train people in how to use Hotmail. [11:06]
So these guys are distributing technology, getting software capacity out there, but they're not actually flying around the world. [11:13]
distributing:v.分发;分配;分销;使散开;使分布;分散;(distribute的现在分词)
I need to think about this more." [11:20]
While I was thinking about it, people started using even more things like this, just as we were. [11:21]
They started using LinkedIn and Flickr and Gmail and Google Maps -- all these things. [11:26]
LinkedIn:人际关系网;邻客音;社交网站; Flickr:n.网络相簿; Google:谷歌;谷歌搜索引擎;
Of course, all of these things are cloud based and don't require any training. [11:30]
They don't require any programmers. [11:35]
They don't require consultants . [11:37]
consultants:n.[经]顾问;咨询顾问;咨询公司;咨询人员(consultant的复数);
Because the business model for all these businesses requires that something be so simple we can use it ourselves, with little or no training. [11:38]
You just have to hear about it and go to the website. [11:45]
And so I thought, what would happen if we built software to do what I'd been consulting in? [11:48]
consulting:adj.咨询的,商议的;v.咨询,请教;商议;(consult的现在分词形式)
Instead of training people how to put forms onto mobile devices , let's create software that lets them do it themselves with no training and without me being involved . [11:54]
devices:n.[机][计]设备;[机]装置;[电子]器件(device的复数); involved:adj.有关的; v.涉及; (involve的过去式和过去分词)
And that's exactly what we did. [12:03]
So we created software called Magpi, which has an online form creator. [12:04]
No one has to speak to me, you just have to hear about it and go to the website. [12:10]
You can create forms, and once you've created the forms, you push them to a variety of common mobile phones. [12:14]
variety:n.多样;种类;杂耍;变化,多样化;
Obviously, nowadays, we've moved past PalmPilots to mobile phones. [12:19]
And it doesn't have to be a smartphone , it can be a basic phone, like the phone on the right, the basic Symbian phone that's very common in developing countries. [12:22]
smartphone:n.智能手机;
And the great part about this is it's just like Hotmail. [12:30]
It's cloud based, and it doesn't require any training, programming, consultants. [12:34]
But there are some additional benefits as well. [12:38]
additional:adj.附加的,额外的;
Now we knew when we built this system, the whole point of it, just like with the PalmPilots, was that you'd be able to collect the data and immediately upload the data and get your data set. [12:41]
upload:v.上传;
But what we found, of course, since it's already on a computer, we can deliver instant maps and analysis and graphing. [12:51]
instant:n.瞬间; adj.立即的; conj.同"assoonas";
We can take a process that took two years and compress that down to the space of five minutes. [12:56]
compress:vi.受压缩小;vt.压缩,压紧;精简;
Unbelievable improvements in efficiency . [13:02]
Unbelievable:adj.(非正式)难以置信的;不可信的 improvements:n.改善;改进;改善的事物;(improvement的复数) efficiency:n.效率;效能;功效;
Cloud based, no training, no consultants, no me. [13:04]
And I told you that in the first few years of trying to do this the old-fashioned way, going out to each country, we probably trained about 1,000 people. [13:09]
old-fashioned:adj.老式的;过时的;守旧的;
What happened after we did this? [13:19]
In the second three years, we had 14,000 people find the website, sign up and start using it to collect data: data for disaster response , [13:21]
response:n.响应;反应;回答;
Canadian pig farmers tracking pig disease and pig herds , people tracking drug supplies. [13:29]
tracking:n.追踪,跟踪;v.跟踪;(track的现在分词) herds:n.畜群;大量(herd的复数);人群;v.聚在一起;结交(herd的三单形式);
One of my favorite examples, the IRC, International Rescue Committee , they have a program where semi-literate midwives , using $10 mobile phones, send a text message using our software, once a week, [13:36]
Rescue:n.救援;抢救;营救;获救;v.抢救;营救;援救; Committee:n.委员会; semi-literate:半文盲; midwives:n.助产士; v.促成; text message:n.文本信息;短信息;
with the number of births and the number of deaths, which gives IRC something that no one in global health has ever had: a near-real-time system of counting babies, of knowing how many kids are born, [13:48]
near-real-time:近实时;
of knowing how many children there are in Sierra Leone , which is the country where this is happening, and knowing how many children die. [13:59]
Sierra:n.(尤指西班牙和美洲的)锯齿状山脉; Leone:n.利昂(塞拉利昂货币单位);
Physicians for Human Rights -- this is moving a little bit outside the health field -- they're basically training people to do rape exams in Congo, where this is an epidemic , a horrible epidemic , [14:07]
Physicians:n.[内科]内科医生(physician的复数); rape:n.强奸罪;强奸案;v.强奸;强暴; epidemic:n.流行病;蔓延;adj.传染病;流行性的; horrible:可怕的,极讨厌的,
and they're using our software to document the evidence they find, including photographically , so that they can bring the perpetrators to justice . [14:19]
evidence:n.证据,证明;迹象;明显;v.证明; photographically:adv.用照相;逼真地; perpetrators:n.作恶者;行凶者;犯罪者;(perpetrator的复数) justice:n.公平;公正;司法制度;审判;
Camfed, another charity based out of the UK -- [14:28]
charity:n.慈善;施舍;慈善团体;宽容;施舍物;
Camfed pays girls' families to keep them in school. [14:32]
They understand this is the most significant intervention they can make. [14:36]
intervention:n.介入;调停;妨碍;
They used to track the disbursements , the attendance, the grades, on paper. [14:39]
disbursements:n.[会计]支付;垫付款;港口开支(disbursement的复数);
The turnaround time between a teacher writing down grades or attendance and getting that into a report was about two to three years. [14:43]
turnaround:n.转变;转向;突然好转;回车道;
Now it's real time . [14:49]
real time:adj.实时的;接到指示立即执行的;
And because this is such a low-cost system and based in the cloud, it costs, for the entire five countries that Camfed runs this in, with tens of thousands of girls, the whole cost combined is 10,000 dollars a year. [14:50]
low-cost:adj.廉价的;价格便宜的;
That's less than I used to get just traveling out for two weeks to do a consultation . [15:03]
consultation:n.咨询;磋商;[临床]会诊;讨论会;
So I told you before that when we were doing it the old-fashioned way, [15:10]
I realized all of our work was really adding up to just a drop in the bucket -- 10, 20, 30 different programs. [15:13]
We've made a lot of progress, but I recognize that right now, even the work that we've done with 14,000 people using this is still a drop in the bucket. [15:20]
recognize:v.认识;认出;辨别出;承认;意识到;
But something's changed, and I think it should be obvious . [15:27]
obvious:adj.明显的;显著的;平淡无奇的;
What's changed now is, instead of having a program in which we're scaling at such a slow rate that we can never reach all the people who need us, we've made it unnecessary for people to get reached by us. [15:30]
scaling:n.缩放比例; v.剥落;
We've created a tool that lets programs keep kids in school, track the number of babies that are born and the number of babies that die, catch criminals and successfully prosecute them -- [15:43]
prosecute:vt.检举;贯彻;从事;依法进行;vi.起诉;告发;作检察官;
to do all these different things to learn more about what's going on, to understand more, to see more ... [15:55]
and to save lives and improve lives. [16:03]
Thank you. [16:07]
(Applause) [16:09]