Mystery doctor’s letter

The report is two weeks old, it has what it takes to become a scandal and yet it goes unheard: a large number of general practitioners spend up to an hour a day reading medical letters, especially from clinics. And they don’t understand them. A study conducted by the University of Düsseldorf has shown this very clearly. The Ärztezeitung has reported on this. Nobody should be able to say that he did not know. And yet: Nothing.

Incomprehensible abbreviations, superfluous information, no structure, real gaps. The doctor’s letter in its current form is obviously not a suitable instrument for doctor-to-doctor communication. There are clear legal obligations for reliable discharge management. Author and reader of the letter also both studied, even the same subject. Nevertheless the quality of the communication is so miserable that the physician letter is more than a source of error: It is obviously a mistake warranty.

And yet I am again meeting players in the healthcare sector for whom the scan of a handwritten doctor’s letter is already a step in the direction of digitization. Most recently at a high-ranking conference in Berlin in April 2019. Spoiler alarm: It’s not. The study by the University of Düsseldorf clearly shows how low the fruits of the digitisation of the health system actually hang. 12,000 symptoms are classified. They must be recorded and documented, and one or more of the 10,000 diseases described must be deduced. What is an ongoing overload for the human brain mutates into a finger exercise in digital communication. Every computer science student in the first semester will program a communication logic that reliably processes and transports this information. Just as a warm up in the morning.

Did we ever think that a letter was the right medium to share complex medical data? We are not yet talking about the legitimate requirement of patients to receive their own medical data and its clinical interpretation first and foremost themselves – and in an understandable form. Anyone who has a serious interest in increasingly digitalised medicine for the benefit of people will start tomorrow.

Three questions – three answers: Dr. Stefan Knupfer, Board of Directors at AOK Plus

The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it.

Focus today: Dr. Stefan Knupfer from AOK Plus

The expert questions today go to Dr. Stefan Knupfer, Deputy Chairman of the Board of AOK Plus for Saxony and Thuringia, based in Dresden. In 2006, Dr. Knupfer was appointed as an authorised representative of the Management Board. With the merger to form AOK PLUS, he assumed the role of Managing Director of the Market Division. Since 2011, he has worked as Managing Director of the Finance/Controlling unit and authorized representative of the Executive Board.

The future of the principle of solidarity in an ageing society

Peter Ohnemus, DacadooPeter Ohnemus, founder and CEO of Dacadoo: How can the principle of solidarity be financed in a world where we live to be 85 years old on average and where 30% of the German population will soon be 65+? 

 

Dr. Stefan Knupfer, AOK Plus

Dr. Stefan Knupfer, Deputy Chairman of AOK Plus: The logic underlying the solidarity principle to this day is based on the assumption that an ageing society must also be a sicker society. I think this approach is obsolete.

Isn’t it rather the case that older people stay healthy longer and age healthier? Isn’t it also the case that ageing people today have better and cheaper therapies available than a few years ago?

The main burden of health expenditure in a person’s life lies in the last three years of life and is significantly higher for chronically ill people than for those who are not chronically ill. So is it not much more sensible to focus on the prevention of chronic diseases at this point? I think that the digital transformation offers numerous opportunities here, the potential of which is currently far from being sufficiently exploited.

The fact is that both medical progress and, in particular, digitalization are progressing at a rapid pace. This is accompanied by numerous opportunities that have not yet been exploited, or only insufficiently exploited, to make health care more efficient and different, without losing sight of the well-being of the individual in an ageing society.

In addition, the social and economic system in Germany is currently essentially based on private property, whereby a redistribution principle or the approach of a Sharing Economy has so far had little effect. As a result of demographic change and increasing tendencies towards individualisation, the solidarity principle of statutory health insurance schemes is getting into difficulties. In the future, this will pave the political way for a citizens’ insurance to provide basic services or a new financing of the solidarity principle through tax subsidies, e.g. from a financial transaction tax.

In the future, distributive justice will have to play a greater role. Health will become a public good. Particular challenges lie in the equitable distribution of health resources and in equitable access to health prevention and care for all people, regardless of their origin or income. Rationalisation through digitisation alone will not be enough to compensate for cost pressures from medical progress and demographic change, making the question of alternative system logic unavoidable.

In a sharing economy based on distributive justice, everyone has equal access to medical-technical innovations. Trends such as increasing “medical tourism” in the sense of cross-border use of medical services and the increasing willingness to share data also necessitate a fundamental rethink. In my view, Big Data can be a new “currency” and replace obsolete causality arguments. In times of digital transformation, an idea of solidarity extended by the data division dimension will continue to express the will of people to stand up for each other in the future.

Experimental medicine for terminally ill patients

Liz Parrish, BiovivaLiz Parrish, Gründerin und CEO von Bioviva: Do you believe that terminally ill patients should have access to experimental medicine? Please explain.

 

 

Dr. Stefan Knupfer, AOK PlusDr. Stefan Knupfer, stellvertrender Vorsitzender der AOK Plus: In my opinion, experimental medicine represents the basis of all therapeutic interventions, as it lays the foundation for further clinical trials with proof-of-principles experiments.

Experimental medicine makes it possible to understand human diseases, so as their origin, their pathogenesis and their effects on the organism in general and to develop new effictive therapies of various kinds from this understanding. Experimental medicine usually means basic research – of course with the aim to improve practical therapeutic action at the bedside.

However, until the findings of experimental medicine are actually available at the bedside, often a lot of time passes – time that a terminally ill person may no longer have. Such a terminally ill human being, fully aware of and fully aware of his situation, and freely to choosing to do so should, in my view, have access to experimental medicine – that is, to medical interventions that are not yet fully ecidence-based for health care.

The key point, however, is that terminally ill people are often no longer able to make such a decision of full consciousness and full willpower themselves. Here I see an ethical fundamental question of our society that urgently needs an open discourse: how do we deal with the advanced medical options we now have to artificially keep people alive? May trusted people speak for terminally ill relatives, ie act in their (presumed) will when it comes to choosing experimental medicine as a last resort or even providing a terminally ill relative for further basic research?

So far, there is no social consensus, no “modus operandi”, which is carried by all people. In this respect, a generalized answer to the question of access to experimental medicine for terminally ill people, which can only be answered individually, is currently not possible.

The doctor as “health pastor”

Frieder Hänisch, Limbach GruppeFrieder Hänisch, Business Development, Limbach Gruppe: Is the essential role of the physician in the future still the “health pastor”, who brings about the therapy decision and has a competence advantage over technical services (e.g. ADA-App), or is he only needed as a legal entity for liability issues in the health care system?

Dr. Stefan Knupfer, AOK PlusDr. Stefan Knupfer, stellvertrender Vorsitzender der AOK Plus: To start with, a counter question: Is the doctor really a “health pastor” today? Is he not rather a quite rational “health status surveyor” and a therapist of often only symptoms, but not of systemic and dynamic states – because illness and health are not static entities?

The so-called “talking medicine”, which places high demands on the social skills of the physician, has in recent decades actually stepped more and more into the background of medical activity. However, I believe that this trend will again develop in the direction of a return to what we call “pastoral” competences. Social competences, a high degree of empathy and the ability to advise and perhaps even coach other people will play a decisive role in the role of the physician in the future.

Similarly, physicians will be required to have a much greater understanding of digital applications in the future, because they will support the work of physicians on patients to a much greater extent in the future. The role of the physician will be between the physician as “Life Scientist” and the physician as “Mental Scientist”.

The information asymmetry between doctor and patient is decreasing more and more, which means that mature and well-informed patients will expect the best possible offers from a doctor for their respective health situation in the future.

Disappointment CES – the future of healthcare is out this year

Many colorful pictures, perfectly suitable for photo galleries on almost every news website. The CES in Las Vegas is a grateful media event. For years there has been no listing of gadgets and news without a “Health” section. But where is the promised future this year? The column often remains empty. Disappointment CES.

The BBC refers to Pillo, a likeable pill dispenser assistant for the home. But it’s already several years old. Otherwise BBC names technology for pain therapy, the effectiveness of which it directly denies.

Withings presents a device for – Attention! – measurement of blood pressure. The in-house communication department promises results on a clinical level. This is certainly practical, as is often the case with Withings, the design is pleasingly appealing and Withings received the CES Innovation Award for it. This in itself says a lot about the innovative power that this year’s CES will bring to the healthcare sector. Blood pressure! Next to it are smart watches. Genuine innovations. But I don’t want to do withings bashing. The company has successfully left the stopover at Nokia’s health unit behind. After all, they do show something.

The Stuttgarter Zeitung reads “CES in Las Vegas – Completely new perspectives in medicine” – but that was last year. This year, the topic is drowning behind autonomous vehicles, larger televisions and powerful mobile phones. There’s no question that none of the three is being played on for the first time, neither in Las Vegas nor elsewhere. Where is the impetus for the future of healthcare? Anyone who had expected the impetus to change the often cumbersome healthcare system from innovations on the consumer side (the author counts himself among them) can only hold true: Disappointment CES for the healthcare industry.

Three questions – three answers: Frieder Hänisch, Limbach Gruppe

The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it.

Focus today: Frieder Hänisch from the Limbach Gruppe

The expert questions today go to Frieder Hänisch, Project Manager Business Development at the Limbach Gruppe based in Heidelberg.  The Limbach Gruppe was founded as an association of independent laboratories and is the largest owner-managed laboratory group in Germany.

Asymmetry of knowledge

Peter Ohnemus, DacadooPeter Ohnemus, founder and CEO of Dacadoo: DNA testing is becoming more powerful and cheaper. How will we manage this asymmetry between customers and health insurers in the future? The customer can know everything about his clinical picture and the health insurance companies simply have to pay “blindly”?

Frieder Hänisch, LimbachgruppeFrieder Hänisch, Business Development, Limbach Gruppe: There are two scenarios in which genome sequencing is used in a way that can be experienced by the individual: Diagnostic sequencing based on a case of illness or sequencing on behalf of a customer for self-payers.

In the case of a disease, genome sequencing is indicated in a selection of disease patterns for therapy decisions. In Companion Diagnostic, the most effective drug is selected on the basis of the individual genome. Prominent examples are oncological diseases such as breast cancer. Here, medicine has learned that the drugs originally developed are ineffective in some patients because the mechanism of action of the drug cannot interact with the cell receptors. In 2017, however, there were only 14 disease entities for which such a procedure can be used meaningfully.

In my view, there is no asymmetry in this scenario. Both the patient and the health insurance company have a high degree of interest in the fast, target-oriented and thus also most cost-effective therapy.

In the case of a healthy payer, the knowledge of the genome information has to be considered from both sides: A) the information is available to the health insurance company but not to the contributor, and in the opposite case B) the genomic information is available to the contributor but not to the health insurance company.

A) The health insurance company corresponds to an insurance company in its business model. It therefore always has an interest in knowing individual disease risks and their probabilities of occurrence in order to control the business model via the contribution rates. In extreme cases, this means measuring premiums on the basis of the individual genome. As long as society does not block it by ethical norms and legislation, the procedure described is likely to be followed in the future.

It should be mentioned restrictively that the genome only permits statements about the probability of occurrence for a selection of diseases. In my view, knowledge about the Internet browser history of a health insurance fund member is much more meaningful for the formation of risk models than genetic information.

B) The current commercial offers for genome sequencing such as “23andMe” (genome sequencing service for 99 USD, as of November 2018) or MyHeritage present themselves more as lifestyle products for enthusiasts and genealogists. In essence, there is another question at the forefront: Does a psychological factor come into play when private genome analysis provides a probability of illness for serious illnesses that can only occur in the middle phase of life? Huntington’s disease, for example, does not break out until around the age of 40. Knowing a predisposition can lead to an enormous increase in psychological stress. The right of knowledge contrasts with the right to conscious ignorance.

I would not speak of a “blind payment” by the health insurance companies. A payment is made in case of illness, not in case of the probability of a future illness. Furthermore, on average 80% of the individual health costs are incurred at the end of life due to intensive medical care (about the last two years of life). From this fact out I consider the information advantage of an individual by knowledge of its hereditary information negligible for the health system.

Personalization vs. data protection

Arkadiusz Miernik, Universität FreiburgArkadius Miernik, Professor at the University of Freiburg: How will the further development of data-based, personalised treatment approaches be possible if data protection requirements become increasingly strict?

 

Frieder Hänisch, LimbachgruppeFrieder Hänisch, Business Development, Limbach Group: Thank you very much for this very up-to-date and important question. It is also a complex question.

Even today, without personalized treatment approaches, pharmaceutical research faces the great challenge of identifying the ideal patient population and including it in the later phases of clinical trials. Since the statistical effect strength of the new treatment approach must exceed that of the treatment previously used, the choice of study group per se is becoming increasingly difficult. The fundamental hurdle is therefore the study design and only much later data protection.

Data protection becomes relevant if the largest possible data pools are to be created over a longer period of time and then evaluated. In other words, all studies that use a big data approach. On the scientific side, I’m a little sceptical about the use of Big Data. More data does not necessarily mean better data. For me, the most important question here is the minimum data set that is required to answer the question.

I see the use of new technologies such as blockchain technology as a promising solution. It offers the possibility of a validated and complete documentation of the used data (smart contracts). This technology makes it possible, for example, to link the personal data of study participants with a token. Each use of the data in the sense of an analysis should generate a traceable transaction. The data owner thus has the option of controlling the use of his data and retaining decision-making authority similar to copyright. A little further thought can also result in new payment models for the use of personal health data. The study participant deposits the data anonymously and, in the event of a request for use from a study, can release the transaction, if necessary even for a usage fee.

Unfortunately, as far as I know there is no implementation of this technology yet, so this thought experiment has yet to prove itself in reality.

Interaction of the physical and the mental

Florina Speth, 2b AHEADFlorina Speth, Senior Researcher, 2b AHEAD ThinkTank: The interplay of our mental and physical state is often still ignored in the Western medical world. How will this develop in the future?

 

Frieder Hänisch, LimbachgruppeFrieder Hänisch, Business Development, Limbach Gruppe: In contrast to physical diseases, which are described and understood very well in molecular terms, mental diseases are predominantly phenotypically characterized. Similar symptoms are interpreted as similar diseases. Since the symptoms and intervals of the disease phases are very broad in the area of mental diseases, this basic assumption may lead to a misleading classification of disease patterns. It would be better to classify according to the molecular profile. As an analogy, the reclassification of bacteria based on findings from genome analysis should be mentioned here.

Furthermore, the diagnosis of mental diseases is essentially dependent on standardized questionnaires, in which the patients’ self-awareness contributes to the diagnosis and is also based on the psychologist’s subjective experience. Although biomarkers for diagnosis are in research, they have not yet gained market acceptance.

However, the further development of this field of science is clearly recognizable and the standard work on the classification of mental diseases “Diagnostic and Statistical Guide to Mental Disorders” (DSM-V) increasingly refers to the basic molecular events.

Neurodegenerative diseases – such as Alzheimer’s dementia – are diseases of old age. Life expectancy worldwide rose from 50 years in 1960 to over 65 years in 2010. This increase by 15 years has unmasked these clinical pictures. They have always been there, but their symptoms were hardly relevant because other diseases had already led to death.

These orthodox medical examples show a developing understanding for the mental impairments also in the western world. With reference to your initial question, I cannot name any good reasons in Western medicine for this strong physical focus. In Asia this connection of body and soul is, in my opinion, also based on the religious world view. In Japan every object is attributed a soul, which is a completely different basic understanding than our western division into organic/animated and inorganic substances.

 

3 Questions – 3 Answers: Bioviva

A new format starts here on the blog: The 2b AHEAD expert network in dialogue. Health experts regularly raise relevant questions on the future of health. Other experts from our network comment on this – and in turn ask new questions that will go to new experts. In this way, an inspiring dialogue grows and we will continue to expand it. Would you like to become a part of it? Just send me a short mail or comment here.

In the focus today: Liz Parish and Avi Roy from Bioviva

The expert questions today go to Liz Parrish, founder and CEO of Bioviva, and Avi Roy, CTO of Bioviva. Bioviva is one of the pioneers of telomerase – or to describe the result: Bioviva is working to prolong human life by intervening in the genetic code. Significantly prolonging it. Bioviva’s research focuses on the ageing processes of individual cells. Parrish, Roy & Team are among the most important drivers of the longevity movement.

Success-based medicine

Peter Ohnemus, DacadooPeter Ohnemus, Founder and CEO of dacadoo: With digital health, the proof of positive outcomes of drugs can be fully documented. When do we want to start designing a 100% outcome-based healthcare system?

 

Liz Parrish, BiovivaLiz Parrish, Founder and CEO of Bioviva: We do not have any evidence to support the claim the ‘digital health’ can absolutely prove positive (or negative) outcomes for drug trials. Most molecular and physiological biomarkers are hard to measure digitally without having an advanced molecular pathology lab. But regardless, your question regarding the outcome-based healthcare system is a valid one. Currently, in the UK the National Institute for Health and Care Excellence (NICE) balances the choices of medicines available to patients based on a multifactorial assessment of cost-effectiveness, opportunity costs associated with decisions, and the impact of treatment option on quality-adjusted life years (QALY). QALY’s and disability-adjusted life years (DALY) are the main outcome-based method to test the efficacy of a treatment in a healthcare system. Although flawed this is currently considered the gold standard by health economists and politicians. In conclusion, all countries that can afford to have a functioning health care system try to assess the efficacy of treatments based on outcomes, but the biomedical science community need to provide them with better biomarkers than QALY and DALY’s.

Who do we trust?

Arkadiusz Miernik, Universität FreiburgProfessor Arkadiusz Miernik, Freiburg University:  Should we trust the big pharmaceutical companies or rather biohackers in the future?

 

 

Liz Parrish 2, BiovivaLiz Parrish: We think that it is foolish to blindly trust any organisation or system. At BioViva we really like the Russian proverb, which was used by President Ronald Reagan on many occasions, “Trust but verify.” To elaborate, we are building a standardized bioinformatics testing platform which will test the efficacy of anti-ageing treatments regardless of them being produced by big pharmaceutical companies, or small biotech startups, or indeed biohackers.

Consequences for the immune system

Florina Speth, 2b AHEADFlorina Speth, Senior Researcher, 2b AHEAD ThinkTank: How does our immune system react when we continuously and permanently prevent diseases?

 

Avi Roy, BiovivaAvi Roy, CTO, Bioviva: Dr Speth, I am not quite sure that I understand your question, but I’ll try to answer it. In biogerontological research, and at bioviva we are trying to rejuvenate the human body and its organs and tissues at a cellular level. Our research and therapeutics target the hallmarks of cellular ageing which includes genomic instability, telomere attrition, epigenetic alteration, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication.  these processes happen in every cell type in the human body. when we think about treating a disease we are not necessarily thinking about cardiovascular disease or dementia instead we are targeting these fundamental cellular processes that go awry overtime. Therefore immune system cells will be beneficially affected by these anti-ageing treatments and would produce favourable outcomes. We imagine a future where we can rejuvenate long live cells, kill cells that are senescent or cancerous, and create new functional cells from stem cells.

The immature patient has had his day

The roles of doctor and patient in the future: What was the immature patient yesterday has long since changed. The one who just had to wait patiently and yield to the judgement of the only competent expert in white is no longer satisfied with this role. Or at least should not do it anymore. See below for counter-examples.

Steven Joffe from the University of Pennsylvania has just described in a pleasingly differentiated and clear article how the three factors of patient rights, available knowledge and direct-to-consumer tests have lastingly changed the doctor-patient relationship. He outlines how the immature patient comes to eye level. Joffe’s article deserves an urgent reading recommendation. It is hereby pronounced.

Three factors
  • Factor 1: Patient rights. For the first time ever, their formulation has led to the claim of patients to have their own opinion, their own decision and the corresponding information provided by the physician.
  • Factor 2: The Internet as a constantly growing source of medical knowledge.
  • Factor 3: The increasing availability of medical tests with scientific requirements directly for patients. We have already discussed this new role for laboratories with the associated business models on various occasions here and here. Joffe clearly emphasizes the impact of this development on the entire healthcare system.

For the sake of precision, we are talking here exclusively about the doctor-patient relationship between practicing physicians. The immature patient of the hospital is a similar but more complex subject. I will take up this point at a later date.

A contemporary role of the doctor

Joffe shows how, on the one hand, our traditional image of roles in health care is still very much alive. Here is the expert whose judgement is to be followed. There the receiving patient. On the other hand, Joffe demonstrates how these roles already lose their justification.

The contemporary and forward-looking role of doctors is therefore threefold:

  • The doctor as the patient’s advisor and health coach,
  • the gatekeeper for advanced medical knowledge and special testing, and
  • Finally, access to optimal follow-up services. That is, the medically necessary, although perhaps not directly required of the patient. Here, the doctor is the one who has an overview of the consequences of an illness and treatment. Who, on his own initiative, is committed to what is medically necessary – and in this way creates added value.

So much for the present.

Second opinion at Yahoo?

However, this present also includes this picture from a doctor’s office, which has been circulating on Twitter these days and has received thousands of approvals within a very short time:

 

The immature patient - Dr. Google must stay outside
The sign reads: “Patients who have already received their diagnosis via google are asked to obtain a second opinion not from us, but from yahoo.”

 

The reaction: several thousand likes, hundreds of comments along a line “Patients can be so annoying if they don’t trust the doctor’s diagnosis”. Yes, they are, at least for perceived half- and three-quarter gods in white. Is a doctor afraid of patients who want to take responsibility for themselves? In any case, he has difficulties with setting commas in the4 German language. But there is always something.

Those who hang up such signs in their practice deny their patients much more than just the ability to search the Internet for specific health information. With the reference to Yahoo, the poster looks like it did in the year 2000. The mentality behind it is much older; it goes back deep to the last century.

Counter-question: Who seriously wanted to recommend to a patient to rely exclusively on the knowledge that a single expert reproduces from his memory within a few minutes? With an effort of research, limited by the time that the health care system is currently paying.

A future-oriented role for the physician

Even more important from the point of view of futurology is the question of how to continue the series of trends and drivers:

Patient rights, available high-quality knowledge and B2C test procedures are followed at least by

  • Artificial intelligence in everyday use by doctor and patient,
  • an exponentially growing database in type and quantity,
  • large international players who are entering the healthcare market and claim a competent role here,
  • more and more: an interpretation of biology and medicine as information technology.

On this basis we then negotiate the roles between health seeker (ex-patient) and competent companion, supporter and initiator (ex-physician). The immature patient has had his day.

 

The healthy pace: Alexa vs. card

Two messages that @medinfode pointed out this week: Alexa learns diagnostics and the German Handelsblatt reports a breakthrough in electronic patient records. In their random juxtaposition, they form a lesson about the importance of speed: the healthy pace makes the healthcare of the future.

Doctor Alexa

Message one: Amazon is working on Alexa recognizing possible diseases by the human voice. I have already reported on similar approaches in connection with Beyond Verbal. And Amazon is already in the spotlight here in the blog as one of the key players in healthcare. As early as 2017, Amazon applied for the corresponding patent on the algorithm. Now this has been granted. In a nutshell: It is well known that Alexa constantly listens to what happens in the environment of the smart loudspeakers. With this development step at stake, Amazon is moving on to scanning the voices of the environment for diseases: Coughs and sniffles, but apparently also depressions. We futurologists have long predicted this: emotion becomes a natural part of data collection and analysis.

The benefits for Amazon are obvious. Anyone who knows the physical sensation of a person can address him personally at a decisive point. If you hear coughing, you can play out personalized advertising. And what’s more, they can also suggest orders and sell healing products. And, by the way, this creates an almost perfect usecase for models with ultra-short delivery times. DocMorris is currently advertising its online services nationwide with the slogan “Those who should stay in bed should not have to go to the pharmacy”. This logic is already outdated here: If you have the right smart speaker, you don’t even have to go to your online pharmacy.

Doctor with card

The other success message – and yes, it is a success message: The most important players in self-administration in the health care system of Germany have agreed on a policy paper that should provide us with a first form of the electronic health card for everyday use by 2021. This is a) more than has been achieved in the past 15 years. But that’s b) just exactly what it is: a paper. We have agreed on what the doctor´s associations should process and what the Gematik should process.

The key data sound promising: the patient retains sovereignty over the data. We at 2b AHEAD predicted in a large study as early as 2015 that this is where the future lies. Uniform standards should ensure broad application. And at least the Federal Minister of Health can already be quoted with the statement that the card is after all only one of potentially many access routes. The network structure in the background is decisive. And the health insurances publicly agree: A deviation is no longer possible without loss of face. On the other hand, who hasn’t actually lost face in the years since 2004? No one has been disturbed yet.

The healthy pace

And here is the connection: The one factor that is repeatedly underestimated in prognoses on artificial intelligence is its learning speed. Once in the world, the growth of performance continues to accelerate. Prerequisite: A sufficient amount of data is generated in the system. The fact that this is the case is unlikely to be seriously debated with Alexas’ market penetration. The forecast is characterized by a healthy pace. Some people program network standards, while others use algorithms to evaluate large amounts of data. Some are imposing sanctions on doctors to purchase suitable reading devices, others are having algorithms evaluate large amounts of data. Some hope for Gematik’s first successfully completed project, others have algorithms evaluate large amounts of data.

Who wins? Exactly.

No cyborgs! Amazon positions itself

Andrew Bosworth, head of VR at Amazon, has made his view of the future of mankind transparent: “We don’t have any projects involving implants. We don’t build cyborgs.” Superpowers yes, but no cyborgs.

 

Like all major tech companies, Amazon is also working intensively on projects for the future of healthcare. Andrew Bosworth emphasizes the importance he attaches to expanding human vision. The priority of VR and AR technology is correspondingly high. In the current interview, Bosworth announces a pair of glasses that we can wear every day, using additional third party information. Amazon is committed to expanding human capabilities. But this expansion takes place outside the body. Amazon is thus positioning itself among those who are striving for a non-invasive human evolution.

GAFA goes Healthcare

No cyborgs, or just yet – the big tech groups are clearly working on their role in the healthcare of the future. The focal points are quite different. At Microsoft, health boss Simon Kos is driving the development in the direction of networking medicine and care. The company is striving for a central role in the classic medical sector and beyond. Simon Kos outlined the key points during his keynote speech at the 2b AHEAD Future Congress in Wolfsburg in June 2018. The video is available here.

Simon Kos, Microsoft, and Michael Carl, 2b AHEAD
© www.AndreasLander.de

Apple is focusing more on the development of its own technology. Cupertino is upgrading its staff and has just strengthened the functionalities of its own devices, above all the Apple Watch. Here, the already hermetically closed ecosystem is being expanded step by step, with a focus on the collection of vital data. The diagnosis being the expansion stage.

 

Google, on the other hand, has long since set an accent in medical-scientific research. The video with Andrew Conrad is legendary; targeted acquisitions expand the portfolio.

 

Elon Musk, who, strictly speaking, is not a member of the GAFA family, plays a remarkable role here. He obviously has nothing to do with a “no cyborgs”-claim. On the contrary, his impulses point strongly in the direction of digital armament for humans. He stresses at every opportunity that this is our only protection against the ever more powerful artificial intelligence. Only the intentional expansion of the human body will prevent us from becoming the cute domestic cat of artificial intelligence. I described the details and the state of development in detail in a trend analysis published here by 2b AHEAD last summer.

 

Healthcare of the Future (2/2)

In the summer of 2018, I gave the keynote speech at the Roche Days “Diagnostics in Dialogue”. I then noted a few very basic thoughts on the healthcare of the future. They have just been published by Roche. The first part is here; this is the second part of the slightly shortened text.

From patients to healthcare customers

Data-based knowledge of people’s sensitivities will also blur the boundaries between illness and health. The fact that people are not either 100 percent healthy or ill is not a new idea for the healthcare of the future. However, the broad data basis makes it possible not only to discover existing diseases. In the future, healthy people will also know a lot about the risks of potential diseases. This in turn raises the question of where the line between healthy and sick lies. The WHO defines health as a state of physical, emotional, mental and social well-being that goes far beyond the absence of illness or complaints. A forward-looking understanding.

Today’s patients depend on the data collection, evaluation and interpretation of their attending physician. In their perception, they are dependent on him. Patients of the future have the largest amount of data on their own health status and have access to their evaluation and interpretation. While classical patients look towards illness, symptoms and deficits, future customers focus on health. Patients become health customers.

Customers look for suitable service providers

Health customers are changing the health market with their attitude. They choose the right health service provider to optimize their state of health. Its attractiveness will depend on the added value it can deliver. It will be crucial for the successful service providers of the healthcare of the future to know exactly what the needs of potential customers are. They will analyse how each of their healthcare customers “ticks”, what their needs and expectations are and how best to communicate.

In the sense of “optimized” health, technologies could also be used in the world of tomorrow to expand or fully maintain bodily functions: The contact lens displays necessary information when needed. New organs are created in the 3D printer from the patient’s stem cells. Perhaps it will also be completely normal to order organ replacement from the doctor long before the first organ resigns.

Healthcare of the Future Michael Carl

Human – Machine Organisms

In the future, personal interaction will lose its central role today. People will increasingly experience that a machine simply understands them better. Communication with machines can be superior precisely because it follows clear structures and takes into account a multitude of data and parameters. If we continue to consistently think ahead, computers could become personal assistance systems that make calls on behalf of their owners, obtain information and offers at a frequency and perseverance that people would not be able to. Service providers in the healthcare of the future will have to adapt to this.

As a result, the way work is done will change completely. Where today we are talking about interfaces between man and machine, in the future we will look at man-machine organisms. In learning systems, algorithms will emancipate themselves as human tools. They will become de facto fully-fledged team members and will even take on management tasks.

New way of thinking

All these changes require a fundamentally new way of thinking and thus a change in corporate culture. In order to do justice to the possibilities and progress of digitalisation in the healthcare of the future, we must fundamentally rethink our ideas of values, quality and dealing with mistakes. Our way of thinking so far does not allow us to keep pace with the exponential pace of change. We must not just wait and see. We must act, even if we exceed our competencies and avoid good intentions. In the world of tomorrow, the maxim applies: Better to apologize afterwards than to ask for permission beforehand.

The Future of Healthcare (1/2)

In the summer, I gave a keynote speech at the Roche Days “Diagnostics in Dialogue”. Afterwards, I wrote down some very basic considerations about the future of healthcare. They just appeared in a Roche publication. This is the first part of the slightly shortened text.

The feeling that the world is turning faster and faster is not deceptive. The familiar linear and controlled pace of development is increasingly becoming a thing of the past. Our environment is changing exponentially – one could actually say that our world will never again develop as slowly as it does today. This development will be driven by the large amount of data available – also in the future of healthcare.

Internet of Everything

Today’s idea of data composition and data quality is generally too narrow. Technology experts confirm: By 2020 at the latest, thoughts and sensations will also be part of everyday data. Even today, electrodes can read brain waves used by paraplegic people to steer their wheelchairs. In a few years’ time, electrodes will no longer be attached directly to the patient’s head, but sensors will read our thoughts from a meter away.

Every object of everyday use will potentially be connected to the Internet and networked – the chair on which we sit, our refrigerator or our car. In the so-called Internet of Everything, not only computers, laptops, tablets and smartphones are connected to each other, but also intelligent machines that generate additional data. For tomorrow’s children, the phrase “I’m going online” is incomprehensible, since it would mean that they were offline before.

Networking large amounts of data leads to highly adaptive products that can adapt to the individual, changing needs of people. This especially applies to the future of healthcare: Recorded data from smartphone apps, sensors from smart homes and wearables open up new possibilities for individually adapting health services to each patient.

Personal health networks

This form of personalized medicine is therefore data-centered medicine. Data about a patient is already numerous today, and continues to increase exponentially. Where yesterday perhaps a laboratory value and an X-ray image were the basis of a medical decision, in the future a multiparametric overall picture will be created for the medical recommendation of action. This will also change structures and processes in the context of patient management. Patient data assume the leading role in the entire treatment chain. The data-based knowledge of a patient’s condition and the potential diagnoses, therapies or preventive measures derived from it are also driving the increasing specialization of professions in the future of healthcare.

New health providers

Dynamic healthcare networks will emerge around the individual, whose nodes will be both the traditional players in the healthcare industry and new providers: companies in the food industry, sports and fitness, medical technology or the IT sector. The pace of decision-making for preventive measures or therapies is increasing, as is that of new developments for products and health services. In addition, this form of personalized medicine offers the opportunity to find new places for health and to place health topics flexibly, for example at home, in the car, in a restaurant or at work.

Future of Healthcare Michael Carl

Data Interpretation and Data Sovereignty in the Future of Healthcare

When patients have more and more information, this does not mean more knowledge or understanding at the same time. This is why the explanation and interpretation of data and the communication of risks, for example, are becoming increasingly important. Patients need experts to advise them. However, this role will no longer automatically fall to the family doctor in the future. On the contrary, different players in the healthcare industry are competing for this function, which is usually limited in time. These can be contact persons for certain clinical pictures – for the cancer patient the oncologist, for the woman who wishes to have children the gynaecologist – or contact persons who are important in a certain phase of life, e.g. a caregiver for an elderly person. There will be competition for the control function. Because whoever plays this role will have a decisive influence on the other players in the network and their care tasks.

Blockchain as key

Of course, all these predictions only occur when people release their personal data for medical analysis. Data protection of the future must therefore mean that the patient has sovereignty over his or her data. He determines how they are dealt with. They must be able to rely on the fact that their data is available at all times. At the same time, he must be protected against access by unauthorized third parties.

Blockchain technology plays a decisive role in this context. The best-known and oldest blockchain application is the digital currency Bitcoin. In the blockchain, information is not stored on a single server, but rather decentrally on different computers in a network. In order to falsify information, it is no longer sufficient to hack a single server, but every single computer in the blockchain. This makes the technology particularly secure. It is thus also suitable for the exchange of sensitive health or disease data in the future of healthcare.

Read in part two of the text how data-centric medicine leads to a new picture of disease and health. Digital communication is fundamentally changing the future of healthcare.