SITiG and bitkom call for a federal agency for digital medicine

There are good reasons to think that the development towards a digitalised health economy in Germany is too slow. Unfortunately, there are even many good reasons for this. Anyone who can once again watch how medical specialists manually transfer patient data into the hospital database, including depreciation errors, has no more questions here. The device is out of order, again. This happened to me ten days ago. Bitkom and SITiG have now proposed setting up a federal agency for digital medicine to speed things up.

A motor for health communication?

This federal agency for digital medicine  is to develop standards, so the publications of the initiators in short and long, in order to make safe health communication possible. In the language of bitkom: “A Federal Agency for Digitised Medicine can create framework conditions for technical and semantic interoperability and for the implementation of data protection and data security requirements”. That´s Achim Berg, bitkom President. This agency shall have a catalytic effect, unites all players and will make Germany the “number one technology and research location” for medicine in Europe. The only thing still missing is the German government’s eHealth strategy, on which all of this could be built. A rogue who thinks of the Federal Government’s AI strategy and its almost comically formulated goal of establishing artificial intelligence as an “export hit”.

The Ärztezeitung sums up the initiative of SITiG and bitkom (involuntarily?): At its core both associations are concerned with control. With this federal agency for digital medicine they want to create a new instance of central supervision.

More Power to the Patient

The initiative fits in with the picture of future healthcare that has long been demanded by the associations. The result of these demands is known. The initiative also fits in with the tenor of the “Digital Health” conference organised by bitkom last week in Berlin: “More Power to the Patient”, the title of the conference, summarized here very succinctly.  Core results of the keynotes and contributions: It needs the electronic patient file. And again: lots of solutions for the object “patient”. But only little power for the user of the system, only little decision-making authority for the customer of the health economy. People are always turned into patients. And a “patient” obviously always needs others who know what is good for him. Others who decide for him and others who improve his care. Others who turn him into an object and others who set up federal agencies for this purpose.

The future of healthcare

Once again to take notes: Those who equip their field staff with iPads have not yet digitized their sales. Anyone who supplies a school class with laptops has not yet made a contribution to digital education. And anyone who demands an agency that will develop standards for the interoperability of data in the course of the introduction of the electronic health card in a long process and at great expense has neither digitized the health industry nor made a significant contribution to the future of healthcare.

The healthcare of the future will enable people to measure, change and raise their state of health and well-being – ideally beyond a 100% natural or God-given threshold. People will use technology to do this: Data of the most diverse kind and quality, algorithms for their evaluation, databases, genetic engineering, 3D printing and the like more. This is the scope of the digitalisation of health. Anyone wishing to support this through a federal agency should set up an agency that – analogous to the newly established digital agency of the German federal government – promotes leap innovations financially and structurally. There is plenty of room for this – see above. A federal agency for digital medicine, which ultimately springs from the spirit of controlling a complex system, will achieve exactly the opposite.

Beyond Verbal: The Voice Leads to Diagnosis

When the voice becomes an early warning system for serious diseases: A pointer to a technology that may not be entirely unique, but which is exceptional in any case. Yuval Mor developed it with his team at Beyond Verbal. This is where voice control takes on a whole new meaning in the healthcare of the future.

This is the approach: Beyond Verbal can show that specific severe diseases lead to characteristic patterns in the human voice. These include severe heart diseases, but also neurological diseases such as Alzheimer’s and Parkinson’s disease. These patterns cannot be identified by human ears. Beyond Verbal has developed an algorithm that can detect these subtle changes with amazing precision. The special thing: The algorithm is able to hear these changes before the heart fails, before Alzheimer’s can be diagnosed in the conventional way. Voice analysis therefore allows a much earlier intervention, permitting action instead of reaction. Which language someone speaks is, by the way, completely irrelevant for the analysis. The characteristic patterns occur in Mongolian as well as in Swiss German.

Yuval Mor was a speaker at the 2b AHEAD Future Congress 2018 with his topic and presented his project for discussion. The colleagues at 2b AHEAD have already put the video of his impulse online. It is available here.

Beyond Verbal - Yuval Mor

A matter of course, but always worth remembering: Beyond Verbal introduces one of the technologies into the healthcare of the future, which very concretely lead to a fundamental shift of knowledge. This is an effect that we are seeing again and again. It is particularly easy to show here: The algorithm generates knowledge that can lead to a considerable increase in well-being and well-being. The traditional players in the healthcare industry can only distinguish themselves by how well integrated and self-evidently they deal with this knowledge.

Please test it for yourself!

And to make it even more concrete: Beyond Verbal has made the app “Moodies” freely available in the app stores as a kind of by-product. It accesses the same algorithm and analyses the emotional state of the speaker within a few seconds. I now use this app regularly on keynotes, both to demonstrate the power of Artificial Intelligence, and as feedback of my own effect, simply to improve myself. I can only encourage you to try “Moodies” for yourself.

Digital diagnostics: Disruption does not start in harmlessness

Today, two tweets have rushing through my timeline. Both touch on the subject of digital diagnostics and they show an idiosyncratic, seemingly contradictory picture. Does digital diagnosis lead to better results – or a diagnosis by a human doctor? And from whom do we want to receive such a diagnosis?

Digital diagnosis as a life saver?

The Intelligent Health AI from Basel is bringing positive news, enthusiastic about the feasibility.

Digital diagnosis: AI can do

One could object: Where is the news? The fact that the diagnostic capability of halfway modern systems of artificial intelligence is superior to human expert knowledge should come as no surprise. This imbalance is well documented. Every oncologist, radiologist and probably almost every laboratory doctor will confirm this. Even if the ideas of the consequences probably differ considerably: The fact is indisputable.

Analog students at MIT?

Futurist Andrew McAfee paints a different but remarkable picture of his practice at the university:

Digital Diagnostics

Contrary to all reason, it seems that the next digital elite – nothing else is being trained here at MIT – is actually putting up with disadvantages. They opt for human diagnostics and not for digital diagnostics. He does not comment on the motives. Even if he did, this would hardly lead to a statistically reliable picture.

Three models of interpretation

Let us place the two impressions next to each other and interpret them together. Three patterns of interpretation seem plausible:

Interpretation 1: In case of doubt, technological fascination is always the solution for the others. Autonomous driving is as inspiring as it perfectly makes sense, if only one’s own steering wheel does remain. I call this the deficit model of technological disruption. The guiding principle is the fear of losing familiar solutions, services and features, despite all the technological fascination.

Interpretation 2: The time lag shows an apparent contradiction. This is the model of harmonization over time. Today, students reject what they will get used to over the coming years. At first glance, this is an obvious idea. At second glance deceptive: Those who allow themselves to be guided by this interpretation are in danger of covering up the disruptive character of innovation with harmony sauce.

Interpretation 3: In this juxtaposition we clearly see how one of the most important innovations in health care will take place. The model of the creation of meaning through innovation. A conventional diagnosis that does not involve life and death will – with good reason – be made and communicated by a human doctor in the foreseeable future. Even if an AI would actually be better, there is no real risk. However, when it comes to the threat of fatal diseases, AI offers a leap in quality; those who want to overcome this threat are less choosy when it comes to choosing the means. The main thing is: something works, even if it´s digital diagnostics.

Disruption does not begin with harmlessness

If this third approach prevails, we will see AI in use very soon. The triumph of digital diagnostics, however, will not begin in the harmless and risk-free, but – on the contrary – where it really counts: In the fight against life-threatening diseases. Ebola, malaria, rapid cancer will bring AI into the everyday life of healthcare before it also devotes itself to the fight against colds and lice infestation. Sometime later.

I tend, you will suspect, to the third interpretation. The most important innovation of healthcare of the future will begin with questions of life and death. But please, judge for yourself.

3D Printing of Organs: State of the Art and Prognosis (2)

The future technology 3D printing of organs. The first part focused on Dr. Anthony Atala and his work at the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina. He will probably be the first to receive formal approval for 3D printed implants. Dr. Gabor Forgacs has a different focus. While Dr. Atala strives to replace organs 1:1 with printed implants, Dr. Forgacs sees greater potential in the field of pharmacology. He is interested in printing individual biomaterials on which doctors can test the effectiveness and mode of action of pharmaceuticals. A test on the individual body, but before prescribing the drugs to the individual patient. The advantages are obvious: risks are reduced, intolerances become apparent in advance, and dosages can be tested. As a result, patients can be treated more efficiently: cheaper, gentler, more effective.

With Organovo, Dr. Forgacs can claim to have founded the first commercial company in the field of 3D printing of organs. He was already a guest at the 2b AHEAD ThinkTank in 2012. With his focus on samples for toxicological tests, he also avoids most hurdles to approval. In addition, he expects an application of 3D printing, especially in the area of prostheses, which has long since become reality in many areas. Hearing aids have long been in use in the double-digit millions. However, the actual potential of Forgacs’ approach seems to lie in the area of pharmaceutical development anyway. Every day that technology can shorten the enormous development cycles of new drugs is enormously valuable in monetary terms alone.

3D printing of organs Gabor Forgacs

Use cases as drivers for 3D printing of organs

It’s worth taking a look at TeVido BioDevices, a company based in Austin, Texas. In contrast to Atala and Forgacs, founder Laura Bosworth does not start on the technology side, but from a relevant problem. In this case: the reconstruction of the breast after cancer. More precisely: The medically correct, but often visually unsatisfactory reconstruction. TeVido manufactures artificial nipples using 3D printing technology with natural optics thanks to natural substances.

3D printing of organs is therefore a safe candidate for a promising future: technology with experience and potential for scaling, decentralized know-how, relevant use cases.

3D Printing of Organs: State of the Art and Prognosis (1)

3D printing of organs is a regular guest on almost every list of technologies  influencing the healthcare of the future. At the same time, this technology seems almost old again, we have been talking about it for so long. Would we still call it a future technology? Without compromise, yes. 3D printing of organs has the potential to fundamentally change healthcare. The image of our body is changing. yesterday, medicine was working on restoring an original state given by God or nature, tomorrow the improvement and expansion of physical functionalities will become the central task. Here is a brief overview of the main players and their roadmap.

Probably the most important actor is Anthony Atala, surgeon, urologist and director of the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina. During my most recent visit in spring 2018 I could not only hold a printed kidney in my hand, I could observe machines printing blood vessels, bones, livers, heart cells. His initiative to industrialize the processes for the production of any organs is even more promising. Only half of his total of 500 employees in the laboratory are physicians. At the same time, mechanical engineers, among other things, are working on reliably standardizing the processes in order to be able to offer them at many locations in this way.

The principle “3D printing of organs” is always the same and simple in logic: Whoever is able to grow organs from human stem cells can a) produce organs whenever he needs them and b) will prevent the organ from being rejected by the body. Risks are reduced and lifelong therapies are eliminated. The acute shortage of donor kidneys in particular is eliminated; the transport of transplants is no longer necessary. So far the consensus.

100% or more?

Among the researchers developing this technology, opinions differ at c): Will we also be able to improve the organs? Will my printed heart, my kidney, my liver be more efficient than the original one? And will my organs receive additional functions that were not yet provided for in the original configuration of my body? We see how the image of our body changes in the face of this possibility alone: The functional scope of the institutions, the coordination among each other – all this becomes a configuration. The body becomes a configurable machine. The only difference is whether the ideal is to restore the initial 100% as accurately as possible – or an individual and targeted deviation.

Dr Atala is the most important representative of those who rely on the 100% model. At the same time, he is the one whose laboratory is closest to formal approval by the FDA. His perspective: At the beginning of the 2020s, the first procedures for 3D printing of organs will be approved. First for rather simple structures, later step by step also more complex ones. Until the mid-2040s, it will be normal in many parts of the world to talk to your physician of trust about an exchange of almost any organ as a matter of course. In this way, he expects to be able to increase normal life expectancy to around 120 years.

3D Printing of Organs
Dr. Atala showing a printed kidney

Read about the work of 3D printing pioneer Gabor Forgacs in part 2.