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.

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.

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.

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.