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.

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.

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.

Retail goes Healthcare: Best Buy and Great Call

Retail goes Healthcare. A short message only, hardly taken up in European media: The US electronics retailer Best Buy has acquired a healthcare company: Great call. For $800 million. Great Call offers a whole package of health care services, mobile and decentralized, i.e.: at home.

A short review: Best Buy, de facto the US counterpart of Europe´s “Media Markt”, was facing insolvency just a few years ago. Consistent cost reduction, new store layouts and above all a concentration on new customer needs have led to a turnaround. Only recently, Amazon was considered the existence-threatening competitor of Best Buy. Amazon is now seeking the proximity of Best Buy and entering into strategic partnerships.

Future picture of retail and health

With this acquisition, Best Buy enables itself to extend the Smart Home solutions from its program a significant step and to act as a provider of health services. There is no doubt about the strategic importance of the segment anyway. Smart Home is an enormously growing segment in the electronics trade, even though its practical use is still limited: music, everyday shopping, some security and surveillance, lights on and off. At the same time, the market is growing enormously. The reports differ in detail; all in all, we can expect the market to quadruple from the beginning of 2017 to the beginning of 2018, with increasing momentum.

This is clearly based on concrete expectations for the future of both the retail and the healthcare sector. They will be even more influenced by technology. Wherever providers can offer highly personalized services, they will enable meaningful and profitable business models. Best Buy also points to the strong growth of potential customers. The company expects +50% of the US population to be over 65 over the next 20 years. I recently explained why I consider demographic change to be an enormously promising development. This assessment is again proven here.

 

Retail goes Healthcare - Best Buy´s CEO Hubert Joly
Retail goes Healthcare- Best Buy´s CEO Hubert Joly

The step of adding services to hardware sales is neither new nor revolutionary in itself. With the dynamics smart home solutions show in the market, it makes sense to want to supplement services here, that at the same time open up new industries and markets. Whoever is able to enter the customer´s house … We would expect this from every digital ecosystem operator from iOS to Android, from hardware producers, as well as from industry specialists to defend their own business models. However, this is where the retailer becomes active. This is a clear indication of which players across all sectors see very sober opportunities to realize business models in the healthcare sector. It´s just: Retail goes Healthcare.