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.

Healthcare-Tech: Apple strengthens commitment

Healthcare-Tech in focus: around Apple, the sensors for potential developments are particularly finely adjusted. And even if Apple traditionally communicates very sparingly: The company’s job advertisements are a reliable source of news and trends. The US media company CNBC is just pointing out that Apple is looking for developers to expand the range of its own processors. One focus is on healthcare. CNBC quotes an Apple posting: The new employees should “help develop health, wellness, and fitness sensors”.

One possible field of application is Apple Watch. It already has functions to measure heart rate and activity data. Relevant blogs from Silicon Valley such as Venturebeat have already included the news. What is interesting is that Apple is obviously in the process of bringing the development of healthcare technology in-house. This would be a clear indication of the priority this issue has for the most valuable company in the world.

Healthcare-Tech-Apple-Fotolia

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.

 

Demographic change and healthcare: Good News

Demographic change and healthcare: The core business of health insurance in the future will no longer just be healing the sick. Health insurers will support healthy people – from the prevention of diseases to increasing well-being and life expectancy. This is the result of a current trend study by 2b AHEAD ThinkTank. Demographic change has a direct impact here.

Trend study health insurance

The healthcare sector will undergo unprecedented change by 2030. With digitalization, the possibilities of medical research, diagnostics, therapy, rehabilitation and prevention are growing at exponential speed. These effects are nowhere more evident than among the fastest-growing groups in our society:

  • The old who don’t feel old even when they retire,
  • the still older, who in many cases can still lead an active and active life, and
  • the very old, still rare today, soon an everyday occurrence.
The good news

The majority of today’s forecasts and future studies address demographic change as a problem and a threat. Of course, it will present us with social and economic challenges of an unprecedented scale. But for both individuals and our communities, demographic change represents the greatest conceivable progress: the considerable extension of one’s own life in activity and self-determination. Demographic change may be expensive news, but above all it is good news.

People born in this decade realistically reach an age of over 100 years. It is the interaction of four influential drivers that brings the dream of longer life within reach. The first condition is the freely available gene analysis. The second development concerns the breeding of individual copies of internal organs, which may be optimised compared to the previous version. The third prerequisite is a comprehensive understanding of the aging processes of humans. The fourth element is the synchronization of the human psyche with the virtual world. A breakthrough in research in all four fields is likely in the coming years.

For the sake of completeness: There is a well-founded opposite position to this, especially taken up here in the blog. It is represented among others by the medical ethicist Ezekiel J. Emanuel. He fears extension as a phase of helplessness and diminishing dignity.

The increase of well-being

A decisive change in dealing with human health is the disappearance of the binary assumption that a patient is either healthy or ill. This categorical distinction has always been a fiction anyway. Nobody’s just sick or just healthy. Instead – assuming the corresponding amount of data and its continuous collection – the individual well-being can be measured and located on a scale. This is changing the goal of medical action. While yesterday the focus was on repair and damage prevention, tomorrow it will be on gradually improving one’s own well-being. What can I do to feel a little better tomorrow – and who will support me? The enlightened healthcare customers of the future are very consciously and with the support of digital assistance systems selecting the most competent physician for their situation, the appropriate insurance and the trustworthy data manager from their individual healthcare network. At the same time, they will no longer accept that the interaction of several service providers is associated with increased effort for them.

In the near future, evidence-based, personalised recommendations for targeted prevention will replace the always identical bonus booklets of health insurance companies and lump-sum and overall undirected health-promoting measures.

Test Case Robotics in Nursing

This can be clearly seen in the emergence of robotics in care. Robotics became a widely accepted matter of course in the course of the 1920s. This has long been the case in the field of dementia care. The fact that a robot has the patience to listen to the same question, the same story, the same excitement over and over again as it did the first time makes this development even easier.

However, the development will not be limited to animated stuffed animals. This is shown in the example of medication. Where nursing staff still have to work by hand today, the procedure is time-consuming and prone to errors. The next step is automated dispensing of medication to the patient at home: individual implementation of the medication plan by a pill robot. In the next step, robots learn to analyse the state of health of humans. By blood sample, air analysis, nutrition tracking, later by observing the skin temperature, the movement patterns and by voice analysis. The dosage of the active ingredient is calculated in real time.

In the next expansion stage, the medication robot is able to print the individually appropriate active ingredients onto a carrier directly before ingestion. Is this a relief for the nursing service? With great certainty. Does this development, and thus indirectly the demographic change, have the potential to improve the well-being of the individual patient? With a very high probability. These are the simple questions. But whose knowledge is the robot`s work based on? As soon as he has access to networked medical knowledge, his professional competence will always be higher than that of the individual doctor. For the time being, the family doctor is still needed to issue prescriptions, which also makes up for a reason to exist professionally. His profession will change permanently, a thesis that Markus Bönig of Vitabook has just confirmed here. The medicines or active ingredients do not have to be purchased in the pharmacy around the corner anyway. This opens up completely new business areas for new players.

Smart Home

An additional driver of this development is the currently exponentially growing networking of buildings, starting with Ambient Assistant Living. The smart home of the person in need of care is the first and most competent care robot. This means that completely new players are suddenly active in the health industry: Network operators, property managers, building contractors, manufacturers of electronics and sensor technology. This, too, is an indirect consequence of demographic change.

Health insurers as the health promoters of the future must start much earlier in the process, which means that they will occupy a much more active and positive position in the perception of health customers. The one-size-fits-it-all-principle has had its day. In future, health promoters will not react only when health customers are ill, but will continuously monitor their current state of health and act before the onset of a foreseeable illness. This too: That’s good news.

 

Healthcare in old age: Why this man limits his medical care himself

We live longer and longer. So far so familiar. In any case, from a Western perspective, this is basically synonymous with: This is an enormous step forward in civilization. We are getting older – and we will be able to enjoy the gain in lifetime healthy and fit. Healthcare in old age ensures that we extend the phase of active life. It promises to limit and limit the time of helpless, suffering existence.

The counter thesis represents Ezekiel J. Emanuel, oncologist and medical ethicist at the University of Pennsylvania. He’s pointing: We’ll postpone the date of our death. The time, however, when we can no longer live fit and active, is moving forward. And drastically. His consequence: He plans to limit his life. 75 is a good age to be remembered positively by family and friends. To be precise, Emanuel is not planning suicide or euthanasia. But after his 75th birthday he will only accept palliative medicine, not curative medicine. No tests for prevention, no nutritional optimization, no exercises for mental fitness. Healthcare in old age exclusively for the well-being, not for the prolongation of life.

Ezekiel Emanuel Healthcare im AlterHe published his position and the underlying statistics in a detailed article in The Atlantic: Why I hope to die at 75. The editor Mareike Kürschner took up a conversation again and now, four years after the statement, asked again (Paywall). Meanwhile Emanuel is 61 years old – the self-chosen end is in sight. We’re in position.

The path to self-determination

Two thoughts stand out: Emanuel describes quite touchingly how the fact of the self-chosen end completely changes his perspective on the years before. How he feels activated to take care of the big questions of life. To attract important people from his environment, to learn, experience, experience… Obviously, the limitation of life expectancy leads to exactly the degree of self-determination and self-efficacy that healthcare providers often promise in vain in old age.

The second idea lies on a higher level: We afford to spend a considerable portion of the health care costs for the last 14 days of life alone. Against this background, the conscious renunciation of the attempt of healthcare in old age to find out a few more months of life is almost revolutionary. As understandable as this attempt may be in individual cases – from an overarching perspective it sometimes seems somewhat desperate.

I put this up for discussion: the better we understand how to prolong human life, the greater our responsibility grows to determine the point in time at which the bow closes with dignity. tbc.