During the 13th Trend Days Health in Lucerne, more than 800 decision-makers from the Swiss healthcare sector addressed the question of where digitization in healthcare will lead, which opportunities are visible on the horizon, and which trends are already a reality. Speakers from the IT industry, medicine, politics and healthcare gave presentations and discussed Big Data, data protection, the Internet of Things and digital readyness. Although digitization is developing enormously fast and ever more rapidly, the status of digitization in healthcare in Switzerland today is not much further along than in agriculture, as one speaker noted – the challenges are complex.
“Changes always take place in contexts,” was how futurologist Matthias Horx introduced the event in his presentation. An insight that resonated in almost every presentation at the congress. The “health megatrend” identified by Horx goes hand in hand with demographic change, a shift in values and technological progress. Healthcare stakeholders are comprehensively challenged:
- of patients who, with growing health awareness and demands for autonomy and individual solutions, are making new demands on information, support, care and provision.of technologies such as Big Data, electronic patient dossiers, integrated information systems, the standardization of structured data-
- exchange as well as a high degree of data security.
- of insurers and healthcare providers who need to manage cost explosions and meet the increasing demand for prevention products.
Digital Pills & Cost Management
At the interface between computer science and psychology, Dr. Tobias Kowatsch is working on behavioral digital health interventions at the University of St. Gallen and ETH Zurich. Here we explore how apps, mobile coaches, and other sensors integrated into hardware used on a daily basis can measure and check vital signs and reflect them back to the user in terms of an intervention. Examples of applications are mobile intervention for depressives or chat bots in aftercare or accompanying patients when they take their medication.
Monitoring patients, in turn, also generates a vast amount of data. The smartphone alone has at least 17 sensors (overview 1), as Volker Schmidt, CSS Insurance, explained in his presentation on digital prevention offers. Based on this data, not only user interactions can be created via game-like interfaces. The data obtained – Big Data – can be stored in databases that provide information on disease progression – along with other data that healthcare providers collect. The goal of such evaluations is to improve cost efficiency by more closely calculating and forecasting typical disease patterns and service costs. Insurance products can be optimized in this way and cases of abuse can be detected more easily, as Rolf Schmidiger, SUVA, explained to the audience. To ensure that the patient is not completely degraded to the status of a statistical “case,” an app is to be used in another field of digitization activity, process optimization: the layman’s comprehensible medical bill, which is intended to do justice to the patient as an informed customer.
The fact that there is a gap between the digital everyday world in which people move today and customer communication channels of healthcare providers is impressively demonstrated by a slide from the presentation by Stefan Spycher, Vice Director of the Federal Office of Public Health FOPH, on “Digital advances in the Swiss healthcare system” (Fig. 1).
Thus, at least in 2015, fax was still the preferred data transmission medium for patient information. “Digital customer interfaces will be of high importance in insurance and consulting services in the future. They are predestined for an attack by a Health Uber,” stated Ralph Landolt, member of the Board of Directors C-Level, Partner & CEO BoydakStrategy Consulting, in his presented “Maturity analysis against the background of digital transformation”, alluding to the Californian company Uber, which competes significantly with the cab industry in most cities. The C-level managers in the healthcare sector are aware of the fields of action, and strategies are also in place – the only thing missing is a culture of change in the organizations with their dominant core businesses (overview 2).
The vision of Big Data in research
Via mobile apps from more than 5 billion smartphones in widespread use in 2020, a massive stream of data is emerging from traditional and non-traditional sources that can be used for predictive modeling and AI-assisted diagnosis in self-learning systems – this is the vision of Prof. Marcel Salathé, Life Sciences & Computer and Communication; Academic Director, Extension School EPFL. This requires technical infrastructures that can process huge amounts of data. In this context, the speaker presented www.healthbank.coop. A cooperatively organized project in which volunteers share their health data, e.g. from the Electronic Patient Dossier or other sources, to Healthbank and make them available for research. This system is promoted by various representatives in the health sector.
Prof. Christian Lovis, Director of the Division of Medical Information Sciences at the University of Geneva /HUG, spoke about another very well-known project: IBM’s Watson. Watson collects thousands of images as well as associated diagnoses and is able to generate independent diagnoses and analyses based on the stored knowledge. The automation of diagnostics is one of the visionary goals for the use of Big Data, in addition to various research projects, for example. research into rare diseases.
What sounds visionary, however, harbors powerful stumbling blocks. Prof. Salathè described one of these as the “conflict of our age”: humanity can keep its data in silos for fear of losing privacy, or instead make data available for research purposes (and ensure that it cannot be misused). Prof. Lovis raised more fundamental methodological problems in this regard: Information overflow needs evaluation systems. These filter evidence, identify reliable sources, and revise dogma. Correlation and causality too often turn out to be an inappropriate pairing. Who determines evidence, who revises dogma, who identifies sources?
The fascination with Big Data in research, with its opportunities, should not make scientists insensitive to requirements for controllability and care – an ethical challenge in an era when technology is readily available and data is widely collected.
Relationship cannot be digitized
“As a family doctor, you are too busy with social and psychosomatic problems,” Aldo Kramis, MD, president of the Cantonal Medical Society of Lucerne, noted in the panel discussion, saying that the only thing left to do is to reduce things to what is feasible. The question is what benefits digitization brings to family doctors as the first point of contact for patients. This is a critical point when discussing apps and Big Data. The technical standardization of the electronic patient dossier alone is politically explosive. After all, according to Spycher, the Federal Council’s decision on the EPD has finally given the go-ahead for implementation. The benefit has to be the basis, according to Stoffel, MD, co-CEO. Central Board of the FMH, will be shown.
Horx already anticipated the fanned-out conflicts in his opening presentation when he said, “The future emerges when relationships succeed.” By this, he meant both the relationships between people and the relationship between people and technology.
HAUSARZT PRAXIS 2017; 12(5): 29-31
