Best practices are increasingly moving towards defining the OR as an interdisciplinary and interprofessional service…
The digital patient
The digitalisation has also reached the health sector – and will shake it up. The potential is huge, as is the need for change. Transparency and speed have increased significantly for all those involved, both inside and outside an organisation. In order to keep up in the digital race, a cultural change is needed: flat hierarchies with a broad acceptance of responsibility by practitioners in day-to-day operations, radical patient orientation, a just-do-it mentality and a willingness to take risks will allow for optimally networked cooperation.
An article by Stefan Märke and Daniel Walker.
Before digitalisation, successful companies were characterised above all by the fact that they “produce” reliably and efficiently. Rigid hierarchies and obedient employees guarantee success. Moore’s Law, on the other hand, states that the number of transistors and thus the performance of a processor doubles every 1-2 years. This exponential dynamic is driving the digital revolution. The decisive factor will be how quickly and comprehensively an organisation can learn and adapt to new circumstances. In such an environment, the “art behind closed doors” that is still widespread today will quickly become obsolete.
The pressure to transform is continuously increasing, as experience from other industries has shown: The Winner Takes It All. In 2016, 94.5% of all search queries in Germany were made via Google. Bing, Yahoo, T-Online etc. share the rest. This is an extreme example because the solution is entirely digital. But the underlying logic also applies to other industries. Digital solutions cost a lot to develop, but can grow quickly and at low cost. At the same time, the larger the network, the more valuable it becomes for all parties involved. As a logical consequence, small companies merge, are taken over by larger ones or are partially or completely pushed out of the market by the industry leader.
Compared to other industries, the healthcare sector is still at the beginning of its digitalisation journey. But the next 10 years will be exciting. Many technologies are currently on the doorstep of market maturity. Numerous patients and employees measure health data in their everyday lives. Artificial intelligence already detects certain types of cancer on X-ray images more reliably than a specialist. The digital patient file will replace the fax machine – hopefully by tomorrow.
However, many solutions must become even more reliable and precise in order to meet medical requirements. With the increasing integration of already existing individual solutions into an overall system, completely new possibilities are being opened up. Diagnosing X-ray images with the help of artificial intelligence within seconds, however, does not significantly improve the patient experience if the patient previously had to wait three hours for the X-ray. The quote from Bill Gates, the founder of Microsoft, applies:
The use of technology in an efficient process increases efficiency. Using technology in an inefficient process increases inefficiency.
In order to make use of the potential of digitalisation, essential parts of medical services need to be reconsidered. As we will see from Mr Zimmerli’s example, this starts long before the patient enters the hospital.
Mr Zimmerli has heart problems
On 30 June 2023, Mr Zimmerli turned 50 years old. “Half a century,” he thought, “am I getting old now?”. He felt full of energy. He had recently been promoted, which gave his confidence a new boost. And now that the children were slowly becoming independent, he had more spare time to do things with his wife again. Under these circumstances, he almost forgot that a few months ago he was diagnosed with tachyarrhythmia (a heart rhythm disorder in which the heart beats too fast and therefore not strong enough) and has to take medication. Luckily, the cardiac arrhythmia had been noticed at all.
Mr Zimmerli had never given much thought to his health. In order to reduce his health insurance fee, however, he had agreed to have numerous health-related data from his everyday life fed directly into his electronic health record: the heart rate monitor integrated into his wristwatch, the stress detection of his computer at work or his weight and the body temperature measured by his car every time he drives. Thanks to blockchain technology, the data is protected from misuse. Should there be any abnormality, he would be notified at an early stage. With early detection, the chances of treatment and recovery would be significantly better.
On a Sunday last April it happened: Mr and Mrs Zimmerli had taken advantage of the first spring-like Sunday and were just returning from an extended bike trip when his smartwatch vibrated. A message appeared on the small screen indicating a potential health problem. Mr Zimmerli swallowed empty and tried not to act surprised.
While his wife was showering, he read on his tablet: Compared to his performance data last season and compared to other men his age with a comparable lifestyle, it was noticed during today’s bike tour that his performance had decreased more than average. This could be an indication of heart problems. That’s why the system suggested he get a check-up. Since it was a data-indexed preventive examination, the health insurance covered all the costs..
His health condition worsens
Four years later. Mr Zimmerli is sitting in the self-driving car on his way home from the office, looking through the documents for the next morning’s meeting, when the system reports in again. Unfortunately, the data from the various monitoring devices would indicate a worsening of his heart problem. This is not an emergency and the situation can currently still be compensated for by an appropriately higher dosage of medication. Since the pills Mr Zimmerli has to swallow communicate with the monitoring system, the dosage had already been increased automatically during the last few days.
At the same time, the health insurance app recommends that he make an appointment at the hospital for a thorough examination and treatment. Mr Zimmerli is informed that he should expect an inpatient stay of 24 hours. He has the hospitals that achieve the best treatment results in connection with cardiac arrhythmias projected onto his windscreen by voice command. He sorts the top results by distance from his home and points his index finger at “Make an appointment”.
Immediately afterwards, he is shown possible treatment slots. Mr Zimmerli decides on the slot for next Monday. He is supposed to check in at the hospital at 9 am. In order for the treatment to be prepared in the best possible way, he already releases his somatic health data and his medical history to the treatment team assigned to him. A few moments later, the hospital’s AI system has analysed his data and reports that the probability of success for the planned treatment is over 75 per cent due to the early detection of the problem.
Mr Zimmerli needs inpatient treatment
On his way to the hospital, Mr Zimmerli studies his provisional treatment plan on his smartphone. He is first to be thoroughly examined again. If the physical examination confirms the data-based diagnosis, intravenous medication is to be administered in an attempt to bring the heart beat into the right rhythm. Otherwise, the doctors would have to try to normalise his heartbeat with electric shocks (administered under short anaesthesia).
Sometimes, Mr Zimmerli learns, the rhythm falls back into the old pattern or even gets worse within the first few hours after treatment. That is why he has to stay in hospital until the next morning, so that he can be treated immediately in case of an emergency. Numerous links lead him to detailed medical information, videos and testimonials from other patients. Mr Zimmerli feels a little uneasy.
On arrival at the hospital, his smartphone displays a welcome message on the screen. With an iris scan, Mr Zimmerli verifies his identity and confirms his presence. The device replies on behalf of the hospital: “We wish you a good recovery. Please follow the directions.” Mr Zimmerli walks in amazement in the direction indicated. The light-flooded entrance hall reminds him more of the hotels from his business trips than of a hospital. His way leads him over an elevator to the fifth floor and then to room 5.24 – a special room in the intensive care unit.
Here, a nurse welcomes him and places a smartwatch on his wrist. With it, he can be located and identified at any time. She informs Mr Zimmerli that the scheduled heart ultrasound examination will be delayed by 38 minutes. He also always sees such information on the large screen opposite the bed; his treatment plan with all current appointments, the expected time of discharge and the names of the specialists responsible for him are also listed there.
He is allowed to move around the hospital grounds without restriction before treatment and discover the various entertainment options, says the nurse. A little movement and variety helps him to get better. For the examination appointment, he should be back in his room on time. If he has any further questions, he can contact Alexa at any time. The charming Amazon Echo digital assistant is installed in every room and is very familiar with the hospital environment.
Mr Zimmerli locks his valuables in his personal mobile safe and takes a tour of the ward. He follows the smell of fresh coffee and discovers an inviting lounge area with a couch, small tables and stools. Various drinks and snacks are available for free service. Signs inform Mr Zimmerli that he will have to do without these temptations as he has to be sober for the planned treatment. He grabs one of the e-readers lying around and sits down in a couch. For a brief moment he pauses and looks out the window. “This no longer has anything to do with the hospital where I visited my sick grandmother back then,” Mr Zimmerli recalls.
The vibration of his bracelet reminds him why he is here. The doctor is on her way to see him and he should go back to his room for the examination. On the way there, he observes a medical device autonomously coming out of a lift. It seems to have the same destination as he does. A few minutes after Mr Zimmerli, the doctor also arrives. It turns out that the device Mr Zimmerli observed is actually the heart ultrasound device needed for the examination. It drove itself from its last examination to room 5.24.
The ultrasound examination is a quick procedure and confirms the data-based suspected diagnosis. According to the doctor, this is actually always the case – but at the moment they are still obliged to carry out this additional examination for legal reasons. The doctor explains to her patient the risks of the treatment planned for 11.30 a.m. with possible electrocardioversion under general anaesthesia. This time Mr Zimmerli remains in bed. At about 11.20 a.m. there is a knock at the door. The anaesthesia team enters and begins with the preparations. Two different drugs are administered slowly and under strict monitoring via the vein – unfortunately unsuccessfully.
After a short briefing by the doctor, Mr Zimmerli’s room suddenly changes. Wall covers are folded up and various medical devices are revealed. A mask is placed over Mr Zimmerli’s face and he slowly dozes off.
Quickly back home
All hospitals have to make comprehensive measurements of outcome quality and patient satisfaction. Their compensation depends largely on the results achieved. Experience shows that patients feel less stress when a person they already know accompanies the recovery process after anaesthesia. That is why Mr Zimmerli first hears the voice of the nurse he already knows, who speaks gently to him. She has received a message from the central patient monitoring system that her patient will wake up at any moment and has therefore sat down at his bedside.
Fortunately, the treatment was successful. A few hours later, Mr Zimmerli feels able to eat something, which his nurse insists he should do. He selects a menu via his smartphone, which is delivered about 10 minutes later by a self-driving food robot to the small table by the window. ” It should be that simple at home!” Mr Zimmerli thinks to himself.
The next morning, Mr Zimmerli is allowed to sleep in. This has become the standard in modern hospitals. Continuous monitoring via a multitude of sensors and devices means that it is no longer necessary to wake the patient at 7 o’clock for a blood sample. At half past nine, as announced on his treatment plan, the doctor enters the room. She smiles and tells Mr Zimmerli that all the values look good and that he can go home. Mr Zimmerli is not surprised, after all he has regularly looked into his medical records and seen the positive values. Nevertheless, he is glad to have this confirmed by the specialist.
She informs him that he is receiving new medication. He has already received a first dose of this medication, and another package is already on its way to his home by drone. During the first few weeks, he still has an increased risk of his heart falling back into the wrong rhythm. That’s why he has been given an intelligent patch that records his heart data with a high degree of reliability and sends it to the hospital.
Mr Zimmerli recovers at home for the next few days and goes for short walks. Every now and then, his health app gives him advice on how to behave. For security, a treatment team is on standby around the clock, which would be automatically alerted in case of an emergency. On the fourth day, he reports to his doctor from the hospital for a short video consultation. She allows him to go back to work the next Monday and wishes him all the best.
Mr Zimmerli’s example shows that digital medicine will be much more than ” just” high-quality treatment. It is not about replacing doctors and nurses with robots. It is about recognising illnesses so early that they do not become a (major) problem in the first place and giving patients as much autonomy as possible. It is about being able to offer the right service at exactly the right time in the right place.
This will be possible by processing huge amounts of data, linking different players and setting smart incentives. For certain diseases, an inpatient hospital infrastructure will still be needed in 10 to 15 years. But quite a few cases that occupy hospital beds today will be treated in outpatient units or even at home. Or, in the best case, will not need treatment at all. The way medical expertise is offered and “consumed” will continue to change. The tech giants are experts in user experiences, data processing and artificial intelligence – and they are marching towards medicine at high speed thanks to their knowledge. It will be exciting to see how hospitals will meet this challenge.
How much innovation can we expect?
Some of what Mr Zimmerli experiences may sound adventurous from today’s perspective. In fact, humans tend to overestimate technological development in the long term. But in the short and medium term, we tend to underestimate the influence of technology.
Let’s look back to 2009. Many of today’s established services and companies didn’t exist yet or only recently. In 2009, Uber and WhatsApp were founded and the very first Bitcoins were mined. No one was using a selfie stick, Instagram didn’t exist yet, let alone TikTok. In terms of mobile computing, netbooks were all the rage, and the iPad didn’t hit the market until a year later. Airbnb and Spotify were celebrating their first birthdays. The energy company Exxon Mobile was the most valuable company in the world, today’s leader Apple was not even in the top 20. Many technologies that Mr Zimmerli experienced already exist today. If you look at past developments, you can certainly expect that in 5 to 10 years many of them will be part of our everyday life – also in the medical field.
Extract from Care Management, Medizin Wissenschaftliche Verlagsgesellschaft, updated version 2020.