written by Alain Veuve MD, Switzerland
When will digital transformation finally reach medicine?
When will digital transformation finally reach medicine?
March 01, 2016 | Categories: Digital Transformation
About author Alain Veuve Alain Veuve MD, Switzerland

Healthcare in Switzerland and Germany is excellent, so it is said. Compared with other countries this is undoubtedly so. And still, if you detach yourself from existing mental structures, you will find that many things are in a state of disarray. And the user is undergoing a silent transformation into the digital age. People are better informed and scrutinize things more closely. These are harbingers of an upheaval that will completely shakeup a deadlocked industry. To our good fortune.

Wake-up call: A visit to the doctor

I must be the absolute nightmare of any doctor: I am an avowed hypochondriac, pathologically inquisitive and Internet-savvy. There’s always something. And so it came on that morning in 2013 that I once again had a diffuse discomfort in my chest that I absolutely had to have clarified – immediately and once and for all.

So I set out to deal with the issue. An hour later, I knew so much about possible causes of my discomfort that I could reliably assess the situation on my own (bear in mind that I’ve been doing this for 15 years). I could have saved myself the effort of going to a general practitioner, but, as a hypochondriac, this is not an option. Once 8 o’clock came around, I made a “today-at-all-costs” appointment.

Later, when consulting my physician, I described my discomforts. What followed was a hostile dialog as sometimes can take place between teacher and a notoriously corrective overachiever. I was difficult. The consultation was difficult.

Not the fact that the physician wasn’t able to visualize the entire bandwidth of possible causes within five minutes, but that he left the impression that he knew everything – when it was painfully obvious that he didn’t.

And later, when he took a book from the shelf that was published in 1984, I literally broke out into a cold sweat. If he incorporated such old knowledge, then I was in serious danger. In danger of not having the wisdom of the last 30 years being included in my treatment. That something important would be overlooked and I, as a result, would expire.

At exactly that moment I informed the doctor, kindly but with determination, that I had lost my trust in him – and left. I think he was actually quite relieved to see me go.

Generally, I think that the entire healthcare industry has a fundamental issue with data. It simply doesn’t have any.

The experience sensitized me and I’ve paid particular attention to the issue during the past years. The good news: There are plenty of doctors who are trying to stay up-to-date on a broad front.

Compared to the standards in the IT industry, a patient file is no more than a Post-it note

All this manual note-taking and sending medical records round and round is sheer horror. I’ve experienced it countless times that important information was lost between doctors and how it had to be painstakingly restored and exchanged, usually by phone.

Capture everything possible

I know there are initiatives underway to modernize the handling of medical data. The problem is that this has been going on for ages.

What we need is a global, open standard for capturing and maintaining medical data!

But, we are continuously losing opportunities that would enable better treatment and help us to find correlations and thus fundamentally improve medicine every day.

In large areas healthcare knows astonishingly little about the human body

If you have a broken leg or need a new knee joint, then medicine knows pretty much what to do and does a good job.

Beyond that, however, knowledge is comparatively trivial. To this day, for instance, we haven’t really begun to understand how cancer occurs and which treatment options are the best.

Instead, billions are invested in the trial-and-error development of generalized medications that have a comparatively low level of efficacy, especially in oncology.

What is especially perfidious here is that many doctors, many of them highly decorated, are permanently acting as if they have these illnesses under control. When a family member was stricken with terminal cancer a few years ago, it took seven doctors until someone finally stood up and was able to inform us that there wasn’t any real knowledge with which they could hope to control the situation – and that that was simply that.

Though there were medical studies and treatments of choice – none of them had any relevant prospects at being successful. And though this was indeed terrible news, it was the right approach for all concerned. Not only did all treatments fail to make a difference, they were also extremely expensive.

This happens every day. Every day we pay for treatments that offer very few prospects for success, place an additional burden on patients and keep an entire apparatus of doctors and care staff at work. And this simply because this area is over-regulated and undergoes very few fundamental changes.

We are all footing the bill

For some families, health insurance costs more than pure living costs. One reason for this is, of course, that mortgage interest rates have shrunk considerably. And yet it’s striking – our family of five is paying 30 percent more on health insurance than on interest and amortization on our house.

Medicine must become data-driven – medicine must be digitalized

It’s a disgrace that we don’t collect all medical data systematically and begin to use the information extensively for treatments and the development of medications.

It’s a disgrace that, though I can have my genetic material analyzed, I’m not allowed to receive the data in a statistically evaluated context in Switzerland and Germany (and in several other countries). So that I could see, statistically speaking, which illnesses I am more or less vulnerable for. So, even where a rudimentary data set exists, there are lawmakers that prevent its use.

It simply has to stop that countless hours of tinkering and medical trials are wasted developing drugs that are then introduced into the market as generic medications. What must take the place of this approach is a highly personalized brand of medicine. And the plain fact is that this is only possible with a good set of data. It is thus also obvious that a new business model must be found for all providers of medical care. And this is exactly the reason why the big players aren’t doing more. They’re scared to lose more than they could win.

Data protection concerns are for the healthy!

Whenever I speak with people about these things, someone is bound to say something about “data protection concerns”. “What if thus and such finds out that I once had a stroke?” “I don’t want anyone to know that I’m HIV-positive.”

I understand these fears. But that is exactly what they are – fears. Those who are really interested and also have a very real impact are the insurers. And, lo and behold, one is already obligated to bare all to them. And woe to those who fail to disclose anything that might have medical relevance. In that case one can very quickly lose one’s daily allowance privileges, for instance.

Individualized insurances

The subject of individualized health insurance is an especially interesting and important topic. Here, the costs-by-cause principle (anchored like almost nothing else in other areas in our society) and the solidarity principle stand in direct opposition.

We just can’t apply the costs-by-cause principle, because we don’t have access to the data. Even though individualized insurances would be a good thing here to help lower healthcare costs. This doesn’t mean that we must sacrifice solidarity for this.

Costs must be reduced

Costs must me fundamentally lowered, for such an inefficient healthcare system is no longer financially viable (just think about demographic trends). Not only can’t we finance it, we shouldn’t finance it, either.

After all, we’re talking about efficiency, automated processes and rationalization everywhere and this has in actuality reached healthcare too. But, it seems to me that unfortunately we are looking at the wrong places to start. Caregivers, for example, who are essential as we are talking about people and social contacts.

The medical revolution

We are ready for a medical revolution and the signs are encouraging, especially regarding cancer. It doesn’t come as a surprise that Silicon Valley corporations, once more, are at the vanguard here, not the pharmaceutical companies.

In my opinion, Google has done most of groundbreaking work in this area during the past few years. Just a few days ago Google (via Google Ventures) invested an almost-laughable (from a pharmaceutical perspective) amount of US $ 130 million in Flatiron Health.

An executive at Google Ventures made the following comments to Techcrunch about the deal:

Alain Veuve
Cancer will likely touch all of us at some point in our lifetimes, either as a patient or as the family or friend of a patient. Flatiron has pioneered a way to learn much more about cancer, so that we can improve the way we care for patients and treat the disease. It’s rare to find a team of the caliber assembled by Flatiron Health that combines pragmatic insights from the healthcare industry with the deep technical insight of the IT industry. They are working on one of the biggest problems in healthcare, and their progress has been nothing short of stunning to date.
Alain Veuve
Managing Director
AOE Switzerland

And now, just imagine that instead of a couple of hundred million Euros countless billions would be invested by pharmaceutical companies in fundamentally new paradigms in medicine. Just imagine that.

I can only hope that we will see the same fundamental improvements in this area as we’ve already observed in other sectors. Before it gets me or my loved ones – or you and your loved ones.