Background article – MEDICA 2017

From chatbots to artificial intelligence, from big data to the health cloud: the digital revolution in medicine is taking place right now.

MEDICA HEALTH IT FORUM highlights the opportunities and prospects for doctors and patients.

“Izzy is your friend. She understands you and helps you to be prepared by keeping track of your menstrual cycle”: this is what you’ll find if you type “Izzyperiod” into the Facebook search box. It has already been shared over a thousand times and received over 750 comments by the end of August. If Izzy was a person, this wouldn’t be out of the ordinary: but Izzy is, in fact, a chatbot. Text-based systems like these, which anyone can have a “natural” conversation with online, are on the rise worldwide. They are tipped to have massive development potential in the healthcare system. The MEDICA HEALTH IT FORUM at the world’s leading medical trade fair, MEDICA 2017 (November 13 – 16 in Düsseldorf, Germany with over 5,000 exhibitors), offers an exciting overview and perspective on the topics and trends that are set to shape the digitalization of medicine. Artificial intelligence (AI), precision medicine, medical support via the internet which uses big data and participatory health as well as chatbots: this year this long-established forum offers a huge range of options.



“We’re developing a female chatbot, based on Facebook Messenger. She’s called Izzy”, said Dr. Hajnalka Hejja, a doctor and the founder and CEO of Smart Health UG aka MediLad. Hejja is one of the speakers at the MEDICA HEALTH IT FORUM. Her session is called “In case of discomfort, ask your chatbot: Intelligent robots and apps enter the healthcare ecosystem” (November 13, 1:20 pm). Izzy is a friendly voice for young women that want to learn more about reproductive health. She’s not for preventing pregnancies. Smart Health UG aka MediLad leaves that task to other service providers. Izzy’s primary application is predicting menstruation and ovulation. The difference between Izzy and apps is that Izzy does not require installation of an app or software and interacting with Izzy is thus completely different. This is because interaction takes place in the form of a conversation, between the user and the female chatbot (via Facebook Messenger). Only a little data needs to be entered to determine the menstrual cycle with sufficient accuracy.

So far, young women from the U.S. and Britain have been the main users of this service, according to Dr. Hajnalka Hejja. “Although Izzy is currently only available in English, there are also a few German users”, said Dr. Hejja. The chatbot service is targeted at all young women who grew up in social environments where discussing aspects of pregnancy was tough or impossible. Izzy is free to use, but services such as these also require that financing is secured.

Germany would be a good location to establish high-quality applications in the healthcare system, said Dr. Hejja. There are numerous private insurers and private service providers who would be ready to pay for these innovative forms of information and communication. “Our plan is to develop specific services with companies whose target group is female. We’re currently looking for partners in this area”, said Dr. Hejja. Izzy wants to continue its development, becoming a market place for feminine healthcare products. Communication via Facebook Messenger would just be the first distribution path, according to Smart Health UG aka MediLad. Other messenger services such as Telegram or Kik would follow. Dr. Hejja admits that using a chatbot in the healthcare system is quite unusual at this current point in time. “However, this will change because our society is changing. This also applies to Germany".

Research knowledge is brought to the patient quicker
Services like these are a component of the digitalization craze in medicine, and the empowerment of patients that goes with it, as provided by implementation of IT in precision medicine, for example. This area also paves the way to the future. The Federal Minister for Research, Professor Johanna Wanka, recently stated that the government has provided a total of 700 million Euros for research in precision medicine in this legislative term. However, she also stated that there are still hurdles to be overcome in getting research knowledge to patients quickly. This is the main focus of Professor Erwin Böttinger’s research. The former Leader of the Berlin Institute of Health (BHI) has transferred to the Hasso-Plattner Institute (HPI) and is slated as a keynote speaker at the panel discussion “The future is digital: How data and analytics will transform the healthcare market (in the next 5 years)” at the MEDICA HEALTH IT FORUM on November 13. He doesn’t rule out the notion that the BHI and the HPI might cooperate on some projects in the future. At BHI, they’re focusing on advancing the development of clinical decision-making aids for implementation in real time at the point of care. This even includes activity in education, higher education and further training.



Precision medicine from the “Data Cloud”.
Böttinger explained his path: “Now, at HPI, I can drive precision medicine forward in a very focused way, by developing new digital solutions. That’s why I took on the position of Head of the Digital Health Center at the HPI”. The aim of the work there is to develop a “health cloud”, a comprehensive, patient-controlled health data platform that can be accessed anywhere and empowers patients and supports healthcare facilities and staff in handling chronic illnesses and providing healthcare.

Patients and healthcare staff alike can thus open up completely new perspectives for themselves. The patient makes his/her data available. Data from clinical studies is readily available. An algorithm brings both data sets together and uses them to calculate whether the patient is eligible to take part in a study and which study. Patients and doctors can benefit from research and science almost immediately. The informed patient and their doctor thus make a decision together on which therapy path should be taken, where applicable. Research is brought to patients very quickly, and the roll-out of this technology ensures that it is implemented as widely as possible: “We wanted this to be applied with as wide a scope as possible”, Böttinger said. It doesn’t matter whether the healthcare entity is a regional group of care facilities, university clinics or private facilities. The main factor in making it a success is having regional partners from the various areas that want to develop solutions together. The organization of the German healthcare system poses challenges to all stakeholders here. This is because transferring data between sectors is difficult in this country, and this has not changed - and it also makes it difficult to trace a patient’s progress and history, or even to present it properly.

Encouraging experiences in the U.S.
However, the U.S. experience in this sector is encouraging. Böttinger was able to put medical research into practice at the renowned Mount Sinai Health System in New York: “We’ve got a trans-national program for implementing pharmacogenomics there”. Böttinger set up a team to deal with Clopidogrel, for example. This anticoagulant (thrombocyte aggregation inhibitor) is frequently used after coronary angioplasties, among other illnesses. In this group of patients, around a quarter are resistant to Clopidogrel. This means that these patients cannot benefit from this treatment and thus their risk of an infarction, a stroke and other illnesses remains high. This resistance is determined by genes and can be detected using genetic data.



The patient can only benefit from this technology if their genomic data are available and are used, however. The software for this was created at Mount Sinai, and it will initially mainly be used to support doctors in finding therapies. If the doctor prescribes Clopidogrel and enters this into the patient’s electronic file, then the program checks whether this patient had genetic tests done on them which are available in real time. If this analysis shows that the patient is Clopidogrel-resistant, then this information is displayed on the doctor’s screen. The software then suggests an alternative medication.

In reality, can this approach be used to a far wider extent: can it really be transferred to the many, distinct segments of the German healthcare system? In Böttinger’s opinion, the solutions that will significantly improve healthcare will be comprehensive cloud-based solutions that can cross all sectors to integrate data, with this data even being managed by the patients themselves. In comparison to the official infrastructure of telematics, this would save costs, improve the quality of care, enable care to be user-oriented and ultimately offer the patient more comfort and convenience. Böttinger added: “The health card could be a step in this direction”.

Data as a business model? Not for doctors and clinics.
Currently, electronic health cards aren’t the driving force behind developing cloud-based solutions. It’s actually powerful groups such as Amazon and Google that are driving this forward in the healthcare system. Undoubtedly, their interest in this is commercial. This could pave the way for other service providers: “I think that confidence and trust are particularly important in medical research” said Böttinger. He believes that German healthcare facilities should use data, provided that patients have actively consented to this. “However, using data as a business model hasn’t ever been considered as an option for doctors and hospitals”, underlined Böttinger. Instead, solutions which serve the interests of the public are far more important, e.g. the HPI wants to develop a comprehensive health data platform. The digitalization of medicine should automatize many services, such as documentation and issuing prescriptions, and free up medical staff for more important tasks. “Lightening the burden of our colleagues is one objective in our work”. Böttinger makes this an integral part of his projects. The drive to empower the patient does not contravene this objective, because ultimately everyone can benefit from excellent therapy and care for ill people.



Combining big data and AI saves lives
The empowerment of the patient is also one of xbirds’ objectives. The victor of the eHealth Venture Summit at last year’s MEDICA HEALTH IT FORUM has set itself a lofty goal: “By 2020, we want to have saved a million lives". This objective should be achieved by using big data and artificial intelligence (AI). The app that they have developed collects all available data from smartphones or other end devices such as wearables, fitness trackers and smart watches. These data are “combed through” for situations which occur concurrently with undesirable events, which have not actually occurred but which are statistically significant. In a nutshell: The reading and collection of vital function and movement data can be compared to parameters that are typical for the occurrence of certain incidents or symptoms and supply advice on whether the user of the app is at risk of a relapse or if their condition may get worse.

More concretely, this is already being examined in clinical trials to check that this concept is reliable for diabetics. Continuous monitoring of various data and coordinates creates an overview of the patient’s normal daily routine, and automatically finds all of the factors that have a higher probability of occurring in conjunction with hypoglycaemic events (i.e. long periods of sitting, falls). The user would then receive a notification for this, with a prompt to eat something or a warning to see a doctor immediately, for example. This, on the one hand, provides early detection of illness and on the other provides patients with a better understanding of the concomitant events that occur with their individual illness and enables them to improve their therapy and day-to-day dealings with their disease.

As the specialist audience at the MEDICA HEALTH IT FORUM has become more and more international over the last years (just as MEDICA itself), most program events at the forum, along with their presentations, speeches and discussions, are held in English. One exception is the main focus event “Telemedicine”, on November 15 (11:00 am – 5:00 pm). Under the management of the Center for Telematics and Telemedicine (ZTG) and the German Society for Telemedicine (DG Telemed), it focuses on the European Union’s strategy for digital medicine and the digital agenda of the current Estonian presidency of the Council of the European Union. Estonia is also particularly keen on innovation, in terms of its digital infrastructure and the organization of its healthcare system.

Further information about the MEDICA HEALTH IT FORUM in Hall 15 (Stand E 56) is online at: http://www.medica-tradefair.com/mhif2.

Author: Dr. Lutz Retzlaff, freelance medical journalist (Neuss, Germany)