The health care sector is facing a far-reaching and unpredictable revolution. Smartphones are capable of replacing many devices that have become standard in medical practices and some apps will soon be able to provide diagnoses as well. Patients are becoming less reliant on doctors.
By Martin U. Müller, Der Spiegel July 20, 2017
|The airplane had just taken off when one of the passengers lost consciousness. Eric Topol pulled his smartphone out of his pocket and immediately performed an electrocardiogram (EKG) on the passenger. He used the device to do an ultrasound scan of the man’s heart and measured oxygen levels in his blood. He was then able to give the all-clear and the plane could continue its journey. The man had lost consciousness merely due to a temporarily slowed heart rhythm.
Topol is a cardiologist in La Jolla, California, and it wasn’t the first time he had encountered such a situation while flying. On one occasion, he used his mobile phone to determine that a passenger had suffered a heart attack and the plane had to land immediately. Of particular interest to Topol, though, is the fact that anyone can perform such an EKG, whether a professor of medicine, a flight attendant or just a simple passenger. All one needs is a $200 sensor and a smartphone with an app that can analyze the heart’s rhythm.
Hardly any other object has changed the world to the degree that smartphones have. It has become completely normal to use our mobile devices for shopping and managing our schedules. Political revolutions have been organized by smartphone and you can use one to find a life partner or to plan a funeral. Every single day, 10 times as many smartphones are sold around the world as babies born. And now, smartphones are conquering medical care.
For millennia, sick people have been dependent on help from others, a healer or a doctor. But now, mobile devices are beginning to change that age-old state of affairs. Coupled with the power of artificial intelligence, the mobile phone promises to fundamentally change medical care. Many medical examinations that were thus far only possible in a doctor’s office can now be undertaken at any time by anyone – even while sitting at home in your easy chair.
With the help of small and affordable accessories, smartphones can measure electrical activity in the brain, intraocular pressure and blood pressure. They can perform an EKG, recognize atrial fibrillation (a type of abnormal heart rhythm), check pulmonary function, record heart murmurs, take photos of your inner ear, perform breathalyzers, perform aorta scans and even sequence DNA.
Soon, there will be little difference from a technical standpoint between a general practitioner’s office and a fully equipped smartphone. On the contrary: It is already the case that patients are sometimes better served by a mobile phone.
|Doctors Have Competition|
|Apps like M-sense are revolutionizing migraine diagnostics. At the University of Magdeburg in Germany, a mobile phone program called Neotiv is being developed to reliably diagnose Alzheimer’s. There are even scanners reminiscent of the “Star Trek” Tricorder: You simply hold it up to a patient’s forehead and receive diagnostic information within seconds. An Israeli company has developed SCiO, the first smartphone app for mass spectrometry. If you briefly hold it up to an apple, for example, its exact composition will appear on your display. The app also works on pills: Using the app, the device scans an object’s structure, compares it with a database and then tells you what it is – a paracetamol tablet, for example. Even today, such a test is far from standard, even in hospital emergency rooms.
It is far from clear what all of these changes will mean for the health care industry – for patients and doctors and for the manufacturers of large medical devices that may soon no longer be necessary. One thing, though, is certain: Doctors have competition, and that competition is stimulating the industry. Within just a few years, patients won’t just be able to decide which doctor to go to, but will also be able to choose between local doctors, online diagnoses and intelligent scanning devices – and they will perhaps even be able to undergo an examination in their own cars.
The patient is becoming more powerful – and doctors are becoming less essential.
|One of the leaders of the scene in Berlin is Markus Müschenich. Ever since he decided to devote his life to digital medicine, the 56-year-old’s life has been unrelenting: here, an appointment with German Health Minister Hermann Gröhe, there a video conference with a promising startup. Müschenich is pretty much constantly speaking into the headset of his telephone, and when he’s not, he is giving presentations to doctors, insurance company officials and politicians. A former pediatrician, he always wanted to do more than just treat patients. “I still don’t regret having set aside my lab coat,” he says.
Müschenich was part of the management team at a hospital in Berlin before becoming a member of the board of directors at Sana, a chain of hospitals and clinics in Germany. But he didn’t find his true calling either in pediatrics or in analyzing the economic data of heart centers. He moved on to found a company that developed an app to help cure cross-eyed children – and then convinced the health insurance company Barmer to refund the price of the app to its customers. The result was the first-ever prescription app.
Today, he owns the company Flying Health, an incubator for medical industry startups that shares both its money and know-how. His portfolio includes Patientus, a Lübeck-based company that offers doctor consultations by video link, and he offers consulting to the diabetes startup mySugr, which was just recently sold to the Swiss pharma-giant Roche. He is also involved in a company developing software for pregnant women called Onelife and is trying to increase the value of Neotiv, the company that is developing an app to identify Alzheimer’s.
Müschenich and his 10 employees work out of a co-working space in Berlin that is shared by other startups. And he has adopted the scene’s typically effusive optimism. “Every day, I see young people here who demonstrate that they are better than we are. That’s inspiring.”
Currently, the health care system consists of the in-patient and out-patient sectors, but economists in the industry are convinced that the digital sector will soon join them. Germany currently spends a total of 350 billion euros ($403 billion) per year on health care, and the high-tech segment will certainly siphon some of that money off from the traditional sectors like hospital and practice care. Müschenich expects the digital medical care sector in Germany to be worth 100 billion euros by 2025. “From an organizational standpoint, the digital sector will come before the two other sectors,” Müschenich says. In the future, he explains, doctors will become dependent on getting references from digital systems.
Experts at the Gottlieb Duttweiler Institute (GDI), a future-oriented think tank in Switzerland, likewise believe that smartphones will become the “core interface” of the health care system. “Cost pressures will push the system towards digital,” says Karin Frick, head of research at GDI. “It seems logical for patients to undergo an initial examination using smartphone systems. Companies that understand that first will be the winners.”
|Not far from the airport in Hamburg, on Röntgen Street – named after the German physicist who discovered the electromagnetic radiation used in X-rays – the German headquarters of Philips can be found. Today, the Dutch multinational is no longer the same company it was for the almost 100 years prior to 2014 and the change can even be seen in the architecture. Floors here have been given the names of different Hamburg neighborhoods and meetings are held in “boxes.” The CEO has a desk in an open-plan office space and next to the restrooms, there are mounted pods for employees’ mobile phones.
Televisions that bear the Philips name no longer have anything directly to do with the company – the brand has been licensed out. The light bulb division has likewise been sold off. The only thing left is medical equipment. “Wherever I go, I have to explain that the Philips of today is purely a medical technology company,” says Peter Vullinghs, Philips head in Germany and manager of 4,800 employees. He does, though, see parallels with the television business, which he once ran. “They went from being high-end products to simple consumer goods. The same thing is now happening with medical technology,” he says. A slew of new competitors has joined the market, including Vullinghs says, Google, Apple, Samsung and IBM.
|Dr. Automobile and Expendable Doctors|
|Philips is a leader in the electric toothbrush sector. Some models have sensors that track tooth-brushing behavior and can display the information with the help of a smartphone app. While the company still sells large pieces of equipment for clinics and hospitals, an increasing number of apps for private consumers are also being developed. The company makes a fall detection sensor for the infirm which can determine how serious the fall was and whether emergency help is necessary. The Philips Vital Signs Camera software can determine from a simple mobile phone picture a patient’s heart and breathing frequency and can even perform and EKG – with astonishing accuracy.
Business models are also changing. Whereas standard practice has long been that clinics and hospitals periodically buy large pieces of equipment worth several thousand, or even millions, of euros, use fees for such machinery could be the future. Philips’ portable ultrasound machine Lumify, for example, which is linked to a smartphone to produce high-resolution images, includes a monthly software subscription fee. Philips sees midwives as a promising market for the device. They could perform a scan on site and then send the results to a gynecologist. Further in the future, it seems likely that software could be developed to take over the analysis of the ultrasound scans entirely.
Siemens Healthineers, the medical technology division of the German technology giant Siemens, is taking a somewhat more conservative approach. “Our customers are not the patients, but continue to be hospitals and medical practices,” says Arthur Kaindl, head of Digital Health Services. Every hour, some 200,000 patients are examined with the help of Siemens equipment worldwide.
Taken together, the resulting database could soon become more valuable than the machines themselves. Data, after all, is priceless. “It looks like we will ultimately be producing software that helps doctors make a diagnosis,” Kaindl says. Such support could ultimately evolve into technology taking over some of the tasks traditionally performed by doctors, but medical equipment manufacturers, if they are willing to say such a thing at all, only do so if they are guaranteed anonymity. They are wary of unnecessarily angering their clients, including clinics, first-aid responders and medical specialists.
|Competition from Unexpected Places|
|Artificial respiration equipment specialist Dräger, based in Lübeck, believes the development is coming slowly but surely. Even today, doctors are increasingly relying on software support for such complicated procedures as weaning patients off of artificial respiration. It has also become common for doctors to transfer monitoring data to their mobile phones. The U.S.-based company Johnson & Johnson has even developed a machine together with Sedasys that can take care of short-term anesthesia more or less on its own – for a 10th of the price commanded by an anesthesiologist. But the manufacturer has since stopped selling the product due to low sales figures.
Digital products experience more rapid success when patients benefit directly. Medtronic, for example, has introduced a system for diabetics in Germany. By way of a sensor planted under the skin, blood sugar levels are measured constantly and shown on the patient’s smartphone. A pump injects the exact amount of insulin necessary. But even if such systems help patients, that doesn’t mean that all doctors accept them. “Unfortunately, we have found that there are still practices that aren’t connected to the Internet,” says Michael Struck, head of the diabetes division at Medtronic. Another problem is that doctors receive no financial benefit for introducing patients to the smartphone system.
Time, though, is of the essence. The new technological possibilities currently opening up have meant that companies are entering the medical market that few expected – like automobile manufacturer Audi. For years, the company has been developing a kind of mobile health center. Convinced that self-driving cars will provide drivers with a sudden block of free time, Audi engineers have been experimenting with in-vehicle wellness treatments. Breathing exercises are recommended on the basis of so-called biofeedback and EKG analyses while a vibration massage system is also being developed.
But the company has much more ambitious goals as well. “The car is perfect for medical examinations,” says Christiane Stark, who heads the project Audi calls Fit Driver. Automobile interiors offer a private and protected space and already, they are full of countless sensors. “A basic examination of the driver would be no problem in the near future,” Stark says. From there, it would be simple to establish a secure connection to a remote doctor. If an in-person consultation were necessary, the car’s navigation system could send the vehicle to the nearest applicable facility.
Whereas Tesla crashes receive a fair amount of attention, particularly when drivers rely on the onboard autopilot, other incidents go almost unnoticed – such as one from last July. A man driving his Tesla on a highway in the U.S. suffered a pulmonary embolism, but was able to enter the address of the next hospital into his navigation system. The car drove him there automatically even as he suffered in the driver’s seat. The man survived, likely thanks to his Tesla. Which raises the question: Will cars of the future be able to detect life-threatening conditions automatically? “It is certainly possible,” says Audi expert Stark. And medical professional Müschenich is willing to go even further: “Patients will arrive at the doctor with a complete diagnosis. They can be produced by their car or by their smartphone.”
Source Der Spiegel
|A Critical Review of Consumer Wearables, Mobile Applications, and Equipment for Providing Biofeedback, Monitoring Stress, and Sleep in Physically Active Populations, Peake JM, Kerr G, Sullivan JP. Front Physiol. 2018 Jun 28;9:743. doi: 10.3389/fphys.2018.00743. eCollection 2018.|
Germany’s Race to Catch Up in the Startup World in Der Spiegel
Eric J. Topol sits down with Malcolm Gladwell on Fixing the US Healthcare Mess in Medscape
The Impact of Artificial Intelligence in Healthcare in OpenMind
Can radar replace stethoscopes? in Friedrich-Alexander-Universität FAU