HealthTrends Conference Report: Women in Digital Health

During the Women in Digital Health Event last Thursday, February 6th, 2020, Prof. Dr. Emanuela Keller provided some insights into the use of Artificial Intelligence (AI) algorithms in the neuro ICU of the University Hospital Zurich. 

The Health-Trends team was on-site and summarized the most important impressions from this exciting presentation in a short report. Enjoy reading it.

A world-leading ICU department struggles with typical problems in the healthcare sector

The ICU department (Intensive Care Unit) of the University Hospital Zurich is a worldwide leading institution of its kind and can be compared to other similar departments in major leading hospitals around the world. Although the infrastructure of the ICU department is top-notch, Prof. Dr. Emanuela Keller made clear in her presentation that the ICU of the University Hospital Zurich is also struggling with some problems typical of today’s healthcare system:

  • Multimorbidity of patients: Patients over 50 years of age suffer on average from two or more diseases. This multimorbidity increases the complexity of treatment in the ICU. It poses a particular challenge for physicians, as they often treat many patients (usually more than 10 per physician) and must set priorities accordingly. Keller compared this situation with a „House of Cards“: If a patient is treated incorrectly at a given time, massive complications immediately arise and there is too little treatment time left for the other patients. The house of cards collapses as a result.
  • Complex patient situations: ICU patients are continuously monitored with many different technical devices due to their critical health conditions. These devices cause an average of up to 700 real-time alarms per day and per patient. However, many of these are false alarms triggered by, for example, movements of the patient, changed medication, etc. The above-mentioned multimorbidity and the individual health characteristics of the patient create complex patient situations, some of which require very individual treatment.
  • Flood of medical data: In 2019, a total of 419 patients were treated in the ICU department of the University Hospital Zurich. Each of these ICU patients generates up to 40 GB of data from medical devices, biomedical sensors, etc. in and on the patient’s body in one day. These data must be continuously evaluated and interpreted in order to continue the treatment of the patient. The flood of medical data, combined with the already mentioned complex patient situations, leads to a massive challenge for the medical staff. Especially in an emergency situation, it is not possible to quickly integrate this flood of information into the decision-making process
  • Poorly connected technical infrastructure: Not surprisingly, Keller also pointed out the poorly connected technical infrastructure and the lagging e-health discussion (especially the poor usability of electronic patient file systems). The above-mentioned technical equipment from different providers is unable to communicate with each other, or only to a limited extent. In addition, these devices generate data outputs that are not standardized. In combination with the enormous amount of data that every ICU patient produces daily, this leads to an almost unsolvable task for ICU staff.
  • Academic information overload: Last but not least, Keller also pointed out that the publication of academic research results on the subject of precision medicine (as in other medical research fields) has increased exponentially in recent years. At the same time, the half-life of medical knowledge is constantly being reduced. This leads to a flood of information that can no longer be handled by today’s medical personnel.

As a summary of these challenges, there is a strong need for a data-based intelligent dashboard that consolidates and interprets the data in one place in an understandable way. In particular, it should be possible to take decisions quickly on the basis of current treatment situations (e.g. alarms due to a changing patient situation). Therefore, the ICU has created an „ICU Cockpit“ with the help of Supercomputing Systems.

ICU Cockpit – Great Ambitions for Precision Medicine at Zurich University Hospital

The ICU-Cockpit is a joint IT research project of the University of Zurich, ETH Zurich, IBM Research and Supercomputing Systems with the goal of creating an integrated platform for patient monitoring and therapy support. Data from numerous medical devices are synchronized and algorithms for early warning systems and therapy support are developed, with the initial focus on multimodal neuromonitoring and the prevention of secondary brain injuries. 

The aim of the project is to initiate a fundamental development in emergency and intensive care medicine and to achieve a significant improvement in the way diagnostics, treatment and risk management are handled in everyday clinical practice. Data from all patients will be collected at all times and continuously analyzed. In particular, the treatment should be continuously adapted on the basis of these data and predictions about the possible state of health and course of treatment should be made. Keller emphasized that the „ICU Cockpit“ does not aim to replace ICU physicians but to provide them with the right tools to make the right decisions in complex patient situations in a timely manner. 

Since each patient situation is unique and can only be compared with other patients to a very limited extent, a separate AI algorithm is trained for each patient. This personal algorithm evaluates the data and interprets it with regard to the current and future course of treatment. Keller even pointed out that the algorithms cannot be transferred to other patients. Such individual algorithms are particularly helpful in coping with the approximately 700 alarms per day and patient. In a first step, the alarms are classified (e.g. has there been a recent change in medication, has the patient moved specifically, etc.). If an alarm is identified as a real one, further analyses of the expected change in health status are carried out on the basis of this. For this purpose, logical analyses based on the various parameters (e.g. blood pressure, pulse, etc.) are executed and accordingly transferred to a color-supported correlation matrix. These colorings help the medical staff in making treatment decisions.

Prof. Dr. Emanuela Keller has pointed out that the ICU cockpit is a closed circle consisting of data collection, development of algorithms, validation, monitoring and adaptation of the treatment to the patient. Partners such as the University of Zurich, ETH, Supercomputing Systems or IBM have helped with the setup of the infrastructure or the development of algorithms. However, the confidentiality and security of patient data is a very high priority, which is why such a closed cycle was chosen. At the same time, Keller pointed out that in Switzerland, compared to other countries, there are fewer restrictions in terms of data law and that this is a great opportunity to further advance data-based research for ICU patient treatment.

Our conclusion of the evening

The lecture by Prof. Dr. Emanuela Keller took place in the context of a Women in Digital Health event at the headquarters of Supercomputing Systems in Zurich’s Technopark. It was a presentation in front of a small group of listeners, whereby the 20 or so attendees were seated comfortably at a large conference table. In our opinion, this fact contributed significantly to a good and open discussion at the end of the lecture and, together with Prof. Dr. Emanuela Keller, some details of this exciting topic could be highlighted once again. 

From our point of view, the subjects of the lecture were also very exciting, as it described the topics of artificial intelligence and precision medicine in a very practice-oriented way and showed the possibilities of this technology that exist today in practical manner. Keller was able to give a very vivid overall picture of the challenges within the ICU of the University Hospital of Zurich and the associated possibilities of new technologies in healthcare. All in all, it was therefore a very successful and exciting evening. Many thanks at this point to the initiators of Women in Digital Health for the organization of this event.

About Women in Digital Health

Women in Digital Health is an initiative founded by Aisha Schnellmann, Daniela Gunz, Gabriela Hofmann and Sunjoy Mathieu, which is intended to provide a platform for exchange, especially for women with a connection to digital health. Regular events on various topics take place. The four initiators emphasize that men are also cordially invited at any time. The next event will take place on 4 March 2020 in the Zurich area (ETH Rocket Hub), where the ceremony for the founding of the association „Women in Digital Health“ will also be held. You can find more information on this at https://womendigitalhealth.net/

Some impressions of the evening:


Guest Post contributed by Matthias Mettler, Health Trends

Matthias Mettler is a business economist and consultant. He is an expert on the Swiss digital health and innovation scene. The passionate networker has been active in management consulting for several years and currently works for Synpulse Management Consulting. The focus of his consulting work is on digital business building and new customer-oriented business models in healthcare. Before consulting, Matthias worked in various business development positions and was active in the startup scene for some time.

Digital hospitals help doctors provide better patient care. Here’s why.

Digital transformation is set to revolutionize how hospitals deliver care. But is digital technology being harnessed equally effectively across all aspects of the healthcare system? “Not quite,” pointed out Pamina Göttelmann, Business Development Manager of imito AG. “Digital technology is well-adopted in areas such as diagnostics and treatment. But if you look at systems for documentation management and communications, technology can still play a bigger role in improving how these processes work.”

In hospitals today, for every hour a physician spends with a patient, they spend an estimated two hours updating the patient’s electronic health record. Unsurprisingly, a recent survey by Merritt Hawkins found that more than 78% of physicians experience periodic feelings of professional burnout due to factors such as loss of clinical autonomy, diminished time with patients, and the administrative burdens of updating electronic health records. “The workload and documentation load of nurses and doctors have increased. Today, everything needs to be documented, and this can be incredibly time-consuming. This is where new technologies can help,” she elaborated.

We rely on medical professionals to provide excellent medical care especially in their direct interactions with patients. So, when hospitals utilize digital technology to improve their legacy documentation management and communication systems, doctors and nurses will be able to focus on what matters most – the patient.

Smartphone technology makes better doctors 

We recently spoke with Pamina, who shared with us about how her team is harnessing smartphone technology to streamline clinical processes in hospitals in Switzerland. The imito mobile app integrates seamlessly into the various systems used in hospitals (e.g. user identification, electronic medical records, archival of images), equipping medical professionals with a user-friendly tool to document photos or videos and communicate directly at a patient’s bedside, scan and save important documents, and digitally measure wounds, everything directly saved in electronic medical records, only while using a smartphone.

“Smartphone technology is not a new technology, but it is relatively under-utilized in the healthcare sector, especially in hospitals,” she explained. At least officially. According to survey results, more than 50% of doctors who work in hospitals use their smartphones for clinical documentation. These are exchanged via Messenger apps such as Whatsapp to gather feedback from more experienced colleagues. Under these conditions, data security is a concern.

When implemented effectively, however, app technology can help keep electronic health records accurate and facilitate the transfer of patient medical data between different healthcare institutions.

The cost of going digital 

The benefits of digitally transforming processes in hospitals are well-documented. In fact, healthcare professionals Pamina’s team spoke to want these systems improved. But convincing decision-makers in hospital management to invest can be a challenge. “If the IT department in the hospital is strong and innovative, they are more likely to get pilots funded. Otherwise budget can be a real issue,” shared Pamina.

This is because overhauling legacy documentation management and communication systems, while necessary, can be costly. As a significant example, The Lucerne Cantonal Hospital purchased a new clinical informational system from the American software manufacturer, Epic, for 65.4 million francs (excluding MWST) in 2016. This cost includes the investment and operational costs for 8 years. A centralized IT solution for all medical, patient-related, and administrative data, implementing it requires the hospital to significantly rethink how its systems operate, how its medical professionals work, and the care that its patients receive.

Though hospitals that opt for digital health products that integrate with their current systems instead of a complete overhaul will find it lighter on their wallets, budgets for such changes still remain tight. This is where having the support of healthcare professionals can make a huge difference. “You have to be very patient. But if your product’s core functionalities are based on solving real pain points that doctors and nurses feel every day, it will eventually succeed. If you show healthcare professionals the potential benefits, their support could mean convincing hospital management to implement your solution,” explained Pamina.

Transforming patient care by supporting digital hospitals in improving its processes, therefore, is a marathon, not a sprint.

What’s next

The future of the digital hospital looks promising. Many new technologies continue to emerge to bridge the gap between patient care and process. New models of digital hospitals continue to develop, such as the “cognitive hospital”, a next-generation hospital that is a “smart” facility itself and a strategic partner in patient care.

However, much of this future depends on how the healthcare industry solves this major challenge: Ensuring medical data security while enabling interoperability between systems. “The digital hospital is data-driven. Sharing medical data across healthcare institutions, however, is so difficult because it remains in isolated information silos. This is one of the reasons why progress continues to be slow,” concluded Pamina.

About Pamina Göttelmann

Pamina_G

After completing her master thesis “Setting Investment Priorities for Mobile Solutions in Hospitals”, Pamina deepened her acquired knowledge with valuable field experience in mHealth. As a project manager at the University Hospital of Zurich, she initiated the introduction of mobile clinical app solutions in the hospital and was responsible for the development of its corporate mobile strategy. She has co-authored and shared some of her field experience in two publications. Pamina joined imito in November 2018 as the Business Development Manager.


About the author

Aisha Schnellmann is a Singaporean sociologist by training, interested in healthcare, education, and sustainability issues. She is passionate about producing content that promotes meaningful dialogue, focusing on print and digital content that resonates with a strong call-to-action. Based in Zurich, her interest in digital healthcare grew from the conversations she had with committed medical staff in rural hospitals in Asia, who remain hard-pressed with the technology available to them.