Building trust to deliver on digital health care's promise

welcome this is great to start this uh often this morning afternoon for our Asia colleagues who are online as well welcome to this event which is the promises of and challenges of digital Healthcare we have to invite guests with us which is a pleasure I'll introduce you shortly so let's get started we have not just you here in the room we also have a lot of people online we had 600 registrations yesterday so let's see how many are actually coming through here you have I would like this to be an interactive session as well but we organize ourselves is actually through a slido which if you can go to the next slide here if you take your mobile phones out and we can actually get started with the first quick question to you and the tax request a question a poll and we look at that just shortly but before we do that I'll give you a short introduction into why are we here what are we trying to achieve here here and the introduction to my guests speakers here on the stage so Kobe I think changed the world dramatically Kobe changed the whole digitalization pause for many organizations including the healthcare sector we hope right so we'll discuss that a bit further has this transformation really happened what are the challenges that have been identified but clearly what we have also observed in the covet crisis is that the Healthcare Systems have underperformed and they came out of the covet crisis with the significant gaps right that needed to be fixed and filled and particularly also Staffing Staffing is a big one right we're all looking for healthcare managers who actually are Professionals in the Healthcare System who can help actually make that an efficient Administration system here again an opportunity for digitalization to come in to fix the problems we have and I think this is what we would like to explore here today is exactly what is what is happening out there what are the big drivers here for digitalization in the Healthcare Systems what is holding us back on fully digitalizing I'm just thinking of Switzerland who hasn't done yet the full step of integration and digitalization but what is holding us back here why are we where we are and what are the Healthcare System differences that are driving this agenda um so with that I would like to actually do a quick introduction to our two speakers and here on the left side of me is more like much mudar and molec is a cardiologist and the chief medical officer and co-founder of biophormis that's a virtual care delivery and digital Therapeutics company prior to that it was actually also a medical officer at Amazon and associate director and Healthcare transfer of the healthcare transformation Lab at the Massachusetts General Hospital to welcome here to stage and then we have Claudia Witt with us here as well she's a full professor in Medical Faculty of the University of Zurich and director of The Institute of complementary and integrative medicine also at the whole university of hospitals Zurich and she's a co-director and teacher of the Digital Society initiative here with us today on stage so welcome here as well so to get us started let's look at the poll I you have had hopefully all the chance to already vote and let's have a look at what is actually digital Healthcare and what does it mean to you digital Healthcare is such a broad topic right it and I think it's wonderful to see actually how you reacted here and how it's still reacting which is very good so why don't we get started here on that one and Claudia when you're looking at the results here what what is your interpretation of digital Healthcare how do you define that so I would like even to broaden the field being the co-director of the Digital Society initiative we're really about shaping the digital future of our society and we have to understand that digital health is only really one part of it and to explain a little bit what I mean here I would like to use three examples so think about workplace and you want to reduce stress in your employees you can initiate a digital health program there for stress reduction but you would like to increase efficiency as your motivation and reduce errors perhaps due to stress on the same at the same moment you also increase health because stress is one of the big predictors for chronic diseases another thing is we can learn a lot from ai ai is so broad artificial intelligence and thinking about Finance we have algorithms which are used to predict who should get a loan and who not but this algorithm has bias in the data because they are not trained on really all available data and they also have an issue of fairness in it I can tell you it's harder for women to get a loan than for men due to fairness and bias issues we have the same in medical algorithms where we also have bias in the data we have fairness issues if we use algorithms for resource distribution in medicine and then the other thing is how do we get these things adopted implemented do we really trust trust is a main predictor for the adoption of digital health so who of you here I only can see those in the room is using chatri PT but many of us it's a generative AI algorithm and due to using chatri PT we might change our trust which also the purpose change our trust in AI algorithms in medicine so what I want to say here these things are highly interconnected and digital health is one part of it but I also want to come to digital health because when I see here these categories we have I've done app research for over 10 years so developing apps putting them in a randomized control trials as an academic not as a company and it was an easy clearly described field it has totally changed so my news project in Germany which is an innovation form-funded project we have an app we have an algorithm we do Taylor Health with video consultations we will link to electronic patient records we even have to include data from the health entrances and we have prevention in it's complex and this complexity makes it so difficult what I mean here is we really are a large Consortium and we need the different skill set but we also have to address this complexity because if not we will just burn money and won't increase women's health as project as on limit sales at the end so for me to summarize here digital health is part of a much brighter a much broader framework of digitalization of our society and there we can't think about single areas anymore because they are all interconnected apps include Taylor house apps include AI algorithms and vice versa that would be my take home here in the beginning from this poll and Claudia as you were speaking actually the change thread and it looks like there's a block in the middle right that actually all move together yeah but yeah molik what do you think is is it as defined as daily health or how do you define digital Health well first of all thank you again for the invitation it's a really real pleasure to be here with you guys today and for those joining online so if you think about the definition of digital health I mean literal definition is really around the digitization of traditional physical brick and mortar analog Health to Virtual and digital means but really the only reason from my perspective we talk about the word digital Healthcare is because as an industry Healthcare has been very slow to adopt and transform a transition from analog to digital world if you think about other Industries as you mentioned Claudia around Finance or banking or Airlines or retail you know we don't talk about online banking it's just banking so I think one of the reasons there's still this conundrum about how do you define it and we still use the term is this again we're not there yet in terms of the question here I mean it's a little unfair right if you think about it all of these things all five things are in the spectrum of digital Health some of them are tools as I think about digital health is a tool to achieve some outcome or goal which either is Acts us to Care quality of care better Diagnostics better Therapeutics right so some or prevention so some of these are tools like telemedicine is interesting it's not surprising that Telehealth telemedicine is the most common answer here given how much it's exponentially exploded during the covet pandemic if you think about the us as example you know when I was running an innovation Lab at Mass General back in 2015 we tried to launch a tele Cardiology clinic uh and we had two cardiologists that volunteered out of probably 50 and we did maybe 50 visits the entire year it was like pulling teeth to get people to adopt telemedicine and then comes coveted and overnight people transitioned into you know close to 10 000 visits in their very first year so this goes to show you a lot of the challenges with adopting some of these tools is not the technology to your point doesn't exist it's what are all the other ways people will drive adoption the lack of production right so some of these are tools and some of them are actually applications if you think about prevention here or wearable devices really talking about the application of digital Health to certain aspects around again prevention diagnosis monitoring or Therapeutics right so in terms of digital Health again at least in the US and globally now the definition is very all-encompassing it's actually a little bit of a challenge now because everything's digital Health right if you think about everything has some software component to it so we have to get very precise when we start talking about what part of what aspect of digital Health are we referring to when we have these conversations because otherwise everything in some way of shape has software components to it nowadays and I think you mentioned that Claudia before trust is a big big one right in this adoption right I I guess that also plays a major role um and if you're now and there are lots of hands going up actually once we talked about chat jbt and I hope not everybody is using it to diagnose themselves and get their treatment options out but actually if you try it it's actually fascinating and it gets you something back which is really in a storyline it gives you exactly this is what you have and these are the conditions and these are the treatment options and these are the drugs that you should be taking and now you go to doctors they're like GPT tells me I should do this right so is this is this building trust or not how do you see that and more like maybe you're working in that field quite a bit there but it's a great question look I think of these things as um driving information access and reducing the information asymmetry right so you think about chat GPT so I took a red-eye flight last night from DC to to Zurich uh and when I landed I went to Wi-Fi and use my chat GPT app actually and I asked the question what are some of the success stories of digital health um and Chad GP gave me some really great answers and then I asked the question it was high levels I said give me some very specific examples uh and actually gave me company names and studies published in digital Health So within I don't know 60 Seconds I had prepped for the session no I'm just kidding uh but the point being that if you take somebody who hasn't spent like you or me 20 years in the field studying and evaluating it you can quickly catch up into what are the different the amount of literature out there and the speed of innovation you can quickly use these kind of tools to get up to speed the challenge with these things is the 80 20 rule right it's very easy to get 80 percent of the way there with tools like the internet chat GPT but the last 20 percent were truly requires a level of skill and expertise for that confirmatory diagnosis or the clinical action plan the intervention that part clearly you're not there yet with any of the digital tools so I think as I think about the roles of these tools it's great to drive some level of information reduce information asymmetry and get some level of skill and knowledge up we still require The Last Mile which I think is missing which I think is supposed to be that way could still require the domain experts to drive the last so Claudia what do you think are the main drivers for these adoptions uh is it a regulator um is it a fee system is it the culture around it this is access to devices I mean it could be all of that right or nothing I think as we already mentioned trust is an important part but um trust is influenced by many things and cultural aspects are strongly influence it so when we see for example the Nordic countries we can go in the direction of Sweden things are so much more transparent there you can have a look in text records of other citizens and I think the trust having your data in a database and being transparent is different there than it is here in Switzerland or for example in Germany so cultural aspects are part of it but excess is another aspect and I think we have to be very careful in our developments and I like our digitalization very much but still we will have a part of our population who won't like to participate or who can't participate and we still have to offer proper Health Care to those who don't want to be part of the digital world and the other one other has professionals and I'm one of them and at the end it's we have to learn how to integrate AI into our interprofessional teams so we are still in the learning process how we work great together as an inter-professional Team all human and now we have artificial intelligence and that's something different than just having information from the internet we have to integrate it we have to learn the communication skills here we have to learn how we trust and what we need all and I think that's one of my main messages also we all need digital skills I mean all of our citizens that we can make informed decisions together and we have to start now not in 10 years that we are prepared what is coming in the future quite quite interesting that you're also saying like look the medical doctors have to make the move as well right and um do you think if we change the healthcare reimbursement and and say like digital is a drug or is be treating as a drug and actually the doctors are giving it away as like a drug treatment scheme is that going to change then their mindset is that helping so there are examples Germany is already doing it you have the kind of diggers there I call it a digital you can prescribe it I was even involved in the evaluation of one of these diggers I think it's a really nice idea to have something which has a well evaluated level it's even a kind of fast-tracked evaluation but when you look up the registry at the moment yeah 50 around 50 gigas in and on less than 20 are permanently in the others are still running their trials so it's still not a big market and then the Physicians or psychologists who can also prescribe have to prescribe it but then imagine your patient coming and say okay can you explain how this is working on my mobile device and you even can't build the time you put into this explanation this shows a little bit that we need this complexity addressed if we have to address it we have to be trained in it we have to be able to build for it when we spend time on it and then it will be easier adopted if not patients won't get it enough yeah and with all the devices out there it doesn't make it easier right so yeah absolutely there's still people out there with their old Nokia phones right they're still running because their batteries are endless it seems um but anyway if you're looking at this now from a Healthcare System performance in the U.S we see a lot of costs right and on the performance somehow as well and particularly now also with mortality outcomes of the kovit we've seen where there's their deficiencies is digital Health helping us to fix that Gap and how quickly is it progressing in the US yeah great question I mean I think I would say look there's some as I was mentioning earlier there's some really good examples of success stories where digital Health truly has uh against in successes and I can take a few examples here right so in the spectrum of Public Health to sort of Wellness prevention to diagnosis and monitoring great examples along the whole Spectrum but just something as simple as think about the use of digital Technologies for surveillance monitoring or contact tracing during the pandemic it's a great example of leveraging technology to drive a true Public Health good whether it be epidemic surveillance or contact tracing I think people use that and I think there are some real benefits to that in at least in the US and elsewhere if you think about just one step further around access to care again this example that telemedicine adoption significantly increased from the pandemic and it's another great example where people deploy digital Health Technologies and tools to drive access to care not just for people who are sort of like you know what we call worried well but really for patients who actually couldn't get to the hospitals right whether for isolation purposes Transportation issues their hospitals obviously were understaffed at the time so these patients literally was a life and death manner they couldn't get true access to care because of telemedicine people with complex congenital issues or transplant patients they're able to access care using Technologies so I think those are some examples where there truly are successes but overall as an industry I do believe we're still significantly behind the adoption curve I think just to summarize what Claudia was saying here which is I feel like you know they're different reasons why digital Health hasn't been adopted as quickly as we would like in different geographies but ultimately comes out to me to three PS it's always people products and payments right at least from my experience so the people part is all about change management culture you talk about culture change from a patient perspective it's also a culture change from a professional provider perspective I mean it takes a lot of uh inertia for healthcare professionals to change Behavior right they are usually risk-averse they're usually skeptical of new technologies and they're obviously worried about their workflows right a lot of Technologies add more burden and time and cost initially so that the people part is really to me very critical in how you drive adoption and change the second part is product well from product there's two components of product one is the actual technology itself there are pockets in the US where connectivity and access to Wi-Fi or housing our issue still so even if you have Technologies it's not evenly distributed the access to those Technologies so their their geographies and ZIP codes in the US there is no telemedicine even because they can't participate right so I think that's still a product problem the other product is proof validation you talked about randomized control trials usually for most Healthcare professionals adopting Technologies they would want to see real strong evidence that is validated which means it's safe and then it's effective both right safe and effective a lot of times people jump to the it works without the safety part and I'll give you an example what I mean by that in a second here so that's the product the third which is really critical at least in the US I think it's probably most places in the world is payment what I mean by that is sometimes there aren't natural mechanisms to pay for this Technologies or to pay people Healthcare professionals to use the technology so as we think about the different economic models of financing models of healthcare whether it be the UK model or whether it be the US model you have to find a way to find to pay for these things for the time and the cost of the product otherwise it just won't be adopted unfortunately so I think these are sort of the common probably three p's I feel like really hold us back from a wide scale adoption but I think we're getting there and a lot of those things are being resolved as we speak what has no cost has no value I guess right so yeah yeah that's important so I would like you also to be able to participate and we continue here for another 15 minutes but in the meantime you have actually the chance to go into slido put in your questions and for those also online please use that feature go in there put your questions up and then we'll take another 20 minutes here to answer actually your questions that you have brought along uh but before we do do so let's continue here a couple of more minutes right on on our discussion is getting really interesting um so Claudia maybe on on your side um you've heard now about the US right you've been also working across a number of different countries in Israel as well where are the countries where we can learn the most from on where did they get the digitalization already or are getting the digitalization right and we can benefit and learn from them I think there's always a difference between having strategies on a political level and having it really implemented and when I say implement it it comes really sometimes to the nitty-gritty details like having your data in your health records structured in a way that it is not text data and not PDFs as it often is but have it structured that you can really transfer the data into other databases being interoperable between different databases not only in the medical system because as we have learned in the pandemic there's also other data like travel data for example or environmental data which is important to link with the house data and there are these kind of digital Health indexes and when we look into those we see that in other countries like Denmark like Sweden are pretty good in it and if it comes really to having it done in detail having this data available using this data also having it coded in a way that you can transfer it Israel is also a very good example also during the pandemic with their green card for vaccination and everything so I think there are countries where we can learn a lot from and we have to understand that we have a difficult situation in Switzerland because we have now started this digisonte project where we've really tried to harmonize it but so far a lot of our data is really scattered on Continental level and even different formats so even coding being female is in some cantons differently coded and having the semantic clear which is now something we all know and being interoperable with higher and other standards between the databases that's something we learn here a little bit later than other countries but we have to learn it yeah definitely I think we need to make some great progress here and it's good that other data providers out there have systems in place right that work and can actually show the use case I think that's quite important that we learn from other countries here um but you know when when it really comes to the healthcare delivery right as you said it quite nicely molec is kind of we need to deliver a system that is effective it's cost efficient right how do we prove that if we don't even track the data correctly right and and make it interoperable right it's a huge data play that is missing right to actually prove that we are cost effective Health effective with these tools yeah absolutely absolutely and I think look I think if we really wanted to the three piece I mentioned right if you want to validate to your point in this case the economic impact of digital Health you will need sort of this partnership between the healthcare provider system which for the most part hospitals and health systems or independent private provider groups with the health plans and insurance companies to really understand the impact both to a quality perspective and then a cost or utilization perspective to ensure that some of these tools actually driving the internet outcomes one of the challenges right now and one of the internal debates we have as a country is what is the trade-off between convenience and quality right A lot of times digital Health tools drive a lot of convenience uh it's yet unproven if it always drives higher quality an example of that is there's a paper published from some Professor Harvard about maybe five or six years ago now they look at the early use of telemedicine which is episodic transactional interaction between consumers and a healthcare provider and what was the rate of antibiotic prescription for just Chief complaint of a cough and what they found was that the rate of antibiotic prescription was significantly higher in telemedicine compared to Brick and Mortar clinics now that's a problem because we know vast majority of those cases are viral and not bacterial and it has a at least a probability of raising antibiotic resistance so not only do we want to measure the cost but what's harder is how do you measure quality and what is the definition of quality it's actually not always that easy so we'll need some real you know alignment and what are the metrics uh that are measurable quantifiable and then actually measured structure in a structured way when folks have this use of digital Health tools or digital Technologies to make sure over time that we're driving again the internet consequences I do worry a little bit about what the example you gave jokingly around self-diagnosis but a lot of those tools are available today and patience because of access to care is so difficult nobody wants to wait four hours to eight hours in the emergency room or wait three weeks for a doctor's appointment so they're just you're going Dr Google and they're asking the question not with the diagnosis is but should I go see a doctor even or can I just do a telemedicine consult but you know as we say in in data science garbage and garbage out so if the thing you searched for was it the right set of symptoms the right set of questions the answer you get may also be incorrect so how do you drive again a little more education awareness and I think this is where there's a huge opportunity for a Health Care system to drive the education to say what are the best uses of digital Technologies uh to make sure people are using it consistently in an accurate way versus people experimenting with these tools on their own without regulation we didn't talk about regulation but that's another key component here a lot of these tools are unregulated because they're not intended to be diagnostic tools or therapeutic tools but this very fine line between looking up information and is it a screening tool is it a diagnostic tool versus just an information search engine like where is that line uh so I think there's a lot again a lot of opportunity to think about again measurement tools for outcomes and validation but also ability to influence how people use these tools so it's safely used um I think it's quite interesting because what we have seen as a phenomenon is as well that people don't go to the doctor anymore they go to the emergency care right they go directly into the hospitals which is also stressed to the system as well whether it has is that something that is actually driven because of the information overflow do you see their connection there or is it the convenience right it's like oh going to the doctor now after covid I haven't seen him for a while anyway I could just go to the emergency care and get it on right away it's a good question I think it probably different based on geographies but this in the U.S it's it's multifactorial but I think the primary primary reason for overuse listen just overuse of emergency rooms and Hospital systems is either lack of appropriate insurance so they're underinsured or uninsured populations what they're what we usually say is uh emergency room is literally primary care for most of those patients unfortunately right so that leads to overcrowding of the Eds and these really long wait times I mean you guys probably think like that's insane there's four hours actually average wait time for emergency rooms in the US like six to eight hours and sometimes as much as 24 hours um if you look at hospitals like National which is like the top three hospitals in the country even uh they're so busy about a month and a half ago there were 40 to 50 patients that stayed overnight in the Ed because there was no beds in the hospital so it's that much overcrowding so the other Factor though then is like well what's the reason the other factories on the other side is Staffing shortages you mentioned that earlier yeah and I think what's interesting is that digital Health tools have a huge role to play in both of these things so one example I'll give you is one of the really recent phenomenons in the U.S is this idea of hospital at home you may have to heard the terminology uh it's been around in the rest of the world for for decades Australia Spain other countries uh but the US doing the covet pandemic there was a waiver by the government that hospitals would get paid the same amount for hospitalization as doing hospitalization in the home now the only way to do that safely is to have a set of digital tools to monitor people in the home safely transmit the data back to the hospital and do virtual interactions to make sure they're safe in the home environment the other spectrum is on Staffing is use digital tools to increase your what's called Staffing efficiency how to use digital Technologies to take the nurse to Patient ratio in hospital setting from one to two to one to four to one to eight to like one to twenty so again there's many opportunities to think about digital Technologies and driving either operational efficiency and or quality of care to drive better outcomes yeah so we also talked a bit about or haven't talked yet so much about the prevention part right which is quite important as well I think that's also where a lot of these Apple devices and fitbits and so on actually that's where they are starting as well because that's also where they get a lot of traction it's a good entry point but is it really holding through and is it is that the way of getting that you know adoption rate through these devices Chloe what what are your thoughts on that I think prevention has a lot of opportunities and when I see other things I participated over the last years and there is a prediction that prevention will play a much bigger role in the future than it is playing at the moment and that perhaps if we do it well enough that we need less treatment and we also want to save costs on associative perspective here but that's a part where the variables the apps AI can really play a role and I think they're a little bit easier adoptable I assume many of you use also any of those fitness apps or these apps where you can check which content you have in your Foods so we are very much used to it and adopted just download the next app we're often not so aware of our data lens and what is done with our data at the end but the barrier is lower here and now we are in this area when is something a medical product it's a totally different set of regulations coming up but also safety and Effectiveness play role or it's just in the fitness area where nearly no regulation a I think we will see a lot of change in this in the future and we if we really predict in the future with digital Twins and everything prevention will be important and I think we will have also to put a lot of effort into trust because especially with prevention when you monitor your behavior and all of us have some unhealthy behavior and behavior is a risk factor for disease development so do we really want to be caught if we behave not well and as a consequence our health insurance premium is going up so here's again about trust what is done with my data but we need a lot of data to do proper prevention but that's a direction which is coming yeah and yeah as you said right some of our behaviors like PMI is the most costly Healthcare risk factor of all of them all and Then followed only then I think two two parts down with smoking right so it's really BMI sitting the numbers get moving but at this point in time another five minutes we continue but then we'll take your question so please submit on slido if you can also those online will take care of these questions here as well and I guess what would be also interesting to know from you is insurance right how can we as insurers help is there do you think we can be part of the story yeah I think it's interesting example of wearables right I think I agree with Claudia that in the long term there is no doubt in my mind that these Technologies around Wellness prevention wearables for getting more engagement with your Fitness and and overall health will be critical to driving kind of Health behaviors to reduce Healthcare consumption and read the cost of healthcare I mean every country in the world suffering from this issue of non-communical diseases are rising at alarming rates cost of healthcare is going up countries are investing massive GDP on health care costs I think the long term clearly that's one of the answers the challenge is short term because what happens with a lot of these kind of tools and Technologies it takes years of maintaining good behavior to see a change in the right and at least in most countries in the U.S specifically where you don't have a National Health Care system you have patients are only aligned with a specific health insurance company health plan for on Commercial three years two to three years and even Medicare Medicare Advantage is about six to eight years but there's no plan that you're with like 15 20 to 25 years and again in health in U.S Healthcare uh when you're 30 40 50 you're with a commercial insurance company when you get to 65 you switch to Medicare so this idea of health insurance companies clearly they can play a huge role but who will take the first step to say I don't I'm not worried about this patient member being part of my health insurance they're going to go on to somebody else so do I want to invest time and resource into Behavior change when somebody else will reap the rewards of that investment 10 20 years down the line it's a fundamental that's been a massive child in the U.S is right that

that classic shifting of insurance plans every few years how do you drive investors so what they've done instead is focus on the costliest sickest patients where the ROI the return investment is within 12 months so you take cancer Alzheimer's heart disease right those are all where you can immediately see the benefit of the cost of healthcare and utilization within 12 24 months but they're not as focused on prevention so there's this interesting dialogue around who are the right entities that should really Drive adoption of Health Care is it employers is it public health infrastructure or is it that all all health insurance companies come together and say well some of us will benefit this people are shifting around everywhere as a as an industry let's all invest in this I think you're absolutely right there's some great new Health Plan designs globally but also in the US now as you were mentioning earlier that's digital first or they have reward systems that if folks you know take 10 000 steps a day or they go to the gym X number of times a month or a year that you can drive your premiums down based on healthy behaviors so there's great science and behavioral economic science around this about you know nudges and a positive rewards and negative rewards and how do you drive Behavior change so I think there's a lot we can do the question is who will really drive that and I think that's a little bit up in the air incentivization is the issue right so totally with that I think we've now moved to questions from you and let's start with the audience in here if you have questions please raise your hands yes please I heard some wonderful things from Claudia and enabling technology but I have not heard about languages what is the problem there where a patient talks to his physician and is not quite sure whether he should tell the truth so how interpretable are these data or information from the patient to The Physician they speak a different language and this needs to be translated and this is the first step to generate also trust and this is a path to go and when we have once and this more precise data and information then you go back to research and development in Pharma or Diagnostics but as long as this is not properly interpretable we have a problem thank you that's a good point I think with data science we really have a we see the data gaps and actually we have to reconstruct them as we go because we we know that there must be actually an underlying condition that is not declared or not in the data record so we have to reconstruct how we do we deal with that we already deal daily with it because we never have the full data of a patient that's also one of the problems we have as clinicians because there is no electronic patient record so when I see my patient I know he has been with this and that doctor and I still I see all the data we have in our hospital but he if he has been in another hospital I still have to validate some of his or her's diagnosis and in this case I would say digitalization is really a good Advantage if we at one point move to having proper electronic patient records where I as a patient have all my data in understandable data hopefully which I also understand as a patient and then can share this data with the doctors with whom I want to share it and the house professionals we would have a better level on which we can do a shared decision making together [Laughter] onboarding is for the electronic patient records and that's something we haven't addressed here yet we have to make it easier to participate and at the moment it's still due art to the regulation and regulation makes sense but it's still very complicated so yes one more quickly what we lack at least in this little country is we are communicating badly we need to set up a visual for patients that they can see what is going to happen with their data and data content thank you yeah it's a very good point absolutely any other questions in here we have one in the back the very back and I see we already get some questions online as well if you want to join go to slido and add some more questions um hi we talked about telemedicine and and also a bit about reimbursements and in Switzerland obviously it's very complicated to have reimbursement for for the care that you do that is not in the Miguel and that is not really defined and if we go towards the telemedicine digital Healthcare how are we able to to get reimbursement for for the services that that we propose that are not clearly defined yet um so yeah very complicated question we work on this as well but I think it's it's good to talk about this as well because the reimbursement is very important for for practitioners and obviously um well again I mean I'll be curious to obviously with the Switzerland Healthcare System from Claudia but I'm giving an analogy there from the US so you know years ago when telemedicine first started uh most of the companies that did it uh didn't have like you said a reimbursement pathway so usually what happens with these kind of Technologies is this concept of early adopters there's always patients and populations that are willing to pay out of pocket by cash pay for convenience and once you have the initial adoption curve and you prove out the value proposition it slowly drives policy change you say okay now it'll be covered right so I think if you look at the example of Minute Clinic by CVS teledoc American well all these companies that started you know over a decade ago in the US they all started with director consumer and then you realize that's only small segment of the population is willing to pay out of packet for these Technologies in the early adopters is a fraction of the population so then the naturally go from direct to Consumer to employers and Senpai employers will have restrictions and eventually get to insurance so that's a natural curve that a lot of Technologies follow in the U.S but be curious here if that's the same model or is or how are you guys thinking about reimbursing for some of these access points some of these things really difficult here and we had it was more flexible during the pandemic so during the pandemic I could build a video consultation but now a video consultation because it's billing is back to the old style it's the same as a telephone call so why should I set up a more expensive and more time consuming setup for video consultation when I get the same money as just picking up my telephone and the same with apps so we can't prescribe apps yet some health insurance companies offer certain apps but then it's a health insurance company service and I think that's the same as other regulatory Frameworks we have to be more agile in the future because if not we can't test out Innovation and we can have a kind of test framework but it is too rigid at the moment as it is maybe I can have one comment of that real quick please which is really nice this topic is fascinating to me because if someone's asking the wrong question right the question you're really asking is adoption of a tool or technology would really question you should be asking is what's the ultimate goal you're trying to achieve so look at example that you just gave I would say the challenge in healthcare for most countries is that value creation is not synonymous with value capture in this example you would say the value creation is that the patient had a great experience uh they saved time they saved a visit to a facility they didn't have to take time off of work in the middle of a day uh that's productivity benefit to the company they work for there's all these benefits but they don't translate to the same single stakeholder so part of the reason you can't pay for these things is that the value creation of the patient side where the value captures not the doctor or the Healthcare System it's actually the company they work for or right so that triangulation is what the big mess is in healthcare so you just have to think through like hey what are the strategies you could use as an ecosystem of partners that clearly is benefit to that experience but we haven't figured out how to tie the ROI to either single or multi-entity to then start to pay for these things and that to me is conundrum for lots of things in healthcare and but I hear it again and again what we established during kovitz flexibility and everything we just lost it it's amazing right can't we go back a step and say like there must be things we've learned from the covet and that we need to keep so um I think on that front let's move to the questions online here and here we have the first question is that there's no shortage of digital Healthcare apps but is there enough testing to guarantee they actually help people I'm happy to take this one because it's one of my research areas and it's really interesting when you look into the number of healthcare apps last year when I looked it up it was over 300 000. and I think it's about thousand thousand five hundred or even less where we have randomized control trials to see if they're really effective in doing what they say they do and this is again coming back to the point where it says we have the whole Fitness area and we have the area where we are more in the field of medical devices and if it comes to medical disease areas I would say we have the strongest research on depression and perhaps diabetes because this started very early this Depression had started already when it was not even in app format it was just online internet tools and there is data showing that when a patient is doing it in a kind of online tool that it is as effective as seeing a psychotherapist face to face and it's even more scalable but for many other diseases we need this evidence and research is expensive and when you see these small startups building these apps they have to build multiple apps and they're really not even coming from a background where you develop medical devices you have to be a totally different type of company to be able to be in medical device regulation so we still will have this large Market but now we will have a clearly more defined Market in treatment areas and there it's software as a medical device and I guess we also go into FDA approval processes with many of these devices as well I guess that is a rigorous process in place already Yes instead just to add to that I mean I think in at least in the US there's this Concepts people the terminological use what's called intended use or fit for purpose which is really important right so if you take an example of diabetes a great example there are apps out there in the marketplace therefore keeping a log or a diary that's a religious diabetes their apps are on education for diabetes and there's apps for truly management of diabetes so they intended use of the application becomes a critical decision factor of which of the apps to Claudius Point are really designed for that guidance education Wellness our lifestyle versus medical diagnosis and medical treatment and I think that definition by the app manufacturers is really critical to know what is the intended use and two things one you have to communicate that effect with the audience the patients misinterpret to your point earlier why am I using this app and that creates a lot of issues from a safety perspective then two The Regulators can't regulate 400 000 apps for example so part of the challenge with regulation is sometimes they have to wait for adoption and harm to know how aggressive don't regulated because there is no infrastructure to regulate hundreds of thousands of apps out there yet right so it's a little bit of the speed of innovation is outpacing how policy and government can keep up so part of the challenge you're seeing here is is just that enforcement is missing a little bit excellent let's move to the next question what are the main adoption successes of digital Health Tools around the world and we talked about a number of them what do you think I'm happy to start until you can add more I mean I think we mentioned a few already earlier but I think maybe if you go down that Spectrum from you know public health and initial diagnosis to think about from a diagnosis and monitoring perspective again lots of advances over the last decade have been made around digital diagnoses or even in-home diagnostic testing is very popular now and that's all Innovation that allows you to do smartphone diagnosis or in in-home Laboratory Testing if you take a different lens on digital Health around pharmaceutical industry though again lots of advancements in terms of using digital tools for trial recruitment how do we have more participation in clinical trials how do we get better access to clinical trials for you know patients in rural areas on a therapeutic side again lots of development around using data science machine learning for drug Discovery right I think there's many many examples if you the spectrum of healthcare is very very broad so I think if you think of these there are many examples out there but there are pockets of innovation I think at scale we're still obviously it's an evolving industry I'm saying and just to bring some Hands-On examples when we think about Diagnostics I think we have great developments in image analysis just to think about breast cancer screening and then MRI so we know there's really research showing that the algorithms are better than the Radiologists and this is just one example here yeah and I think it's also some of these are in the market they're quite effective they're trusted skin cancer treatment scanning for example that's quite an effective tool it works quite well its adoption rate must be high there but yeah it's really smaller sectors that are coming through slowly now how willing is the medical profession injury in really embracing digital health care how big of a block is that or are they a blocker it depends it perhaps depends also a little bit on the generations and where you work so if you're working in one of the bigger hospitals you have to go with the Innovation because there's already so much digitalization around but on the other hand side we know in Switzerland I think we have around 15 to 70 percent of the primary care doctors mainly the older generation who don't document their patients electronically they still have paper pencil recording and um but when I see our young generations of our medical students also as a house professionals many of them are digital natives so over the time we will have a lot of change and on the other hand side we just have to increase skills and trust also comes over a better understanding what these tools do and feeling more confident to explain to their patients what they're doing it has always two sides I have to understand it myself but I also have to have the competency to explain this in an understandable way to my patient and I think we're in a good way here but still we have some work to do yeah I would say that look as I said earlier I think I think physicians in general the healthcare industry is usually relatively slow to adapt new technologies I think it's been proven there's a common statistic people use that on average it takes 17 years for any new innovation to achieve wide skill adoption like that's a reality which I think is terrible but I'll defend my physician colleagues a little bit because part of the Hippocratic Oath we all took is this concept of first Do no harm right I think we're having this debate over the weekend with some friends of mine that may be the Hippocratic Oath should have been on average do more good because part of the first Do no harm is incredible skepticism to avoiding anything that has even the potential for harm which means just status quo so I think there is this skepticism I think the way to overcome that there's really what Physicians know well which is evidence-based just getting information Publications evidence out there through high quality research is the way you drive Behavior change when you think about the pharmaceutical industry right there's lots of drugs we use as clinicians where we don't know the mechanisms of action or we don't know exactly the side of our profile but we use it because that's a New England Journal paper that says that this you know great monoclonal antibody has this great outcome that's been well studied in a randomized trial and is published and we just trust it and it's FDA cleared how do you do the same level not the exact same level but those types of evidence generation to drive both awareness and then adoption by physician Community I think will be the key excellent we're getting close to the end of this uh discussion that we have here it was a lovely discussion and let's I have one more question for you guys here so let's let's go for that but first quickly summarizing I think we took us quite on a journey here right we started with Chachi PT as being the new friendly medical doctor here waiting for for us to be explored but it's really about convenience quality versus quality right that's there was a key factor that we that we discussed here um and I think we also started with kovit kovit as a big driver in the digital technology coming to Market that option rates were high during covet crisis but then as we came out we seem to have lost a lot of fit again right a lot of the gains are gone again can't we go back is the big question mark there we've talked a bit about of course digital Health Data data is everything we need to be able to measure we need to have one system and integrated of approach it approaches to actually Diagnostics to Medical care all the data needs to come together and then we yes we looked into a couple of good examples where progression has definitely succeeded and the integration has happened depression you mentioned diabetes these are different definitely things that we need to look carefully into and how we can learn from them as well from other markets as well we've heard Israel being a good system there as well northern Europe as well and then yeah good good input on that our hypocratic out and maybe a statistical approach to it right and I liked it 50 of doing good is probably a good one but what do you look into the future what needs to happen that this that we get this right so Claudia maybe to you first I love to look into the future we just finished our strategy lab for KI and Ai and medicine at the University of Zurich and we see something very clearly coming which we haven't talked about yet which is a digital twin this means our body in a complex software and this means the whole time putting data into this very personalized software which addresses data protection IT addresses also aspects how do I deal with prevention but I can simulate prevention then I can simulate diagnosis I can simulate treatments so if I have cancer I can see if treatment a might be more beneficial and have less side effects for me than treatment than another treatment and for this we really have to prepare and preparation means more digital competencies for all of us we have to put them now into the curricular means changing regulatory Frameworks changing them in Frameworks which are more agile and we have to predict in the future at the moment we are fixing our current problems in our regulatory Frameworks but we have to see what we see what we need in 10 years and we need something which is less rigid and we are not we're not used to it and I think we really have to change our mindset to address this Molly you know look as an entrepreneur I would love to see rapid adoption and scale of digital health of course but I think in reality will happen in healthcare will be slow and steady will win the race and part of the reason that slow and study usually wins the race in healthcare is you just want to make sure that you always remember you're dealing with people's lives and people at the end of the day and you really want to make sure that you want don't leave Publishers behind the technology and Equity piece this idea of digital divide you want to make from a safety perspective that really is measured because one of the worst things that can happen which has happened in healthcare before is you have an adverse event or Sentinel event because it uses some technology that's not safeguarded and the whole field is Texas takes like a 10-year step back right that happened with gene therapy 20 years ago at UPenn right a single child died and the whole field just got stuck for literally two decades so part of this thinking around digital health and adoption is of course we want to see slow steady progress but we just want to make sure that it's done in a in an ethical way in a systematic way but as I predicted there's no doubt in my mind the next two decades this will be we won't talk about digital Healthcare it'll just be Healthcare excellent wonderful words thank you all for joining us in this seminar much appreciated thanks for taking the time to be here also our online audience thanks for submitting your questions and being part active part of this discussion thank you all for being here thanks to the my guests here on the on the panel thank you thank you [Applause] [Music]

2023-07-01 17:36

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