Healthcare of the Future, International Conference Biel/Bienne, 5 April 2019

Thomas BÜRKLE

Corresponding Author Thomas Bürkle, Bern University of Applied Sciences, Quellgasse 21, CH2501 Biel/Bienne, Switzerland; e-mail: thomas.buerkle@bfh.ch.

Bern University of Applied Sciences, Biel, Switzerland

Michael LEHMANN

Bern University of Applied Sciences, Biel, Switzerland

Kerstin DENECKE

Bern University of Applied Sciences, Biel, Switzerland

Murat SARIYAR

Bern University of Applied Sciences, Biel, Switzerland

Serge BIGNENS

Bern University of Applied Sciences, Biel, Switzerland

Erwin ZETZ

GS1 Switzerland, Bern, Switzerland

Jürgen HOLM

Bern University of Applied Sciences, Biel, Switzerland

Healthcare in 2030?

Imagine you live in the year 2030. Global warming is still a big issue. You live in the suburbs of a big city because few people still live in rural areas. You commute to work by public transport. Occasionally you will use your electric car. In many Western countries the majority of baby boomers have already reached retirement age with almost a quarter of the population older than 65, so medical care is also a constant issue.

As a human being, you can still get sick. The many elderly people and a life expectancy of almost 90 years means that chronic diseases and dementia have increased despite medical progress. However, technological progress and prevention due to increased health literacy have led to less than expected increases in health care costs. Thanks to intelligent assistants, older people can live safely at home for longer in a more self-determined manner. In 2030, digital medical services are standard via the internet. Your GP advises you via telemedical services to fill in a digital questionnaire with your medical problems. If necessary, the intelligent house-doctor system transmits measured vital and behavioural data to the family doctor. Furthermore, he requests from your electronic health record the three-monthly follow-up of your personal wearable devices, which continuously monitor your blood pressure, pulse, oxygenation, blood glucose and activity levels. His information system post-processes this huge amount of data in real time to present a medical dashboard of your current condition to your doctor while you are still in the videoconference. With the help of this decision support system your GP can easily distinguish those problems which he can solve remotely from those where he really needs to see you. He can even inform your employer that you will be unable to work for some time. The GP information system calculates in real time a recommended therapy scheme including your personal genomic data to ensure compatibility. Your GP reviews this recommendation and sends a medication order directly to the pharmacy. Amazon delivers your medication within an hour to your home with its rapid drone services. At the same time, your health insurance automatically receives a digital invoice for the treatment.

Well, like the people reading Jules Verne's “Around the World in Eighty Days” [1] in 1873, we don't know which of these scenarios might become reality in 2030, 2050 or ever, but we certainly live in a time when ubiquitous IT provides us with computers in our pockets which are powerful enough to support photography, video and audio recording, video telephony and access to a wide variety of information worldwide – we call it a mobile phone. We have already reached the stage where personalised medicine can examine the individual conditions of patients to find the appropriate therapy for each person. Data mining and artificial intelligence promise to discover new ways of treating previously incurable diseases; something which recently prompted a politician to say that within 10 years we will have overcome cancer [2]. On the other hand, an ageing society and the loss of family ties confronts us with an increasing number of elderly and multi-morbid persons striving to live independently for as long as possible.

This is the setting for the 2019 conference Healthcare of the Future. The medical informatics conference is centred around emerging digital communication options and their influence on future medical treatment. It originates from a research project which started in 2012 [3] with a scenario similar to the beginning of this introduction. A clinical pathway was drawn up for the case of an elderly Swiss lady called Elisabeth Brönnimann-Bertholet, who is suffering from diabetes and hypertension, under the assumption that her progredient hip arthrosis now requires surgery (fig 1).

In a visionary brainstorming process, Bern University of Applied Sciences BFH, the Swiss branch of the standardizing organization GS1 [4] and the umbrella association of the Swiss business sector ‘Economiesuisse’ [5] analysed the required medical and information processes and drafted an innovative cross-sectoral treatment pathway for Mrs. Brönnimann to obtain a total hip endoprosthesis (TEP). Communication within the pathway relied on emerging information technologies [3].

In the meantime, a new bachelor study programme for medical informatics has been founded [6], a department for medical informatics established, and an institute for medical informatics research constituted at the BFH. With this background, a larger second research project called “Hospital Of The Future Live” (SDZL) [3] began in 2016, with 25 partners including six Swiss hospitals, four major IT suppliers, IHE Suisse, and eHealth Suisse: the coordinating body for the implementation of the Swiss electronic health record Electronic Patient Dossier (EPD) [7]. The goal of SDZL was to turn parts of the visionary scenario into a tangible reality – at least in the laboratory environment of BFH medical informatics. SDZL [3] had a multi-stakeholder driven approach. Project goals were set and continuously adjusted in five plenary meetings with all involved parties. The cross-sectorial treatment pathway for TEP was split into a total of 68 more or less atomic work packages at home and in the outpatient situation prior to hospitalisation, the inpatient rehabilitation sector and the return to the home situation. These work packages centred around communication-intensive tasks where either current shortcomings were found or potential for improvement was expected. Work packages were then combined into (often cross-sectorial) student projects. A detailed description of the process can be found in [3].

A good example is the electronic Medication Management Assistant eMMA. This is a laboratory prototype for an app on mobile devices designed to help patients take their medications regularly, and has the goal of improving drug therapy adherence. eMMA uses a Conversational User Interface CUI to remind the user to take their drugs. If the medication is not taken, eMMA asks for the reasons, just like relatives who chat with the elderly via SMS [8]. Primarily, this app is designed to support Elisabeth at home prior to her inpatient treatment and after her return from rehabilitation. In a future setting, however, it would also be linked to Elisabeth's inpatient treatment to convey the medication information to the hospital staff and to receive the newly updated medication scheme at discharge. The future Swiss EPD [9] could have an important role in these transitions.

The 2019 conference “Healthcare of the Future” is to some degree a result of these research projects. Our goal for the conference is to discuss advanced interaction based on modern information technology between nurses, caregivers, patients and healthcare institutions with other specialists in medical informatics in an international setting. We would like to demonstrate whether and how this interaction could improve and accelerate healthcare processes, and we would like to discuss the future role of the empowered patient within their own care process.

After a short presentation of the conference background the programme will start with the keynote

“Digital Patient Communication: Improving the Hospital-Patient Relationship”. Three sessions in the scientific track deal with the topics

• Workflows in healthcare

• How does eHealth change the care process?

• Knowledge-based IT support

In parallel we will have young two researcher sessions under the topics

• eHealth and the informed patient

• Apps to support the patients and caregivers

Biel/Bienne 14 February 2019

The Programme Committee

References

[1] J-G. Verne, Around the World in Eighty Days http://www.gutenberg.org/files/103/103-h/103-h.htm. last visited 14 Feb 2019.

[2] Online Focus Special. Spahn hält Krebs in 10 Jahren für heilbar – Krebsgesellschaft bremst ihn aus. https://www.focus.de/gesundheit/ratgeber/krebs/krebs-spahn-will-krebs-in-10-jahren-besiegen-krebsgesellschaft-bremst-ihn-aus_id_10262417.html last visited 14 Feb 2019.

[3] T. Bürkle, K. Denecke, M. Lehmann, E. Zetz, J. Holm, Integrated Care Processes Designed for the Future Healthcare System. Stud Health Technol Inform 245 (2017), 20–24.

[4] GS1 Switzerland, https://www.gs1.ch/en/home last visited 14 Feb 2019.

[5] Economiesuisse, https://www.economiesuisse.ch/en last visited 14 Feb 2019.

[6] J. Holm, T. Bürkle, R. Gasenzer, F. von Kaenel, S. Nüssli, S. Bignens, S. Il Kim, M. Lehmann, A Novel Approach to Teach Medical Informatics. Stud Health Technol Inform. 216 (2015), 1011.

[7] C. Lovis, A. Schmid, S. Wyss, ehealth Suisse – coordinating e-health in Switzerland Healthcare IT Management 6(3) (2011), 46–47.

[8] M. Tschanz, T.L. Dorner, K. Denecke, eMedication Meets eHealth with the Electronic Medication Management Assistant (eMMA) Stud Health Technol Inform. 236 (2017), 196–203.

[9] Bundesgesetz über das elektronische Patientendossier (EPDG), 2015, https://www.admin.ch/opc/de/classified-compilation/20111795/index.html last visited 14 Feb 2019.

[10] Bundesgesetz über das elektronische Patientendossier (EPDG), 2015, https://www.admin.ch/opc/de/classified-compilation/20111795/index.html last visited Dec 21st, 2018.