Innovation artists in conversation: Will the doctor come to us at home in the future?

Nicolas Kubanek Welcome to our series Platz für Innovationskünstler*innen (“Space for innovation artists”), the podcast that introduces you to the movers and shakers behind innovations in the Nuremberg Metropolitan Region. Today we’re taking a look behind the scenes at Fraunhofer IIS to discuss the digitalization of our healthcare system. In the process, we’ll examine the extent to which patients can receive medical care without having to leave their homes. To answer this question, I’m joined by Christian Weigand, who is head of the Mobile Health Lab for mobile and digital medicine in Bamberg and CTO of the Digital Health Application Center. Christian, thanks for taking the time to talk to me today – and welcome to the podcast! Could you start by telling us a bit about your professional background?

Christian Weigand Hello and thanks for inviting me. I’m thrilled at the opportunity to talk to you about my work. I have been active in the field of telemedicine for 21 years and am responsible for a working group at Fraunhofer IIS that deals with telemedicine and mobile health. In parallel, I also work at a spin-off company founded by Fraunhofer IIS in collaboration with Medical Valley. We advise companies on how to market their telemedical ¬– that is, digital health – applications. Since last year, the major innovation in the field of telemedicine has been the concept of an “app on prescription.” This creates reimbursment opportunities for telemedicine – and many companies now want to know exactly how to proceed in this area. With this in mind, they come to both Fraunhofer IIS and the Medical Valley Digital Health Application Center to inquire about how to place their products on the market and how to obtain reimbursement for them.

Nicolas Kubanek The concept of telemedicine itself is no longer an entirely new subject or phenomenon. What exactly are you working on at the moment and what stage of development have you reached?

Christian Weigand At Fraunhofer IIS, we’re working to develop a telemedicine platform – in other words, a communication platform that aims to make the exchange of information between patient and doctor easier. Data can be transferred from patient to physician and back again. The novelty here is that – unlike in existing telemedicine applications, where no one knows exactly what happens to the data or who might have access to it – we don’t simply store the data in the cloud. We’re pursuing a different goal: We want the data to remain with the patient and for the patient to be able to decide who they provide which data to and when. This will allow them to make their own decisions about which documents or data they show to which doctor. Conversely, in the future, it should also be possible to carry out research using medical data that are now recorded almost continuously from patients via wearables, for example. These data are an important resource for pharmaceutical research but can also be used by research institutions such as Fraunhofer or universities for the development of big data analyses or artificial intelligence (AI) algorithms, which require large volumes of data. If we could obtain meaningful information about the patients’ situation, this would be enormously helpful when it comes to creating better algorithms and therefore better solutions for patients in the future.

Enabling patients to make their own choices regarding their personal data

Nicolas Kubanek You’ve talked a bit about your objectives. Let’s now look at the bigger picture: What is your overall vision? What would you see as an ideal future?

Christian Weigand I’ve obviously touched on some of this already. My vision is to enable patients to decide for themselves who receives which of their data when and to give them the chance to participate in studies independently. For example, the patient would receive an inquiry on their smartphone from a research institute currently looking for patients with a specific condition. They would then be asked: “Would you like to give us access to your data for our research?” The patient could then decide for themselves whether they were happy to do so and whether they wanted to help research into the development of new products for a specific disease, for example. They could therefore contribute to improving this research.

Nicolas Kubanek What exactly would this look like for me as a patient? Would I have to sign up on my smartphone? Or would it be organized through my primary physician? How closely would it all be linked up with the healthcare system?

Christian Weigand Currently we have the apps on prescription that I mentioned earlier. Here, the patient is prescribed an app that is intended to collect and analyze certain data from them. They also receive advice on how to manage their disease better, and it’s even possible to deliver certain therapies. Many patients, however, have not just one but several conditions and may have one, two, three, four, or five such apps prescribed by their physician. The whole thing then becomes very confusing for the patient, especially in terms of data handling. They may have to enter some data in one app and other data in another, and each app manufacturer also has their own cloud in which these patient data are stored. At the same time, no one has direct access to the data, nor can they use them for research purposes.

This is what we want to change, so that patients can decide for themselves who to give their data to. We can install a “federated data system,” so to speak, where the data is not stored in the cloud. Rather, we leave the cloud on the patient’s smartphone. If the patient needs to access certain data – for example, to tell their primary physician about pre-existing conditions – they can share these data with their doctor during a face-to-face consultation, for example, by showing the doctor a QR code on their smartphone. Once the physician scans the code using their software, they are shown the relevant information immediately. This takes one-to-one communication between physician and patient to an entirely new level and can prevent duplicate examinations. For example, a patient goes to physician A and has an X-ray taken. The next day, they go to physician B, who says there’s unfortunately nothing they can do without the X-ray image – and so they need to take the X-ray again. This results in additional costs for the health service and is unpleasant for the patient, who is then exposed to the radiation dose twice. In our health system, the sort of communication we’d like to see only takes place to a limited extent. New, digital solutions in conjunction with our approach could make things easier for the patient and the health system alike because the patient has their data with them at all times and wherever they are. It doesn’t matter if they go on holiday and need to access their data while abroad, if they’re moving from one physician to another, or if they go to a hospital – they almost always have their data, their medical history, with them in their pocket and can provide relevant information to the attending physician.

Nicolas Kubanek That sounds like it would make things a lot easier. If I think about my own situation, I have an Apple Watch that can now record an ECG or measure blood oxygen levels. What role will this play in the future? What other developments can we expect to see in this area?

Christian Weigand Telemedicine is going to become hugely sought-after as a result of wearables, but we should also take care that medical devices that record this data actually measure them accurately and are certified, so that these data can be put to use. Wearables are becoming increasingly compact, stylish, and portable and can measure much more than they could do a few years ago. In an acute situation, for example, it’s possible to record an ECG using an Apple Watch. Thanks to telemedicine, the patient can immediately share this information with their physician, who then interprets it and provides a response. Wearables can be a helpful tool when it comes to identifying critical conditions and issuing preventive warnings with the help of corresponding algorithms. This allows the individual in question to visit their physician in good time or to change their habits, live a healthier life, and thereby avoid critical situations. Although the Apple Watch was originally just a wearable, as in a gadget, it’s increasingly becoming a useful product for medical applications. In the future, this may extend to the measurement of blood oxygen saturation. With these diverse capabilities, wearables look set to bring new energy to the somewhat antiquated world of telemedicine, which is now experiencing a revival.

Challenges in data protection

Nicolas Kubanek My watch gives me regular reminders that it’s time I stood up and moved around. What’s the situation in terms of data protection in Germany? What are the biggest challenges in this respect?

Christian Weigand Not just in Germany but actually Europe-wide, we have some of the world’s best data protection legislation. The approval of medical devices is similarly stringent. Indeed, numerous scandals relating to these products in the past have resulted in a tightening-up of EU guidelines. The more data we record digitally, the more important the data handling becomes. In Germany, we have a particularly cautious attitude to data protection and treat it as a highly sensitive subject. The General Data Protection Regulation (GDPR) helps us to handle data responsibly, and I believe that European data protection legislation can provide a role model for countries around the world. Although this creates greater hurdles for manufacturers of medical devices, I believe that rigorous compliance is fundamentally necessary and correct. I also see this in my work at the Digital Health Application Center, where we provide companies with relevant advice: What guidelines must be observed? How must the technology be designed so that it complies with the Medical Devices Act and data protection guidelines, and so that an app on prescription or a digital health application (DigHA) can actually be registered? The patient can then be reassured that the device is appropriately certified and monitored, and that the data collected are secure. Time and time again with major American companies such as Facebook, Google, and others, we see that you can’t be entirely sure whether data protection guidelines are actually being adhered to. In Europe, we have a high standard of data protection.

Nicolas Kubanek You work at the interface between research and companies with the task of bringing new developments to the market. Will DigHAs soon be something that is relevant to the wider population?

Christian Weigand Fraunhofer is engaged in applied research. The idea is that everything we do will become a product in the near future. We take what’s going on in basic research and seek to refine it in partnership with industry so that it can give rise to new products. What I do at Fraunhofer is first and foremost research, but this research has already been put into practice within one project or another. Fraunhofer’s involvement is not apparent because we don’t market any products ourselves. That’s up to our industry partners. But some of our technology has been jointly licensed and installed here or there. Many companies now offer telemedical DigHAs, and there are a total of 11 or 12 DigHAs listed with the Federal Institute for Drugs and Medical Devices (BfArM). The technology has therefore been ready for digital health solutions for some time. All that’s missing right now are reimbursment solutions and the appropriate political framework – but we’re also seeing rapid progress in this area. In principle, companies are now lining up to register their DigHAs with the BfArM. This is also clear from our consultancy work, where we’re now absolutely swamped with inquiries.

Nicolas Kubanek In other words, it’s possible that I’ll only need to leave the house to access emergency care in the future?

Christian Weigand The coronavirus pandemic has shown that there can certainly be major advantages to digital health solutions. At the same time, however, telemedicine solutions will never be a substitute for direct patient contact, even if some consultations are carried out digitally. Technological solutions should support and assist this direct contact but never replace it.

Nicolas Kubanek The pandemic is causing many existing megatrends to accelerate. Perhaps that also applies to your fascinating work! It’s all very exciting, and I’d like to thank you for taking the time to talk to us today. I wish you every success with the further development process and look forward to using my first digital health solution on my mobile phone in the near future. Thank you, Christian.

Christian Weigand Thanks for inviting me and for the opportunity to talk to you today! I hope you’ll soon be able to use health solutions on your mobile phone – powered by Fraunhofer, of course!

Nicolas Kubanek That’s the perfect note to end on! Many thanks.

Christian Weigand Thank you.

Find out more about Innovationskunst initiative (in German): https://www.innovationskunst.de/