Welcome to the Smart Hospital

Day-to-day life in medical centers will be completely transformed by digitalization in coming years. German hospitals are at the forefront of the digital transformation, the healthcare market in Germany is booming and foreign investors are flocking.

October, 2019

The surgeon’s focus is as sharp as his instruments. He is preparing for a procedure to remove a cerebral tumor in a patient’s brain – a complicated operation that will take hours. There are no monitors or computers in the operating room. Instead the doctor is wearing HoloLens – ‘mixed reality’ smart glasses produced by Microsoft. Hidden behind the dark lenses is intelligent computer software that allows the surgeon to look into his patient three-dimensionally before and during surgery. Activated by voice command, the glasses show CT or MRI images of the patient created prior to surgery and then projected onto the lenses.

If a question arises, the surgeon can call a colleague or specialist (who has the surgeon’s field of vision on their screen) to confer and assist with diagnosis.

© apoQlar GmbH

Virtual surgery is an emerging field that will change the practice of operations. “We assume that soon every doctor will wear a HoloLens Mixed Reality device,” predicts Sirko Pelzl, CEO of apoQlar. The Hamburg-based start-up is partnering with Microsoft and distributes HoloLens devices to hospitals in Germany and to foreign countries such as Singapore and Thailand. ApoQlar has already equipped seven hospitals in Germany with its Virtual Surgery Intelligence (VSI) solution, including Essen’s Universitätsklinikum and the Marienkrankenhaus Hamburg. “These glasses could completely replace computers and monitors in the OR (operating room),” Pelzl says. VSI costs start at EUR 1,000 a month. The fee includes the HoloLens, the software and server performance. In addition, after two to three years, apoQlar will exchange the glasses for a newer version.

Digital Health Trends

64%

of German managers are convinced that AI will fundamentally change Germany’s healthcare system*

187 bn

the value of the digital healthmarket by 2020, from electronic records to intelligent instruments**

16 %

the compound annual growth rate in revenue of German medical technology companies up to 2028***

16 bn

amount hospitals could save through increased efficiency via digitalization*****

90 %

of German doctors see digitalization as a big opportunity for the healthcare system and hospitals in general****

Sources
* PwC; ** Roland Berger; *** “Gesundheit 4.0” Spectaris industry association; **** Bitkom; *****McKinsey

Virtual surgery is just one example of how digitalization could improve medical care for patients, doctors and nurses alike. New technological possibilities are entering the market at a rapid pace. By the year 2021, all Germans are to have an electronic medical record that stores all medical data compiled from physicians and clinics. There are also highly innovative medtech companies like apoQlar driving change. Thus, it’s not surprising that many overseas investors are taking a major interest in the German healthcare sector.

»We can hardly wait for the new generation of Holo Lens. It will open up even better ways to perform virtual surgery.«

Sirko Pelzl, apoQlar CEO

While critics of digitalization in healthcare fear that the hospitals of the future will have less human interaction and increased anonymity, the benefits outweigh the concerns. New technologies provide greater efficiency and therefore reduce costs within the entire healthcare system. Consulting firm McKinsey estimates that digitalization in the German healthcare sector could have cut around EUR 34 billion of total health expenditure in 2018 – a potential saving of 12 percent.
Paperless data-storage solutions like the electronic medical record promise to deliver the biggest cost reduction, some EUR 9 billion. Online interactions between clinics and patients, algorithms that support physicians’ decision-making, automated workflows and patient self-service are other ways to cut costs, McKinsey says.

Two surgeons wearing Micro­soft HoloLens glasses perform telesurgery assisted by VSI (Visual Surgery Intelligence). Using mixed/augmented reality, naturally rendered 3D images are uploaded to improve orientation and precision.

© apoQlar GmbH

While critics of digitalization in healthcare fear that the hospitals of the future will have less human interaction and increased anonymity, the benefits outweigh the concerns. New technologies provide greater efficiency and therefore reduce costs within the entire healthcare system. Consulting firm McKinsey estimates that digitalization in the German healthcare sector could have cut around EUR 34 billion of total health expenditure in 2018 – a potential saving of 12 percent.
Paperless data-storage solutions like the electronic medical record promise to deliver the biggest cost reduction, some EUR 9 billion. Online interactions between clinics and patients, algorithms that support physicians’ decision-making, automated workflows and patient self-service are other ways to cut costs, McKinsey says.
But cost advantages aren’t all that makes the digitalized hospital a must. Patients can also look forward to greater information thanks to new applications that can help them achieve their health goals and that support doctors in making more accurate diagnoses. For example, data from wearables or smart watches can uncover irregularities in a patient’s health, which can then be analyzed by intelligent algorithms. The roles of doctors and nurses will also change.

Source: McKinsey & Company

As machines perform an increasing number of daily, time-consuming tasks such as compounding drugs and searching for irregularities in diagnostic images, doctors will have more time to interact with patients. Moreover, their overall workload will diminish. So fewer mistakes will be made.

Trendsetting in Essen

Essen’s Universitätsklinikum is a state-of-the-art German hospital that aims to become a model of digitalization – indeed, digitalization is at the very core of its corporate goals. The hospital is currently piloting smart algorithms that perform routine work in radiology: checking images from CT scans and evaluating screenings for signs of cancer. The algorithm is a form of artificial intelligence that is fed with data and is constantly learning. The more data, the better the results. The hit rates in this pilot phase are high: metastases in cervical cancer can be detected at an early stage with 95 to 97 percent accuracy.

In the biobank at Essen University Hospital, up to 1.2m samples are stored fully automatically and cooled at minus 80 degrees Celsius. Here medical assistant Alexandra Heidemann sends the samples to to be refrigerated.

© Stefan Finger/laif

Even the time-consuming task of preparing drugs in the university hospital pharmacy is done by a robot. The intelligent machine picks up the prescription, weighs and mixes the ingredients and then produces the drug. A human pharmacist checks to ensure the mixture is correct. Robots are also at work in the biobank of the clinic, where blood, body fluids and tissue samples from patients are stored. In the past excess material was thrown out, but it can now be processed by a machine for use in further research. The machine fills remnants of blood or urine into small plastic containers.

»With every surgical intervention, you have to balance risk versus benefit. Artificial intelligence helps us make more accurate predictions.«

Andreas Bollmann, senior rhythmologist at the Leipzig Heart Institute and CEO of Leipzig Heart Digital

Photo: © Christian Hüller

Further personal data such as age, sex and medical conditions is also preserved. In this way, an ever-expanding digital memory is being created to help researchers at the hospital and other institutions.

Less travel for cardiac outpatients

Cardiac patients will be big beneficiaries of the smart hospital. The frequency of their heartbeats and the general condition of their cardiovascular system can be recorded by tiny sensors inserted underneath their skin, thereby significantly reducing the number of hospital visits needed.

The sensor automatically passes on the data via a small transmitter in the patient’s home to hospitals and doctor’s offices. This information is then evaluated by patients’ physicians who can consult with cardiologists to determine the best treatment.

Healthcare fairs

BIO-Europe, November 11–13, Hamburg

Europe’s largest partnering conference for the global biotech industry turns 25 this year. BIO-Europe 2019 expects 4,300 attendees from 60 countries and 2,300 participating companies. GTAI is giving a tour of key biotech innovation clusters in Germany before the event (November 6–10).
GTAI tour info https://bit.ly/2YClxFx
BIO-Europe info https://bit.ly/2YwZe4V

Medica, November 18–21, Düsseldorf

MEDICA is a must for leading healthcare companies. International visitors are invited to discuss business opportunities with GTAI at Hall 15 Booth L30.
www.gtai.com/medica

Sensors like this are “already common practice in German hospitals,” says Andreas Bollmann, senior rhythmologist at the Leipzig Heart Institute and CEO of Leipzig Heart Digital – a subsidiary of Leipzig Heart Center, which is part of the Helios Kliniken group. “Processing the data, feeding it into databases and drawing conclusions – that’s the real challenge,” Bollmann says.
Since 2015, the Leipzig Heart Institute has established a reputation as a pioneer in cardiovascular clinical research. It is currently the largest cardiovascular clinical research facility in Germany. In 2018 the Leipzig Heart Institute raised EUR 2m for research and published over 200 scientific studies.

Source: McKinsey & Company

Bollmann is currently researching machine learning in the context of atrial fibrillation ablation, a routine operation performed on cardiac patients to treat atrial flutter. Last year, he developed the SAFER system, short for ‘HelioS Atrial Fibrillation ablation rEgistRy.’ The system draws upon data from 29 clinics within the Helios Group to minimize the risk of complications during the procedure. Currently the data set contains more than 28,000 procedures from 2010 to 2019. “This makes it the largest German register of atrial fibrillation ablations and allows us to create variables for quality assurance,” says Bollmann. Bollmann was also part of the June 2019 ‘Healthcare Hackathon’ organized by the University of Mainz and supported by the Federal Ministry of Health. The object of the event was for healthcare professionals and entrepreneurs, working together in teams of 18, to find solutions to challenges currently facing hospitals.

Natural rendering is a visualization method that makes magnetic resonance imaging (MRI) and computed tomography (CT) look more natural and realistic. Slices and renders are colored and given depth to generate an easily recognisable, photo-realistic image of even the finest tissue structures.

© apoQlar GmbH

The task for Bollmann and his team was to use machine learning to design models that allow for better characterization and classification of atrial fibrillation. Using this process, they were able to draw conclusions about the length of hospital stays and the risk of serious complications during the procedure.

Revolutionizing preventive care

If Bollmann’s team’s findings make it to market, they could revolutionize prediction and preventive care. The method developed during the Hackathon might lead to personalized risk forecasting. “Before a procedure, we inform patients about their risk,” Bollmann explains. “To evaluate the risk, we use average values. However, the risk of a somewhat healthy 50-year-old is different from that of an 80-year-old with severe comorbidities.” Using special software, physicians could enter data such as age, gender and previous illnesses and then calculate the individual risk of the patient.

This is just one of many examples of how digitalization will likely improve healthcare outcomes and patient satisfaction in the hospital environment. It may be some time before systems like the one developed by Bollmann and his Hackathon colleagues are implemented, but the future is already within sight.

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