#HEALTHAPPSCOMBAT
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Maxima and minimaHypermediaLecture/ConferenceComputer animationJSONXML
Transcript: English(auto-generated)
00:18
Thank you. Welcome, everyone, to this session in the health
00:24
track. Before we start, actually, with our Fight Club and the combatants of the Fight Club regarding e-health and regarding health apps, I have the privilege to just share a couple of thoughts in order to introduce the session, a couple of thoughts
00:42
on transformation of health care delivery. So let me start by just asking, we hear a lot about disruption in many, many industries. The question for health is, is health care also an industry that's going to be disrupted, or is health care going to be different than other industries, and it's going
01:01
to be more about transformation? Remember that, in essence, health care is a conservative industry for good reasons. It's about health. It's about people. It's about people's lives. It's about privacy and sustainability and many other things. So the question really is, do we want to disrupt such a system, or do we
01:21
want to transform that system? Now, today, later on, we're going to talk a lot specifically about diabetes, as this is one of the big chronic diseases that can benefit from digital health and health care transformation. So I want to share with you some thoughts on diabetes specifically. We have a huge diabetic population
01:42
all around the world with amazing increase in prevalence, about a 55% increase in prevalence up to 2035. Today, we're talking about 420 million people worldwide with diabetes. And the prevalence increase is not only in the emerging countries, but also in the US and the European countries
02:03
with quite some significant numbers. Now, the interesting thing is that diabetes has been around for quite a while. But still, if you look at the clinical outcomes and what really has been achieved so far in the treatment of diabetes, we must say that only 50% of people are actually diagnosed.
02:22
Only 20% have access to care. Only 12% get decent quality of care. And only 7% actually reach their clinical treatment targets and outcomes. So this is a big challenge out there that needs to be, in our opinion, that needs to be addressed
02:42
and that has huge opportunities for digital health. Now, if we look at the innovation that is around, and here I'm talking about Europe specifically, we have a lot of medical and clinical innovation around. And there's a lot of medical and clinical innovation coming out to the markets every year.
03:01
In Europe, we have about 320 different oral anti-diabetic drugs. We have over 150 insulins and insulin types and brands. We have other more modern pharmaceutical treatment options as GLPs and DPP4s. And we have far over 200 different types
03:21
of medical devices, that is, medical device technology at the disposal of people with diabetes in order to treat and manage their disease. But yet, as you've seen in my previous slide, only 7% of people actually reach their treatment targets.
03:40
So there must be, quite obviously, something missing. There must be something else that can connect the dots and actually lead to better outcomes at hopefully lower costs for the health care systems. On the other side, while traditional care delivery is all about health care professionals, doctors
04:00
and nurses treating people, while with the prevalence and the increase of the number of people with diabetes and the, let's say, struggles that most of the public health care systems have in terms of their financing, these resources are already today not enough. And for sure, there will not be enough in the future
04:22
to take care of this disease. Let's have a look at the cost that we have in the health care systems and maybe put that into today's perspective of the disease and also of digital solutions. In Europe, we spend about 1,000 billion euros just on health care.
04:42
This is total direct cost for health care. We're spending 700 billion euros on treating chronic diseases. We're spending 120 billion euros in direct costs for treating diabetes. And you can add to that another 30% to 50%
05:01
of indirect costs coming from absenteeism, reduced productivity, disability, and condition-induced unemployment. Now, the interesting part is that 80% of those costs can potentially be saved because they come from potentially preventable complications
05:21
and the overall cost of the health care system to operate. So there's a huge potential that we see also for making the health care systems more sustainable if we find ways to use the innovation that is available, connect the dots with digital health solutions, apply them for the better of the patient
05:41
and for a more sustainable health care system. Now, if we then look at what we call the mHealth market and the projections that we have for the mHealth market, by 2017, the market is projected to be at around 5.7 billion. These are basically apps.
06:00
These are basically direct-to-consumer revenue models, mostly based on the app sales, subscription, and the devices and services that are sold with it. Now, compare the classical market estimation for mHealth with the potential that could be out there
06:20
by engaging really in getting better outcomes and helping health care systems to better provide care to patients. There's a huge gap, and I think that gap can also be addressed with digital health solutions. Coming back to the 120 billion that we spent in direct costs for treating diabetes,
06:43
there's an enormous increase in the cost per patient if you compare the different stages of disease progression, complications, and co-morbidities, going from twice the cost of the general population up to 24 times the cost
07:00
for treating this population of patients. So, what is important here, and I think here is also the opportunities that we see with new digital solutions is find the adequate balance and the right tools for integrating self-care and professional care and supporting behavioral change processes,
07:22
avoid disease progressions and co-morbidities, and promote healthy living, prevention, and good health in general. As you can see, I'm kind of already addressing one of the topics. The apps will be a very important part of that, but the apps will not be enough.
07:41
If we want to, let's say, take care of the triple aim, which is taking care of the cost of providing care, having a good patient experience with the care provision, and also manage health and manage population health in the different markets. And for that, we believe that digital healthcare
08:03
and technology and IT will be enablers for a better procedure, a better process of delivering care to patients, and as apps will be an important part of that, we will have this discussion right now with some concrete examples. Thank you very much.
08:28
Well, thank you, Lars, for your presentation. I think it really puts a context of what is going to pass now. You are going to be witnesses of the first health apps combat.
08:40
We have brought together two influencers that are really big in health, especially for diabetes. These people, they really think that new technologies and mobile health can change the world, but we want to face them with the difficulties and the shadows of these new trends
09:01
that are really reshaping how we deliver healthcare. For doing this combat, I have with me Mingsong Kim. Please come on stage. He is going to be the referee of this special combat,
09:22
but first of all, I need to ask you, do you really think that health apps are really valuable to relief? Please come up, those of you who really think that these apps are really giving us a big value. Come on. Get up.
09:42
Okay. I don't see much hands up. Okay, now, who thinks they are not really adding value, that they are just tools? I don't see hands. One, two, three. Well, what about the rest of you? Do you have an opinion? No?
10:02
Well, let's see this discussion, and maybe this will change a little bit. Can you present our fighters? Yes, sure. I would love to do that. Just to give a little bit about my background, why I'm standing here. My name is Mingsong Kim. I'm a venture capitalist from Excel Health.
10:20
We solely focus on digital health start-ups. I invest, or we invest in our fund 500K to 5 million euros in series A companies. I've seen 2,500 digital health start-ups, and I invested, or we invested in three of them, five of them. Last one was Medog. It was a telemedicine company from Finland,
10:42
3.5 million last year. Happy to be on board. Also, I'm very honoured to announce that I am the successor of healthcarestartups.de, so if you want to know about digital health, please look at the blog. Yes, so thank you very much for having me. I will now present the healthcare experts.
11:02
I will be guiding you, or I will try to guide you through the session here. So now, to make it a little bit more fun, and we are here in a combat, I will try to moderate it in a more, let's say, boxing way, so I will try it. I'm not a professional announcer, so I will try this.
11:25
From the cold northern part of Germany with 1.93 metres and 94 kilos, let's please welcome founder of D-Doc and K-POM survivor Bastian Howe.
11:52
Last but not least, from the cold north, out of Sweden, please welcome 1.75 and 64 kilos,
12:02
co-founder of MySugar, Frederik De Boer. Carla, please explain the format, how this battle will go on.
12:20
Okay. This is how this is going to be done. They have a first round, five minutes each, to present a little bit their common ground. Frederik will be discussing about why health apps are really, really good, and Bastian will go for the difficulties and the shadows.
12:42
Then we have round two. They have three minutes each for replaying. And finally, we'll have a discussion. We'll have Lars again on the stage so they can really fight hard. That's why we need to get into the stage. You can also join the discussion with our hashtag, please, go on Twitter, healthappscombat,
13:02
and let's try to do this really, really nicely. No blood. No blood, please. All right. Dan, you have five minutes. You will start, Frederik. Absolutely. Round one. Go.
13:21
Hi. That's how we start a boxing match, right? Well, to give you some background, my last 31 years, I've lived with type 1 diabetes, meaning my life depends on blood, needles, and sweat, and tears,
13:41
and everything else that comes with doing this therapy. My body's broken. I need to replace a bodily function, yeah? It's not easy. Technology helps. Technology helps. It keeps me alive. A little bit of hormone when I need it, injected through a needle, it keeps me alive.
14:03
Through technology and medicines, I can control this disease, yet it is always a struggle. The past 10 years, I have taken this disease I have and this therapy I live with to a professional level. I've become a working diabetic,
14:22
or what should we call it, a professional diabetic. I've started working on making diabetes suck less using technology. This has launched me into the science of diabetes, into the science of bringing technologies to market, into, as an entrepreneur out in the field,
14:43
speaking with doctors, patients, grassroots organisations across the world. What we've built is an app which helps people in day-to-day life. But to do so correctly, we needed to start with the science.
15:01
So, you know, we took a look at what was out there, and were astounded by the fact that, you know, it wasn't a new thing. People have been building apps and electronic systems since, well, 25 years, 30 years back, to manage diabetes, apps, or things like that,
15:20
computer programmes. And looking at the number of trials out there, over 700 of them, we distilled that down to the most impactful studies and trials in this field, and started seeing a pattern. Even among the 31 top-notch trials that have taken place over the past 25, 30 years,
15:44
there was a difference. You see, if the quality of the trial was good, it still didn't mean that it was a good thing for the patient's diabetes. But if the quality of the system which was used in the trial was good,
16:00
if it was based on feedback, if it was based on solving real problems and not just keeping a journal of therapy data, then it actually had an impact. It had a positive impact, not across the board, due to the quality difference.
16:21
The well-built and well-thought-through systems actually drop that little magical number we all strive to drop, the number of hypos. It drops the risk for heart complications and heart disease down the line. That's the outcome number everyone is looking for, so it does help.
16:41
Because apps drive engagement. If you engage in therapy and the data becomes useful in day-to-day life, oh, that's when magic happens. Now, science tells us it kind of works if it's built well. Now, let's take this to a patient's perspective,
17:04
away from the science and into day-to-day life, because we don't care about outcomes. What we care about is living life. It's about taking that feedback into therapy and making it a short-term positive and a long-term positive feedback loop.
17:21
And that is possible through apps, because they are so intervolving in our day-to-day lives. Now, this little app I've been part of creating, this ecosystem of apps I've been part of creating, has now helped a bit over 600,000 people.
17:41
600,000 people have now experienced a different way of seeing diabetes therapy. You have seen it as the monster you can tame instead, instead of this drag and eternal grind. It's a philosophical change, really, using technology.
18:03
I could tell you hundreds of user stories, because I've emailed with over 35,000 of our patients, of our users, of my brothers and sisters. But it all distils down to a moment
18:20
which I shared two years ago here at Republica. An email I got one day from one of our users in Germany saying nothing, but it had an image, an image of an app's logo tattooed on a forearm.
18:43
That is powerful. What's happening with the time? Yes, exactly. So where are we at right now? You've got five minutes. All right, five minutes left. You've got five minutes. All right. Then my closing remark,
19:01
and that is not the only time where a user of an app has tattooed the logo on his forearm. If you look at the impact in real life of an app and can distil that down to the number of tattoos,
19:21
I think we have a winner. Thank you. Well, thank you, Frederik. This was basically from a perspective of a co-founder of a diabetes start-up. I saw, Sebastian, I'm very curious about your opinion from the perspective of a patient. You have five minutes. I will count the time. Go.
19:44
All right. Hello. Thanks for coming. I'm happy to be here. If this was a real boxing thing, I guess I'd be used to fighting somebody with tattoos, you know, of an app or whatever. I feel a bit like fighting Robocop, you know, the digital thing and the professional diabetic.
20:04
Well, I'm not. I'm Bastian. I'm aesthetic. I'm type 1. I do think I know quite a lot about my own diabetes, but that's about it. I care about myself and my diabetes. Before I start going into the argument,
20:20
I'd like to reframe the question a little bit in three small points. First point, some of the arguments I will make I will not truly mine because I don't really ... I'm not really against apps, right? I actually do use at least one app on a very routine basis, but there are a couple of points that I think need to be considered, so I'll get into those.
20:40
Second thing is I will really look at apps from a patient perspective, and I will look at them from today's perspective, so I'm not going to get into where apps could be in the great new future five years, ten years from now, but let's look at apps as they are today, health apps as they are today, and most of these apps,
21:01
at least as far as they concern me as a type 1, they are about collecting data. I'm not talking about fitness trackers. They do that as well. For diabetes, that is important as well, but they collect my ... or they want me to collect my blood sugar levels, my insulin doses, my carbohydrates,
21:20
my activity, my mood, whatever. They actually want me to give them all that data by whichever means, mostly manual. I'll get to that later. The reason why that is important is, from a patient perspective, I know we're at Republica, right, so many of you are probably into all this quantified self thing
21:42
and playing with data, and you actually do a lot of ... I've seen a workshop here on food and stuff, so everybody here is very pro doing all these things, and that's great. Do that if you're into that, because it's a hobby, or it's fun, or you like doing it, or it's your passion, or you want to prove something, or whatever it is, in a way, it's fun.
22:04
For me, it's not. I don't do this because it's fun. I have to do this. I have to do this 24-7 every day, and I fucking hate it, and that makes a big difference. Now, when you look at all these apps that ask me to enter all this data,
22:20
and then they come by making it more fun with gamification, et cetera, you know, it doesn't really help me. It still doesn't. It's still not fun. It sucks. That's the one point. The other point is that I enter all this data into all these apps, and then it's kind of stuck there, because nobody makes any use of it. So I enter all this data into an app, I go to my doctor,
22:42
I show her my phone, and she's like, yeah, right, where's your written log book? And I kind of understand her, because she can't deal with ... There's 1,600 apps out there dealing with diabetes. My doctor can't know all of them. Now, I'm using this one, somebody else is using another one, et cetera. The data is stuck in an app, and it doesn't get anywhere.
23:02
What we need are ecosystems where this data kind of comes together and makes sense, right? So far, where we are right now, they don't. I enter data, I collect data, I have to do this. I want my doctor to make use of it, and it's not happening. I go to my endocrinologist four times a year at least,
23:22
and she doesn't even look at my phone. She doesn't care. Now, that doesn't really make sense to me. What we need is we need some sort of standardisation here. We need interoperability, and that's something ... One minute. That's something that I found out this morning going to the restroom. Even the toilet paper factories have figured this out, right?
23:44
If you go to the loo in the morning, and you take your toilet paper roll, and it's there, that's great. If it's not there, you could ask your girlfriend to knock at the neighbour's door, ask for toilet paper, she'll give you a roll of toilet paper, and, yes, it fits on your toilet paper holder. It's that easy, and that works all over Germany.
24:01
It works all over Europe. It's great. It doesn't work in healthcare. If I use my app with data, and I want to share this data with somebody else, that ends. It doesn't work for me. Thank you very much. All right. Now we enter round two.
24:21
So, Frederick, now it's the second round. You have only three minutes. Are you ready? Absolutely. All right. Go. Where to start? Ecosystems. I love that one.
24:40
So, ecosystems are right now being developed, and you know what? It is not the electronic health record systems developing it. It's not the industry developing it, the med tech industry developing it. It's technologists, it's technology companies developing them.
25:03
Right now, we are right before a big bubble is bursting and opening these systems up to each other, and it's super exciting. Right now, we are in a discussion at my little company
25:21
integrating with a number of different hospitals, but still that's just a number of hospitals. I think this is going to be bigger, this change coming now that technology companies are stepping into the game, and I love it. We also are at a point in time
25:41
where the medical industry is changing. The med tech companies are opening up. Just a few weeks ago, we launched integrations with a market leader. We already get into our little app data from CGM systems and blood glucose testing devices. Soon also other gadgets. I won't go into detail there yet,
26:04
but data is slowly becoming passively gathered, so it becomes a question of making use of the data, not just with HCP, with a healthcare professional, but that the systems become intelligent enough to make use of the data directly facing to us, patients,
26:23
and that is super exciting. Now, I believe that we need to get away from this belief that to keep on top of stuff, you need to sit there and manually enter data all the time. One minute left.
26:42
Apps are marvellous. If you want to gather data on a problem you experience in your therapy, and make the best out of it, if they help you make decisions based on that data. I'm the co-founder of a mobile health company in diabetes,
27:02
and diabetic myself. I use our own app about two weeks a month when I see something starting to change where I don't know what it is. I use it for two weeks to figure out the problem, solve it, and go on with my life. Then I come back when I see the next problem occurring.
27:21
This is the level we need to be speaking about. This is where they come in super handy to solve problems, and not as a lifestyle. Thank you very much. Thank you. All right, Basquiat. Same rules apply to you, three minutes.
27:41
Please go. Well, I agree with your second statement that apps should go away from me having to enter data, and data should come through sensors. I actually wear a sensor. That's the kind of app I use on a daily basis. I do use it daily many, many more times than I've ever used a blood glucose meter.
28:00
So I agree with that. I don't agree with your following statement that we should go away from using apps on a daily basis because for my condition and for yours, I would say I do need it on a daily basis because diabetes is not about a problem that you fix now, and then for the next couple of weeks you don't need to think about it anymore. An app will not move that problem to somewhere in the future.
28:22
I need an app that will help me every day, but it needs to be with me without bothering me, playing around with me, and kind of asking me to do stuff all the time. So I kind of agree and not agree, but okay. I also agree or I like the fact that you put up this ecosystem argument
28:40
because I think yes, that's where we're going. However, when you're saying it's not the medtech industry that's gonna be developing this ecosystem, but it's gonna be others, then I get a little bit cautious, but we're not gonna get into this whole data security privacy issue debate because that's gonna just disrupt.
29:00
This could be the knockout punch, right? If we start talking about data security and privacy, then this is dead. We're not gonna get into this. However, we do need good data security and privacy protection rules engaged. I think I have one more point that's maybe farther away from the app discussion as such,
29:24
but it's something that I feel is often overlooked, and that has to do with the human side, and that's something that maybe we can keep for the debate. We had this whole discussion about software as a drug in other forums. With the whole app thing and sensors and automization and EHR systems,
29:42
we're getting towards software as a doctor, right, or apps as a doctor. So apps start actually doing diagnosis, and you can actually use apps to find out if your heart rate is okay, maybe in the future if you're diabetes is all right. One minute. So what does that do to me as a patient and to my doctor
30:01
who yes, maybe I don't wanna see him every three months but in a way, it's good to know that he or she is there. We already have two little doctors out there. If we start introducing more and more automization apps, et cetera, then we will have even less. I talked to a doctor just a few weeks ago, and he said, you know what, I'm a land arst in Germany, right?
30:21
He likes driving around seeing patients, and he says, you know what, I actually like my job because I go out there, I see patients, and I work with them. He said, you know, I was introduced to telemedicine, and now I sit at my desk all the time, I sit in my office, and I look at screens and data. He doesn't like his job anymore.
30:41
Now that is going to be the ultimate result of digitalization and more apps that my doctor doesn't see me anymore, I don't see my doctor anymore, but all I talk to is apps that keep on annoying me with beeps and messages, and I don't have anyone to turn to anymore. I don't know. I don't know. Thank you very much, Bastia. Thank you very much.
31:01
So, I think what we're going to do now is we're going to bring up Lars on the stage, you know, when we start the discussion. I think you already mentioned something very interesting. You know, you think that the ecosystem will be, so maybe we should go behind it, or how should we do it? Let's do so. Yeah, should we go behind it? Don't hide.
31:20
Don't hide. Don't hide. Maybe these people want to come up also and fight with you. Do you have gloves? So, Lars, I mean like the statement that the ecosystem will be developed maybe not from meta companies, but maybe companies such as Apple and Google.
31:41
What is your statement to this? Well, obviously we see loads of those companies, big ones, and also startups coming into the arena, an arena that has previously been, you know, only been with the MedTech industry. And for sure, what they can provide
32:01
and where their strength is, is in, let's say, hosting, collecting data, managing data, interoperability issues, standardization issues, and connectivity issues. And for sure, they are the experts in those kinds of things. Now, the MedTech industry still needs to develop
32:22
the technology, the sensors, the drug delivery technology that actually then has an impact on how the treatment is being delivered. And with the medical knowledge that the industry has, I think it's important to take that also into account
32:42
in terms of the regulatory, the quality, and the way healthcare systems work and how we can best support patients and healthcare professionals in delivering care. So there's a lot of, let's say, intangible knowledge available in the MedTech industry that other industries obviously don't have.
33:01
But I must say, digital is just the next step in the evolution, and also MedTech industries need to, let's say, add to their hardware, to their sensor, to their technologies that they have today, the data and the digital part in order to make it a complete picture. I mean, you have over half a million diabetes patients
33:22
on your platform or on your app, MySugar. So how would you like, or how do you see the future? How would you like to work together with these MedTech companies? We already work together with quite a few of them. Just two weeks ago, we integrated with the world leader in diabetes, blood glucose measurement.
33:44
We already integrate with these automated systems, which both Bastian and I wear as small sensors, and certainly in our skin. We get those data points already, and I think that when the MedTech hardware companies start working with the software companies,
34:01
that's when magic happens, because what you connect is internet technology with medical technology. And in that intersection lie a lot of innovation. So software isn't just, like, just an app, just a health app is not enough to create relief. I mean, that's the question.
34:21
Yeah, yeah, it is already an ecosystem, and it will start, it just started to grow for real. But the question, like, growing the ecosystem, where do you see, who will push this interconnectivity, let's say, for instance, between the MedTech companies and the health apps, or even with the healthcare
34:41
professionals, what do you think, Bastian? Well, I think that's, as I said, that's what we need, integration, interoperability, and data exchange between different platforms. And I'm happy to see that you, as an app company, you're working on dealing with others, and I'm happy to hear that the MedTech sector thinks that they have intangible knowledge that will kind of protect them from the speed
35:03
in this whole digitalization debate, but I'm not quite sure that's really gonna be the case. In a way, I would wish that it is, but, you know, four years ago, I was in Russell's on the MedTech forum as a keynote speaker, and I was pulling out my blood glucose meter and my iPhone 4S at the time. You know, four years in IT is a long time at a mobile.
35:23
And I said, you know what, guys, beware. My next blood glucose meter will be my iPhone. And today, the device I pull out 20, 30 times a day to check my blood sugar is no longer my blood glucose meter, which still sits here, which I use twice a day to calibrate, but it is my iPhone. If you ask me a similar question today
35:41
regarding apps and ecosystems, I would say, beware, guys, because my next diabetes app, and that goes to both of you, is not gonna be an app, it's iOS. It's, you know, Apple already introduced health kit, research kit, and now just the care kit. That's where things are going. You will be delivering data points.
36:00
You will be collecting them through hardware. You will be maybe upgrading them through your app. You will be delivering them there, and that's where I will see them. That's what I think. Lars, what did you think four years ago? Did you think that the iPhone can be used as a glucose meter? Actually, yes. I mean, for me, that is very clear
36:21
that consumer technology and MedTech will converge in one point in time. And obviously, if you have a device already today that is able of connecting and of doing that, why should you have two or three or four? Nobody wants that. Now, the challenge is actually the quality in the regulatory setup. So as we know, consumer devices move much faster
36:43
and lower, let's say, regulatory hurdles than medical devices, so we need to find ways in order to bring that together and to assure quality for the safety of the patients. That's one thing, but we see that happening. Now, coming back to the MedTech industry, I do believe that the MedTech industry,
37:03
evolving after the four years you have been there, has also evolved, and we need to sit not where the data is collected. We don't need to sit where the data is hosted. We need to sit where actually actionable decisions can be made with the data. Now, there has been a lot of discussion of,
37:21
you know, let's collect all the data, have all that data integrated into one ecosystem, but the more data we collect, the more the healthcare professionals as well as the patients will be overwhelmed with the data that they have. Already today, they're actually not capable of processing all that data in the traditional way of care delivery
37:42
as we see it in a doctor's office. So what we need here is actually an automation, is algorithms that go into retrospective analysis of the data that is there, go into prospective analysis to see, you know, what could happen and what could I do
38:00
in order to prevent something, and then eventually go into prospective or prescriptive analysis to really actually also automatically give the right suggestions on what could be done. But the question is also like when you have an app like MySugar, are you going into that direction to make suggestions for the users,
38:20
and further down the line, are you going to replace a doctor? We already help make decisions because that regulatory and quality assurance, which is needed in medtech, well, we have already dealt with that. We already have the quality assurance systems in place, and we live up to the criteria of the FDA, the TGA,
38:42
the CE, the TUV, et cetera, et cetera, et cetera. Little app companies are audited by TUV twice a year, sorry, once a year, and blind audits too. It's kind of exciting, but we're now at a level, also app companies where we deliver class
39:01
to be medical devices, meaning actually telling you how much insulin to inject, and that's pretty hardcore, a little app company. So there are now two or three apps doing so, and also at the quality level which is needed. Roche, MySugar, well, there are actually just two.
39:24
So even startups and medtech coming together and living up to those quality criteria, it's already happening. Now replacing the doctor, hmm, I don't think that's possible.
39:40
You see, diabetes is not just about the data. Diabetes is so much about the psychology. Me going on stage here, my blood glucose rises because, you know, stage fright. And that little tidbit of information, it's hard to capture with apps and data points.
40:02
You need someone who knows it and who is able to help you get through that. And that's human. And when I see so many digital health apps, they are trying to give more suggestions, and try to dehumanize basically the whole healthcare process. I mean, what are your thoughts on this?
40:20
You've seen also a lot of diabetes apps. Well, like I said in the beginning, I'm not really against apps. I just think that they can stand alone. They need to feed into larger systems, and I think we need to think about them a little bit differently. I agree with your point as well, making things more automated.
40:40
The dehumanization part, I don't know. I mean, I don't wanna deal with me as myself in terms of looking at different apps and figures and think so much about it. If there is an app that really, you know, helps me in an unobtrusive way to make better decisions that I am still the master of, I wanna make my own decisions.
41:00
I wanna, you know, look at what I eat or just the sports I do and then decide do I need more insulin or less. If an app can really help me make better informed decisions, and if my doctor through that app can maybe even assist me, then I'm all for it. And I think, now to leave that combat form with a little bit, I think yes, this is where we're going.
41:21
But as I said in the very beginning, I was looking at where are we today, and today we're not really there yet. Yeah, I mean, when I talk to healthcare professionals and patients on the whole notion of digital health and apps and all that is included into that, they basically always come up
41:40
with two barriers of adoption. On the healthcare professional side, it's the fear of obsolescence, and on the patient side is the fear of dehumanization. And I think if we do it right, so if we design the right technology and put it to service to the system and the people with diabetes,
42:02
what we're gonna achieve is exactly the contrary. So we're gonna achieve, I mean, there are not enough healthcare professionals anyhow. And with the growing prevalence, it won't be possible to take care of all those people in the traditional way. The second point is, if we look today at a normal consultation,
42:21
it's about 10, if you're lucky, 12 minutes, four times a year. Now, if your patient of those 10 minutes spent six minutes looking at his screen and the data and trying to figure out stuff in only four minutes in meaningful interactions and conversations with the patient, that is dehumanizing. But if you actually have smart data algorithms,
42:43
you go into automation of decision-making of things that the human mind cannot process anyhow at quick speed, well, then you might be reducing that type of activities to a minute or two and have more time for those meaningful conversations with the patient. So it's completely the contrary that will be achieved
43:02
with well-designed systems. So basically, he has more free time to the patient and less time for all these administrative red band, basically. Exactly, which is what Bastian said before, exactly, physicians are physicians because they want to be close to the patient and they're forced into administrative,
43:24
let's say other types of work that could be avoided if we design the right systems. Now, the bottleneck that we're facing here when we're talking about this ecosystem thing, you are here, Frederick is here, I am here as the patient we actually do lack a doctor
43:41
because that's kind of the other side for me. You guys kind of do the ecosystem and the tools but I am talking to my doctor and he or she should stand right here. That's a bottleneck we will be facing or you are probably facing already because I've already, I do use my iPhone or whatever every day and I do use it for my diabetes data
44:03
and most of the type ones I know deal with one or the other app as we speak. It's the doctors so far who don't and like I said, I can understand them because the ecosystems that we are talking about here are not in place so it makes it almost impossible for them to deal and interpret all the data
44:24
but we need to convince them to come on board. You need to provide the better ecosystems but you also need to convince the doctors to actually want to do this. So far, my father is a doctor, he just retired until his last day in the office. He didn't even use a cell phone or a PC.
44:42
He was doing it all manually. That's the state of affairs in Germany for some of the healthcare providers. I mean the average age of a doctor is 60. So I just wanted to ask you when you started this company, my sugar, did you try to convince doctors to use your app and then how was the result? How was the process? We focused exclusively on patients from day one.
45:03
We didn't even build a doctor's portal or something like that. Why is that? Well, one of the things we found out already six years ago was that if you ask at a hospital, if you ask the nurses, the diabetes educators, the doctors, and the administrators about using IT systems
45:24
currently on the market for managing patients and stuff, and the administrative parts, the administrators loved it. The nurses, the educators, the physicians bloody hate it because they want to spend time with the patient.
45:40
So why start there when currently it's only seen as a burden to the physicians? One software comes in which solves real problems for physicians in their practice so that they can focus on the real patients, on the real issues as soon as possible,
46:02
then that's gonna work out. Sorry to interrupt, but I don't know if you have been saying what's going on in our Twitter fall. I think that maybe in the audience there's someone who has a question or wants to share an opinion. Are there any questions from the audience?
46:21
Or opinions you wanna share besides the ones that are in Twitter? Yeah.
46:52
I'd like to know more. Sorry, I'd like to know more about that and where are the hurdles that people,
47:00
that you need to work on as companies? Can I take it? So I mean, diabetes is decision making and physician decision making in diabetes is very much a data thing. So basically what you do as a person with diabetes, you measure your blood glucose several times a day. Today, most write them down in a little book,
47:24
go to the doctor, he looks at the patterns and at the values in order to make therapy adjustments, in a nutshell. Now, this happens in about 80% of the cases still today. The data is not gathered automatically. It's patients that write it down on paper
47:42
to show it to their physicians. 60% of the data that is in there is wrong already. So you're actually giving the physician a, let's say a data set to make therapeutic adjustment decisions where the data in the way it is there
48:01
is actually almost non-understandable and 60% is even wrong. Now, the next evolutionary step is, and that's about 20% of the cases, that data is already collected from all the different devices that a person with diabetes uses and is aggregated into all sorts of graphs
48:21
and graphical ways of showing that data that should be helping the physician to make better decisions. Yet, a recent study that we have put out, even in the cases where you have the right data collected automatically, no errors, no flaws, and displayed in a graphical way
48:41
that you can change and analyze, still up to 80% of clinical decision making is wrong. Not understanding, not getting the right data patterns for making the right clinical decisions. So here, the big challenge and also the big opportunity
49:03
that data can provide to physicians is actually not only adding more data, it's adding meaningful algorithms in order to filter and data mine and show the physicians already where the problem lies
49:21
and what possible solutions to that problem could be out there. So there is another, like when we talk all about data, I think there is one question that we want to take out of the Twitter fall. If we introduce more and more apps, do doctors become data analysts? Who wants to, Bastiaan, or? And that's their last question.
49:40
That's the last question. That's the last question. I forgot. Who wants to tackle that? Well, I started that issue in the last, in my second round. It's something that I wouldn't want and that the doctor that I interviewed a couple of weeks ago said that he wasn't very happy with the land arts to actually liked having real contact
50:03
with his patients and who was introduced to the great new world of digitalization and telemedicine and was kind of complaining about not having to sit in front of the computer and looking at graphs and visualization charts and FaceTime interviews or Skype sessions and kind of losing the joy in his work.
50:23
If that was the result and that remains to be seen, then I think we do have a problem. But as Lars pointed out in response to that, the idea is something else. So wait and see. All right, just to sum up the whole thing, like Lars said, there are fewer numbers
50:42
of healthcare professionals, doctors, but there is a rising number of diabetes patients, so therefore health apps or digital health solutions can provide or are an opportunity for relief towards society. Moreover, digital health solutions can save time
51:01
for the doctor with all the administrative part to focus on the patient, to have more time where it really matters. On the other hand, Bastian said, as a chronic or as a diabetes patient, it's not fun to collect data. Like me, for instance, with this fitness thing, he has to do it due to his chronic decision
51:22
and therefore he doesn't want to only collect the data, he wants to share it. And therefore, I believe that's what Frederick also said, is we need an interconnected system between the healthcare professional or the care providers and the patient. Only then, I think we all agree
51:42
that we have a holistic solution together with the ecosystem that health apps can be a relief. I think in the next five years or in the next four years, we will have also a lot of dynamics within this market. We mentioned Google and Apple coming into the European,
52:01
entering the health market. So I am looking forward with you guys in the next four years to watch the digital health ecosystem carefully and also invite you to think about data privacy, about health apps, about the ecosystem. Thank you very much. Thank you.
52:21
I'm so sorry.