Artur Olesch on the use of health data, European policy and book recommendations

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me, Tjasa Zajc. What have you been reading lately? This is the question that I asked Artur Olesch, Berlin-based journalist specializing in digital health.

[00:00:22] He's also the founder of AboutDigitalHealth.com and the editor-in-chief of ICT and Health International. Artur follows digital health development on a daily basis, he is an advisor to many conferences, he moderates events and has a broad understanding of what's happening with healthcare and legislation in Europe.

[00:00:45] In this short discussion we talked about which books related to healthcare and more broadly caught his attention.

[00:00:53] We also touched upon topics of the EU AI Act and other regulations that you see in Europe and our expectations about the potential and the pitfalls or fears that we have around healthcare digitalization.

[00:01:08] Enjoy the show and if you haven't yet make sure to subscribe to the podcast wherever you listen to your shows.

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[00:01:50] Artur, hi and thank you so much for joining me on Faces of Digital Health for a discussion around healthcare trends. You're a well-known journalist covering digital health in Europe.

[00:02:17] So I'm sure we're going to have plenty to talk about around the EU AI Act, around the development in Europe. But since it's summer and since you often write reviews or what stuck with you when you read new published books in digital health,

[00:02:34] tell me what are your top three and why? What are some of the key insights that you read in the books lately? First of all, thank you Tjessa for having me on your podcast. I've been following you for years.

[00:02:51] So also as a journalist in healthcare in digital health, you are giving me so many insights and so many inspirations and I'm really glad that you do that podcast. And you reach some people that maybe are not familiar with digital health.

[00:03:05] So you are doing a great job. But now let's go to the first question. Yeah, you are right. Finally summer and finally a little bit more time for reading and for all the books that's been laying on the shelves for months.

[00:03:22] The first one I would recommend and singularities near by Ray Kurzweil. Probably Kurzweil is an American computer scientist and engineer who became famous basically with his book, The Singularity is Near. It was published in 2005 if I'm not wrong.

[00:03:45] Yeah, and in 2005 Kurzweil predicted that around 2013 we will reach so-called singularity. It's a state in which the development of technology is so fast that humans basically are unable to control it or to follow it.

[00:04:05] And the singularity is near is a kind of continuation or rather an update of these visions that Kurzweil already predicted in 2005. So what's interesting is that Kurzweil outlines very bold visions for the development of new technologies such as for example autonomous cars,

[00:04:29] super computers or other advances in clean energy. But for me, of course the top turn healthcare was the most interesting one. When talking about healthcare and medicine Kurzweil is focusing on three trends or three things.

[00:04:46] The first one is the use of AI of course to predict 3D models of protein structures and the development of new drugs. Kurzweil writes for example about AlphaFold. It's a Google DeepMind project that aims to accelerate research or even unlock the mysteries of how life itself works.

[00:05:10] And in this case, his predictions seem quite realistic and I really liked it. Further on Kurzweil highlights some kind of controversial technologies about which I have my doubts.

[00:05:27] So it's still very interesting and very insightful book but in some parts I think he lost himself in predicting future that is probably unrealistic.

[00:05:38] So for example he claims that in 2040 or 2050, latest 2060 we will be already able to copy our brains and consciousness to the cloud so we can live forever in the cloud. This is the first prediction. The second prediction are visions of nanorobots in medicine.

[00:06:02] He envisions that millions of miniaturized robots infused into the human body, into the human blood will repair ourselves and kill viruses and bacteria potentially making people immortal. So I read recently an interesting article on Wired and they sum up the book of Ray Kurzweil very shortly.

[00:06:29] Ray Kurzweil rejects death and it's really straight to the point. In my opinion this is more science fiction than science for now but nevertheless it's a fascinating book and I really recommend it so if you can read it just do it.

[00:06:47] Speaking of predictions if you just stay with this one for another second. So you also have keynotes where you give presentations around your observations on healthcare and I find it quite interesting that you mentioned basically the overhyped expectations related to the progress that we can see in healthcare.

[00:07:06] So from that perspective what are some of the other thoughts that you hear in the industry in terms of the potential that potentially seems a bit unrealistic to you based on your insights. Yeah as you said there is a lot of hype around new technologies.

[00:07:26] We have AI, generative AI that is quite new. Everybody is talking about generative AI. AI is everywhere at once. Of course at this stage everybody hopes that AI is this medicine for healthcare system that is not working very well.

[00:07:44] And I also have my high hopes regarding AI but slowly we are realizing what we can do with AI and AI is not a silver ballad for everything that is not working in healthcare.

[00:07:58] There are a few things like for example doctors are overburdened with all the bureaucracy of all the paperwork, typing in the patient records into the computers. So in this area AI can be a big help but in other areas I think that it is still overhyped.

[00:08:19] Of course I make also my predictions because people are very interested in predictions. They want to know what will happen next. They want to be ready for what will happen next. But I try to be quite down to earth not to overpromise.

[00:08:35] We are still in healthcare so we shouldn't overpromise that for example in five years AI will accelerate the development of medicines because we are giving hope to patients that are waiting for this medicine.

[00:08:49] So let's be realistic. Let's of course make big visions because these big visions are made for that to motivate people to make progress so it is still okay. Yeah, that actually totally reminds me.

[00:09:05] So the association that I had when you were talking about the expectations and managing them was the quote from one of the interviews that you did with Professor Barbara Preysak,

[00:09:19] the head of research platform governance of digital practices from the University of Vienna in Austria where you guys talked about the use of data and data solidarity. And she said that societies that chase profit and economic growth will always reward irresponsible data use.

[00:09:42] So what do you think about that in light of all the discussions that we have around GDPR, around AI, around the European health data space where we emphasize that we want to use data for good

[00:09:54] but you have a lot of people in the industry that are based warning that profit is going to be the primary priority. Yeah, that's a good question. I'm neither an expert on ethics nor a lawyer but I will try to answer.

[00:10:13] First of all, I'm quite happy that the discussions continue despite huge disagreements on how we use data in health. From my perspective, the use of data is very strongly linked to democratic values and that is why this discussion will have no end probably.

[00:10:35] We need to find a compromise. It's very difficult to have this global consensus because every country has a different approach to data which is influenced by its culture or the level of trust in the government and so on.

[00:10:49] Of course, we have in Europe here our approach to data that is very ethical and we want to create this trustful ethical data ecosystems.

[00:11:00] So let's stick to the Europe and I really value Professor Barbara Preysnack's contribution to do work on ethical use of data and I agree with her words that you mentioned that societies that chase profit and economic growth will always reward irresponsible data use.

[00:11:21] The problem is that the system we have. So now it's a matter of matching regulation to this system. I think there is a broad agreement already on the primaries of data, the data are assets of every patient and of course this raises a lot of questions such as since data are out by the patient as we have the right for example to sell it.

[00:11:44] For example, for scientific purposes probably not. I had this discussion with Professor Preysnack recently and she told me it would be somewhat similar to organ trade and would encourage for example analytical behavior.

[00:12:05] So this is one aspect and another aspect of data use is the secondary use of data. I guess that almost everybody will agree that randomized data should be used for scientific purposes in some way, for example to develop new drugs.

[00:12:24] But what counts as such data? Just health parameters, just data that we are covering. For example, all the variables data that is covered in the doctor office or maybe also behavioral and lifestyle data.

[00:12:43] So you mentioned also the European health data space and the European health data space EHTS is a kind of optimistic sign that there is a European consensus on how to share data and how to use data.

[00:13:02] When you asked me about data and how to use it, when to use it and should we use it for profit or not. I sure finished approach which I heard at one of the conferences I attended.

[00:13:17] The health system has a responsibility to protect our health but also we as citizens. We also have kind of responsibility to create a strong health system by sharing our data.

[00:13:32] So it's solidarity approach which is from my perspective very fair. So, fairing data is caring. We will have this discussion about buying data, about selling data.

[00:13:46] We are at the early stage of digitalization and the access to data. It's the first time in the history that we have access to data. We can use data. So now we will have to work out the way that we use it in an ethical way and in accordance to values that are common here in Europe.

[00:14:06] I think that there's a lot already happening with data gathering and data analysis in the US, much less in Europe. In the public eye it's often underestimated how far data use still is because of different standards because of like interoperability.

[00:14:27] So the actual usability of healthcare data. We like to talk a lot about the potential of data analytics but a lot of data just sits where it is.

[00:14:41] So what are some of the solutions that you saw maybe in this kind of data field that you found most inspiring? Are there any use cases that you saw in Europe? I know that you also visited the ARC in Israel and Israel is a frontrunner in AI development. I'm sure very inspiring but anything in Europe that kind of caught your eye?

[00:15:07] I've been following some examples of data used in hospitals using a simple AI algorithms for example to monitor patients health staying at the hospital or just orchestrating the patient journey within the hospital.

[00:15:27] And I think this is an example where we can really improve the quality of healthcare when patient is staying at the hospital. We are sometimes talking about this high tech solutions like generative AI in healthcare but there are already great algorithms that are used by leaders like for example Mayo Clinic.

[00:15:51] Recently I found out that Mayo Clinic is using a range algorithms, very simple ones and they are just helping for example to setting up alarms and when something is going wrong with the patients so the people of staff in the kind of command center they had a feedback directly.

[00:16:12] So this is something that maybe we should go this direction of course this customer focused solutions like personalized prevention, personalized advice, how to eat, how to move, when to do sport, how to sleep.

[00:16:30] This is also something that I think will contribute to healthcare system, not in the future but already is contributing a lot of startups working on solutions just for a consumer user.

[00:16:44] You reminded me when we talk about personal health, one of the questions that I still have around digital therapeutics is how successful digital therapeutics for mental health are.

[00:16:57] I know they are supposed to be an add on therapy to existing therapies but do you have any insights in terms of the actual usability or feedback from clinicians that have prescribed DIGAS and why they prescribe them, how they learned about them because we often say that people in digital health know what digital therapeutics are but most clinicians won't really.

[00:17:27] I don't think it's true because recently I was visiting my doctor and I asked her if she knows what is DIGAS, what digital therapeutics are and she told me of course I know I have even some leaflets of some DIGAS so I can prescribe you if you want to.

[00:17:48] I had this possibility to try one of the DIGAS within a pilot project and it was very interesting opportunity and also experience because I had an app that was giving me advice on how to sleep and to improve sleep even if I don't have problems with sleeping.

[00:18:12] I still this one month program and being coached by someone by digital code was an opening experience and I realized it could work really but the thing is that we still have to learn how to use this kind of solutions because we've been learned so many years that it's enough to take a pill and everything will be better

[00:18:39] but we haven't been learned how to improve our behavior to get better, what I can do personally to get better and this approach is I think very damaging in the long term and I hope that we will start teaching at school also how to take care of ourselves

[00:19:01] and this will also lead to this digital maturity or digital literacy among citizens that they will know okay maybe the pill isn't perfect so I will take the DIGAS, I will take a DIGA.

[00:19:18] There have been a few articles in the press that the doctors really don't know what is DIGAS it was something like 50% of doctors don't know what are digital therapeutics.

[00:19:28] I'm not surprised because it's the beginning how long the digital therapeutics and DIGAS are on the market only a few years so we will still take a few years that everybody knows what it is also the citizens and the patients.

[00:19:44] I agree that we're still in very early stages of that. I said three books, we started with one what are the other two? Wow you surprised me.

[00:19:56] Okay three the first was a read Kurzweil the second one that I read two months ago is the book called intelligence living and working with AI written by Wharton professor Anton Molyk. If I'm right.

[00:20:12] Yeah, unlike Kurzweil book Molyk is quite optimistic about AI developments and he sees AI as just another tool for the advantage of humans and he encourages experimentation with the native AI to know a rest of progress.

[00:20:34] He's a professor of AI so I trust him probably more than I trust Ray Kurzweil was working for Google and basically he was also promoting a lot in his book all the solutions AI solutions made by Google.

[00:20:49] My professor he is very down to earth when it comes to AI so what particularly resonated with me was his view on AI in healthcare there's not much about AI in healthcare in his book but according to Molyk, AI is not able to for example replace any healthcare worker that can take over some tasks and it's very realistic view because healthcare is a system with a lot of

[00:21:19] this internal relationships in which doctors and nurses have roles beyond only medicine and it's interesting how all these relationships are working and how it's hard even if let's imagine that there is a item can already replace a doctor and nurse so even if it's possible we won't make it because all the relations that in the healthcare complex system.

[00:21:44] They won't make it even possible so if you have some times I really recommend this book by Professor Molyk. It's a great dive into the AI buy from the very realistic point of view.

[00:21:58] Yeah, as I mentioned earlier we still have a lot of data issues that need to be solved before large scale AI applications. One that I find most intriguing is the use of billing codes for basically prediction models.

[00:22:16] I know that there's an Israeli company that's already doing that so if you've got two patients and just take their billing history you can potentially predict what kind of complication one person could have based on the same pool of patients with similar problems.

[00:22:36] So using that and tailoring preventative measures based on that information is one of the things that I find in a way scary from the personal point of view that somebody predicts what's the next disease that you might have but at the same time it could have a huge impact on the efficiency of healthcare systems.

[00:22:56] Yeah, we still have to think about is what to do with this kind of data to know in advance that you will have this disease or another one.

[00:23:07] Do I want to know it or rather not? So I guess it will be possible in the future of course but it will be also my freedom to decide if I want to know and a freedom not to know basically.

[00:23:23] And there are some scary solutions recently I've been writing an article about for example operation room black boxes.

[00:23:30] So black boxes like in the airplane that are recording everything that is happening during the surgery on the one hand it's fantastic because after the surgery you can analyze step by step what is happening at the operation room and you can find out okay we did this mistake and we should avoid it next time.

[00:23:50] On the other hand of course it's like a big brother for a surgeon for doctors working at the operation room because the big brother is watching their hands and when something goes wrong we can analyze it step by step pixel by pixel.

[00:24:08] So it's also scary but I think it has also a big potential in the future.

[00:24:13] Yeah for the improvement of the work of individual practitioners and professional development. You go to a lot of conferences does anything stand out to you in terms of what you heard recently in 2024 you were at him zero you were at Bits and pretzels and many other conferences when you started talking about scary potentials and.

[00:24:43] And the potentials and surveillance I remembered the session at him's Europe 2024 around the usability of VR where they used it for simulating a plane crash.

[00:25:02] And there's a game that you can still play online and basically try to remember all the safety instructions that we always get when we sit on planes.

[00:25:15] And those that flew more than three times probably don't listen to instructions anymore when you hear them before takeoff but through VR they show that actually people remembered much much much better the information really stuck with them in terms of what the right way of acting is if a plane crash happens.

[00:25:41] So what did you hear at conferences in 2024 that gave you most food for thought or you thought was really insightful. Not just something that we keep hearing about.

[00:25:55] I keep hearing about AI of course all the time as I said before also the him's conference there were a few sessions on AI but I would say it wasn't an overhyped topic during the him's conference.

[00:26:11] So there was a fantastic session on AI leadership with Chris Ross from Mayo Clinic and some of our representatives of leading hospitals in Europe in Israel and also in France. And I learned a lot of how to implement AI in a health care.

[00:26:29] What is the topic number one from my perspective just leaving behind I a little bit leaving behind you are act and he had to use that was also the main topic of the him's conference.

[00:26:43] Also called ambient intelligence systems EHR electronic health records it's the pain point of health care right now. I'm so fascinated by the use of this ambient intelligence that automatically create electronic health records.

[00:27:02] This is something quite new and I have seen it recently at one of the conferences it was in the him's conference but I've seen how these computers are just creating electronic health records just by listening to the conversation between a doctor and between a patient.

[00:27:20] And this is so fascinated because doctors have been typing in all the data for years. And finally they can free up their hands and they can talk to the patient and computer is doing that what they've been doing for years.

[00:27:38] So I think this is something that is enormous potential of course.

[00:27:43] We have to think about is how to convince a patient but they are already studies where the patients said yeah we are convinced this is working and I'm really happy that my doctor finally can talk with me can take time to talk to me.

[00:28:02] Not just looking at the computer and just typing in. So there are a few first studies that are showing the advantages of such a system.

[00:28:12] So I think this is something that is coming and with the generative AI the progress in ambient intelligence will be quite huge in in in the next years. Yeah I'm I hope that finally after this years of doctors hating really hating.

[00:28:32] We will have something that will make you great again. Yeah yeah it's good also for patients if they get a copy of the conversation because studies have shown that when you're talking to a doctor.

[00:28:51] I don't know what the right percentage is it 60 or 80 percent but like the majority of things that the doctor says you won't remember just because it's an emotional situation.

[00:29:02] It's a very specific situation and one thing we often just patients is how well prepared it's worth going to the doctors and I really liked the book from a behavioral specialist from Israel.

[00:29:17] I can't tell you I'm sure yeah so she wrote this book called your life depends on it and the gist of the book is that whenever you go to your doctor remember these three questions.

[00:29:29] What are the risks what are the benefits and what are the alternatives of anything that's just it to you and just through that you can increase the amount of information that you get and increase the thinking around.

[00:29:42] What are the next steps are going to be and speaking of books what's your number three I can't believe we are basically centering this whole discussions around the three books I thought it was gonna be the first question and then we're just gonna steer to other places but it's good like this too.

[00:29:59] Yeah but I'm reading books about a I all the time so I promised the third book won't be about. Yeah so what is it right.

[00:30:09] Yeah so the third book that I reading right now is super forecasting the art and science of prediction no medicine no health care just prediction and future so this is a book about how to predict the future using various techniques however it's not about fortune telling it's about tapping into historical information or analyzing the data.

[00:30:36] So I think that the opinions of various experts to create some kind of scenarios of the future so I think but even if it's not about health care that this book is also useful for people working in health care because it teaches how to anticipate the development of for example new technologies in health care and even a.

[00:30:57] So yeah after reading this book I really started to doubt even whether a very cool to buy the the author of the book singularity is near is a good forecaster or if his forecast are coming from tip of the nose as the offers described it is phenomenon this eagle focused approach.

[00:31:19] Yeah this is the third book if you are already asking about books I will add to last that I'm going to read this summer and I would also recommend the first one is a new book by Frederick third he's a Google's first chief information evangelist and the title is what's next is now how to live future and the second book.

[00:31:46] The type just ordered on Amazon is a brief history of intelligence why the evolution of the brain holds the key to the future of a I hope this book will enable me to understand how human intelligence is working and how I in the future could be built to mimic this human intelligence and if it's possible anyway.

[00:32:10] So a lot about predictions and a lot about AI.

[00:32:15] Why maybe it's maybe it's about someone this break where I have more time to deep dive into topics and just to write about things that I would like to write about and I don't have to rush from one conference to another one you know what very well.

[00:32:33] Yeah but it's also a good strategy because as you mentioned in the beginning technology is developing very rapidly and if we want to write about it.

[00:32:43] We also need to understand it and that's one of the huge challenges in healthcare how can you ask you the workforce that's already incredibly burdened and the need for experts that have the technical and clinical knowledge is increasing.

[00:32:59] And that's really challenging because it's not yeah basically two very heavy subjects need to converge in one person.

[00:33:09] Yeah exactly at the HIMS conference during the session I leadership I remember Chris Ross from Mayo Clinic said that there is no way to implement any AI algorithm any new tool that is not integrated into electronic health record because doctors are already working on the same thing.

[00:33:29] They're already overburdened and they don't want another application another system another screen even one click more is too much.

[00:33:38] So it's a very healthy approach to technology I think it's a new approach to technology because before we were so fascinated about all these possibilities all these applications and we have all the startups developing great tools and promising.

[00:33:55] You don't have to worry about clicking more because it will help you in your work but at the end of the day the doctor the nurse they have to use it and they have to click it through or open another window.

[00:34:08] And that's quite new approach no new tools just everything implemented integrated into electronic health record. Yeah yeah a dream come true for many healthcare professionals. One last question.

[00:34:23] As someone observing health tech very closely what are you most hopeful about and what mode worries you most in terms of trends. Yeah I think that I have a lot of hopes high hopes because there are so many unsolved problem in healthcare. The first one I mentioned already.

[00:34:49] This is so called ambient intelligence that would help to to create the electronic health record and to gather data from patients. This is the biggest hope for me that finally we will solve this problem of electronic health record and doctors will have more time for patients.

[00:35:09] Where another hope is that AI can do a lot for patients and for citizens. We are the early stage of the development and we are slowly experimenting with how we can implement AI in prevention for example.

[00:35:28] And I hope that in the future we will be able to connect all the data points from different data silos and all the behavioral data or the medical data.

[00:35:42] All the data from variables to find out some kind of tracks and to find out what's wrong with the patients in advance or how we could really prevent some diseases.

[00:35:55] This is not new but this is something that I hope that the doctor of the future won't be doctor walking basically in the hospital but doctor that will be health architect or something like this.

[00:36:07] So yeah this is my big hope I don't know if it's down to earth. So but also yeah as for concerns I'm afraid that for example data protection issues or the interest of individual groups will inhibit potential positive changes in health care.

[00:36:31] Because we've been talking about all these technologies and all these advances it's great. But for years I have kind of impression that data production is simply an excuse in health care which is stuck in archaic structure.

[00:36:49] So I often say that health care in health care we are basically dealing with so called theater of innovation not innovation but theater of innovation. Seemingly everyone wants to change and but too many groups are beneficiaries of the current inefficient health system.

[00:37:10] So that's why resistance to digital transformation is so strong even if we can't see but it's there. So don't ask me what to do with that to change it but I'm afraid that this data protection thing will just hamper all the innovation that we have.

[00:37:31] And we will continue doing what we've been doing for years so this is something I'm really worried about. Yeah progress is slow in that regard but you just got me thinking because when I was thinking about this question I didn't consider what my answers would be.

[00:37:48] What is your answer.

[00:37:50] I think my biggest fear would be that we start relying on health care too much and that I'm on the operating table while the doctor is using an XR headset to basically manage the operation and the hospital is under a cyber attack so that system gets hacked.

[00:38:12] So that would be quite. So the cyber security is key for the future of health. I think it's getting increasingly complicated and as hospitals are digitizing it's becoming more and more crucial for systems to be protected.

[00:38:28] And the thing about cyber security is that the less user friendly the system is the more secure it is as soon as we try to make it more user friendly with access cards etc. As single sign on it's more vulnerable. So yeah that's on the fear side.

[00:38:45] On the whole side now I'm in the role of the journalist and I will be asking.

[00:38:51] So what are you hoping for actual usable predictions or advice based on patient data so for example I'm tracking my sleep through the Apple watch and I tested a ring which gave you scores but it wasn't really useful because I got these great sleeping system.

[00:39:15] I scored one day and. You might say oh you should do exactly what you did that night so your sleep is going to be this good.

[00:39:25] The problem is that the reason my sleep was great that one night was that I have a five year old and he was staying with his grandparents on that night. So the solution isn't for me to upload my kids to someone else so I'll sleep good.

[00:39:39] So I think you still have a lot of work to do in the recommendations for behavioral change and all the factors that are impacting our health. But yeah the thing that I mentioned before around improving and optimizing care through better preventative actions.

[00:39:57] So yeah based based on billing data or some other clinical data I think that has huge potential so we don't have one side fits all screening programs today which are still very useful but we probably do a lot on the optimization side of those. So that's that.

[00:40:16] Yeah that's what you said about this scoring system because I had a similar situation and then I realized that even the best AI can still understand the context of the situation. And context of the situation is very important.

[00:40:35] I recently had an interview with an expert on robotics and she told me imagine that there is a interview for a new job position and you are very nervous but you still try to smile and you still try to look very relaxed.

[00:40:51] So the AI system would say he's relaxed he's smiling. He's doing very well but people sitting on the other side of the table they would say OK he's pretending to be so relaxed because we know how he feels at this situation.

[00:41:07] So the story about scoring systems and why sleeping when I had a COVID-19 a few years ago for the first time. The first night was really a nightmare because I tried to sleep but I couldn't so I decided let's not move and maybe I will fall asleep.

[00:41:27] And I didn't sleep at all that night but in the morning my smartwatch told me you slept very well eight hours just because I was trying not to move that night. And my smartwatch interpretation was like OK not moving it means sleeping very well.

[00:41:49] Yeah yeah yeah yeah still allows to do in that department. So we'll continue the discussion I'm sure at another opportunity at another conference where we will meet in person.

[00:42:02] But for today Arthur thank you so much for your time and the insights that you share and do keep writing about the books that you read on your LinkedIn profile. It's really useful for others that maybe haven't picked them up to get some sneak peek into that content.

[00:42:21] Thank you very much. Thank you for having me and please keep doing your podcast because it's also great source of insights and information on what is happening on the market. Thank you I will. Thank you.

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