Digitalization in medicine

An interview with Prof. Dr. med. Sehouli about man and machine

Clinical routine and research - what is the current state of affairs?

Interview partner or otherwise content related
Prof. Dr. med. Jalid Sehouli, is an internationally recognized expert in gynecological cancer (gynecological oncology) and works both as a director at the Charité University Hospital in Berlin and as a leader in various national and international projects within cancer research. He is also a writer and author of various works.

CH: Prof. Sehouli, can you give us an insight into how far the topic of digitization has already entered everyday clinical practice?

JS: Digitalization is already there - no question about that - but it's still a long way from being able to take an iPad in your hand, for example, and use it to control all the processes that go on in everyday hospital life. Likewise, not all network systems in use are connected to each other. We at the Charité are already very far in the field of digitalization and have just started a pilot project in which we are introducing the digital medical record. Patients do have a medical file, but due to the involvement of various doctors, but also other disciplines such as social medicine, psychology, etc., not all of the information can be found in the classic file and, above all, it is often not filed systematically. That's why we have just launched this digital project, where we can already conduct rounds via electronic medical records with the iPad in the patient's room and present the patient with x-rays or laboratory findings. It is quite annoying that one makes rounds in the clinic, which usually take five to twenty minutes per patient and where one often finds oneself in the situation of answering the patients' questions about the organisation: "I don't know", "haven't seen it yet", "can't find the findings now". The patient of course wants a plan, wants to see results and wants to have them visualized and explained. And digital technology is certainly helpful here. I am also convinced that this is a way to simplify processes. This does not mean that digital medicine can actually replace the relationship with the patients, but it can simplify things and avoid unnecessary "ballast discussions" and create more space and time for the really important conversation with the patients

CH: In your new book "On the Art of Delivering Bad News Well", you describe very vividly from your own practice how important it is to attach a higher value to the patient consultation and to proceed there in the same calm and structured way as in the treatment itself. What is your opinion, will digitalization rob the patient of important "human" closeness to an important reference person like the doctor or will it allow more humanity, as the doctor has more time for an exchange with the patient again?

JS: That is of course a big challenge. I don't think that digital medicine can be measured by the fact that the doctor-patient relationship must measurably improve as a result. Because the doctor-patient relationship has a lot to do with trust, has something to do with contact, with re-encounter, and this should not be in competition with any technique.

That a triangular relationship between doctor-computer, computer-patient is created is not desirable. The focus must always remain on human relationships. The exchange, the dialogue, must remain the leading factor in all processes. The triangulation between computer, doctor, patient should not negatively influence the relationship between man and man I get feedback from patients again and again "I was with the doctor for 15 minutes and he did not look at me once". And this is very important: Maintain mindfulness! Nevertheless, digital medicine can simplify processes and reduce the need to search for findings. Because if I have five to fifteen minutes and then hear that the food was ordered wrong and I don't know when the computer tomography will be done, I don't even get to the conversation that the patient has pain or psychological problems.

The digital processes are important, but should be in one platform. What I keep seeing is that there are many independent digital solutions that are theoretically compatible. But when it comes to making it compatible, so that you transfer one system to the other system, then again there are problems. From my point of view, it is therefore very important to think big and not always find new individual solutions. We need a platform for each individual patient in horizontal support and a multimodal therapy strategy. We must try to prevent the isolated fragmentation of processes in the patient.

CH: This seems to be one of the central issues, even beyond medicine: The silo issue is a major obstacle to showing the real added value of the overall solution.

JS: Right! And above all, this fragmentation is a central problem that distracts from the basic question: "What am I doing this for?" If I do this in order to have a control system, do I do this in order to relieve the burden on non-core processes or do I do this, for example, in order to make my working methods more transparent to my patient. I think these are the key questions and that's why I would always warn against saying that digitalization actually improves the doctor-patient relationship. This is not a hypothesis that can simply be made provable. The physician is, due to this compression of all work processes, understandably more and more in a hectic pace, but if one had asked the physicians 50 or 100 years ago, who were not called physicians at that time, they would also say "time? we have little time".

CH: Let's turn to the field of research: here too, you are driving forward projects that use the latest technologies. Can you give us more details on this?

JS: We conduct national and international clinical studies. They are monocentric and multicentric, i.e. in one clinic or in many other clinics or practices. The documentation of medical results is thus generally recorded electronically nowadays. This means that the study nurse at the centre enters the blood values and we record the data centrally, thus reducing transfer errors from the paper file to the electronic database. It also speeds up the process of identifying what data is missing and allows interim analyses to be carried out much earlier. So-called electronic documentation files CRF (Case Repot Form) are firmly established.

A more recent topic is that people are increasingly trying to measure not only disease, but also quality of life. This is done by means of questionnaires sent to patients via mobile phone, iPad or computer. And the latest trend is that you generally measure activities, how the heart beats, what the steps are like during the day, whether someone is sleeping well... For example, we are in a project with GARMIN, in which patients during chemotherapy are continuously questioned about the side effects of cancer therapies, activities, etc. This is a major new trend, not only in terms of life time and length of life, but also in terms of what the patient evaluates, the so-called 'patient reported outcome (PRO)'. All this is of course digitally structured as well.

CH: So many new perspectives are opening up in research. - One last question to encourage all those who are currently still shying away from the topic of digitisation: How technically minded are you personally, or how much technical understanding is needed to initiate such projects?

JS: I'm, do I think, just a little bit technically minded, I'm more of a user than a technical expert. As a classical physician, one is not so close to the technology. That is why you study medicine and not physics, mathematics or engineering. I have basic knowledge and use a mobile phone, but a very old one. I use WhatsApp a lot, answer my e-mails and of course make my electronic presentations with the classic software programs like PowerPoint etc. I think it is important to realize that the 70-year-old person today is also different than twenty years ago and that digitization is not a question of will, but our reality. When I see what our children do with electronic media, I was naturally far from it as a child. Currently, however, new medical courses of study are also starting which have defined digitalisation as the focus of their education. This branch will certainly become even bigger in the future.

What is important for my current projects are simply good partners. Partners who also understand the subject matter and do not just have the technical background. A partner also needs to understand the processes where he can support, where goals such as patient relationship, compliance or adherence to therapy are needed and a sense that the technology will not interfere. And that succeeds.

CH: What do you pay attention to and how do you manage to find really good partners?

JS: That's really a big challenge, because unfortunately there's no real platform where you can look for references and see who's done which project. You don't even know if my neighbour in the clinic or the neighbouring institution has such a concept. That's why this is really difficult and has a lot to do with word of mouth. That's what I sometimes miss when we talk to partners, that they have the solution right away, but very much on a technical level, but don't know the field trials yet, don't have clinical experience and don't even have the reproducibility of their processes. This, I think, requires a continuous dialogue and therefore I would be very happy if there were also a structure in which you could record your successes, but also your failures.

CH: Thank you, Prof. Sehouli for the interview.

"On the art of delivering bad news well", Kösel-Verlag, ISBN 978-3466347025