Saphire Gazette: Professor Hein, when I am thinking about the model of social state in Europe or even in the world, my mind comes to Germany. For several good reasons, I think that Germany has succeeded over several years of hard work and accomplishments of the people to establish a good name for a society that is taking care of its citizens. Health is one of the most important contributing aspects to this. However, it is for some time that I see this model being shaken – internationally of course but also in Germany. This might seem irrelevant to our case of the research project SAPHIRE. But it is not: innovative technologies like the ones developed in the project can help to bring better services to more people. However, there are several impediments towards this goal: especially for the first steps, progress is difficult and uptake is not straightforward.
What is your personal view and opinion to this? And which are your own predictions for the future?
Professor Hein: If you mention the problems of the health care system in Germany, then you probably refer to the cost explosion and the rising contributions to the health insurances.
From the point of technology you should take into account, that only approx. 5 % of the whole costs of the health care system are related to medical devices, but approximately 60 % are related to personnel costs.
Therefore, we may have a management problem or cost problems with pharmaceuticals, but no direct problem with medical devices. Of course an indirect problem are the decreasing investments into these technologies. On one hand investments will be done only if it can be shown that the technologies can reduce costs or improve the quality of the treatment, and therefore reduce the costs of aftercare and rehabilitation.
On the other hand technologies need time for the evaluation and redesign, which is only possible if the technology is in use and cost-intensive clinical studies are carried out.
Another issue especially in Germany is the focus on medical treatment and the relative disregard of prevention and rehabilitation.
The proof that rehabilitation for instance by home-based training - as planned in the Homecare Pilot Application in SAPHIRE - will lead to a significant decrease of re-hospitalization and enhanced quality of live is more difficult than the proof that a specific treatment leads to better parameters of a patient directly after the treatment.
In addition, the long-term improvement of a patient’s health depends to a great extend on the individual motivation and ability of the patient to change his/her eating and smoking habits.
In general, I think the health care system relies more upon the health care institutions than to stimulate and improve the patient’s own motivation. But, this has to be change in the future due to the high costs of the treatment in comparison to prevention and rehabilitation.
Saphire Gazette: At a recent issue of an established journal in the area of Computer Science (Communications of the ACM, May 2006 issue, P. J. Denning and R. Dunham, Innovation as Language Action), a distinction is made between invention and innovation. While the first is regarded as a prerequisite for the second, it is recognized that the way to the second is a bit bigger and not so trivial.
The SAPHIRE project aims to develop an intelligent healthcare monitoring and decision support system on a platform integrating the wireless medical sensor data with hospital information systems. How close do you think to an innovation?
Professor Hein: I think, technical developments in the field of medicine are in general good examples for the gap between an invention and an innovation.
If a close cooperation between engineers and the medical staff cannot be achieved even very good ideas will not be transformed into a system that can be successfully be used in this complex field.
Problems arise from different scientific languages (Latin vs. English), different working styles (patient treatment vs. research and implementation), different publication strategies (finished studies vs. technical concepts), and so on.
There is no general solution for these problems, but research projects like SAPHIRE are necessary to establish links between medical and engineering science and to develop solutions for the specific medical requirements.
Saphire Gazette: In the project, OFFIS is responsible for two essential parts of the infrastructure: the Interoperability Platform and the Homecare Monitoring Pilot Application. Especially for the interoperability platform, the idea is to build on wireless medical sensor networks that shall base on semantically enriched Web services. How can ideas and concepts that are originally created as parts of the SAPHIRE project become part of a mainstream process? I am afraid that this does not only need some good quality research work but also some type of appropriate positioning within the market. In which ways do you think that it is more appropriate to support this process?
Professor Hein: Our concept of the Interoperability Platform only makes sense in the context of standardization and dissemination activities of the OSGi Alliance (Open Services Gateway Initiative), especially in the area of home automation.
While web services can be used from every computer, the sensor networks require a standardized framework for data acquisition, data processing and semantic enrichment.
OSGi offers a middleware concept based on Java Virtual Machines and allows basic functions as an execution environment, standard services, a live cycle management and service registry.
OFFIS works on extensions of the OSGi architecture to allow the integration of medical devices.
Another aspect is the standardization of hospital information systems and the electronic health record. Data acquired at home have to be integrated into these systems to allow a convenient access by the responsible clinician.
OFFIS is very active within the IHE initiative (Integrating the Healthcare Enterprise). Here the interfaces between different information systems will be defined to allow optimal workflows.
Saphire Gazette: The other main component of OFFIS involvement in the project concerns the Homecare Monitoring Pilot Application. Homecare has been regarded as a panacea for many different ‘diseases’ - costs reduction, better quality of life for the patients, improved use of the hospital resources and a change in the way that hospital beds are used. On the other hand, there are deeply rooted ideas and attitudes that come from the medical experts and doctors – and (not surprisingly) by the administrations of the hospitals and the insurance institutions. This means, at least for me, that any solution shall not be accepted for adoption by the ‘health industry’, as long as this has not been introduced or supported actively by the community of the medical professionals.
What is your view and experiences on the above?
Professor Hein: Of course, as I mentioned earlier, the medical professionals have to be integrated into the design and development process.
Only if our medical partners can show in their studies that the use of our technologies will lead to better medical treatments or costs reductions, the health industry will accept our approach.
In addition, we have to elaborate business cases for our industrial partners, even while we cannot foresee the general legal and administrative framework for the new emerging field of homecare.
Within the project we have to show, that - in our case - the home-based training and monitoring is affordable by the patients or the health insurances and on the other hand hospitals have a countable benefit, too.
Saphire Gazette: In SAPHIRE we are lucky to work with two extremely good User partners: both the Romanian hospital and the German clinic have been a fortunate surprise, as they can organize a very good participation and interaction with all the technology partners. However, I think that you would rather agree there is a difficulty in the language, the mentality and the attitude of medical professionals regarding the use of new technologies. And it is good to agree that they are not always wrong, as much of what they are offered is not necessarily improving their daily routine.
Which are your experiences and feelings about this?
Professor Hein: Indeed, engineers tend to develop – in a technical sense - nice solutions and because the technical design and implementation process itself is quite complex, they also tend to ignore the medical context and the medical needs.
That is the reason why we have implemented a design workflow over the project starting with an initial requirement analysis from the medical point of view and ending with a clinical evaluation of the two demonstrators.
In addition, the European directive for medical devices force us to continuously monitors potential risks for the patient.
This all requires a continuous communication with our clinical partners and a good personal understanding.
I agree with you, that we can be lucky to have such motivated and interested clinical partners.
Because they trigger our technical developments and ask for their real benefit, we will hopefully be able to produce good solutions.
Saphire Gazette: Coming back to the starting question about the social state in the sensitive area of health, how do you view the risk of high technology in the area of health:
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