Q: How do you relay that kind of information between the hospital and the home?
A: That is a critical question, because nothing I described will work at scale without having the appropriate platforms that can exchange information across the care chain. You need a solid foundation before you can build a house. It’s the same with information infrastructure in healthcare, which is still quite fragmented today and which was not designed for connecting care to the home.
At Karolinska we envision an integrated information infrastructure for wireless and location-independent monitoring of a patient’s vital parameters, including patient self-assessment, where data flows seamlessly between different care settings. In all of this, the patient should be in the driver’s seat. They should have secure access to their medical records, imaging studies, lab results, etc. – while also being able to share that data with primary care physicians and other caregivers.
We are not fully there yet, but we are taking steps in the right direction. We are also building a central health data platform which will ingest, transform, store, and make data available from many different sources. This platform will make it possible to create patient overviews, support research, and develop new clinical decision support applications, including machine learning algorithms that could help predict and prevent patient deterioration. There is a lot of promise in AI, but we need to do the groundwork first by putting the right information infrastructure in place and by gathering properly annotated data.
Q: You mentioned data exchange with primary care physicians. How do you see the role of partnerships in building a more distributed and connected healthcare system?
A: I think partnerships are going to be crucial. What I have spoken about cannot be done by any sole entity. We need to work together, and that’s why we are partnering with many different organizations across the healthcare ecosystem – including other healthcare providers, pharma, med tech and IT companies.
Primary care providers are of special interest because they could take over some of the specialist care that is being delivered in hospitals today. For example, patients with congestive heart failure could have regular follow-up appointments with their primary care physician, rather than having to go the hospital every few months. Ultimately, given the demographic pressures we are facing, I foresee that more and more care will shift to primary care providers. It’s another reason why we need to have a strong information infrastructure in place that can connect data across settings.
Q: Looking towards the future, what are you personally most excited about as a clinician?
A: Working in perioperative medicine and intensive care, I am excited about the prospect of having more information about patients before they enter the hospital. Today, there is a lot we know about our patients – but there is also a huge amount we don’t know. For example, I would love to know more about the patient’s lifestyle and health: how much are they moving every day, do they experience oxygen desaturation at night, did they follow the no-alcohol protocol in the weeks prior to surgery? We could gather a lot of that information – or at least indications of it – through remote patient monitoring.
Having that kind of information would help us better tailor our treatments and anesthesia plans to specific patient needs. We would also be able to better predict the risk of complications, enabling us to intervene early when needed. And we may learn that certain patients actually don’t need the intensive care they are getting today, which would allow us to free up scarce beds for other patients. There is a significant shortage of intensive care beds in Sweden, and realistically we cannot double the number of nurses – so we will need to get smart about how we use technology to use our resources most efficiently.
I think we should not underestimate the urgency of healthcare transformation. In Europe, the ratio of the working population to people aged 70 plus is now 3:1. By 2050, it will be 2:1 – leaving much fewer people to care for the sick and elderly. We really need to act now – and innovate together – to be prepared for the demographic shifts that are coming.
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