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More time with instead of just for patients.
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The digital transformation is providing a powerful boost to innovation in medicine. The doctor's competence is undisputedly the real key to successful treatment, but digital technology can also support and relieve the doctor in his or her work. Whether as a high-precision robot in the operating room, as a fully automatic laboratory device for reliable analyzes or as software that searches for abnormalities in X-ray images, blood or tissue samples. And with the advances in the development of artificial intelligence (AI), it is foreseeable that more and more tasks in the health sector will be taken over by machines; For example, an algorithm can link the identified abnormalities to other parameters and thus support the risk assessment in preventive care.
Roche Diagnostics Germany
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"The time that we can personally spend with our patients to explain their illness is a gift for both sides," says Dr. Alexandra Farfsing from Roche Diagnostics Germany. “Our patients deserve to be informed about their diagnostics and therapy as precisely and meaningfully as possible. In addition to a great deal of sensitivity, this also takes time. We gain this time in everyday life when routine tasks in medicine are performed by intelligent machines and the additional use of artificial intelligence and algorithms.”
Digitization is already making it easier to make complex diagnoses and to develop new therapeutic approaches. Pathology plays a key role in this. The precise diagnosis lays the foundation on which every therapy decision is built. The pathologist analyzes tissue samples from patients and looks for pathological changes. “Pathologists are, so to speak, the pilots of therapy. They lay the foundations, make the precise diagnosis for the patient and thus set the direction for therapy,” says Prof. Dr. Frederick Klauschen, head of pathology at the LMU in Munich. And his colleague Prof. Dr. Sven Perner, Head of Pathology at the University Hospital Lübeck, adds: "Pathologists are to a certain extent advocates for the patient,
Head of pathology at the University Hospital Lübeck
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To what extent can digitization support the pathologist in this responsible task? "The technical possibilities for this are already available," says Alexandra Farfsing. “These include solutions for fully automatic sample acquisition, tissue analysis on digital devices and their additional computer-aided evaluation. Due to the possibility of virtual networking in the tumor board, all relevant experts can come together in a timely and uncomplicated manner. In addition to the precise diagnosis, they can then discuss a tailor-made therapy. In this way, our patients quickly gain clarity about their current state of health.”
But despite such possibilities, medicine is only at the beginning of its digitization, as Sven Perner explains: “Today, AI is only used very occasionally in pathology. The proportion should be around 0.1 per thousand.” The reasons for this are complex. "A major hurdle in the digital transformation of pathology are the costs that an investment in digital technology inevitably causes," says PD Dr. Barbara Ingold Heppner from the Institute for Pathology at the DRK Kliniken Berlin. In addition, there are legal issues to consider, both in relation to data protection and responsibilities if the software does make a mistake.
Roche Diagnostics Germany
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“Health data must be well protected and at the same time used for medical research and ultimately for the well-being of patients. There is a great openness among the population to donate data for research purposes. Out of respect for the complexity of data protection, they are sometimes not given this freedom of choice to give their consent, since projects are not even started due to concerns,” reports Dr. Maike Reith from Roche Diagnostics in Germany.
The question of remuneration for purely digital pathology services must also be asked. And finally, digitization itself must bring clear added value for the actual task of every doctor - the most successful possible treatment of diseases. "In the future, we will need good concepts for the usability of AI, but also for billing by the health insurers and close cooperation with data protection officers and associations," says Prof. Sven Perner. His colleague PD Dr. Barbara Ingold Heppner adds: "In the future, we shouldn't necessarily digitize everything, but rather specifically adapt certain work processes in pathology in the digital workflow in order to make work easier for the employees. ”
In addition to AI, which will play a central role in the interpretation of histological patterns and immunohistological staining in pathology, molecular pathology already plays a crucial role in the direct therapy control of various cancer diseases. “Molecular genetic diagnostics in particular, which is based on next-generation sequencing, is becoming increasingly relevant in oncological diagnostics. This is based on the simultaneous analysis of the sequence information of many gene regions of a tumor. This enables the identification of patient-specific genetic changes as starting points for targeted therapies. However, this technically very complex investigation generates large amounts of data in each individual case, that have to be processed and assessed - unthinkable without digital support," says Dr. Jan Gronych, Medical Director Oncology at Roche Diagnostics Germany.
Head of Molecular Pathology at the Institute for Pathology of the Charité Berlin.
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The importance of molecular pathology will increase significantly in the coming years. This affects both the inclusion of other types of cancer and the breadth of molecular investigations, so that personalized precision oncology will benefit more and more patients with more and more therapeutic options "The combination of molecular pathology and AI-based histological categorization opens up completely new possibilities for very efficient and precise diagnostic decision-making paths that represent an excellent basis for optimal personalized therapy for as many cancer patients as possible,” predicts Prof. Dr. Michael Hummel, Head of Molecular Pathology at the Institute for Pathology at the Charité Berlin.
Digitization must not be an end in itself, was one of the central statements of a digital co-creation workshop on the future of pathology, for which physicians from all over Germany met in virtual space at the end of November. Led by Alexandra Farfsing, the experts discussed what can be expected of digital pathology in the future. And that is nothing less than a reinvention of the profession. “In addition to the 'basics' that this profession already requires today, the pathologists of the future will need to have a deep understanding of the possibilities of artificial intelligence and digital technology. Your work will enable increasingly complex diagnoses as well as new and more individual therapeutic approaches," says Dr. Rasmus Kiehl, Institute for Pathology at the Charité in Berlin.
Digitization is not an end in itself - that means in concrete terms: Digitization must help the doctor and the patient. However, digitization is currently not economically measurable, which is why digital tools are not financed by the cash registers. "We need studies that can show the added value in numbers so that our healthcare system can keep up in the future," says Frederick Klauschen.
The workshop participants welcomed the fact that digital technology will enable more flexible working models in the future. "For me, making our current working models more flexible means the possibility of location-independent diagnostics from anywhere in the world," says Edward Michaelis from the Institute for Pathology at the DRK Kliniken Berlin. "This gives me and my family a very different work-life balance than before and could make pathology more attractive, especially for a younger generation of medical professionals."
An argument with weight in view of the lack of young people in pathology, which is already noticeable today. And last but not least, digitization also opens up completely new opportunities for exchange and networking with specialist colleagues all over the world. The medical progress made possible by such an open, international exchange was only recently shown by the example of the corona pandemic.
Medical Director of the Center for Pathology in the Allgäu Clinic Network in Kempten
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"Pathology can be a pioneer in terms of digitization in medicine," emphasized PD Dr. Konrad Aumann, Medical Director of the Center for Pathology in the Allgäu Clinic Network in Kempten. "We should support digitization and innovations in our field in order to make molecular diagnostics as attractive and promising as possible for the young generation of physicians."
Digitization as a enabler - the title of the workshop sums it up. "In ten years we will have a very high degree of digitization in many areas of medicine," says Alexandra Farfsing. We are already laying the foundations for this today by jointly shaping our medical future. We call it co-creation. Pathology will also follow this path – for the benefit of the patient.”
