The smart patient: Let digitization keep you healthy

By David Matusiewicz and Jochen A. Werner

Stay and become healthy with digitization!
Digital nutrition, digital exercise, digital sleep - this guidebook conveys in an impressive and easy-to-understand way how digitization makes us healthy. In around 60 short stories, from babies to after death, the authors take us into the fascinating world of digital health and explain how the smartphone can keep us healthy and make us healthy.
The book describes how digitization is essential for people and their health. The shift in the interface between humans and machines has long since begun. And one person in particular benefits: the human being!

• Language: English
• Publisher: Klartext Verlag
• Release date: Oct 31, 2023
• ISBN: 9783837526332

Book preview

Prologue

In Germany, we have the best health care system in the world. This is the reassuring saying to this day. How often we heard that at the beginning of the pandemic! When we talk about intensive care medicine, this is probably true in the broadest sense. Unfortunately, if we think about all the processes in healthcare, we are approaching the other end of the spectrum. Therefore, let’s therefore more aptly state that we have one of the most mature analog healthcare systems. And that brings us to the impetus for our book, which we want to give in the short prologue, not as criticism, but as a stimulus to finally raise the enormous efficiency reserves in the German healthcare system.

Let’s start with a first short patient journey. After weeks of back pain and increasing helplessness on the part of her family doctor, patient Lynn finally gets an appointment at the district hospital to have the MRI examination of her back that she has been longing for. Since the hospital cannot transmit the digitally created images to the doctor who is continuing treatment via, let’s say, a cloud solution, the hospital uses the sick Lynn as a mail carrier. So the patient waits another half hour for a CD-ROM (1979 technology) to be burned. Sounds complicated, doesn’t it? Burning pictures! During the production process, Lynn asks the lady at the reception, who already seems a bit annoyed, if she could please receive a copy of the examination findings by e-mail. For data security reasons, she was not allowed to do so. But she could receive the report by fax (1843 technology – you read that right: 1843) or by mail, the hospital employee replies. By fax? Should she give the number of her company? In the boss’s outer office? Lynn herself doesn’t even own a fax machine. Is it worthwhile to buy one? If she is to get more findings now, then maybe this could make sense. Lynn wants to think about it and get more information on them, maybe at Media-Markt or Saturn. But do they even have fax machines? Maybe you can buy a used machine on the internet? Or maybe the machines have been sold out since the pandemic? At the very least, the health departments had a huge need. Finally, Lynn gets the CD, drives it several miles in her car to her primary care physician’s office, and finds a parking space on a self-pay basis. Thus, her primary care physician gets the records of the mature patient delivered in person in a safe way to complete the file. But there’s more good that comes from the office visit. Lynn can make the appointment to discuss the upcoming findings with the doctor right on the spot. This eliminates the busy signal or the sometimes seemingly endless waiting time in the telephone queue. Now the CD-ROM is read in. Good news for the practice, as the CD-ROM drive had been repaired the day before. But the drive still hums conspicuously loud. But the important thing is that it works. The report of the findings will be sent to the doctor shortly. Hopefully this will work out by the agreed meeting date in a week’s time. And there is another good thing about the on-site visit to the practice. Lynn can take her prescription with her for medication against her inflammatory bowel disease. The indestructible dot matrix printer is already rattling away. Incidentally, this technology dates back to 1952, a process in which the dots of color produced optically combine to form letters and characters as if by some miracle. The noise level during printing is often considered annoying, but not in this practice. Here, the noise level is higher than that of the printer. Incidentally, today there is a technology where even the dot-matrix printer mentioned can be classified as questionable in terms of data protection. This is because what is printed can be reconstructed relatively easily and even automatically from an audio recording. Such or similar discussions are often held in the German health care system. And this more is more than often about what is questionable, and less about what is possible. Unfortunately, Lynn can’t take the printed prescription with her yet either. The doctor’s signature is missing. Maybe take a seat in the waiting room for a moment? No, that’s not possible either, all nine chairs are occupied. In the waiting room for private patients, two of the five chairs are free, but she is not allowed in there. Therefore, she had to wait at the reception desk. Hope comes up. The doctor arrives, seems a bit stressed, but puts a sign on the prescription as she passes. Thanks! And so Lynn, once again acting as a messenger in the health care system, drives to the pharmacy with the printed prescription, where unfortunately her drug is not available until the following day. Lynn exchanges the prescription for a payment slip for collection. The prescription is collected at the pharmacy and driven to the billing center, where it is scanned again. But the patient doesn’t have to do that herself. There are companies that are well paid for the transport and scanning.

One conclusion from this short experience for Lynn is that there is still far too much waste of resources (CD, paper, energy) in the reality of care, and thus the carbon footprint. Another conclusion is that Lynn only finds out a week later what the investigation has revealed. Add to that this totally unacceptable waste of time. Waste of a very high good that Lynn definitely could have used differently. Even though there are actually doctors who think that if the patient wanders through the system and has to keep records together, he will remain motivated. We say that this is a completely unnecessary burden, especially for sick people. Something must change here quickly, otherwise patients should also be reimbursed for their efforts, perhaps at the expense of health insurance? A patient’s journey today sounds more like an odyssey. It also reminds us somewhat of the story of Asterix and Obelix (comic book heroes from 1959), in which a Gallic village (or, the village of health) defended itself against the much more advanced Romans (or, the digitization protagonists), who kept trying to launch hostile attacks. One goal of our book is to understand digitization as a kind of magic potion to make the health village, which is becoming global, a bit better, faster and, above all, more effective for all its inhabitants – both the doctors and the patients.

References:

Backes, M., Dürmuth, M., Gerling, S., Pinkal, M. and Sporleder, C. (2010). Acoustic side-channel attacks on printers. In Proceedings of the 19th USENIX conference on Security (USENIX Security’10). USENIX Association, USA, 2010.

Sexuality and birth digital – midwife online

Selma and Gerald have wanted a baby for a very long time. On the continuum between sexuality and childbirth preparation, digital transformation is changing their thinking and attitude about it in many ways. On the one hand, social media provides a place for the two to go. Selma in particular didn’t get much of her sexual education at school, but picked it up online. For example, Selma wanted to know if she was normal in terms of her body or her sexuality, and she then asked and got answers in the comments section from sex educators like Gianna Bacio – one of the most successful German sex educators on TikTok. On the other hand, studies show an increase in sexual dysfunction (erectile dysfunction, inhibition or lack of orgasm) especially among young men like Gerald, which can also be seen in the digital context. At times, he developed compulsive behavior around pornography on the Internet, which led to his expectations of himself getting too high and he had to seek out medical advice. He also legally ordered sexual enhancers online via a German startup with a medical advisory board. To do this, he filled out a digital questionnaire, received a doctor’s letter, and had everything sent to him a few days later with a prescription from England and information about an online pharmacy from the Netherlands. In addition, he started watching videos for his pelvic floor training on their online portal and began exercising to get off the blue pills in a short time. This is men’s health 2.0. The ubiquitous availability of information and digital options relating to sex and reproduction on the Internet is thus bearing its colorful fruits.

There is also a wide variety of information on the Internet specifically about the desire to have children. On one hand, the two simply want to get digital inspiration for the act of creation, and on the other hand, they want to have more control with regard to planning their offspring. And so, they wait monthly for a digital signal until they are allowed to fulfill their purposeful sexual needs – fun has turned into seriousness. After all, chance, fate and luck are often no longer the norm when it comes to planning children. The topic of sex according to plan has long ceased to be a taboo subject. Many people suffer from an unfulfilled desire to have children, so their entire daily routine, including their love life, is planned digitally, for example with digital fertility meters. Clinically tested fertility tracker in the form of a bracelet can be easily connected to a smartphone. This tracker is worn by the woman only at night during sleep. Sensor technology is used to map which phase of the cycle the woman is in and when is the best time to reproduce. An additional vibration function provides an alarm or reminder signal in everyday life. In addition to this digital aid product, there are also digitally controlled basal thermometers including an app for determining the fertile days. Thus, the menstrual cycle control can be done directly in the app. Such coupled apps enable support for the desire to have children, but also for contraception. By means of the individual ovulation symptoms and the calculated survival time of the sperm, it is possible for various apps to determine quite precisely at what time a pregnancy is possible. And completely without taking additional hormones, too. Only in the morning the temperature is measured orally, vaginally or rectally. The data is evaluated in the app. In addition, a cycle computer can determine fertility and fertility obstacles. That sounds like a lot of possibilities, right? And it goes even further. Additional functions are: records of irregularities, cycle length, sex prognosis, determination of the so-called conception date and the possible date of birth. This even extends to discussions about genetic analysis and designer babies, which, however, would go too far here for ethical reasons alone. Today, practical questions that normally only a gynecologist can answer are being answered digitally. And they can do so at any time and from anywhere. But there is also a critical view of the digital meticulousness surrounding the topic of sex and birth. Selma and Gerald eventually get used to controlled sex. They just can’t fully live out the sex anymore without having dates and times in their heads. All these little technical helpers have become little digital beacons of hope. The stress that often results from this, however, can lead to a natural failure of reproduction. Hormones and sperm also react sensitively to stress.

This is where reproductive medicine, a special field of medicine, comes into play. This field researches reproduction, the biological basis, the control of human procreative ability and the associated disorders. A pioneer in this field was the Erlangen University Hospital, where the first German test-tube baby was born in 1982. This child was created by fertilization in a test tube (in vitro fertilization). And this discipline is also using more and more digital technology – for diagnostics and therapy. The procedure as such, however, has been more or less analog for decades: For this purpose, the eggs are punctured, after maturation and ovulation have been stimulated by hormones. The egg cell can then fuse with the male sperm cell in a Petri dish. Two or three days later, the embryo is inserted into the uterus through a catheter. This option has been a common procedure in Germany for over thirty years. In addition to this procedure, intracytoplasmic sperm injection is also a commonly used procedure. This refers to the injection of a sperm thread into the egg. Other procedures subject to reproductive medicine include egg donation, embryo donation and the use of surrogacy. Therefore, the discipline will not be completely replaced by digitization, at least in the medium term.

And it finally worked – Selma and Gerald are soon-to-be parents. And even during pregnancy and before the birth of their child, the two fully rely on digital tools. But does all the technology on offer actually make sense? Many parents-to-be would like to be able to look at their child and, in particular, their baby’s face before it is born. What sounded like science fiction until a few years ago has become a reality. New technologies enable parents-to-be to watch so-called baby movies or baby TV. This type of prenatal diagnostics can ensure that abnormalities such as heart defects or kidney malformations can be detected in the womb and health-preserving or even life-saving measures can be taken before or immediately after birth. But to this day, it is unclear whether the luxurious high-tech offering can harm the health of the unborn child. Since then, due to a new radiation protection ordinance, 3D ultrasound can no longer be performed on pregnant women. 3D and 4D ultrasound images are now only permitted if they are necessary for medical purposes. Not everything that is technically possible is therefore useful. As additional support, Selma and Gerald find app-based childbirth preparation courses quite useful. They also talk to a midwife online every week, who gives them practical tips in the form of apps and answers all their questions virtually. In addition, it will be possible in the future to request the birth certificate with just a mouse click after the birth, which is another step toward digitization from the beginning of life on.

TAKEAWAY-MESSAGE

Nowadays, digital information can help with clarification and also identify a woman’s fertile days more precisely, in order to support child planning on the basis of data. It is important that the desire to have children does not determine all your actions and love life. If even digitally accompanied monitoring measures do not bring the desired success, specialist advice from a reproductive physician can be sought out. And even before and during the birth, a midwife can provide you with important analog and/or virtual information.

References:

Melzer, H. (2019). Auswirkungen der Digitalisierung auf Sexualität und Beziehung. Nervenheilkunde, 38(10), S. 759-764.

Schnoor, M., et al. „Physische, psychische und soziale Entwicklung der nach intrazytoplasmatischer Spermieninjektion geborenen Kinder – die Deutsche ICSI-Langzeitstudie." Journal für Gynäkologische Endokrinologie/Österreich 31.3 (2021), S. 7-93.

Digital twins – your avatar in the virtual world

No, this is not about human twins, even if you are still thinking about babies after the first short story. It is about so-called digital twins; a digital copy of a human being. This short story is about Anton, who had a personalized avatar created as an image of himself for the virtual world. His avatar could either be a fantasy creature or a photorealistic copy of himself. The name avatar comes from Sanskrit and refers to the assumption of an earthly form by a deity. In December 2009, the most expensive film production of all time with a production cost budget to date was released under the title Avatar – Departure to Pandora. At the end of 2022, Avatar 2 (The Way of Water) again thrilled people in theaters and became a mega-hit in Germany. Another example of avatars is the somewhat older film Surrogates from 2009 with Bruce Willis. The film is about people not leaving the house at all anymore because normal life outside their own walls is too dangerous. Human-like robots controlled from virtual reality take part in social life and foe example, go to work for the people who are also at home. And in the 2015 feature film Ex Machina, a young web programmer falls in love with a human-like robot woman. This was about the construction of a woman and the value of humanity itself, and at the same time about the fact that the boundaries between man and machine are increasingly fading and that in the future, digital twins will no longer be science fiction.

Anton has chosen to create a photo-like virtual image of himself. He uses his avatar, which he lovingly calls AntonX2, for his educational or follow-up consultations with doctors and in the hospital. Doctors and clinics already offer him the opportunity to get in contact with them, with the help of VR glasses or via a screen on his smartphone or laptop. He was able to take a look at his hospital and his room in advance as an avatar and in this way prepare himself well and somewhat contain his anxiety. AntonX2 talks to his virtual doctor, who also has a photorealistic avatar and is waiting for him in the virtual doctor’s office to answer his questions. As of now still live, but in the future the doctor will be equipped with a chatbot that will take over the communication. Then Anton, aka AntonX2, will be able to talk to his automated doctor avatar until all his questions are really answered and may even small talk. AntonX2: Do you have another medical joke in store? Virtual doctor: At what point can you tell if you’re talking to a real human doctor or a chatbot doctor? (… pause for thought …) After 3 minutes, then only the chatbot is there. Overall, this saves Anton a lot of trips and unnecessary waiting time. When he is sick in bed, he can travel the world from there with a pair of glasses or meet with friends without leaving the house. His grandmother Antonella, who lives in a retirement home, can thus meet him more often virtually for coffee and cake, which would otherwise not be possible because Anton moved further away after he finished his studies. Antonella can also take world trips from the retirement