INSIgHTS

A recent study published in the journal Clinical Infectious Diseases has demonstrated that the use of an artificial intelligence tool has led to a significant reduction in mortality rates amongst hospitalised COVID-19 patients, including elderly and at-risk populations.

The tool is the outcome of a project named ‘Digital Control Centre for COVID-19’ by health innovation body, EIT Health, which was initiated in April 2020. Since then, the tool has undergone development and validation, and has shown early success in the stratification and personalisation of treatment for patients with serious COVID-19 leading to improved treatment responses and, ultimately, a 50% reduction in mortality rates. As of early August, there have been over 18 million cases of COVID-19 worldwide, and it has led to the death of over 689,000 people. The main cause of death for patients with COVID-19 is respiratory failure, however many patients experiencing respiratory symptoms can be effectively treated if adequate care is provided at the right timepoint. The observational cohort study was conducted amongst 786 patients admitted to Hospital Clinic, Barcelona. Results also demonstrated that the tool was able to predict, with 90% accuracy, the trajectory of the disease in individual patients to allow for timely and appropriate treatment. Use of the tool led to improvements in patients’ condition at day five amongst 93.9% of patients treated with a personalised therapy approach. The tool works by analysing the data of hospitalised patients with COVID-19 who are experiencing respiratory symptoms, and defining three distinct clinical pattern stratifications which reflect differing symptom complications – inflammation, co-infection and thrombosis. Early knowledge of these symptomatic patterns conferring various clinical complications lead to differing therapeutic approaches and subsequent personalised treatment decisions. Researchers at Hospital Clinic Barcelona-IDIBAPS created the artificial intelligence solution capable of analysing, in real time, more than a trillion anonymised data points of COVID-19 patients, identifying clinical patterns and

Artificial Intelligence Tool Aiding Personalised COVID-19 Treatment Decisions Demonstrates 50% Reduction In Mortality

suggesting personalised treatments. This provides a real-time control centre for all COVID-19 patients admitted to hospital, under the supervision of an expert in infectious diseases. “The artificial-intelligence system that we have built is capable of supporting clinicians in the early diagnosis of patients more prone to develop complications, thus we have been able to provide timely and personalised treatments. This ‘Central Control System’ can be used for multiple applications beyond COVID-19 and represents a clear example of how AI can improve medicine and health outcomes,” said Carolina GarcíaVidal, Hospital Clínic de Barcelona. The solution will now be validated and expanded to other hospitals within the EIT Health network, including other Spanish hospitals (Mutua de Terrassa and Hospital Germans Trias i Pujol), the Netherlands (Erasmus MC) and Belgium (University Hospital UZ Leuven, KU Leuven). 

Healthcare Must Make Better Use Of Well-Being Data

Digitization causes the disappearance of artificial boundaries in health care: between outpatient and inpatient health care, between treatment and prevention, health and well-being, soft and hard data.

Headache or backache, weakness, lowered mood, sleepiness – each of us experiences changes in the body from time to time, which may be a symptom of a disease or only a temporary decrease in psychophysical fitness. Muscle pain is not always a symptom of flu, and not all stomach pain is a sign of food poisoning or more serious digestive problems. It is the physician who decides whether or not we are dealing with a disease, based on 70,000 codes of the ICD-10 – International Classification of Diseases. It is an extensive catalog that reflects what modern medicine knows about humans and diseases. However, beyond this set of illnesses, which are clearly described and classified, there is a gray zone. These are conditions ignored by classical medicine. Is malaise the ICD-10 R53 code, meaning “malaise, fatigue” or just a temporary, subjective sense of exhaustion? Is insomnia described with the code F51.0 a disease or just a temporary disorder?

Classical medicine that uses specific measures treats the patient as a fully measurable system of mental and physical features. These binary states – healthy or sick - do not take into account softly defined “well-being”, that is, feeling healthy and happy. Science has given this area up to unconventional medicine, including homeopathy, acupuncture, herbal medicine or energy therapy, in which patients often seek help, feeling that classical medicine is unable to meet their nonstandard expectations. This stratification

»The consequence of taking patient data into account in the process of diagnosis and treatment would be a profound shift in the healthcare models.«

of medicine may finally come to an end thanks to technologies that analyze the health of each person individually, using not only personalized treatments, but also personalized diagnostics.

Holistic algorithms New technologies, such as wearables, which collect data on health parameters, lifestyle, diet and behavioral patterns, give an increasingly accurate, personalized picture of each person’s health, which can be supplemented with other determinants such as the living environment or genetic data. This way, health and well-being begin to merge into one condition described subjectively, and not objectively, as is the case in modern health care. Why is it important? Among other things, to enable evidence-based medicine to meet different needs of people, taking into account their personal perspective. What for some is just a slight headache, for more sensitive people is a condition that hinders normal functioning. Furthermore, to prevent a crisis in science resulting from the erosion of social trust. Today, millions of people seek help outside the health system because they cannot find solutions to their problems, which are not necessarily a disease, but still generate discomfort. Insomnia, burnout that has not yet been diagnosed as depression, mental strain caused by an increasingly faster lifestyle or stress significantly reduce well-being, and thus the quality of life. And the latter, along with economic development, social transformation and the increasing, although still diversified, standard of living, is of growing importance. The development of digital health, including the rising popularity of smart watches measuring sleep quality, physical activity and mobile health applications confirms that people want to have control over their health and well-being and that they are looking for harmony that cannot be described in medical terminology.

Physician as personal coach Digital health has filled a niche, which resulted from the development of highly institutionalized health care. Everyone can gain deep insight into their own physical and mental health, understand complex mechanisms and patterns, and get tips on how to improve their fitness and well-being. What technology enables should now be used by health care systems. One of the steps should be to extend the scope of data collected in the electronic patient record. Today, standard records contain diagnoses, laboratory test results and medical photos, medical history, prescription drugs, i.e. parameters describing the condition of a patient, of a person. Artificial Intelligence can pre-analyze all information, providing the physician only with relevant links between the data, suggesting potential problems and negative trends. The involvement of technology will be necessary because doctors are already overwhelmed with both the amount of data for manual analysis and the number of patients waiting for assistance. By adding data collected by the patient to the patient’s file, including soft lifestyle information, it is necessary to guarantee the automation of interpretation, create appropriate algorithms and incorporate them into IT systems. The same artificial intelligence

New technologies, such as wearables, which collect data on health parameters, lifestyle, diet and behavioral patterns, give an increasingly accurate, personalized picture of each person’s health, which can be supplemented with other determinants such as the living environment or genetic data. solutions could also be included in consumer solutions. In this case, you need to go a step further and enable data transfer from electronic medical records to commercial mobile applications. The benefit would be to move some of the physician’s competences to the patient and make better use of human resources to handle cases requiring a personal visit.

Ministry of well-being The consequence of taking patient data into account in the process of diagnosis and treatment would be a profound change in the functioning of the health care system. Given that certain health parameters monitored continuously could predict the onset of disease well in advance, medicine would become more proactive than reactive. Thanks to mobile technologies, care would be shifted from health care facilities to the patient’s home. This would necessitate major changes in the infrastructure of the health care system, shifting the burden of financing from cost-intensive hospitals to the development of technologies such as telemedicine, robotics and remote health monitoring systems. The transformation would also affect the current health insurance system, which would have to move away from firmly defined benefits guaranteed under a specific premium to individualized therapies, depending on subjective but measurable needs. Such a model may sound utopian, but, thanks to digital health technologies, it is possible to develop. However, this will not happen as a result of digitization, but must be backed up by a change of mindset at the decision-making level. Today’s societies need ministries of prevention and wellness rather than ministries of health. 