EH 4_2015

EUROPEAN HOSPITAL  Vol 24 Issue 4/15 6 IT & TELEMED Continued from page 5 The German IT security act a proper professional background are crucial. ‘Learning by doing or learning by reading is insufficient to keep you abreast of the develop- ments and to become really familiar with the applications being used,’ he says, contradicting the proponents of Blended Learning, who consider this method to be the future of knowledge acquisition. ‘When day- to-day business makes concentrat- ing on other issues difficult and when interruptions are part of the work day, a focused seminar away from the office hustle and bustle is clearly the better choice.’ Quantify resources To be able to operate the IT infra- structure safely hospitals have to know how many members of staff are needed for the task. Therefore quantifying the resource require- ments is unavoidable, says Vrielink. Does that mean hospitals, many of which are already operating on a tight budget, have to hire more staff? ‘There is no clear-cut answer to that question,’ Vrielink says, ‘but indeed some of them will have to do that. If, as mentioned above, the costs are correctly calculated these human resource investments will be worthwhile. That is a management task, not a consequence of the IT security act. Additional costs should be within reasonable limits.’ Fill future security needs now In the course of the next few years, building and medical technology must be reviewed from the IT per- spective, since both areas will con- tinue to increase the network den- sity; but what to do with the data flood – where to store all the data? ‘This question, no doubt, will keep us busy in the next few years,’ Vrielink concedes. ‘There will be efforts to make the data collected in the hospital available for research purposes, or to turn dead data into revenue-generating data by making them available for analysis. This will create new security issues. Well- known problems such as interfaces to open networks, or the security of remote maintenance access for building and medical technology, will intensify.’ Management has to re-assess the IT strategy Does that mean hospital manage- ment has to rethink its strategy and re-assess IT? The answer is ‘Yes, but’… ‘The re-assessment pro- vides the opportunity to examine Frederik Humpert-Vrielink, Managing Director of CETUS Consulting and specialist in data security and risk management, has comprehensive experience in the implemen- tation of DIN 80001 – Risk Management for healthcare IT networks. He has been advis- ing hospital groups on the development and successful implementation of IT security management systems for over a decade. the entire facility and to identify black holes that gobble up money. Purchasing, redundancies, hidden double work, inefficiencies – these are but a few areas where targeted process optimation based on secure and confidential IT will reduce costs. Implementing a security manage- ment system always involves close scrutiny of all business processes. For hospital managers who moan about the financial burden, Vrielink offers a recommendation: ‘Facilities that face insolvency should ask themselves whether their current sit- uation is not the result of the ‘Ghost of Christmas Past’ – of misguided decisions. No hospital will have to shut down because of sensible investments in IT and IT security. It is wrong investments and omit- ted process and IT optimation that exacerbate financial pressure.’ Mathematical graphs and networks seek answers Systems medicine Discovering what causes dis IT is a resource just like water or energy Report: Marcel Rasch ‘Network Science in a biomedical context is derived from the concept of a system,’ Professor Rudi Balling explains. ‘If you look at any system you will find certain similarities that will occur over and over again. There are components that react with one another and we can look at this interaction over time and observe the dynamics. All of this can be described mathematically with graph theory as a network. ‘Transferred into the world of biological systems, organs and cells, and lastly also diseases, this means that we can also record the differ- ent cell types and different relations between the cell types as graphs or networks respectively. ‘If we, for instance, look at a liver tumour or Interview: Sascha Keutel Dr Heyo Kroemer: ‘Today, new ana- lytical technologies allow us to col- lect highly complex data on diseases – and consequently to understand these diseases better. For example, it’s no longer particularly expensive to sequence a genome and identify genetic variants that may or might be disease-relevant. Similarly, we can have a comprehensive look at inflammation, we can see where the relationships between the dif- ferent components change. These changes can then also be visualised as graphs and be compared with one another mathematically. We try to describe and understand diseases as changes in networks.’ Challenges ‘In the world of medicine and bio- sciences this is our first attempt at systematically and (almost) com- pletely capturing all components. The main challenge currently is of a purely technical nature. Currently, capturing the genome sequence is no longer a problem; but capturing all proteins quantitatively is still a big challenge. Each organ produces its own, different set of proteins, and therefore the genome is read epigenetics, the modifications of all DNS structures; or, proteome technology allows us to view all proteins. When we use these new analytical procedures and combine them with bio-informatics, we will be able to understand diseases and processes to an extent that allows us to intervene far better.’ Exactly who or what drives sys- tems medicine forward? Systems biology allows the mathematical visualisation through graphs and networks of complex body processes such as disease development. The aim is to improve understanding processes and triggers of diseases, so as to access and repair a damaged network. ‘We are still approaching this issue with a lot of naivety and underestimate the complexity of biological systems, and therefore of diseases,’ says Professor Rudi Balling, Director of the Luxembourg Centre for Systems Biomedicine at Luxembourg University. Systems medicine – the interdisciplinary field incorporating biochemical, physiological and environmental interactions in the study of human body systems as part of an integrated whole – draws heavily on the technological advances in information technology (IT). New ways to use data impact on healthcare and society, says Professor Dr Heyo Kroemer, Dean of the Medical School, Georg August University, in Göttingen, Germany. ‘We live in times when many things undergo fundamental changes. New possibilities to use data may well herald the beginning of a new era in medicine.’ organ-specifically. Measuring this is very difficult. ‘There is also a kind of “back- ground noise” in the body that fluc- tuates from hour to hour, minute to minute and from person to person. Unfortunately at the moment, we don’t understand what level of fluc- tuation is “normal” and what level may be an indication of disease, which is gene-controlled in respect of the adaptation of a certain organ. Even more important is the under- standing of control cycles, such as blood pressure and blood glucose. Why does the body change the con- trol variable of blood glucose, which makes obese people more prone to developing diabetes? We need to do more research here.’ ‘The human body has around 20,000 genes that can probably ‘Many of my colleagues are con- vinced that the new technology is the driver but, frankly, I don’t think so. As far as I’m concerned it’s the demographic change that prompts us to act. Our ageing population, which naturally means people are sick more frequently, and immense medical progress, create a pres- sure towards the development of affordable and feasible solutions. ‘What we’ll see in the future is a triangle of many patients, few payers and a wide array of ser- vices made possible by medical progress. This triangle is a well- nigh insurmountable challenge for a healthcare system financed through solidarity-based mechanisms – if we don’t use modern technologies. One of these options is the system medicine approach, which will lead to physicians being able to predict individual courses of disease better. Medicine will become much more precise and much more specific.’ Thus the importance of constant exchange between clinicians, IT people, physicists and mathemati- cians… ‘Exactly. The systems medicine approach requires cooperation between physicians, specialists in analytical procedures, such as pro- teome analyses, and experts who mediate between physicians and analysts, who basically process data – the bio-informatics specialists. The success of systems medicine relies on the cooperation of these groups. Moreover, we need experts who deal with healthcare-related issues that cannot be solved within health- care itself, such as legal or ethical issues regarding huge data volumes.’ ‘Potentially, systems medicine also has significant social relevance. On the one hand it creates the precon- ditions for broad segments of the ageing population to be able to participate in medical progress. On the other, we already see today how Big Data can change our lives. Point in case: the availability of huge amounts of personal data on smart- phones. ‘We know from the USA that the integration of these data into the patient record has already begun. This will allow people to be health-monitored around the clock and to analyse the data. The interac- tion between patients and Big Data and the impact this has on diagnos- tics and therapy has the potential to change our healthcare system fundamentally.’ code 100,000 to 300,000 different proteins. The possible combinations are therefore almost infinite and we have not yet discovered which combinations nature actually utilises and under which conditions. Our ultimate objective is to intervene in a damaged network to repair it.’ An ideal approach ‘It would be ideal to carry out fam- ily studies. On average, we would have to examine 30,000 to 40,000 patients to obtain relevant data that could point to a disease or its devel- opment. However, if we examine families with known hereditary dis- eases, then it suffices to sequence just one family to find the path of inheritance and the responsible gene. We need to get to the depths of things. ‘We are also currently develop- ing Spatial Systems Biology where, in addition to temporal systems biology, we are looking at the spa- tial resolution. Thanks to modern imaging procedures and new, high- resolution microscopes we can see how a cell works, when, where and which proteins move in, which way and what they do exactly. We try to model and predict these dynamics.’ The objective ‘We want to observe what hap- pens when mutations occur, or what changes when we change different parameters. In the future, we will work mainly with non- invasive imaging procedures that have an ever-improving resolution. This allows the combination of dif- ferent procedures, which is very interesting. However, in doing this we always produce an enormous volume of data – in future likely to be in the region of terabytes of data per second. Therefore, we either need better storage solutions or we’ll have to analyse in a more sophisticated way.’ More to come ‘We’ll have to have in-depth discus- sions around the issue of data pro-

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