The GP of the future must ally with artificial intelligence

Novartis, Ibm and Net Medica launch a digital clinical platform, Openet: an urgent paradigm shift is at the door for the role of family doctors

The Pepper robot There are at least a couple of directions towards which Italian healthcare is called to evolve in the coming years, as the Covid-19 pandemic has made clear. In addition to the more general trend of personalized medicine, on the one hand there is proximity medicine, i.e. the territorial medicine close to the patient, and on the other hand the so-called initiative medicine, in which the patient no longer passively expects the patient to come by himself. in hospital (perhaps with guilty delay) but proactively meeting those who need a clinical evaluation, proposing ad hoc solutions and focusing on early diagnosis and remote management.

In this context, very recent news is introduction of Openet, an open source digital system to support general practitioners, born with the ambition to buy family doctor time, so that he can have more energy to devote to patients, as well as create a direct connection with specialists. A tool created by Net Medica Italia based on the medical-scientific information of Novartis and which exploits the potential of Ibm Watson, proposed to identify the most fragile patients who need attention with the algorithmic help of artificial intelligence, also allowing a remote management (as far as possible) of the treatment path, supporting the general practitioner first of all in the assistance of the chronic patient.

What a platform like Openet underlies, and which also the news portrays as necessary and urgent, is a renewed role of the family doctor within the healthcare ecosystem. This is both to give a concrete response to the objectives of Mission 6 of the National Recovery and Resilience Plan (the Pnrr) - which focuses on territorial care, home visits, telemedicine and territorial operational centers - and to exploit health technology to ensure that the GP can devote himself to high-value activities, relying on technology itself for the most repetitive tasks. We discussed this for Wired with Pasquale Frega, country president and CEO of Novartis Italia.

Pasquale Frega, how does a digital clinical platform equipped with artificial intelligence represent a concrete answer to the PNRR?

"The experience of the pandemic has changed everyone's sense of urgency in providing care. Today there is still an incredibly long latency in the period from diagnosis to therapy, with impressive data regarding the timing of the patient's journey, even for serious illnesses. The pandemic has sensitized public opinion, the medical profession and politics on the need to become much more reactive, taking care of patients already at the onset of the first symptoms. And there is a lot to do. In the summer of 2020, 500 million euros were made available to the regions with the aim of reducing waiting lists, and after a year these funds have not yet been spent: only recently the Ministry of Health has created a task specific force to address the issue.

“In this context, the role of digital is to find useful information in the huge health databases available to us to speed up the diagnosis and treatment of patients. The Italian data in health are often defined as the sleeping giant, since they are data that no one uses. The Openet digital clinical platform is just an example of how, thanks to artificial intelligence, accurate information can be received by the doctor on the need to take charge of a patient, perhaps because he has not been visited for a long time, because he has missed a follow-up examination or why he went to the specialist without then closing the circle by returning to the general practitioner. "

Pasquale Frega, CEO of Novartis Italia What are the advantages that digital can bring, not only in general on the health system, but in particular on the daily work of the family doctor?

"We saw it well in the test phase for Openet in which 600 GPs were involved, and there are another 1,000 waiting to leave: a digital platform allows not only teleconsultations, but also to identify which patients need it (even without having requested an appointment) on the basis of algorithmic criteria. If following the consultation the doctor believes that the patient should be visited by a specialist, he can organize everything already on the platform, creating a hospital-territory-patient triangulation which is not by chance a fundamental feature of the new design of the Italian treatment system financed by the Pnrr.

"We all know situations of patients who get lost in the treatment path because it is not sufficiently structured: Openet, installed on the device of the individual doctor, aims to simplify this path, and it should be noted that it does not use special databases, but operates on the existing database already used by family doctors. As the name suggests, the key points are first of all the presence of an open network between the different actors of the system, and then an accessible system that can be adopted without barriers.

“I think it is useful to give concrete demonstrations of which both the potential of digital in data management that knows how to seize all the opportunities. Family doctors are emerging from a very difficult phase in which, during the most acute part of the pandemic, they were on the front line and were the first to be overwhelmed by the health emergency, initially finding themselves alone. Having a virtual assistant who favors an initiative medicine shows how today we can work in a completely different, smarter way. After the first pilot trials on heart failure and psoriasis, and after the positive feedback we have received, now the will is to extend Openet to other pathologies, potentially without any limit.

Here, too, FIMMG could be sensitive, according to you could be a little softened, passing on the concept that more than losing control, the GPs were the doctors on the front line and that they were the first to be overwhelmed by the emergency where they initially found themselves alone. What do you think?

The CEO of Ibm Italia Stefano Rebattoni, speaking of Openet, said that "the central element to support the continuum of taking charge, diagnosis, care and assistance of the patient are the information that technologies such as cloud, AI, blockchain and IoT can make available in a timely manner ": do you think an alliance between the pharmaceutical world and that of big tech companies is essential in the future?

“The convergence of know-how and different technologies is changing the face of healthcare in recent years. Putting three partners such as Novartis, IBM and Net Medica around the same table, that is, making the scientific part dialogue with the technological one, was decisive for the development of this platform and beyond. Without the desire for collaboration and convergence, projects of this kind cannot be carried out, simply because none of the companies alone possess all the necessary skills.

"What has been achieved is a proof of concept of the fact that technology can impact the daily life of the patient and the doctor. Often patients, family members and caregivers are forced to follow tortuous paths made of endless hours of waiting and journeys of hope: everything can be impacted and optimized thanks to systems capable of combining clinical and technological know-how. And as a further reinforcement of this trend, the Digital Transformation Observatory of the Politecnico di Milano has positioned health and healthcare as the most distant area from the digital vortex: this means that it is the sector in which there are the greatest opportunities for digital transformation and the lower risk of the pandemic-induced acceleration effect turning out to be a bubble. We are only at the beginning of the journey, very far from seizing all the opportunities. "

A digital platform, a telemedicine tool, believes it may be enough to counterbalance the decline in healthcare and diagnosis services that has been registered contextually to the Covid-19 emergency?

"What we have launched is a valid solution, but it is only an example: to significantly impact the problem of waiting lists and the decline in healthcare services, other solutions will be needed in parallel. The time is right not only because waiting lists have swelled and there has been a 37% drop in NHS performance during the most acute months of the pandemic, but also because we have realized that we need to change ways. of working . It is no longer possible to passively wait for patients to present themselves to the doctor and for them to queue outside the office once they arrive: the possibility of a technological leap seen during the pandemic has finally opened the receptors also of health professionals on this issue, it is understood that inertia must be combated and that technology is a great help in this. If before the pandemic the family doctor would have been reluctant to this kind of change, today the mentality is completely different. "

In this regard, how the fugue of the general practitioner will have to evolve to adapt to an infrastructure increasingly digital patient care?

“The trend of recent years has been to transform the general practitioner into a bureaucrat with a thousand tasks to do and less and less time to do the clinic and be proactive towards the patient. The technology reduces the bureaucratic burden and leaves time to analyze health databases, with the possibility of referring neglected patients to care.

This transformation can be decisive for the country's new treatment system, and the doctor of base can become the gatekeeper who orchestrates the patient's care path. In the past there have been projects in this direction launched for example in Lombardy, which did not go through simply because too soon, we were in the pre-pandemic and the sense of urgency was completely different. From that point of view, the general practitioner could only send the patient to hospital, forcing him to long waiting lists, while in the future the same doctor will have a role more similar to that of a healthcare manager and the patient's care path . ”

In your opinion, what is the most pressing urgency in terms of enabling a real territorial medicine?

"We start from the patient's journey, with a view to the race against time and ease of access to care: the PNNR allows you to design the new system by modifying access to hospitals as we know it today, creating new levels of care closer to home. The State-Regions Conference has recently signed an agreement for 1,250 new local territorial units, already by 2026. Before going to the hospital, the patient will have home tools, a local unit at a very short distance and then a low-cost care center. intensity for short stays such as day hospital, everything before going - when necessary - to the most important treatment center. Imagining this system without digital support is impossible: if there is no medical record that can be consulted from one level of care to another of the four available, each level would have to do it all over again and it would be something absurd that would make the whole system useless. . For this reason, the digitalization of treatments, the digital medical record and the platforms that allow the interface between the levels are the basis of this new model. ”


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