ROY LICHTENSTEIN, 1963
Acrylic paint and oil paint on canvas
My keynote speech at the ML-assisted and 5G-enabled e-Health Systems workshop, (31/1/2020). Please note that was before the COVID-19 pandemic. However, the message is even more urgent in the post-COVID era.
“It is a great honour for me to be here today. And it is an honour for 2 reasons, 1 is because by being here I am back to my roots where I started my journey, and 2 because it gives me the unique opportunity to discuss with you some ideas about our market.
Biotronics3d is active in the market of diagnostic medical imaging and artificial intelligence. Every single month our DC servers receive, analyse and store close to 1 million examinations, sometimes picking at 2M. We serve 120,000 users in 17 countries with thousands of transactions every second and store for them 3PB of medical imaging data. All that is good but I would like to discuss with you what we did next.
It was a few years back when I received a call from Ed Rudd, our chairman. He was very excited about the concept Uberisation of our modern economy, he kept on talking about how most of the business plans he receives (Ed is a keen investor among other things) try to Uberise their market. The Uberisation of everything, he said: “To Uberise, to replace the middleman is the theme of our times.”
For those living in the last few years on a different planet, I think I should explain what Uber is.
Like the gigantic health systems (NHS and the likes), the taxi business model was inefficient, not mobile, and as any passenger using a minicab in London on a Saturday night can testify, often very unpleasant. It was a model built around the needs of taxi drivers and their companies, rather than me and you, the needs of the guys paying for their services. Mobile technology and the internet has existed for over a decade, but the taxi industry has simply refused to embrace it, holding on to its old ways. Enter Uber, a Silicon Valley startup. It uses a mobile platform. It is GPS-enabled. It allows you and me, the passenger to rate the driver. It’s paperless. It’s efficient. It reduces the cost of service. And while Uber has faced regulatory pushback in almost every country launched, its innovation has seriously disrupted the existing models and it has been handsomely rewarded. Regulation typically drafts behind, not ahead, of innovation (Brussels please take notice!).
If you think about it, at its core Uber is all about connectivity. How to use an online platform to bring together two communities, the drivers and the passengers. Connectivity is key.
But healthcare also, when you think about it is really about connectivity. We have the basic human connectivity which exists between the patient and the caregiver, and this is as old as recorded human history, probably much older than that. But there is another form of connectivity that is woven into the fabric of the modern health care that is the connection between the caregiver and the body of information needed to provide excellent and personalised care. That body of information can be the knowledge recorded in textbooks, or the data itself, or the opinion of an expert peer. So when you get down to it, the practice of medicine depends on how we handle these two forms of connectivity, our human connection with the patient and our cognitive connection with the information.
The question is how do we solve the connectivity problem and also why should we do that?
Today we are seeing a major shift in healthcare globally, mainly brought by cultural and socio-economic forces and advanced in technologies and consumer behaviours. The population is ageing and chronic conditions requiring management during patients’ daily lives are on the rise. Alongside these issues, we are seeing widespread connectivity emerge across all economic classes.
Technology has set all of this change in motion. We are already seeing more empowered patients. In our company, we call those patients the “super patients”, the ones who are very close to Dr.Google. People want information. They want to make their own diagnosis. They want to research their doctors. They want to find ways to get to be 100 years old and still enjoy the quality of life. They want to have instant access to clinical skills regardless of where they are.
I am here to talk about a truly novel way in which our business model fuelled by a Cloud platform, 5G and machine learning is poised to make a valued contribution to the transformation of medical imaging and radiology. We call it RaaS-Radiology as a Service, and we believe our concept of RaaS, or to Uberise Radiology will transform our market.
My name is Harry Hatzakis and I am the CEO and co-founder of Biotronics3D. Let me please begin with a confession: I am a CEO who was trained in business only loosely and only much later in his life; However, I fanatically remain and will remain a self-declared nerd, with a profound thirst for technology innovation. I co-founded Biotronics3D back in 2004 trying to create a “controlled” workbench for our crazy ideas and our “what-if” scenario. Many years later, I consider interesting that some of our crazy ideas resonated with a big part of our market and we managed to build commercial success out of it. Good for us! But what was even better for us, was the copious amounts of adrenaline we felt in our bodies every time we were testing to the market our “what-if” hypotheses for the first time. Because it is extraordinary how much you can push the boundaries of innovation if you lose your ability to sleep at nights; an experience that I feel very privileged to be part of, and I wouldn’t change it for anything.
I am in love with medical imaging, I love the beauty of the data, I have great respect for the subtleties that exist and that when appreciated was an exceptionally skilled eye can save your life. It happens every single day around me, and those are the stories we often like to tell. But of course, medicine remains one of the youngest sciences that consistently humble even the most competent practitioners. Over the years I have witnessed innumerable failures and misfires. Most of those failures are down to break down of communication or shortage of skills or simply human error. These are the stories that should also be told.
Let me please tell you about my market, medical imaging. After 2000 everything changed. What was a traditional product-centric, vertically-integrated healthcare delivery model became an open, complex, very often chaotic, interdependent one.
This concept really hit home for me when my mother, an elderly lady living not far from here, had an MRI and she wasn’t happy with the diagnosis, so she used her laptop, went online and managed to find an expert in Mayo clinic (on her own I must say) to seek a second opinion. 3 hours and $100 later she had that.
Connectivity has changed. People connected 24/7 with mobile devices. New forms of commerce transforming how people can get products and services. Consumers’ expectations, like my mum. that they can get what they want with ease & speed will continue to rise.
At Biotronics3d we imagine a world in the next 10-20 years that looks like this: Patients receive personal care around the clock. Virtual coaches and doctors work with patients to optimize day-to-day preventative care. Everyone has their own virtual care team that lives with them in augmented reality. A wellbeing concierge. Meanwhile, primary care physicians (real humans) are assigned to a pool of patients who they monitor remotely, supported by a team of real human specialists. But much of the “personal” connection will be done through virtual humans (maybe there is a place for IBM’s Watson AI system in healthcare, after all, you clearly need the machines to help us with the deluge of clinical information overload, the clinical information obesity).
And in this brave new world, medical Imaging will be asked to play a major role. I think it will be the catalyst for driving the next evolutionary step in healthcare. Why? Because Medical Imaging is the only way to present a pretty accurate picture of the anatomy and pathology of a person remotely, to a doctor miles away.
It all starts now. Healthcare must shift its focus toward the patient. There is no other way. Healthcare services should put the patients’ needs first and foremost. This is what Biotronics3d, our company is doing. Just as Uber has demonstrated with putting the passenger first, ignoring the patient will be fatal for health solutions companies: they will be the new taxi drivers, baffled by how the world has passed them by.
But we cannot do this without three essential ingredients
- The mobile platform – web-enabled technology:
Where would Uber or airb&b or amazon or eBay be without the mobile platform? At biotronics3d we invested heavily over many years to build this platform, we call it 3dnet, and it provides the digital backbone to our strategy.
- The network – 5G
While some new technologies are pushing towards and providers further apart, 5G represents an enormous coming together, and in health care bringing pieces together making things simpler, is one and the same of making them safer. It is an open invitation not simply change how we do certain things but to fundamentally rethink how to do all of it. To deliver on our mobile platform we need fast networks and low latencies.
- The engine – Machine learning
We are facing a matching problem; how do we better match the patient with a doctor and also a doctor with the right kind of information. Effectively we operate with the same principles as an online dating agency matching a pool of men with a pool of women. Modern dating agencies apply AI rules to bring intelligence and automate this matching. We are also investing heavily to apply machine learning algorithms to automate our matching problems. And to keep on the dating agency analogy, first we needed to better profile our various communities.
Before I finish, I would like to please tell you two more things
If you ever watch Travis Kalanick, the founder of Uber, talk about his company, he always defines Uber as a big data company and not as a taxi company. He claims he is in the business of collecting and analysing data related to passengers’ journeys.
Likewise, we are not a PACS/RIS company. We collect and analyse data related to medical imaging. What do we do with that is of paramount importance. We see tremendous opportunities in aggregating and analysing patient data to improve care and avoid the need for acute care. Technology can do a lot of the heavy lifting in the area of prevention and serve as an early warning system for disease. If we do this, I don’t think we can just improve healthcare, but we can exponentially improve healthcare.
The other thing I would like to tell you is Uber was one of the first companies experimenting with the self-driving car, using the accumulated knowledge they have analysed. Likewise, at the same time, our industry started experimenting with AI for the diagnosis of medical images. The parallels are endless.
If you remember one thing from me from today, please remember this:
Solving the big issues of our generation requires bold new business models grounded on the new technologies.
Our industry, medical imaging, faces communication and skill shortage problems. Thus an uber-like approach, using a mobile platform, 5G and machine learning will transform the way healthcare and medical imaging is practised.
The new doctors but also the patients will become to a certain extent data scientists and communication and data hubs.