@WernerLeodolter

Shaping the Subconscious Mind of Healthcare Organizations Digital Biomarkers and future Clinical Decision-Making

Werner Leodolter

Prof. Dr., CBMed

The psychology of decision making(of humans and organization(al units))

• Analogy and Intuition (Hofstaedter: „The heart of thinking“, Gigerenzer)

• Thinking fast and slow (Kahneman) - System 1 und 2

• Instinctive linking of experience and perception/sensations and the formation of mental models for the future lead to• overestimate the likelihood of positive outcomes• emotional transfer of actual presence in the future• ignorance of non-events (Gilbert)

• The pitfalls of psychology are also valid for organisation(al units)• bias, priming, self-deception etc.

• Those pitfalls even accumulate in organizations with more personswith the same biases etc. (due to culture, structure, same information sources, following the leaders - „leadership“ etc.)

June 2016 © Werner Leodolter 2

The cognitive process –how do we take decisions?

• the single person

• in the organization

• in the process chain of mybusiness model

perceive

Recognize, evaluate

decide

act

© Werner Leodolter 3

The cognitive processhybrid – analog+digital

IoT, VR, AR, Drones, speechanalysis, affectivecomputing, chatbots, virtualassistents etc

© Werner Leodolter 4

perceive

Recognize, evaluate

decide

act

image and patternrecognition, Speech analysis, affectivecomputing, Decision support Systemschatbots, virtualassistents etc

5

perceive

Recognize, evaluate

decide

act

The cognitive processhybrid – analog+digital

© Werner Leodolter

Methods:Rule based (Expert Systems e.g. with fuzzyLogic)Supervised andunsupervised machinelearning, etc.

6

perceive

Recognize, evaluate

decide

act

The cognitive processhybrid – analog+digital

© Werner Leodolter

• In the organization

• In the businessprocess

automated

7

perceive

Recognize, evaluate

decide

act

The cognitive processhybrid – analog+digital

automated

© Werner Leodolter

Wahr-nehm

en

Erkennen, Verstehen,

Nachdenken, Abwägen

Ent-scheid

en

HandelnDATA,

DATA,DATA

The basis:

8

The cognitive processhybrid – analog+digital

© Werner Leodolter

The basicidea

© Werner Leodolter 9

…network man and machine intelligently

…Hybrid Intelligence

Decisions and actionsof

organisation(al unit)semerge from

organizationallyconsciousas well as

organizationallyunconscious

processes

The subconscious mind of your organization –cascaded hybrid intelligences

© Werner Leodolter 10

Shape thesubconscious mind

deliberately

Let emerge Hybrid Intelligencies

in a targeted way

Agencies other HC providers

Assistents, ChatbotsPatients

What does this mean in real life? –How to support value based care - examples

• Telemonitoring, „eMail-visits“ etc. are broadening the HC organization´sperception

• Exploiting the EHRs…….. – „Digital Biomarkers“ as part of the subconscious

– My patient – patients like mine

– Derive predictions from statistical models developed with supervised machinelearning

– give hints for clinical reasoning! – why this prediction?

– Beware of bias in the data!

• Visualize process quality and outcome in realtime feedback loops - Make that part of your organization´s perception and self-regulation – its Subconscious

• Design a payment and care delivery environment that supports good clinical processes – watch the effectiveness of incentives closely – value-based care

CONFIDENTIAL - Property of CBmed

Digital Biomarkers for Precision Medicine (DBM4PM)

Clinical data

Industry Partners+

Scientific Partners

CONFIDENTIAL - Property of CBmed

as part of a comprehensive Biomarker Research initiative

1.7 Health technology assessment

Area 3: Metabolism

&Inflammatio

n

Area 1: Data

&Technologies

Area 2: Cancer

1.5 Metabolomics1.1 Clinical information system1.2 Semantic data management

1.4 Next generation sequencing

2.2 Tracking the trace2.4 Minimal residual disease and CAR T-cells

3.1 Diabesity

3.2 Cardiovascular disease3.3 Biosensors

3.4 Bone metabolism

3.5 Fertility 3.12 Electrochemical biomarkerdetection

3.6 Liver function

3.9 Microbiome-gut-brain

3.10 Sepsis

3.11 Fungal infections

2.7 ADX models

2.5 Eukaryotic initiation factors

2.8 Core Lab for Target Identify-cation and Probe Development

1.9 Clinical MALDI Applications1.8 Digital Pathology

1.6 Immunology 1.3 Knowledge discovery & data mining

2.51 Fusion Technology

Digital Biomarkers supporting clinical reasoningin diagnosis and decisions for therapy (CDS)…… • Principle: My patient – patients like my patient

• Use Cases

– Prediction of Delir to take action in order to prevent delir (and the associated suffering and costs)

– Prediction if ICU will be necessary for patient leads to better utilization of expensive ICU beds

– Readmission forecast for patients - analysing comparable EPRs – challenging staff to prevent readmission

– Early detection of sepsis (from parameter patterns) thus preventing ICU-admissions or reducing ICU-length ofstay

– Decision support for therapies – precision medicine (NGS – Genome, Proteom, Biomarker, Biobank, etc.)

– Homecare monitoring: proposals to prevent forecasted adverse events for chronically ill patients at home

– Help to convince patients to change their behaviour („these are EPR´s of real persons behind“)

– Prevent medication–related adverse events (esp. with polypharmacy)

– Clinical pathways, etc.

Use case: Will the patient suffer from delir?

Diether Kramer, Werner Leodolter

Reference

Prediction NO Y

NO 1145 163

Y 200 394

Accuracy : 0.8091

95% CI : (0.7908, 0.8266)

Sensitivity : 0.7074

Specificity : 0.8513

'Positive' Class : Y

Random Forest

1 - Specificity

Se

nsitiv

ity

0.0

0.2

0.4

0.6

0.8

1.0

0.0 0.2 0.4 0.6 0.8 1.0

Area under the curve: 0.9095

Predicting Health – Predicting Delir

Train and Improve Clinical Reasoning• Among the strategies proposed to improve clinical reasoning, education and

training are instruction and practice on • generating and refining a differential diagnosis,

• Imagine: a doctor with decision proposals for diagnostic, therapy etc. • He will mostly click „yes“

• Will he be a good doctor after 10 years doing that?

• Provide decision making simulator trainings - like airline pilots!

• Simulation of clinical decisions including decision proposals that make no sense – Trainees have to detect them when evaluating all decision proposals

© Werner Leodolter18.04.2018 17

„Hybrid Intelligencies“ shaping OrganisationsThe more you automate decisions – the more you have to consider the

subconscious mind of the organization

We shape our tools and then our tools

shape us.Marshall McLuhan: Understanding new media

Illustration ausDIE ZEIT13.2.2014

© Werner Leodolter 18

Shape the Subconscious Mind ofyour organization

It is easy to use this metaphor………

…………just think of yourself

Leverage your patient´s data and use „Digital Biomarkers“ – …….like CBMed and KAGes

CDS: build decision simulators and train your staffperiodically

Enable your organization for value-based care

https://youtu.be/wB9hRIm75ow

contact:werner.leodolter@uni-graz.at

Redneragentur Speaker´sagency: Topspeaker

german book:Springer-Verlag

Since July 2017:

http://www.springer.com/in/book/9783319536170

…..further reading, links and video

http://cbmed.org

www.kages.at

Improving Diagnosis in HealthcareErin P. Balogh, Bryan T. Miller, and John R. Ball, Editors; Committee on Diagnostic Error in Health Care; Board on Health Care Services;Institute of Medicine; The National Academies of Sciences,Engineering, and Medicine

http://ebooks.iospress.nl/volumearticle/46457

Development and Validation of a Multivariable Prediction Model for the Occurrenceof Delirium in Hospitalized Gerontopsychiatry and Internal Medicine PatientsDiether Kramer, Sai Veeranki, Dieter Hayn, Franz Quehenberger, Werner Leodolter, Christian Jagsch, Günter Schreier

Thank you!

Werner Leodolter

Prof. Dr., CBMed

@ Speaker twitter handle