Targeted prevention and therapy after intensive medical treatment – 5 Questions for… Prof. Dr. Gernot Marx and Dr. Denise Molinnus

The Digital Hubs, funded by the German Federal Ministry of Education and Research (BMBF), were launched almost a year ago. Their goal is to transfer the IT infrastructures established in the Medical Informatics Initiative beyond the university medical context into regional healthcare. Physicians’ offices, regional hospitals, rehabilitation and nursing facilities, and emergency medical services, for example, will be included. The Digital Hub DISTANCE, supervised by the SMITH Consortium, is dedicated to intensive care follow-up using the PICOS App. Prof. Dr. Gernot Marx, Director of the Department of Operative Intensive Care Medicine and Intermediate Care at RWTH Aachen University Hospital, heads the DISTANCE Hub. Dr. Denise Molinnus is responsible for the coordination and scientific management. At the same time, she is doing her habilitation in application-oriented research at RWTH Aachen University.

We spoke with Prof. Dr. Marx and Dr. Molinnus about the current status of the DISTANCE project and the challenges involved in establishing the PICOS App.

You, Professor Marx, come from the field of anesthesiology, intensive care and emergency medicine. You, Dr. Molinnus, come from the field of biosensors. How did you come to be involved in digitization in healthcare?

Prof. Dr. Marx: Intensive care medicine and also anesthesiology are very parameter-based specialties in medicine that have been digitized for a long time. That’s why I turned to the topic of digital medicine relatively early on. In intensive care medicine, for example, we have been using digitized and automated documentation for many years. The added value of “lots of data” was therefore present in my mind very early on. For more than ten years, I have been involved in my research in the areas of telemedicine, artificial intelligence and algorithm development.

Dr. Molinnus: For me, the interest in digital medicine started during my studies. I studied biomedical engineering and worked in the emergency room during my studies. This made it clear to me that I wanted to further develop technology in medicine. In my PhD, I then specialized in sensor technology, specifically wearables and monitoring of patients. I think that digital medicine in combination with sensor technology is the future. You can already see that with diabetes patients with glucose sensors. Here, data is automatically sent to the wearables, mobile devices or smart watches, and the parameters are also sent to the doctors. This is exactly where I would like to pick up and further advance digitalization in medicine. This is also a good basis for the DISTANCE project. Here, I can further develop the app with the background and technology I learned in my studies.

DISTANCE focuses on the medical aftercare of former intensive care patients with the involvement of regional health care providers. What is the current status of the project and what are the next milestones?

Dr. Molinnus: The goal is to build a digital hub in DISTANCE, where data from the various general hospitals and physician networks will be collected and stored. At the moment, we are in exchange with the physician networks and general hospitals to build the architecture around DISTANCE. Here it is very important that we have a close communication structure with the rollout partners in order to really move the project forward successfully. In parallel, we are developing the PICOS App, which is the use case in the DISTANCE project. As of October 1st, the PICOS App will be widely tested.

Prof. Dr. Marx: Since the first funding period of the Medical Informatics Initiative, we have had the intensive care Use Case ASIC in the SMITH Consortium. In this context, we developed an app. The aim here was to diagnose acute respiratory failure at an earlier stage and initiate therapy accordingly. We were then able to use the experience we gained with the development of the ASIC App immediately for DISTANCE to develop a very convincing app more quickly. This applies, for example, to regulatory measures in the sense of medical device approval and the topic of data protection and data security. We have already taken many important first steps so that we can finally start the project with the patients and the many partners from different health care sectors.

The PICOS app just mentioned forms the heart of the Digital Hub DISTANCE. It accompanies the physical and psychological condition of former intensive care patients. What challenges do you face in developing and implementing the app?

Dr. Molinnus: The biggest challenge was definitely knowing that patients, when they are fresh out of the ICU, may have cognitive and psychological limitations. So it was important to address that. We designed the PICOS app in intense colors and kept it simple as well as intuitive to use. Patients should enjoy using the app, not be put off, and see a purpose behind it.

How do you ensure that older people and those who are not media-savvy can also use the app?

Prof. Dr. Marx: Right from the start, we made sure that the app was designed in such a way that people with vision problems, for example, could still use the app easily. This works through font size, icon size, or even color scheme. We have also tested this accordingly. Above all, however, we support older and non-media-savvy people through our service: If there are any questions or uncertainties, they can contact us at any time. Depending on how it is desired, by e-mail or telephone. We are easy to reach, and I think that’s a very big factor in our success. You know how it is when you have a technical problem yourself and need to get support: If that doesn’t happen immediately, the desire to get involved quickly fades. We are now at the relatively early stages of the project, and I expect the app to look somewhat different in the end than it does now. In our company, there is a willingness to take good suggestions for improvement and develop them further. The company Healthcare IT-Solutions, which provides technical support for the app, is very agile and is also available to implement relevant suggestions.

Please finish the following sentence: working in the DISTANCE project is important to me because,…

Dr. Molinnus: here the patients are directly involved in the project and we can actively shape digital medicine in Germany through the connection between medicine and technology.

Prof. Dr. Marx: we can succeed in achieving better patient care across sectors through research and data use and provision.