Implementation of eHealth and AI integrated diagnostics with multidisciplinary digitized data: are we ready from an international perspective?

Abstract

Digitization of medicine requires systematic handling of the increasing amount of health data to improve medical diagnosis. In this context, the integration of the versatile diagnostic information, e.g., from anamnesis, imaging, histopathology, and clinical chemistry, and its comprehensive analysis by artificial intelligence (AI)–based tools is expected to improve diagnostic precision and the therapeutic conduct. However, the complex medical environment poses a major obstacle to the translation of integrated diagnostics into clinical research and routine. There is a high need to address aspects like data privacy, data integration, interoperability standards, appropriate IT infrastructure, and education of staff. Besides this, a plethora of technical, political, and ethical challenges exists. This is complicated by the high diversity of approaches across Europe. Thus, we here provide insights into current international activities on the way to digital comprehensive diagnostics. This includes a technical view on challenges and solutions for comprehensive diagnostics in terms of data integration and analysis. Current data communications standards and common IT solutions that are in place in hospitals are reported. Furthermore, the international hospital digitalization scoring and the European funding situation were analyzed. In addition, the regional activities in radiomics and the related publication trends are discussed. Our findings show that prerequisites for comprehensive diagnostics have not yet been sufficiently established throughout Europe. The manifold activities are characterized by a heterogeneous digitization progress and they are driven by national efforts. This emphasizes the importance of clear governance, concerted investments, and cooperation at various levels in the health systems. Key Points • Europe is characterized by heterogeneity in its digitization progress with predominantly national efforts. Infrastructural prerequisites for comprehensive diagnostics are not given and not sufficiently funded throughout Europe, which is particularly true for data integration. • The clinical establishment of comprehensive diagnostics demands for a clear governance, significant investments, and cooperation at various levels in the healthcare systems. • While comprehensive diagnostics is on its way, concerted efforts should be taken in Europe to get consensus concerning interoperability and standards, security, and privacy as well as ethical and legal concerns.

Machine learning and artificial intelligence in haematology

“…IBM Watson for Oncology uses machine‐learning algorithms and natural language processing of the EMR to combine patient and disease features, published literature, available clinical trials and leading oncologists’ experience to suggest and rank treatment options 35 . However, this effort has been criticized for not living up to its expectations, 36 high implementation costs, difficulty extracting information from the medical record and low concordance between its recommendations and actual clinical decisions among the challenges observed 36–38 . Overall, the incorporation of recommendation systems into diagnostic and therapeutic decision‐making as well as error prevention will undoubtedly grow in the near future.…”

“…35 However, this effort has been criticized for not living up to its expectations, 36 high implementation costs, difficulty extracting information from the medical record and low concordance between its recommendations and actual clinical decisions among the challenges observed. [36][37][38] Overall, the incorporation of recommendation systems into diagnostic and therapeutic decision-making as well as error prevention will undoubtedly grow in the near future.…”

Emerging methods in radiology

“…Another promising approach toward metabolic imaging is 13 C hyperpolarized MRI, for which a special preparation step results in highly increased signal from 13 C contrast agents. Among these, [ [1][2][3][4][5][6][7][8][9][10][11][12][13] C]pyruvate is evaluated in clinical trials for the visualization of metabolic changes during treatment of prostate cancer (. Fig.…”

“…)national E-health infrastructures, it will not become a clinical reality [9]. Profound knowledge of information technology infrastructures, data formats, and interfaces must be acquired and legal prerequisites for data ownership, data sharing, and protection of patients' privacy clarified.…”

To the question of the digital platform “bioinformatics” creating and its system-forming solutions

“…Current situation with coronavirus pandemic urges on integration of available data on biodiversity, studying molecular mechanisms of host-pathogen interaction that needs in turn integration of data in microbiology, medicine, systems biology fields [27]. A concerted effort is being made in Europe to achieve consensus in this area on standards, security and privacy, and ethical and legal issues [28]. An example of this trend in Asia is the expansion of electronic health records at the University of Malaya Medical Center (UMMC).…”