Preventive Healthcare. Doctor’s Opinion. Digital Health Interview: Anna Erat

Welcome to a special edition of Digital Health Interviews! While we typically feature startup founders, digital health influencers, and tech experts, today we have a delightful change of pace. We are thrilled to extend our invitation to medical workers, doctors, clinicians, and hospital managers to join us on our YouTube channel. After all, the software and hardware developed by startups primarily aim to assist doctors, making them one of our key target audiences. It's incredibly valuable to gain insights from this perspective, which is why we are delighted to introduce our esteemed guest, Dr. Anna Erat, a medical doctor.

Introduction:

Anna Erat: Medical Director, Speaker, Independent Board Member (INSEAD IDP), Mentor ETH. Presently, she holds the position of Deputy Director at the Hirslanden International Medical Center and serves as a team doctor for the Swiss Ice Hockey Federation. Alongside her role as a sports medicine consultant at AlphaClinic, she provides her expertise for noteworthy events like Art on Ice and the Scandinavian Beach Polo World Cup. Moreover, she actively contributes to various advisory boards within Switzerland. Her extensive qualifications include teaching medical and executive MBA students in Europe. Notably, she holds a Ph.D. in health systems management and has completed training at Harvard Business School and the International Director’s Programme at INSEAD.

Anna Erat: “Thank you very much for having me today. It’s really important for us as medical doctors because we are at some kind of the frontline. I think sometimes it’s difficult to understand what our daily confrontations are, so it’s really a pleasure being here today. As you know, I’m the medical director at the Hirslanden checkup center. Hirslanden is the largest private hospital group with 17 hospitals in Switzerland. We focus more and more on Healthcare, not only pure Sickcare but also on both primary and secondary kinds of prevention.”

Prevention is actually something that even doctors and many professionals within the healthcare industry do not really distinguish, so we need to define it before elaborating on everything else: “We can divide it into two groups: one is how to prevent disease and to improve performance before you get sick — how to stay fit, and keep diseases away. That’s primary prevention. Secondary prevention is once you are sick, you can do something in order to improve your prognosis, and the course of your illness. For instance, 60% of the people in Switzerland over 60 have high blood pressure. So what can you do to manage it in the best possible way to optimize the outcome and have a high-quality life for a long period of time? Or, let’s say, if you have diabetes type 1, what can you do to avoid unnecessary complications? Prevention covers a huge span of health and disease, including longevity, which is in every person’s mouth kind of at the moment.”

Dr. Anna doesn’t consider prevention a luxury problem, because, as she thinks, it really isn’t: “90 percent of the healthcare expenditure in our country and on the global level goes to combating chronic diseases, and only 10% is allocated to prevention. If we can shift that obviously there can be a lot of cost savings. However, the more health literate you are, the more likely you are to pay attention to prevention: to have the means to eat very healthily, to exercise in a way that suits your everyday schedule, and so on. We know it, there’s statistics. But we want to reach the entire population, and on the public health level, this has been done for years and years. I mean the UN actually; the Declaration of Human Rights in 1948 already captured the essence of prevention and how important it is for public health. So it’s not a new phenomenon, but it is easier to convince and also to operationalize the prevention in the segment of the population that is more health literate.”

Educating the population is super important here: “I mean the entire population, beginning with small children in pre-kindergartens, even with just what they get for lunch, how they move, what kind of toys they have, how much time they’ve been outside. They're all a huge part of trading habits.”

Last year Dr. Erat started the “HealthUp Switzerland” initiative, where preventive medicine meets modern lifestyle. Its main point is to educate people regardless of age, and origin: “Nowadays with the technology that we have, we can reach almost anyone globally. It’s also about sharing information with policymakers. This is a very important part; the policymakers are not only those sitting in the government, but also, for instance, health insurance companies, health coverage plans, schools, etc. In fact, I had a really interesting conversation at the World Economic Forum with the Prince of Sweden Daniel. He and his wife — the Chronprincess Victoria — have put a huge effort in Sweden into getting children at a preschool and school level to integrate physical exercises into part of the curriculum. This is super important, but we need to reach every part of society including the decision-makers, policymakers, and regulatory bodies.”

In Switzerland, insurance companies cover preventive medicine now, it depends on the plan that a person has: “Here’s a quite complicated landscape, but it’s mandatory to have a health insurance plan. You can’t live here as a resident without it. And it’s only partially covered by the employer, so it’s a very different system than in the US, for instance, and also very different from the beverage system in the UK or in Germany. But the healthcare plans partially cover prevention, and depending on the plan, they cover more or less. For instance, for everyone over 50 in Switzerland the healthcare plans have to cover a colonoscopy every 10 years.”

Since our channel is focused mostly on technology and innovation in the healthcare field, we decided to ask what kind of software or devices Dr. Anna was already using daily to help her patients. The most operational one is, as she said, an electronic patient record system because nothing works without it: “It would be nice, of course, to have a national International System where we can share data very easily in a secure fashion. That it’s not the case in Switzerland, not yet. We still have some challenges, but I don’t know any medical doctor who doesn’t have an electronic patient record system. It’s most certainly a must, also from a regulatory point of view. It’s very difficult to record patient data properly without a system that’s secure. There are various brands depending on where you are working. You would be surprised, but at the beginning of the COVID pandemic, for instance, a lot of the reporting of COVID-positive patients was done either via fax or post. So you can imagine its lack and when it was registered. That’s what we’re really struggling with on a grassroots level partially. But we have a lot of software and wearables that we use on a daily basis as well as remote patient monitoring. But we also rely on the patients themselves: what they have, what they can offer, what they show. A lot of these gadgets and devices aren’t medical devices. So we have to be careful about the data and how we interpret it. But it’s useful, it’s wonderful, and it empowers patients which I really like.”

Dr. Erat focuses on working with sportsmen, and athletes. How has the whole industry of sports changed with the appearance of hundreds of trackers and medical devices that capture all the biomarkers? “A lot! But that’s a little bit different because here we’re going to lifestyle and performance, and that’s totally different from medical devices. Some athletes like to be monitored more and some — less. That’s very important to respect as well because the mental pressure can be huge when they are monitored. Some people love it, other people hate it. It has to be taken into consideration: if you want to go and win the World Cup or the World Championship, you need to feel comfortable about how you’re being monitored. You also need to rely on a person looking at it and trust that the data isn’t shared or it doesn’t land in the wrong hands. This is hugely important but some of it is crucial medical data, and the other is more performed as a lifestyle one so you have to distinguish it.”

But are we already using the data we get efficiently? “I think we’re not. I’m looking forward to artificial intelligence and a lot of data analysis that’s of course already used quite frequently in the radiology department, and it’s extremely helpful. It’s not for most of us particularly, it’s not a threat, but an amazing asset. And we are looking forward to contributing to it. That’s also an important point: there’s a lot of technology, but a lot of it isn’t very useful.”

On Dr. Anna’s Instagram account, we found a fun video where she was trying out robotic devices to help with performance enhancements, rehab, and recovery. How soon do hospitals and rehab centers start using those on a regular basis? “A lot of rehab centers, particularly in the field of neurology and neurodegenerative diseases, have already used these devices, fortunately. There are also a lot of gamification elements and learning by playing. We know that children learn very nicely when they can use the same goods as adults. These devices are very helpful if they are operated in the right way, in the right setting.”

In Dr. Erat’s opinion, what digital solution aimed specifically at athletes is really lacking in the market? “It’s definitely blood sugar and glucose monitoring. In certain disciplines, the way the body processes is of extreme importance. It’s calculated that in 10 years the industry of wearables and various devices will be around $30 billion. From a financial and economic point of view, it’s huge but that also reflects in which direction we’re going, and it’s fascinating.”

Then we spoke about fully personalized and DNA-based medicine. How long before this becomes our norm? “I don’t think we can ever have fully personalized medicine: it’s always about nature and nurture. “Nature” means “genetic material”, and “nurture” means “lifestyle”. 30 to 50% of all cancers can be prevented by various lifestyle measures and environmental factors. However, the other 50 to 70% aren’t preventable ones. Not talking only about cancer, genetics in certain diseases plays a huge role, and I see great potential there. The same goes also for medications. Many of the medications today, freely mainstream ones — antidepressants, opioids, pain killers, or blood thinners — don’t work in certain genetic constellations. And when we talk about these medications, we also talk about a huge mass of people that are using them. This means that a very large number of people using these drugs aren’t reacting in any way, so they can’t profit. Genetics is of the essence but it’s not going to solve all our problems.”

Traditionally, at the end of the interview, our guest gave some recommendations for startup founders in digital health: “Put patients first, in the center, and build everything around them. Of course, you have to be business- and tech-savvy. Obviously, you need good financing schemes. You need marketing, supply chains, and all of that. But the core always has to be patients and their needs. A lot of times we forget the patients’ actual needs. We think they might need something, but they actually don’t need that at all. So you can build an app for years that’s not going to be useful at all because that’s totally relevant to patients, doctors, and the healthcare staff. So put the needs of patients first, build everything else around it, and talk to these people.”

Our previous episode was with Alfred Angerer: New Healthcare Management Approach