CEO SUMMARY: Siemens has a vision of tight integration of in vitro and in vivo diagnostics with informatics to support a single goal with two themes: enhancing work flow in healthcare. Theme one is that these technologies can support better productivity of clinical, operational and administrative processes. Theme two is the advancement of “knowledge medicine” to improve health outcomes.
FROM THE DAY LAST SUMMER when the world learned that Siemens was acquiring both Diagnostics Products Corporation (DPC) and Bayer Diagnostics, there has been great curiosity about how Siemens intends to integrate its new in vitro diagnostics businesses with its existing imaging and healthcare informatics businesses.
That is why it was a scoop when Dr. Frank Anton, President, Sales and Service, for Siemens Medical Solutions, of Erlangen, Germany, gave a speech on this very topic at Frontiers in Laboratory Medicine (FiLM), the lab management gathering in Birmingham, England, co-produced by THE DARK REPORT and the Association for Clinical Biochemistry (ACB). Frank’s speech, delivered on January 31, was the first time he had spoken to a clinical laboratory audience about Siemens’ plans for integrating imaging, in vitro diagnostics (IVD), and informatics.
Frank declared that the key to understanding Siemens’ strategy is one word: efficiency. Siemens intends to integrate these three healthcare resources in ways that will foster improved efficiency in both clinical services and the operational workflow of healthcare.
“What is the most important mega-trend that controls the markets in which our company operates?” Anton asked. “The most important trend is demographic change. As people age, the number of people receiving healthcare increases steadily. At the same time, there is more ability to pay for healthcare now and in the future. But the rapidly rising cost of healthcare is challenging healthcare systems across the globe.
“In healthcare, it is not a question of the availability of money, it is more a question of how to realize the potential of increased efficiency in healthcare systems,” observed Anton. “Many years ago, our company decided we were in the business of improving efficiency in health care.
“But how? Where are the growth opportunities for improving efficiency?” he asked. “Mainly, the opportunities are in improving workflow—by making early diagnoses, for example. One way we can improve workflow is by focusing less on technology itself, but on knowledge that aids in diagnosing and treating disease. Our term for this is ‘knowledge medicine.’ Siemens is in the business of making knowledge-based decisions accessible for providers of healthcare and by integrating our key systems.
Seeking To Improve Quality
“We want to generate product solutions that increase the quality of healthcare delivery and decrease costs at the same time,” Anton said. “To accomplish this, our company must deliver innovative products and optimize the processes of providing healthcare. Another way to say ‘optimization of processes’ is to say we need to improve workflow in all areas of care delivery. In fact, the goal of technology innovations should be to improve workflow.
“To address workflow, you have to address diagnostic technologies, such as X-ray, CT, and ultrasound. You also need the ability to network because information technology systems need to be connected throughout the hospital and across the healthcare continuum,” explained Anton. “It is essential to complement these with molecular technologies on the diagnostic side.
“That is Siemens’ strategy. We seek to be the first integrated diagnostics company,” he said. “Through our recent acquisitions, we aim to serve the entire continuum of care. In recent years, we have done quite a few acquisitions to complement our product portfolio.
“In 2000, we acquired Shared Medical Systems, which was the biggest IT company in the medical application provider area in the United States and Europe,” stated Anton. “In March 2005, we acquired CTI Molecular Imaging, Inc., the world’s leading provider of PET imaging equipment and services. Last spring, we entered the in vitro diagnostics market by acquiring Diagnostic Products Corporation, followed by our purchase of Bayer Diagnostics to expand our position in molecular diagnostics.
“Molecular and in vitro diagnostics are the most interesting extensions of our spectrum of services and our capabilities regarding our strategic possibilities,” Anton explained. “We want the company to cover the whole chain of patient care events: from early prevention, to specific diagnosis, and to specific therapy for individual patients. We view each from a disease orientation— and not just as a technology assessment, but as a needs assessment.
“To do a needs assessment from a disease orientation perspective, we require two elements,” he continued. “First is IT integration. In our view, we want to collect information from the IT system, mine that data, and extract knowledge. We then want to add that knowledge and information to already available knowledge in ways that support knowledge-driven healthcare. Second, and of equal importance, Siemens wants to use in vitro diagnostics and molecular imaging to extend our specific diagnostic capabilities in ways that also improve workflow.”
Three Areas of Growth
Anton pointed out that Siemens believes it is now a player in healthcare’s primary growth opportunities. “We believe three fields will drive the coming growth and innovation in healthcare,” he said. “First is in vitro diagnostics. Second is molecular imaging. Third is knowledge-driven healthcare.
“In each of these areas, we deal with electrical systems and that’s why these are important businesses for us,” continued Anton. “For example, we deal with assays and biomarkers in both in vitro diagnostics and molecular imaging. Our intent is to integrate these two different areas.
“This integration has to happen,” he emphasized. “We cannot continue to focus only on molecular imaging without integrating all of the knowledge that comes from assays and biomarkers. With the acquisition of DPC and Bayer Diagnostics, we have acquired knowledgeable and capable companies that fit very well into our overall strategy and that will be adapted into the overall IT system we are developing.
“This brings me to the third field, which is knowledge-driven healthcare,” he continued. “With knowledge-driven healthcare, we can integrate medical information that will enable healthcare providers to make knowledge-based decisions.
“Siemens is the first company to integrate in vitro and in vivo diagnostics and the whole spectrum of therapy,” he explained. “It gives us all the necessary elements to deliver a comprehensive service for diagnostics and therapy for our customers. And, again, the idea is to improve workflow.
“Molecular medicine and IT are the primary factors driving growth and innovation in healthcare,” Anton stated. “The challenge is, first, to handle all the data and, second, to interpret the data in the right way. It’s not always easy to get a quantitative assessment using only simple images. Some images are not easily explained. Sometimes it’s hard to get information out of certain images and that is where computer-aided detection plays a role.”
Supporting The Radiologists
Anton then displayed an image of a lung and described how computer-aided detection helped to identify cancerous nodes. “In the first step, the system identifies the nodes,” he said. “In the second step, the system quantifies the nodules, and in the third step, the system compares the current image with that from an earlier exam. This can all be done automatically as a way to support radiologists. It is not a substitute for the radiologist’s knowledge. It assists with quantitative assessment.
“In this way, technology creates new challenges in healthcare,” he continued. “The example demonstrates how technology can improve workflow and be a part of the solution to healthcare’s problems.
“Siemens believes that technology improves workflow because it can be involved in the whole continuum of care,” added Anton, “including the clinical cycle, the therapeutic cycle, and the administrative cycle. From the time when the patient comes into the healthcare system until the patient leaves, all the information has to be collected and combined, because you don’t want to enter information more than once.
“Then, the clinical information, the therapeutic information, and the administrative information should be linked in such a way so that wherever the patient goes, the information required for the next step is already there. Even if the next step is an intervention or if the next step is printing the bill,” he added.
“That’s why healthcare systems need an integrated IT solution,” Anton said. “In the long run, you will not survive by trying to integrate a number of different systems into one. Such a system will become less competitive compared with a system that covers the whole continuum of care. Once you have such a system, it will be a huge step toward improved workflow.
“In these systems, you need a workflow engine and a rules engine,” he continued. “Rules are like the notes on a page for an orchestra. Next is the workflow, which is like the music sheets. Then comes the workflow engine, which is like the conductor who drives the performance. The workflow engine enables decisions. You do not expect the workflow engine to make decisions. It simply enables decisions.
“The only reason to use innovative technology is to improve workflow,” Anton explained. “I admit that, in the past, technology companies simply introduced new systems because the technology was available. But we should now develop technology only if it improves workflow. We could debate this issue for many hours, but I will say the best use of technology in healthcare is to improve workflow.”