Interview with Lars Kalfhaus


Lars Kalfhaus is the Managing Director of Emminens Healthcare Services, a company that belongs to Roche Diagnostics. The company provides solutions to improve tailor-made assistance to patients affected by chronic diseases, in particular by diabetes mellitus.

The company has 10 years of experience in the eHealth sector, and it is present in a hundred hospitals in Spain. The company has launched Emminens eConecta, a cloud-based platform that connects every patient to his/her doctor with a view to increasing life quality and reducing economic costs.

The introduction of mobile technologies in the healthcare area is a growing trend that goes beyond applications for smartphones. Do you think users, as well as healthcare professionals, are ready to take in their introduction?

Right now, the factors for digital health introduction are stronger than ever. Widespread use of low-cost mobile technology (smartphones and tablets) and of medical devices and data sensors that make real-time gathering and transmission of data possible are a good example of that. Moreover, current trends include significant technological advances in data storage and processing capacity (known as “Big Data”) and “on-the-cloud” treatment of data. All this information may be essential in epidemiologic research and clinical routine; by using it, patient treatment may be improved and new conclusions may be reached. 


What is required to strenghthen the presence of technological solutions such as those introduced by Emminens?

The grounds for the introduction of digital health are already firm, given the high level of computerization achieved by healthcare systems. In some cases, some adjusments on treatment and follow-up processes are required in order to make an even better use of the potential shown by this opportunity. Current technological infrastructure is frequently fragmented: coordination between providers, as well as interoperability of different systems and their integration in digital medical record models (as well as in health information systems) is required. 


How may healthcare attention to patients affected by chronic diseases be improved?

Using platforms such as Emminens eConecta makes it possible to provide a customized, much more continuous follow-up process which in turn improves assistance in face-to-face visits. Comprehensive, up-to-date information the doctor receives enables him/her to be much better informed about the patient’s evolution on a day-to-day basis, as data are provided in a visually appealing, detailed manner. This increases the quality of time devoted to face-to-face visits. In fact, when using this system around 80% of the time is devoted to patient care, and only 20% of the time is devoted to administrative or data analysis tasks. All the aforementioned brings about an improvement in processes and in patients’ health; as a consequence, cost of care is also reduced. 


What role should the patient play in this change of paradigm? How is he/she expected to get involved in it?

Undoubtedly, digital health requires engaged, proactive patients who become managers of their own conditions but for whom support and supervision by his/her healthcare team is always available. This will increase motivation, adherence and self-sufficiency. Emminens offers an ongoing monitoring system and a permanent contact with the patients: this is important when it comes to patient motivation (which may be straightforward) and to keeping patients involved in the control of their conditions. In fact, our experiences so far in Spain are very positive. 


The “quantified self” concept is one of the pillars of change in chronic disease management. What is that about?

 “The quantified self” or “self-tracking” concept is a trend to gather data on daily personal health with a view to improving general health status and quality of life as a result. Thus, it is essential to help people change poor habits by fostering positive ones and using progression as a reward to continue gathering information continuously. The trend is quite recent in people with a good overall health status, but the concept of vital sign monitoring has been established in the management of chronic diseases such as diabetes for around 20 years, when precise devices for monitoring blood glucose levels were introduced. 


Tell us about some specific advantages in terms of management and costs derived from the introduction of healthcare technologies such as those introduced by your company. 

Nearly 80% of health expenditure is somewhat related to chronic disease management in the healthcare system. In fact, a diabetic patient generates a given expenditure: twice as much as that of a healthy person. Nevertheless, if no proper control is available and mild complications arise, expenditure may be 2 to 6 times higher, and even 24 times higher in extremely severe cases. 

Besides, economic expenses related to doctor visits should also be added: adults affected by type-2 diabetes mellitus visit the doctor nearly 3 times as much per year, and their medical expenses are 2.3 times higher than those of people who are not affected by the disease. On the other hand, we know that the closer and more frequent the contact between the medical team and the patient, the better the health results obtained. This brings forward the need for a proper technological tool to provide closer, more efficient contact using the scarce resources available and to generate health results at a much lower cost. Our approach is focused on reducing costs by using solutions that enable healthcare professionals to provide the best treatment to their patients and improve monitoring of their conditions. A patient under a better control is a patient who uses less resources.


You mentioned that the eConecta system by Emminens may reduce unplanned visits by 80%. How may this be achieved?

By enabling access to information and on-line communication with patients. When keeping the patient permanently connected with the medical team by two-way communication and by sharing the patient’s health data, it is possible to make a therapeutic decision without the patient being required to physically attend the healthcare center. 


How may the application of algorithms foster decision-making when managing a chronic disease such as diabetes? 

The first technological step for support has been representing data in graphs. It has been shown that faster, medical decisions may be taken when doing so (data from the VISIO1 study). Algorithms are one step forward. The system has more than 20 customizable algorithms used for pattern detection; clinical decision-making by healthcare professionals is supported so that they may introduce the required changes in treatment. An initial pilot study shows that this function reduces the time required for data analysis from 10 minutes to less than 1 while improving detection precision to 87% (which avoids false positive results). With these tools, beside making efficient decisions, the healthcare team may devote more of their time with the patient to motivation, therapeutic training and doctor-patient interaction. 


A diabetes follow-up programme has been launched in several chemist’s in Barcelona. Could you tell us what the programme is about? Do you plan to launch it in other cities? 

The programme is being developed in several chemist’s in Catalonia. It is included in a pilot project jointly fostered by the Federación de Asociaciones de Farmacias de Catalunya (FEFAC; Federation of Chemist’s Associations in Catalonia) and Emminens, that has been in charge of developing the technological platform that permits customized monitoring of diabetic patients. Through 4 tailor-made control sessions, users are provided with guidelines and advice to keep healthy habits, as well as a report for each visit so that the information may be useful for the specialist. Such a close-at-hand service makes it possible to keep diabetes under control, as well as closely monitoring the main risk factors that may be associated to it. 

The control report includes all the information generated in each session, particularly the monitoring of several signs such as glucose, blood pressure and cholesterol levels. Abnormal findings are identified and, if necessary, the need to adjust treatment or visit the doctor is established. We expect the experience gained in the first 11 chemist’s to be useful as a base to expand custom-made assistance for diabetic patients to every other chemist’s in Barcelona in the next few months. Besides, we have also launched another project in Sevilla, in cooperation with the Colegio de Farmacéuticos (Chemist’s Official Association). Emminens eConecta is there used as a platform for a new service aimed at diabetic patients as well. 


Finally, what are the future challenges faced by digital health?

On the one hand, it is essential to develop easy-to-introduce, user-friendly tools, both for healthcare professionals and patients. This involves inter-operability and connectivity with already-existing healthcare systems, as well as a connection with other devices in the healthcare area and beyond it. On the other hand, applications should make the patient feel driven to use them in daily life: they should not be regarded as an annoyance or an intrusion in the patient’s normal life. At the same time, as more and more advanced algorithms are developed, it would be useful to perform clinical studies that show how effective and safe the systems are.


By Jose L. Cánovas