PICTURE OF HEALTH
Regional chief of Siemens Healthineers foresees a future of more personalised, accurate and accessible care enabled by digital imaging advances.
Elisabeth Staudinger has no background in healthcare or engineering, but she can accurately and thoroughly describe the functions of highly sophisticated medical machinery with ease. The president of Siemens Healthineers-Asia Pacific is also an enthusiastic learner when comes to the latest advances in healthcare, which continue to astound her.
She is especially impressed by new imaging technology that can look further into the body, and in more detail than ever before, without the use of harmful radiation.
“It is amazing how much we can see with so little radiation now, and for me that is totally fascinating,” she remarks. “Even after being in this industry for a long time, those cinematic renderings still make me go ‘wow’, as it’s basically a movie from inside your body.”
Siemens has taken medical technology into a new era with its Cinematic VRT (virtual reality technology) systems. Data from computed tomography (CT) and magnetic resonance imaging (MRI) scans can now be rendered with lifelike lighting and other effects to create hyper-realistic anatomical images. For me it calls to mind the 2000 movie Hollow Man starring Kevin Bacon, but the video demonstration I’m watching on my smartphone could actually be used to save a life.
Siemens Healthineers, a separately managed healthcare business of Siemens AG, produces and supplies healthcare providers with technology in core areas of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine, along with digital health and related services.
Drawing on the German parent’s 170 years of experience and 18,000 patents, the company now has a presence in 70 countries and employs about 48,000 employees. In fiscal 2017 it generated revenue of €13.8 billion (US$15.92 billion) and a profit of €2.5 billion. Its main products include x-ray, ultrasound, CT and MRI scanners along with blood-testing equipment.
Overseeing this business in Asia is Ms Staudinger, who joined Siemens in 1998 in its global procurement and logistics division in Munich after graduating in economics and business from Vienna University. Within two years she advanced to a managerial role and was posted to Shanghai.
Given that she had taken Chinese studies at Nanjing University from 1992-93 and then done master’s thesis research on social security in China at Beijing University, the move from Germany to China was not the culture shock it would be for most people. In fact, the move that made a more profound difference in her life was the one from Siemens’ procurement and logistics division to its healthcare sector.
“I was always interested in joining Siemens’ healthcare business because it deals with things that are matter to people, and you can see how it has an impact on our lives,” she recalls. “After I had an opportunity to join the medical business within Siemens, I never considered going anywhere else.”
After holding several management positions at Siemens Healthcare in Germany and China, she moved to Forchheim, Germany, in January 2009, as chief executive officer of its refurbished systems business unit. Four years later she was on the move again, this time to Singapore as Healthcare Region Lead for Asean-Pacific in Singapore, and this year she assumed additional responsibility for Siemens Healthineers Greater China.
OPPORTUNITIES AND CHALLENGES
Asia Pacific provides many challenges and opportunities for Siemens Healthineers, reflecting the differences in the region’s demographics and geography, Ms Staudinger observes.
“In Asia, it is a lot about enabling access to healthcare as there is huge population and people who need healthcare, who want healthcare, who deserve healthcare, at an affordable cost. This is one of the big things for us here,” she says.
Making healthcare more affordable in Asia Pacific includes making Siemens’ high-tech products more affordable wherever possible. Rapid advances in technology have driven down costs in many areas and this is helping. For example, CT scanners were considered beyond the reach of many Asian hospitals, especially smaller public facilities, one or two decades ago. But today a unit can be had for between $50,000 and $80,000.
“How much you paid for a CT scanner 15 years ago and how much you get for a fraction of the price today, there has been huge progress,” Ms Staudinger says. “This is because imaging (technology) has become more affordable over the years and we are continuing to push that.”
Meanwhile, digitisation is opening up new ways of making healthcare more accessible by being able to serve more people. This can be done by connecting doctors with scanners to make it easier for people in remote areas to have examinations done and obtain thorough and accurate diagnoses.
“Very good and expert radiologists are typically not available in the countryside and if you have a way of putting a scanner in a remote area, using IT, you can send the image anywhere in the world because it is basically just a big data file,” she explains.
Siemens Healthineers provides the IT infrastructure and applications to exchange images, which includes tablet and smartphone apps for doctors to view images, and in-house cloud technology called Teamplay. “Ultimately, the doctor does not have to be where the patient is and it’s a big advantage to enable this way of working,” she adds.
In terms of opportunities in Asia Pacific, the market environments range from wealthy Japan with its mature and ageing economy, to India with its large and young population but underdeveloped public healthcare system.
Thailand is somewhere in between, where there is a very well established healthcare system with universal coverage so that basic needs are provided for. However, that has put a financial burden on the government, which is constantly looking for better ways to ensure decent coverage for all 68 million citizens.
For island countries such as Indonesia and the Philippines, it is “very challenging” for governments to provide healthcare to people in remote areas, but some lessons learned from Japan could be applied.
In Japan, there are small outlying islands where there is no doctor because no one wants to live there, but Tokyo has to find a way of serving the population and again, digitisation has provided a great opportunity.
“It is all about having a radiologist or people who know how to operate the scanner in the bigger city. Then you place a scanner on the remote island and all you need now are nursing staff, with very basic training, to work with machine and the patient on the other side,” Ms Staudinger explains. “This can be replicated in Indonesia or in the Philippines.”
NEW TRAINING APPROACHES
In frontier markets such as Myanmar and Cambodia, the opportunity exists to build a new kind of healthcare system from scratch. Beyond building hospitals that have a certain level of capability, a lot is riding n the way doctors are trained so that they are familiar with new diagnostic technologies. The company now has distributors in the two countries.
“Putting the money on the table to build the hospital and buy the equipment is actually the easy part,” she says. “If you really want to deliver high-quality care you need doctors who know what they are doing and that has been a big focus for us.”
For instance, in Myanmar, Siemens Healthineers has invested a lot of resources in training radiologists since the economy and healthcare sector began to open up in 2011, as most were familiar only with x-rays.
“They were not trained in reading CT or MRI images or any of the more complex imaging which is available today,” Ms Staudinger says. That has changed as a result of training programmes involving the company and local associations, and input from local doctors who have returned to Myanmar after studies or extra training abroad.
Siemens Healthineers works in Myanmar with the local radiologists’ association and doctors to discuss what they need, then brings in experts to set up training. It also uses PEPconnect, an online learning platform that allows physicians and medical technologists to access course material on the company’s systems. All told, the system offers more than 7,000 learning activities in up to seven languages.
“All the machines do not help if you do not have people who can do something with the information,” Ms Staudinger stresses.
Another big challenge, besides connecting doctors to machines in remote areas, is maintenance because it is almost as difficult to get a capable technician to go there as it is to find a capable doctor.
Siemens Healthineers seeks to overcome this problem by working very closely with healthcare providers and local representatives who not only sell but also keep the equipment running. The company provides the local maintenance team that it trains, along with a lifetime guarantee for all its big machines.
“You have to really take care of this very sophisticated and high-end technology,” she says. “It is not like just putting it there and then doing nothing for five years as there is a need to regularly look after the machine to make sure that it keeps on running.”
Maintenance services are further enabled through LifeNet, a web-based customer portal for managing Siemens Healthineers systems at clinical facilities. It is now optimised for use with mobile devices. The portal provides a real-time status display with a view of system availability and the overview of all upcoming maintenance work and upgrades for the systems for up to a year in advance.
IMAGE BUILDING
How many people know that there are major differences between x-ray, CT scan, and MRI machines? Like many people, I have always believed that these diagnostic tools are different only in terms of what kind of image can be produced. Ms Staudinger rook the time to take time to explain what I needed to know.
“I was always interested in technology even though I did not study in the engineering field,” she says. “I was never afraid of technology and when you go into that medical imaging space it is really techy stuff. But I really like it, especially how you can create clinical value out of it. That is a lot of fun.”
As Ms Staudinger updates my knowledge of the field, she also notes that imaging equipment is entering a new, higher-tech phase. Various artificial intelligence (AI) applications have been incorporated into Siemens Healthineers’ machines, for both safety and monitoring such as predictive maintenance. This allows the company to know or predict when something might fail, so that it can send a technician to take the appropriate action so that there is no interruption of essential services.
There is also an added dimension to diagnosis, where AI can support the radiologist to make sure that they do not miss anything on the image. There have been plenty of advancements in this field that are already available on the market but “there is a lot more to come”, Ms Staudinger says with a sense of excitement.
“To the extent that people say someday the radiologist might be replaced by AI, we do not think that this will happen. But we do believe that there will be a lot of work which can be done by artificial intelligence and algorithms,” she points out.
“Ultimately, the doctor can focus on maybe the 20% [of diagnoses]which are more complicated, while a lot of the routine work will be done by computer.”
Everyone now has access to applications on their smartphone or a wearable device to monitor their vital signs and these too will become “very important” in the future as the way healthcare is delivered is going to be more “patient-centric”, she believes. “This goes beyond just making the scanner smarter or diagnosis faster.”
Ms Staudinger is eagerly looking forward to a future of even more accurate diagnoses and personalised healthcare, with better outcomes for patients everywhere.
“Going forward, a lot more care will happen in a decentralised setting, where there will be a lot more diseases where you can actually stay at home and still receive treatment by being connected, by having sensors and by being able to transmit data to people that can monitor your condition,” she says.
“It will be a more individualised, more precise, more decentralised setting, it will put the patient at the centre and all of it will be enabled by digitisation.”
Putting the money on the table to build the hospital and buy the equipment is actually the easy part. If you really want to deliver high-quality care you need doctors who know what they are doing and that has been a big focus for us