Future of Health Services

The role of physician and health provider in disruptive era

Budi Wiweko
budiwiweko01@ui.ac.id
budi.wiweko@gmail.com

Academic Health System Universitas Indonesia - Indonesian Medical Education and Research Institute
Faculty of Medicine Universitas Indonesia
Dr. Cipto Mangunkusumo General Hospital

Jakarta
 Outline of My Talk

1. Disruptive innovation
2. Consumer health informatics
3. Bioinformatics and precision medicine
4. Take home messages
Disruptive
innovation

Technological
advances
Consumer
health
impacting
informatics healthcare
and the
magnitude of
Bioinformatics disruption
and precision
medicine

Take home
messages
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine
A disruptive innovation is an innovation that creates a

new market and value network and eventually disrupts an existing

Take home
messages market and value network, displacing established market-leading firms,
products, and alliances.
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine Ovarian aging is characterized by a decline in both the total number and overall
quality of oocytes, the latter of which has been experimentally tied to
mitochondrial dysfunction.
Take home
messages Clinical studies in the late 1990s demonstrated that transfer of cytoplasm
aspirated from eggs of young female donors into eggs of infertile women at the
time of intracytoplasmic sperm injection improved pregnancy success rates
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages
AUtologous Germline Mitochondria ENergy Transfer = AUGMENT

Woods and Tilly. Semin Reprod Med, 2015

 SOCIAL EGG FREEZING:
A reproductive chance or smoke and mirrors ?

Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages

Lucia Martinelli et al. Croat Med J. 2015;56:387-91

Disruptive
innovation
Disruptive
Consumer
health
informatics

Lisa is 37 years old and she has just broken up with her long-term boyfriend.
Bioinformatics She always imagined that this relationship would lead to marriage and children.
and precision
medicine Lisa is stable and happy in her career. However, she is now worried that if she does not meet someone
new, and soon, her biological clock will be merciless with her and she will be left childless.

After a visit to a fertility clinic she decides to freeze her eggs, in order to remove the pressure of having
Take home to rush into a new relationship.
messages
She wants time and is not ready to date again.

She wants to raise a child with a committed partner and believes that freezing her eggs will offer her the
best chance of ensuring this.
 Disruptive
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages
Some companies are even offering financial plans to support women to
freeze their oocytes in a venture which could turn out to be quite
expensive
Disruptive
innovation

Consumer
health
Budi Wiweko, 2019
informatics

Bioinformatics
and precision
medicine

Take home
messages
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

He Jiankui defends 'world's first gene-edited

Take home
babies'
messages Prof. He announced earlier this week that he had altered the DNA of embryos
twin girls to prevent them from contracting HIV.
Disruptive
innovation

Consumer Disruptive
health
informatics

Bioinformatics
and precision
medicine

Take home
messages
 Diagnostic and Research Center
(DIARC – FKUI)

Disruptive
innovation EMBRIO BIOPSY

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages

Iffanolida, Wiweko et al. Ina Repromed, 2015

 Diagnostic and Research Center
(DIARC – FKUI)

Disruptive
innovation
NGS

Consumer
health
informatics

Bioinformatics Aneuploidy detected, XXY

and precision
medicine
Microarray

Take home
messages

Iffanolida, Wiweko et al. Ina Repromed, 2015

Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages
 Doctor’s oriented health services

Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages

New Paradigm
 INTERNET OF THINGS (IOT) CONSUMER HEALTH INFORMATICS

Disruptive
innovation

Consumer
health
informatics
The use of internet-based and electronic resources to educate and improve
medical outcomes and healthcare decision making for patients, caregivers and
Bioinformatics
and precision consumers.
medicine

The consumers has capability to retrieve information and

Take home recommendation regarding disease, medication and treatments
messages

Bosworth A, York C, Kotansky H, Berman MA.

An inventor's perspective on consumer health informatics. Am J Prev Med. 2011;40(5 Suppl 2):S241-4.
Disruptive
innovation

TELEMEDICINE ACTIVITIES
Consumer
health
informatics
Three in four large employers
(74%) plan to offer telemedicine
to workers in 2016, a dramatic
Bioinformatics
and precision
increase from 48% in 2015.
medicine

Take home
messages

Foguem et al. Telematics and informatics, 2015

Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages
Disruptive
The Indonesian Test-Tube Babies Facebook Club is a type of OSG
innovation
which was evaluated in this study

“Honestly doc, initially I was embarrassed to come here. To seek treatment for infertility,
Consumer
because how do I explain to you how I felt. However, I tried browsing here and there
health
before finally deciding to come here, and one of the pages I opened was the Indonesian
informatics
Test-Tube Babies Facebook Club. I read the comments, the moral support, and I was
touched. Initially, I feel embarrassing as I thought I was the only one with this infertility
Bioinformatics
problem, but it turns out there are so many people going through the same thing. Also,
and precision
medicine they all do not feel embarrassed to fight, it is fascinating, and finally decided to come
here.” (Respondent 11).

Take home
messages

Wiweko et al. ISBE, 2017

Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
Objective: To evaluate the correlation between chronological and
medicine biological age by comparing the normograms of AFC, AMH, and FSH

Main Outcome Measure(s): Normogram of AFC (n=366),

Take home AMH (n =1616) and FSH (n =415)
messages
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Chronological Age AMH Level Biological Age

Take home
messages 25 years old 5.4 ng / mL 25 years old
25 years old 0.5 ng / mL 42 years old

n = 1616 Wiweko. Ina Repromed, 2015

 TENDENCY OF DECISION ON
Disruptive
REPRODUCTIVE TECHNOLOGY CHOICES
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages

Wiweko et al. AIP Conference, 2019

Disruptive
innovation

Consumer
Big data: the next frontier for innovation in therapeutics and
health healthcare
informatics
Naiem T Issa, Stephen W Byers, and Sivanesan Dakshanamurthy

Bioinformatics The digital revolution in healthcare is now. The amount of data is exploding from
and precision
medicine basic science to clinically based genomics and personalized medicine, and continues
to evolve in healthcare at both the population and the individual levels.

Take home
messages Clinical phenotypes are being described more quantitatively and biochemically
using genomics, transcriptomics, proteomics and metabolomics.
 How Big Data is Collected

Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages

Components of big data along with the actions that can be taken with big data
Disruptive
innovation

Consumer
health
informatics

Bioinformatics is the use of computational tools to interpret information from

Bioinformatics genomes and their derivatives (e.g., transcriptomes, proteomes, and
and precision
medicine metabolomes).

Bioinformatics approaches can readily identify molecules or cellular components as

Take home
messages targets of clinical interventions, allowing for better knowledge of the
mechanism of the disease.
Disruptive
innovation
Understanding the
interactions between
Consumer genetics, lifestyle, and
health
environmental factors
informatics
provides deep insights into
disease pathogenesis and is
Bioinformatics
helpful for the early
and precision
medicine diagnosis and treatment
of human diseases.

Take home
messages
 PROMOTIVE AND PREVENTIVE APPROACH

Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages Understanding and balancing genetics-lifestyle-environment interactions are
essential for systems health
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages The synergistic relationship between smart healthcare and the translational
biomedical informatics subdisciplines
This flowchart provides a brief
overview of the AI workflow.

The first step is the collection of

data.

The data includes electronic medical

records (EMRs), hospital data, and
cloud data sharing.

The second step is data pre-

processing. The third step is the
selection of the appropriate model.

The data is analysed using artificial

intelligence methods such as
machine learning and natural
language processing (NLP).

Then the training dataset is used to

train the model. The final steps
include the evaluation and
validation of the model.
Big data includes electronic medical records (EMRs) and
other data.

EMRs can capture data from various ways and the data is
analysed using artificial intelligence (AI) such as machine
learning and natural language processing (NLP).

AI has been used in the many aspects of reproduction, from

research and experiment to clinical practice. This schematic
reviews the 7 main applications of AI in reproductive
medicine.
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
medicine

Take home
messages
Tele Presence

Rehabilitation Robot

Surgical Assistant
Medical Transportation Robot Sanitation and Disinfection robot

Robotic Prescription Dispensing Systems

 4 P’s approach
Disruptive
innovation
Predictive
Preventive
Personalized
Consumer
Participatory
health
informatics

“PRECISION MEDICINE’’ refers to medical treatment adapted to the individual

Bioinformatics characteristics of each patient.
and precision
medicine
Concept:
Ability to classify individuals into sub-populations that differ in their susceptibility to a
Take home
messages
particular disease, in the biology and / or prognosis of those diseases or in their response to
a specific treatment.
Disruptive
innovation

The virtual medical coach model with

Consumer multi-modal data inputs and algorithms
health to provide individualised guidance
informatics

Bioinformatics
and precision
medicine

Take home
messages
Disruptive
innovation

Consumer
health
informatics

Bioinformatics
and precision
Bioinformatics concepts particularly amenable to public outreach are those that
medicine
focus on molecular biology and its impact on public or personal health, as well as
those that address ethical consequences and policy considerations affecting
Take home
messages daily life.
Disruptive
innovation

Consumer
health
informatics
Genomics and
bioinformatics for
Bioinformatics
and precision the clinical audience
medicine

Take home
messages
Disruptive
innovation

Consumer
What should
health
informatics everyone know
about genomics and
Bioinformatics bioinformatics ?
and precision
medicine

Take home
messages
Disruptive
innovation

Consumer
health Convergence
informatics Will Accelerate
Discovery and
Innovation
Bioinformatics
and precision
medicine

Take home
messages
New Biology, which focuses on the life sciences, draws on integration of multiple
scientific fields in the creation of biology-based solutions to societal challenges

National Academic of Sciences, 2014

 PEMANFAATAN TEKNOLOGI DAN INOVASI DALAM PENCEGAHAN PRIMER PENYAKIT

Input Proses Output

Remaja

Ibu hamil

Alat deteksi dini Bayi baru lahir Deteksi dini

• Diabetes mellitus
Clinical • Hipertensi
Pengembangan Mandatory • Penyakit ginjal
Big data Model biomarker non invasif screening kronik
Genomic • Kardiovaskular
• Kanker
Early detection • Stroke

Deteksi dini
Artificial intelligent (AI) • Tuberkulosis
Environment • Malaria
• DHF
Pencegahan • Hepatitis
Internet of thing (IOT)
Life style

Indonesia Sehat 4.0 Budi Wiweko, 2019

 PEMANFAATAN TEKNOLOGI DAN INOVASI DALAM PENCEGAHAN PRIMER PENYAKIT

Input Proses Output

Sistem Kesehatan Reproduksi Nasional

Berbasis Teknologi
Perencanaan keluarga Penurunan angka
Deteksi dini morbiditas kematian ibu
e-Family Indonesia dalam kehamilan
Penurunan angka
Pendidikan kesehatan kematian bayi
reproduksi Indonesia
Dokter-KU Kohort ibu hamil per
Dokter KelUarga Indonesia kabupaten / kota Penurunan kejadian
Layanan kesehatan stunting
reproduksi Indonesia

Inovasi Program
Asuhan Kehamilan Indonesia

Pemanfaatan Wearable Device

Big data GEMILANG: Gelang Kehamilan Cemerlang

Indonesia Sehat 4.0 Budi Wiweko, 2019

PEMBANGUNAN KETAHANAN DAN KEMANDIRIAN KESEHATAN INDONESIA

Input Proses Output

Peningkatan kualitas RS
rujukan regional Distribusi tenaga kesehatan

Peningkatan produksi alat

Pengembangan academic kesehatan dan obat dalam negeri
Pusat riset dan inovasi
kesehatan Indonesia health system Indonesia

Peningkatan akses dan kualitas

layanan kesehatan
Tele medicine Indonesia
Big data

e-Family Indonesia Peningkatan akses dan kualitas

Artificial intelligent (AI) jaminan kesehatan nasional
Dokter-KU
Internet of thing (IOT)
Dokter KelUarga Indonesia
Mengatasi “gap” layanan
jaminan kesehatan nasional

Iur biaya dan premi JKN

Indonesia Sehat 4.0 Budi Wiweko, 2019

 TAKE HOME MESSAGES
Disruptive
innovation
1. Disruptive innovation in health care are aligned with the development of AI,
machine learning, robotics, IoT, digitalization and genomics.
Consumer
2. New paradigm shifting in patients-physician relationship are relevant with
health
consumer health informatics.
informatics

3. The development and knowledge of bioinformatics are very crucial to

support establishment of precision medicine.
Bioinformatics
and precision
4. Electronic health records of personal data, including genetics, proteomics
medicine
and metabolomics play important role in precision medicine.

5. Precision medicine looks very promising to increase the accuracy, safety and
Take home
efficacy of promotive, preventive, diagnostic, and treatment approach.
messages