Interview with Prof. Panos Vardas
Prof. Dr. Panos Vardas
Professor of Cardiology
Past President, European Society of Cardiology (ESC)
Chief Strategy Officer, European Heart Agency (EHA)
Role in the project: WP6 Leader
Bio: Professor Vardas, a cardiologist qualified in Athens, Greece, with a long training in the UK, where he earned his PhD in Clinical Electrophysiology, has been the Head of the Cardiology Department at Heraklion University Hospital in Crete, Greece, from 1990 until 2016. Currently, Professor Vardas holds the position of Chairman of Heart Sector of the Hygeia Hospitals Group (HHG) in Athens, Greece.
In Greece, Prof. Vardas held major academic positions, including Dean of the Medical Faculty of the University of Crete (2003-2007) and President of the Hellenic Cardiological Society (1999-2001). In 2002, he was the founding editor of the Hellenic Journal of Cardiology and has been President of the Hellenic Cardiovascular Research Society since 2007.
In Europe, Prof. Vardas has held various scientific and managerial positions. He served as President of the European Society of Cardiology (ESC) from 2012-2014 and founded the ESC Brussels office in 2013, where he continues to serve as Chief Strategy Officer at the European Heart Agency/ESC. Prior to that Professor Vardas was President of the European Heart Rhythm Association (2009-2011).
Prof. Vardas was awarded the Gold Medal of the ESC in 2014 and the Silver Medal of the International League of Humanists in 2008. He has been further honoured as invited professor at several universities and as Honorary Member of a significant number of national cardiac societies. He is visiting professor at many distinguished universities: Imperial College (London, UK), London School of Economics (London, UK), Charles University (Prague, Czech Republic), and University Hospital (Zurich, Switzerland).
Prof. Vardas has participated as an author in more than 620 peer-reviewed publications ( h-Factor 93) , as well as in chapters of well-known medical books, the ‘’textbook of the ESC’’ being one of them. He has been a fervent contributor to the activities of the ESC for 29 years. Apart from his dedication to cardiovascular medicine, Prof. Vardas’ main interests today lie in digital health, health economics, health technology assessment, and business administration.
Q: You have a long and impressive trajectory within academia, healthcare, publishing, and European health policy. From your perspective, what is digital health?
A: Digital health is a domain with a very wide spectrum, which is also evolving very fast. Within that spectrum we can identify several distinct categories: digital health and telemonitoring, sensors and wearables, and Big Data and analytics as applied to electronic health records (EHR) and other functions. Apart from these, other important areas of digital health are cybersecurity, regulations and laws related to digital health, and then some very disruptive technologies such as the emerging use of digital twins in clinical research. We have to take into consideration that all of these techniques are coming together in different modes.
Q: Why is digital health relevant to cardiology?
A: In my capacity as deputy editor of the European Heart Journal, where I oversee the areas of digital health and innovation, I can say that every day we receive a significant number of articles related to artificial intelligence (AI). Indeed, AI in medicine and even beyond in cardiovascular health care is a fast evolving reality.
To take one example, AI-enabled electrocardiogram (ECG) will offer us an unprecedented diagnostic opportunity. A few months ago a very important paper authored by researchers at the Mayo Clinic was published in The Lancet, which showed how by looking at AI-enabled ECGs, we could identify signs of atrial fibrillation (AFib) that are not visible to the human eye. This is amazing as new horizons for ECG interpretation are opened.
Q: What are some of the concerns regarding digital health?
A: When we are talking about digital health apps – one of the most popular aspects of digital health – it is clear that we desperately need regulations. Most of these applications, regardless of how useful and clinically validated they may be, are not characterised as medical devices, so they are not well regulated.
Besides, while in the U.S. there is progress around both developing new digital health technologies and figuring out how to get reimbursement for them, in Europe there is a big delay around reimbursement on behalf of the healthcare systems. This means that potential users and patients have to pay for these products out of pocket. So one very important concern here is regarding reimbursement, which essentially enables these innovative technologies to be used in routine clinical practice. Germany is a leader in this space and recently introduced the Digital Health Care Act, which aims to streamline reimbursement for digital healthcare solutions.
Beyond applications, telecommunications and telehealth services are also not reimbursed properly at the moment in Europe. For example, the teleservices that are a natural extension of pacemakers and atrial defibrillators are not reimbursed in most European countries.
Q: How is digital health transforming clinicians’ daily practice?
A: Diagnostic medicine is practically based on a number of algorithms. That’s why when it comes to diagnosis, we have “good” doctors and “bad” doctors. All those “bad” doctors usually fail to follow the proper algorithmic approach. In this regard, I am expecting AI to be extremely useful because it will be based on well developed algorithms without significant mistakes.
Talking about complex surgery, the transformation will experience some delay. AI-empowered surgical robots will eventually arrive, but that will take some decades, possibly up to 60 years.
The real question here is whether AI will replace physicians or whether it will empower them. Often we like to be romantic and say “AI will empower physicians.” In my opinion, it is unavoidable that in the next 50 years, AI will progressively replace physicians and human physicians will have to compete with AI physicians.
Already some authors are using the words “human physicians” vs “digital health physicians” and for sure, at least in the field of therapeutics and diagnostics, AI will be very powerful.
Q: How is digital health transforming patients’ detection, care and (self-) management?
A: Let me present to you a few examples. Patients nowadays have the opportunity with their mobiles to take a photo of a small black spot on the skin and, using one of those digital applications, to conclude if that black spot is a melanoma or not.
Undoubtedly this is a huge advancement, but this is just the start, as we have to expect much more.
As a digital futurist, I am thinking that 20 years from now in each home there will be many facilities to monitor individuals’ symptoms, signs, and conditions. I could imagine even that in some houses, a small room could be equipped as a special “hospital room” for any individual who may be sick. Being in this room, the patient would have the opportunity to get examined telematically by their physician or care team. Some conditions such as sleep apnea, for example, are very easy to be diagnosed using telemonitoring.
Heart failure – a chronic disease with increased incidence – is going to be much better monitored while the patient is in his or her home.
Q: What do you think is needed for digital health technologies to (upscale/) mainstream in our health systems?
A: Nowadays we are talking about fully digitised paperless hospitals. According to the Health Information and Management Systems Society (HIMSS), there are seven levels of paperless hospitals. In Europe, I doubt if more than 5 to 6 hospitals at the moment are classified as Level 7. In Greece, for example, the most advanced digitised hospital is classified as Level 3. Level 3 means that a lot of digital work involving laboratories, images, and pharmaceutical business is installed in the hospital. Possibly only 2-3 private hospitals in Europe have conditions of Level 6. This is indicative of how much work lies ahead of us.
On the other hand, payers like to see cost effectiveness, so the start-up companies and physicians that work with all those new technologies have to persuade payers about the cost effectiveness of the new digital products.
For example, if I as a physician can show that I used a certain telehealth application or system to follow 1000 persons for one year and that saved some money for the insurance company by intervening early and catching preventable events, this is important.
The healthcare systems should work to develop this kind of trust. In many cases the insurance companies are looking to these digital systems as if they are experimental systems, not clinical validated yet. So trust, cost effectiveness, and development of the technology are the key in this process. It will take 5-15 years of developments to persuade fully the healthcare systems to pay for these services, but it is a one-way road.
Q: How is the (EU and national) regulatory environment changing on digital health ?
A: It is well known that the European Union does not have any real right or power to intervene into healthcare at a national level. Based on this understanding, it is getting clear that each country should deal with the digital transformation of its health system individually.
On the other hand, the EU could and should have a strong right to decide about laws and regulations overlooking digital health technologies and practice. It is indicative that it took several years of discussions until it reached an agreement that led to the recently announced new EU regulation for medical devices (2017/745/EU, 2017/746/EU, 5/04/2017).
I’m expecting to see in the next 2-3 years something similar related to medical applications and teleservices. A lot of legal issues that impact on these decisions are in limbo at the moment. For example, does a medical application represent a real medical device? How should the credibility of digital health devices be evaluated?
Q: In your opinion, what actions should be taken in order to move towards a stronger European health union?
A: Health union is something very general.
Focusing on digital health, it is getting clear to me that we need literacy, special education, new laws, rules and regulations in order to exploit the benefits of this new revolution.
It’s clear, digital health transformation is a one-way road. However we need well-orchestrated patients’ organization, health care professionals, industry, and of course taxpayers and politicians.
Q: Prof. Vardas, you are involved in the BigData@Heart project as Leader of WP6 Communications of results and guidance documents. Why is it important to ensure a broad dissemination and exploitation of the BigData@Heart results, making them available to all relevant stakeholders?
A: BD@H is a collaborative project between academia and industry that is using both clinical data and metrics on the one hand and AI and big data analysis on the other. It is very encouraging to recognise that big data is involved in our practice.
Until recently it was not medicine but the banking system that was the leader in Big Data exploitation.
I am thrilled with the recent developments in AI and Big Data analysis.