‘The key question is: what is technology demonstrably delivering?’

Lukas Dekker

Interview with the first DCVA Ambassador

Data analysis, digital twins, smart cameras, smartphones that monitor your heart rhythm: there is much to be achieved with technology in the area of prevention, earlier detection and better treatment. The brand new professor Lukas Dekker wants to be the first DCVA Ambassador to build bridges between cardiologists and technologists. ‘We are already working together. I want to make good agreements about what we will achieve.’

Technology that promotes the quality of care and reduces the burden of interventions. At the Eindhoven MedTech Innovation Center, in short: e/MTIC, doctors, technicians and entrepreneurs work side by side to develop medical equipment. For example, the Lukas Dekker project team is working on ways to monitor patients after surgery or other treatment on a long-term and affordable basis. He also wants to use data analysis and improved imaging techniques to do interventions in the heart against arrhythmias in exactly the right place.

As a cardiologist, aren't you an odd man out at the technical university? Or as a technologist among cardiologists?
‘It’s really not that bad. Eindhoven has a long-standing tradition of cooperation between doctors and technicians. That is exactly the reason that I moved from Amsterdam to Eindhoven. I am a doctor for four days and a technologist for one. So literally I travel back and forth between the disciplines. At e/MTIC we work with ninety PhD students and postdoctoral researchers on the entire process from idea to prototype to product. This will help the patient.’

How do you see your role as the first DCVA ambassador?
‘Acceleration is the goal of the DCVA and of e/MTIC. Cooperation is therefore obvious. I would like to have a bridging role in this: how can technology help patients? DCVA has nice, clear goals with regard to reducing the burden of disease by 25% in 2030. I want to spread that message at e/MTIC. I also want to make this cooperation, apart from the high goals, as practical as possible. How are we going to tackle it? What do we do first? When can we get started?’

What is needed most and what are you going to tackle first?
‘I'm still working that out. The first year I will make a roadmap. It’s important to first tell this story to as many people as possible and to clarify what this means for the average cardiologist and technician. I don't want the message to be: we will work together. Because that’s what we already do. The time that everyone limited themselves to his or her domain is over. But what does that collaboration deliver? We should talk about that.’

Wanting to build bridges between those worlds suggests that those worlds do not yet understand each other sufficiently. Is that the case?
‘That’s changing rapidly. With atrial fibrillation we have a small group of people who keep coming back with complaints. There are already many gadgets to monitor these patients for a prolonged period of time, for example with a small pin under the skin. But that’s an unpleasant treatment, with a risk of infection, which also costs thousands of euros per device; expensive in relation to the benefits. We must turn the question around and tell the industry: develop something that’s not perfect but does what it should do, without a need to last five years and that works remotely. It should do this, it should deliver this, and may cost this. That’s language that designers understand. Indeed, such clear specifications make them happy.’

What do you think is a good example of technology that should deliver a lot?
‘A clear example: with the financial support of, amongst others, the Dutch Heart Foundation, we are developing a smart camera that can monitor four patients at the same time in the hospital, thereby greatly increasing the chances of survival and at the same time relieving nurses of work. The camera costs two thousand euros. The first reaction is: wow, that’s expensive. Our challenge is to demonstrate with models and numbers that we earn back that amount in multiple ways, both in money and in reducing the burden of disease. Only then such an innovation will have the opportunity to be widely introduced.

It sounds like it's very simple, as long as you have those numbers.
‘Of course it is. And at the same time it’s not. That camera is a clear example of bringing together technology that already exists on an urgent topic that everyone understands. Things you do in the hospital are often fairly easy to convert into figures. But a lot is happening outside the hospital and that’s an important part of our challenge. For example, we want to apply the same technology to guide heart failure patients at home. That’s a lot more complicated. We must ensure that good evidence is collected for the effectiveness of these solutions. For that we have to work with a lot of people.’

You once said: the technology is not the challenge. Then what is?
‘In many cases, the technology is already there. The question is: how do you handle all that data? That’s a question for me as a doctor. I meet people who are alarmed by their heart rhythm disorder and wear not one, but two smart watches. One per wrist! Then the one watch says something different than the other and then there is panic. Even if the patient feels fine. I regularly receive PDFs with data from such devices via email. What if I see something that’s worrying, can I trust it or do I have to redo the research with my own devices?’

What is the biggest obstacle to putting this type of innovation into practice?
‘Purely practical: the regulations and making agreements. There is too much data rather than too little. If in the future, we actively monitor patients at home, that flow of information will only increase. Who intervenes when the alarm starts ringing? The district nurse? The doctor? Or still someone at the hospital? Who acts in which situation? When do we intervene and when do we not? How do we know for sure that the data is reliable? How do we protect the privacy of patients? Allowing devices to reliably cooperate with other devices, and with people. We still have a lot to learn in that area.’

But the DCVA, 4TU and e/MTIC will take care of that?
‘I have great expectations of this collaboration. It is a club of very involved people. The mission really appeals to me: reducing the burden of disease by 25 percent in ten years. I get a lot of inspiration from that. Now it is important to get all those people around us just as enthusiastic. Challenge accepted!’