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Luis Iván Cuende: Bitcoin Blockchain Entrepreneur

Stephanie Overby

Luis Iván Cuende must have been born an entrepreneur.

Having no access to capital, equipment, or collaborators in his native Oviedo, Spain, he gravitated toward the first thing he could get his three-year-old hands on: one of his software-engineer father’s old computers. By age 12, Cuende had released his own distribution of Linux. At 15, he won the HackNow award for technical talent. And he spent his 17th year as advisor to Neelie Kroes, then the European Commissioner for
Digital Agenda.

Today the 20-year-old is CTO of Stampery, a San Mateo, California, based startup he co-founded in 2015, which leverages the Bitcoin blockchain—the shared public ledger that records and secures Bitcoin currency transactions—to provide instant data notarization and document certification.

“I’ve always wanted to create things; that’s what makes me happy,” says Cuende, who splits his time between Silicon Valley and Madrid. “I got started with software because it’s easy to launch a product without the need for a factory or millions of dollars.”

Cuende started to see how he could make a big impact when he was working with Kroes, whom he views as one of the most disruptive politicians he’s met.

“She has one of the freshest minds I have seen in the policy world full of suits,” he says.

After his time as one of her advisors was up, he attempted to launch several businesses, which ultimately led to Stampery.

Know Your Strengths— and Weaknesses

Four years ago, Cuende developed Cardwee, an application that enabled companies to provide customer loyalty points via Apple Passbook. “It was the very first one, and it was a very good product,” he says. “But I knew nothing about business or marketing.”

The lesson? You can build a solid product, but if you don’t know how to sell it, you will fail. “It’s the second most important thing in business,” Cuende says. “I’m good at giving talks to big groups, but I’m very bad at selling in person to big clients. My co-founders have much more experience in that, and I try to learn from them.”

Setbacks Aren’t Failures

Cuende met his Stampery collaborators, CMO Tommaso Prennushi, a former marketing executive, and CEO Daniele Levi, a former professional DJ and a cryptography enthusiast, in 2012 at the annual tech festival Campus Party, held that year in Berlin. “We were the only ones talking about Bitcoin in Spain at the time,” Cuende says.

The trio developed several Bitcoin-related products that went nowhere. At one point, they tried to get a banking license to create a Bitcoin exchange, but that required “millions of dollars we didn’t have,” Cuende says.

They tried a new tack, coming up with the idea for Stampery. Cuende calls it “the most obvious” noncurrency application for the Bitcoin blockchain—and one they could develop at low cost. Cuende and his team built Stampery and then secured US$600,000 in pre-seed funding, led by Draper & Associates, in November 2015.

An Upside to Risk

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Stomper provides legally binding proof of a digital document’s existence, integrity and ownership.

Most successful new business ideas are obvious, Cuende believes. “It’s not that you see something that other people don’t. It’s just that the idea involves risk. It’s something that people are afraid of today.”

A few years ago, most people associated Bitcoin only with nefarious activity, he says. But the blockchain technology underpinning Bitcoin fascinated Cuende and his partners. The blockchain maintains a verifiable chronological record of Bitcoin transactions, and it resists tampering by involving a network of thousands of independently managed computers in securing every update.

“Having an immutable ledger enables you to do a lot of stuff that couldn’t be done otherwise,” says Cuende. This includes transferring electronic money without needing a bank or other institution to guarantee it. “But why should we limit that ledger to storing only financial transactions? Anything that needs to be recorded in order to have a reliable proof of its existence, integrity, and even ownership can benefit from it. It’s the first time in the history of the computer that digital information isn’t necessarily modifiable and destroyable.”

Cuende saw only one downside: “The blockchain is very bad at transaction volume.” Cuende and his co-founders wanted to be able to certify millions of documents at a time; the Bitcoin network was capable of 2.5 per second. That’s where their technological innovation came in. Stampery is designed to stamp billions of data sets per second. In addition, the technology can work with any blockchain network, not just Bitcoin’s.

That makes using the Bitcoin blockchain low risk. “If it goes down tomorrow—which is highly improbable—we can migrate to another blockchain,” he says. In addition, the legally binding proofs that Stampery generates to certify the existence, integrity, and ownership of documents will remain valid and accessible even if Stampery disappears, because it leverages a decentralized technology.

Disrupting Decades of  Paper Pushing

Stampery currently has 1,500 customers, who fall into three user groups: creators protecting their intellectual property, attorneys certifying documents, and software developers. Lawyers saw the value immediately.

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“They need to create proofs from a lot of their digital documents on a daily basis. Then we have creators who use it to prove that they were the first creating a music track, art, even a process,” Cuende says. “What we’re seeing lately is a lot of enterprise interest for areas such as document management and systems security.”

Users can stamp up to 10 files monthly and access 1 gigabyte of encrypted storage for free, or pay $9.99 to stamp 1,000 files and access 50 gigabytes of storage. The product integrates with Dropbox cloud storage. Customers can also use Stampery to certify that e-mails were sent and received.

“You can make a deal via e-mail, click a button, and certify it with no one else involved but the two parties,” says Cuende.

Stampery is focusing on nonregulated use cases to establish the market and raise awareness. But the company is also actively lobbying regulators “to see the value of storing truth in a ledger that is mathematically secure,” says Cuende, particularly in Europe where notaries play a bigger role in the economy than they do in the United States.

Pen and paper have been the standard for hundreds of years. Human notaries are not “immutable, but they have these notebooks in which they establish truth, which is recognized by the state. Obtaining this type of trust involves cost and liability,” Cuende says. “Replacing it with math could save billions for whole industries.” Early in 2016, Stampery made a deal with the Estonian government to enable everyone with an e-Residency ID to use the system to certify and notarize personal and business documents.

Learn When to Step Up

Now that one of Cuende’s co-creations has become a full-blown business, he is adapting to 10-hour workdays and managing a growing team. “Being able to attract talent is super important to me. It’s great to work with very bright people that are better than me in many things,” says Cuende. “My days have gotten crazier. There’s pressure from everywhere,” he says. “It’s a challenge. But I love that feeling.” D!

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Connected Cars Rev Up For A Revolution [VIDEO]

Michael Zipf

Every two years, almost a million car enthusiasts flock to the Frankfurt International Motor Show (IAA), the world’s largest automotive trade fair, to enjoy the legendary spectacle of automakers rolling out their latest models to an accompaniment of flashing lights, throbbing bass beats, and stylishly dressed dancers.

While the giant exhibition halls on the ground Couple buying a car --- Image by © Don Mason/Blend Images/Corbisfloor echo to the sound of visitors jostling to examine paint work and leather, sleek sports cars, people carriers, electric vehicles, and the ubiquitous SUVs, the atmosphere in the New Mobility World exhibition on the first floor is altogether calmer. Nevertheless, this is where pressing issues about the future of mobility are being discussed.

The exhibitors here include Samsung, IBM, Deutsche Telekom, and – making its debut appearance – SAP. Awake to the far-reaching revolution that lies ahead of the automotive sector, these IT companies are in Frankfurt to showcase ways in which information technology is already making it possible to connect today’s highly digitized vehicles with each other, with their drivers, and with the technological infrastructure around them.

Revved up for a revolution

Chris Urmson considers the convergence of vehicles and IT to be “the most exciting development of our age.” Speaking in Frankfurt, Urmson, who heads up Google’s driverless car program, described the number of people killed on America’s roads every year – 36,000 – as “unacceptable” and stressed that his company’s intensive research into autonomous vehicles was aimed at improving road safety.

Robert Wolcott, Professor of Innovation Management and Corporate Entrepreneurship at Northwestern University’s Kellogg School of Management, spoke of “a new industrial revolution” whose impact would be “on a par with that of the railroads in the 19th century.”

So it’s no surprise that the IT sector is steering its focus toward the automotive industry.

At the IAA’s Smart City Forum, SAP has teamed up with various cities to present solutions designed to put an end to the daily traffic gridlock. And, to judge by the figures below, their capabilities are sorely needed:

  • By 2050, around 70% of the global population will be living in cities.
  • The number of cars on the planet is set to almost double by 2030.
  • Experts predict that the volume of freight traffic on Europe’s roads will increase 80% by 2025.
  • On average, a car driver in Germany spends 36 hours stuck in traffic jams every year.

Smart cities for a better quality of life

Smart Traffic Control enables cities to optimize traffic-light controls and free up additional car lanes during the rush hour to alleviate congestion, while data collected by RFID chips, sensors, cameras, and induction loops is used to compile congestion profiles and monitor real-time traffic issues. The Chinese city of Nanjing, which is home to 8 million people, has chosen to adopt smart traffic control technology to crunch the 20 billion data points captured in the city every year to produce actionable information for predictively responding to traffic congestion. And the software even learns as it goes along. In June of this year, the city signed a Custom Development Project with SAP. Currently, the SAP HANA platform helps Nanging analyze the data generated by its 10,000 taxis. The plan is for other modes of transportation to provide data in the future too.

“Smart traffic is one of the hottest topics for the world’s ever-expanding cities,” says Norbert Koppenhagen from the SAP Innovation Center Network, who is also at the IAA to showcase SAP’s cooperation with the German city of Darmstadt, near Frankfurt. “If we can keep the traffic flowing, we’ll make city-dwellers’ lives a whole lot more livable.”

The SAP Vehicle Insights cloud application links vehicular data with sensor data to provide actionable insight into driver behavior patterns and efficiency. The software helps logistics and mobility services providers monitor live vehicle conditions and manage their services within the constraints imposed by pollution and traffic congestion. The SAP Vehicle Insights also helps fleet operators manage their fleets optimally.

City App is another innovation being showcased in Frankfurt. Developed in collaboration with the German city of Nuremberg, this app features crowdsourcing functions that allow citizens to report defects and damage in their immediate vicinity. Algorithms assimilate these reports with data about factors such as traffic density in the affected city zone to help municipal authorities optimize their response.

There is also considerable buzz around TwoGo, the mobile app that lets employees at enterprises, institutions, and municipal authorities link up and share their daily commute to the office. “This is an exciting time for TwoGo,” says Alexander Machold, a member of the TwoGo business development team. “We’ve got vehicle manufacturers, parking garage operators, local authorities, and government ministries all looking into how TwoGo could help them cut costs and develop new business models.” What’s more, he says, the app sometimes opens the door to cross-selling opportunities for other SAP solutions.

“The number of connected cars on our roads is growing; more and more vehicles are being outfitted with sensors; and even driverless cars are becoming a genuine possibility. All in all, this is a great opportunity for us to transform cities, industries, and businesses sustainably to create a better future,” says Stephan Brand, Vice President, PI Analytics Applications, Products and Innovation at SAP.

The Internet has changed the way we buy cars, while mobile technology is changing what we expect them to do. Learn more about The Hyperconnected Car.

This story also appeared in the SAP Business Trends community.

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How One Business Approach Can Save The Environment – And Bring $4.5 Trillion To The World Economy

Shelly Dutton

Despite reports of a turbulent global economy, the World Bank delivered some great news recently. For the first time in history, extreme poverty (people living on less than $1.90 each day) worldwide is set to fall to below 10%. Considering that this rate has declined from 37.1% in 1990 to 9.6% in 2015, it is hopeful that one-third of the global population will participate the middle class by 2030.

For all industries, this growth will bring new challenges and pressures when meeting unprecedented demand in an environment of dwindling – if not already scarce – resources. First of all, gold, silver, indium, iridium, tungsten, and many other vital resources could be depleted in as little as five years. And because current manufacturing methods create massive waste, about 80% of $3.2 trillion material value is lost irrecoverably each year in the consumer products industry alone.

This new reality is forcing companies to rethink our current, linear “take-make-dispose” approach to designing, producing, delivering, and selling products and services. According to Dan Wellers, Digital Futures lead for SAP, “If the economy is not sustainable, we are in trouble. And in the case of the linear economy, it is not sustainable because it inherently wastes resources that are becoming scarce. Right now, most serious businesspeople think sustainability is in conflict with earning a profit and becoming wealthy. True sustainability, economic sustainability, is exactly the opposite. With this mindset, it becomes strategic to support practices that support a circular economy in the long run.”

The circular economy: Good for business, good for the environment

What if your business practices and operation can help save our planet? Would you do it? Now, what if I said that this one business approach could put $4.5 trillion up for grabs?

By taking a more restorative and regenerative approach, every company can redesign the future of the environment, the economy, and their overall business. “Made possible by the digital economy, forward-thinking businesses are choosing to embrace this value to intentionally reimagine the economy around how we use resources,” observed Wellers. “By slowing down the depletion of resources and possibly even rejuvenating them, early adopters of circular practices have created business models that are profitable, and therefore sustainable. And they are starting to scale.”

In addition to making good financial sense, there’s another reason the circular economy is a sound business practice: Your customers. In his blog 99 Mind-Blowing Ways the Digital Economy Is Changing the Future of Business, Vivek Bapat revealed that 68% of consumers are interested in companies that bring social and environmental change. More important, 84% of global consumers actively seek out socially and environmentally responsible brands and are willing to switch brands associated with those causes.

Five ways your business can take advantage of the circular economy

As the circular economy proves, business and economic growth does not need to happen at the cost of the environment and public health and safety. As everyone searches for an answer to job creation, economic development, and environmental safety, we are in an economic era primed for change.

Wellers states, “Thanks to the exponential growth and power of digital technology, circular business models are becoming profitable. As a result, businesses are scaling their wealth by investing in new economic growth strategies.”

What are these strategies? Here are five business models that can enable companies to unlock the economic benefits of the circular economy, as stated in Accenture’s report Circular Advantage: Innovative Business Models and Technologies that Create Value:

  1. Circular supplies: Deliver fully renewable, recyclable, and biodegradable resource inputs that underpin circular production and consumption systems.
  2. Recovery of resources: Eliminate material leakage and maximize the economic value of product return flows.
  3. Extension of product life: Extend the life cycle of products and assets. Regain the value of your resources by maintaining and improving them by repairing, upgrading, remanufacturing, or remarketing products.
  4. Sharing platforms: Promote a platform for collaboration among product users as individuals or organizations.
  5. Product as a service: Provide an alternative to the traditional model of “buy and own.” Allow products to be shared by many customers through a lease or pay-for-use arrangement.

To learn more about the circular economy, check out Dan Wellers’ blog “4 Ways The Digital Economy Is Circular.”

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Heroes in the Race to Save Antibiotics

Dr. David Delaney, Joseph Miles, Walt Ellenberger, Saravana Chandran, and Stephanie Overby

Last August, a woman arrived at a Reno, Nevada, hospital and told the attending doctors that she had recently returned from an extended trip to India, where she had broken her right thighbone two years ago. The woman, who was in her 70s, had subsequently developed an infection in her thigh and hip for which she was hospitalized in India several times. The Reno doctors recognized that the infection was serious—and the visit to India, where antibiotic-resistant bacteria runs rampant, raised red flags.

When none of the 14 antibiotics the physicians used to treat the woman worked, they sent a sample of the bacterium to the U.S. Centers for Disease Control (CDC) for testing. The CDC confirmed the doctors’ worst fears: the woman had a class of microbe called carbapenem-resistant Enterobacteriaceae (CRE). Carbapenems are a powerful class of antibiotics used as last-resort treatment for multidrug-resistant infections. The CDC further found that, in this patient’s case, the pathogen was impervious to all 26 antibiotics approved by the U.S. Food and Drug Administration (FDA).

In other words, there was no cure.

This is just the latest alarming development signaling the end of the road for antibiotics as we know them. In September, the woman died from septic shock, in which an infection takes over and shuts down the body’s systems, according to the CDC’s Morbidity and Mortality Weekly Report.

Other antibiotic options, had they been available, might have saved the Nevada woman. But the solution to the larger problem won’t be a new drug. It will have to be an entirely new approach to the diagnosis of infectious disease, to the use of antibiotics, and to the monitoring of antimicrobial resistance (AMR)—all enabled by new technology.

But that new technology is not being implemented fast enough to prevent what former CDC director Tom Frieden has nicknamed nightmare bacteria. And the nightmare is becoming scarier by the year. A 2014 British study calculated that 700,000 people die globally each year because of AMR. By 2050, the global cost of antibiotic resistance could grow to 10 million deaths and US$100 trillion a year, according to a 2014 estimate. And the rate of AMR is growing exponentially, thanks to the speed with which humans serving as hosts for these nasty bugs can move among healthcare facilities—or countries. In the United States, for example, CRE had been seen only in North Carolina in 2000; today it’s nationwide.

Abuse and overuse of antibiotics in healthcare and livestock production have enabled bacteria to both mutate and acquire resistant genes from other organisms, resulting in truly pan-drug resistant organisms. As ever-more powerful superbugs continue to proliferate, we are potentially facing the deadliest and most costly human-made catastrophe in modern times.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” said Dr. Keiji Fukuda, assistant director-general for health security for the World Health Organization (WHO).

Even if new antibiotics could solve the problem, there are obstacles to their development. For one thing, antibiotics have complex molecular structures, which slows the discovery process. Further, they aren’t terribly lucrative for pharmaceutical manufacturers: public health concerns call for new antimicrobials to be financially accessible to patients and used conservatively precisely because of the AMR issue, which reduces the financial incentives to create new compounds. The last entirely new class of antibiotic was introduced 30 year ago. Finally, bacteria will develop resistance to new antibiotics as well if we don’t adopt new approaches to using them.

Technology can play the lead role in heading off this disaster. Vast amounts of data from multiple sources are required for better decision making at all points in the process, from tracking or predicting antibiotic-resistant disease outbreaks to speeding the potential discovery of new antibiotic compounds. However, microbes will quickly adapt and resist new medications, too, if we don’t also employ systems that help doctors diagnose and treat infection in a more targeted and judicious way.

Indeed, digital tools can help in all four actions that the CDC recommends for combating AMR: preventing infections and their spread, tracking resistance patterns, improving antibiotic use, and developing new diagnostics and treatment.

Meanwhile, individuals who understand both the complexities of AMR and the value of technologies like machine learning, human-computer interaction (HCI), and mobile applications are working to develop and advocate for solutions that could save millions of lives.

Keeping an Eye Out for Outbreaks

Like others who are leading the fight against AMR, Dr. Steven Solomon has no illusions about the difficulty of the challenge. “It is the single most complex problem in all of medicine and public health—far outpacing the complexity and the difficulty of any other problem that we face,” says Solomon, who is a global health consultant and former director of the CDC’s Office of Antimicrobial Resistance.

Solomon wants to take the battle against AMR beyond the laboratory. In his view, surveillance—tracking and analyzing various data on AMR—is critical, particularly given how quickly and widely it spreads. But surveillance efforts are currently fraught with shortcomings. The available data is fragmented and often not comparable. Hospitals fail to collect the representative samples necessary for surveillance analytics, collecting data only on those patients who experience resistance and not on those who get better. Laboratories use a wide variety of testing methods, and reporting is not always consistent or complete.

Surveillance can serve as an early warning system. But weaknesses in these systems have caused public health officials to consistently underestimate the impact of AMR in loss of lives and financial costs. That’s why improving surveillance must be a top priority, says Solomon, who previously served as chair of the U.S. Federal Interagency Task Force on AMR and has been tracking the advance of AMR since he joined the U.S. Public Health Service in 1981.

A Collaborative Diagnosis

Ineffective surveillance has also contributed to huge growth in the use of antibiotics when they aren’t warranted. Strong patient demand and financial incentives for prescribing physicians are blamed for antibiotics abuse in China. India has become the largest consumer of antibiotics on the planet, in part because they are prescribed or sold for diarrheal diseases and upper respiratory infections for which they have limited value. And many countries allow individuals to purchase antibiotics over the counter, exacerbating misuse and overuse.

In the United States, antibiotics are improperly prescribed 50% of the time, according to CDC estimates. One study of adult patients visiting U.S. doctors to treat respiratory problems found that more than two-thirds of antibiotics were prescribed for conditions that were not infections at all or for infections caused by viruses—for which an antibiotic would do nothing. That’s 27 million courses of antibiotics wasted a year—just for respiratory problems—in the United States alone.

And even in countries where there are national guidelines for prescribing antibiotics, those guidelines aren’t always followed. A study published in medical journal Family Practice showed that Swedish doctors, both those trained in Sweden and those trained abroad, inconsistently followed rules for prescribing antibiotics.

Solomon strongly believes that, worldwide, doctors need to expand their use of technology in their offices or at the bedside to guide them through a more rational approach to antibiotic use. Doctors have traditionally been reluctant to adopt digital technologies, but Solomon thinks that the AMR crisis could change that. New digital tools could help doctors and hospitals integrate guidelines for optimal antibiotic prescribing into their everyday treatment routines.

“Human-computer interactions are critical, as the amount of information available on antibiotic resistance far exceeds the ability of humans to process it,” says Solomon. “It offers the possibility of greatly enhancing the utility of computer-assisted physician order entry (CPOE), combined with clinical decision support.” Healthcare facilities could embed relevant information and protocols at the point of care, guiding the physician through diagnosis and prescription and, as a byproduct, facilitating the collection and reporting of antibiotic use.

Cincinnati Children’s Hospital’s antibiotic stewardship division has deployed a software program that gathers information from electronic medical records, order entries, computerized laboratory and pathology reports, and more. The system measures baseline antimicrobial use, dosing, duration, costs, and use patterns. It also analyzes bacteria and trends in their susceptibilities and helps with clinical decision making and prescription choices. The goal, says Dr. David Haslam, who heads the program, is to decrease the use of “big gun” super antibiotics in favor of more targeted treatment.

While this approach is not yet widespread, there is consensus that incorporating such clinical-decision support into electronic health records will help improve quality of care, contain costs, and reduce overtreatment in healthcare overall—not just in AMR. A 2013 randomized clinical trial finds that doctors who used decision-support tools were significantly less likely to order antibiotics than those in the control group and prescribed 50% fewer broad-spectrum antibiotics.

Putting mobile devices into doctors’ hands could also help them accept decision support, believes Solomon. Last summer, Scotland’s National Health Service developed an antimicrobial companion app to give practitioners nationwide mobile access to clinical guidance, as well as an audit tool to support boards in gathering data for local and national use.

“The immediacy and the consistency of the input to physicians at the time of ordering antibiotics may significantly help address the problem of overprescribing in ways that less-immediate interventions have failed to do,” Solomon says. In addition, handheld devices with so-called lab-on-a-chip  technology could be used to test clinical specimens at the bedside and transmit the data across cellular or satellite networks in areas where infrastructure is more limited.

Artificial intelligence (AI) and machine learning can also become invaluable technology collaborators to help doctors more precisely diagnose and treat infection. In such a system, “the physician and the AI program are really ‘co-prescribing,’” says Solomon. “The AI can handle so much more information than the physician and make recommendations that can incorporate more input on the type of infection, the patient’s physiologic status and history, and resistance patterns of recent isolates in that ward, in that hospital, and in the community.”

Speed Is Everything

Growing bacteria in a dish has never appealed to Dr. James Davis, a computational biologist with joint appointments at Argonne National Laboratory and the University of Chicago Computation Institute. The first of a growing breed of computational biologists, Davis chose a PhD advisor in 2004 who was steeped in bioinformatics technology “because you could see that things were starting to change,” he says. He was one of the first in his microbiology department to submit a completely “dry” dissertation—that is, one that was all digital with nothing grown in a lab.

Upon graduation, Davis wanted to see if it was possible to predict whether an organism would be susceptible or resistant to a given antibiotic, leading him to explore the potential of machine learning to predict AMR.

As the availability of cheap computing power has gone up and the cost of genome sequencing has gone down, it has become possible to sequence a pathogen sample in order to detect its AMR resistance mechanisms. This could allow doctors to identify the nature of an infection in minutes instead of hours or days, says Davis.

Davis is part of a team creating a giant database of bacterial genomes with AMR metadata for the Pathosystems Resource Integration Center (PATRIC), funded by the U.S. National Institute of Allergy and Infectious Diseases to collect data on priority pathogens, such as tuberculosis and gonorrhea.

Because the current inability to identify microbes quickly is one of the biggest roadblocks to making an accurate diagnosis, the team’s work is critically important. The standard method for identifying drug resistance is to take a sample from a wound, blood, or urine and expose the resident bacteria to various antibiotics. If the bacterial colony continues to divide and thrive despite the presence of a normally effective drug, it indicates resistance. The process typically takes between 16 and 20 hours, itself an inordinate amount of time in matters of life and death. For certain strains of antibiotic-resistant tuberculosis, though, such testing can take a week. While physicians are waiting for test results, they often prescribe broad-spectrum antibiotics or make a best guess about what drug will work based on their knowledge of what’s happening in their hospital, “and in the meantime, you either get better,” says Davis, “or you don’t.”

At PATRIC, researchers are using machine-learning classifiers to identify regions of the genome involved in antibiotic resistance that could form the foundation for a “laboratory free” process for predicting resistance. Being able to identify the genetic mechanisms of AMR and predict the behavior of bacterial pathogens without petri dishes could inform clinical decision making and improve reaction time. Thus far, the researchers have developed machine-learning classifiers for identifying antibiotic resistance in Acinetobacter baumannii (a big player in hospital-acquired infection), methicillin-resistant Staphylococcus aureus (a.k.a. MRSA, a worldwide problem), and Streptococcus pneumoniae (a leading cause of bacterial meningitis), with accuracies ranging from 88% to 99%.

Houston Methodist Hospital, which uses the PATRIC database, is researching multidrug-resistant bacteria, specifically MRSA. Not only does resistance increase the cost of care, but people with MRSA are 64% more likely to die than people with a nonresistant form of the infection, according to WHO. Houston Methodist is investigating the molecular genetic causes of drug resistance in MRSA in order to identify new treatment approaches and help develop novel antimicrobial agents.

The Hunt for a New Class of Antibiotics

There are antibiotic-resistant bacteria, and then there’s Clostridium difficile—a.k.a. C. difficile—a bacterium that attacks the intestines even in young and healthy patients in hospitals after the use of antibiotics.

It is because of C. difficile that Dr. L. Clifford McDonald jumped into the AMR fight. The epidemiologist was finishing his work analyzing the spread of SARS in Toronto hospitals in 2004 when he turned his attention to C. difficile, convinced that the bacteria would become more common and more deadly. He was right, and today he’s at the forefront of treating the infection and preventing the spread of AMR as senior advisor for science and integrity in the CDC’s Division of Healthcare Quality Promotion. “[AMR] is an area that we’re funding heavily…insofar as the CDC budget can fund anything heavily,” says McDonald, whose group has awarded $14 million in contracts for innovative anti-AMR approaches.

Developing new antibiotics is a major part of the AMR battle. The majority of new antibiotics developed in recent years have been variations of existing drug classes. It’s been three decades since the last new class of antibiotics was introduced. Less than 5% of venture capital in pharmaceutical R&D is focused on antimicrobial development. A 2008 study found that less than 10% of the 167 antibiotics in development at the time had a new “mechanism of action” to deal with multidrug resistance. “The low-hanging fruit [of antibiotic development] has been picked,” noted a WHO report.

Researchers will have to dig much deeper to develop novel medicines. Machine learning could help drug developers sort through much larger data sets and go about the capital-intensive drug development process in a more prescriptive fashion, synthesizing those molecules most likely to have an impact.

McDonald believes that it will become easier to find new antibiotics if we gain a better understanding of the communities of bacteria living in each of us—as many as 1,000 different types of microbes live in our intestines, for example. Disruption to those microbial communities—our “microbiome”—can herald AMR. McDonald says that Big Data and machine learning will be needed to unlock our microbiomes, and that’s where much of the medical community’s investment is going.

He predicts that within five years, hospitals will take fecal samples or skin swabs and sequence the microorganisms in them as a kind of pulse check on antibiotic resistance. “Just doing the bioinformatics to sort out what’s there and the types of antibiotic resistance that might be in that microbiome is a Big Data challenge,” McDonald says. “The only way to make sense of it, going forward, will be advanced analytic techniques, which will no doubt include machine learning.”

Reducing Resistance on the Farm

Bringing information closer to where it’s needed could also help reduce agriculture’s contribution to the antibiotic resistance problem. Antibiotics are widely given to livestock to promote growth or prevent disease. In the United States, more kilograms of antibiotics are administered to animals than to people, according to data from the FDA.

One company has developed a rapid, on-farm diagnostics tool to provide livestock producers with more accurate disease detection to make more informed management and treatment decisions, which it says has demonstrated a 47% to 59% reduction in antibiotic usage. Such systems, combined with pressure or regulations to reduce antibiotic use in meat production, could also help turn the AMR tide.

Breaking Down Data Silos Is the First Step

Adding to the complexity of the fight against AMR is the structure and culture of the global healthcare system itself. Historically, healthcare has been a siloed industry, notorious for its scattered approach focused on transactions rather than healthy outcomes or the true value of treatment. There’s no definitive data on the impact of AMR worldwide; the best we can do is infer estimates from the information that does exist.

The biggest issue is the availability of good data to share through mobile solutions, to drive HCI clinical-decision support tools, and to feed supercomputers and machine-learning platforms. “We have a fragmented healthcare delivery system and therefore we have fragmented information. Getting these sources of data all into one place and then enabling them all to talk to each other has been problematic,” McDonald says.

Collecting, integrating, and sharing AMR-related data on a national and ultimately global scale will be necessary to better understand the issue. HCI and mobile tools can help doctors, hospitals, and public health authorities collect more information while advanced analytics, machine learning, and in-memory computing can enable them to analyze that data in close to real time. As a result, we’ll better understand patterns of resistance from the bedside to the community and up to national and international levels, says Solomon. The good news is that new technology capabilities like AI and new potential streams of data are coming online as an era of data sharing in healthcare is beginning to dawn, adds McDonald.

The ideal goal is a digitally enabled virtuous cycle of information and treatment that could save millions of dollars, lives, and perhaps even civilization if we can get there. D!

Read more thought provoking articles in the latest issue of the Digitalist Magazine, Executive Quarterly.


About the Authors:

Dr. David Delaney is Chief Medical Officer for SAP.

Joseph Miles is Global Vice President, Life Sciences, for SAP.

Walt Ellenberger is Senior Director Business Development, Healthcare Transformation and Innovation, for SAP.

Saravana Chandran is Senior Director, Advanced Analytics, for SAP.

Stephanie Overby is an independent writer and editor focused on the intersection of business and technology.

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Small And Midsize Businesses Have The Capacity To Drive Europe’s Future As A Digital Superpower

Katja Mehl

Part 10 of the “Road to Digital Transformation” series

Representing 99.8% of all companies throughout Europe, small and midsize businesses have tremendous power when it comes to impacting the region’s economy. One innovation at a time, they’re transforming entire industries, propelling emerging industries forward with adjacent offerings, and even supersizing a favorite childhood toy to make living conditions better for the poor and homeless. But perhaps the greatest evolution is found in the growing adoption of technology among firms.

According to the IDC InfoBrief “The Next Steps in Digital Transformation: How Small and Midsize Companies Are Applying Technology to Meet Key Business Goals with Insights for Europe,” sponsored by SAP, 35.4% of all European firms feel that their adoption of digital technology is either advanced or well underway. Germany and France are great examples of countries that are embracing advanced business networks and automation technology – such as the Internet of Things – to boost productivity and computerize or consolidate roles left empty due to long-term labor shortages.

Despite the progress made in some countries, I am also aware of others that are still resistant to digitizing their economy and automating operations. What’s the difference between firms that are digital leaders and those that are slow to mature? From my perspective in working with a variety of businesses throughout Europe, it’s a combination of diversity and technology availability.

digital transformation self-assessment

Source: “The Next Steps in Digital Transformation: How Small and Midsize Companies Are Applying Technology to Meet Key Business Goals with Insights for Europe,” IDC InfoBrief, sponsored by SAP, 2017. 

Opportunities abound with digital transformation

European companies are hardly homogenous. Comprising 47 countries across the continent, they serve communities that speak any of 225 spoken languages. Each one is experiencing various stages of digital development, economic stability, and workforce needs.

Nevertheless, as a whole, European firms do prioritize customer acquisition as well as improving efficiency and reducing costs. Over one-third of small and midsize companies are investing in collaboration software, customer relationship management solutions, e-commerce platforms, analytics, and talent management applications. Steadily, business leaders are finding better ways to go beyond data collection by applying predictive analytics to gain real-time insight from predictive analytics and machine learning to automate processes where possible.

Small and midsize businesses have a distinct advantage in this area over their larger rivals because they can, by nature, adopt new technology and practices quickly and act on decisions with greater agility. Nearly two-thirds (64%) of European firms are embracing the early stages of digitalization and planning to mature over time. Yet, the level of adoption depends solely on the leadership team’s commitment.

For many small and midsize companies across this region, the path to digital maturity resides in the cloud, more so than on-premise software deployment. For example, the flexibility associated with cloud deployment is viewed as a top attribute, especially among U.K. firms. This brings us back to the diversity of our region. Some countries prioritize personal data security while others may be more concerned with the ability to access the information they need in even the most remote of areas.

Technology alone does not deliver digital transformation

Digital transformation is certainly worth the effort for European firms. Between 60%–90% of small and midsize European businesses say their technology investments have met or exceeded their expectations – indicative of the steady, powerhouse transitions enabled by cloud computing. Companies are now getting the same access to the latest technology, data storage, and IT resources.

However, it is also important to note that a cloud platform is only as effective as the long-term digital strategy that it enables. To invigorate transformative changes, leadership needs to go beyond technology and adopt a mindset that embraces new ideas, tests the fitness of business models and processes continuously, and allows the flexibility to evolve the company as quickly as market dynamics change. By taking a step back and integrating digital objectives throughout the business strategy, leadership can pull together the elements needed to turn technology investments into differentiating, sustainable change. For example, the best talent with the right skills is hired. Plus, partners and suppliers with a complementary or shared digital vision and capability are onboarded.

The IDC Infobrief confirms what I have known all along: Small and midsize businesses are beginning to digitally mature and maintain a strategy that is relevant to their end-to-end processes. And furthering their digital transformation go hand in hand with the firms’ ability to ignite a transformational force that will likely progress Europe’s culture, social structure, and economy. 

To learn how small and midsize businesses across Europe are digitally transforming themselves to advance their future success, check out the IDC InfoBrief “The Next Steps in Digital Transformation: How Small and Midsize Companies Are Applying Technology to Meet Key Business Goals with Insights for Europe,” sponsored by SAP. For more region-specific perspectives on digital transformation, be sure to check every Tuesday for new installments to our blog series “The Road to Digital Transformation.”

 

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Katja Mehl

About Katja Mehl

Katja Mehl is Head of Marketing for Europe, Middle East, and Africa at SAP.