Healthcare Thoughts

It has been great to follow and engaged online via Twitter – and great live-streaming  – with participants of World of Health IT (WoHIT) 2016 in the historical city of Barcelona. And what a great team of active Ambassadors they had on site keeping the channels of communication open to all! From Stefan Buttigieg (@stefanbuttigieg) to Danielle Siarri (@innonurse) I could almost taste the great food they enjoyed!

From genomics to cybersecurity, and much more besides, this huge and successful inaugural exhibition in Barcelona advances the conversation

I hope to attend in person in future years of WoHIT but in the meantime, I hope to see many of you in Malta for eHealth Week 2017!


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Next week – May 12th at 6pm CET,  I’ll be joining an HIMSS Europe & SKIPR organised Twitter chat (using the official Hashtag: #eHealthChat) entitled “Up-scaling health-IT: time to break the bottleneck“.

Voices across Europe will be discussing Trust and Standards. It’s one of the main themes of eHealth Week in Amsterdam in June (Read more and register here!).

From the patient’s perspective, both Trust and standards are critical if you want to move forward with eHealth

From the trust perspective, we can’t go beyond niche adoption without that by participants. Clinicians need to trust it, and patients too. And legislators, public health monitoring etc. It would be foolish to do that even if somehow people did go forward without confidence. Security is critical. Arguably clinical data is the most sensitive and the volume generated is growing year on year as we strap more instruments to ourselves, aim for paperless, and connect the machines and systems together.

And where do I start with Standards?!

Interoperability – or the lack of it right now – is the biggest issue for me to date. Time and time again we hear of brilliant innovations, and trials here and there. but nothing hooks together. It’s a problem within one urban area, it’s a probably nationally, and , frankly, as far as I’ve witness, somewhat non-existent at a multinational, european level.

Furthermore  ‘wellbeing’/’fitness’ solutions such as platforms provided by Apple, Google,Microsoft,  Samsung, Withings (soon-to-be-Nokia), Fitbit, etc, to name but a few, don’t always have common great experience with interoperable standards of their own and for now remain relatively distinct from clinical data.

I keep going b ack to one, probably erroneous analogy, but one that resonates for me: If the world of Finance can do it – individua accounts, globally, networks of cash machines, credit cards, merchants etc, why can’t medicine? The answer is: We can. Let’ make it happen!

I’m impatient and keen to see more integration. It’s not there for technical but also legal reasons. Often for good reasons. But a great discussion on how to move forward on this seems smart and a great reason for this chat!

Join us, on May 12th, at  6 PM CET (5 PM GMT / 12 PM EST / 9PST). It’s in English and moderated by the excellent minds of Christina Roosen, VP, Public Affairs, HIMSS Europe (@croosen @himsseurope ) and Ruud Koolen, Editor in Chief, Skipr, @Ruud_Koolen / @skipr

Oh and don’t forget to use the Official Hashtag: #eHealthChat !

See you there!


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This post was written for, and published by, HIMSS Europe on the 11 March 2016, in the run up to eHealth Week 2016 in Amsterdam. 

The kind of healthcare innovations we find ourselves discussing today are a natural extension to the never-ending innovation medicine has always been about. Always learning, always improving for the betterment of the health and comfort of the people it serves.  An extension from diagnosis and treatment into an even increasing focus of prevention, and better management of the condition. Ignoring this continued innovation, the opportunities to transform the daily lives, at some point and to varying degrees, of hundreds of millions of European citizens would be tragic.

At eHealth Week in Amsterdam, organised by HIMSS Europe, the Dutch Ministry of Health and the European Commission I’m confident we’ll see the fruits of much innovation.

For those who have infrequent interactions with the health service, current healthcare delivery probably seems  OK, but even within this ‘silent majority’, there remains scope for each and every one of us to be better taken care of and for opportunities for preventative or early warning of need for care to interject. Innovative solutions to improve education through communication is hugely important too for public health.

Even if occasional, there is also probably a better way, to say nothing of the economic impact, than the disruption of organising and making the visit to your General Practitioner or other clinician to get a relatively simple issue addressed. And for those of us with more complex medical needs, the opportunities for transformation seem truly open-ended, given how little has changed – from the patient’s perspective – since the dawn of the connected phone, the internet and consumer-focused technology more broadly.

As much as human contact is important – looking into the eyes of your doctor inherently reassures and will have certain advantages for the clinician too, there must surely be scope for technology to replace some of this in-person interchange.

The fear of the unknown shouldn’t blind us from the problems of today

We also shouldn’t be too starry-eyed about the current level of interaction we are able to have with doctors. Intermediaries: administrative personnel or other clinical support team are often part of the picture and access and data doesn’t flow flawlessly or without error. The financial and resource pressures on systems across Europe to sustain the existing delivery models will only increase.

There is however a danger; imposing ‘solutions’ on patients. Some of us live with our conditions for decades, and they’re as much part of our daily lives as anything else we do.

Perhaps more than ever, the delivery of healthcare has to become more personalised. Innovations need to be designed and implemented as a partnership, not least if it requires encouraging people to wear or install equipment into their homes. And dare I mention it: for all the opportunities for long term economic opportunities for countries as a whole, there is presumably going to need to be a mature conversation about the up-front investment requirements. Who will pay for the wearable? Who will train the patient?  Somehow populations – clinicians and patients – across Europe and beyond need to have a voice in what they want, and ultimately be prepared to pay as a society.

Let’s discuss on Twitter about the pros and cons of innovation in healthcare – #eHealthChat

With all these thoughts in mind, I am really excited to participate in the live tweet chat on 12 April at 6 pm CET organised by HIMSS Europe and ICT&Health on such an exciting topic in healthcare at the moment: Innovation. We will discuss the pros and cons of innovation, reading different people’s experience with innovation, both the success stories and the challenges which still need to be overcome. Through these conversations we will be able to overcome our fears of the unknown to make innovation a positive reality.

I look forward to talking to you on Twitter! Don’t forget to use the official hashtag #eHealthChat!

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This post was written for, and published by, HIMSS Europe on the 11 March 2016, in the run up to eHealth Week 2016 in Amsterdam. 

When I first became unwell, almost 20 years ago, the specialist told me that dialysis and other clinical care should be managed around my life and not my life around the condition. I loved the philosophy and I aspire to that goal. In so doing I’m prepared to risk a paradox with more self-management to liberate the most burdensome aspects.

As we progress deeper into the 21st century, innovations enabling mobile, remote and other aspects of health tech can provide tools to do this. Reducing the patient in the person is ultimately what it comes down to. Less disruption for ourselves, those we are close to, and to our work.

We now enjoy a much greater access to informed sources and an ability share experiences with fellow patients thanks to the internet. Now we have the emergence of wearable sensors and connected devices in the home, giving us a much richer – and frequent – picture of what is going on with our bodies.

More time living, less time as a patient

Helping us to adjust home treatments will help us avoid hospital visits, and when we really need to go (or communicate with the doctor remotely) we can be alerted. This builds confidence for the patient and the doctor, and results in less disruption.

The good news is that we have already seen progress. A the time home, my dialysis machine had zero capability of recording, let alone feeding back data to the doctor’s 200km away. An outpatient appointment could only deliver a fraction of information and a lot could change between. Solutions now exist. For diabetics, for example, devices provide much more regular readings, adjustment opportunities, and a record for the clinician to review. And there are connected scales, blood pressure cuffs, thermometers and smart watches.

But there’s more to do and I’m inpatient! Thankfully the Dutch Ministry of Health, the European Commission and HIMSS Europe organise the eHealth Week 2016 in June which will no doubt deliver the latest solutions and thinking.

Smart interpretations of trends, warnings, and individual tailoring. And perhaps above all: we need to find a way to improve, dramatically, how the data picture is shared in a coherent, legal and helpful fashion with health providers and patients without multiple siloed data streams – a troubling picture already starting to emerge – overbearing the recipient. Fail on this and the data may not be used safely or to its full potential. Furthermore, training, financing and consent are all part of a complex picture that are ultimately probably harder to sort out than the technology itself, to say nothing of the fact that not everybody wishes to have bits of equipment strapped to their bodies.

Personally speaking, addressing these hurdles is worth the end goal. More time living, less time as a patient.

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This post was written for, and published by, HIMSS Europe on the 15 February 2016, in the run up to eHealth Week 2016 in Amsterdam. It was also published, in abbreviated form, in Dutch, on ICT 

Through choice or circumstance, millions of Europeans live in another EU state. A further 180 million or so do so on temporary visits according to Eurostat. And like me, some of these citizens live with a chronic medical condition and find themselves immersed within the realities of more than one health care system at some point in their lives.

The child of two different EU nationals, and later living in third Member state, it hasn’t always been easy to keep a consistent and reliable information state for my health. To date I have been the guest – across borders – of 15 different hospitals and visited tens of general practitioners and depended on an even great number of specialists.

There is impressive work to implement reliable and interoperable systems within respective European countries, but I have yet to see evidence for much hope when it comes to information flows, when you cross from one to another country.

And yet, we have a policy context across the European Union where citizens are mobile and furthermore enjoy various rights to cross-border healthcare, so is it not important that the we start to think about how the data can match this?

Nothing has changed over the past 20 years.

As things stand it is as if the innovation of information technology simply never existed, with clinicians sending ad-hoc patient information, usually in paper form, between one another. And this assuming that they are minded to cooperate, linguistically interchangeable and have the time to spare.

Retroactively requesting records, can also prove challenging. Handed over after weeks or months, and if my torturous experience has anything to go by, in an often incomplete state, it’s not a tenable approach.

The only certain continuity – present at all those different appointments, assessments or overnight stays is the patient. With little other option the patient ends up giving a verbal (and layman’s) history to the doctor of the moment. However, with the tools currently available it is impossible to be comprehensive once you get beyond a tonsillectomy, assumes a compos mentis patient and demands a forgiving consultant.

It’s time to build the foundations, for now and for the future.

I am excited to be attending the eHealth Week 2016 (link it to the website) in June. With the main slogan, “You, at the heart of transition”, it gives me great hope that the spotlight turns to the patient’s perspective, currently almost untouched territory, ripe for thought and innovation.

Just perhaps the notion of a “data hub” residing within the profession, or perhaps just who has access to the keys, needs to be turned on its head, to build reality where the patient is empowered to hand over an accurate picture of their health. Not least to be best placed to address the issues of the future where there will be shift akin to the transformation “always-on” internet following the punctual “dial-up”. No longer an appointment or a test, but 24 hours per day of data creation with mHealth and remote monitoring etc.

Many of the challenges at a national level including around “patient portals” aren’t be mutually exclusive but I hope the groundwork can be built with a thought to interoperability at the pan-european level to match the movement and clinical access policies many citizens already take advantage of.

(Very approximate figures, to give an idea of population flows were based on: Eurostat: EU citizenship – statistics on cross-border activities

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This year it feels like it’s actually happening: consumer focused health tech is happening.

And yes, fitness bands are as plentiful as TVs, but this year it seems the focus has moved – ever so slightly – away from merely fitness, and more towards health.

Much of how it’s marketed ends up being a question of regulatory hurdles, but it’s exciting to see the shift.

Check out your hemoglobin? No problem. Buy a relatively inexpensive device – Embar (from Ceracor) and enjoy non-invasive readings, and results/graphs etc on your smartphone. It currently seems marketed to athletes, rather than as a medical instrument but perhaps before too long this sore of technology could help millions with renal, hepatic and other chronic conditions.

Check your wriggling infant’s temperature and have the hope of it being a reliable reading ? The newly announced Thermo from Withings may be up your street with 16 sensors taking 4000 measurements in 2 seconds (and presumably some relatively intelligent software engine to interpret all that).

There’s also an actual blood pressure watch-looking device from Omron. It’s not using PST – which we have to hope can be the future – but that means it’s legal and hopefully accurate!

And for all I tire somewhat of the pedometer type bands, the downward trend in pricing is exciting. It gets people to understand the benefits of having continuous data about their wellbeing. It gives company the revenue, an ability to scale , recruit talent, and ultimately generate more specialised products which may not otherwise have been possible.

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Some ‘patients’ – usually people with chronic condition who use health services as much as many use their local supermarket – are pushing for more, many techies are fiddling about with the emergency of tech-driven fitness, and the big companies [Apple, Alphabet/Novartis, Microsoft, Fitbit etc] know they’re on to something. And, not to be forgotten, the ever-increasing number of ‘Health hack’ conferences are popping up worldwide.

The demand is insatiable, and I’m delighted to see it’s finally happening.

Right now many of the consumer gadgets are just that  – toys. They rarely have the capability or indeed the legal, regulatory, approval to go beyond incentives for a better lifestyle. None of them can really make health claims, but they’re all hovering around the field.

From social competitiveness with Nike Fuel points, peer-pressure rankings from the number of paces you’ve walked, pretty pictures of food you’re suppose to eat, they are however, building a platform to bolt on much more interesting and valuable clinical capability.

The bridge from taking a pulse to a good indicator of blood pressure  – or glucose reading – is surely not all that far off.

Take the Apple Watch: Launched with enormous fanfare and Apple was keen to show off its ‘state of the art’ ‘top secret’ ‘health and fitness lab’ to accentuate what it saw as an important component of the wearable.

The bulging ceramic (or glass on the lower-cost model) back plate is rumoured to be  technically capable of more than reading a pulse. Perhaps by the 2nd or 3rd generation, we could dare to hope that this back plate will do a heck of a lot more, including blood pressure readings (via PST). Now, whether they market it as blood pressure remains to be seen. I suspect ultimately it will depend on legal rather than technical decisions.

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