EMEA News

Chief Information Officer Adrian Byrne will provide an update on University Hospital Southampton NHS Foundation Trust's journey as a Global Digital Exemplar.

WHAT HAPPENED A pan-European network focusing on robotics is aiming to reduce barriers to adoption by creating a platform for healthcare and technology providers to collaborate. The Digital Innovation Hubs in Healthcare Robotics project is bringing together 17 partners from 10 countries, including Germany, France, the UK and Switzerland, who will connect their regional networks and expertise, led by the University of Twente in The Netherlands. The European Commission is investing €16m in the project, which started this month and is expected to run until the end of 2022, covering clinical services, hospital logistics, and home and care-based robotics, aiming to “stimulate (...) innovation in all aspects of healthcare”. WHY IT MATTERS Digital innovation hubs, a response to concerns around the slow uptake of digital technologies, are described by the Commission as “one-stop-shops” supporting the digitisation of companies and of public organisations. Despite representing over 90 percent of all businesses in Europe, only one in five EU SMEs are "highly digitised", according to the Commission. University of Twente Professor Stefano Stramigioli, coordinator of the pan-European network, said commercial companies would receive more than €8m through the project, supporting their efforts to develop and deploy digital technologies in healthcare.  SMEs and midcaps based in Europe will be able to apply for funding in open calls up until the spring of 2021, starting this summer.  ON THE RECORD “The route for embedding medical innovations in clinical practice is tough, time-consuming and requires substantial investments," Stramigioli said. "It involves clinical testing, developing efficient production methods, reaching investors, establishing a company and handling distribution, just to mention a few steps. With DIH-HERO, we can make sure that these strengthen and supplement each other where possible.” Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

An interview with Grahame Grieve, FHIR Product Director at HL7 International.

Most maternity providers in England are making a "good start" in adopting digital technologies, according to a new report by NHS Digital. Published in November this year, the analysis looked at the progress made by all 135 providers, and the investment being made in software, equipment and infrastructure. The digital maturity assessment (DMA) found great variation across the country, with some trusts scoring zero (the lowest level) on some sections and others 100 (the highest level), although only a minority had “very low digital maturity”. “We now want to see greater collaboration across the NHS so those maternity services not using digital can be helped along the journey,” said Juliet Bauer, NHS England chief digital officer. The overall national average score was 51, and findings indicated that areas of high and low digital maturity were distributed across England. The highest scoring section was governance, which scored 77, while the lowest one was remote and assistive care, scoring 23. “It would appear the maternity providers are often doing well on the same elements but are also encountering challenges in the same areas. This allows a great opportunity for the national teams and networks to focus on solving those common issues,” the report reads. At the time the analysis was completed, NHS Digital identified 20 suppliers providing maternity systems to trusts across England, and “close to a quarter” of providers said they were considering re-procuring their IT system in the next 12 months. The DMA was commissioned after a national review outlined the potential role that technology could play in transforming England’s maternity services. It included more than 200 questions prepared by clinicians, spanning the acute and community setting, and responses were converted into scores to allow them to carry out comparative analysis and calculate an overall score. “The Maternity DMA is a ‘self-assessment’– this means that it is mainly based on the opinions of those who complete it, rather than pure fact. As a result of this, there may be inaccuracies or inconsistencies compared with what actually happens," according to the analysis. Digital midwife Julia Gudgeon, clinical advisor for the Digital Maternity Programme at NHS Digital, and one of the report’s authors, said: “We have listened to clinicians working in the field and women themselves, both of whom are key to developing the use of digital tools to improve the experience of service users. This insight helps us to understand what to do and what not to do. “Our hope is that the findings of this report will inspire further collaboration so that women, technology and maternity services can work together to provide better health, better care and better value." Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Wherever you go in Europe, AI is already there. In November 2018, the German government announced its national AI strategy, a draft of which had been published in the summer of 2018 already. Now the strategy has a price tag: €3bn is about to be invested by the German government over the course of six years, the first €500m of which will flow in 2019. Germany was comparably late. In March 2018, French president Emmanuel Macron announced that his government would invest €1.5bn into AI by 2022. March 2018 also saw the publication of the White Paper ‘Artificial Intelligence at the service of the citizen’ by the Italian government’s Digital Agency. In April 2018, the UK came out with its ‘AI sector deal, worth £1bn, including £300m of private sector investment. And in May last year, Sweden released what they called their National Approach for Artificial Intelligence. On a European level, the European Commission has published its ‘Communication on Artificial Intelligence for Europe’ in April 2018, to be debated in the European Parliament in due course. The European Commission will also increase its investments into AI under the research and development framework programme Horizon 2020 to around €1.5bn by the end of 2020. AI: Another word for digitisation? So what is going on in the old world? Interestingly, many European governments don’t really define what they consider to be ‘AI’. “Many topics that are called AI now were called digitisation before”, said a group leader in the German Federal Ministry for Economic Affairs and Energy recently, adding that he did not want to be quoted with this sentence directly. Learn more about why AI is more than just a political buzzword in Europe in the recently repositioned HIMSS Insights eBook, a bi-monthly series featuring global examples of projects aiming to foster the development of a digital health ecosystem. You can read the article in the second eBook which is focused on AI in full here. Twitter: @DillanYogendra1 Contact the Editor: dyogendra@himss.org

The European Commission, EU member states, Norway and Switzerland have developed a plan to boost collaboration and further the development and use of AI in Europe, prioritising areas of public interest, including healthcare and transport. Initiatives will tackle the "low and fragmented" levels of investment in AI in the EU, compared to the US and China, according to the Commission, and the new plan focuses on four areas: fostering talent, making data more available, ensuring trust and increasing investment.  "We agreed to work together to pool data – the raw material for AI – in sectors such as healthcare to improve cancer diagnosis and treatment. We will coordinate investments: our aim is to reach at least €20 billion of private and public investments by the end of 2020. This is essential for growth and jobs," said Vice President for the Digital Single Market Andrus Ansip. The plan provides a “strategic framework for national AI strategies”, according to information released this month.  At this stage, five member states have adopted a national AI strategy, backed by a dedicated budget: the UK, France, Finland, Sweden and Germany. Through Horizon 2020, working with member states, the Commission will support the development of a common (anonymised) database of health images based on patients voluntarily donating their data, initially targeting the most common forms of cancer to help improve diagnosis by using AI. Meanwhile, common European "data spaces" will be created to enable seamless data sharing across borders, and advanced degrees in AI will be supported through initiatives such as offering dedicated scholarships. “These common European data spaces will aggregate data, both for the public sector and for business-to-business needs, across Europe and make it available to train AI on a scale that will enable the development of new products and services. “The rapid development and adoption of European rules such as interoperability requirements and standards is essential. The EU must also provide support to ensure that these data sets can be seamless accessed, exchanged and reused," the Commission said. Meanwhile, a group bringing together experts from academia, industry and civil society is working on developing ethics guidelines for the development and use of AI, with an initial version that will be open for consultation expected to be published shortly. The final document will be released in March next year. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Thousands of women in England were “warned unnecessarily” that they did not receive an invitation to a final routine breast screening in an incident believed to have been caused by an IT error, according to an independent review released this month. Back in May, then Secretary of State for Health and Social Care Jeremy Hunt told Parliament that around 450,000 women aged 68-71 missed their final screenings, from 2009 until the beginning of 2018, and that between 135 and 270 might have had their lives shortened. The incident was initially thought to have been the result of a failure in the introduction of an algorithm randomising women for the AgeX trial assessing the risks and benefits of extending the age limit for screening. A review chaired by Macmillan CEO Lynda Thomas, consultant oncologist at the Royal Marsden NHS Foundation Trust Martin Gore and Care Quality Commission Chairman Peter Wyman found that policy on the upper age bracket for breast screening had been “ambiguous” since the programme was introduced in late 1980s, and that the incident stemmed in fact from a specification issued in 2013 aiming to clarify how it should be defined.  The document, stating that women should be invited for screening "within 36 months of their previous screening, until they reach the age of 71", resulted in a "misalignment" with IT systems in use and the implementation carried out by breast screening units. Junior minister Steve Brine told Parliament earlier this month that “the impact of the change in policy was not fully understood at this time”. According to the report, ministers were “incorrectly advised” and the public announcement from May “overstated the scale of the incident”, causing distress to women that “were left anxious until they received the results of their catch-up screening appointments”. “We have found that for many years there has been a lack of clarity around the specific age range during which women should be invited to routine screening, and that this led to confusion about what should have been offered to women and what was offered in practice. This confusion continued and ultimately led to the Secretary of State declaring an incident in May 2018,” reviewers wrote. The inquiry found at an “early stage” that the algorithm used to carry out the randomisation for the AgeX trial was “operating as designed”, and ministers said the trial would continue as planned. “There was no large-scale failure to invite women because of a systemic algorithm problem as announced in May 2018,” the inquiry found. “The primary failing for the purposes of the incident declared in May was not the IT itself, but the absence of an appropriately specific policy to be delivered against, a lack of clarity about what the IT was designed to do and a lack of understanding of how women had been invited to screenings in practice for decades.” Women are invited to screening in “batches” created by units using the following IT systems: the National Breast Screening Services (NBSS) and Breast Screening Select (BS-Select), introduced in 2016, which takes information from another system, the National Health Applications and Infrastructure Services (NHAIS). The review found that these systems, although “dated and unwieldy”, were also “operating as designed”. However, over a period of nine years, about 5,000 women were not invited to their screening appointments, a failure caused by errors in using the IT and “slippages in units’ screenings which meant that some women might have had incremental lengthening of their screening intervals until they left the age range for core screening”. Brine told Parliament that Public Health England had now estimated that the number of women that might have had their lives shortened as a result of the incident was “zero to 34”. “We agree with the recommendation that PHE progresses as quickly and as sensitively as possible the clinical review with the NHS of all women who may have suffered harm,” the minister added. In his statement, Brine also said the government was pledging an initial £1.8m for the replacement of the NBSS system, acknowledging the review’s criticism, and that they would “continue to monitor closely all screening IT systems to ensure they are robust and operating as they should”. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

From Google hiring Geisinger Health CEO David Feinberg to drive its health care initiatives, then moving DeepMind’s Streams team under his supervision, to Apple getting its first FDA clearance for an atrial fibrillation-detecting algorithm and an ECG built into its Watch, it seems that big tech companies have been making significant strides during the past year in paving the way toward disrupting health care. In Europe, findings from an annual HIMSS Analytics survey, included in a recent report, indicate that patient empowerment will become the "key focus" in eHealth, with "patient-generated data" - through wearables and other gadgets aimed at consumers - and "patient/ consumer-owned health records" seen as some of the core trends changing the delivery of care as we currently know it. Based on the responses of nearly 600 professionals in the field, the results show, however, that a European country's priorities shift to patient empowerment only after a "certain level of EMR maturity" is reached. "EMR implementation continues to be the top priority among respondents in Europe, although its relative importance has declined compared to last year," it is stated in the report. "Initiatives to integrate and use patient-generated data as well as improve patients’ access to their information made it to second and third rank. "These patient-related activities are of the highest importance for governmental health authorities, whereas healthcare providers put less emphasis on them. We expect those topics to become even more important over the coming years as the shift to consumer-driven health(care) is likely to accelerate." Key challenges: securing talent, boosting cybersecurity capabilities amid strained budgets The Nordic countries, especially Denmark and Sweden, and the Netherlands are leading the pack when looking at the adoption of digital technology and innovation, according to the analysis, and trends uncovered indicate that the European C-suite digital leadership is "likely to grow" even further and include more Chief Nursing Information Officers, Chief Digital Officers and Chief Innovation Officers. “If you only have some of them in your health institution, you might not (yet) be in trouble. However, should you have none of these positions (established and funded), you may want to think twice,” it is explained in the analysis. And while the main eHealth hurdle remains IT security, a lack of funding is perceived as the “major challenge” for providers, with 59 per cent of employees arguing that their institution’s IT budget for the next 12 months is “too low”. What should we expect from 2019? Comparing the results with those of last year's survey, researchers wrote in the report that the "outlook for the coming few years has not changed much in 2018 compared to 2017's vision". “This suggests that progress in the key areas identified last year has been slow and that a lot still remains to be done. “Hence, the next two to three years will see more of the same: patient (owned) medical records, health information exchange with external providers, patient self-monitoring initiatives and EMR implementations. Contrary to the hype, and in line with last year’s results, few blockchain-based solutions will be implemented.” Healthcare IT News is a HIMSS Media publication. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org