EMEA News

Key European eHealth interoperability experts gathered in Brussels, Belgium, last week to discuss a multi-stakeholder initiative that could allow a one-time interoperability testing of eHealth products with mutual recognition across the EU and beyond. New usages, new technologies, an ageing population and many other factors have contributed to a change in healthcare, leading to more connectivity between systems and an increasing need for interoperability. Organised by the EURO-CAS project partners under the Horizon 2020 European research and innovation programme, including, among others, Integrating the Healthcare Enterprise Europe (IHE Europe), Agence eSanté Luxembourg, the European Institute for Biomedical Imaging Research (EIBIR) and Personal Connected Health Alliance (PCHAlliance), attendees looked at the potential use and scale of introducing a Conformity Assessment Scheme for Europe (CASforEU) based on existing well-used norms and standards to overcome interoperability challenges in the healthcare sector. Webinar: Interoperability Sets the Foundation for Care Coordination Dr Ceri Thomson, Head of Policy Sector, eHealth, Well-Being and Ageing at DG Connect, European Commission, stressed the importance of breaking down data silos and estimated that CASforEU could contribute to the key pillars for the transformation of digital health and care.  There are currently several examples of best practice of cross-border health information exchanges in the field of ePrescriptions and patient summaries that could be extended to other use cases, such as laboratory tests, images, discharge letters – but these are all subject to fundamental underpinning infrastructures being in place, Dr Thomson explained. CASforEU governance. Source: EURO-CAS project “Workshops in several Members States confirmed the need for pragmatic interoperability testing, and CASforEU as a solution," said Karima Bourquard, IHE-Europe Director of Interoperability. Assessing conformance to a common set of standards is critical for the future. A scheme like CASforEU could avoid costly and time-consuming need for re-testing across different countries and regions, it was argued. “The EURO-CAS Organization will drive CASforEU and be the place where procurers, vendors, users and all interested parties from all Europe can meet to ensure optimal applicability," added Samuel Danhardt, Interoperability Expert at Agence eSanté Luxembourg. For more harmonisation, CASforEU will be aligned with other existing international schemes, such as IHE-CAS and PCHAlliance’s Continua Certification, relying on ISO/IEC 17025 accredited test laboratories for EU-wide recognition. As discussed at the meeting, when put in practice, healthcare providers could procure CASforEU products or request testing before buying to ensure interoperability, and vendors would only need to do the CASforEU test once to access the Digital Single Market. Anett Molnar is a Senior Manager, Public Policy and Engagement, for HIMSS EMEA.

Innovation Factory’s Alaa Chalabi talks using wearables to detect sleep disorders and snoring habits at WISH in Doha, Qatar last week.

The UK’s HealthTech Advisory Board, created to help guide the government and look at transforming the use of technology across the NHS, will meet for the first time today, the Department of Health and Social Care (DHSC) has said. Health and Social Care Secretary Matt Hancock vowed to "sort out" the IT infrastructure of the NHS earlier this year, calling it “the world’s most frustrating place to work for its IT”, with “only 10 per cent of the challenge" being the technology.  “Ninety per cent of the challenge is the culture,” he said. The new initiative will bring together clinicians, academics and tech experts to explore and support efforts to harness innovation and reduce pressures on the system. “It will highlight where change needs to happen, where best practice isn’t being followed, and be an ideas hub for how we transform the NHS to improve patient outcomes, patient experience, and to make the lives of NHS staff easier," Hancock added. The board will be chaired by Dr Ben Goldacre, Evidence-Based Medicine DataLab Director at the University of Oxford, and members include NHS Digital Academy CEO and Director of Digital at the Salford Royal Group Rachel Dunscombe and Nicola Blackwood, Chair of the Human Tissue Authority and former Health Minister. Roger Taylor, who was appointed as Chair of the Centre for Data Ethics and Innovation back in June, will also be joining them, along with: Nicole Junkermann, NJF Holdings Founder Manoj Badale, Blenheim Chalcot Co-Founder David Gann, Imperial College London Professor of Innovation and Technology Management Sir Mark Walport, UK Research and Innovation Chief Executive Daniel Korski, PUBLIC CEO and Co-Founder Michelle Brennan, Johnson & Johnson Medical Devices Companies Group Chair Dan Sheldon, Well Pharmacy Head of Digital Jeni Tennison, Open Data Institute CEO Parker Moss, F-Prime and Eight Roads Entrepreneur in Residence. “To make the changes that are needed we must work together and have a common vision. We need to couple this with an agile culture where we constantly improve systems and champion the innovators," Hancock said at the Health and Care Innovation Expo in Manchester in September. “The culture change we need to see requires strong management and leadership. I’m determined to grow stronger leadership across the NHS. We should train more of our own, yes, and bring in more talent from the outside too who know how to inspire change.” In October, an initial digital, data and technology strategy was published by the DHSC, outlining plans to modernise the NHS IT infrastructure and introduce a clear set of open standards that all digital services and IT systems in the NHS would have to meet.  Asked how he would measure the success of innovation being embedded into the NHS at the GovTech summit in Paris last week, Hancock said: "When I'm no longer the world's largest owner of fax machines." Freedom of Information requests submitted by the UK's Royal College of Surgeons earlier this year indicated that NHS hospitals trusts in England owned more than 8,000 fax machines, and a report from DeepMind Health's independent reviewers panel from 2017 said the health service retained "the dubious title of being the world’s largest purchaser of fax machines". At the GovTech summit, Hancock added: "I want to see an improvement in the outcomes of government services and, so, I try to resist what is a pressure that all politicians come under, which is to give very fixed and specific targets, because (...) there may be even better technology that comes along that I might discover at this conference that we've never heard of before." Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Nine councils in the UK have been awarded a share of up £700,000 to design and deploy digital innovations for social care through a project led by the Local Government Association (LGA), commissioned by NHS Digital. In June, it was announced that twelve local authorities would receive £20,000 each to identify how digital technology could help address local challenges and improve services, part of a "discovery" funding phase, and initial reviews have now been published by the LGA. “All of this year’s cohort have shown true innovation which made it extremely difficult to decide who to fund for implementation,” said Kate Allsop, Digital Lead on the LGA Community and Wellbeing Board. “The discovery phase has enabled a detailed study of user needs to determine the scope of some really interesting projects.” A pilot in Wirral will now see the council provide biometric wearable devices to people with autism and complex learning disabilities with a view to analyse the data collected to spot anxiety triggers. In London, Havering Council is looking to design an app for social care workers to streamline recruitment processes and ensure information such as employment history or training can be securely shared. The other seven projects will be led by Bracknell Forest Council, Isle of Wight Council, Lincolnshire County Council, Nottingham City Council, Shropshire Council, Stockport Metropolitan Borough Council, and Sunderland City Council. Last week, NHS Digital announced that the Care Provider Alliance would receive £784,000 to create a new service that would offer digital support for the care provider sector, looking to drive uptake of existing resources.  Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

The traditional model of outpatient care is creating unnecessary pressure on patients, clinicians and the NHS as a whole, a new report from the UK's Royal College of Physicians (RCP) has warned. Excluding A&E, outpatient appointments account for around 85 per cent of all hospital-based activity in the UK, and figures indicate that the number of consultations has nearly doubled in England in the past decade. Inefficient systems, poor communication, delays and long waiting times illustrate the need for a different approach, according to the RCP.  The NHS should “grasp the nettle”, said Professor Stephen Powis, NHS England national medical director, and leveraging the use of technology and innovation to reduce frustration among clinicians and patients should be a key part of the redesign process. “As part of the long-term plan for the NHS, it’s right we look at ways to cut unnecessary appointments, save thousands of journeys, reduce traffic and pollution and make the NHS more efficient,” Professor Powis added. Webinar: Essential Knowledge Series: Trends in Outpatient Practice Management and EMR Solution Adoption Recent research from charity Age UK, cited by the RCP, indicated that a fifth of pensioners attending an outpatient consultation in the past year "reported feeling worse afterwards because of the stress involved in the journey alone". Remote monitoring and telephone or video appointments could reduce the heavy reliance on face-to-face consultations, and the RCP said both clinical staff and patients “recognised the benefit” of these alternatives in appropriate settings. But evidence also showed that patients did not want to “lose in-person contact”, and doctors argued that the best approach would be a combination of telehomecare and face-to-face consultations. Tech allowing patients to submit personalised data could also be used to drive self-management and enable "clinical monitoring from a distance", but the RCP warned that "making good use of technology requires careful thought and planning". "It is as much about changing clinical practice and professional culture as procuring high-quality, tested products," doctors said. Their findings also suggested that a reluctance to adopt digital technologies was due to “concerns with locally available IT infrastructure and support, data protection, loss of remuneration from clinical commissioning groups and discrimination among patients less comfortable with the necessary technology”. “Having re-evaluated the purpose of outpatient care and aligned its objectives with modern-day living and expectations, we must ensure that the benefits are measured in terms of long-term value for patients, the population and the environment, not just short-term financial savings,” said Dr Toby Hillman, co-author of the report, clinical lead for the RCP sustainability programme and consultant respiratory physician. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Last year’s WannaCry ransomware attack on the UK health service did more than expose weaknesses in healthcare cyber resilience – it also highlighted weaknesses in emergency responses to healthcare cyber attacks. Speaking at the recent HIMSS AsiaPac18 in Brisbane, Extreme Networks Healthcare Solutions Director Bob Zemke said a key lesson from the May 2017 attack was the importance of not just defending against risks, but of also having defined response plans when systems are compromised. The WannaCry attack hit more than 200,000 computers in over 100 countries, costing the UK’s NHS alone an estimated £92 million, exploiting a flaw in older Microsoft Windows operating systems, such as unpatched Win7 and Server 2008. “It started hitting any device with Windows hidden in the back of their systems, even the parking meters,” Zemke said. “It created a fear and response that was not based on logic. Instead, the response was to shut down as many systems as possible to prevent the infection from spreading.” Webinar: What Most Computer Security Defenses are Doing Wrong, and How to Fix It At many UK hospitals, this included shutting down the internal telephone system, even though it was not Windows-based. “We saw nurses actually notifying the media that the comms systems were taken offline,” he said. “Shutting off the systems created more panic and frustration in the clinical community. And then they went right to the media to voice their frustration and that made the situation even more of a pressure maker.”  Zemke said what is needed is a strategy for every connected device in a hospital, covering key questions such as: What is it? What does it do? What is the risk if the system goes offline? What are its normal activities and patterns of online communication? Does it need to talk to other systems? Is the device patchable or have you been instructed by the manufacturers to not apply operating system patches? “New security challenges will always arise – that's the world we live in,” he said.  “But the process and procedures we put in place ahead of time will allow us to then adequately and formally respond when an event takes place.” Zemke said better communication between clinical departments and the IT team was essential, including defining departmental liaisons and reporting structures, and response plans when events occur. It was also crucial to remember that many threats to connected systems do not emerge from outside. “Ten years ago when we looked at connected medical devices, we believed the idea that a firewall would protect them from the outside world,” Zemke said.  “We thought the vulnerabilities and threats were coming from outside hospital but what we found was we had more issues with just misconfigurations by vendors of devices operating in the same environment, rather than malicious attacks coming from the outside.” Originally published on Healthcare IT News Australia.

The Welsh Assembly Public Accounts Committee (PAC) has questioned the “competence, capability and capacity" across the system to digitise healthcare services in Wales after an inquiry uncovered a “raft of problems”, from delays in the delivery of digital projects to “unclear” lines of accountability. The committee found that there had been 21 outages of national systems from January to July this year. A letter from the Cardiff and Vale University Health Board indicated that a national data centre failure that occurred between 3 to 5 August affected “all of Wales”. The PAC said it was “deeply concerned about the slow pace of delivery of modern informatics systems”, asking the Welsh Government to set out a “clear timetable” to put the infrastructure on a “stable footing”. Webinar: The INFRAM: Your Pathway to Healthcare Infrastructure Development “We trust our inquiry and this report will be a wake-up call to all those involved in harnessing the power of digital innovation to improve healthcare in Wales. We believe it’s time for a reboot," said Nick Ramsay, PAC chairman. Dr Peter Saul, Royal College of GPs Wales Joint Chair, said the report, released today, raised "alarming findings about the weaknesses of IT in the Welsh NHS". "Data outages can be extraordinarily disruptive for practices and for patients. They affect appointments, prescriptions and the nuts and bolts of a functioning practice and can take hours to recover from. Unfortunately these data outages are becoming all too common, leaving GPs scrambling to find solutions or workarounds while waiting rooms fill up. "Embracing safe, reliable and innovative technology will be vital for the future of healthcare, but that will be undermined if the Welsh NHS cannot get its IT right. Whether it's the basics like appointment booking, or larger projects such as electronic prescribing or electronic patient records, we need IT that works," Dr Saul added. Government to review committee's findings The inquiry follows a report from the Wales Audit Office, published at the beginning of the year, which indicated that the NHS as a whole spends less than two per cent of its budget on ICT. It estimated that around £484m would be needed, on top of existing budgets, to digitise services. “There is a need for clarity from Welsh Government as to whether the tentative estimate is in the right ballpark, and the witnesses we asked thought it was, and whether significant resources will be set aside and over what time frame,” the committee said.  Their findings also indicated that the NHS Wales Informatics Service (NWIS), the organisation responsible for IT, was “being asked to do too much within its current resources and needed clearer priorities”, and concerns were raised about the cybersecurity risk posed by the CaNISC cancer IT system, which has not been supported by Microsoft since 2014.  "The Committee would like to see CANISC replaced urgently and as soon as is practicably possible," PAC members wrote in the report. "Given the red risk rating and the cybersecurity issues, there is a compelling argument for accelerating the work if possible. However, the Committee recognises that this would require careful consideration of the knock-on consequences." The Welsh Government and the NWIS said they would review the committee's findings in detail. “We welcome the report published today by the Public Accounts Committee into the use of information technology and the vital role it plays in our Welsh health and care system," said a spokesperson for NWIS. “We participated in the Public Accounts Committee review in April and July this year and were pleased to share insight into the specification, planning, delivery and management of national digital health and care services for Wales. “As an NHS organisation we are working with our partners across the health and care system to make the most of the benefits that digital services can offer to health and care professionals, patients and citizens." Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

If you think the digitisation of nursing is just about nurses filling out scores on a mobile device, it’s time to think again because artificial intelligence (AI) could be about to revolutionise the way nurses do their jobs. Recent digital developments include bottles which automatically issue reminders to drink, diapers that sound an alert when wet and sensor-equipped stoma pouches.   Heiko Mania, NursIT CEO, and a former nurse, believes AI will change the focus of nursing care: “Modern nursing expert software not only streamlines nursing documentation, it will automate it using AI, sensors and smart nursing aids. At the same time, professional nursing care will change from reactive to predictive, preventive nursing care.” Mania said they had developed a nursing care expert system, CareIT Pro, which supports automation in nursing. He explained that smart algorithms and AI could reduce the need for information to be entered and could link content, so that further workflows and tasks could be automatically initiated at the right time. He added that the software automatically recognised patterns, evaluated the planned nursing goals and recommended necessary adaptations. Webinar: AI: Evaluating Opportunities for Healthcare Providers He said sensors, wearables and smart devices were also enabling increased automation: “Intelligent tools automatically deliver data on the patient to the nursing expert software and thus allow automated documentation. Alarms, nursing tasks and digital processes can be generated and started independently. Nursing staff not only receive digital to-do lists, but can also see the current status and quality of the nursing processes at all times and react to them at an early stage. An intelligent drinking cup can automatically fill the drinking protocols and remind the patient to drink regularly or the stoma pouch sensor generates an automatic care task for changing the bag when it is almost full. We are currently developing an intelligent nursing mattress with a partner company that can detect not only the patient’s movement, breathing, position, pressure and sleep, but also incontinence.”  Improved quality of care and patient safety If the Internet of Things (IoT) is set to transform nursing, it is also starting to change the way nursing is taught. Widener University in Pennsylvania has introduced a range of simulation training from programming intravenous pumps and pumps for medication to updating electronic health records.  It also runs disaster simulation training as Widener, in line with other nursing schools, has recognised the need to prepare nurses for such incidents in the wake of 9/11. Nancy Laplante, Associate Professor of Nursing at Widener University, has recently published a paper arguing the case for introducing IoT in disaster training. Laplante believes this would highlight the application of these technologies in a meaningful way and enhance the experience for nursing students. She would like to teach the students to use mobile apps to track patients, triage them and track them to different hospitals, rather than using, for example, old-school paper-tagging of victims.    She said that downloading simple drawings, like Rich Pictures and Use Case Diagrams, which show all the participants in the disaster scene at a glance, can also improve understanding: “We were looking at what we call this rich picture for disaster scenarios and it was one way to help visualise all the interactions that would occur.  What we wanted to do was to give students an understanding of how complex communication is in a mass casualty disaster scenario. It is not just nurses talking to patients; they are going to have to deal with fire fighters, police officers, bystanders and health providers that are off site.”  Laplante said students had to get to grips with new technology as it was a growth area. She said that nursing students had to understand, embrace and help develop new solutions as they could transform their practice. However, she pointed out that while IT was an important aspect of nursing, it could never take the place of nurses: “I don’t personally believe that nurses can ever be replaced because you always need that human touch. My hope and my feeling for technology is that it can help enhance our care.”  It is likely that technology will fundamentally change nursing over the coming years and, provided it is used correctly, it seems it really could improve the quality of care and lead to increased patient safety.   .jumbotron{ background-image: url("http://www.healthcareitnews.com/sites/default/files/u2556/AIJumbotron.jpg"); background-size: cover; color: white; } .jumbotron h2{ color: white; } Focus on Artificial Intelligence In November, we take a deep dive into AI and machine learning.

Ten UK health tech start-ups to receive £40,000 through KQ accelerator Ten UK start-ups working at the intersection of biomedical and data science have now been selected to take part in the £400,000, 16-week KQ (Knowledge Quarter) Labs accelerator run by the Francis Crick Institute in London, meant to speed up development and adoption of data-driven technologies addressing global health challenges. Vision Game Labs, which is creating home-monitoring and remote-diagnosis vision kits for smartphones, using gaming techniques to gather visual data and diagnose eye disease, is one of the start-ups that will receive £40,000 to validate their business proposals through the programme, which is funded by Innovate UK, before looking for further investment. “The start-ups all have the potential to make an impact on global health outcomes and will have access to unrivaled support and resources. “These ventures will help shape the future of health in a sector that is a vital part of the government’s modern Industrial Strategy,” said Chris Sawyer, Innovation Lead, Digital Health at Innovate UK. Ireland’s largest acute hospital finalises Cerner Millennium implementation Ireland’s St James’s Hospital has now completed the rollout of the Cerner EPR, with every inpatient specialty and department going live with upgraded Millennium functionality in a programme labelled “Project Oak” – referencing the move away from paper-based processes. The functionality is set to reduce duplication and allow quicker access to clinical information, with 2,400 staff members receiving more than 21,000 hours of training ahead of the implementation, according to the supplier. “We are in the early stages of the launch, but careful planning has ensured that patient care has not been disrupted significantly over the weekend,” said Dr. Gráinne Courtney, Chief Clinical Information Officer at St James’s Hospital. “The implementation of this system is set to bring a raft of benefits to patients attending the hospital as health records are available instantly to those caring for a patient. Increased efficiencies mean patients will wait less time for their diagnoses, treatments and care. Over the course of the coming months and years we anticipate this will translate into shorter wait times and hospital stays.” HITN sister publication MobiHealthNews reported last month that the European Investment Bank was backing the implementation of Ireland’s eHealth programme with a €225m loan to support the creation of a “modern patient-centred health service”, according to Health Minister Simon Harris. NHS trust goes live with Patient Administration System East Kent Hospitals University NHS Foundation Trust has gone live with an Allscripts Patient Administration System (PAS) in a project that involved the migration of 42 million records to the new system. The trust runs five hospitals and community clinics, providing a range of services to a local population of around 695,000 people. “Deploying a new PAS is a major undertaking, but our old system was outdated and we had to change it to move onto the next stage of our IT development," said Andy Barker, East Kent Hospitals IT Director. "The Allscripts PAS gives us the platform to move forward with an electronic patient record." East Kent Hospitals ran a joint procurement for a new PAS with Maidstone and Tunbridge Wells NHS Trust back in 2015. Both trusts will now be deploying the Allscripts Sunrise EPR. Maidstone and Tunbridge Wells went live with the Allscripts PAS in 2017. Neurology advice line for GPs saves the NHS £100,000 a year An advice line run by the Walton Centre, a specialist hospital trust, in Liverpool, enabling GPs in the north west of England to call neuro consultants for advice, reducing the need for additional appointments, is saving the NHS £100,000 a year. According to NHS England, nearly 40 per cent of 181 calls received in 2017-18 were solved by GPs, saving around £52,000. Karen Kirkham, NHS England National Clinical Advisor for Primary Care, said the NHS would be looking to scale up similar innovations, with a long-term plan expected to be published later this year. “The Walton Centre’s advice line is an example of integrated care in action, connecting GPs with hospital specialists to provide more joined up care for patients. We often find these kind of improvements also make savings that can be reinvested back into the local NHS. “In this case patients also need less time off work because they need fewer appointments and to travel less, which is also good for the environment,” Kirkham added. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org