EMEA News

Five new AI centres will be created in London, Leeds, Oxford, Coventry and Glasgow.    

Public Health England will bring together a group of experts to scale up the agency's work on "predictive prevention", enabling people to take greater control of their health and care through personalised advice and interventions, according to a new policy paper released this week. “We are testing new ways of providing people with preventative advice, using cutting edge technology often called 'predictive prevention'," the government said. "Innovations like these provide exciting opportunities for the future of health and social care - offering earlier diagnosis and more targeted treatments, supporting self-management of conditions, making health and social care more convenient, and joining up data across services securely to deliver better and more personalised care." Leveraging the use of digital technology and data, the PHE-led programme will be “founded on the highest standards of data privacy”, being compliant with the Data Protection Act 2018, the GDPR and the work of the National Data Guardian. “The Government wants to see health and social care exploring digital services that use information (which individuals choose to use) to offer people precise and targeted health advice - specifically designed for their demographic and their location; their lifestyle and their circumstances; their health needs and their health goals. “Targeting interventions this way not only means we can direct specific public health interventions towards those most at risk - it means that those who want it can have preventative care that is relevant to them and more effective than ever before,” the document reads. While no further details about the PHE project were released today, the paper outlines plans to "prevent people from becoming patients" and realise the government's vision to improve healthy life expectancy by at least five extra years before 2035, including through virtual consultations or the use of social media. A recent NHS Digital programme saw a 13 per cent increase in first time attendances for breast screening over a four-year period in Stoke-on-Trent after the North Midlands Breast Screening Service started sharing information about the process and its importance on Facebook community groups.  "The NHS must go from being the world’s biggest buyer of fax machines to the tech pioneers of the future. And I know we can do it," Health and Social Care Secretary Matt Hancock said earlier today at the annual meeting of the International Association of National Public Health Institutes in London. The government is expected to publish a green paper on prevention next year. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Artificial intelligence (AI) is increasingly permeating medical imaging, but its integration into clinical practice will depend on the capacity of AI technology to facilitate workflow. How far has radiology advanced on this path? Insights asked a leading expert to find out.

NHS Scotland has signed a new agreement with Microsoft to deploy Office 365 and migrate all systems to Windows 10 E5 during the next three years in an effort to boost cyber resilience and mitigate any potential threats. "We're creating the environment and the tools to allow staff and services to flourish. At the moment they are too often hampered by systems that don't join up or make collaboration easy,” said Jeane Freeman, who was appointed as Scotland’s Health Secretary in June this year. Freeman explained this included the development of a new national digital platform and setting out “common standards and approaches for healthcare systems”. HITN sister publication MobiHealthNews reported in August that Dr Alistair Hann, former Skyscanner Chief Technology Officer, had joined the NHS Digital Service, based within the national health board NHS Education for Scotland, to help build the new platform, working with Geoff Huggins, Director of the NES Digital Service, and Liz Elliot, former Chief Operating Officer at the Health Data Research UK institute. Webinar: How Cybersecurity Leaders Avoid Data Breaches in Healthcare Commenting on today’s announcement, Huggins told HITN: "We're building a joined-up health and social care system, based on a National Digital Platform, so that people can get the best care, regardless of where they are. Moving to 365 is a fundamental building-block in that process." Earlier this year, the Department of Health and Social Care agreed a centralised deal with Microsoft, enabling all NHS organisations to use Windows 10 and strengthen their cyber defence capabilities, nearly a year after the WannaCry attack disrupted operations at around one-third of NHS hospital trusts in England and 603 primary care and other NHS organisations. NHS Scotland has the option to extend its three-year agreement with Microsoft for a further 24 months under similar terms. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Cambridge University Hospitals NHS Foundation Trust (CUH) has become the first NHS trust and the first Global Digital Exemplar (GDE) to be revalidated against the new Stage 6 HIMSS Analytics international Electronic Medical Record Adoption Model (EMRAM) standards that came into force at the beginning of the year. The changes were designed to reflect progress in the healthcare technology and information space during the past few years, with the Picture Archiving and Communication System (PACS) requirement, for instance, moved from higher to lower stages of the model (PACS is now part of the Stage 1 criteria, as opposed to Stage 5). New standards were also introduced to ensure that cybersecurity and disaster recovery were “fully recognised as important factors in a modern health service”, John Rayner, Regional Director for Europe and Latin America, HIMSS Analytics, told Healthcare IT News. “In addition, areas of compliance have been increased to raise the bar and to acknowledge the importance of having these critical services hospital-wide, rather than in a single clinical area. As a result of these changes, some hospitals are likely to find achieving the higher stages of the model more challenging than they did prior to January 2018,” Rayner said. Cambridge University Hospitals went live with Epic back in 2014 CUH, which runs Addenbrooke’s Hospital and The Rosie, originally achieved Stage 6 of the EMRAM standards back in 2015, following the creation of its eHospital digital transformation programme. Webinar: Applying Machine Learning to Patient Records to Improve Clinical Recommendations The HITN team visited CUH more than four years after the “big bang” go-live of their Epic EPR,  configured during an 18-month period to incorporate the trust’s clinical workflows and to support local and national guidelines, and found overwhelming support for its digital agenda. Their EPR is now reportedly being used by around 3,400 staff at peak times across all clinical areas, and Luke Bage, Senior Charge Nurse, told HITN that the system “continually seems to improve”.  “The Epic that you see at the beginning of the year is not the same Epic that you see at the end of the year,” said Dr Afzal Chaudhry, Renal Consultant and Chief Clinical Information Officer (CCIO) at the trust. After developing electronic early warning alerts within the EPR, launched in their Emergency Department in 2016 and across all adult inpatient areas at both hospitals in 2017 to ensure that nurses and doctors are notified if a patient’s clinical observations meet sepsis criteria, the trust has seen a 42 per cent reduction in sepsis mortality. In April this year, CUH linked Epic to the Cerner Millennium system used at West Suffolk NHS Foundation Trust, helping clinicians securely access clinical information about a patient held within each other’s EPR to improve quality of care, as figures show that nearly 30 per cent of their patients attend both trusts for treatment. The next month, through a digital primary care portal called EpicCare Link, a similar initiative was launched to help GPs and community nurses securely access clinical information about their patients from within the Epic EPR, currently available at Granta Medical Practices in Cambridgeshire. The Care Everywhere HIE functionality also connects CUH to Epic hospitals around the world and, once University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital for Children NHS Foundation Trust go live with Epic next spring, the trust will also be connected to them. CUH wants to become the first trust to reach EMRAM Stage 7 in the UK Meanwhile, CUH signed a £107m seven-year contract with Novosco in June to replace and strengthen its infrastructure to take account of “more mobile working, device integration, and accommodate telemedicine, whilst keeping the system secure, protected, and accessible”, according to Chaudhry. The transition process is underway, and the trust now has an ambition to reach Stage 7 of the EMRAM.  “The main things that we would like to focus on are a robust methodology for quality improvement informed by the use of data, so that we’ve got real data-driven analytics to help us understand where we have the greatest opportunities to improve patient care and to measure the beneficial outcomes of that in a sort of continuous improvement cycle,” Chaudhry said. Commenting on today's announcement, Dr Ewen Cameron, CUH Executive Director of Improvement and Transformation, added: “To validate against the new criteria shows how far we have come over the years since we implemented Epic and since our last HIMSS inspection. Our aim now is to further advance our use of technology to provide even greater benefits to our patients and staff and, as a result of doing this, become the first Stage 7 trust in the UK.” Only two other organisations have previously reached Stage 6 of the EMRAM in the UK, Kingston Hospital NHS Foundation Trust and St George's University Hospital NHS Foundation Trust. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

How can European citizens be given union-wide, secure access to their health data? And how can Member States collaborate on the secure and authorised access to national genome databases? At the recent European Data Summit in Berlin, organised by the Konrad-Adenauer-Foundation, a breakfast session supported by HIMSS Europe saw experts tackle these issues, with Marco Marsella, Head of the eHealth, Well-Being, and Ageing Unit from the European Commission, presenting their plans to support Member States in enabling cross-border health data exchange and facilitating the secondary use of patient data for research purposes in the field of genomics. Marsella said there was no need for new standards, arguing that the focus now had to shift to adopting existing standards to facilitate cross border eHealth. The European Commission already supports a variety of initiatives in these areas, including the European Reference Networks for Rare Diseases or pilot projects to exchange patient summaries and e-prescriptions across national borders. “Most of the EU Member States and governments seem to be willing to support these initiatives; but some are more successful than others to promote health information exchange across the care continuum and to enable their citizens to access their health records”, said Jörg Studzinski, Director Research and Advisory Services at HIMSS Analytics, who participated in the meeting. “It will be important to create more agile, effective and efficient governing structures and legal frameworks to provide the necessary push in this area – in particular within Germany." Germany aims for national EHRs by 2021 Niklas Kramer, from the German Federal Ministry of Health, admitted that Germany has not been very successful in digitising its health services. The current government, however, has outlined an eHealth strategy aimed at adopting the country’s Health Telematics Infrastructure for information exchange and introducing nationwide electronic health records by 2021. But the complexity of the project, looking at the accessibility, sharing, and use of health data, was highlighted by the panel. The German research community, for instance, is getting increasingly frustrated over the legislative barriers regarding the use of big data, at a time their peers in other countries are making significant scientific progress in this field. “eHealth policy should be key part of the eGovernment modernization efforts and Germany should follow the Estonian and Nordic approach when it comes to free flow of data, research and health treatment. As for the European Genomics Declaration, it would be great to see Germany joining forces with other Member States to link genomic databases across borders”, said Dr Pencho Kuzev, Data and Digital Policy Coordinator at the Konrad-Adenauer-Foundation. “There is a clear commitment and guidance from the European Commission to facilitate a multi-stakeholder approach to make cross border healthcare a reality and overcome the current technical gaps and challenges when it comes to exchanging data”, added Anett Molnar, Senior Manager, Public Policy and Engagement at HIMSS Europe. “HIMSS and HIMSS Analytics are prepared to support the European Commission and Member States through opinion exchange, workshops and research initiatives and jointly further the mission to transform healthcare through the use of information and technology.”

The use of Electronic Patient Records (EPRs) is now an accepted part of modern medicine, as many now recognise that using EPRs is safer and more productive than using paper. EPRs or Electronic Medical Records (EMRs), as they are known outside of the UK, are frequently associated with improved simultaneous access, improved legibility, and, most importantly, improved patient safety, especially in areas such as clinical decision support, prescribing and computerised order entry - using the EPR to request blood tests, imaging examinations, and therapy assessments. EPRs come in all shapes and sizes and range from the wall-to-wall "one size fits all" monolith approach, to the best of breed/ best of suite to the "home brew" in-house development approach, particularly popular in Spain. The approach is often defined by the hospital’s historical investment, the availability of resources - now and in the future, the views and preferences of clinicians, and the ability of the CIO to influence the chief executive and the members of the senior management team. One would hope that whatever the approach looks like, it has come, as a result, of detailed analyses which has thoroughly examined all the pros/ cons and benefits to both clinician and patient. Data collected by HIMSS Analytics from over 800 European hospitals (excluding Turkey) tell us that 22 per cent of EPRs are provided as wall to wall "one size fits all" (80 per cent or more applications from the same vendor), 23 per cent of EPR systems are best of breed (less than 50 per cent of applications from the same vendor), 42 per cent are best of suite (when 50 to 79 per cent of applications are from the same vendor), and 13 per cent of EPR systems are in-house developments (50 per cent or more of applications are self-developed). Whilst choice of system and the degree of variability in approach is interesting, even unusual, given that most acute care hospitals are all providing healthcare in very much the same way, EPRs all have one thing in common - they all contain structured data fields that "do things".  Hospitals invest in IT but see no additional value or benefit from a patient safety or quality of clinical care perspective The clue is in the "E", the "E" being an abbreviation for Electronic. If the EPR system collects the height and weight of the patient the system should be able to calculate the patient’s Body Mass Index (BMI). If the BMI is collected, the doctor can be assisted by a "weight based dosing" algorithm, which, together with the patients date of birth, may prevent the doctor from prescribing an adult dose of a drug to a child or help the doctor by ensuring that the dose of the drug is in accordance with the patients BMI. If the EPR is capturing laboratory results the doctor can be assisted to prescribe the appropriate dose of an anti-coagulant because the system is able to recognise the latest INR result. EPR systems can also assist members of the nursing team to provide nursing tasks that are commensurate and aligned with different levels of risk. For example, should a falls risk assessment determine that the patient is at high risk of falling, the care plan is automatically populated with nursing interventions that are only associated with this level of risk. This goes some way to ensure that care is standardised and reduces the possibility of low risk interventions being offered when the risk of falling is high. To be clear, scanned paper, electronic forms, systems that contain large amounts of unstructured data or 100 per cent free text with no alerts, no warnings, and no clinical decision support are not EPR systems. The abbreviated "E" in this case probably stands for Electric. Sadly, we see hospitals that have invested significantly in information technology, more systems than sense, multiple clinical data stores, little connectivity, robots in all the right places, but no additional value or benefit from a patient safety or quality of clinical care perspective.  So, if you are a Chief Information Officer or a Chief Clinical Information officer reading this, make yourself a note to review all the data fields within your clinical application(s) to make sure that first of all those clinical data fields are capable of receiving structured data and then that those data fields actually do something to help clinicians. If your EPR is helping clinicians with clinical decision support, well calibrated alerts and warnings your EPR is likely to be electronic, if not, it’s an electric record.  Finally, if you have persuaded the Chief Executive and members of the Senior Management Team to invest in scanning facilities and an Electronic Document Management system as an alternative to an EPR system, you may be at some point be asked to explain why.

Former UK science minister Lord Drayson’s Sensyne Health has announced the commercial launch of the GDm-Health solution, developed to enable remote management of gestational diabetes in collaboration with Oxford University Hospitals (OUH) NHS Foundation Trust and the University of Oxford. GDM (gestational diabetes mellitus), a pregnancy-related disease, can lead to adverse maternal and foetal outcomes without close blood glucose control. Sensyne Health’s cloud-based product includes an app that connects to a wireless blood glucose monitor, transmitting data, including measurements or any other notes logged by patients, to a web-based clinical dashboard that care teams can access. It allows patients to speak to the professionals involved in their care directly, and the development of the app follows a two-year long clinical evaluation in the NHS for more than 1,000 women, according to the company. Global Digital Exemplar OUH and its fast follower, Royal Berkshire NHS Foundation Trust, have already made the solution available to patients and their midwives. Batoul Mustafa, who used the app during her pregnancy, said GDm-Health enabled her to have “more personalised antenatal care”.  "The overwhelming positive response to GDm-Health from the NHS and from women with gestational diabetes is testament to its clinically led design and the fact it is technology that is addressing an area of urgent, clinical need. We look forward to its wider adoption in the coming months,” Lord Drayson said. The three other NHS sites that will start implementing GDm-Health are Buckinghamshire Healthcare, Croydon Health Services and Milton Keynes University Hospital. “GDm-Health will allow us to provide more responsive and personalised care to our women with gestational diabetes and we are excited to be one of the first Trusts to implement GDm-Health,” said Erum Khan, Consultant Obsetrician and Gynaecologist at Milton Keynes. Sensyne Health is backed by Sir John Bell, Regius professor of medicine at the University of Oxford and author of the UK’s Life Sciences Industrial Strategy, and former NHS England national medical director Sir Bruce Keogh.

Genomics England has awarded a multi-year contract to Cambridge-headquartered Congenica to provide diagnostic decision support services that will underpin the delivery of the NHS’s world-first initiative to create a national Genomic Medicine Service (GMS). Created through a partnership between the Wellcome Trust Sanger Institute and the NHS, Congenica has established a footprint in the UK, US, and even China since launching, working on their 100k Wellness Pioneer Project. Its clinical genomics interpretation software Sapientia has been validated within the 100,000 Genomes Project, with scientists using it for clinical analysis and genomic interrogation to obtain actionable clinical reports, and the company's new contract to deliver the NHS GMS follows a “competitive tender process”, according to Genomics England. Health and Social Care Secretary Matt Hancock announced earlier this year the ambition to sequence five million genomes in the UK during the next five years, with all seriously ill children and adults with certain rare diseases or hard-to-treat cancers to be offered whole genome sequencing as part of their care starting from next year. “The UK has always been at the forefront of genomic medicine and the launch of the new NHS service further demonstrates this. “The experience that Congenica has gained in working alongside the NHS and Genomics England to achieve this, [sic] puts us in a strong position to expand globally and integrate genomics effectively into other international healthcare systems,” said Dr Andy Richards, Congenica’s Chairman. Towards the end of August, the firm announced that Wendy Britten was appointed as its new Chief Financial Officer, joining them from pharma giant AstraZeneca. “By working with Congenica from the start of the 100,000 Genomes Project, we’ve been able to provide high quality variant interpretation of genome sequences to the NHS, helping deliver benefits to patients at scale. “Now that we are embarking on the next exciting step in our journey to embed genomic medicine in healthcare, Congenica will continue to play an important role with Genomics England in delivering results to clinicians and diagnoses to patients,” said Professor John Mattick, Genomics England Chief Executive.

Bradford Teaching Hospitals NHS Foundation Trust will open an AI-powered command centre at the Bradford Royal Infirmary next spring, thought to be the first of its kind in Europe, through a partnership with GE Healthcare. The trust provides acute and community health inpatient services for approximately 500,000 people from Bradford and the surrounding area in England at the Bradford Royal Infirmary, where its Emergency Centre is based, and St Luke’s, along with three other community hospitals. The new air traffic control-style or NASA-inspired centre is set to provide real-time access to an overview of the 800-bed hospital to help inform decisions on how to manage patient care, with up to 20 staff monitoring a so-called “Wall of Analytics”, pulling data from existing systems. NHS under strain: system facing unprecedented demand With more than 96 per cent of bed capacity at the Bradford infirmary regularly used and 125,000 A&E attendances per year, the new centre is expected to reduce length of stay and the need for additional wards and beds, particularly during winter times. “Demand for services is growing at Bradford Teaching Hospitals every year. The command centre will enable us to optimise our use of resources and improve how we move patients around the hospital for treatment and successful discharge,” said Professor Clive Kay, Chief Executive at the trust. A report published last year by the European Commission found that - excluding beds in the private sector - the UK, Spain, Denmark, and Sweden recorded in 2015 the lowest number of hospital beds relative to the size of their population, with under 300 per 100,000 people, looking at EU member states. Analysis from independent think-tank The King’s Fund indicates that the number of NHS hospital beds in England has more than halved during the past 30 years, while the number of patients being treated has significantly increased. Speaking at an event organised by communications firm Freuds in London back in September, calling for better use of IT in the NHS, NHS England Deputy Chief Executive Matthew Swindells said: “We have a choice, either we reinvent healthcare or we build three hospitals a year. I don’t think building three hospitals a year is what 21st century healthcare looks like.” GE-developed command centres opened in US and Canada GE Healthcare has partnered with a number of healthcare providers to launch several command centres in the US and Canada. At the Baltimore-based Johns Hopkins Medicine, two years since the opening of the Judy Reitz Command Centre, the technology has been linked to a more than 40 per cent improvement in facilitating transfers for patients with complex medical conditions from other hospitals in the region, according to the supplier. These initiatives are different than existing transfer, bed management, and resource centres, the company says, because they are “multi-purpose and scalable”, managing “patient safety and experience”, including “predictive and prescriptive decision support tools, not just dashboards from IT systems”. “Command centres help to orchestrate the delivery of care across the organisation, bringing consistency to processes, prioritising actions, eliminating waste and predicting tomorrow’s pressure points,” said Mark Ebbens, European Command Centre Lead at GE Healthcare. Healthcare IT News reported earlier this year that GE spun off its healthcare business as a separate company towards the end of June, after recording more than $19bn in revenue in 2017. The total value of the procurement at Bradford Teaching Hospitals is estimated to cost around £5.5m, excluding VAT, according to a contract award notice published at the beginning of October.