Are Healthcare people missing the point?

As the need for the provision of healthcare has moved from Hospitals to the Community, we have been looking at who “gets” that?

Actually not very many people, by that I mean, very few hospitals, and very few established vendors. In a survey that we are still conducting, of approx 100 key Hospitals in the UK NHS – the ordinary consumer (that’s you and me) with our smart data on our wrist, is light years ahead of knowing about their health situation, than the very places they go to when things look serious.

What is worse is that, not just established vendors seem to be clinging on to their market position with solutions that cannot possibly keep up with what the ordinary guy expects – but that newer start ups, who regularly look for funding – are being overtaken by Apps that are already in use for free. on our iPhone or Android device.

We have written about this before on our these Press pages, but our initial and interim assessment is that, whilst accepting that hospitals are routinely underfunded in the UK – their salvation will be the inclusion of primary care, sorting out issues before they ever get to the need for what hospitals currently do. so they become a one-stop shop. There are significant reductions in costs in this combination.

Approx 10% of the hospitals we deal with ourselves, get this notion – and either reach out to providers of community finance, or they include private paid-for health clinics, within their own walls. These tend to be the ones that regularly top the league tables of health excellence.

But what does not work – is doing nothing, because patients are now starting to walk with their feet away from these hallowed institutions anyway. We are very interested in hearing from those organisations who link ordinary Apps, with their healthcare services provision, and if we can, we will be pleased to publish their experiences.

New look at Digitalisation in healthcare

The recent Seminar announcement from EHTEL is worth visiting – we look at the specifics… what they say is this:

Digitisation in health opens up tremendous perspectives for new data-driven services. Our webinar to debate how individual health data combined with data collected in health and social care will provide the fuel for innovation in the future.

The implicit question is: What is Europe’s role in data economy and could maintaining trust be the biggest opportunity for Europe?

Jointly with Sitra, EHTEL is pleased to invite you to a webinar around the IHAN approach for trustfully personalised health services. Sitra’s IHAN® project aims to build the foundation for personalised wellbeing and healthcare services. It is a collaboration effort for European organisations. Evidently such an effort can be of interest for eHealth Competence centres, and all projects and initiatives involved in managing digital health data, also with a view for Artifical Intelligence based services.

Having been inspired by an EHTEL network meeting, we will inform on what IHAN is all about. What are building blocks for the IHAN rulebook like architecture, interoperability and trustful use? What are the core technical components including identity wallet, consent management and logging. How can these components be built according to IHAN requirements?

As an example, My Travel Health – Tokyo 2020 will be presented: The pilot project aims to benefit all stakeholders – travellers get medical attention faster and more precisely; the provider’s health data is securely exchanged with traveller’s consent; and medical teams can quickly get trusted patient information in their own language.

EHTEL moreover understands the webinar as an important milestone to define an AI-friendly environment in health and social care. This idea will be highlighted in more detail at the EHTEL 20th Anniversary & Symposium early December in Barcelona.

The Seminar is Monday 16th sept, at 15.00 CET; or 14.00 UK time. Join via: Skype for Business (connecting details will be shared upon registration)The Seminar is Monday 16th sept, at 15.00 CET; or 14.00 UK time.

Full Agenda is here for download,

Some Healthcare Updates…

Two of the leading independent voices in European and USA healthcare have published today and in past few days, some important announcements that need sharing.

The first – from the COCIR trade association in Brussels, concerns standardisation of medical device standards; this is really key, because without this, countries cannot refer or regulate new innovations and vendors cannot offer this internationally; what they say today is:

Brussels, 25 July 2019 – In response to the European Commission’s publication of the draft standardization request for the MDR and IVDR, COCIR has developed detailed feedback and recommendations for improvement of the document. We have always underlined the importance of having harmonised standards available and cited in the Official Journal under the new Regulations. Unfortunately, the proposed draft standardisation request still includes several elements that prevent flexible harmonisation and timely reference of standards in the Official Journal. COCIR recommends to the European Standardisation Organisations to reject this request if it is adopted in the currently proposed form. COCIR is more than ready to engage in further discussions with the European Commission and member states on this topic. We specifically call upon the next Commissioner for the Internal Market to find pragmatic solutions to the current deadlockBack

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And in the USA, the AHIMA organisation based in Chicago, has two days ago announced the aim of country-wide use of a standard Patient ID; you wonder what they did before….

This is a different and expansive take on their usual technology coding and practical approach., as they move nearer to compete with HIMSS.

We will get a view shortly from our colleague Christina Roosen, who knows both organisations well – to see where this is heading.

Care On Our Own Terms

As Kaveh Safavi of Accenture continues his annual look at our global healthcare, we look at the changes that healthcare providers have to face up to, and ask – what are they afraid of?

Fear manifests itself in a number of ways. The traditional route in surgeries and hospitals, is to stick to the status quo. Nobody gets fired for doing what they always did. or to put it more directly – burying one’s head in the sand. As said above, nobody gets fired for being myopic.

I “get” that fear of the unknown, is relevant. But fear of what we already have, and which the public are increasingly demanding – should be a wake up call. The question is, – is fear of progress created by simple lack of understanding.

People that know about these things in UK NHS Management, tell me that “the NHS will be fully digitalised within the next 20 years”. This is both 20 years too late, and also misunderstands what we mean by digitalisation, and what you and I increasingly demand from our healthcare providers.

For a start, just about all of us in possession of our Apple Watch, our Smart mobile – are already capable of managing our own health and scary symptoms, in real time, online, thanks very much, from the comfort of our armchair. When we call our Doctor, phone our hospital – we already have the data, personally and as consumers, of our own health situation. And moving on – as patients, we do not need the large corporate AI to automate the personal data that our hospital does not yet have. What we need, is the immediate link between our personal way of life, and people who know how to treat us at a place called a hospital, when we get sick.

So when Kaveh Safavi, Health spokesman at Accenture – says in his recent Seminar at HIMSS Europe – that patients are now increasingly moving away from traditional routes to health provision – he is sounding a warning bell. And he has the global numbers to prove it.

What he says is, – is that trad primary care is in decline. In the years 2013-2017, use of virtual access to healthcare, rose in the USA by some 200%. Already, in the UK, some 33% of the population go online to access our healthcare provider, at least once per year. In Finland, some 67% of the population would gladly get their healthcare access online – if only the infrastructure was there to do so.

But interestingly, – what Kaveh eloquently also says is – this is no cause for alarm. It is simply that, as patients and that dreaded word “consumers”, we are making lifestyle choices. It is not a case of “either/or”. Or “A or B”. It is a multiple choice of A-B-C-D-E, and these choices are based on what is the best availability of the healthcare that we need, that fits our lifestyle. So, if we prefer to drop in to a walk in clinic at our train station en route to the office – so be it,- as long as they have access to our data. Some regions are already recognising this Scénario. In Spain, some 33% of the population go online for virtual healthcare, and a further 83% prefer a retail environment to get primary care access.

This means two things; first – if we believe that prevention is better than cure, then investment and recognition needs to go into the provision of consumer based services. As said above, the growth of smart phone solutions means we are all doctors now. And that second, there is nothing to fear from a mix of healthcare provision at our local hospital. You could argue that the relevance for a hospital will increasingly be the provision of every level of walk in service, in the same way that supermarkets in Sweden offer walk in healthcare.

I’m sure Steve Jobs did not envisage the tangential App development in our personal lives, when Apple launched the iPhone all those years ago. But we live in a real world. And if you are reading this article on your ipad as you travel to work – well, that wasn’t too scary now, was it?

Healthcare. How to make AI work for You.

We look at the constant hype surrounding this overblown topic and ask; can it deliver for you?

On the basis of what we have seen – probably not. Although according to multiple independent reports “When it comes to healthcare AI, the UK is the powerhouse of Europe” – there are conflicting statements by  UK Government saying that “dealing with the NHS remains challenging”. And looking at a recent statements from others,  the evidence from startups and those tech companies who are at the forefront of developing new AI based solutions, take up is small, and there is  “little benefit to the value proposition”, from using AI per se. So there is a conflict between commercial take up – and perception of relevance.

What is worse, is that we are already seeing one hospital terminate their digitalisation journey, because – as one clinical Consultant told me – “it just doesn’t work”. 

The reasons  it “doesn’t work”  are many and varied, but largely fall into two camps,  first of which  is because the introduction of AI or Digitalisation, is not an IT or Tech discussion. It is a business process discussion. It is an HR and best use of people, discussion. If it remains easier to flip the paper pages of a file to see someone’s latest notes – then that is what it is.  But also – the announcement of a single IT decision point of the new NHSX quango, is itself a misnomer. At the upcoming Digital Health Conference, focussing on the new NHSX facility – there are no less than six Decision Makers all involved in the decision making process

So… what are the practical steps that you need to take, to get the best out ofAI based new technology?

1. Understand and create a Roadmap, of what you want to get out of this process? If it is simply to shore up your existing practices, then forget it.

2. Know which areas you  wish to include – both from a data access point of view, and also groups of people.  The more groups involved, the worse it will be.

3. Understand that what works for one hospital, may probably not work for you. Make clear choices about solutions that can deliver a specific benefit.

4. Do not engage in Trials.  AI data management is not a clinical discussion, and the algorithms used are already proven. You are already good to go.

5. Have milestones of progress. 

6. And only when you have all of the above written on a piece of paper – then involve your IT people.

You may well now find that the money you had previously allocated for something nebulous, will indeed deliver when broken down into manageable practical specifics.

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Conception and Reality

We explore the magic at the Fertility Fusion Clinic in North West UK, and see how their Team create success for their patients.

The conversation is already ten minutes old – before the flood gates open.

The young lady, in her mid thirties, has been biting her tongue for some moments before there is the first visible welling in her eyes. The girls at Fertility Fusion are experienced in softly opening a dialogue but time is not on their side. They have to get to the point. Like so many couples, this elegant woman has travelled for more than three hours to attend this Conference, for her moment of discussion with people who can make a difference, because for her too – time is not on her side. The Fertility Fusion clinical manager, a younger lady – gently steers the woman away to somewhere quieter;
“Let’s have a chat”. She says.


For most people, the magic of conception is clouded and clothed in happy images, of intangibles, of Storks, or “twinkles in eyes”. This only serves to accentuate the feeling of disappointment when for so many women and men – it just doesn’t work out. Whole relationships crumble under this augmented pressure. Couples that attend a fertility conference are brave and are there for a reason.

Fertility is big business. At a time when CCGs are increasingly walking away from IVF financing, the “fertility” industry has been quietly growing and expanding, with a plethora of contradictory information, all aimed at couples who are emotionally ready to part with large sums of money to whichever expert reaches out to them.

The Fertility Fusion approach is noticeably different. First – there is no discussion of money – in fact the opposite. Once the opening scene-setting has been established – “where are you at the moment?” – the clinicians look at what NHS funding is indeed available. For some couples, this is an issue, and whilst Fertility Fusion might indeed be in the business of delivering dreams, we are now at the practical end of the discussion, almost in reverse from what people expect.

Couples need their hand held. The girls at Fertility Fusion patiently explore the clinical options – and are straight and to the point. Couples need to know factually their options, and if this involves bad news, there is no value in hiding that. Individuals need to be told the dangers of their lifestyle. For some patients – they would prefer to be in denial. The Team at Fusion are years experienced in this fine balancing act of how to deliver information.

And this translates into measurable success stories. Fusion Fertility is currently the most successful of regional clinics, and couples and individuals come form across the UK to be treated.

On the opening conference day when I was there – there is a steady trickle and then a flow, of couples, of same sex partners, of single women, of confused men. And I am a guy, a voyeur – a disinterested onlooker, from a distance. For these discussions at heart, are woman to woman.

The men shake my hand warmly at the end of their discussions with the Fertility Fusion team – even though I have done nothing and neither have they. They want to be involved but they do not know how to. Shaking my hand gives them a value.

I have to leave to get my train. My daughter calls me; “Can I borrow your Volvo?”. I love my Volvo – but this is not the time to get picky. “Yes of course dear; I filled it up last night”.

I am a lucky guy.

Fertility Fusion can be contacted at; fertilityfusion.co.uk

Is AHIMA the new force in US Health Data Management?

It’s not like AHIMA (ahima.org) is a new kid on the block – their Association has been around for some time. It’s just that the recent spate of emails to us about their SmartBrief facility, and the depth of the info it conveys, make us wonder why we have not recognised its presence before.

In fact we did – it’s just that AHIMA itself has started to widen its reach, and is giving its bigger brother so to say, HIMSS – a clear run for its money.

At a time when HIMSS changes in key personnel over the past twelve months, has given it a more authoritarian look and feel and dare I say, less welcoming.

So here we are… AHIMA focusses on the technical stuff, coding, courses, helping to you to understand better your patient data. And they have their annual events too, and their frequent Seminars.

Sure, HIMSS has its global footprint – and we will be at HIMSS Helsinki in just a few months – but watch out for the increasing News briefs from AHIMA and go subscribe to their service.

COCIR concerns in the event of a no-deal Brexit

If anybody had any doubts of the damage that Brexit is doing to our UK and EU economies, the following official announcement today from COCIR, should be a wake up call that is already too late.

The date of withdrawal of the United Kingdom from the European Union – 29 March 2019 – is drawing ever-closer. While we sincerely hope that both parties will continue to do their utmost to find an agreement, our industry is increasingly concerned over preparations for a “no-deal scenario”. Such an outcome means that the UK will no longer remain part of the European Single Market. Given recent communications by the European Commission (1), this will have detrimental consequences for our industries in the European Union. Our major concerns are that:
–    UK Notified Bodies, which currently play a critical role in certifying medical devices placed on the EU-27 market, will no longer be able to issue EU certificates. 
–    Non-EU manufacturers that currently have an Authorised Representative based in the UK will have to change to one based in the EU-27.
–    Manufacturers transferring to a new – EU-27-based – Notified Body will need to change how their devices are labelled to reflect the new Notified Body number or face non-compliance with the Medical Device Directives. 
Unfortunately, it appears that the European Commission and the EU-27 Member States are currently not planning to adopt a specific transition period for medical devices (similar to the one planned by the UK). However, we would like to point out that the current timing is insufficient to allow for manufacturers to receive certification by a new Notified Body. Even where a transfer is possible, and new CE certificates from EU-27 based Notified Bodies have only been issued in the last few weeks, re-labelling all their devices would be challenging at best and unfeasible in many cases, particularly for manufacturers with large product portfolios. If devices are not available, even temporarily, the resulting impact on European healthcare systems – and the safety of EU citizens – could be substantial. 
Therefore, in the best interest of citizens, we call on the European Commission, together with Member States, to agree on a limited transition period. This will allow those manufacturers directly impacted by any no-deal Brexit to continue to place devices certified by a UK Notified Body on the market. 
Standard practice for medical devices (2) when changing to a different Notified Body would be to provide six months following the Date of Withdrawal. This would allow the re-labelling of devices after the certificates transition to a new Notified Body. Even 12 to 18 months could be necessary in case manufacturers have to switch to a completely new Notified Body to ensure the necessary time for the re-certification process.
Such a transition would give manufacturers much-needed certainty and ensure that hospitals, healthcare professionals and citizens in the EU see reliable and predictable access to these devices. 
This, however, provides a short-term solution to a long-term challenge. We therefore encourage the EU and the UK to expedite negotiations on a trade agreement that includes the mutual recognition of medical device certification. 

 1 – ec.europa.eu/info/sites/info/files/qa_brexit_industrial_products_en.pdf 
 2 – www.doks.nbog.eu/Doks/NBOG_BPG_2006_1.pdf

Raising your Voice

The things that we already take for granted in our private lives, the “hey Siri” – the access to Alexa, – and untold information simply by asking a machine that sits by our bedside or we carry in our pocket – also can deliver big savings in time and costs when used in healthcare.

It’s been a while in coming; but now that clear uses have been developed that deliver benefits for the man in the street – now is the time for Community clinics and Hospital Outpatient areas, to take this seriously.

We focus on the latest, that is already clinically proven across the USA; this is what they say…

-Orbita, Inc., provider of the only HIPAA-compliant platform for voice and chatbot applications in healthcare, today announced through its collaboration with Mayo Clinic, the availability of Mayo Clinic’s award-winning first-aid voice application on two additional platforms:  Google Assistant and voice-powered web chat. This takes Mayo Clinic beyond its initial foray into voice with the Mayo First Aid skill for Amazon Alexa, and provides new capabilities to deliver first aid content via Google Assistant-enabled devices and a voice chatbot offered at www.mayoclinic.org.

“Expanding the delivery of Mayo Clinic content through more voice channels helps give consumers ready access to trusted health information where and when they need it,” said Sandhya Pruthi, M.D., general internal medicine physician and associate medical director of Mayo Clinic Global Business Solutions. “We’re pleased to continue innovating with voice and exploring its value to enhance patient and consumer engagement.”

Research shows consumer adoption of voice devices is exponentially faster than web and mobile predecessors. This bodes well for value-based health care where improved patient engagement aims to translate into quality improvements and cost reduction. 

“Mayo Clinic is sharing these new offerings just weeks after buzz at CES that the AI-powered virtual assistant, Google Assistant, would be on more than one billion devices by January 31, 2019,” said Orbita CEO Bill Rogers. “Clearly, voice is here to stay. Orbita is honored to collaborate with Mayo Clinic in exploring new voice opportunities for health care.”

At HIMSS, the health IT event bringing more than 45,000 attendees to Orlando, Fla. this week, Mayo Clinic and Orbita are highlighting:

  • Mayo First Aid for Google Assistant: Users of Google Assistant can tap “account”, then explore to access the “Mayo First Aid” action. After saying “Hey Google, Talk to Mayo First Aid,” they proceed with asking a question such as “How do I treat my baby’s fever?” 
  • Mayo First Aid Web-based Voice Chat : The same content and experience currently available through the Mayo First Aid Alexa skill and now Google Assistant, is also available via web-based voice and chat at  www.mayoclinic.org/voice/appswww.mayoclinic.org/symptoms, andwww.mayoclinic.org/diseases-conditions on web and mobile browsers that support voice input. Unlike most of today’s chatbots, which are only keyboard driven, this new Mayo First Aid Voice Chat experience offers an integrated voice and text-based interface.

These solutions join the Mayo First Aid Alexa Skill. Last month at the Chattanooga-based Alexa Conference, event organizers selected Mayo Clinic First Aid for the 2019 Alexa Skill of the Year for Healthcare Award. Orbita received the 2019 Best of Show Bronze Award and the 2019 Best Third Party Tool Award.