Has COVID been a blessing?

As we slowly – for most of us – move out of Covid restriction -we look at how the forcing of Hospitals to be online may well be the saviour they have still yet to recognise.

Some four years ago, I am sitting with a Clinical Consultant at a major Uk Hospital and he says to me, ‘Richard”, he says: “we can never do patient appointments without the patient being there. The Nurses just won’t stand for it”.

This is an interesting observation. Because, whilst we all have seen instances of reluctant or obstructive IT Teams, or even “Transformation Teams” – and now more likely, Data teams, towards the introduction of new tech driven processes, what we are seeing still, is that these insecurities are supported at a human nature level, and the excuses of choice are related to “unacceptable risk”, or “doesn’t fit our road map” or worse “we already have a policy for this”.

This is a pity, because if there is one benefit from COVID turning our lives upside down, it is that our lives can be much better when we put everything back in order. And there is no reason not to.

Because, what we know now of course, is that the secure tech exists, and has done so for some years, for perfectly capable remote patient discussion – and its advantages of bringing to the party additional protagonists to fit whichever patient we are talking to – are well known. So the question is:

Why did we not think of this before?

Well, we did. And it was not you and I in healthcare, that created or discovered it. It was our phone companies, and our search engines, whose livelihood depended on things being secure, flexible, and above all workable – long before you and I started to relate the same services that we use in our daily lives – to our working lives.

The upshot of all this, is that it now brings into question, why are we persisting with our old ways of doing things, our giant clunky solutions, our old SQL and single-sign on etc processes, when they have already long been superseded by mobile Apps that you and I can download for a few pence, and that require no support, and connect with planet Zog, from the moment we start to install in our front bedroom.

Yet you could say this is a negative. The driver for this unseen revolution, has been the necessity of COVID, to not meet people. Fair enough. I get that.

But now we are there, can we not recognise the promised land that gives us Carte Blanche to absolutely look again at how we run our hospitals, what is new and available right now, to do the same job that used to and still costs us zillions – when we can indeed reach a much better utopia, further, and use our resources much better?

What we have found over the past two years when we talked at all levels throughout Hospitals, is that there is no single Department, or Division, etc where we can point a finger. It is the prejudice of the individual that restricts them from going outside their comfort zone, that it is Ok to go outside their comfort zone – that it is essential to do so.

The problems that we are currently experiencing, of longer waiting lists, of five hour waiting times at E&E, and I could go on – are the result of the inability and unwillingness to prepare for change. Which brings me to my point. We surely do not want to experience another pandemic, to realise that we could have done it all better, so much earlier.

DIGITALISATION; HERE’S AN IDEA YOU MIGHT LIKE!

Does success in “becoming digital in our workplace” mean we are all techies?”  We interview Katie Trott, Chief Nursing Information Officer at the Royal Free Hospital, Uk, fresh before her HIMSS Discussion on 8th June, to see how they do it at her Hospital.

I am sitting in my office – I pick up the phone, and I call Katie’s Hospital, and the Reception immediately connects me, there is a sound of some children in the background, and then I realise – Katie is at home, this is her mobile line. 

“I’m sorry”, she says, there is a hint of amusement in her voice “I have the kids at home”.  No matter. And so I get straight to the point – you have been responsible for some major large clinical tech initiatives in your past – does this mean you have a technical background?

“No, “ she says immediately. “But I do know how to wire a plug”.

This is all going well.

So we start again, and you could say it gets worse. When Katie started in the NHS as what  was then a Nurse Auxiliary, at 16yrs old – there was no discussion of technology per se for people at the front line. Patients were patients and treatments were treatments. Katie’s background is clinical. It just so happened, like so many chance encounters in life, that she was rather good at explaining to patients and colleagues “what was going on”.

This facility to communicate, to bring things back to their essential levels, has been the secret sauce of what – looking back – has been a step by step process over the years, ie, the innate ability to communicate benefits and to lead others into new pastures. As clinical care has inevitably needed more and more clever toys  and cool IT, so somebody has to engage with the people who have to make it all work. At the Royal Free, under her direction, they delivered a new EHR in just 11 months.

Katie is self-deprecating; “I was just in the  right place at the right time” she says. “We sort of made a decision that we need to do this or that, and then sort of figured it out as we went along”. Clearly this is not true – but what is standout is the motivation to go forward – even though at the time, you might not be sure of what that “forward” can actually deliver.

And it has created some changes in attitudes.

“When I first got into delivering digital or clinical solutions, the mindset was definitely that “big is better”. If we want to do something else, we just got some velcro and stuck on a new module”. But our view now has changed to  scaling down, and adopting “best of breed”, a sort of FHIR approach, for the specialist areas that have specific needs.”

Katie continues; “Perhaps I was naive, but I remember when I first started, I thought that fast means better, that you just plug new solutions in. But over time, I discovered the benefit of taking it step by step. That testing and safe empowerment is a process. Sure, we can plug it in, – but everyone needs to be involved before we go play”.

What it seems is that there is a shift in areas of influence. The clinical demands of patient delivery , are becoming the driver of the IT requirement, as opposed to the other way round, And that IT per se, may not understand the clinical needs it is trying to address.

Two things are  becoming clear – and that tie in with what we have seen from other NHS Leaders that we have talked to.  That success in digital delivery, depends on the individual, and not being scared of appearing to be the idiot. It is a phrase that Katie uses a lot in our discussion – and  also the recognition that we are every day in a brave new world, and we have to sort it out.

It is time to end our discussion. We could talk for much longer, but Katie is at home, and there are noises in the background.

THE PURSUIT OF EXCELLENCE

We talk with Dr Minesh Patel, Partner at the Moatfield Surgey in the UK, and ask – how come they are so good at delivering healthcare for the common man?

Why is it in the UK NHS, that there are good surgeries, and not so good ones, and well, rank awful ones? Why are some standout – and others not so? If human nature is a common denominator, why are there not a set of standard rules, a sort of “go to guide for repairing a surgery”, a recipe book for getting it right, that we all can apply, and that’s job done? And if human nature is indeed the common linking factor, – does this explain why some surgeries are so terrified of change? And others embrace it.

At a time when “innovation”, and “digitalisation” are this year’s buzzwords, can these be imposed by some higher authority – “look, here’s some money, go and start this or that process?” – And if that is the case, then why do we not all have standout surgeries?

The answer is that my human nature, is not your human nature. In short, the success of a surgery, depends on the individual, and the mix of individuals, in each case. You’ve got to “want” to be innovative, to deliver excellence. The only question is whether this is nature at all – or nurture, can we “learn” to be innovative?

Minesh Patel hesitates as he answers this one. In his case, there was never much choice. His father was a doctor, his own daughter is a student doctor, so this is a family tradition so to say, The choice of working in a hospital, or running a surgery, was the freedom to improve and innovate given within a surgery, but it was a journey, taking in improving PCT performance, being Chair of a CCG, leading the clinical strategy development of a developing iCS, before settling and developing the Team at Moatfield, in East Grinstead.

Minesh readily admits that he cannot change or improve everything. Sometimes, the structures themselves do not lend themselves to change. And health inequality from one region to another, one person to another, is a life reality. Having said all that – is there a “process”, an attitude of mind, that is the difference , and what would be the roadmap for other surgeries to follow?

“The answer is little steps, all the time”, answers Minesh.

“At Moatfield, we have a daily huddle, we analyse all of our processes, and we act quickly. Our new website took just 4 days of re-tooling. We are not afraid to act if we believe in something” Minesh uses the word “innovative” a lot. 3 years ago, he became Chair of the National Association of Primary Care (NAPC), which he says has brought him into contact with a lot of like minded and talented people around the country, both within other surgeries and other providers, who are beacons of excellence, and who are learning from each other. It’s a case of seeing “what are the neighbours doing”. so to say. But it is also visionary.

Although we are talking about the daily routine, there is a focus also on the wider picture, why can’t we do things in a different way.

We are getting ahead of ourselves in the discussion.

As if on cue, I look at my watch – we have been talking for 29 minutes. “I’m really sorry!”, Minesh says…. “I have a patient call in a minute”

WHAT NOW, FOR HEALTHCARE IN EUROPE?

We interview the VP of HIMSS EMEA, Sean Roberts, newly moved to the UK from his native California, for his plans for HIMSS over the next twelve months – and his view of healthcare on this side of the Atlantic. HIMSS is the largest healthcare trade association in the world. Its annual Global Conference resonates around the world; European healthcare vendors, particularly from Scandinavia, use the USA as their launch pad for their European and even domestic healthcare promotion.

It is not the first time that Sean and I have met. Sean is an anglophile. The last time of any significance, that we met, we went to a rather bijou little restaurant somewhere in south west London on one of his frequent stop-offs. It is rare to find an American with such a detailed knowledge of eating places in London where tourists don’t go.

This time it is different. We are in Zoom territory now. Sean has much shorter dark hair this time – he is wearing a dark blue t-shirt, the background in his home office is bare white, and he looks quizzically at the PC screen;

“Can you hear me now?

I get up and move around my own office.

“Yep! I’ve got a better connection if I stand just here….”

And this is no stop-off. Sean has moved his whole family, wife, and dog – across the Atlantic, to use London as the base so to say, for promoting better clinical management and outreach, in Europe. It is an irony compounded by the fact that the HIMSS Global Chief Clinical Director, who advises the PHE – is also already UK based.

Obviously, COVID dominates the first part of the conversation. And I ask; “So, at a time when each European country is fending for itself, why choose the UK?”

Sean hesitates and replies; “it is because English is de facto the international language, but above all, because your frontline NHS worker bees, are so “resilient”.” It is a word Sean uses several times in our conversation.

And it is not because the UK has best healthcare COVID outcomes. That accolade goes to Denmark. They plan on doing 5.5 million vaccinations, by July 2021 and everyone’s bet is that they will do this. I concur; my last time running through CPH just a few months ago, my passport control took just a few seconds and even before getting my bag, there was a nice young Danish girl in blue uniform asking me “would I like a COVID test? It’s free of charge for all visitors”. I was directed through the arrivals area, up some steps and into a covered area, and within twenty minutes tops, I had my first COVID test. “Yes, we will call you at your Hoel in day or two of there are any probs”, the nice nurse said.

What Sean is able to do, is make comparisons between one country and another, and make suggestions to each government, each hospital -“Look, have you thought about mirroring how these other people do it? Their outcomes are better”.

Looking outside one’s own internal bubble, and learning from others, is a key message that Sean is trying to promote in the UK. And the delivery of this message is not without its problems. It may not all be to do with technology, but more about national culture. Those countries that do best in containing COVID, are those who have an implicit trust in their governments. If the government says this is the right road, then this is what we will do.

Despite the fact that we are a Telehealth society now, we are hampered by the lowest common denominator in terms of wifi connectivity. The growth of Telehealth, of video conferencing, has not been because surgeries and hospitals want to go down that road, it is because they have had to take that avenue. The success of Telehealth and remote consultation at surgery and hospital vet, is directly related to each individual organisation’s willingness to adopt these new processes.

But having said that, Sean continues, these messages are getting through. IHE and HL7 and links with the WHO, are the new common standards, and HIMSS has a programme for 2021, for increasing its pan Europe roll out. The next Conference, which may well be hybrid, will be again based around Finland and their new initiatives, – it is scheduled for 7th-10th June.

Scandinavia remains a natural point of departure for HIMSS EMEA, and there is a sadness that only 5% of visitors to HIMSS events are from the UK. In the same way that just a year ago, nobody had heard of COVID – so life and healthcare is a different process now. Let’s see in June if the message has got through.

Digital Therapeutics and Care at Home. Webinar 3rd June.

We focus on the latest  EHTEL’s “Second Imagining 2029*” webinar. This virtual meeting is part of the EHTEL Innovation Initiative agenda for 2020 on Exploring Digital Therapeutics, Artificial Intelligence, and Virtual Coaches.

With the Imagining 2029 series of webinars – hosted by its working groups – EHTEL invites the digital health community to reflect jointly on accelerating digital transformation – acknowledging the opportunities and challenges raised by the current COVID-19 crisis. This is what they say

Given today’s situation in which health systems, and especially hospitals, need to manage ever more knowledge and increasing amount of data, they are faced with a number of challenges. These relate to e.g., increasing clinical benefits, providing treatment in a variety of locations (in the hospital itself, in new forms of hospitals, at home), and involving health and care staff effectively in the changes occurring.

The objectives of this first webinar on digital therapeutics and care at home are to:explore how, throughout Europe, care is shifting from the hospital to the home, explore what digital therapeutics has to offer in terms of this paradigm shift, and identify in what ways AI and digital therapeutics work together.

The Date: Wednesday 3 June 2020, Time: 12:00 – 13:30 CET (90 min)

The first part of the webinar is a brief welcome and introduction by TicSalutSocial member, Juan Guanyabens, and EHTEL Principal eHealth Policy Analyst, Diane Whitehouse.

The shift of care from hospital to home: Example 1 – Presenter: Astrid van der Velde and Ed de Kluiver, Isala Heart Centre, Netherlands (NWE-Chance).

The shift of care from hospital to home: Example 2  – Presenters: Massimo Caprino and Riccardo Re, Casa di Cura del Policlinico – CCP, Italy (vCare).

What digital therapeutics has to offer and the relationship between AI and digital therapeutics. – Presenter: John Crawford, CrawfordWorks, United Kingdom and EHTEL Honorary Member.

The discussion will be based around several key questions, that should provide concrete evidence of developments in the field. After the discussion, the moderators will summarise the key messages of the webinar as preliminary conclusions.

The Virtual Meeting is on invitation. Please register your interest via the Webinar Event and Registration Page and find here More on Innovation Initiative workstream in the EHTEL website.

 

Medical Grade Wearable Devices for vital signs Continuous Monitoring

The need for a mobile and wearable clinical device – to take the pressure off our clinics and hospitals – has never been greater. It’s not like  there is no need.  The problem, so to say has been twofold; the reluctance of hospitals and staff to embrace a new technology that appears to reduce their personal involvement; and the lack of absolute clinical quality.  Sure, we have our Apple Watches, but that does not make us all doctors.

But things are changing. We look at the new wearable watch from CardiacSense, and ask, has the time now come for clinical grade solutions in the palm of our hand or on our wrist?  Eyal Copitt, COO of CardiacSense, latest manufacturer of a watch and wristband within the heart monitoring space,  explains what they do in these difficult times. This is what he says;

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Rapid expansion of the Coronavirus emphasizes the immediate need for long-term continuous remote monitoring of vital signs to closely monitor the conditions of those infected with the Corona virus.

Coronavirus patients suffer from high core temperature, high respiratory rate, high heart rate and low Oxygen saturation

The need for monitoring is at hospital for badly ill patients as well as at home for lightly ill people.
Devices with wireless communication allows hospital and home monitoring without the need for direct contact of medical staff and patients.

The CardiacSense watch and wristband have them all,  – core temperature, highest accuracy measurement of heart rate, respiratory rate, SpO2as well as absolute cuff-less blood pressure and arrythmia detection and wireless communication.

The above turns CardiacSense watch and wristband to be the ultimate affordable continuous monitoring solution for inpatients and outpatients, sending real-time measurements to the nurses station and receiving back written instructions from the medical staff through the device screen whether the patient being in the hospital or at home.

Using the CardiacSense watch and wristband medical grade continuous monitoring enables better monitoring and communication for isolated inpatients reducing staff infection risk and allows light coronavirus patients stay at home, while the monitored data being auto sent to the hospital’s monitoring center.

Eyal can be contacted at; Eyal@cardiacsense.com.

 

 

 

 

 

 

Can We Celebrate 70 Years of the NHS?


As increasing numbers of ordinary people move away from this cherished institution – we ask the question – why do they do so?

This is not about private medicine and public services. The UK NHS and its principle guardian of healthcare – free to all – at the point of delivery – is the cornerstone of just about every UK and European belief that healthcare is a public right – not something that you only get if you can afford it.

Fair enough.

The problem is when you put that into practice for the ordinary lives of people like you and I. The principle might be ok but – well, if other places are offering something better, and its within our price range, we are going to choose whatever that something else is.

And so they do.

At the recent Employee Benefit Fair in London just a couple of weeks ago, of the 115 Exhibitors, some 30% were all offering private walk in Doctors facilities.  And the services they were offering were better, than their NHS counterparts, particularly in areas that can be monitored remotely by smart technology on the wrist of all of us. As the provision of healthcare moves away from hospitals into a more community based environment, if for just a few bucks a  month, say you can have your diabetes monitored every day, in real time – or your heart and blood pressure similarly managed – does it matter that you never get to see a real Nurse?  All you want is the Nurse to call you when things look wrong – and for you to be able to drop by as you pass thru the local train station en route to work.

So why do so few NHS Hospitals and CCGs want to adopt similar practices?

The problem is twofold; if we can  solve a specific problem, with  technology, using half the nurses – then we can schedule the remaining nurses somewhere else where there is a greater need. Except that clinical grass roots staff have a fear of change and a fear of losing their job. And Managers have a fear of losing their nurses – and their silo based budgets.  As long as they have lots of people coming through those hospital doors – the money will keep rolling in.

And second – we regularly get emails and responses from NHS senior Managers saying;  “Sure, come by for a conversation, but not for a conversation that means we have to do something”. There is this misplaced belief among so many NHS Managers that as things have always been done this way – then life will continue to be done this way.

Not any more.  

We are seeing already that the public is voting with its feet. Sure, its a small beginning – but its a beginning none the less. As a senior more enlightened NHS Director told me – “we cannot keep trying to squeeze 100 appointments into the time reserved for only 40”.

There will become a time, sooner rather than later, when the public itself will start to wonder why they are paying any money for public healthcare at all. By then of course, it will be too late.

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Cyber Security in Healthcare.

It is commonly understood that the recent UK hacking situation in the NHS, was via its connected machinery, rather than direct into the hospital servers. We focus on what’s up at the forthcoming conference in San Francisco, with this  timely announcement from Tel Aviv based company Cynerio, who today announced its mission to protect the future of healthcare by focusing on its weakest link – the connected medical device ecosystem.

What they say is, by building a tailor-made solution for healthcare providers, they deliver  complete visibility into a healthcare organization’s medical device ecosystem, protecting it from cyber threats and helping the organization meet HIPAA regulatory requirements.

The company was founded by cybersecurity experts Leon Lerman, CEO, and Daniel Brodie, CTO, to deliver a cybersecurity solution specially designed for healthcare providers, based on the industry’s first technology that combines device behavior modeling with medical workflow analysis to provide full visibility into medical device behavior and activity on the network, accurately detect anomalies with deep understanding of the medical context and stop the threat to ensure patient safety and data protection.

“Connected medical devices are delivering a new level of patient care, but present new challenges of managing and securing the growing clinical ecosystem. For attackers, medical devices are easy targets, as the devices aren’t built with security in mind and healthcare security teams have limited ability to protect these devices with traditional IT security solutions that are more focused on standard platforms. Our technology offers a comprehensive solution, purposely built to protect the medical device ecosystem and their sensitive data,” explained Lerman.

Cybersecurity again in the News…

We look briefly at two companies that have got in touch…

Fortified Health Security have recently recently partnered with Beacon Health System to strengthen the health system’s overarching cybersecurity program. Their Kristin Deuber writes to us to say:

“The program kicked off in April 2017, during the formation of Beacon, which required the health system to consolidate policies and to implement a more unified and centralized cybersecurity program. Fortified discovered through its baseline research that the health system had moderate cybersecurity system development with data loss prevention, and had deployed a SIEM solution on limited systems. In addition, like most healthcare organizations today, there was zero SIEM visibility into their medical device inventory, as well as the risks associated with those connected devices.”  She attached some deeper info, which is available on demand from us here at ProfoMedia. And we have invited their President, Dan Dodson,  to write a guest article – so watch this space.

Also out of the blue, is the Proficio company, whose Tamara Yaravoy says that they have won some eleven Cybersecurity Excellence Awards. This is clearly better than my 200 mtrs  swimming certificate when I was a kid.  She goes on to explain in more detail:

“In the Cybersecurity Excellence Awards, Proficio won gold in the Best Managed Security Services and Cybersecurity Team of the Year – North America categories. The company was also recognized with a bronze award in the Best Cybersecurity Company category, where they had competed against forty other cybersecurity companies.

Proficio secured top honors in the Info Security PG’s Global Excellence Awards, placing in four different categories. The company won gold in the Cyber Security Vendor Achievement of the Year category for significantly expanding its operations in North America, EMEA, and APAC, silver for Best Security Company of the Year (Services), bronze in the Best Overall Security Company of the Year category, silver in the Managed Security Services category for its SOC-as-a-Service offering, and bronze in the Managed Security Services category for its Splunk Enterprise and Splunk Enterprise Security services. Proficio was the only cybersecurity company to be recognized with two awards in the Managed Security Services category.

In the Cloud Computing Excellence Awards, Proficio was recognized for excellence and innovation in their SOC-as-a-Service offering. Proficio was one of only nine companies selected for this award which honors vendors that have most effectively leveraged cloud computing in their efforts to bring new, differentiated offerings to market.

Proficio was once again awarded a placement on the Security 100 of CRN’s 2018 MSP 500 list as well as San Diego Business Journal’s Top Cybersecurity Organization List. The CRN Security 100 list is designed to help partners wade through the ever-expanding security market, from the long-standing legacy vendors to the niche players, and navigate the fast-growing security vendor market.”

Cyber security in healthcare,  is expected to be the target of choice for those malovelences trying to destabilise how our services work. Last year’s attacks on UK hospitals showed the issues of Windows XP reliance, and that was just a baseline start.

You can look back at our earlier pages on other cyber vendors. Do contact these and the above vendors as this topic will become more visible as the year goes on.

WHAT IS THE PROBLEM WITH MAKING DECISIONS?

We look at the increasing lack of leadership in our UK Public Services, and its negative impact – and we say; its time to do something.

The question really is; “why”, – is it necessary to do something? Public Services are not going to disappear overnight. Whether you take a week to do nothing at all – or a year – will not necessarily impact on your own job. It might, however, impact on someone else’s life – but as a Clinical Director told me recently – “I have a nice house, and nice holidays; why am I putting myself on the line?”

Lack of decision-making means that the people who we entrust to look after us, provide our essential services, and who we had hoped would go the extra mile – have no need to do so. This results either in a lack of engagement, where – according to a colleague of mine recently moved from the private sector into local government – that her colleagues already had their coats on by 16.58 each day… or an increasing level of stress related absence through the paralysis of moving things forward, in times of increasing pressure and demand for the very services they feel unable to deliver.

It’s not our job here to tell others how to do their job. But it is our job to explain the damage that simply putting things off, keeping things the same, and hoping that maybe tomorrow things will work out – doesn’t fly. Particularly as we are moving, and have moved – into an arena of “personalised service”, where our individual use of personal data, our smartphones, our iPads, our fitness trackers – means that technology exists to deliver great improvements in quality of pubic service.

As Bogi Eliasen of the CIFS in Copenhagen said at the HIMSS Conference almost one year ago – by harnessing the data that is flowing, in realtime, across our desks every minute – we can better employ our people, enable them to make decisions related to the data that they themselves have access to, reduce the stress in our places of work – and actually do what the public are asking us, and expect us – to do.

Because – the fact is – we no longer have the option of simply throwing more people, and more cash, to continue doing things the way we always have – because it just doesn’t work any longer. There are just too many people living longer, with too many orthopaedic ailments, exponential rises in diabetes sufferers, that having a few more nurses, a few more clinics, some more phone-lines – can never hope to keep pace with the needs of society that are getting worse.

It is for this reason that the recent PR from NHS England, about its new Diabetes Partnerships, – is like adding an Elastoplast to cover my broken leg. It misses the fundamental point. Hospitals that prefer to use in house resources rather than engage with specialist IT help, are simply putting off the moment of truth – that we have reached a tipping point.

What we have seen is that, due to the new personal focus of our provision of services, we need to move out of the “silo” mentality of me doing my job, and you can do yours. We need to start looking at how we treat society as a whole, in particular the mix of Community based solutions linked to (say) hospital services.

In the same way that “if you always do what you always did – you will always get, what you always got~’ so it is obvious that our current ways of doing things, at just about every area of Management that we have looked at for this Article – simply do not deliver the results that society is increasingly asking for.

This means investment in new technologies, that are proven, and that can link performance to results and to costs. The technology exists and has done for some time. The question tho – is whether our Social and Public Service leaders can take the lead and deliver what the rest of us are asking. After all – they have nice houses and nice holidays to go to. We wouldn’t want them to risk all that, now would we?