The parallel evolution of striving for more sustainability and social responsibility, the tsunami of introducing new (medical) technology and the COVID pandemic, with its resultant economic and mental crises, were leading to three fundamental shifts in healthcare, Prof. Pascal Verdonck told the Conference.
Prof. Verdonck is member of the Royal Flemish Academy of Belgium for Sciences and Arts and Board member of the Belgian & European Association of Hospital Managers.
He said the first shift went beyond the concept of hospital to the concept of community. This allowed patients to receive good and appropriate care within their own community and thus closer to home. This did not mean that the hospitals became redundant, but that they organised care close to or in the comfort of the patients’ homes. This included integrated care, making use of telemedicine, chronic care management, patient remote monitoring, patient self-management with or without coaching, etc.
The second shift was from healthcare to health, meaning caregivers would not simply act in the healthcare process but in fact intervene in the prevention and pre-care process to enable better and healthier living conditions for their previous, current and future patients. This health continuum described how clinicians should not only focus on diagnosis and treatment but also get involved across the patient care spectrum, in healthier living, prevention and home care.
“This started from the idea that citizens are in a continuous loop. When citizens are treated and receive home care, they are treated as patients. Once they are fully recovered, they go back to being citizens. As citizens are either future or past patients, it is logical that healthcare practitioners are connected to both citizens and patients.”
The third shift was to go from quality to value, and to offer every patient the best possible value he or she could get. Quality meant that the delivered care was safe (that it did not harm patients), effective, (consistent with best professional knowledge), patient-centered and met the needs of the patients.
Prof. Verconck said health was a state of complete physical, mental and social well-being. Healthcare was thus only a minor component for the health of an individual. In 2010, the European Commission defined the primary goal of healthcare policy as that of maximising the health of the population within the limits of the available resources, and within an ethical framework built on ”equity and solidarity principles”. This goal encompassed three pillars of major importance – maximise health, with limited resources, in an ethical framework. Over the last decade the goal to maximise health had not changed, however the limitations and the framework surrounding this goal had changed significantly including the call for more social responsibility and sustainability, the fear of the impact of climate change and Covid 19,…
Achieving this original ambition in a sustainable manner required strong leadership and everything started with the vision from a patient focus. It was medical technology (MedTech) with medical devices ranging from preventive diagnostic in vitro test, to digital applications that drove this digital transformation towards a value-based, connected and finally to integrated care around a patient.
Covid 19 a game changer for healthcare transformation and the breakthrough of health technology
Prof. Verdonck said Covid-19 had changed the world. We were still all adapting our way of living (‘on line’ customer and retail service), our way of working, way of care provision and cure, by accelerating new ((bio)engineering and technology.
“‘Necessity is the mother of invention’ said Plato and so we feel nowadays the fourth industrial revolution: the acceleration towards a bio-revolution (biopharma, biomolecules, biosystems, biomachines, bioengineering, biocomputing). In healthcare we became open for a new generation of ‘health conscious’ consumers and ‘tech-fan’ healthcare providers.”
Prof. Verdonck said health technology (Health Tech), was defined according to the World health Organisation as ‘application of organised knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives.’
“In our opinion it can be classified in three categories – Biotech, Digital Health and MedTech.
- (Red) BioTech, is the use of living systems (cells, biomolecular processes) to develop technologies and products to help and heal people
- Digital Health means the use of information and communication technologies to help address the health problems and challenges faced by patients. The European Patient Forum defines it as health care practices supported by electronic processes & communication
- Medical technology including:
- Medical devices including surgical tools, implants, active devices and active implantable technology
- In-vitro diagnostics including self-test, bedside and laboratory equipment
- Embedded or stand-alone software
“Within health technology, the MedTech is subject to strict European quality and safety rules (EU Medical Device Regulation). However, its use often still depends on the experience of the healthcare provider, the quality of the hospital and the knowledge of the user.”
Towards a health data framework turning data into value
Prof. Verdonck said value, integration and connection were based on data. Without data that measured a patient’s outcomes and costs, the value to optimise the healthcare process could not be calculated. Without efficient data exchange, healthcare networks described above could not operate and healthcare staff would once again work on their own isolated islands, leading to redundant examinations and consultations.
“The healthcare of the future will generate massive volumes of data. Connected devices, healthcare workers and patients will create and use data lakes. Sensors will perform the data collection from health, activity, location, emotions, parameters, etc. They will be the well of the data lake.
“One should not only think of wearables or insideables that monitor parameters of the patient but also the external ambient sensors that measure humidity, temperature, weather, pollution, etc. Measuring the living environment of a patient is something that is already done with a technique called ambient intelligence. Ambient intelligence creates a digital environment that is aware of the individual’s presence and context, and is sensitive, adaptive, and responsive to their needs, habits, gestures and emotions.
“Combining these measurements with the patient-specific data allows for a more patient-specific approach. This data, used as currency in the network, can take many forms, ranging from personal to population or environmental data and will be transferred between a variety of interested parties.
“It is ‘data science’ that forms the important connection with the above ambition of a value based, connected and integrated care and the future of digital therapy as part of e-health, m-health and telemedicine. Nowadays, data is typically spread over different entities: central servers of hospitals, decentralised personal different communication protocols can establish a connectivity (data transmission) between all those different parties in this integrated and connected care network: Wi-Fi, Bluetooth, cellular (3G, 4G, 5G), LoRa, etc. Of course, merely collecting and transporting data will not be enough. This continuous flow of data collection will outgrow the storage capabilities of modern-day healthcare infrastructures, and the IoMT and decentralised healthcare will only increase further the demand for storage space.
“Physical examinations will be partly substituted by a flow of digital information. Such a huge volume of data could easily overwhelm healthcare workers, leading to a situation in which value and patient outcomes no longer improve. The amount of non-processed data might lead to a decrease in efficiency and poor use of time, and thus also to a worsening of patient outcomes.
“Therefore, next to collection, currency and transmission, intelligence needs to be introduced into the data framework. This intelligence, when done by computers is called artificial intelligence (AI) and can be a great asset to healthcare teams. AI is able to analyse data in order to provide insights that can inform the actions of healthcare staff, decision-makers or the patients themselves. Signals that would otherwise go unnoticed or reacted upon too late can now be detected by the AI to trigger alarms directly to the responsible party. The use of this artificial intelligence in healthcare can be put into three categories: knowledge-based decision support systems, data-driven clinical decision support systems and computer-aided diagnosis.
“Last but not least, an important aspect of data is security. With the new GDPR regulations of 2018, data protection has gained a tremendous importance over the last two years. This, in combination with a huge volume of generated data, leads to the “necessity of rethinking the concept of data protection as a whole.
“The possibility to use this data in a secured and effective way will lead to an increase of the future value of health care. So future value will be equal to innovation to the power of data. Hence, without data, innovation will not create any value or vice versa.”
Prof. Verdonck said the vison of the above transformation was based on an evolution towards value-based, integrated and connected care where data science (including big data, artificial intelligence and augmented and virtual reality) was the hinge between the patient centric approach and e-health, m-health, telemedicine towards digital diagnosis and therapy.
“Achieving the original ambition to maximise health, with limited resources, in an ethical framework in a sustainable manner requires patient focus. This means that healthcare is transformed, step by step to a value based, connect healthcare leading finally towards integrated care around an individual. It is medical technology (MedTech) that drives this digital transformation connecting data science with digital diagnosis & therapy, thanks to sensors, data and algorithms.”
