HIMSS Europe: EHDS, AI and the patient journey
Anticipating AI sandboxes, increased interoperability across Europe and the paradigm shift towards patient journeys in care delivery redesign.
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Rome was buzzing with digital health at the end of May as the HIMSS Europe conference took place at La Nuova Congress Center. Delegates from 80 countries and representatives of health ministries of 20 countries marked the event with discussions about the implementation of the European Health Data Space (EHDS), the EU AI Act, and more.
EHDS and the EU AI Act have been setting the framework of rules and hopes we want to see in Europe in future development of technology. The key aim of EHDS is to enable cross-border health. The discussions now resolve around the HOW and practical implementation of relevant health standards.
Different countries in Europe are at different levels of digitalization and giving patients access to their data. Countries such as Portugal, Slovenia, Croatia, Estonia, Poland and Hungary, enable patients to access national portals that contain their prescriptions, referrals, discharge letters, etc. In other countries such as Belgium and Spain, patients can access regional portals. In the Netherlands, Germany and Switzerland, individual healthcare providers offer their own patient portals. This means if a person visits multiple facilities, they must use different portals to access their health data.
Let’s start with data
European diversity can be great and inspiring if you’re on a backpacking trip across countries. But it becomes a nightmare when you try to harmonize expectations around health data standards and privacy on the European level.
While some consensus has been achieved, it’s time to be more ambitious, says Jordi Piera-Jiménez, Director of the Digital Health Strategy Office, Catalan Health Service.“To date, a lot of work has been done to define the European electronic health record exchange format and other standards. These promote I would say the exchange of PDFs translated into English language. This can be a starting point for the European health data space. But while talking about exchanging PDFs translated to English language can be a starting point, I believe that in the 21st century European citizens deserve more.”
He believes information systems of the future should be based on re-built foundations, and translation of medical language in technical language. This is what the openEHR specification, built and continuously improved by clinicians, aims to do: define clinical concepts to a very granular level, to make sure all the relevant information is captured in a structured format. FHIR messaging standard is the leading standard for data exchange, but doesn’t necessarily capture in data all the relevant clinical concepts.
Speaking of connectivity and digital transformation: HIMSS has several digital maturity models:
EMRAM - Electronic Medical Record Adoption Model,
AMAM - Adoption Model for Analytics Maturity,
INFRAM - Infrastructure Adoption Model,
C-COMM - Community Care Outcomes Maturity Model,
DIAM - Digital Imaging Adoption Model.
These models are used by healthcare institutions as guiding principles in digital transformation. Many participants shared their experience with reaching different levels of maturity. Cleveland Clinic London, for example, reache EMRAM Stage 6 (out of 7 stages). The hospital doesn’t use paper."This includes closed-loop medication management and connecting all devices, such as infusion pumps and vital signs monitors, to the EHR. This integration allows for seamless data transfer and minimizes the risk of errors from manual transcription or data entry. By reducing the need for manual data transcription, we enhance efficiency and patient safety. However, the connectivity between numerous devices introduces new requirements and requires new caution due to increased cybersecurity risks. When it comes to advice on how to best connect all the devices in the hospital for the seamsless data transfer and make sure staff knows how to navigate the tech-driven environment, Nana Odom, Director of Clinical Engineering at Cleveland Clinic London advises the following:
Always consider a standardized approach,
Reduce the number of interfaces and middlewares as much as possible,
Design should be collaborative - Ensure involvement of all stakeholders (Clinical, Technical, Infrastructure, other relevant stakeholders) from the start - design, testing phase,
Provide support as the technology is implemented,
Support technology adoption effectively,
Clinical engineers should be part of the initial process of requirements gathering and design.
Can’t AI do it?
When we talk about automation with AI, it’s worth noting, that data structuring and coding still requires a lot of manual work and double-checking if for example the right codes were assigned to the right clinical concepts. Think about it in the context of automatically generated subtitles. They can easily be applied to videos, but you still need to do your part in language checking and corrections, if you want the subtitles to be accurate, especially with names and abbreviations. Expecting generative AI to do all the work in structuring free text, is a popular topic, but not a solution. “Generative AI can be a way to to ease the task of conversion. It’s an effort that it's very costly. It requires a lot of human power. But again I think that we should put efforts in rebuilding the foundations of our information structure,” says Jordi Piera Jimenez.
With AI, let’s start with operations
Most current applications in healthcare are centered around optimization of non-clinical workflows with AI in healthcare.
The EU AI Act classifies AI systems into four different risk levels: unacceptable risk, high risk, limited risk, and minimal risk. Each class has different regulation and requirements for organizations developing or using AI systems. As named by Rachel Dunscombe - CEO of openEHR International and former the UK AI council member leading on AI in digital health and care, the key discussions among the experts and regulators at the moment are:
the design of national sandboxes for testing data models,
the necessity for corporate indemnity insurance to protect clinicians who currently take individual risks when using AI,
an ongoing debate about the pace of policy development: when “the next ChatGPT revolution comes" how will policy-making respond faster?
How is healthcare delivery transforming and what it means for digitalization
WHO estimates a shortage of 10 million clinicians by 2030. With healthcare workforce shortages, aging population, increases in chronic disease incidence, it’s clear that care delivery needs to be thoroughly redesigned to obtain healthcare sustainability.
Value-based care is the prime word in the shift towards optimized care and financial sustainability of healthcare systems.
Prevention doesn’t mean just healthy living and well-being, but more tangible for healthcare systems - the focus on secondary prevention and keeping an eye on existing patients at risk of costly complications. How does this transfer to digital transformation? Svava María Atladóttir is the Executive Director of Development at the Landspítali National University Hospital Iceland which is moving to a completely new hospital by 2030. Taking into account the trends toward at-home care, virtual wards and hospital at home, she sees new care delivery planning includes focus around patient journeys and multi-discriplinary work to ease transitions for patients from one setting to another. “Building the physical building is the easy part. Even choosing the technology is somewhat easy. What is challenges is ensuring that we are changing the processes, how we provide care and that we are really communicating with our patients and with the whole community about the changing approaches to care-provision,” says Svava María Atladóttir.
Navigating the healthcare systems is complex. Through their own experience of patient and caregiver, Luke and Monika Evason pointed out the need to improve transit between pediatric and adult care, because at the age of 18, patients are suddenly on their own, while much of the care was taken care for them just a week before their birthday. I like to compare this transit as falling of the cliff for chronic patients: in pediatrics care is more risk-averse and connections with clinicians closer. In adult care you fall into a much larger pool of existing older patients, which may mean longer waiting times, less contact with clinicians and more self-management of care. Less convient and less safe. Not what we want in 10 years time.
Keep an eye on
Several interesting EU-supported projects were presented at HIMSS:
EDIHTA - harmonizing healthcare technology assessment for digital health (ends 2028).
FLUTE - improving prostate cancer discovery through AI and cross-border data utilization.
Gravitate Health - improving access to medication information in one’s native language and improving adherence to medication.
Label2Enable - adding “food labels” to digital health solutions.
AI4Health.Cro - non-profit public-private consortium of experts in the field of AI, healthcare and startups that see artificial intelligence (AI) as the key to advancing healthcare and medicine.
Warifa - personalized recommendations for managing NCDs-related chronic conditions such as cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases.
Also, tune in to the podcast episode with full statements of the speakers above!
These include:
Jordi Piera-Jiménez, Director of the Digital Health Strategy Office, Catalan Health Service, who shared his view and experience on data management and data standards,
Rachel Dunscombe, CEO of openEHR foundation and former the UK AI council member leading on AI in digital health and care, who presented the discussions on AI,
Svava María Atladóttir, Executive Director of Development, Landspítali National University Hospital Iceland, about what it takes to build a new hospital which is what she needs to do by 2030,
Nana Odom, Director of Clinical Engineering at the Cleveland Clinic in London, who shared her advice for clinical engineers,
Diana van Stijn, Chief Medical Officer and co-founder of Lapsi Health and resident of Pediatrics at UMC Amsterdam, who talked about the doctor’s perspective on the use of tech and upskilling,
Luke Evason, Consultant and Monica Kleiijn Evason, Leadership Coach and Book Author, who both talked about the patient perspective on gaps in healthcare, particulary at the transfer of children going from pediatric to adult care.
What’s up next
Moving from the focus on policy and digital health regulation, with 400 speakers and over 3500 attendees, HLTH Europe, focused on healthcare innovation, will take place in Amsterdam between 17-20 June 2024.
If you’re still thinking of going, use the CODE HE24_TJASAZ to get a 150 EUR discount on your ticket!
