EDITORIAL: European AMR Patient Group Scales up Education and Outreach on Antimicrobial Resistance

Patient safety is an essential metric when it comes to building resilient public healthcare systems both at the European and global level. It is also indispensable in the provision of health care in all settings including hospitals and long-term care facilities. The lack of proper adherence to patient safety manuals undermines public confidence and trust in health systems, increases mortality and morbidity due to unsafe care, and increases the burden on the public purse in terms of healthcare costs. Unfortunately, patient harm resulting from safety lapses, though avoidable in most cases, is a growing canker that threatens global public health. Safety lapses lead to healthcare-associated infections (HAIs), which result in prolonged hospital stays, long-term disability and high costs for patients, family and healthcare providers.

Health First Europe and the members of the European Patient Group on Antimicrobial Resistance (AMR Patient Group) are committed to raising awareness about the real-world impact of antimicrobial resistance and healthcare-associated infections (HAIs) that have become a bane for individual and public health. The HFE-led initiative’s overarching objectives are to help reduce the inappropriate use of existing antibiotics, promote antimicrobial stewardship and infection prevention and control measures across Europe, and develop novel antibiotics where needed. The AMR Patient Group empowers patients across Europe with the necessary knowledge about antimicrobial resistance so that everyone understands when it is appropriate to take antibiotics and how to take them responsibly by addressing the gap in awareness at the patient level about the danger of antibiotic misuse and the lack of effective infection prevention measures.

The European Centre for Disease Control (ECDC) estimates that a total of 8.9 million HAIs occur each year in European hospitals and long-term care facilities combined, with more than half of certain HAIs considered preventable.[1] HAIs represent a common pathway that often leads to sepsis, which in turn contributes to approximately 37,000 deaths directly resulting from HAIs. This is devasting for patients and caregivers alike.

HAI prevention and control is a core element in tackling AMR. HAIs are often caused by resistant bacteria, but the occurrence of an infection in the first place may also increase the risk of developing resistant strains. Even though antibiotics have played a central role in the treatment of human infections, the lack of awareness on the general health risk associated with the excessive and inappropriate use of antibiotics menaces public health and patient safety. Antimicrobial resistance alone is responsible for approximately 33,000 deaths per year in the EU and is estimated to cost the EU €1.5 billion annually in healthcare costs and productivity losses. These figures and the general trend paint a bleak picture of the public health system. The situation is dire.

AMR will likely increase through the heavy use of antibiotics in COVID-19 patient treatment. Hence, the importance of diagnosing and implementing digital technologies, encouraging behavioural compliance in hand hygiene, checklists and safety protocols, and promoting the optimal prescription and sustainable use of antibiotics. As a result, there should be stronger preparedness for our healthcare systems and timely responses to this public health challenge.

Going forward we face an urgent need to arm ourselves with effective tools to improve patient safety in all healthcare settings. “In order to effectively fight healthcare-associated infections and antimicrobial resistance, there is a need to not just raise awareness and promote education, but, rather, a new paradigm shift – one that is patient-centered. The genesis of the European Patient Group on Antimicrobial Resistance is in line with this patient-centered paradigm shift as it includes many active patient groups coming from all over Europe,” says Ms Laura Cigolot, coordinator of the AMR Patient Group.

On 7 April 2021, the group launched a Declaration on AMR, calling on European and national authorities to commit to a full range of interventions in the field of education, prevention and investment. Currently, the AMR Patient Group is undertaking a major pan-European survey to assess awareness and knowledge of antimicrobial resistance and HAIs among the general public in five European countries: France, Germany, Italy, Spain and the UK. The findings of this questionnaire will be collected in five national reports which will be used to identify best practices and address current gaps in the implementation of national action plans on AMR.

It is now more urgent than ever to step up actions to prevent HAIs and the related development of antimicrobial resistance throughout the patient journey.

[1] ECDC, 2018. “Infographic: Healthcare-associated infections – a threat to patient safety in Europe”.

EDITORIAL: We need to talk about surgical site infections in Europe

Surgical site infections are prevalent and damaging in Europe; a multilevel and holistic strategy is needed now

By István Ujhelyi MEP (S&D/Hungary) on Brussels Morning 

Brussels (Brussels Morning) It has been a turbulent year for millions of Europeans with COVID-19 making health a priority not just politically, but in everyday life as well. Meanwhile, other health issues are quietly impacting the lives of Europeans and it’s time to address them head-on.

As someone who is deeply committed to improving the health quality of care of EU citizens, and as the son of two doctors, I was deeply appalled to know the damage that something as preventable as surgical site infections (SSIs) has been causing throughout Europe. Mental and physical suffering and tens of thousands of deaths have ensued despite current efforts by European hospitals to thwart SSIs. According to the European Centre for Disease Prevention and Control (ECDC), 800,000 Europeans experience SSIs every year, making up around 20% of all healthcare-associated infections (HAIs). This frighteningly high figure could be halved, solely through successful implementation of international guidelines by practitioners, like other HAIs.

Drug-resistant

SSIs are often caused when patients become resistant to antibodies after undergoing surgery: a phenomenon called antimicrobial resistance (AMR). Such resistance is what makes patients who are affected by drug-resistant infections more likely to develop complications, leading to their demise. Even if patients survive their infections, the damage that they create will unfortunately lead to prolonged and unnecessary patient hospital stays, at the very least. Prolonged bed occupancy not only overburdens our already stretched healthcare systems but also the patients and their families.

We all need to play our role to protect and promote patient safety while decreasing the rate and burden of infections, especially in relation to AMR bacteria. That is why investing in a cohesive and strong European health system throughout the EU with good quality and harmonised health standards across all member states is so important.

To prevent, better manage and combat SSIs and stop the resulting traumatic suffering and death they cause, we need a multilevel and holistic strategy.

Standardised approach

Firstly, clear, coordinated, and standardised guidelines within a broader European legislative framework on infection control and prevention are needed to tackle this issue. Consensus should be built around evidence-based guidelines, such as those devised by WHO, and clear protocols should be defined.

The European Commission could facilitate the creation of an expert forum to adopt these guidelines, supporting their implementation around Europe, while avoiding  continuing disparities in our healthcare systems.

Including recommendations on HAI reduction in the European Semester could also be beneficial, to motivate national progress on their control and prevention. To those ends, the creation of quality standardised instructions and safety checklists could help implement guidelines and simultaneously reinforce accepted safety practices whilst promoting better communications among healthcare workers.

Moreover, developing harmonised educational and training standards on infection prevention and control for healthcare professionals as part of their national healthcare professional curricula from undergraduate level could also be an attractive policy action. Such standards could apply the current learning tools created by the WHO or the ECDC, for instance.

The increasing prevelance of SSIs could be dealt with swiftly if we employ a multilevel and holistic strategy and, therefore, significantly impacting the lives of thousands of Europeans.

From creating a European Framework to developing a European curriculum for infection prevention and control, we can start to claw back the damage caused by SSIs and create long-lasting improvements to the safety and care of European citizens.

NEWS: Read HFE and Navarre (Spain) joint article on patient safety

Patient Safety

In the frame of the campaign for the Declaration for Patient Safety, Health First Europe collaborated with the Spanish region of Navarre to publish an article on the best practices for safety and quality of care at the regional level.

Navarre, one of the north regions of Spain, is strongly committed to promote patient safety. Its 2014-2020 health plan, establishes a strategy for patient safety in health centres, following the recommendations, based on evidence from the Spanish Ministry of Health.

You may find below the article in English and Spanish.

EDITORIAL: The challenges of digital health approaches for the 2020-2030 European health professionals

By Guglielmo M. Trovato MD, the European Medical Association (EMA)

The challenge that we are facing for Health Care Workforce in the Digital Age requires the explicit definition of few concepts. Most or all concepts must be shared and agreed before discussing of any clinical revolution from digital health approaches. This theme, encompassing predictive, preventive and personalized medicine, is mostly relevant for our need of innovation and of participatory medicine: for this reason the topic is again discussed in the current article.

Digital literacy is rapidly increasing worldwide, and also among the health human resources galaxy. It refers to an individual’s ability to find, evaluate, and compose clear information through writing and other mediums on various digital platforms. Digital literacy is evaluated by an individual’s grammar, composition, typing skills and ability to produce writings, images, audio and designs using technology. While digital literacy initially focused on digital skills and stand-alone computers, the advent of the Internet and use of social media, has caused that most of its focus to shift to mobile devices. Moreover, self-instructional learning and market-driven information are overwhelming, and web-literacy, i.e. the skills of reading, writing and participating on the web, contributing to both content and activity is becoming an all-embracing feature of the digital revolution.

Digital health literacy uses the same operational definition, but in the context of technology. Technology solutions have the potential to both promote health literacy or be a barrier. To be effective, health technology solutions should go beyond building literacy and numeracy skills to functional and critical skills, such as navigating the healthcare system, communication with healthcare providers, and shared decision making. According to P. Dunn et al. (2019) digital health literacy, demands particular skills complementary to general and health literacy both in health professionals and in general population.

future proof digital knowledge and skills.

Also in medicine, digital competences should be appropriately increased and warranted, avoiding unrealistic and over-ambitious goals but with the aim of training appropriately future-proof health care workforce. In general, the term “future-proof” refers to the ability of something to continue to be of value into the distant future— with some guarantee that the item does not become obsolete. The concept of future-proofing is the process of anticipating the future and developing methods of minimizing the effects of shocks and stresses of future events, tasks and development.

Health workforce includes medical doctors, nurses but also health professionals that support the health services, such as hospital managers, ambulance drivers etc. No skilled health worker might be able to deliver services effectively without adequate facilities, equipment and consumables such as basic or advanced devices and a reliable supply of medicines and technologies, backed by adequate funding, strong health plans and evidence-based policies. It is not a simple task the choice of the knowledge and skills that health care workers reasonably need to maximise the benefits of digital technologies, already in use or forthcoming.

Accordingly, health system budgets need to balance several vital demands – human resources, physical capital and consumables along with the novel lines of continuous and vocational education within a meaningful strategy.

The goal of reaching an universal health care coverage requires knowledgeable, skilled and motivated health workforce. WHO estimates a projected shortfall of 18 million health workers by 2030, mostly in low- and lower-middle income countries. However, Countries at all levels of socioeconomic development face, to varying degrees, difficulties in the education, employment, deployment, retention, and performance of their workforce.

Digital revolution refers mainly to the shift from mechanical and analogue electronic technology to digital electronics which began anywhere 60-70 years ago with the adoption and proliferation of digital computers and digital record. Digital computing and communication technology are paving the road of the mass production and widespread use of digital logic and devices. Greater interconnectedness, easier communication among individuals, groups and population allowed that comprehensive information may be more freely delivered everywhere and to everybody with limited political or authoritarian constraints. Nonetheless, information overload, invasions of “internet predators”, the strategies based on faked news and disinformation, several forms of social isolation, and last but not least, media saturation on specific topic must be faced as the most ominous facets of this process. Overall, digital technologies have significantly increased productivity and performance of industry, organizations and, in general, businesses. Menaces to privacy are many, including mass surveillance, which is of great concern for civil and human rights issues. Reliability of data is an urgent issue in many field because information could easily be replicated, but not easily verified, with consequent cascade effects with economic, social and political implications.

Artificial intelligence (AI) development is the first of the goals of the digital revolution. It refers to the capability of a machine to imitate human intelligence, reacting, working and even ideating like human or non-human living beings.

Machine learning (ML) refers to computer systems using algorithms and statistical models for tasks without using explicit instructions, relying on patterns and inference instead.

The main components of digital revolution.

Deep learning is one arm of machine learning methodology which can be supervised, semi-supervised or unsupervised. Its architectures are based on deep neural networks, deep belief networks, recurrent neural networks and convolutional neural networks. All, and others, have been applied to fields including computer vision, speech recognition, natural language processing, audio recognition, social network filtering, machine translation, bioinformatics, drug design, medical image analysis, material inspection and board game programs, where they are claimed increasingly of results comparable to and in some cases superior to those reached by human experts.

Digital health refers to digital technologies, which already widely use deep learning, exerting direct or indirect impact on health, healthcare, living, and society. Digital health focuses to increase the efficiency of healthcare delivery and organization, eventually making medicine more personalized and precise.

The questions chosen by Health First Europe are very pertinent to the current debate and put unmet needs of the population, along the unmet needs of health professionals, namely medical doctors, at the center of this process of development, addressing to changes and challenges related to the digital revolution in health systems:

Changes and challenges related to the digital revolution in health systems.

1.        What structural changes in health care settings can support health workers in leading the digital revolution?

2.        What skills do health care workers need to maximize the benefits of digital technologies?

3.        How EU policies can support health care workers in scaling up innovation?

 There are few adjunctive questions, taking into account that relationship among several factors and stakeholders are complex. and among them:

Relationship among several factors and stakeholders are complex.

 4.        Is it demonstrated, or likely, that digital health changes may improve health care quality and effectiveness, sustainability and affordability also in limited resources subsets?

5.        Do digital health changes may be in conflict with marketing information strategies in the wider audiences?

6.        Is this process aligned with the increasing request of more “humanities” in medicine and the approaches addressing to the global ecosystem health?

 Digital Scribe and electronic clinical records. One particularly relevant topic in rapid advancement regards the development of “digital scribe”. According to E. Coiera et al (2019), nothing appears to cause more frustration for many clinicians than the electronic health record (EHR). Current generation electronic health records suffer a number of problems that make them inefficient and associated with poor clinical satisfaction. Digital scribes or intelligent documentation support systems, take advantage of advances in speech recognition, natural language processing and artificial intelligence, to automate the clinical documentation task currently conducted by humans. Whilst in their infancy, digital scribes are likely to evolve through three broad stages. Human led systems task clinicians with creating documentation, but provide tools to make the task simpler and more effective, for example with dictation support, semantic checking and templates. Mixed-initiative systems are delegated part of the documentation task, converting the conversations in a clinical encounter into summaries suitable for the electronic record. Computer-led systems are delegated full control of documentation and only request human interaction when exceptions are encountered. Intelligent clinical environments permit such augmented clinical encounters to occur in a fully digitised space where the environment becomes the computer. Data from clinical instruments can be automatically transmitted, interpreted using AI and entered directly into the record. Digital scribes raise many issues for clinical practice, including new patient safety risks. Automation bias may see clinicians automatically accept scribe documents without checking. The electronic record also shifts from a human created summary of events to potentially a full audio, video and sensor record of the clinical encounter. Digital scribes promisingly offer a gateway into the clinical workflow for more advanced support for diagnostic, prognostic and therapeutic tasks.

DIGITAL KNOWLEDGE AND SKILLS should integrate and overlap practical skills and clinical reasoning and actions. They must not counteract any of them in the naïve or ambitious aims and claims of being advancements or substitutes of the actual contact, not only relationship, between patients and health professionals. This is a relevant concern of patients and medical doctors.

The wider use of digital technologies is contributing to the efficiency of healthcare delivery also in limited resources subsets. Actually, affordable and reliable information and communication are a valuable help for addressing the medical problems and challenges faced by people in health and disease, in public health and in the base of primary care, i.e. family and community medicine.

Hardware and software solutions and services, including telemedicine, web-based analysis, email, mobile phones and applications, text messages, wearable devices, and clinic or remote monitoring sensors concur to the development of interconnected health systems.

 The use of computational technologies, smart devices, computational analysis techniques, and communication media to aid healthcare professionals and their clients manage illnesses and health risks, as well as promote health and wellbeing are facets of this multi-disciplinary scenario. The involvement and commitment of different stakeholders, including clinicians, researchers and scientists, engineers, industry and policy makers addressing public health, health economics and data management choices are the vital components of this process. Also gender and racial inequalities, including domestic violence, are topics under active development by digital health strategies.

EUROPEAN HEALTH CARE NEEDS ALSO A GREATER SUSTAINABLE CONTRIBUTION BY PRECISION MEDICINE TOOLS.

Medical practice and any aspect of health care is the goal of digital revolution in health systems, but the counterpart is the possible and useless effects of excessive non-clinical expertise.

Precision Medicine, almost a synonymous of personalized medicine, is an approach in active development for disease treatment and prevention. It takes into account individual variability in genes, environment, and lifestyle for each person to predict more accurately which diagnostic workup, treatment and prevention strategies will be more suitable for a disease, a complain and for which groups of people. Its basis are also clinical medicine, including health psychology, physical examination and epidemiology, which are activities suitable of measure and inclusion in numeric data-bases. Bioinformatics and computational biology are key preliminary components of precision medicine and, comprehensively, of digital health. Medical best practice and improvement of any aspect of health care is the goal of digital revolution in health systems,  but the counterpart is a possible useless and effects of pervasive non-clinical expertise.

Bioinformatics is an hybrid science that links biological data with techniques for information storage, distribution, and analysis to support multiple areas of scientific research, including biomedicine. It is fed by high-throughput data-generating experiments, including genomic sequence determinations and measurements of gene expression patterns. Database projects curate and annotate the data and then distribute them via the World Wide Web. Mining these data leads to scientific discoveries and to the identification of new clinical applications. It has since several years also practical applications, well established in genetics and rare disease, and even more in oncology.

Computational Biology, with wide areas of overlap with bioinformatics, is the science of using biological data to develop algorithms or models to understand biological systems and also their relationships with health and disease.

The BioSProject is an ErasmusPlus action focused to widening expertise and knowledge in Bioinformatics and Computational biology, by a forthcoming e-learning/mooc course. This will be a valuable open access contribution for improving quality of skills and performances of European Health Professionals and Medical Doctors, enhancing interest and active participation of health professionals to innovative experience and practice.

Knowledge in Bioinformatics is a basic mathematical template for medical reasoning.

TARGET

No health system change change is realistically planned and developed without dual educational interventions addressed to undergraduate and post-graduate students of medical schools and to already active health professional. All will benefit of well targeted continuous medical education actions. In this sense, careful on-site analysis of actual skills and of unmet needs of health workers are the preliminary steps. Accordingly, the achievement of basic digital and web-based social media competences is only a first step. Knowledge in Bioinformatics is a basic mathematical template for medical reasoning.

Actually, the different profiles of health professionals correspond to different needs and lines of access to big-data banks and tools: genetics, oncology, infectious disease, cardiovascular disease, behavioral and lifestyle approaches, robotic surgery are different field which must be addressed appropriately and also by attractive dissemination campaigns.

G. Trovato EMA

Guglielmo Trovato 

EMA– European Medical Association

REFERENCES

Trovato FM, Catalano D, Musumeci G, Trovato GM. 4Ps medicine of the fatty liver: the research model of predictive, preventive, personalized and participatory medicine-recommendations for facing obesity, fatty liver and fibrosis epidemics. EPMA J. 2014 Dec 7;5(1):21. doi: 10.1186/1878-5085-5-21. eCollection 2014. Review. PubMed PMID: 25937854.

Trovato GM. Sustainable medical research by effective and comprehensive medical skills: overcoming the frontiers by predictive, preventive and personalized medicine. EPMA J. 2014 Aug 27;5(1):14. doi: 10.1186/1878-5085-5-14. eCollection 2014. PubMed PMID: 25250099.

Trovato GM. Behavior, nutrition and lifestyle in a comprehensive health and disease paradigm: skills and knowledge for a predictive, preventive and personalized medicine. EPMA J. 2012 Mar 22;3(1):8. doi: 10.1007/s13167-012-0141-2. PubMed PMID: 22738244.

Dunn P, Hazzard E. Technology approaches to digital health literacy. Int J Cardiol. 2019 Oct 15;293:294-296. doi: 10.1016/j.ijcard.2019.06.039.

Mathews SC, McShea MJ, Hanley CL, Ravitz A, Labrique AB, Cohen AB. Digital health: a path to validation. NPJ Digit Med. 2019 May 13;2:38. doi: 10.1038/s41746-019-0111-3.

WHO guideline Recommendations on Digital Interventions for Health System Strengthening. Geneva: World Health Organization; 2019.

Divakar U, Nazeha N, Posadzki P, Jarbrink K, Bajpai R, Ho AHY, Campbell J, Feder G, Car J. Digital Education of Health Professionals on the Management of Domestic Violence: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res. 2019 May 23;21(5):e13868. doi: 10.2196/13868.

De Angelis G, Wells GA, Davies B, King J, Shallwani SM, McEwan J, Cavallo S, Brosseau L. The use of social media among health professionals to facilitate chronic disease self-management with their patients: A systematic review. Digit Health. 2018 May 3;4:2055207618771416. doi: 10.1177/2055207618771416.

Howarth A, Quesada J, Silva J, Judycki S, Mills PR. The impact of digital health interventions on health-related outcomes in the workplace: A systematic review. Digit Health. 2018 May 10;4:2055207618770861. doi: 10.1177/2055207618770861.

Sharma A, Harrington RA, McClellan MB, Turakhia MP, Eapen ZJ, Steinhubl S, Mault JR, Majmudar MD, Roessig L, Chandross KJ, Green EM, Patel B, Hamer A, Olgin J, Rumsfeld JS, Roe MT, Peterson ED. Using Digital Health Technology to Better Generate Evidence and Deliver Evidence-Based Care. J Am Coll Cardiol. 2018 Jun 12;71(23):2680-2690. doi: 10.1016/j.jacc.2018.03.523.

Mazzanti M, Shirka E, Gjergo H, Hasimi E. Imaging, Health Record, and Artificial Intelligence: Hype or Hope? Curr Cardiol Rep. 2018 May 10;20(6):48. doi: 10.1007/s11886-018-0990-y.

Peeling RW. Diagnostics in a digital age: an opportunity to strengthen health systems and improve health outcomes. Int Health. 2015 Nov;7(6):384-9. doi: 10.1093/inthealth/ihv062.

Coughlin SS, Stewart JL, Young L, Heboyan V, De Leo G. Health literacy and patient web portals. Int J Med Inform. 2018 May;113:43-48. doi: 10.1016/j.ijmedinf.2018.02.009.

Vayena E, Haeusermann T, Adjekum A, Blasimme A. Digital health: meeting the ethical and policy challenges. Swiss Med Wkly. 2018 Jan 16;148:w14571. doi: 10.4414/smw.2018.14571.

Cardon LR, Harris T. Precision medicine, genomics and drug discovery. Hum Mol Genet. 2016 Oct 1;25(R2):R166-R172.

Shinbane JS, Saxon LA. Digital monitoring and care: Virtual medicine. Trends Cardiovasc Med. 2016 Nov;26(8):722-730. doi: 10.1016/j.tcm.2016.05.007.

Murray E, Hekler EB, Andersson G, Collins LM, Doherty A, Hollis C, Rivera DE, West R, Wyatt JC. Evaluating Digital Health Interventions: Key Questions and Approaches. Am J Prev Med. 2016 Nov;51(5):843-851. doi:10.1016/j.amepre.2016.06.008.

Alami H, Gagnon MP, Fortin JP. Digital health and the challenge of health systems transformation. Mhealth. 2017 Aug 8;3:31. doi:10.21037/mhealth.2017.07.02.

Reynolds CJ. Better value digital health: the medium, the market and the role of openness. Clin Med (Lond). 2013 Aug;13(4):336-9. doi:10.7861/clinmedicine.13-4-336.

Hodson R. Digital health. Nature. 2019 Sep;573(7775):S97. doi:10.1038/d41586-019-02869-x.

Makin S. The emerging world of digital therapeutics. Nature. 2019 Sep;573(7775):S106-S109. doi: 10.1038/d41586-019-02873-1.

Savage N. Digital assistants aid disease diagnosis. Nature. 2019 Sep;573(7775):S98-S99. doi: 10.1038/d41586-019-02870-4.

The Lancet Psychiatry. Digital health: the good, the bad, and the abandoned. Lancet Psychiatry. 2019 Apr;6(4):273. doi: 10.1016/S2215-0366(19)30102-6.

McNeil CM, Harnett PR. Our Faustian pact with the digital world. Lancet Oncol.2017 Feb;18(2):171-172. doi: 10.1016/S1470-2045(17)30005-0.

Coiera E, Kocaballi B, Halamka J, Laranjo L. The digital scribe. NPJ Digit Med. 2018 Oct 16;1:58. doi: 10.1038/s41746-018-0066-9. eCollection 2018. Review.

Smith B, Magnani JW. New technologies, new disparities: The intersection of electronic health and digital health literacy. Int J Cardiol. 2019 Oct 1;292:280-282. doi: 10.1016/j.ijcard.2019.05.066.

Dunn P, Hazzard E. Technology approaches to digital health literacy. Int J Cardiol. 2019 Oct 15;293:294-296. doi: 10.1016/j.ijcard.2019.06.039.

The Author: Guglielmo Trovato, MD, Professor of Internal Medicine at the School of Medicine, the University of Catania, Italy, is the EMA Director for MEDIA, e-learning and Telemedicine.

Acknowledgments and disclaimer. This article is the preliminary draft of the contribution to the forthcoming meeting “A Health Care Workforce for the Digital Age” to be held the 5th  November 2019 in the European Parliament (Brussels, room ASP 5G 305) from 12:00 to 14:00. The article is also an educational tool of BioS Project, an Erasmus Plus action https://bios-project.eu/site/  addressed to a Multilanguage e-learning course in Bioinformatics and computational biology, disseminated also through https://twitter.com/BiosProject1?lang=en  and https://www.facebook.com/383190028923085/posts/550894582152628?sfns=mo The Project is in active development with multiple Partners, including EMA https://emanet.org/ . The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflect the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

EDITORIAL: Sepsis, educational and best practice frontiers

Sepsis: Beyond the boundaries of fatality, enhancing clinical skills and precision medicine

Sepsis is a clinical syndrome with a distinctive response of the body’s defenses to life-threatening infections. This may result in organ dysfunction or failure (severe sepsis). Sepsis is strongly related with all the body organs or systemic diseases and to the quality of the best-practice in use, particularly critical  in surgical or  intervention techniques. In this view, apart the clinical risk analysis and management of the entire process of care, the techniques used, and the personal skills of the health professionals, with the quality of the equipment supply, the actual factors that may  be easily unseen. The quest for bio-markers consistent with the unmet needs of medical doctors and of their patient and the efforts for overcoming bacterial antibiotic resistances are currently the main efforts of the medical research.

Research and innovation should take advantage from greater knowledge and skills in bioinformatics. The European Medical Association, a partner of HFE, is actively involved in the development and dissemination of the Erasmus Plus BioS Project, aimed at the increase of competence of European health professionals in bioinformatics and related fields. The caveats related to in-silico approaches must be flagged: algorithms may equally warrant scientific innovations or hide the lack of it; a patient is more than a set of covariates.

Recommendations. Epidemiology and prevention includes all the actions suitable for an adequate hygiene and immunization of all populations and for safer procedural pathways during any hospital stay. The most unresolved critical points in sepsis are early and timely diagnosis; both currently impaired by low degrees of suspicion for the possibility of emerging sepsis, by the shortage of use of the simplest microbiological testing but, equally or more, by the insufficient diffusion of non-invasive imaging skills suitable to detect and monitor the emerging sites and sources of infection. In primary care, in emergency facilities, in hospital wards and in intensive care units the inclusion of appropriate knowledge, skills, expertise and imaging equipment must be extended as much as possible. The very low cost of Ultrasound machines makes this investment affordable even in limited-resources context. The counterpart of this effective development is the need of providing high quality and lasting educational support in diagnostic and intervention ultrasound procedures, including echocardiography.

A realistic perception of disease, for enhancing resilience of patients and health professionals,  is the basis for a strong agreement and alliance of doctors and patients against diseases, which have many concealed effects. Support of patients with such severe diseases should not be only “consolatory” for accepting “fatality”, because such interventions may hidden the real needs and the quest for most appropriate potentially available expertise.

G. Trovato EMA

Guglielmo Trovato 
Professor
EMA– European Medical Association

PUBLICATION: Green is the new Black: embracing sustainable health

Green is the new Black
Embracing sustainable health

Environmental actions to tackle climate change are rightfully gaining space in the EU and national policy agenda. We are exceeding the Earth’s capacity, reaching the limits of growth on a finite planet.

Looking at our economy, it is clear to me that healthcare is part of the problem and must become part of the solution. As the third largest employer in the world, health care has the potential to make a significant impact on European sustainability strategies, maintaining quality of care and safety as a priority.

Reducing hospital admissions and waste is not only critical for human health, but also for environmental and financial sustainability. Waste management initiatives offer great opportunities to reduce both environmental footprints and waste disposal expenses while improving the supply chain.

I believe we can achieve significant cost savings – as high as 40-70 percent of waste disposal outlays, representing €3.5-6 billion in savings for the health industry. In addition, I see a major role for health care settings in reducing environmental impact by using their resources more efficiently, designing ‘greener’ buildings, and fostering primary care.

Know your waste stream

The first step to improving a facility’s waste management is to understand its overall waste stream. Non-regulated waste, which makes up around 85% of a hospital’s total waste stream, is no different from the waste generated by a hotel, where up to 60% is either recyclable or compostable.

Regulated medical waste makes up about 5-15% while hazardous chemical waste makes up a smaller percentage (less than 5%) of a health care organization’s waste by total volume. Hence, I believe it is important to embrace a recycling culture inside hospitals and start reducing the amount of environment damaging products such as plastic. For instance, a small initiative is to replace plastic bottles with glass ones, and to offer other types of material at hospital canteens.

Cafeterias in hospitals serve hundreds of people per day, and the source of their food can have a dramatic effect on a hospital’s environmental impact. By serving locally grown fresh produce, hospitals can minimise the energy used to ship and refrigerate fruits and vegetables. Hospitals can also work with local composting companies to remove food waste that can be used as fertilizer in sustainable farming.

Greener hospitals

I know that reducing energy use is particularly tricky for hospitals, but I assure you it is not impossible. For instance, upgrading the light bulbs and replacing them with low consumption bulbs will save money and reduce the negative impact on natural resources.

Hospitals should work with vendors to ensure that the products the hospital purchases are as environmentally friendly as possible, from medical supplies to printer paper.

Making the EU a global leader in greener health

We still have a long way to go in order to achieve environmentally friendly hospital and health centres. However, good collaboration amongst EU systems and a common vision for future actions can only help.

For the EU institutions, environment and health are two important policy areas. In line with its values, the EU seeks to promote the wellbeing, security and interests of the citizens.

Since the Treaty of Amsterdam, sustainable development has been at the heart of the European project, influencing EU policies and legislation, for example, through the EU Sustainable Development Strategy and EU role in shaping to United Nation 2030 Agenda.

Sustainability shall continue to inspire the Commission’s political decision-making and guide the development of the post-EU2020 growth strategy – I am convinced health care must be part of the picture.

Pr. Damien Gruson

EDITORIAL: Green is the new Black: embracing sustainable health

Green is the new Black
Embracing sustainable health

Environmental actions to tackle climate change are rightfully gaining space in the EU and national policy agenda. We are exceeding the Earth’s capacity, reaching the limits of growth on a finite planet.

Looking at our economy, it is clear to me that healthcare is part of the problem and must become part of the solution. As the third largest employer in the world, health care has the potential to make a significant impact on European sustainability strategies, maintaining quality of care and safety as a priority.

Reducing hospital admissions and waste is not only critical for human health, but also for environmental and financial sustainability. Waste management initiatives offer great opportunities to reduce both environmental footprints and waste disposal expenses while improving the supply chain.

I believe we can achieve significant cost savings – as high as 40-70 percent of waste disposal outlays, representing €3.5-6 billion in savings for the health industry. In addition, I see a major role for health care settings in reducing environmental impact by using their resources more efficiently, designing ‘greener’ buildings, and fostering primary care.

Know your waste stream

The first step to improving a facility’s waste management is to understand its overall waste stream. Non-regulated waste, which makes up around 85% of a hospital’s total waste stream, is no different from the waste generated by a hotel, where up to 60% is either recyclable or compostable.

Regulated medical waste makes up about 5-15% while hazardous chemical waste makes up a smaller percentage (less than 5%) of a health care organization’s waste by total volume. Hence, I believe it is important to embrace a recycling culture inside hospitals and start reducing the amount of environment damaging products such as plastic. For instance, a small initiative is to replace plastic bottles with glass ones, and to offer other types of material at hospital canteens.

Cafeterias in hospitals serve hundreds of people per day, and the source of their food can have a dramatic effect on a hospital’s environmental impact. By serving locally grown fresh produce, hospitals can minimise the energy used to ship and refrigerate fruits and vegetables. Hospitals can also work with local composting companies to remove food waste that can be used as fertilizer in sustainable farming.

Greener hospitals

I know that reducing energy use is particularly tricky for hospitals, but I assure you it is not impossible. For instance, upgrading the light bulbs and replacing them with low consumption bulbs will save money and reduce the negative impact on natural resources.

Hospitals should work with vendors to ensure that the products the hospital purchases are as environmentally friendly as possible, from medical supplies to printer paper.

Making the EU a global leader in greener health

We still have a long way to go in order to achieve environmentally friendly hospital and health centres. However, good collaboration amongst EU systems and a common vision for future actions can only help.

For the EU institutions, environment and health are two important policy areas. In line with its values, the EU seeks to promote the wellbeing, security and interests of the citizens.

Since the Treaty of Amsterdam, sustainable development has been at the heart of the European project, influencing EU policies and legislation, for example, through the EU Sustainable Development Strategy and EU role in shaping to United Nation 2030 Agenda.

Sustainability shall continue to inspire the Commission’s political decision-making and guide the development of the post-EU2020 growth strategy – I am convinced health care must be part of the picture.

Pr. Damien Gruson

EDITORIAL: Preventing hospital associated venous thromboembolism

Europe should lead in understanding & prevention of blood clots 

The European Thrombosis and Haemostasis Alliance (ETHA) is an association of 22 national European thrombosis and haemostasis associations representing medical professionals in the field of clotting and bleeding disorders. We are allied to give the European thrombosis and haemostasis community a voice and provide input to European Union (EU) health and patient safety strategies, make recommendations on EU research programme funding and encourage sharing and adoption of best practices in the treatment and prevention of thrombotic and bleeding disorders across EU Member States. ETHA has recently become a member of Health First Europe.

Thrombosis is a contributing factor in 1 in 4 deaths, and the underlying cause of many cardiovascular disorders including heart attack, thromboembolic stroke and venous thromboembolism (VTE). Hospital acquired VTE is a leading cause of preventable hospital death, yet best practices to safeguard patient safety and avoid this disease are often not implemented. VTE also contributes to chronic disability for people who have non-fatal clots, including chronic pain and swelling in the leg from post-thrombotic syndrome, or chronic pulmonary hypertension from blood clots in the lung.

Across Europe, the burden of chronic diseases is rising, and populations are ageing, making it all the more imperative to advance the understanding, prevention, diagnosis and treatment of bleeding and clotting disorders. The sheer size of this issue requires cooperation between countries and national associations with a clear steering on the EU level.  We are committed to European  research to identify ways to reduce the rates of preventable clots, develop better prevention methods, and better treat clots when they happen.

A better understanding of haemostasis, and more advanced prevention, diagnosis and treatment for clots are all needed to prevent hundreds of thousands of cases of preventable death and disability in Europe every year. As ETHA we are pleased to work with Health First Europe and the EU institutions to advance patient safety in Europe and address the burden of VTE.

More information about ETHA is available online at www.ETHA.eu.

HFE-Anna-Falanga-EHTA-BW

Dr. Anna Falanga,

Chair

European Thrombosis and Haemostasis Alliance

 

EDITORIAL: MedTech Forum and MedTech Week events are kicking off!

MedTech Forum and MedTech Week events are kicking off!

MedTech Europe is gearing up at full speed to get ready for two flagship events, the MedTech Forum (14-16 May) and MedTech Week (3-7 June).

The MedTech Forum is one of the largest health and medical technology industry conferences in Europe.

Next week in Paris, the 11th edition of the MedTech Forum will bring together CEOs, disruptors, hospital representatives, patients, policymakers and healthtech stakeholders to discuss the future opportunities in the medical technology sector.

900 attendees and 150 speakers will discuss the latest opportunities and challenges on topics such as regulatory, ethics and compliance, digital health, antimicrobial resistance, market access and more…

Part of the programme will focus on innovation and access to market to bring value to patients.

You can check the full programme here and follow the conversation online via #MTF2019

MedTech Week raises awareness on the value of medical technologies in healthcare

MedTech Week (3-7 June) provides a European platform for local initiatives to promote the work the medical technology industry is doing together with different stakeholders – patients, carers, decision-makers and many others.

Since 2015, national associations and companies held more than 150 activities every year in Europe and beyond to illustrate the role of medical technologies in saving and improving lives and enhancing sustainable healthcare systems.

The awareness week will highlight how medical technology provides value to patients, supports healthcare professionals and improves healthcare systems by creating solutions for a healthier tomorrow. Look for the hashtag #MedTechWeek on Twitter to know more.

Call for blogs: This is MedTech is the online platform where to find real stories about people’s lives transformed by medical technology. If you would like to publish a blog, please contact m.lattes@medtecheurope.org

These events are two important occasions for us and we are very excited about the weeks to come.

 

We hope you will join us,

The MedTech Europe’s External Affairs Team.

EDITORIAL: Scaling up innovations to improve health care quality

Scaling up innovations to improve health care quality across Europe

 

Health systems across the European Union are facing numerous challenges – from the ageing of the European population and sustainable financing of health care, to great variations and inequalities in clinical practice within and between countries, a necessary and rising emphasis on patient experience and patient-centredness within health systems, and significant public health threats.

The common driver shared among these challenges is the vital importance of ensuring that health systems are fully equipped with innovative care solutions in the fields of health management, performance and sustainability of healthcare systems to deliver maximum value for the resources invested in them.

Therefore, to address unmet public health needs and effectively transform health care, we need to invest more on innovation in health which has the potential to create new ways of thinking and working and ultimately improve people’s health and well-being. These transformations will help Europe achieve universal health coverage within the context of the UN Sustainable Development Goals.

HFE fiercely operates to encourage this change by promoting new models of delivering healthcare services that put emphasis on an innovative and patient-centric approach.

Today we launch the HFE Compendium of Innovative Solutions to boost efficiency in health care, a best cases compendium which offers a series of innovative solutions to address current gaps, improve health outcomes and make health care more efficient, inclusive and sustainable.

As a vast proportion of resources are spent on curative services, the system has been neglecting the critical role of secondary prevention, screening and early diagnosis.

Accessibility of patients to companion diagnostics, laboratory tests, home dialysis equipment and glucose monitoring systems significantly contribute to the monitoring of pathologic conditions and the identification of specific treatments as necessary. In doing so, these technologies are able to reduce the incidence of complications, save patients’ lives, enhance bodily autonomy, improve the assessment and flexibility of treatment schedules and efficiency of providers’ time, and, ultimately, empower patients to enhance their own informed decisions about their health. Such innovations stand as safe, effective alternatives to hospital-based care, thus reducing hospital expenditures, the burden of device checks and follow-up assessments, and human resources. This further stresses the instrumental role of technology in transforming the workings of the healthcare sector.

Furthermore, automated solutions, the application of artificial intelligence and robotic systems represent additional ways that can help improve workflow efficiency and support health care systems’ transition to new care models, centred on people’s needs. Such innovations can bring accuracy, better planning and better assessment of risks, reducing unnecessary hospitalisations, increasing population health and, ultimately, make the system financially sustainable in the long run.

HFE counts on your support to call new policymakers to renew their commitment to make Europe the best region when it comes to public health, safety and wellness. Innovation is key to improve access and quality across the healthcare ecosystem.

The growth of new technologies, new medical equipment and diagnostic techniques requires technical know-how in addition to clinical knowledge. Hence, partnerships between patient communities, healthcare providers, academic researchers and the newly elected Parliament are key to stepping up the shift towards citizens’ engagement and widening the use of health technology systems and telehealth networks to grow innovation in the healthcare community.

Roberto Bertollini 
HFE President

EDITORIAL: Multidisciplinary and integrated heart failure care

The handbook of multidisciplinary and integrated heart failure care

 

The Heart Failure Policy Network (HFPN), a member of Health First Europe, is an independent, multidisciplinary group aiming to drive policy change in heart failure (HF). HF is common but complex – it is the main cause of hospital admissions in people over 65 and the leading contributor to unplanned hospital readmissions. Unfortunately, European health systems are unprepared to address the HF challenge.

Timely diagnosis is the foundation of effective HF management. However, this is often where the problems start – there is a widespread difficulty in recognising symptoms, and HF is often confirmed only after severe damage to the heart.

In 2018, the HFPN published The handbook of multidisciplinary and integrated heart failure care. The handbook is an overview of the challenges that HF poses on individuals, health systems and societies in general, and includes a collection of innovative solutions to help address problems and improve care. It identifies five ‘pressure points’ along the care journey that present the greatest challenges and missed opportunities. By characterising problems and presenting examples of best practice, the handbook offers a starting point to facilitate policy discussions to improve HF care and support the sustainability of healthcare systems.

The HFPN handbook and independent briefs on pressure points are available for download here.

 

 

 

 

 

 

 

 

 

                     Ed Harding                                                                                       Sara Correia Marques, 

                 Managing Director                                                                                  Head of Programme

     The Heart Failure Policy Network                                                         The Heart Failure Policy Network

EDITORIAL: What can we do to improve SCID?

A rare disease affecting many babies around the world

 

Severe Combined Immunodeficiencies or SCID is a devastating group of diseases by which babies are born without a functioning immune system. No immune system means that they can contract any infection or virus they are exposed to, without any means of defending themselves against them. Babies born with SCID rarely survive beyond their first year of life if they are not diagnosed and treated on time. However, the disease can be cured if it is rapidly diagnosed and treated. A first step to ensure this would be the inclusion of SCID screening in the routine newborn screening national programmes in Member States. This is already a reality for Norway, Iceland, Switzerland, Israel, United States or Taiwan. Several EU countries are assessing its implementation in 2019 or 2020, but the longer it takes, the greater the chances of losing babies’ lives due to this life-threatening disease.

As the Norwegian National Unit for Newborn Screening explains, “we screen because we can treat and cure!”. Indeed, we are fortunate that SCID can be cured if diagnosed and treated on time. Babies born with SCID can undergo a hematopoietic stem cell transplant or receive gene therapy to try to correct their defective immune system. A genetic therapy for a specific type of SCID was the first-ever EU authorised gene therapy, and additional research in gene therapy for SCID and primary immunodeficiencies is currently ongoing ! IPOPI is involved in two EU funded research programmes (SCIDNET and RECOMB) aiming to develop gene therapy for other types of SCID (covering up to 80% of SCID in Europe).

Diagnosis and research on new therapies that bring better health for patients can only have an impact if those therapies are available and accessible to patients. A big challenge today for the patient community, especially in the field of rare diseases, is to help reconcile the need for personalised medicine (most appropriate and effective for patients and, in the long term, cost-efficient) with short-term healthcare budget policies of EU governments.  

 

Johan Prevot
Executive Director
IPOPI – International Patient Organisation for Primary Immunodeficiencies

EDITORIAL: Lapse in transparency and access about patient safety information

On 9th November 2018, the first stakeholder meeting of the Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections took place in Vienna to discuss a cross-sector and multi-level approach to tackle AMR and foster synergies to keep antibiotics working.

On behalf of Health First Europe, I had the pleasure in joining the round table debate on evidence-informed public health policies and practices to combat AMR and HCAI. The debate focused on the role of evidence, measurable indicators, and reliable data which are critical to foster public health policy and to gather the necessary political traction to trigger policies and social behaviour changes.

The latest data released from the ECDC estimates that about 33000 people die each year as a direct consequence of an infection due to bacteria resistant to antibiotics and that the burden of these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined. It also explains that 75% of the burden of disease is due to healthcare-associated infections (HAIs) and that reducing this through adequate infection prevention and control measures, as well as antibiotic stewardship, could be an achievable goal in healthcare settings.

Health First Europe believes that AMR policies need to ensure patient safety and keep future bacterial infections treatable. Effective AMR policy should address 2 main mechanisms:

  • Preventing the spread of (resistant) micro-organisms by effective infection control measures
  • Reducing inadequate prescription and inadequate use of antibiotics

Clear evidence and measurable indicators are the main enablers when raising awareness on these key priorities. Thereof, 24 months ago we launched the HFE Patient Safety Indicators project. Health First Europe has developed 11 policy indicators and carried out 3 steps of in-depth analysis of patient safety policy in 7 European countries (Italy, France, Belgium, Spain, Germany, Netherlands and UK). This analysis aimed to assess the implementation of the Council Recommendation on Patient Safety, including the prevention and control of health care associated infections (2009). The goal of the research was to achieve better standards on patient safety, and how to reduce the spread of antimicrobial resistance (AMR) and HAIs in Europe.

In order to have a clear understanding about information accessibility, HFE put itself in the shoes of citizens who are keen on learning more about the latest policies framework about safety, AMR, HAIs.

As shared during the round table, HFE mapping faced a shocking lack of evidence, widespread information, and access to data related to each country’s national policies on AMR, surveillance, screening programmes, training etc. As shown by the 24-month research, notwithstanding the fundamental right to safe treatment and healthcare for all, patient safety policies are far behind from being effectively and correctly implemented in Europe. Information provided by national health Ministries’ websites is incomplete, and national associations are not fully aware of all aspects of national policy on patient safety in their country.

Several initiatives to monitor the implementation of the One Health approach to combat AMR are already in place and many more will be carried out in the upcoming months under the coordination of the EU-JAMRAI. It is important to keep in mind that access to clear and consistent evidence needs to be a priority of any dissemination campaign. While AMR and HAI prevention requires everyone’s effort, I regret to admit there are many disparities in education and training courses of healthcare workers. Active engagement of both providers and patients is critical. A dedicated person, responsible for patient safety should exist in as many healthcare facilities as possible. In addition, patients must be more proactively involved in awareness trainings for HAIs, AMR and adverse events. European citizens are partially engaged in their healthcare pathway but lack a proper understanding for the potential that adverse events may affect not only them and their families but also the economics of the healthcare system in their country. Data on adverse events is not available and, unfortunately, harm to patients is chronically under-reported.

To make sure that tackling AMR and HAIs will turn from a high-level scientific debate to everyone’s concern and political priority, it is necessary to foster and make easily accessible:

  • Concrete data be used and understood by the large public and politicians;
  • Measurable indicators for screening programmes
  • Data on surveillance and reduction of HAIs.
  • Data on the consumption and correct use of all antibiotics
  • Data on the implementation and use of diagnostic tool term of costs, patient safety and efficiency to encourage a transparent uptake on RDT.

AMR is a public health emergency and – today is the time to act. Public awareness is still too low and behaviour changes take time to occur. The debate highlighted how all health stakeholders from patients to industries are willing to tackle AMR and to join their efforts to keep antibiotic working. Only by working together, i.e. hospitals, health centres and professionals, patient safety organisations, health insurance companies, and competent national, regional and local authorities – is it possible to implement effective patient safety policies to reduce the spread of AMR and ensure the highest standards of care in Europe in any healthcare facilities.

Learn more about the NEW HFE Patient Safety Indicators Report.

 

Melina Raso

HFE Executive Director

PUBLICATION: Artificial intelligence to transform healthcare – are we ready for health 2.0?

Artificial intelligence to transform healthcare – are we ready for health 2.0?

With a market projected to reach $70 billion by 2020, AI is dominating the debate over technologies and is expected to deeply transform consumer, enterprise, and government markets. In many sectors, AI is already a reality: online customer support, smart home devices, video games, spam filters are only a few AI applications that we are currently using.  AI makes our lives easier, but it also has the potential to help us to solve some of the world’s biggest challenges: from treating chronic diseases to anticipating cybersecurity threats.

Health is one of the areas where AI can make a real difference in people’s lives. AI medicine has a tremendous potential in radiology, prognostics, diagnostics, surgery, resource allocation and treatment recommendations. So why has the health sector been slower than other industries in adopting IoT technologies?

The future of AI depends on trust and education

AI real-life implementation is still facing some obstacles, starting from some crucial infrastructure barriers, such as non-uniform electronic forms, storage capacities and sharing facilities across healthcare settings. Infrastructure issues have straightforward (and costly) solutions but these issues are far from being the only challenge for AI.

Two keywords are at the core of the delayed uptake: trust and education.

When it comes to the uptake of new technologies impacting so much in our lives, everything is about trust.

AI’s uptake depends upon safe access to big data and patient records. But the latter is not possible without patients’ trust. Trust is also very much linked to the ethical challenges that AI solutions bring, from equality to impact on human behaviour and security. No one should be left behind, the benefits brought from AI advancement should foster public health as a whole, not just benefit a few businesses or a small number of patients.

Likewise, in order to secure trust in the development and use of AI technology, policymakers must ensure the security of potentially sensitive data and provide clear guidelines on who is responsible when AI is used to support decision-making processes and when errors or complications occur.

Equally important for AI uptake is education. New skills are required as we move toward a new digital era of care. AI innovation can be enabled only if healthcare professionals’ education and patients’ literacy are continuously supported. The interface between clinicians and machines needs to be effectively and skilfully managed. Medical staff must have a basic understanding of how data is being collected and analysed through AI applications and other digital tools.

Building trust and fostering education

A human element should remain if we want to build trust on AI solutions. I believe that physicians simply cannot be substituted by machines. However, AI can definitely assist the healthcare workforce in making better clinical decisions, or even in replacing human judgement in certain tasks. Good examples of this can be found in image-recognition and radiography, where AI algorithms cover important areas from cancer detection, radiology reporting and analytics to scheduling and patient screening.

AI solutions in radiology showcase the real challenge behind AI literacy: medical professionals must learn to better delegate repetitive, lower-level cognitive functions in order to focus more on higher-level thinking.

Furthermore, medical students should learn to apply big data concepts to better quality of care, to support research and to improve patients’ experience. Medical education must move beyond the foundational clinical sciences by giving more attention to the alignment of humans and digital solutions and to data-driven outcomes. Ultimately, education is essential to feel safe and in control, both for patients and healthcare professional. We cannot trust or use something that we do not know.

AI is not the future, it is the present. Its solutions are already transforming healthcare, as other sectors, presenting new regulatory and technical challenges that EU member states should quickly meet to make AI investments cost-effective and to make AI technology work for everyone.

Next Steps

Follow on Twitter: @eu_labs

About the author

Prof Damien Gruson is Chef de Service at Cliniques universitaires Saint-Luc and coordinator of the My City-Lab Project. My City-Lab is a project financed by the European Regional Development Fund (ERDF) which aims to integrate the innovation of laboratory medicine and mobile health. The scope of the project is to facilitate access to laboratory tests as part of a collaborative approach to ambulatory care of a chronically ill individual, as well as to contribute to the dynamic monitoring of patients with chronic diseases.

EDITORIAL: Health care professionals stand together to foster patient safety

On the occasion of the International Patient Safety Day (17th September 2018), Health First Europe, ESNO – European Specialist Nurses Organisations, COTEC – Council of Occupational Therapists for European Countries and EUROFEDOP – European Federation of Public Service Employees, jointly call Ministers of Health to step up and agree on a high level of understanding on patient safety standards to drive their national policies into a common path. 

Read the joint article below, follow the campaign #Declaration4PatientSafety and SIGN the PETITION on Avaaz

Healthcare professionals stand together to foster patient safety

The burden of illness and health cost is increasing across the globe, and Europe is not immune from this trend. Today, medication errors, unsafe clinical facilities, or practices, a lack in adequate training and workforce resources, huge mobility and uncertainty of staff at local level, as well as low cooperation in and coordination in care, are threatening the wellbeing of EU citizens and the health systems’ capacities to cope with the changing demand of care.

According to the latest data released by OECD, around 15 percent of hospital expenditure in European countries is due to preventable harms e.g. patients being infected while in hospitals. OECD reports that a considerable proportion of patients do not receive appropriate and evidence-based care and, globally, the cost associated with adverse events reaches US$ 42 billion per year (without counting productivity loss). Those costs are likely to increase given the ongoing demographic changes, the follow-on growing healthcare demand, infrastructure upgrades as well as therapeutic and technology advancements.

In this light, it is highly important to make the best out of the resources we have, starting from healthcare staffing. Health workforce is the cornerstone of any strategy aiming at improving quality of care and reducing risks to patients. The capacity of health systems to deliver health services effectively and meet the changing demand of care strongly depends on the availability of a workforce with the right skill set.

It is not only a matter of efficiency, but also of social rights and quality of life. Across the EU, everyone has the right to be treated by well-trained healthcare professionals, be they doctors, nurses, dentists, occupational therapists or pharmacists. The Council of the EU has already called Member States to enhance multidisciplinary patient safety education and training of all health workforce and relevant management staff. EU citizens are well aware of the effect of staffing issues on patient safety and greatly value education and expertise. According to the latest Eurobarometer survey on patient safety, Europeans identify well-trained staff as the essential criterion (53%) for high quality healthcare. Despite the Council Recommendation and the EU citizens’ emphasis on education, of health professionals, this still remains an area under-implemented that urges further efforts.[1] It is extremely worrying that, not all EU countries have a nationally agreed common core of competencies for healthcare professionals dedicated to patient safety, reporting and management of adverse events. Patient safety education should be embedded and compulsory in healthcare professionals’ curricula from university to clinical practice.

In addition, the current lack of human resources in European hospitals does not make things easier. Staff shortage makes difficult the allocation of time for the implementation of process optimisation and continuous training on how to prevent or manage adverse events. This is a problem that policymakers need to address to make health settings more effective and innovative. Health systems that support and invest in staffing, in their education and professional growth, are better equipped to develop innovative and integrated solutions to respond to the increasing demand of health and the burden of patient safety.

Supporting and investing in healthcare staffing mean:

  • Relevant working conditions for all healthcare professionals, who are essential for reducing risks for patients and promoting a culture of continuous learning on patient safety;
  • Patient safety fully included in the standard training of health professionals;
  • Effective support and training to ensure the safest use of new medical technologies.

Preventing adverse events and unnecessary expenses is crucial to ensure sustainability, which is dramatically threatened by the demographic change. As the worldwide population ages, the healthcare systems of every country worldwide will face significant challenges to meet the needs of an aging population. We must prepare healthcare workforce for the future, anticipating skill needs and improving Continuous Professional Development (CPD) and Life Long Learning throughout professional career pathways.

This week we celebrate the International Patient Safety Day, let’s make it count! We jointly call Ministers of Health to step up and agree on a high level of understanding on patient safety practices and standards to drive their national policies into a common path. No country can afford unsafe healthcare and quality of care will always rely on the critical role of health workforce. Increased supply, better resources distribution and a skill mix can only strengthen prevention, integrated service delivery and, ultimately, safety. The last European Commission’s action plan on healthcare workforce was issued in 2012. Much has changed since then, it is now time to update it. The European Health Forum in Gastein is quickly approaching: European policymakers should make the best use of this arena to discuss the common health challenges and how jointly advance health workforce planning and education.

[1] European Commission, Report on the implementation of the Council Recommendation on patient safety, including the prevention and control of healthcare associated infections, 2014

 

                           

EDITORIAL: Committed to protect our health, starting from patient safety and integrated care

Today, 7 June 2018, I am pleased and honoured to be appointed new Honorary President of Health First Europe, one of the EU’s leading stakeholders aiming at improving access for patients to treatment and innovation.

Public health, science and policy have always been my primary concerns. Holding degrees in medicine and paediatrics as well as a Master of public health, my entire career has been devoted to enhancing health and wellbeing for citizen worldwide as well as improve the link and dialogue between science and policy. I have been wholeheartedly committed to the improvement of public health in several areas, such as chronic diseases, maternal and child health and, more extensively, in the development and progress of the environment and health agenda in Europe and at the global level.

Accepting the role of Health First Europe President confirms my commitment for population health by promoting equitable access to modern, innovative and reliable medical technology for all citizens. Developing a modern health care system coupled to evidence based policies for promoting health and preventing disease is a vital investment in the future of Europe. I strongly believe in the need to concretely achieve a truly patient-centred healthcare thus ensuring to every European citizen the benefits arising from the highest standard of quality of care.

Together with HFE’s 24 important stakeholder members, we will work for safer and smarter healthcare in Europe. I realise the vital role HFE plays in bringing awareness to the challenges of modern EU healthcare. As President I aim to elevate HFE even further by tackling some of most pressing problems in health today.

In this vein, I will focus my work on:

  • Prioritising the development of innovative and integrated model of organisation of care within the discussion on healthcare systems sustainability and efficiency.
  • Keeping safety for patient and health workforce under the limelight of the EU institutional debate to implement effective safety policies in the EU.
  • Encouraging key health stakeholders and policymakers make better plan and invest in early diagnosis and screening programmes as key enablers for saving lives while ensuring sustainability of our healthcare systems.

Fully aware of the European Union limited competencies on health, I strongly believe that more can be done to move towards safer, more sustainable and more integrated healthcare systems. European Member States are currently facing enormous challenges such as an ageing population, an alarming increase of chronic illnesses and the growing antimicrobial resistance crisis. Therefore, the European Union needs to pave the way for structural reforms on health and social care to face these challenges; for larger and more focussed investments in prevention and health promotion; for cross border actions and cooperation to overcome fragmentation in health care and health disparities, and unlock the potentials of innovation including those linked to digital health.

Innovation, in its broadest meaning, should penetrate and spread in any health and social reform. Greater research into the value of innovation in health, including innovation of health care models and social care, must be better supported at EU level. It is not sustainable nor viable to introduce innovative solutions in a system which does not have the tools and mechanisms to implement them. I strongly believe that the EU could benefit enormously by addressing more proactively health matters, thus showing its attention and concern for the needs of people in the Union.

Innovative solutions for patients’ safety in all healthcare settings have a crucial role in this framework. About one in ten patients are harmed while receiving health care. According to a recent Report published by the OECD “many of the incidents that cause harm can be prevented”. The direct cost of unsafe care is about EUR 21 billion or 1.5 percent of health expenditure for EU countries. Investing in safer healthcare will prevent 260 000 fewer incidents of permanent disability, and 95 000 fewer deaths per year. These numbers represent an unacceptable waste of lives and resources.

The traditional separation between social and health budget should be overcome in favour of a virtual triangle citizens – care – innovation, where all players jointly act to deliver well-being to each citizen and the whole society. The EU should not scale down its role of identifying and distributing good practices across Member States to meet the growing demand for care and simultaneously support innovation in the sector in the face of an ageing population and the alarming burden of chronic illnesses. Areas like advanced screening, the role of digital data and integrated care models are the future.

Improving patients’ health literacy, patient access to high-quality information and involvement in patient safety strategies and methodologies of establishing patient safety standards and access to treatment is critical to implement truly patient-centred care in European health systems.

I am delighted to continue the good work initiated by my predecessor Mr John Bowis. I will keep continuing to build upon our belief that “health equals wealth” with my commitment to promote a more sustainable, inclusive and innovative healthcare, to enhance a safety culture in health settings and achieve effective public health programmes and practices across Europe.

 

ROBERTO BERTOLLINI

Biographical note on the author

From 2011 to 2016, I have been WHO Representative to the EU in Brussels and Chief Scientist of the WHO Regional Office for Europe. Before this assignment from 2007 to 2010, I have been coordinator of the Evidence and Policy for Environment and Health unit of the WHO Department of Public Health and Environment in Geneva with the special task to develop the WHO global policy and response to the health impacts of global climate change. Since 1991 and until 2007, I have worked in WHO Europe and played senior roles as Director of the Environment and Health programmes and subsequently of the technical division addressing NCDs, infectious diseases and health determinants.

Since January 2017, I have been Advisor to the Minister of Public Health of Qatar, working to enhance the effectiveness and efficiency of the public health system in the country. In addition to this, I am a Member of the Scientific Committee on Health, Environment and Emerging Risks (SCHEER) of the Directorate-General for Health and Food Safety, providing scientific opinions to European Commission Services on health-related issues.