EVENT SUMMARY: Increasing adherence to CAUTI guidelines: Recommendations from existing evidence

Increasing adherence to CAUTI guidelines: recommendations from existing evidence

30 June 2021, 11.00-13:00 CET via ZOOM
Hosted by MEP István Ujhelyi (Hungary, S&D)

 

The event and launch of the ENSH report on “INCREASING ADHERENCE TO CAUTI GUIDELINES: RECOMMENDATIONS FROM EXISTING EVIDENCE’’ was held on Wednesday, 30 June 2021 via videoconference. Moderated by Mr. Brandon Mitchener, Executive Director of Health First Europe and coordinator of the European Network for Safer Healthcare (ENSH), the event brought together multiple health stakeholders to dissect current challenges plaguing catheter-associated urinary tract infections’ (CAUTI) guidelines adherence and to share best practices from the field. Mr Mitchener opened the virtual floor and emphasised on the diversity of participants: academics, healthcare professionals, patient organisations, among others.

The event was hosted by MEP István Ujhelyi (Hungary, S&D), who stressed the need for greater patient protection and safety across Europe. MEP Ujhelyi called on the European Centre for Disease Control (ECDC) and the European Commission (EC) to consider implementing the solutions enshrined in the new report that was co-written by the ENSH and the European Association of Urology Nurses (EAUN), in association with the European Association of Urology (EAU). The host also urged organisers, panellists, and stakeholders to further discuss, support and align consensus on increasing adherence on the European guidelines.

The first presentation of the event was focused on the implications of CAUTI in AMR and healthcare costs in the EU. The discussion was led by Prof. Michael A. Borg, from the Maltese National Antibiotic Committee. According to Prof. Borg thanks to data from the ECDC, we know that 6.5% of European patients in hospital admission will suffer from a healthcare associated infection during their stay, with about 19%-20% constituting urinary tract infection (UTI). He added that urinary tract infection is one of the top three infections acquired in healthcare settings. CAUTI also represent an excess cost of 390 million euros a year for the EU with almost 400,000 excess hospital days, which represents around 3800 life years.

The second part of the event focused on the current European guidelines on CAUTI, the identification of the main barriers to enforce existing guidelines and the recommendations for better enforcement.

Dr Gernot Bonkat of the European Association of Urology was the second speaker to intervene. He noted the rise of antibiotic resistance, the issue of quality of care, and the multitude of guidelines available are not sufficiently followed. Dr Bonkat stressed that the perfect preventive means vis-à-vis CAUTI is a good hygiene program within hospitals.

The third speaker was Dr Jose Medina Polo from the Spanish Association of Urology, who discussed the importance of identifying barriers and promoting education for better enforcement. Dr Medina Polo noted that education at all levels and departments reduced the risk of infection and gave examples on how his hospital in Madrid is actually implementing these best practices in order to avoid CAUTI.

The fourth speaker was Chair Susanne Vahr Lauridsen of the European Association of Urology Nurses. She emphasised on the fact that CAUTI is among the common healthcare infections, and that about 16% – 35% of patients in hospitals are fitted with a urinary catheter during their stay. Susanne Vahr noted that very little is known about patient’s perspective on the use of indwelling urinary catheters and the absence of information on alternatives. She added that patient involvement improved overall behaviour of healthcare providers and that the best way to prevent catheter associated urinary tract infections is to avoid the use of indwelling catheters.

The focus of the third part of the event was towards the correct implementation of the guidelines across European countries.

The fifth speaker for the event was Director on Public Health Mr. John F. Ryan from the European Commission, DG SANTE. Dir. Ryan stated that urinary tract infections are not only commonly healthcare associated infections, but they are also linked to increased morbidity, and mortality to decreased quality of life. He pointed out that CAUTI can lead to extended hospital stays and increased healthcare costs. He noted that the new mandate of the European Centre for Disease Prevention and Control (ECDC) includes healthcare-associated infections in terms of surveillance and risk assessment and better focus will be given to patient safety. He also outlined some of the policy measures undertaken (i.e., health policy platform) by the Commission and those being developed (i.e., introduce new regulatory frameworks).

Prof. Saïd Laribi, Chair of the Chair of the EUSEM Research Network of the European Society for Emergency Medicine was the sixth speaker of the event. He noted a pattern of catheter overuse and poor insertion technique as some of the factors contributing to hospital infections. Dr Laribi suggested that staffs be required to specify the medical reason for catheter insertion, making physicians responsible for determining catheter use. Practitioners should also be made aware of alternatives to avoid overuse, he adds.

Prof. Maurizio Cecconi, President of the European Society of Intensive Care Medicine concluded the meeting stressing the importance on raising awareness on sepsis, a life-threatening condition that occurs when the human body’s response to an infection damages its own tissues. He added that UTI’s, for instance, can amount up to 25% of all cases of sepsis. Prof. Cecconi stated that access to antibiotics for sepsis patients did not occur for up to a third of cases – something that can increase mortality. He encouraged proper antibiotic stewardship protocols, together with protocols for the recognition and treating of sepsis.

In the ensuing debate, panellists agreed that:

  • Education and proper adherence/compliance to CAUTI guidelines are critical success factors to reduce hospital infections.
  • Patient involvement is long overdue and that alternative solutions regarding catheter usage should always be discussed.
  • Equitable access to quality antibiotics is key to avoid resistance among infected patients.

Please read & share the ENSH report here.

Please find the final slide deck including all speaker presentations here.

Please find the event recording here.

More information about the event can be found here.

Event Summary: Strengthening the resilience and resource efficiency of EU health systems: A call for an integrated approach

Event Summary

European Parliament Interest Group on Innovation in Health & Social Care 

“Strengthening the resilience and resource efficiency of EU health systems: A call for an integrated approach”

 

The synergies between Horizon Europe, the EU4Health programme and Digital Europe will ensure a health transformation in Europe. — MEP István Ujhelyi

The meeting of the European Parliament’s Interest Group on Innovation in Health and Social Care entitled “Strengthening the resilience and resource efficiency of EU health systems: A call for an integrated approach” took place on 12 May 2021 via videoconference. Chaired by HFE Vice President Dr Neda Milevska-Kostova, the event intended to gather EU policymakers, academia, and representatives from healthcare associations and patients’ groups to deliberate on how to improve European Health Systems to make it truly patient-centred, specifically to strengthen the capability of the European Union for prevention and preparedness to tackle future disease outbreaks. The debate was aimed at formulating concrete proposals and exchange of best practice for the future of a strong European Health Union.

The meeting was hosted by MEP István Ujhelyi (Hungary, S&D) who started his presentation by reminding participants that the EU4Health programme offers better protection against crises while also improving health and fostering innovation. MEP Ujhelyi added that the epidemic has highlighted the need for resilience in Europe, given the rising tide of medicine shortages in the EU caused by Europe’s dependency on outside countries. He highlighted the need for access to data, enhanced cooperation, and the digitalisation of the medical supply chain, as well as better cross-border training programmes. MEP Ujhelyi reminded the audience that the Conference of the Future of Europe will offer a good opportunity to enhance healthcare systems while not undermining member states’ competencies.

The first part of the meeting focused on supporting integrated and coordinated work between EU Member States. The discussion was led by Dr Loukianos Gatzoulis, Policy Analyst at DG SANTE of the European Commission, who underlined what is coming out of the COVID-19 crisis; a debate, which is about reimagining public health, redesigning our health systems to be more resilient to future shocks, as well as a big opportunity for stronger collaboration between countries and across borders.

Dr. Gatzoulis put emphasis on strengthening primary care, integrating health and social care, and taking advantage of the potential of innovations. He added that the EU could be making better use of knowledge brokering, exchange of best practices, and offering hands on technical, and very importantly financial support from the European programmes.

The attendees then analysed some policy actions needed to reinforce the healthcare workforce. Professor Maurizio Cecconi, President of the European Society of Intensive Care Medicine (ESICM), welcomed the International Nursing Day 2021 and applauded the work being carried out by nurses across Europe. Prof. Cecconi stressed that the pandemic was a challenge, and that ICUs were operating at 150 to 200%, and thus required many extra shifts. He highlighted that a major issue was the lack of staff and resources in ICUs during the pandemic. He recommended further collaboration between research and practice, with further cooperation between healthcare systems and the enablement of free movement of intensivists and other specialists within the EU. Maria Teresa Parisotto, the Executive Director of the European Specialist Nurses Organisation (ESNO), followed this discussion and stated that an American survey showed that 87% of nurses feared going to work during the pandemic, anticipating an analogy in the European context. She noted that COVID-19 was not only responsible for the ‘chaos’, but also for the reduction of healthcare funding and salaries, as well as the increased workload, thus leading to a lack of morale. In her view, a new Health Vision 2030 should be developed with interprofessional teams, through the integration of health networks as well as a better data collection and predictive models.

The following panel provided a space to discuss actions on disease prevention, health promotion and how to address health determinants. Dineke Zeegers Paget, Executive Director of the European Public Health Association (EUPHA), highlighted the importance of prevention in healthcare systems. She stressed that the healthcare systems should better focus on lifestyle and health determinants, such as alcohol, tobacco, drugs, and gaming, as well as on tackling chronic diseases and health literacy. Ms Zeegers added that it would be the role of individuals but also of governments and the industry to truly change how healthcare operates for the better.

Ms Hilkka Karkkainen, President of GAMIAN-Europe, intervened and highlighted the need for the introduction of mental health skills curricula in schools and the development of free-access mental health centres that are open to the public. She stressed the need to stop treating mental health as any other chronic condition and highlighted the work of GAMIAN-Europe on a campaign to increase the awareness of mental health following the pandemic. She called on the EU to develop an EU Strategy on Mental Health.

The last panel addressed the implementation of best practices and promoting data sharing and the contribution was made by Ray Pinto, Policy Director for Digital Transformation at DIGITALEUROPE. He highlighted the importance of data will help understand the issues that occur in European healthcare systems, and how data from European citizens could fuel the development of many digital technologies such as artificial intelligence (AI). He suggested the development of electronic health records that could help healthcare accessibility across the EU, but he also noted the fragmented internal market that will prevent the full potential of the European Data Space, highlighting specifically the exceptions to Member States in the GDPR. He added that to reduce bias and error with machine learning requires large datasets, and that data rules applied in Member States is both protective as it is preventive of data flows, making smaller health AI companies look for data elsewhere to train algorithms. Moreover, he stressed that the European Parliament should aim at ensuring transborder data sharing and anticipate the negotiation between EU Member States and the institutions to ensure the full potential of the European Data Space is used for better health and wellbeing of all citizens.

In the ensuing debate, panellists remarked that:  

  • The Recovery and Resilience Facility will bring a more operational dimensions to the European Semester processes and the Country-Specific Recommendations, which refer also to healthcare workforce.
  • Further investment in most health areas is needed, including more doctors in primary care, as well as enhanced support for multidisciplinary teams. Taking into consideration the resource limitations, where possible, to enable free movement of specialists across the European health Union.
  • There is a need for interoperability of healthcare systems in Europe with further connection between members states, including enablement of free movement of specialists, based on standardised competence frameworks.
  • As part of the resilience and preparedness of healthcare systems for future pandemics and emergencies, consideration should be given to reformulation of medical curricula and health education, including more comprehensive programs for training healthcare professionals as well as providing literacy programs for patients.
  • Mental health is as important as physical health, and systems should reconsider the approaches, especially in providing community support and literacy/education to patients to enable them to recognise mental health problems at early stages as well as to act as expert patients skilled to help other mental health patients.
  • Data and medical innovations will have a crucial role to play in tackling the current issues in healthcare, but also in integration of health and social care systems, in particular to help address acute situations and citizens’ needs at community level.
  • There is a need for openness of data and for reconsidering data protection policies so to enable rather than hamper data use. Digital transformation should not be perceived as merely digitalisation – IT technologies should be embraced as enablers for faster recovery from the current pandemic, as well as for building back better and more prepared health systems.

EVENT SUMMARY: Integration of health and social care to tackle disease outbreaks

[When faced with the current pandemic] Members States who lagged in their integration of health of social care […] had, at the beginning, a higher mortality rate than others

MEP Tomislav Sokol

The virtual meeting of the European Parliament’s Interest Group on Innovation in Health and Social Care entitled ‘Integration of health and social care to tackle disease outbreaks’ took place on Tuesday, 26 January 2021 via videoconference. The meeting intended to gather EU policymakers, academia, and representatives from healthcare associations and patients’ groups to deliberate how to improve European Health Systems to make it truly patient-centred, specifically to strengthen the capability of the Union for prevention and preparedness to tackle future disease outbreaks. The meeting aimed at formulating concrete recommendations to be able to provide meaningful support in the development of the EU4HEALTH programme.

The virtual table was opened by HFE President Roberto Bertollini, who emphasised the cruciality of the meeting. Although the current pandemic has started to be mitigated with the arrival of several vaccines, we should step back a minute and think about how future disease outbreaks and challenges can be addressed and controlled, he said. He stressed the blows that the pandemic has struck against society and how vital it is to put prevention at the heart of the European Health Systems through the use of technology and the interpretation of biological and medical signals as well as intervening early based on the precautionary principle. He highlighted his encouragement after the publication of the Expert Panel Opinion of the organisation of resilient health and social care following the Covid-19 pandemic and emphasised that frequent pan European exercises should be carried out to ensure once again that the word resilience becomes a reality rather than an empty popular slogan.

The discussion was hosted by MEP Tomislav Sokol (EPP, Croatia), who stressed the good timing of the meeting and how it is very connected to the concrete problems and issues that we currently face. He stressed that the European response to the current pandemic was rather slow and that the current public perception of the European response is also negative. He stressed that the issue was not the European response itself, but the lack of a coherent European response due to the national competencies in the area of health. He further highlighted that the link between health and social care is crucial as countries that lacked more in their integration had a higher mortality rate and how important primary care was to prevent future disease outbreaks due to its being the first point of contact in terms of epidemiological measures. MEP Sokol argued that the EU could provide added value thanks to its ability to act, for instance by implementing exchanges and mandating interoperability of health data at the European level, as well as its ability to invest in the European workforce and in terms of making European health systems more cohesive throughout Europe.

The first part of the meeting focused on the causality of the impact of the current pandemic on the collapse in primary care services for long-term conditions and how much impact could be reversed. The discussion was led by Diederik Aarendonk, Forum Coordinator of the European Forum for Primary Care, who described the impact in exacerbating health disparities in the continent, especially in that it impacted those already vulnerable more than those who weren’t. He added that the pandemic widened the educational gap and led to higher stress levels for such groups but also led to the postponement of healthcare and services. He noted that the pandemic can be a ‘game-changer’ for primary care services if there are investments to implement integrated, horizontal, community-based primary health-care systems and investment in the workforce as well as to create a new organisational and financial model based on the integration of health and social care.

The meeting then moved on to a discussion of the policy actions needed to help integrate health and social care to reduce the risk of disease outbreak. Neda Milevska, Board Vice-Chair of the International Alliance of Patients’ Organisations and Vice-President of Health First Europe, said the current pandemic has shown that health should be a priority and that patients should be at the centre of the health system. She highlighted that primary care services are at the frontline of every long-term condition and need support from the healthcare system and the society at large, including with digital solutions. She noted the role that patients can play in treating disease outbreaks both as a partner in shared decision-making or a co-creator in evidence-based solutions as well as a co-designer of holistic public health approaches.

The third speaker of the meeting was Anu Söderström, President of Occupational Therapy Europe, who described what occupational therapy can offer to the EU for Health Programme, specifically in terms of strengthening its health systems pillar. She noted that Occupational Therapy enhances the enablement of digital solutions to improve patients’ access to services, providing an example of how it can help those who live in remote areas through teletherapy. She highlighted that occupational therapy has a high client satisfaction, is cost-effective, and increases social participation, though she also noted that there is an unequal availability to such services. Finally, she stressed that there is a need to increase the digital skills of health professionals and patients, as well as increase patient access to tele-health solutions.

The last contribution was made by Professor Pedro Pita Barros, Member of the European Commission Expert Panel, on effective ways of investing in health. He presented the recently published Expert Panel opinion and how the Expert Group got its inspiration from existing approaches to the resilience of health systems. He noted that there are a number of shared concerns when talking about the resilience of health systems towards shocks, namely: their ability to look ahead, to absorb shocks and to adapt to them and their aptitude to learn from them. He added that there are some elements common to most countries: vulnerable groups were most affected by the pandemic. Non-Covid-19 care patients were harmed due to resources diverted to COVID-19 patients, and that will be pressure on mental health issues in the long-term. He stressed that there is a need to anticipate future disease outbreaks, be ‘prepared to prepare’ a response’ and adapt at short notice through the redesign of patient’ paths inside organisations and through telemedicine. He highlighted that there is a need to invest in training and resilience of the health workforce, ensure relevant data flows in a timely and organised way and pilot the resilience test toolkit provided by the Expert Panel Opinion.

In the ensuing debate, panellists agreed that:

  • social care, though not covered in the Expert Panel Opinion due to its focus on health systems, is crucial to tackling disease outbreaks.
  • when utilising digital tools, data security is also another primordial issue that needs to be tackled.
  • further resources should be provided for primary care workers as well as further training for healthcare workers to collaborate internationally; and that
  • a multi-faceted approach is needed to put prevention at the centre of European health systems and tackle future disease outbreaks.

You are able to access all speaker presentations here:

EVENT SUMMARY: First Workshop of the AMR Patient Group: “Addressing antimicrobial resistance and healthcare associated infections through patient empowerment”

The first virtual workshop of Europe’s first AMR Patient Group entitled, ‘Addressing antimicrobial resistance and healthcare associated infections through patient empowerment’  took place on Wednesday 16 December 2020 from 10:00 to 12:30 Brussels time. The purpose of the workshop was to provide participants with a comprehensive overview of the issues of antimicrobial resistance (AMR) and healthcare associated infections (HAIs), the state of play in Europe, and discussion around the best approach we can take to tackle these deeply concerning problems at the patient-level. The workshop was moderated by Laura Cigolot from Health First Europe (HFE) and participants were given presentations from high-level speakers as well as opportunities to raise questions and have an open discussion to further the group’s mission and objectives.

Ms Cigolot opened the virtual workshop on behalf of HFE, outlining the purpose and mission statement of the new AMR Patient Group: to educate and raise patient awareness about AMR, to build a consistent patient voice on AMR across Europe, and to broaden the AMR debate to include infection prevention control measures.

The first presentation was given by Dr Dominique L Monnet, Head of Disease Programme, Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) at the European Centre for Disease Control (ECDC). Dr Monnet gave a comprehensive overview of AMR to help participants understand all the areas that AMR encompasses. Interestingly, Dr Monnet said he prefers not to use the ‘AMR’ acronym himself as it makes the concept too abstract. Dr Monnet’s presentation also provided case studies and the latest Eurosurveillance statistics on AMR from Europe, which are all available on the ECDC website. He advised on the most effective AMR prevention methods, which included the prudent use of antimicrobial agents and good hand hygiene practices. Dr Monnet noted the ongoing studies into the effects of the Covid-19 pandemic on antimicrobial resistance.

The second speaker was Dr Massimo Sartelli from Macerata Hospital in Italy. Dr Sartelli presented the workshop with an excellent overview of infection prevention and control measures from a clinical perspective. Participants learned the incidence rates of HAIs, how they are contracted in healthcare settings and best practices to help avoid them. Dr Sartelli highlighted that hands are the most common vehicle to transmit health care-associated pathogens, and the necessity of strict hand hygiene practices. His key message was that hand hygiene is a simple and effective solution to protect patients from HAIs and to reduce both the spread of infection and multi-resistant germs.

Ms Annabel Seebohm, Secretary General of the Standing Committee of European Doctors (CPME) was the third speaker to take the floor. Ms Seebohm’s presentation centred around the role of doctors in fighting AMR at the primary care level. She noted that doctors in primary care settings are on the frontline of efforts to improve the responsible use of antibiotics and it is paramount that they promote and implement the prudent use of antibiotics, i.e., only when needed, in correct dose intervals and in correct duration. Ms Seebohm also highlighted the CPME’s policy recommendations to Member States and doctors across Europe to help streamline a European approach to prescribing antibiotics responsibly, as well as CPME’s active engagement in promoting the ‘One Health’ approach, which looks at AMR prevention from an interdisciplinary perspective (i.e., an approach which combines the medical, dental, animal and environmental sectors).

Finally, Ms. Seebohm provided participants with an overview of what European doctors know about antibiotics and antibiotic resistance based on the latest statistics from the ECDC. Optimistically, more than 70% of doctors agreed to having good opportunities to provide advice on prudent use of antibiotics to patients, however 45% of doctors said they have insufficient time and no resources available for not being able to give out advice or resources to patients. Ms Seebohm emphasised that these figures show that not only do we need action in terms of developing guidelines and strategies on the prudent use of antibiotics, but also in the organisation of primary care so that doctors have sufficient time and resources to properly share information with patients.

Ms Emma Kollatou, Manager of Government Affairs and Public Policy at MedTech Europe spoke next about the role of medical technologies in the fight against AMR and HAIs. Ms Kollatou emphasised how medical technologies can help fight AMR throughout the patient pathway, from prevention to diagnosis, to controlling infection spread through tracking and monitoring to stop the spread of resistant bacteria. In her presentation, Ms Kollatou spoke in particular about how In Vitro Diagnostics can help patients at the community level by differentiating between a viral and bacterial infection, and at the hospital level through faster diagnosis which leads to more timely and appropriate treatement and better patient outcomes. In all, medical technologies can help society as a whole through more accurate infection diagnoses which will help to ensure the efficacy and prudent use of antibiotics for generations to come.

Among her recommendations, Ms Kollatou noted that at the European level, the joint action group EU-JAMRAI is coming to an end soon, which means there is a need for joint-action guidelines to be issued. She echoed Ms Seebohm’s call to engage with the ‘One Health’ approach, and also advocated for promoting a prevention culture.

The final speaker of the workshop was Ms Sian Williams, Policy and Advocacy Adviser at Wellcome Trust, UK. Ms Williams talked about the political will on AMR, warning that although it is strong, it is still at risk. She highlighted how we can help to reinforce a mandate for change through collective action, which requires better understanding of antimicrobial resistance at the public level. However, awareness alone is not enough to spark collective action and behavioural change, but rather, people may need a deeper connection to the issue in order to bring about real change. Ms Williams provided the participants with knowledge on how to approach effective patient education and messaging on AMR based on the latest research.

Framing is key in public education on AMR, and Ms Williams advised the Patient Group members on key framing advice from the Wellcome Trust, which included the recommendation that the fundamentals of AMR should be explained succinctly. AMR needs to be emphasised as a universal issue that is solvable, but which requires immediate action. She also highlighted the power of human-focused patient stories and noted the opportunity that the AMR Patient Group provides to encourage patient voices within AMR advocacy.

The workshop included questions and answers sessions and open group discussion where we heard from our members about their concerns regarding AMR and the biggest issues they face as patient representative groups. From the discussion, a recurring issue was raised regarding the difference in approach to antibiotics regulations across borders. This concern further added weight to recommendations that were heard from multiple speakers to adopt a joint ‘One Health’ approach to AMR in Europe at the political, medical and community policy action levels. The work of EU-JAMRAI needs to be carried forward into the future. Overall, the group was in agreement that patients tend to trust their doctors and healthcare professionals, and education on AMR needs to come from all levels. Patients can be both leaders and supporters in the fight against AMR.

In terms of messaging on AMR, the most effective approach is evidence-based and simple messaging, with a focus on human stories to aid understanding and encourage collective action. Ms Sian Williams also gave a prudent example of why AMR concepts need to be clearly explained: many people do not realise that the “resistance” element of AMR applies to the bacteria or microbe, and not to the person themself. This understanding enables people to see that AMR is not an individual or personal problem, but a global community health crisis. Another key recommendation that came from the workshop was the necessity of educating children and their parents to ensure the next generation has a full understanding of the concepts relating to AMR and effective infection prevention measures, especially that of good hand hygiene practices. The effects of the Covid-19 pandemic on AMR rates are still unknown and may overall be contextual. However, it is crucial that good hygiene practices remain into the future and that the importance of AMR action must stay firmly on the global health agenda. The first workshop successfully laid out the groundwork and tools needed to succeed in achieving the AMR Patient Group mission: to educate and raise patient awareness about AMR, to build a consistent patient voice on AMR across Europe, and to broaden the AMR debate to include infection prevention control measures.

To conclude this event summary, here is a great analogy that our AMR Patient Group member Neda Milevska-Kostova from the International Alliance of Patients’ Organizations (IAPO) contributed to the workshop: “Antibiotics are like a fire extinguisher. You need to have one, but you hope you never need to use it”.

EVENT SUMMARY: Virtual meeting of the European Parliament’s Interest Group on Innovation in Health and Social Care– Prevention at the heart of European health systems

‘The transformation of health care in Europe will be influenced largely

by putting prevention at the heart of European health systems’

MEP Irena Joveva

The virtual meeting of the European Parliament’s Interest Group on Innovation in Health and Social Care entitled ‘Prevention at the heart of European health systems’ took place on Tuesday 8 December 2020. The aim of the meeting was to bring together policymakers and representatives from patients’ groups and healthcare associations and academia to discuss how to invest in secondary prevention and preparedness to optimise public health response to health threats, how to implement good practices and policy actions to foster screening and early diagnosis in Europe and to highlight the critical role of clinical laboratories in fostering access to screening.

The virtual table was opened by HFE interim Director Brandon Mitchener, who reminded everyone of the importance of the EU4Health initiative to strengthen the resilience of the EU healthcare system. He noted that the focus of this meeting, and its contribution to the initiative, was to show the critical role that screening and early diagnosis can play in detecting illnesses before any symptoms are noticeable and to curbing the progression of diseases, thus maximising quality outcomes for patients while reducing costs.

The discussion was hosted by EP Interest Group Co-chair MEP Irena Joveva (Renew Europe, Slovenia), who highlighted the impact of the COVID-19 pandemic on exposing the vulnerabilities in the European health systems and stressed the critical importance of bringing together different groups and stakeholders to better inform policy decisions. She furthermore noted that most current healthcare systems focus on tackling the later stages of all diseases, instead of attempting to prevent diseases themselves. She stressed that secondary prevention provides a better chance of curing diseases and helping people live happier and more productive lives. She also underlined the importance of awareness and education and encouraged the meeting to make several concrete proposals for the future of the European Health Union.

The first part of the discussion was focused on finding the most effective manner in which Europe can invest in secondary prevention and preparedness to optimise the public health response to health threats. Elisabeth Dupont, European Regional Manager of the International Diabetes Federation, provided an overview of the devastating impact that the pandemic has had on patients with diabetes as well as the burden that diabetes itself creates both health-wise and economically in Europe. She noted that 75% of diabetes costs in Europe are associated with complications that are preventable. She pointed out that while primary prevention is important, secondary prevention can also enhance the length and quality of life for patients as well as save valuable health care resources as it allows for their re-distribution in other areas. Finally, she recommended driving the digitalisation of health services including creating electronic health records and telemedicine, fostering the integration of care across all sectors, and implementing guidelines and best practices.

Isabel Rubio, President of EUSOMA and a board member of the European Cancer Organisation, highlighted that prevention is the most cost-effective public health strategy. It leads to better survival-rates, especially with cancer patients, due to the detection of tumours at an early stage. She noted that there are disparities in terms of cancer screening programmes throughout Europe as many countries lack them, but most importantly, that there are inconsistencies in terms of the data used by screening programmes as well as an apparent lack of quality assurances. She stressed that this leads to the inability of researchers to properly compare compare data for the different screening programmes across the continent. Finally, though noting that there are many challenges to create new screening programmes, she recommended the implementation of a European cancer dashboard that monitors screening coverage and performance and the creation of a European platform for screening agencies to facilitate rapid best practice-sharing as well as boosting of EU research initiatives supporting screening related policy needs.

Following questions directed to the previous speakers, the meeting moved on to a discussion of policy actions needed to help foster secondary prevention and promote the role of clinical labs in public health. Tanja Valentin, Director of External Affairs of MedTech Europe, stressed that Europe needs a paradigm shift from managing sickness to preserving health, and said intervention at the right time is crucial, but not always the case. She highlighted three examples of how secondary prevention could be beneficial, one of helping to prevent heart failure using diagnostic information to care for the condition and avoid acute episodes. Her second example was on the prevention of AMR, which kills tens of thousands of Europeans a year, and how technology can help prevent it. Finally, she highlighted the use of digital solutions in the fight against COVID-19. Lastly, Ms Valentin recommended to re-think care delivery through task shifting (for example from doctors to nurses, hospitals to GPs, etc.) and using enablers such as technology as well as creating financial incentives to allow for the transition of health systems from those that tackle diseases to systems that prevent them.

The last contribution was given by Damien Gruson, Head of the Department of Clinical Biochemistry at the Cliniques Universitaires Saint-Luc in Brussels. He highlighted the multitude of uses and the future opportunities that technology can provide to medicine. He stressed the need for cooperation between sectors as well as the need for integrated care, as care itself is currently being transferred from hospitals to patients’ private homes due to a reduction of the length of treatment in hospitals since the 2000s. He also mentioned that although the COVID-19 virus has accelerated the use of technology by medics, much more of this needs to be done to ensure early diagnosis, identify groups with higher risk and help patients to avoid exposure to other infections. For this, Dr.. Gruson showed how remote monitoring and data science could be used, such as with biomarkers, but he also highlighted that this needs to be done in a multidisciplinary format that includes the involvement of both patients and healthcare workers.

In the ensuing discussion, panellists agreed that prevention needs to be helped with crucial training by all stakeholders through a peer-reviewed system, but that age and other factors could limit the use of technology. Panellists also agreed that for the implementation of data compatibility throughout Europe a dashboard for quality indicators is needed for several diseases as well as the standard approaches to the collection and organisation of data. Overall, participants agreed on the multi-faceted approach that is needed to put prevention at the centre of European health systems.

EVENT SUMMARY: Virtual roundtable – Preventing infections in the surgical care pathway to tackle antimicrobial resistance

‘Health is an investment, and quality of care is a basic duty’

István Ujhelyi MEP

The virtual roundtable entitled ‘Preventing infections in the surgical care pathway to tackle antimicrobial resistance’ took place on Tuesday 17 November 2020 from 14:00 to 17:30 Brussels time. The purpose of the meeting was to discuss pathways to reduce the burden on surgical site infections (SSIs), curbing antimicrobial resistance and, crucially, enhancing patient safety in Europe. The debate was followed by the launch of HFE Insight Report on ‘Identifying the gaps between evidence and practice in the prevention of surgical site infections’ ” showing a striking gaps between evidence-based measures suggested by official guidelines and medical practices in European hospitals which represent a serious concern for the safety of European patients.

Despite efforts put in place by European hospitals, Healthcare-Associated Infections (HAIs) continue to be the most frequent adverse event during care delivery. Every day, about 80,000 Europeans in hospitals throughout the continent have at least one HAI: 1 in 18 patients. Overall, the ECDC estimates that approximately 8.9 million infections occur each year in EU healthcare settings, and many of such HAIs, as highlighted by the 2017 Resolution of the World Health Assembly, lead to sepsis. This, in turn, result in approximately 37,000 deaths throughout the Union. Hence, HAIs continue to be a significant threat to patient safety throughout Europe. A crucial example of a HAI are Surgical Site Infections (SSIs). SSIs themselves are a threat to millions of lives and lead to over 16,000 deaths. As any HAI, SSIs are often caused by antimicrobial resistance (AMR), which increases costs and the complexity of treatment. But SSIs are preventable, and if the necessary actions are taken, the threat of drug-resistant infections will be minimised, resulting in millions of lives saved. Hence it is paramount that better systems to prevent them are put in place to increase patient safety and care throughout the continent.

In this context, this virtual roundtable was an opportunity to bring together high-level speakers from the WHO, the ECDC, country-level experts and EU health stakeholders with the view to discuss current gaps on the current level of implementation of the WHO Guidelines on SSIs and provide useful political recommendations to prevent and manage the incidence of such infections across the surgical care pathway to curb SSIs and AMR, and, ultimately, enhance patient safety in Europe.

The roundtable was opened by HFE President Dr Roberto Bertollini who called for a holistic, and multilevel strategy to tackle SSIs: from system change to further education, surveillance, and awareness of this issue by EU policymakers, practitioners, healthcare workers, and patients.

The debate was hosted by MEP Istvan Ujhelyi (Hungary, S&D) who called on the need to reduce HAIs and showed his commitment for a harmonised and cohesive European health system and to push health policy issues in the EU. He also highlighted the need for access to quality health and care throughout the Union regardless of where citizens live as it is a matter of human rights and decency. He also showed his interest in the European Parliament report on EU4HEALTH calling the European Commission to develop new guidelines on patient safety and on boosting investment to modernise EU health systems to increase the fight against HAIs and AMR.

To provide a clearer picture of the state of play regarding AMR, Dr Dominique Monnet, Head of the Antimicrobial Resistance and Healthcare-associated Infections Programme at the European Centre for Disease Prevention and Control (ECDC), provided an overview of the extent of this issue in Europe. He stated that the ECDC’s figures on antibiotic consumption confirmed the large variation between countries and praised the efforts of the healthcare community to tackle this vital issue. But Dr Monnet reminded attendants that AMR is still one of the biggest challenges for Europeans as, for instance, Vancomycin consumption, a last-line antibody, has almost doubled since 2015 according to ECDC data. He further highlighted that 25% of healthcare professionals do not have access to guidelines of infection management and that there is a need for their further education and an improvement of infection control practices. Finally, Dr Monnet emphasised that the Covid-19 pandemic has reminded healthcare professionals that compliance with guidelines is critical for the safety of patients and that such compliance now needs to be extended and mandated to finally decrease AMR.

Following the opening remarks of this roundtable, an evaluation of the current SSIs situation throughout Europe was presented. Firstly, Prof. Dr med. Wolf O. Bechstein, the President of the  DGAV, compared the SSI situation in Germany to those of other European countries and showed factors that could lead to higher rates of SSIs such as global warming, the effects of which is normally underestimated. Secondly, Dr Massimo Sartelli, a Member of the ACOI, showed the Italian and Greek perspectives on SSIs and stated that there is still no sense of urgency by most policymakers. Dr Sartelli called on focusing on preventing SSIs rather than curing them and the need for a ‘cultural change’ in which infection prevention and control is of high importance and invited ‘heroes’ to drive sectorial behavioural change. Thirdly, Dr Josep M. Badia, the President of the Spanish Observatory of Infection in Surgery, presented the Spanish experience and stated that though guidelines are extensive, a major issue occurring among Spanish healthcare workers is their non-compliance with them. Dr Badia exposed a vast amount of procedures occurring in Spanish hospitals that do not comply with EU guidelines as well as a high level of disagreement between surgeons and some guidelines. Finally, Prof. Peter Sagar, a Member of Royal College of Surgeons of England, exposed the UK’s perspective and the best practices that need to be done in each surgical operational phase to reduce the risk of SSIs while emphasising that senior surgeons should lead by example and provide staff with guidance. After their presentations, the speakers agreed that there are a variety of actions that need to occur to tackle SSIs throughout the EU.

Following this concept, five multi-level recommendations were presented by members of the research team to reduce the burden of SSIs. Dr Kemal Rasa, the President of the Surgical Infection Society, asserted that there is a need for a ‘post-guideline’ era and the sector needs to act with proper measures and adopt new surveillance methods to be able to deal with SSIs adequately: from mobile phone applications to the use of AI. This would allow for the earlier detection of SSIs and reduce the risk to patients. Prof. Benedetta Allegranzi, the Technical Lead of the Infection Prevention and Control Hub and Task Force of the WHO, agreed with such that there is a need to act to reduce SSIs but this needs to be done with a multilevel approach involving all stakeholders as shown in the WHO implementation framework: educating people, providing them with feedback and data, continuing to remind them with a ‘checklist’ of good practices, and finally change the culture in the practices.

Such a multilevel approach requires a high degree of data. And on this theme, Dr Paul Garassus, the President of the European Union of Private Hospitals, furthered the notion of a preventive approach in healthcare but with a strong focus on providing quality information to professionals. He called for the creation of an international dashboard where professionals would have their performance benchmarked to the one of other practitioners, allowing for the imposition of a quality culture in European hospitals, leading to the protection of human capital.

Following on the theme of education and the lack of implementation of guidelines, Paola Kruger, the Patient representative of the European Patient’ s Academy, argued that patients become key partners through further education and not just be end-users in healthcare. Prof. Dr Pascal Astagneau of Sorbonne University also contended that there is a need for a harmonised training and education system from the beginning of the careers of healthcare professionals at university. He showed how the education of each medical professionals should occur, with specific preparations to reduce the SSI rate. Such training should use modern technologies such as VR sets and simulation-based learning to boost the skills needed to prevent SSIs.

Finally, Dr Tommi Kärki, the expert on antimicrobial resistance and healthcare-associated infections of the ECDC, maintained that there is a need for active surveillance of SSIs and monitoring of the implementation of prevention measure and called for hospital guidelines to be in line with the international guidelines, especially at the local level, due to the large variation of guidelines compliance.

Overall, participants agreed on the multilevel approach that needs to be taken to tackle HAIs and SSIs. It is necessary to build consensus around evidence-based guidelines such as the one from WHO and define clear protocols to prevent SSIs. But there is a need for the creation of a cultural change amongst healthcare workers through the use of data, educating patients with multilingual handouts to increase their freedom of choice, and the need for further investment in the deployment of new technologies to monitor patients after leaving hospitals. All such measures are needed to achieve an improvement in the quality of healthcare that Europeans enjoy, and decrease the impact of HAIs and SSIs throughout the continent.

We invite you to read the full published report. The press release and an extract of the full report are also available in multiple languages: press release (available in English, French, German, Italian, and Spanish) and the extract of the report (available in English, French, German, Italian, and Spanish).

EVENT SUMMARY: EP Interest Group on Innovation in Health and Social Care – Transforming Healthcare: A European healthcare workforce

 It is essential that the EU leads in preparing the second wave of COVID-19 – and potentially the next pandemic – by ultimately facilitating the creation of a “healthcare army” that can move freely throughout the EU and deploy their competences and knowledge where patients most need them.

Prof. Jozef Kesecioglu
President of ESCIM

The European Parliament Interest Group on Innovation in Health and Social Care held a virtual roundtable on 1 October 2020, entitled “Transforming Healthcare: A European healthcare workforce” to discuss how to improve healthcare systems in Europe from the perspective of healthcare professionals.  The purpose of discussion was to define concrete solutions to ensure that health workers have the necessary skills and knowledge to tackle diseases outbreaks while tackling the uneven distribution of healthcare systems capacity within the European Union.

MEP Tomislav Sokol (EPP, Croatia) co-chair of the EP Interest Group on Innovation in Health and Social after welcoming the speakers and participants highlighted the problems faced by healthcare sector and the general shortage of medical professionals. A number of Member States are experiencing outflows of medical staff leading to an increasingly worrying brain drain in such a vital sector. While highlighting one of the pillars of the European Union, freedom of movement, and the need to have mutual diploma recognition across Europe and minimum requirement systems. MEP Sokol also stressed on the need to implement retention measures that strengthen the healthcare systems at a national level. The EU’s multi-annual financial framework is an important tool that could be used to address and implement structural reforms of healthcare systems. The European Commission’s original proposal on the EU4HEALTH budget was a step in the right direction, however, the Council has already decided to reduce the budget allocation earmarked for health. The EP will continue working for more funds to be directed towards improving health systems EU-wide. Cohesion policy funds even if cannot directly address the health brain drain, however, they can be used to improve working conditions and to invest in medical infrastructure which would incentivise workers to give their services at home.

The other co-chair of the EP Interest Group, MEP Irena Joveva (Renew, Slovenia) focused on the importance of the healthcare sector. “The capacity of health systems to address the changing needs for care, as well as the current pandemic, strongly depends on their workforce, its availability, its safety, skills and equipment to tackle disease outbreaks and raising demand of care.” said MEP Irena Joveva. The European Commission has taken important and concrete actions to foster healthcare workforce education across borders, also through providing funding for the training of a multidisciplinary pool of healthcare professionals supporting and assisting Intensive Care Units (ICUs), the C19_SPACE training programme. MEP Joveva highlighted the need to build a European long-term strategy that embraces innovative processes and solutions to the weaknesses of the current European health systems. She also called for a revamp of the Action Plan for EU health workforce that anticipates future needs and skills required in future emergencies and disease outbreaks.

The first speaker of the webinar was Prof Jozef Kesecioglu, President of the European Society of Intensive Care Medicine (ESICM), who emphasised the need to be prepared for the next wave of the Covid-19 health crisis especially through the assistance of personnel working in ICUs. The Emergency Support Instrument of the European Commission, which helps Member States in their efforts to address the coronavirus pandemic, and DG SANTE is funding a training programme C19_SPACE to support healthcare professionals in the European Union to acquire intensive care skills. The training will provide intensive care skills to healthcare professionals, doctors and nurses alike, not regularly working in ICUs or just starting their career in ICUs and will be available cost-free to healthcare professionals across the EU until the end of December 2020. The aim of the training program C19_SPACE is to reach professionals in all the 27 Member States and the UK, working in 1,000 hospitals with a minimum of 10,000 healthcare staff to be trained.

Ms Maria Teresa Parisotto, Executive Director of European Specialist Nurses Organisation (ESNO), stressed that currently in Europe there are significant differences between healthcare education systems. To be better prepared for future health emergencies there should be more harmonisation across the EU and enable nurses to be able to easily work in other countries should the need arise again. Ms Parisotto gave an overview of the nursing sector in Europe and highlighted the difference in nomenclatures, education levels and other criteria between the Member States. The importance of the nursing sector has been elevated during the last months and there is now a necessity of establishing a common training framework across the EU in order to ensure easier movement of healthcare workers in time of need.

Discussing the importance of a digital transformation within the health sector, Mr George Valiotis  Executive Director of European Health Management Association (EHMA), highlighted the key role of: education of healthcare workforce and the need to reorganise relationships between health actors as essential elements to transform healthcare for the benefit of the entire society.  The digital transformation requires dynamic and new skills, as well as embracing the potential that AI has to offer in the health field. The need for at least a certain skill level to be obtained at the end of formal training should be harmonised across the EU, even though the Treaties do not legally allow for outright harmonisation of educational requirements which remain a national competency.

As stated by MEP Sokol ‘Within the tight limitations of the current EU health policy competencies, it is possible to  certain incentives that could encourage Member States to align and improve their educational systems especially for nursing through financing mechanisms, individual projects and management assistance’..

Mr Bert van Caelenberg, Secretary General of European Federation of Public Service Employees (EUROFEDOP), once again stressed how the Covid-19 pandemic highlighted the crucial role that healthcare staff play in society. The so-called “brain drain” of medical professionals has destabilising effects on the sending countries, especially since the leaving workers are usually younger in age leaving behind an aging workforce with added burdens. The outflow of workforce is not only attributable to low wages but also to poor working conditions that push personnel to look for work abroad. As previously mentioned, there is the need to harmonise training programs in Europe which would directly improve healthcare systems across the EU. It is also important to note that there exists an uneven digital capacity in Europe which also needs to be addressed through proper training of the healthcare workforce.

The last speaker of the roundtable was, Ms Kate Ling on behalf of the European Hospital and Healthcare Employers’ Association (HOSPEEM), who focused on the challenges being faced by the healthcare sector. The sector is experiencing staff shortages combined with an aging population as well as an aging workforce, but the demand for services is also increasing. This situation requires more than just an increase in recruitment but the need to tap into new ways into how services can be delivered, such as through AI and ICT solutions. Staff needs to be equipped with the adequate technologies but also must be properly trained. Opportunities for upskilling must be available for all staff and new solutions should empower personnel to better carry out their job and not threaten them. Ideally, staff should be involved in the design and development of new ways of working in order to overcome resistance and ensure that solutions actually work.

In the closing remarks all panellists agreed on duty and opportunity to rebuild and strengthen our health systems and co-create safe, innovative, robust and resilient health systems which are future proofed against any upcoming health related emergency shocks. It urges to agree, at least, on a minimum requirements in health workers` education and training to build an effective European health workforce able to tackle public health emergencies and to enable greater freedom of movement of staff, while still allowing the flexibility for Member States to add requirements domestically.

EVENT SUMMARY: Pathways for fostering patient safety across Europe: Learning from regional success stories

“We need a European Health Union. We need minimum quality standards for public heathcare systems in Europe, it is in the interest of all of us.”

MEP Istvan Ujhelyi

The virtual roundtable entitled “Pathways for fostering patient safety across Europe: Learning from regional success stories” took place on Tuesday 8 September 2020 at 11:00 – 12:30 Brussels time. The purpose of the discussion was to bring together healthcare authorities, academics, healthcare providers and workers as well as EU policymakers to discuss pathways for implementing best practices and for fostering patient safety in all healthcare settings.

European health systems still face significant challenges when it comes to patient safety. Regulatory responses and protocols vary considerably across Member States as well as across individual regions and even individual hospitals. Broadening lawmakers’ and health care professionals’ understanding of patient safety and the many issues associated with it as well as of the potential of innovation and digital solutions in preventing harm is needed in order to advance quality of care in Europe’s hospitals. This need has never been more pressing than in the face of one of the biggest challenges for European and global healthcare systems to date, namely the COVID-19 pandemic. The crisis has once again demonstrated the paramount importance of patient safety protocols for infection control and prevention and the need for timely and efficient implementation of best practices for preventing harm and saving lives. In this context, Health First Europe organized a webinar dedicated to showcasing patient safety success stories from across Europe’s regions and local governments in an attempt to demonstrate the value of innovation for the advancement of quality of care in European health care settings.

Patient harm can be caused by a range of adverse events both preventable and non-preventable. Such patient safety lapses can result from issues including hospital-associated infections (HAIs) due to growing anti-microbial resistance (AMR) or poor sanitation protocols, medication errors, diagnostic errors, pressure ulcers, patient falls, venous thromboembolism or death during interventions with typically low mortality rates. The discussion in the webinar focused primarily on best practices for mitigating medication error and preventing HAIs and AMR as well as on reporting systems for adverse events.

The debate was hosted by MEP Istvan Ujhelyi (Hungary, S&D) who called for the establishment of a European Health and stressed the need for ensuring universal access to high quality healthcare for all Europeans, an issue which has become even more pressing in the face of the COVID-19 pandemic.  Boosting patient safety and tackling existing imbalances in the EU health systems is crucial for ensuring long-term social and economic development in the EU.

In order to know the challenges and identify policy solutions for patient safety, it is crucial to start from the state of play. Dr. Dominique Monnet, Head of the Antimicrobial Resistance and Healthcare-associated Infections Programme at the European Centre for Disease Prevention and Control (ECDC), elaborated on the burden of hospital-associated infections (HAIs) on the healthcare systems of EU/EEA countries. ECDC estimated that about 9 million HAIs occur each year in European acute care hospitals and long-term care facilities, with up to half of those being preventable with various interventions. Dr. Monnet highlighted the connection between growing antimicrobial resistance (AMR) and HAIs, and spoke of the importance of sustained efforts to reduce rates of AMR. Tackling AMR is not only crucial for ensuring patient safety but offers significant opportunities for reducing healthcare costs. Based on a study carried out in 2018 by the Organisation for Economic Co-operation and Development (OECD), each euro spent on measures to tackle AMR will convert into 2.5 euros of savings for the healthcare system. Although there are European and, in most countries, national-level action plans and guidelines, the challenge remains the implementation of tailored interventions in each individual healthcare settings.

The core of the webinar were three case studies focused on patient safety best practices, tackling the issues of medication errors, HAIs and AMR and adverse events reporting systems. The first one was introduced by Professor Elisabetta Caselli from the University of Ferrara. Her case study focused on innovative hygiene technologies and their potential for improving patient safety. In her intervention, Professor Caselli outlined the limitations of traditional chemical sanitization tools including their inability to effectively prevent recontamination, their negative environmental impact as well as their tendency to favour the selection of drug resistant bacteria strains which represent the largest share of HAI-associated pathogens. In comparison, alternative solutions such probiotic-based hospital sanitation technologies offer fewer harmful side effects while successfully limiting the growth of pathogens. Studies into the effectiveness of one such solution, the PCHS system, reported a 50% decline in HAIs incidence as well as 60% reduction in drug consumption and 75% reduction in associated costs. Such data highlights the importance of hospital hygiene (in addition to hand hygiene and other hygiene protocols) in preventing infections.

Alongside HAIs and AMR, the issue of medication error represents one of the most common sources of patient harm accounting for up to 25% of preventable adverse events recorded in the healthcare setting. Medication error refers to any error that occurs in the medication delivery process, from prescription to administration. Departing from the significant costs associated with such errors both in terms of patient suffering and in terms of healthcare spending, Professor Pascal Bonnabry, Chief Pharmacist at Geneva University Hospital, focused his presentation on the potential of IT solutions in overcoming this issue. Tackling the problem of medication error requires a multi-dimensional approach integrating processes, persons (healthcare professionals as well as patients) and the products themselves. IT solutions offer a number of benefits in this regard. They have the potential to improve safety through avoiding human errors and making processes more reliable, to boost efficiency allowing hospitals to do more with less staff and free up valuable time for patient care as well as to improve traceability thus aiding the fight against falsified medicines. In this context, concrete IT solutions such as automated dispensary cabinets, robotized medicine distribution and bedside scanning have the potential to reduce error incidents by as much as 60% from today’s levels.

Staying within the theme of technological innovation and automation, Dr. Paul Garassus, President of the European Union of Private Hospitals (UEHP) spoke of the importance of appropriate systems for risk management and “adverse event” reporting. Specifically, he presented the case study of Sana Kliniken’s Governance System for incident reporting paying particular attention at the issue of effective information management. In this context, Dr. Garassus acknowledged also the importance of managing cybersecurity risks and addressing issues such as data storage for advancing the safety of patients.

Following the presentations of the three case studies, Mr. Jean-Luc Vanraes from the European Committee of the Regions reflected on the role of the European Union in facilitating the scaling of successful patient safety practices and protocols as those outlined by the speakers. He reminded participants of the need to bolster political awareness of the problem of patient safety but also of the cost-saving benefits of addressing it effectively. Furthermore, Mr. Vanraes highlighted the issue of inconsistent protocols on patient safety across hospitals and spoke of the need for an EU-wide public accreditation system with clear standards of quality. This, he said, would be an important step in providing Europe’s regions with the tools to ensure the highest quality of patient care in their local hospitals.

Overall, participants in the debate agreed on the need to embrace innovation in tackling the issue of patient safety as well as on the benefits from knowledge sharing for facilitating the scaling of successful patient safety practices. Investment in the deployment of new technologies will not only markedly improve quality of care for all Europeans but has the potential to alleviate the significant financial burden of patient safety lapses in the long-term.

The discussion’s content will feed into a follow-up report on regional patient safety success stories, which will be published later this year.

This event was made possible thanks to unrestricted grants from BD and Copma Scrl.

Speakers’ presentations: 

EVENT SUMMARY – 2020 DG SANTE Thematic Network 4th Webinar: AI and Robotics

The fourth webinar of the European Commission’s Health Policy Platform Thematic Network on “Profiling and training the health care workers of the future” took place on Monday 9 September 2020 via webinar. The event was organised by Health First Europe and EHMA, as coordinators of the EUHPP Thematic Network dedicated to “Profiling and training the health care workers of the future”. The meeting aimed at discussing education programmes and core competencies in the scope of AI and robotics with the contribution of Dr Imran Aslam from the United European Gastroenterology (UEG), and Ms Monique Kappert, Innovation Manager at the St. Franciscus Hospital in Rotterdam. The speakers introduced their case studies on the use of robotic platforms and AI solutions, the importance of which has been highlighted by the current COVID-19 pandemic.

As introduced by Ms Monique Kappert, with an ageing population, the way we deliver healthcare must change. Most of the times, patients search online for medical recommendations before visiting a doctor. They generate all kinds of data that are potential relevant for their wellbeing; and they expect a different way of treatment and communication. On workforce’s shortage, Ms Monique Kappert stressed that we will be faced by an increasing deficiency of resources can be partially solved by robotics, but healthcare managers and decisionmakers shall always keep in mind that innovation is about people not technologies.

In Franciscus Gasthuis & Vlietland, Ms Monique Kappert and her colleagues explore all kinds of innovations in robotics, for example social humanoid robot able to recognize faces and to engage with people through conversation and his touch screen. With remote-monitoring capabilities, robots empower patient to access larger-scope care.

The case study resulted in the following policy recommendations:

  • Involve people who love to experiment and are enthusiastic by themselves;
  • Engagement of patients from the start;
  • Pick the patient journey as a starting point and change it in the most optimum process, sustainable for long-term;
  • Define a clear process and let the team celebrate successes – even the small ones;
  • Pay attention to emotions of care professionals that are afraid to become unnecessary

The second study case was presented by Prof. Dr. med. Alexander Meining – gastroenterologist at the University Hospital in Würzburg, Germany. He talked about robotics in the field of gastroenterology

Half million robot assisted surgeries have been performed throughout the world every year. Robotics platforms are human operated and controlled tool kits to perform laparoscopic and endoscopic procedures. Three dimensional views, access in crowded organ spaces and fine range of movements on robotic arms enable healthcare professionals to perform complex procedures with more precision, flexibility and control.

Robotic tool kits are used to remove gastrointestinal (GI) cancers, perform bariatric surgery, fix tissues to its normal positions and provide diagnostic access to GI tract. Robotic assisted minimally invasive procedures are associated with less pain, early hospital discharge and better outcomes. Development of slender, versatile and affordable robotic platforms is enabling healthcare professionals to perform less invasive diagnostic and therapeutic procedures with the potential to reduce variation in outcomes. However, a lack of standardised training pathway, certification of GI healthcare professionals using robotic toolkits and European database for safety and clinical outcomes is still lacking. Access to robotic platforms is also disparate in Europe and is a burden to train professionals.

The use of robotic platforms to detect and treat diseases, in our case gastrointestinal diseases, is growing at a fast pace. Clinical application of robotic platforms is currently challenging. Robotics offers many potential technical advantages and are an opportunity for the diagnostic and treatment of numerous digestive diseases, as robotics are being used for Bariatric surgery, rectal cancer surgery, endoscopic therapeutic procedures, etc.

Robotics benefit to the general public, reducing variation in outcomes, improving clinical outcomes and results, and allowing short term advantages of minimally invasive procedures, with for example less operative blood loss, less postoperative pain and consequently, reduced requirement of narcotics, and a shorter length of stay.

To cope with the fast development of robotic surgery, the use of these robotic platforms needs to be increasingly trained, taught, and certificates should be delivered for the use of gastrointestinal robotics. At the EU Level, we experience strong inequalities in the uptake of gastrointestinal robotics and different quality standards for their use. It is therefore becoming increasingly important to develop aligned standards of Robotic Surgery training in Europe.

The case study resulted in the following policy recommendations:

Exchanges of good practices and establishment of common standards in training and quality of Robotic Surgery in general, and in gastrointestinal surgery specifically, is needed. Medical societies are participating in the dissemination of knowledge, high standards and guidelines. A comprehensive European agenda and further dissemination towards health care professionals across Europe should be discussed.

In the open debates, participants discussed the challenges and opportunities of robotic applications to healthcare systems as well as the great amount of data needed to make it work. Robotics in surgery is becoming more sophisticated with the time, new technologies allow minimal invasive surgery and endoscopy. Healthcare workers need to have access to continual training programmes to drive these innovations, constantly updating,

EU institutions are increasingly focusing on the legal challenges posed by the robotics and AI sector. Although much remains to be decided, it is clear that future steps from the Commission will significantly affect the development of robotics and AI research and development in the EU.

The outcome of this debate, as well as of the following webinars, will be included the Thematic Network joint statement, aiming at profiling the healthcare workers of the future and identifying their core competencies and role for promoting data-driven innovation and patient-centred and inter-disciplinary models of care.

EVENT SUMMARY – 2020 DG SANTE Thematic Network 3rd Webinar: Nurses’ training and core competences

The third meeting of the European Commission’s Health Policy Platform Thematic Network on “Profiling and training the health care workers of the future” took place on Monday 22 June 2020 via webinar. The event was organised by Health First Europe and EHMA, as coordinators of the EUHPP Thematic Network dedicated to “Profiling and training the health care workers of the future”. The meeting aimed at discussing the issue of training and core competencies for nurses, the importance of which has been highlighted by the current COVID-19 pandemic. The ways in which healthcare systems and policymakers can support nurses’ education and training to develop their core skills for delivering care was a key theme of the webinar. Speakers presented case studies on core skills and policy actions to enhance nurses’ indispensable role in ensuring continuity of care as well as in identify and implementing best practice models and innovative solutions to improve patient care.

Nursing staff’s education and training are essential to developing skills and competences for the provision of integrated care, especially for those patients coping with chronic conditions and various comorbidities. Digital solutions have a great role to play in ensuring continuity of care, provided that health care professionals are trained for their use as well as involved in identifying the most effective digital tools. Investing in digital skills and in healthcare workers’ education and specialisation is key for building resilient healthcare systems characterised by high patient safety standards. A robust approach to the training and specialisation of nursing staff would be essential not only for dealing with emergencies but for addressing the needs of an increasingly aging population.

Opening the discussion, Mr. Reinhard Waldhör from the Health Trade Union and Public Services Union of Austria, presented a 2019 scoping review on acceptance, effectiveness and efficiency (AEE) studies of informal and formal care technologies authored by Krick et al. The main aim of the review was to examine the existence, usage and benefits of digital technologies in nursing care as well as their potential for offering solutions to problems such as the shortage of skilled workers and the increasing demand for long-term care. Summarising the approach and findings of the scoping review, Mr. Waldhör highlighted the importance of applied AEE evaluation methods as well as on the issue of efficiency of digital technologies deployed in nursing care specifically. He also stressed that sufficient funding should be made available to enable large-scale, long-term evaluations of technologies in the practice of care, filling the research gaps for technologies, target settings and target groups identified in the review.

Departing from those recommendations, Dr. Viorel Rotila, Professor of Social Sciences and President of Health Care Trade Union of Romania (FSSDR), introduced the case study of Romania. Departing from the experience of the Romanian health system, Dr. Rotila discussed the impact of new technologies on nurses as well as the challenges faced by nursing staff when adapting to new professional and technological requirements. In this context, he highlighted the shortage of nursing staff as one of the key problems observed in Romania and one which has been exasperated by the current COVID-19 pandemic. He further pointed at the increased bureaucratisation of the nursing profession which has led to the increase of professional requirements and necessitated continuous re-training thus reducing opportunities for developing meaningful nurse-patient relations. In this context, Dr. Rotila reflected on the impact of new technologies on nurses stressing both the potential for reducing workload as well as the need for appropriate training and skills for the effective utilisation of such technologies.  Professional bodies and institutions were said to often be unable to deal with those new challenges and to provide sufficient support for nursing staff including through the provision of appropriate training and information.

Dr. Rotila highlighted the need for developing robust training programmes and a clear path towards career progression in order to tackle those issues. He cautioned against simplifying training as a means to address nursing shortages in the short term. He suggested that instead alternative strategies such as the creation of new professional categories requiring less training and able to take on some of the nursing tasks could be more effective. Finally, Dr. Rotila called for the modernisation of training practices and the adoption of a new approach to training favouring continuous renewal and development of existing competencies as well as new skills.

Acknowledging the need for revamping of existing training practices in the nursing profession, Dr Eszter Kovacs from the Health Services Management Training Center at Semmelweis University and a Coordinator of SEPEN Tender (“European Support for the Health Workforce Planning and Forecasting Expert Network”), discussed the issue of healthcare planning and its role in strengthening the position of nurses and midwives in the healthcare sector. Dr Kovacs also highlighted the wide-spread shortages of nursing staff but stressed the importance of prioritising quality of staff over quantity. In this context, she discussed the need for developing a common educational framework in Europe in order to remedy the mismatch in training that exists currently. She noted the positive impact that the current COVID-19 pandemic has had in exposing the need for robust data on health workforce across jurisdictions. Dr Kovacs also pointed at the acceleration of the digital transformation of healthcare systems which has been necessitated by the pandemic. In order to ensure that the workforce adapts effectively to this transition, she stressed the need for an EU-level dialogue on nursing education and upscaling.

The above case studies resulted in the following policy recommendations:

  1. Fund research enabling large-scale, long-term evaluation of the efficiency and effectiveness of digital technologies in the practice of care.
  2. Promote digital literacy among nursing staff in order to ensure effective utilisation of digital technologies.
  3. Modernise training practices to make them fit for the digital age.
  4. Develop a common educational framework for nurses in Europe.

Dr Mwidimi Ndosi, Senior Lecturer in Rheumatology Nursing at UWE Bristol in the United Kingdom (representing EULAR, European League Against Rheumatism, nember of the BioMed Alliance) discussed the need for developing harmonised competences and training of specialist nurses in rheumatology. Dr Ndosi agreed with the other speakers’ concerns about the differences in training across Europe. Furthermore, speaking of the situation in the UK, he outlined the lack of sufficient training as well as insufficient succession planning as key concerns in the rheumatology nursing community.  He specifically stressed the need for strengthening training in diagnostics, disease and risk management and health promotion.

Dr Ndosi argued for the development of competence-based training which takes into account the key skills (both generic and specialised) that nurses need to possess. In this context, he presented the Royal College of Nurses Competency Framework which was developed by leading emergency nursing experts in order to support personal and continuous professional development of nurses as well as succession planning. It also represents a benchmarking tool for rheumatology nurses and a tool for establishing nation-wide standards of training. Such frameworks, Dr Ndosi argued, are key in facilitating a clear pathway for career development for nurses by defining specific competencies, qualities and outcomes that are expected from nursing staff. Such competence-based training can be instrumental in facilitating a patient-centred approach to care.

The case study resulted in the following policy recommendations:

  1. Develop robust competence-based training as a means to facilitate a clear pathway to career development for nurses.
  2. Address current mismatch between the training offered across different European countries.
  3. Strengthen specialist training for nursing staff.

In response to the speakers’ input, Alina Timofte from DG SANTE of the European Commission, acknowledged the central importance of workforce training and lifelong learning for achieving resilience of the European healthcare systems. The need for remedying shortcoming in training as well as shortages of healthcare staff have become especially obvious during the current pandemic. While building a sustainable and resilient healthcare workforce remains primarily a national competency, Ms. Timofte stressed the Commission’s willingness to support national authorities in their efforts to address shared challenges. In this context, the Commission has invested in various health-related projects including related to training. Ms. Timofte further noted the key challenge of digitalisation as well as its potential for improving patient safety, boosting quality and reducing inequalities in access to healthcare. To support this process, the Commission is committed to supporting workforce training as well as digital literacy more generally in order to prevent the emergence of a digital divide in access to care.

Sumathi Subramaniam from the Commission’s Directorate General for Education and Culture, elaborated on the Commission’s efforts to harmonise education and training frameworks, which include nurses. She also noted that curriculum development should take into account the lessons learnt from the COVID-19 pandemic. Training and career paths should also seek to address existing gender imbalances in the nursing field in order to ensure a truly diverse workforce.

Building on the discussion, Sara Fasoli from the European Hospital and Healthcare Employers’ Association (HOSPEEM) stressed the key importance of leadership and soft skills (e.g. empathy, communications skills) for nurses. Johan Prevot from the International Patient Organisation for Primary Immunodeficiencies (IPOPI) endorsed observations on the need for more training and better education as well as on the shortage of trained specialised nurses. He stressed that this is a particularly important issue when it comes to rare diseases where significant discrepancies in availability of specialist nursing staff across Member States exists. Reflecting on the challenges of digitalisation specifically, Mr. Prevot highlighted the key role played by nurses in facilitating the digital transition and the uptake of new tools. To allow them to successfully perform this role, however, nurses should be provided appropriate training on data management as well as on the use of specific devices and

Overall, participants agreed that robust and harmonised workforce training is essential for transforming Europe’s healthcare systems and reaping the benefits of the digital revolution. Replacing the current mismatch in training practices with a common European educational framework focused on competencies and specialist skills as the basis for career progression has the potential to make the profession more appealing and remedy nursing shortages. Professional organisations, educational institutions and EU law-makers all have a role to play in facilitating the training of a European nursing workforce fit for the digital age.

The outcome of this debate, as well as of the following webinars, will be included the Thematic Network joint statement, aiming at profiling the healthcare workers of the future and identifying their core competencies and role for promoting data-driven innovation and patient-centred and inter-disciplinary models of care.

 Speakers’ presentations: 

EVENT SUMMARY: My City-Lab Talk Series – AI in Outbreak Management

The latest meeting of the My City-Lab Talk Series “AI in Outbreak Management” took place on 10 June 2020. The event was organised by Health First Europe, as a partner of My City-Lab project, to discuss how AI can contribute to the management of outbreaks and pandemics.

What role for AI in outbreak management?

The potential of Artificial Intelligence (AI) for improving healthcare has become a subject of significant interest in the past years. One of the areas in which AI can have particular relevance is the field of outbreak management. As highlighted by the event moderator Damien Gruson, the urgent need for fostering and deploying AI solutions has been demonstrated by the current COVID-19 pandemic. The current crisis has provided a new impetus for the deployment of AI in the management of outbreak.

In this context, David Gruson, Director of the Health Programme at Jouve, highlighted the relevance of AI in the management of infectious diseases even prior to the pandemic. AI technologies have long been deployed for the purposes of data management and disease outbreak monitoring with the HealthMap project being but one prominent example. The COVID-19 crisis has, however, proven to be a turning point for the field as it has necessitated the overhaul of existing approaches.

Mr. Gruson also outlined some of the challenges associated with deploying AI solutions in the healthcare context. Availability of reliable data as well as the high starting costs and steep investment curve remain major challenges for providers, especially for medium-sized ones. Increased use of AI for tracking in the context of the COVID- 19 pandemic has also raised ethical and political questions about data protection and balancing individual freedoms with collective interest. Finally, Mr. Gruson stressed the need to achieve a balance between ensuring appropriate regulations of the sector to prevent abuses and encouraging innovation. He noted that some positive signs in this respect are present as regulators have shown interest in facilitating the growth of AI technologies.

Neda Milevska-Kostova (International Alliance of Patients’ Organisations – IAPO), for her part delved deeper into the role of patients in the AI debate. She expressed concern that the current pandemic and the associated digital disruption can somewhat overshadow patients as healthcare professionals need more time to service the technology. However, from a patient perspective AI deployment can have concrete practical applications and benefits. AI-enabled smartphone applications for outbreak tracking, diagnostic chatbots and tools for prognosis prediction based on large data-sets are already being developed. While further study into their effectiveness is still needed, such tools have the potential to reduce the waiting time between symptoms and diagnosis and allow patients to assume an active role in the healthcare process. In the context of the development of such tools, ethical and security issues also need to be addressed.

Outstanding challenges and questions notwithstanding, the COVID-19 pandemic has served as an incubator for the rollout of AI solutions in the healthcare sector. Nadine Nehme, Researcher and Scientist at Medicus AI, discussed some of those solutions as well as the general take-up of AI technologies by various countries during the crisis. She noted that AI-driven algorithms and platforms are increasingly deployed to assist healthcare professionals in diagnosis and treatment as well as to track the evolution of the virus and its spread.  A good example in this context is the Infervision software which was developed to read lung scans of suspected and confirmed COVID-19 patients. Platforms such as BlueDot and HealthMap have successfully utilised various data points in order to map and monitor the spread of the virus.

Dr Nehme further elaborated on the role of AI in tracking which has proven critical in the current pandemic. At the same time, she shared other speakers’ concerns over data protection and surveillance. She stressed the need to find the right balance between data privacy and public health in order to ensure that the population does not lose faith and trust in the healthcare system. Finally, Dr Nehme cautioned that AI while promising cannot compensate for the structural problems of existing healthcare systems, which have been exposed by the crisis.

Healthcare management has a great role to play in the roll-out of AI in the healthcare settings. In this regard, George Valiotis, Executive Director of the European Health Management Association, emphasised the need for health managers to equip staff with the skills needed to make use of AI solutions. Similarly, he noted that ensuring patients have sufficient digital literacy to engage with these technologies will also be essential. Mr. Valiotis argued that wider AI deployment offers clear cost-saving benefits as it could reduce the margin of error which is associated with enormous cost for healthcare systems. Furthermore, AI solutions could free up additional capacities as some of the administrative burden is lifted off shoulders of nurses. Mr. Valiotis stressed, however, that technologies cannot replace humans entirely as they cannot replace certain clinician skills such as empathy and persuasion.

Overall, AI has shown great potential for managing outbreaks like the current COVID-19 pandemic, but much is needed in order for such technologies to be deployed in an effective and safe manner. New standards on data protection and management should strike the balance between innovation and patient protection in order to allow healthcare systems to reap the benefits of AI. If deployed successfully, however, AI can help us learn faster and vastly improve the efficiency of our healthcare systems.

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.

EVENT SUMMARY – 2020 DG SANTE Thematic Network 2nd Webinar: Innovation readiness, digital leadership and literacy

The second meeting of the European Commission’s Health Policy Platform Thematic Network on “Profiling and training the health care workers of the future” took place on Wednesday 13 May 2020 via webinar. The event was organised by Health First Europe and EHMA, as coordinators of the EUHPP Thematic Network dedicated to “Profiling and training the health care workers of the future”. The meeting aimed at discussing how to prepare health care professionals to face the digitalisation of care and enhance digital leadership as well as innovation readiness. During the discussion, two case studies on digital skills and digital readiness in health care settings were presented.

 Health workforce education and training are essential to developing skills and competences for the provision of integrated care, especially for those patients coping with multiple chronic conditions. Digital solutions have a great role to play in ensuring continuity of care, provided that health care professionals are trained for their use as well as involved in identifying the most effective digital tools. Investing in digital skills and in healthcare workers education in digital tools (from electronic health records to AI solutions) ultimately results in  providing the best quality of care for patients while speeding administrative processes, diagnosis and making the delivery of care more efficient and effective.

On digital skills, David Farrell, from Health Education England, explained the importance of digital readiness for healthcare workers to quickly adapt to new technologies and support the healthcare systems to embrace digital solution for care. Digital readiness cannot be unilateral, it needs to be fostered by a wide range of stakeholders, from clinicians to health managers, to patients. Access to innovation and digital technologies should also be granted without excluding minorities, providing equal access to digital technologies in order to make the digital environment easy and safe to navigate.

Mr Farrell presented the case study of the NHS Digital Academy, conducted through Imperial College London, a learning programme in digital health leadership for mid to senior-level workers aiming at enhancing digital skills significantly.

This programme brings innovative solutions for stakeholders to adopt digital leadership skills to be applied in healthcare systems and beyond by:

  •  Providing a framework for digital development and awareness for board level leaders to help them to better understand new technologies
  • Ensuring the understanding of the needs of the current digital workforce and foresee the needs for the future digital workforce
  • Supporting digital skills with an assessment framework (staff development, change of mentality for health mangers)

 The project funded by Health Education England which aims at embracing “Digital Readiness”, building a digital ready workforce and embracing new technologies to boost digital leadership, and empower patients. The case study resulted in the following policy recommendations:

 Embrace a digital change in healthcare management

  1. Promote a culture of open discussion amongst patients and health care professional and open research
  2. Embrace digital literacy to empower health workforce as well as patients
  3. Promote cross-border non-hierarchical health systems
  4. Boost fast, integrated, and light organisational processes
  5. Compare and assess the risks against the benefits of digitalisation
  6. Foster scalable, interoperable, fixable, resilient, and fit-for-purpose technology
  7. Foster multidisciplinary collaboration, innovative attitudes and team learning

The second case study was presented by Trine Ungermann Fredskild (Denmark), and it was focused on the Digital & Innovation Skills Helix in Health (DISH) project.

This project is funded by Erasmus+ programme and it addresses the digital skills’ gap of the healthcare workforce by establishing a triple helix partnership consisting of healthcare providers, educational institutions and enterprise, representing 6 countries (Spain, the UK, Germany, Denmark, Poland and Norway). The project aims at identifying new approaches to support citizens (patients and healthcare professionals) in the use of new technology and at preparing health care professionals to the ongoing digitalisation of care. The Dish project focuses on three areas: innovation readiness, digital leadership, and literacy. The project’s training sessions are horizontal and involve both management and staff, encouraging them to reflect upon:

 How to take offset in real clinical needs?

  • How to lead the change? 
  • How to change the workflows?
  • How to be involved in the process?
  • What do they expect from the training sessions?
  • How to follow up after the training sessions?

All the concepts will be tested in the 6 participating countries, and once completed, a general assessment would be carried including good practices learned from each country. These recommendations could also be transferred to other countries’ health care systems.

 The case study resulted in the following policy recommendations: 

  1. Promote a secure use of digital technology
  2. Encourage training and brainstorming technological participation
  3. Promote an ethical use of technology, valuing patients’ insights in the implementation of digital solutions

During the open debate, Aneta Tyszkiewicz (Council of European Dentists) stressed that European universities should foster a harmonised digital curriculum to benefit and prepare students for their future. She acknowledged the digital gap of the European dentist students, (revealed by recent surveys on digital technologies applied to dental care). Digital skills need to be part of the ongoing learning path of health professionals. In the case of dentists, where many are self-employed, a low-cost additional incentive needs to be in place in order to guarantee their access to digital literacy. On digital skills’ gap, Sara Roda (Standing Committee of European Doctors) further stressed the role of digital and AI literacy to foster trust in new technologies and the importance to concretely define the scope of primary and secondary use of data.

Closing remarks came from Karoline Kristensen (European Commission), who acknowledged support and cooperation was needed between a wide range of different stakeholders, across private and public sector, in order to foster healthcare workforce’s digital skills. In this regard, The Commission’s Directorate-General for Health and Food Safety (DG SANTE) is closely working with the Directorate-General for Internal Market, Industry, Entrepreneurship and SMEs (DG GROW) to ensure digital training is present in Universities curricula across Europe. The European Commission is also committed to keep on mapping the digital gaps in European health systems as well as identify essential digital skills in support of EU member states.

The outcome of this debate, as well as of the following webinars, will be included the Thematic Network joint statement, aiming at profiling the healthcare workers of the future and identifying their core competencies and role for promoting data-driven innovation and patient-centred and inter-disciplinary models of care.

Speakers’ presentations:

EVENT SUMMARY: My City-Lab Talk Series – AI in Genomics

The latest meeting of the My City-Lab Talk Series “AI in Genomics: Delivering Personalised Medicine” took place on May 05th, 2020. The event was organised by Health First Europe, as a partner of My City-Lab project, to discuss how AI can contribute and support health care systems in the field of genomics to obtain personalised medicine.

Why is AI so important for personalised medicine?

AI has come a long way in healthcare, with many different applications, also linked to genomics. By identifying individuals’ phenotypes and genotypes health care professionals can offer personalised medicine, tailoring the right therapeutic strategy for the right person at the right time. AI provides a way for physicians to make diagnoses with greater accuracy when Electronic Health Records (EHR) is in place and interoperable, AI technology can use EHR data patterns creating a diagnosis system for physicians. An accurate diagnosis can then result in better, and more personalised, treatment.

As pointed out by the moderator Damien Gruson, the use of AI is increasing and contributing to the transformation of laboratory medicine and ultimately assisting the development of personalised treatments for a patient or group that are genetically alike. This sort of precision comes from pattern identification and predictions made by AI. As goes with all the uses of Artificial Intelligence, policymakers and technology developers shall take into consideration the important challenges coming with respect to data privacy and security, especially with data so sensitive as DNA. With such confidential information for the systems to process through, security must be at the utmost concern for AI producers and users. Along with security, data quality and quantity shall be considered to ensure the effectiveness of AI technology.

MEP Pilar del Castillo Vera (EPP, Spain), Co-chair of the European Parliament’s Intergroup on Artificial Intelligence & Digital, highlighted the important role of AI and digital health especially during this COVID-19 pandemic, given their contribution in offering insights on the spread of the virus and delivering care to chronic patients. With respect to AI and personalised medicines, she added that AI shall be filled with standardized and good quality data in order to make these technologies work. In this regard, European Health Data Space, European Commission’s initiative, is intended to promote health-data exchange and support research on new preventive strategies and data-driven medicines.

AI is very much needed for advancing health research, but still, it is important to bring concrete AI solutions and AI-driven research closer to the patients. Jana Makedonska, from the European Commission (DG Research & Innovation), emphasised that, although AI for health research was rapidly advancing, it had not been broadly implemented for patients’ use. In this regard, the European Commission is committed to working with the Members States to bring innovation closer to the citizens while ensuring the privacy of their data. Commission´s President, Ursula Von der Leyen, announced in her political guidelines a coordinated European approach to the human and ethical implications of AI, which intends to promote data-driven systems, establishing requirements for the safe use of AI.

Ms Makedonska, also stressed that personalised medicine had been a top priority for a decade for EU policymakers working on innovation and health, as proven by two initiatives:

  • The 2018 initiative “+1 Million Genomes” were the EU Member States and the UK are expected to provide access to at least 1 million sequenced genomes in the EU by 2022. In order to provide better and more personalised treatments to patients.
  • The EU Health Data Space, which aims at making possible for citizens to access their health data across the EU, including the interoperability of Electronic Health Record Systems.

Additionally, the Commission has been working with horizon 2020 to create a COVID-19 data-sharing platform, combining genetic and epidemiological data, for the research community. This will ensure tailored treatments for patients and knowledge sharing for the scientific community.

Nicky Hekster, IBM expert in Big Data and AI, emphasised how AI can become a cornerstone for the reform of healthcare. Clinical data are published “every 30 seconds” and this medical literature is essential to improve medicine and help researchers in speeding up the data-reading processes. Mr Hekster also explained the concept of digital twins, a digital simulation of a living model, that continuously learns and updates itself from multiple sources to represent its counterpart real-time condition. In health care, this can be tailored to anticipate the response of a certain illness or drug in patients. But in order to guarantee democratic access and use of technology in health care settings, safety measures need to be implemented, and patients need to be placed in the centre of decisions.

Carrying on with the debate, Angel Martin, Chair of the MedTech Europe Working Group on AI, stressed how machine learning could save lives by helping to diagnose diseases more accurately and providing more reliable and quicker lab results. Despite the use of AI in healthcare is nothing new, scientific literature is growing attention, having 70% of research coming only from the past 5 years. Mr Martin further highlighted how AI could help to process massive amounts of data to provide a tailored treatment for each individual. However, the lack of data harmonisation between systems and areas of expertise is preventing us to use the full potential of AI. Other significant challenges are the lack of trust in AI due to concerns of privacy and ethics and the lack of digital literacy among health care workers. In this regard, promoting digital skills and training are needed to empower health care workers and ensure proper use of AI in health care settings. Furthermore, digital accountability must be guaranteed, and AI systems must be validated and checked by competent authorities.

AI has a great potential to be used in the field of health care, especially regarding personalised medicine, but in order to do so, data interoperability must be ensured. In addition to control mechanisms that ensure the safety of the data. The European Union has shown some ambition in this regard, but a clearer strategic vision and firmer plans for implementation are needed. Integrating innovation into care, building trust, developing skills and constructing policy frameworks that guarantee equitable access to new technologies in the field of health care need to be fostered by all EU Member States.  Finally, the EU must ensure legal and ethical questions centred on safeguarding patients and their rights. For Europe to success, it will have to find a new spirit of cooperation that can overcome the handicaps of the continent’s fragmented technological and legal landscape.

My City-Lab project – financed by the European Regional Development Fund (ERDF) – aims to create two new primary care structures, called My City-Lab, integrating the innovation of laboratory medicine and mobile health. The scope of the project is to facilitate access to laboratory tests as part of an integrated and collaborative approach to ambulatory care of a chronically ill individual, as well as to contribute to the dynamic monitoring of patients with chronic diseases.

EVENT SUMMARY – 2020 DG SANTE Thematic Network 1st Webinar: Continuity and coordination of care

The first meeting of the European Commission’s Health Policy Platform Thematic Network on “Profiling and training the health care workers of the future” took place on Tuesday 7 April via webinar. The event was organised by Health First Europe and the EHMA, as coordinators of the Thematic Network, to discuss best practices in continuity & coordination of care and how to prepare the health care workforce to provide coordinated care and meet the need of chronic patients. The discussion, moderated by Giulio Gallo (DG SANTE) and Lucia Medori (Health First Europe), was enriched by the presentation of two case studies on diabetes and heart failures.

A right skill mix is needed to provide continuity and coordination of care, especially to those chronic patients that need frequent controls and support in self-management. Prof. Tatjana Milenkovic (IDF Europe) in presenting her case studies on diabetic patients’ care, stressed that all health professionals should be educated to be able to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. This approach is key to improve outcomes for people with diabetes having in mind the complexity of the disease and the huge range of complications that can arise. Prof. Milenkovic guided the participants of the meeting throughout the experience of a patient with diabetes, from diagnosis and treatment to make clear how it looks like in real life for some of them.

Mrs. Smith is a married shop assistant in her early forties with two children in high school. She made an appointment with her primary care physician since she was always thirsty, increasingly losing weight, irritable, and fatigued. At the end of her visit, physician informed Mrs. Smith that she needed to have a laboratory test for thyroid problems, anaemia, or diabetes. The physician explained that she will be called if the results were abnormal; otherwise, she would receive a letter in the mail. After 2 weeks of no correspondence from physician, Mrs. Smith called the doctor’s nurse to inquire about her test results. The physician returned her call the next day and apologized because her lab results had been filed in her chart instead of routed to his attention. The physician informed her that the test results revealed she had Type II diabetes, and she needed to make an appointment with him. Until their next visit, the physician advised her to watch her diet. The doctor described the long-term complications of Type II diabetes, such as cardiovascular disease, eye disease, and kidney disease, advising Mrs. Smith to buy a glucometer to monitor her blood sugar levels and made an appointment for her with a dietician in 1 month.

Mrs. Smith had many questions related to how diabetes would impact her roles as a wife, mother, and employee, but her discussion with physician focused on physical symptoms. She left the appointment feeling very frustrated and unsure of how to manage her condition. After visiting with the pharmacist Mrs. Smith read extensively about the complications of diabetes and became acutely anxious about the possibility of daily insulin injections. As a result, she drastically reduced her food intake because she thought doing so would control her blood sugar levels and prevent complications. Soon she developed sleeping difficulties and ongoing anxiety, and missed many of her work and family activities. After her appointments with her physician, dietician, and pharmacist, Mrs. Smith continued to have many questions about diabetes and the effect it would have on her life.

 The case study results in 10 recommendations for health-care professionals how to improve performance in a modern health-care system:

  1. Care is based on continuous healing relationship
  2. Care is customized based on needs and values
  3. Patient is in control
  4. Knowledge is shared and information flows freely
  5. Decision-making is evidence based
  6. Safety Is a system property
  7. Transparency (information is available for informed decision)
  8. Needs of patients are anticipated
  9. Waste is continuously decreased (resources and time of patients and professionals)
  10. Cooperation amongst clinicians is a priority (importance of multidisciplinary)

Moving on the case study on heart failure, Ed Harding (Heart Failure Policy Network) stressed the importance of boosting a multidisciplinary team approach, integrated care models, invest in specialists, as well as the important role of generalists. As was also highlighted by Prof Milenkovic, effective communication (among the care team and with the patients) is the condition sine qua non of continuity of care and for supporting self-management.

In a multidisciplinary and integrated care approach, patients are involved in each stage, empowering patients, their families, their career. Those have been shown to be best practices, in reality they are not put in practice (e.g. patients experience major changes in medications when they transfer to other clinicians). Dr. Josep Comin-Colet (University Hospital Bellvitge, Barcelona) presented the organizational challenges of building the workforce for multidisciplinary teamwork. In the scope of delivering multidisciplinary and integrated care, the following measures resulted in 50% reduction in hospitalization:

  • Endorsement of health pathways by managers
  • Give access to KPIs to professionals: quality improvement
  • Population-based approach (tailored intervention for each patients)

A Nurse-led HF management programme in primary care in Barcelona showed great results. Healthcare institutions in the Litoral Mar area in Spain and the Catalan Health Service developed a nurse-led multidisciplinary HF care model that integrated care and reduced the risk of readmission and death. Adding a telemedicine component has further reduced hospital readmission, length of hospital stay at readmission and cost per patient. This care model is being implemented and improved in South Metropolitan Barcelona with coordination from the Bellvitge University Hospital.

The case study resulted in the following policy recommendations:

  1. Boost HF specialists while supporting generalists
  2. Equip specialists
  3. Streamline care
  4. facilitating formal accreditation for different specialty
  5. removing legal barriers to clinical delegation of tasks (e.g. nurses can prescribe, GP can ask for diagnosis procedures, etc.)
  6. considering the value of recognizing the specialist disciplines other than medicines
  7. formalizing person-centered skillsets

How can we support health care professionals in implementing those changes and innovative model of care in different settings? Antanas Montvila (European Junior Doctors Association) stressed the need to shift the paradigms in medical education: medical care  is focused on treating diseases, more soft-skills and technological skills should be added (team work, prevention, better digital healthcare, patient-centered care, etc.). Medical workforce shall be encouraged by the health care systems and to implement innovative way of providing care. Health care systems shall promote entrepreneur spirits Critical-thinking abilities (choose right tools, right apps for patients).

Ber Oomen (European Specialist Nurses Organisation) added that European health systems and policymakers shall also solve the fragmentation in the nursing professions across Europe encouraging uniformity in education and standardization on what nurses should bring into healthcare. True education in nursing starts after graduation in continuing professional development, where they should be supported in training for on specialization and in filling gaps

Giulio Gallo (DG SANTE) wrapped up the debate stressing that the current COVID19 crisis has made clear the importance of continuity of care and how an integrated approach and digital solutions can support both patients and health care workers in effective communication and in managing health plans.

The European Commission has stressed several times that significant workforce investments and reforms in education and training are needed to equip professionals for the challenges of chronic conditions (e.g. basic training and education of health professionals, regulatory framework for professionals’ activities, profession-based input on self-reporting on skills, peer review and education, continuing professional development (CPD)). In this frame, DG SANTE has launched a call for projects in 2020 (Health programme) to support initiatives focusing on healthcare workforce retention policies, supporting access to healthcare in underserved areas and initiatives on reorganisation of care delivery between hospitals and other community and primary healthcare centres through task shifting and interpersonal coordination.

The outcome of this debate, as well as of the following webinars, will be included the Thematic Network joint statement, aiming at profiling the healthcare workers of the future and identifying their core competences and role for promoting data-driven innovation and patient-centred and inter-disciplinary models of care.

 

Speakers’ presentations:

EVENT SUMMARY: My City-Lab Talk Series – AI in the Fight Against Cancer

The latest meeting of the My City-Lab Talk Series “AI in the Fight Against Cancer” took place on February 25th, 2020. The event was organised by Health First Europe, as a partner of My City-Lab project, to discuss the role of Artificial Intelligence (AI) in the fight against cancer, from screening to treatment.

Why is AI so important for cancer care? Cancer is one of the areas where AI is revolutionizing the health care sector. Thanks to AI, the software can analyse medical images, spotting irregularities and supporting health care professionals in deciding whether or not a second physician needs to visit the patient. Using AI, doctors will be able to select treatment options that work better with specific tumours or patients; machine learning algorithms can pull information from doctors’ and radiologists’ notes in electronic health records in order to identify how particular patients’ cancer progressed. A good illustration of AI application to cancer diagnostics can be found in thyroid cancer care: radiologists and artificial intelligence specialists partnered to develop an algorithm that can determine if lumps on a thyroid should be biopsied.

As pointed out by the moderator Damien Gruson, in the clinical laboratory, chemistry and haematology departments have been the first ones to adopt new technologies and algorithms into their workflow. Rapid changes in health care coupled with advances in technology have stimulated the evolution of new approaches for laboratory automation. In particular, the emergence of AI applied to laboratory robotic systems offers a great promise for streamlining the clinical laboratory.

Yiannos Tolias, from the European Commission’s Directorate-General for Health and Food Safety (DG SANTE), highlighted the commitment of the EU institutions in speeding up AI application for more effective and patient-centred healthcare while coping with AI challenges. The European Commission is currently working in two main areas: data collection and sharing for public interest and regulation for a trustworthy AI. With respect to health data sharing, the Commission announced an ambitious project: the European Health Data Space, to promote data exchange and support research to ultimately advance treatment on complicated conditions, such as cancer. Yet, some legal challenges arise, whereas there is consensus among member states on the primary use of data, not all the stakeholders seem to agree on the access to and rules over the secondary use of data. Moreover, interoperability and quality of data remain challenging. The White Paper on AI, launched by the Commission on 19 February, seeks to give direction with regards to AI regulation in order to achieve an ‘ecosystem of excellence’ and an ‘ecosystem of trust’. The document further acknowledges how AI can pose some important issues when it comes to ethics and the effective functioning of the liability regime.

The European Commission’s Directorate-General for Health and Food Safety (DG SANTE) and the Directorate-General for Communications Networks, Content and Technology (DG CNECT) are closely collaborating to find suitable solutions to tackle the challenges in the application of AI in health care.  Margherita Fanos, from DG CNECT, explained that the Commission is working to boost national and regional funding for promoting the use of AI solutions in the public sector and to enhance digital skills amongst health care workers. With respect to cancer care and health data, Ms Fanos emphasised two main initiatives the European Commission launched:

  • the EU Beating Cancer Plan, which aims to reduce the burden of cancer across Europe, by promoting research and innovative technologies. The use of artificial intelligence is seen as an essential tool to significantly improve the precision of early diagnosis, as it has been already demonstrated in breast cancer care.
  • The “1+ Million Genomes” initiative, which aims at accessing 1 million sequenced genomes in the EU by 2022, setting up a collaboration mechanism with the potential to improve disease prevention, allow for more personalised treatments and provide a sufficient scale for new clinically impactful research.

Insights on the patients’ perspective came from Antonella Cardone, representing the European Cancer Patient Coalition (ECPC). She stressed how AI has been proven to be incredibly beneficial for cancer screening, notably in:

  • Skin cancer screening, where AI can prove the accuracy and allow surgical removal before cancer spreads
  • Colonoscopy, developing a real-time endoscopic image diagnosis support system
  • Lung cancer screening, where AI system uses 3D volumetric deep learning to analyse the full anatomy on chest scans

Additionally, participants stressed the potential of AI in clinical trials. AI can predict cancer treatment toxicity and side effects of polypharmacology and link patient data to clinical data trials.

However, all these innovative solutions seem to be isolated best practices, not fully shared and applied in all EU countries. Why is that so? There is a lack of data infrastructures and interoperability systems and rules ultimately impacting on best practice sharing and the heterogeneity and quality of data. Each health care setting collects data on its own way and when shared might not follow the same parameters to be used or compared with other medical departments.

Beyond technical challenges, some ethical concerns arise, especially linked to the so-called “black box medicine” i.e. the use of opaque computational models to make health care decisions. Big data-based AI can suggest a certain cancer treatment without exposing the rationality behind its decision.  Data science and cancer care still belong to different fields of professionals, where oncologists do not understand algorithms and programmers do not understand cancer care.

Also, to a certain extent, our legislation still needs to catch up to digital services and technologies. Jelena Malinina, representing the European Consumers Association (BEUC), pointed out that our legal systems were human and not machine focused, which arise questions over liability. AI in health sector challenges the existing legal liability rules, where clinicians are currently liable for software malfunctions that contribute to an incorrect diagnosis. Should the uptake of machine learning suggest more accountability from manufacturers and sellers of AI software? How we deal with the question of legal liability will definitely affect the spread of technology in the health sector.

The main take away of the discussion is that fighting cancer remains a substantial and complex challenge. Every person living with cancer has a unique journey, and AI and new technologies can support health care providers in addressing patients’ unique needs. The concerns on AI application to cancer care discussed during the meeting, from ethics to liability, are shared by all the EU member states, and it is worth working together to find common solutions and rules to build a trustworthy AI ecosystem to ultimately save lives.

Please click here to see the pictures of the event.

My City-Lab project – financed by the European Regional Development Fund (ERDF) – aims to create two new primary care structures, called My City-Lab, integrating the innovation of laboratory medicine and mobile health. The scope of the project is to facilitate access to laboratory tests as part of an integrated and collaborative approach to ambulatory care of a chronically ill individual, as well as to contribute to the dynamic monitoring of patients with chronic diseases.

EVENT SUMMARY: A Health Care Workforce for the Digital Age

On 5 November 2019, policymakers and health representatives met in the premises of the European Parliament to debate the role of the workforce of the future in making health care systems more efficient and financially sustainable in delivering care. The event was organised by Health First Europe under the Patronage of the Finnish Presidency of the Council and moderated by Marc Lange, representing one of our members, the European Health Telematics Association.

Digital solutions in health care offer new opportunities to transform health care. However, many barriers are still in place to make the digital transformation happen:

  • The lack of digital literacy to understand and use digital technologies and electronic health records for better patient outcomes
  • Missing digital infrastructures to safely share health data and foster collaboration amongst health care professionals
  • Fragmented views on the required digital skills for the health care professionals of the future
  • Our health care financial models struggle to address digital infrastructure challenges and to translate digital benefits and connectivity into value and cost saving

In this frame, the discussion looked for answers to the key question: How can we ensure that health workers play a leading role in driving a successful digital revolution?

Health care is a crucial economic sector as well as everyone’s business. Our health and wellbeing are inextricably linked – which is precisely why well-structured and thoughtful policies are essential.  As emphasised by MEP Tomislav Sokol (EPP, Croatia), who kindly hosted the event, “There is the need of a deep reform in the EU health systems to ensure sustainability in light of future challenges. It is clear that ageing demographics and the rise of chronic diseases, have increased the demand and availability of treatment and personalised lifelong care, which in turn are creating an economic stress on health systems. Our current structure is no longer sustainable in the long term; therefore, health systems must be adapted to effectively address present needs”.

Digital solution in health care offer new opportunities to transform the way we receive and provide health care services. Health data and advanced analytics can help accelerate scientific research, personalised medicine, early diagnosis of diseases and more effective treatments. In this regard, health workers play a crucial role in driving a successful transformation of care, only in Europe there are 18.6 million health care workers which represent the 8.5% of the total European workforce. Due to that, it is necessary to launch an inclusive debate to shape the profile of the health worker of the future and have a long-term strategy.

Keynote speakers opened the discussion by sharing their expert opinions on what are the structural changes required to support health care workforce in implementing digital care in all health care settings. Maria Teresa Parisotto (European Specialist Nurses Organisations) and Annabel Seebohm (Standing Committee of European Doctors) stressed how the technological revolution will enable cost-efficient remote care and virtual assistance. Unfortunately, the workforce is not always prepared to apply these innovations. Closing the gaps between the workforce skills and the skills necessary to benefit from digital tools is a key priority. Structural changes are required to make the best use of digital solutions and workers should be part of the decision-making process.

According to Paulius Povilonis (European Medical Students’ Association), to maximise the benefits of digital technologies, it is necessary “to bridge the gap between digital health information and medical students, and digital health should be included in the medical CV”.

As confirmed by the data provided by the European Association of pharmaceutical students almost 95 % of new graduates do not know what eHealth is after finishing their studies. Only a few Member States in the EU included eHealth as a mandatory class in the pharmaceutical university curricula. Yet, this should be an opportunity for students to stimulate a real-life experience and improve their working skills. “It is essential to recognise eHealth not as a cost but as an investment for the future of health care” mentioned Tilen Kozole (European pharmaceutical students’ associations).  However, in order to achieve standardised training and ed

ucation, EU Member States need to further cooperate in the creation of an eHealth curricula and share best practices. Doctors can only build their relationship with patients on trust and accountability, but in order to do so, they need to understand how eHealth works. “The future health workforce needs to be trained not only for technical skills, but interpersonal skills, to be able to work with different teams”, claims Antanas Montvila (European Junior Doctors Association).

EU policies need to support health care workers in scaling up innovation. The problem is much deeper than health care systems being in need of a stronger digitalisation; the internet of things is already there and the near future is data driven, collecting information and putting it into context.  Despite so, at the end of the day what makes the difference is professionals being able to use digital tools, not the technology per se.

In this context a special role is played at management level, where training and digital literacy have to be seen as an investment rather than a cost.  European Commission’s initiatives such as the Digital Europe Programme, Erasmus + and the European Globalisation Adjustment Fund (EGF), in addition to regional funds, bring together synergies to invigorate digital skills and literacy in order to obtain better job qualifications and address the needs of different economic sectors, including health care. On this note, Christoph Klein (European Commission, DG CNECT), stressed the importance of cross-border collaboration as well as EU coordination to boost digital skilling across Europe.

Matthias Wismar from the European Observatory on Health Systems and Policies pointed out the need to improve digital education by ad-hoc policies striving digital literacy. In his own words, it is essential “to identify and report which innovations fit in each country and understand how health care workers can implement them. And above all, we need more comparative research and intersectoral and interdivisional skills, we cannot focus only on technology”.

During the debate, the majority of the participants recognised collaboration skills as the key skill to deliver patient-centric digital health. As stressed by Tanja Valentin (MedTech Europe), cooperation with emerging professions and ICT staff as well as flexibility are needed in order to share best practices, deliver care efficiently and learn from others.

To bring the national perspective in the debate, Tapani Piha representing the Finnish Presidency of the Council introduced what Finland has been doing to enhance digital health and provide solutions applicable to the rest of EU countries. The EU can and should help to strive digital health, despite health remains as a national competence. Therefore, EU Member States, need to picture digitalisation as an opportunity to create new jobs, enhance knowledge sharing between health care workers and as a new tax contribution to the system, since digital care is a bigger competence interconnected with diverse fields.  

Looking at the Finnish case, health records are accessible online for patients together with their medical data and prescriptions. On top of that, digital education is already part of the medical curricula and media literacy is open to all citizens, not only students. On this line, the Finnish Presidency of the Council of the EU focuses on the responsible and smart secondary use of medical data, boosting platforms to support digitalisation in the so-called “economy of wellbeing”.

In her closing remarks, Sara Cerdas (S&D, Portugal) pointed out that we must have a common vision to address the digital transformation of care and to foster digital skills. The digital technologies are an inevitable part of the future of European health care systems, it is crucial that health care professionals achieve the skills and knowledge to make the digital transformation of care a reality and deliver care closer to patients. As she said “The health and care digital transformation is happening right now and we need to accelerate the pace to create more sustainable health services. Open discussions with different stakeholders are crucial for planning realistic goals for a greater adaption of this new reality. The education of the health workforce to adapt to this reality is of the utmost importance for a smooth transition, and for the highest quality provision of care.”

The photos of the event are available here