Health First Europe

EVENT SUMMARY: My City-Lab Talk Series – AI and cardiovascular diseases

The latest My City-Lab Talk Series on AI took place on 18 November in the framework of the digital Annual Congress of the European Health Management Association (EHMA). The purpose of the debate was to offer a dynamic discussion among key stakeholders and policymakers on the ways in which AI can support the screening and prevention of cardiovascular diseases (CVDs).

Cardiovascular disease is the leading cause of death in Europe. It causes over 1.8 million deaths each year or 37% of all deaths in the EU. Across Europe, deaths from CVD exceed those from cancer. Currently 60 million Europeans live with CVD and each year over 6.1 million new cases are diagnosed. Annually, the cost of CVD on EU healthcare systems is as high as EUR 210 billion, making cardiovascular disease one of the heaviest burdens on EU healthcare systems

The discussion aimed to bring together a range of stakeholders and policymakers for a debate on the ways in which AI can support the screening and prevention of cardiovascular diseases as well as on the benefits and risks of such technologies and the barriers to their deployment. Participants also reflected on some of the already existing strategies for CVD screening by means of AI and on the role of EU countries and the European Union in boosting patient safety through the uptake of AI-assisted solutions.

The debate was opened by MEP Maria Carvalho (Co-Chair of the MEP Heart Group, European Parliament), who stressed the great prevalence of CVD in Europe and the significant burden that it imposes on European healthcare systems. As stressed by MEP Carvalho, Successful deployment of AI technologies in the fight against CVD would be an important step towards advancing public health.

The debate also featured insights from:

Professor Alan Fraser – Former Chair of the Regulatory Committee and Chair of the Biomedical Alliance in Europe Task Force on Medical Devices, European Society of Cardiology
Birgit Berger – CEO, European Hearth Network
Ed Harding – Director, The Heart Failure Policy Network
Erik R. Ranschaert – AI Project Coordinator Radiologie, ETZ Hospital, The Netherlands

CVD is an area in which AI-based algorithms have shown great promise. Thanks to innovative solutions and big data, cardiologists have better tools to analyse images, detect early signs of CVD and perform more robust risk assessments thus allowing patients to be directed to the right type of care based on their individual symptoms and medical history. New algorithms based on machine learning enable healthcare professionals to predict patient outcomes more accurately and to offer increasingly personalised treatment.

While all of those applications can go a long way in improving the quality of the care offered to patients suffering from CVD, there are a number of limitations in the utility of AI algorithms that should be recognised. Even though there has been much optimism for boosting the efficiency of image diagnostics through AI, a deeper dive beneath the hype reveals that the gains in diagnostic reliability and accuracy are more modest than often suggested. Furthermore, while some indications exist that machine learning can meaningfully improve the accuracy of disease progression prognosis, the efficacy of such tools should not be overstated. Data remains insufficient to determine the actual reliability of those AI technologies. When dealing with big data one needs to also be aware of the danger of chance correlations as opposed to actual causation.

In this context, it is essential that AI is not seen as a panacea on its own but as a tool which when utilised properly by healthcare professionals can greatly enhance quality of care and patient safety. Delegating too much of the treatment decisions to AI algorithms when understanding of the technology is still underdeveloped, risks leaving practitioners unable to critically evaluate the way in which such tools perform in real-life situations. This could further exasperate the lack of trust both by patients and healthcare professionals, who often lack the necessary skills and digital literacy to fully comprehend the way in which AI algorithms make their decisions. To counter this issue, any large-scale deployment of AI in healthcare provision needs to be preceded by the establishment of clear and concrete EU guidelines for evaluating the efficacy of AI tools in medical devices. In addition, requirements to make machine learning code and data utilised by AI algorithms open source would greatly boost the ability of researchers to identify sources of potential bias as well as to validate the results of developed models.

Furthermore, the upscaling of AI technologies in healthcare systems in the European Union would require addressing the fact that many European healthcare systems are currently not prepared to offer the technological infrastructure necessary for AI algorithms to work properly. The progress in the implementation of electronic patient records varies widely across the EU. The state of the IT infrastructure in many European healthcare systems is often inadequate. Even frontrunner countries still face considerable challenges linked to facilitating data sharing and access.

Similar divergence across countries exists also when it comes to the national systems for reimbursement of costs linked to the use of AI-based healthcare services and telehealth provision more generally. Deploying AI without addressing those inconsistencies risks exasperating health inequalities as those who are less able to bear the additional costs or lack the necessary digital skills to make use of innovative devices will simply be left behind.

While AI’s potential to improve the quality of care for patients with CVD is clear, its successful large-scale deployment requires the development of a robust European AI ecosystem incorporating reliable IT infrastructures, health education frameworks providing healthcare professionals with the right digital literacy as well as a comprehensive European health data space, which is standardised, transparent and accessible for all. The establishment of such an ecosystem is only possible if paralleled by the development of a uniform ethical and legal framework for AI in healthcare that tackles issues of data protection, consent, and liability for misdiagnosis and data leakage.

In short, the successful deployment of AI in CVD care and management and healthcare more broadly, requires further technological advances but more than that it requires systemic political leadership. It calls for a cooperative and unified European approach which brings together the full range of relevant stakeholders from engineers to doctors to patients and promotes a common vision of innovative and patient-centred care. The European Union has an important role to play in facilitating this process.

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: 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: 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.

EVENT SUMMARY: My City-Lab Talk Series – Tackling Heart Failure in Europe: Accessing Innovation & Fostering Integrated Care

The latest meeting of the City-Labs Talk Series “Tackling Heart Failure in Europe: Accessing Innovation & Fostering Integrated Care” took place on September 11th, 2019. The event was organised by the City-Labs team to discuss how to improve care to tackle the burden of heart failure, from diagnosis and prevention to reduction of risk of death throughout integrated care models and solutions.

Why heart failure care is so important for public health? Heart failure is a common condition which occurs when the heart is unable to pump enough blood to meet the body’s needs for oxygen and important nutrients. At least 15 million people live with heart failure in Europe and one in five people can expect to live with heart failure at some point in their life. Heart failure accounts for 5% of all acute hospital admissions in Europe and is the leading cause of hospitalisation in people over the age of 65. As pointed out by the moderator of the debate, Brandon Mitchener (Instinctif Partners), the burden of heart failure is rising due to an ageing population, and health care systems need to get ready to tackle this issue quickly.

The meeting provided an opportunity to present the Handbook of the Heart Failure (HF) Policy Network (Health First Europe’s member), designed to drive policy changes that could make a meaningful difference to care for people living with heart failure. Ed Harding, representing the HF Policy Network, stressed the great physical and psychological burden that heart failure represents for European citizens and health systems. Mr Harding explained that integrated management and multidisciplinary care are essential to provide optimal heart failure care. Multidisciplinary and integrated care is about delivering the best care possible through care plan with a focus on the needs of the individual patient at each stage of their condition. Regular follow-up, access to advanced treatments, psychosocial support, therapeutic education, continuous assessment and regular medication/device review are the essential features of an optimal heart failure care.

With early diagnosis and right care, hospitalisation can be reduced by up to 30%. Yet, the number of early diagnosis remains low, people with heart failure do not see the right specialists, and few patients are followed up properly after discharge. In order to make a shift towards a multidisciplinary and integrated model of care for heart failure, the HF Policy Network calls on governments to recognise heart failure as a financial sustainability challenge for health care systems and to demonstrate measurable improvement on minimum standards.

Alex Lefevre from Roche Diagnostics Belgium presented the key challenges to access innovation for heart failure risk patients:

Missing data and statistics on the cost effectiveness of integrated management and multidisciplinary care for heart failure
Differences amongst hospitals in the implementation of guidelines aiming at reducing heart failure hospital readmission
Health apps which do not fit the patients’ use and needs

Some solutions and actions to tackle these challenges were presented during the discussion, e.g. the development of tools to help doctors follow up with the different guidelines, fostering education on the monitoring and follow up tools, and take patients’ perspective into account in the development of digital solutions and apps.

Damien Gruson, coordinator of My City-Lab, emphasised the impact of heart failure on public health and public expenses: 50% of heart failure patients will die in the 5 years following their diagnosis; 1 in 4 people will be re-hospitalised within a month. Mr Gruson stressed that primary points of care, where access to laboratory tests is facilitated, are part of an integrated and collaborative approach to ambulatory care to support heart failure patients. Such point of care will give the possibility for patients to get their laboratory results in a short time, allowing health care professionals to act quickly. These settings have the advantage of gathering different medical specialities and to speed up the process to prevent and treat cardiovascular conditions.

Heart failure remains a substantial and complex challenge. Every person living with heart failure has a unique journey. Integrated management and multidisciplinary care can support patients and address the unique needs. A takeaway of the discussion is the need to recognise heart failure as an urgent challenge for health sector, requiring a holistic and multidisciplinary approach to bring a meaningful improvement in the care of people living with heart failure.

Please click here to see the pictures of the event.

EVENT SUMMARY: HFE & My City-Lab “Profiling the health worker of the future”

Profiling the health worker of the future: digital skills, innovation and collaboration to meet the new demands of care

On 18 June 2019, Health First Europe as partner of My City-Lab project organised a workshop, entitled “Profiling the health worker of the future: digital skills, innovation and collaboration to meet the new demands of care” within the EHMA 2019 Annual Conference in Espoo (Finland). The lively exchange of views among policymakers, academia, worker organisations, student associations and industry aimed to define the perfect profile of health worker of innovative models of care, such as the one promoted by My City-Lab project, as well as to identify systematic changes in the education and organisation of the health workers needed to implement new models of care. My City-Lab is an initiative financed by the European Regional Development Fund (ERDF) which aims to better integrate the innovation of laboratory medicine and mobile digital solutions into health care systems.

The final goal is to facilitate access to laboratory tests as part of a collaborative approach to ambulatory care of chronically ill individuals, as well as to contribute to the dynamic monitoring of patients with chronic diseases. A city-lab site will soon open in Brussels, its workforce should reflect the changing health care eco-system: patient-centred, connected and collaborative.

Speakers’ slides

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The brainstorming session, moderated by EHMA President, Federico Lega, saw the contribution of worker organisations, student associations, patients’ representatives, industry, policy makers and health care management experts from all over Europe. They brought into the debate their unique perspective over the challenges of health management and education and the core competences of the workforce of innovative and patient-centred health care models, such as the one promoted by the City-Lab project.

Health care is highly labour intensive and one of the largest economic sectors in the EU – accounting for approximately 17 million jobs (8% of all jobs). Population growth, ageing societies, and changing disease patterns are expected to drive greater demand for well-trained health workers in the next 15 years. As stressed by Melina Raso, Health First Europe Executive Director, implementing new model of integrated care (as the one promoted by My City-Lab Project) requires a radical transformation of skills and core competences of the health workers.

On this note, Loukianos Gatzoulis from Directorate-General for Health and Food Safety from the European Commission gave a thoughtful overview of the changing demand of care and the role of new technologies and models of care to effectively address this change. Ageing, multimorbidities, complex needs require new approaches, aiming at integrating of health and social care as well as at providing an adequate number of well-trained professionals. These challenges require new model of care, shifting from “silo-specialisation” towards a multi-disciplinary approach, where health care workers can safely share patients’ data across settings, effectively collaborate in care plan and work in partnership with social workers.

Laboratories can play a vital function in building health care integrated systems and in the care continuum, by bridging the gap between different settings and the patients, ultimately breaking those silos. Most of the medical decisions are based on test results, by investing in data processing, analytics and talented health care workforce, medical labs and primary care settings can bring stakeholders together and ensure timely, evidence-based decisions. Health care professionals can be the drivers of this shift towards this new and 2 integrated model of care.

Therefore, European health care systems should create the right conditions to promote this new model of care, more integrated, preventive and closer to the patients.

(1) A first condition to shape this new model of care is to rethink the relationship between patients and health care professionals: primary care and lab professionals have a great role to play in re-centring care around the patient, fostering partnership with the patients and the care givers, who see and share the same information. Looking at the bigger pictures of the triangle of health care professionals, patients and technology providers, their relations need to be assessed and re-organised in a way that fit the future of care. In this frame, the role of education is essential to connect the dots of the triangle and meet the new technological challenges.

(2) Secondly, appropriate resources should be in place to tackle workforce shortage and promote primary care and laboratory settings. As highlighted by Bert Van Caelenberg from EUROFEDOP, heath care remains an issue of financial resources: some European countries do not have the resources to retain their health care workers who leave for better economic prospects. Not every country can reward graduates equally, so medical professionals leave. EU member states should look deeper into the challenges of workforce shortage and brain-drain and assess how those impact on personal lives, on patient safety and quality of care in each country. Better social security systems, increased wages and equal working condition across borders shall ensure health care providers are where they need to be.

(3) Lastly, but most importantly: health care decision-makers should identify and foster the core competences of the worker of the future. During the debate, participants identified a wide-ranging list of competences needed for the workforce of innovative primary settings and medical labs, such as:

Soft skills (from partnering to communication) and ethical competences
Digital skills e.g. basic ICT knowledge, online interaction competences, data collection and monitoring skills, service competences and guiding skills in digital environment
Management skills, leadership as well as multi-actor service co-development competences
Flexibility

Above all, the majority of the participants recognised partnering skills as the key competence for the whole health care workforce.

Partnering skills can be defined as the ability to apply a collaborative relationship between settings, professionals as well as patients. The end purpose is to work towards shared goals and deliver practical solutions to system challenges or complex and chronic health conditions. The health care worker of the future shall use partnership as a learningmechanism that teaches how to better deliver and coordinate care across settings and over time. With respect to digital skill profiling, it is crucial that health care workers of integrated and city lab models possess sufficient skills and knowledge to make the best out existing digital solutions and bridge the gap between settings. As presented by Tanja Valentin (MedTech Europe), digitalisation allows two main things: it shrinks time (for example on text results) and connects the dots, the players and the key information in a new way, both essential elements to build an integrated health care system.

Nevertheless, participants agreed that the training of the health care professionals might not keep pace with technological developments. The latest survey presented by Marta Simoes from European pharmaceutical students’ associations (EPSA) shows that 75% of pharmacists claim to have no or almost no education on digital health, while 90% of them believe that digitalisation of health care shall change the pharmaceutical curricula and profession for the better, those training combining theory and practices as well as promote inter-professional collaboration. As stressed by Outi Ahonen, Senior Lecturer of Laurea University of Applied Science, health care professionals can be bold and innovative in reforming practices if only they have the right education to make it happen, from informatics to media literacy.

The debate saw also the contribution of Walter Sermeus from Leuven Institute for Health care Policy and Anu Söderström from the Council of Occupational Therapists for the European Countries (COTEC) who stressed digital solutions’ value in order to shift to sustainable and better connected model of care, nevertheless technologies in itself cannot tackle the challenges of the workforce, it is only a tool that health care settings shall use in the most effective way.

With respect to flexibility as a one of the core skills, Lasse Lethonen, representing the Expert Panel on effective ways of investing in health, introduced the concept of task shifting within and between health care settings, concept which is illustrated in the Expert Panel’s opinion on task shifting in health care systems. The Expert Panel’s opinion argues that tasks can and shall be shifted within health care settings, from health workers to patients and their carers, to machines, and to other health workers. Those shifts imply that those involved must be convinced of the rationale for change, flexible in changing tasks and settings and strongly supported in implementing it. Professionals other than physicians, e.g. nurses, medical laboratory professionals, pharmacists, can undertake substantially expanded roles compared to what has traditionally been the case, with the adequate trainings to carry out their function in integrated teams with informationsharing.

The ultimately message of the debate was that Europe shall invest in integrated models and city-lab settings to transform care to better tackle ageing society, changing patterns of diseases, new technologies and decentralisation of organisational structures. Health care workers and management have the chance to lead this transformation, only their vision and expertise can shape the health care systems of the future. In order to make this happen, they need to be placed in a leading role, involving them in decision making and giving them the right tools and trainings to meet the new challenges of health care delivery.

Speakers’ slides

Event Pictures

Event videos

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City-Labs is a project financed by the European Regional Development Fund (ERDF) which aims to integrating 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, always fostering sustainability.

EVENT SUMMARY: My City-Lab Talk Series – A greener health: how to foster environmental sustainability in healthcare

The My City-Lab Talk Series meeting “A greener health: how to foster environmental sustainability in health care” took place on May 14th, 2019. The event was co-hosted by the My City-Lab and Metrolab Brussels projects, both funded by the Brussels Capital Region through its ERDF program. The aim was to discuss to what extent healthcare systems could reduce their environmental footprint, without affecting delivery and quality of care.

As the third largest employer worldwide and a major consumer of resources, health care has the potential to make a significant impact in sustainability strategies. Health care is the only sector generating all existing classes of waste, with 20% being dangerous, infectious, toxic or radioactive in nature. As pointed out by the Moderator of the debate, Bernard Gouget (IFCC – International Federation of Clinical Chemistry), sustainability is a key issue in the health care sector which needs to be addressed urgently to better cope with the challenges of the raising demand of care. Arianna Gamba, from Health Care Without Harm, stressed that behind environmental challenges, there are still big opportunities to drive to the health care sector in a more sustainable path. Health care industry is responsible for 5% of the global carbon footprint, which contradicts the nature of hospitals: saving lives. By polluting, health care settings contribute to a lower quality of life among their patients and society as a whole. Measures like substituting toxic chemicals and improving the transportation system around hospitals can be good solutions to reduce pollution. Additionally, the supply chain of purchased goods and services is estimated to contribute to two-thirds of hospitals’ carbon footprint: European health systems face the challenges to implement sustainable procurement policies and achieve a more sustainable organisation. Within the scope, it is worth mentioning that one of the barriers is that recycling plants often do not accept uncontaminated hospital residues (e.g. clean plastic packaging) since they treat it as hazardous medical waste. There is a need to raise awareness about sustainability among the healthcare sector and its key stakeholders to reduce its environmental footprint.

During the debate, Michele Calabrò (European Health Management Association) emphasised the importance of the topic for the industry workers, who are longing for implementing innovative solutions with a long-term approach. Mr Calabrò also stressed sustainability is very much linked to eHealth, which can bring efficiency to the system while reducing resources’ surplus along with their carbon footprint. Hence, education and digital literacy are key to implement a sustainable approach to care, by educating people in changing their mindset and focus on quality rather than cost, looking more at the long-term benefits.

Still on digitalisation, the Coordinator of City-Labs project, Damien Gruson, highlighted that productive cities are green and innovative. Prevention and education can be used by means of digitalisation to reduce the size of the carbon footprint, providing an opportunity for efficiency. Mr Gruson proposed as a possible solution new tools to integrate and track data on hospital waste. Additionally, by having a qualitative data approach, AI solutions could be used to define patients experience to make heath care delivery more efficient: technology can be used specially to not overuse the services and avoid repetitive tests.

Maguelone Vignes (Metrolab Brussels) made an important connection to primary care approach. She stressed that a part of the solution could be reintegrating health care facilities in the city, specially by fostering primary care in order to avoid unnecessary hospitalisations, to ultimately benefit the patients and saving unnecessary resources and costs. Primary care centres are more efficient since they focus on prevention rather than reacting when a patient is already ill.

Health care settings have a major role to play in reducing environmental impact by using their resources more efficiently, designing ‘greener’ buildings, fostering digitalisation and promoting primary care. Projects such as My City-Lab and Metrolab Brussels aimed at creating effective and sustainable settings to make this happen, and ultimately putting citizens at the core of the health care settings of the future.

Please click here to see the pictures of the event.

My City-Lab is a project financed by the European Regional Development Fund (ERDF) which aims to integrating 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, always fostering sustainability.

Metrolab Brussels (MLB) is a trans-disciplinary and inter-university laboratory for applied and critical urban research, funded by the Brussels Capital Region through its ERDF program (2014-2020). The action of MLB consists in the design, implementation and coordination of a dozen of research projects, all directed towards a single public policy, the ERDF-Brussels program. Urban ecology is one of the topics covered by the project, a key element for city’s growth and citizens’ wellbeing.

EVENT SUMMARY: My City-Lab Talk Series – Diabetes care in the digital age: accessing innovation and fostering self-care

The third meeting of the City-Labs Talk Series took place on November 22nd, 2018. The event, entitled “Diabetes care in the digital age: accessing innovation & fostering self-care”, was organised by the City-Labs team to discuss the impact of digital solutions on the improvement of diabetes care and how promoting access to these technologies can enhance quality of care.

Diabetes is one of the greater public health threats of our time, affecting over 60 million Europeans (about 10.3% of men and 9.6% of women aged 25 years and over). Diabetes prevalence is increasing among all ages across Europe, killing about 3.4 million people annually. Good management of this condition can save lives, prevent complications and ultimately contain increasing healthcare costs. Patients have been provided with several digital solutions which help them unlock the power to control blood glucose levels, plan nutrition, take medication consistently, work out, and keep track of medical visits, etc. The participants discussed digital technologies and their potential to improve self-care and patient outcomes, as well as the conditiones sine qua non for their uptake, from literacy to access.

As pointed out in the first remarks by Barbara Kerstiens (European Commission), the major challenge to prevent and manage chronic conditions, such as diabetes, is the required change in life style. A drastic shift in daily routine is needed to avoid complications and ensure a good self-care. Also, from the perspective of Directorate-General for Research and Innovation, it is essential to foster research to better understand how diseases are evolving over time and better ways to make diagnosis. On this point, Ms Kerstiens reminded that the proposal for the next research and innovation framework programme, Horizon Europe, shall allocate under the cluster health over 7 billion’s budget to foster health throughout the life course, non-communicable and rare diseases and digital technologies for healthcare.

Ignacio Garamendi from the International Diabetes Federation, together with the young advocate Ewout Gubbels, brought the patients perspective to the discussion. As consumers, we are free to make our own choices (being their healthy ones or not) and it has become complicated to encourage citizens to improve their life style and better manage their condition(s). In his remarks, Mr Garamendi identified three key policy actions that all the stakeholder involved must consider: (1) fostering the uptake of digital innovation, (2) promoting digital literacy as well as (3) encouraging patient engagement.

Ewout Gubbels added “being a diabetic patient is a full-time job”, which require good organisation and commitment. Digital tools (from wearable solutions to keep track of their blood glucose to mobile apps for physical activity) can help patients to build a new routine and prevent complications, but sometimes the flow of information can be overwhelming (in some cases not enough accurate information can also be detrimental). To avoid confusion and frustration, digital solution’s providers must guarantee the accuracy of the shared data.

Thanks to the inputs of Tanja Valentin, from MedTech Europe, the participants also discussed how assessing the value of innovative technologies in diabetes care. There is a wide scope of e-products, which makes necessary to assess which technologies fit the purpose and can bring real benefits to the patients. The missing piece of the puzzle is a new value-based model to measure outcome and to understand how to better value innovative solutions. For doing so, we need to know the cost of any intervention, the benefit of treatment, and the role played by each component of the care pathway.

The meeting saw the contribution of Guillaume Gustin, representing of City-labs team, who presented EGLE app. Throughout constant monitoring and connection with your doctor, the app aims at bridging the gap between patients and clinical labs, which is specifically needed for chronic disease patients given the regularity of their checks. He stressed that a daily monitoring is essential to avoid complications and ensure a better quality of life. He stated that, due to the growing healthcare demand, “physicians lack of time and we also lack of physicians”. Mobile solutions have the potential to tackle these deficiencies through improving self-care and access to health data. To make this possible, literacy and acceptance shall be enhanced.

Diabetes presents a substantial and complex challenge. The technological revolution on the horizon can help patients and providers to face all of its complexities. But solutions need to be assessed stressing the patients’ outcome. A takeaway of the discussion is the need to find a ground-breaking formula on value-based healthcare which can transform care, starting with diabetes.

Please click here to see the pictures of the event.

EVENT SUMMARY: My City-Lab Talk Series – Biobanking: indispensable tool or ethical concern?

The second meeting of the City-Labs Talk Series took place on September 19^th, 2018. The event, entitled “Biobanking: indispensable tool or ethical concern?”, was organised by the City-Labs team to discuss to what extent public health could benefit from biobanking. Key future ethical and technical challenges were also discussed.

Biobanks collect and store biological materials (e.g. blood, tissue or DNA) and related data for use in research. The data is considered as essential raw materials for the advancement of biotechnology, life science, drug development and basic human health. However, biobanks bring about important questions on privacy, research and medical ethics.

As pointed out in the first remarks by Anna Pia Papageorgiou (European Commission) the EU institutions and its member states are already looking at how to strengthen collaboration on data sharing (e.g. EU Declaration on genomics) and foster knowledge in biosample management. In particular, she outlined a few of the initiatives that the Commission is taking around biobanking and to support the scientific community’s efforts towards biotech advancement. First, the long-term goals of the European Human Biomonitoring Platform (HBM) in which the Commission plans to assess the exposure of chemical impacts on human cells and any causal relationship between the chemicals and environmental aspects and disease or other health issues. Secondly, the creation of an HCA (Human Cell Atlas) where the goal is to develop a classification for every cell of the human body. Once completed both the HBM and HCA will provide a better understanding of the human body and how medicines and new technologies can better tackle diseases and chronic conditions.

The ethical and regulatory framework as well as the impact of the General Data Protection Regulation (GDPR) was discussed by the participants. As highlighted by Ms Papageorgiou, GDPR applies to the protection of patients’ privacy, a conditio sine qua non for expanding biobanks’ database and securely fostering data sharing. However, some clarity is needed over ownership of the genetic materials as well as common guidelines on the ethical purposes of the research. Another concern of biobanks is that often data are concentrated in the hands of a few private businesses, which is why better collaboration amongst biobanks and research centres is essential.

During the debate, Francesco Florinidi (Biobanking and Biomolecular resource Research Infrastructure BBMRI-ERIC) stressed the importance of cooperation to improve the standardisation of studies using biobanks. In the past, 78% of study results using biobank materials were not reproduced to a satisfactory level which in turn meant the results are difficult to aggregate. By improving the quality of the sample through creating and enforcing standards, future research will become more efficient and lead to more innovation. He also presented the objectives and the works of BBMRI-ERIC, a European research infrastructure for biobanking, which brings together all the main players from the biobanking field (i.e. researchers, biobankers, industry, and patients) to boost biomedical research. Ultimately, BBMRI-ERIC connects several biobanks in various countries so that researchers have access to a diverse variety of samples ranging in type and origin of material. The research infrastructure sets the ethical guidelines and ensures that those who are utilizing the materials and data are following the necessary procedures.

The discussion was enriched by the contribution of Mr Laurent Dollé (Biobanks Wallonia-Brussels) who illustrated the practices within the biobanking process necessary to make the results statistically significant and reproducible. However, with biomaterial and data sharing among different biobanks, it is essential that common guidelines are followed to make data heterogeneous and reliable. Mr Dollé also spoke about how GDPR legislation has affected the operations within biobanks, for instance by increasing expectations of patient outreach is the major change for researchers. It also remains difficult to get consent and share data among members of biobanks and researchers to determine how the engagement should occur and to what extent information should be shared with the patient.

Despite the potentials of biobanks in fostering research and scientific advances, biobanks are financially unstable because it is difficult for them to ensure the right amount of funding. Funding represents a key barrier for biobank facilities which are unable to charge all researchers for the use of biobanking materials. The boards of each biobank must then find other sources of funding.

On this note, Mr Laurent Dollé stressed that biobanking directors must create innovative business plans for ensuring a sustainable development.

Over the course of the discussion, participants identified three pillars supporting biobanking sector. The first pillar concerns patient and citizen care in which the goal is developing technologies and medicines that focus on how the biobanks are changing healthcare by allowing scientists to tailor the medicines. Secondly, healthcare professionals can increase quality of care offered with new medical technologies leading to more efficient diagnosis and treatment of disease. The third pillar includes medical researchers and scientists, essential for transforming data into findings.

If used correctly, biobanks’ data can be indispensable tools for the advancement of public health, provided that the objectives of biobank-based research are consistently defined for citizens and those who represent their interests. This group of stakeholders must be involved by policymakers in shaping future guidelines as well as implementing GDPR in biobanking sector.

Please click here to see the pictures of the event.

EVENT SUMMARY: My City-Lab Talk Series – Applications of AI in health, to solve societal challenges or to become one?

The future does not rely on technology alone,
AI can improve healthcare services without replacing humans

Pr. Damien Gruson, Coordinator of the City-Labs project

The first meeting of the City-Labs Talk Series took place on July 9^th, 2018. The event, entitled “Applications of Artificial Intelligence (AI) in health: to solve societal challenges or to become one?”, was organised by City-Labs team to discuss applications of Artificial Intelligence (AI) in health and medical laboratory and what are the key challenges ahead.

This first meeting was the stage to spur debate on the potential opportunities and challenges of AI applications into the healthcare ecosystem. On one hand, AI based systems are capable of analysing their environment and take decisions with some degree of autonomy to achieve goals. AI offers applications across a diverse set of health areas, including administrative support, lifestyle management, wearables, diagnostics and virtual assistants. On the other hand, the development and implementation of AI solutions bring along socio-economic and ethical concerns, to be addressed to build better healthcare for patients and professionals.

Mr. Costica Dumbrava, Programme Officer for EU policies in eHealth and Ageing Policy, within the Directorate-General for Communications Networks, Content and Technology at the European Commission, stressed the EU’s commitment to put digital solutions at the service of its citizens and boost Europe’s competitiveness in AI. He highlighted that “AI is transforming our world as it presents new challenges that Europeans should meet to make AI work for everyone. More cooperation between citizens and the enterprises is needed to build partnerships, investments and trust”. Trust is a key word in this debate. AI’s uptake depends upon access to big data: collecting, storing, normalizing, and tracing data and patient records represent the first step for starting the AI revolution in health systems. But none of the latter is possible without patients’ trust.

As remarked by Mr Dumbrava, although sharing health data cross-border amongst healthcare settings can be beneficial to patients, there are still key issues in electronic forms, storage and sharing infrastructures across EU. Ms. Jelena Malinina, Digital Health Policy Officer, The European Consumer Organisation (BEUC), stressed that there are still too many challenges to face: from the potential risk of discrimination to data breaches and hacking. Potential employers’, insurance companies’ or clients’ access to personal health data might eventually lead to discrimination. Participants also debated to what extend AI application in health could contribute to inequality or equality, depending on the tools available to finance digital innovation. As highlighted during the discussion, we must remember that AI has the potential to reduce costs and thus give possibilities to reduce inequalities in healthcare access.

The Roundtable was also enriched by the contribution of Pr. Damien Gruson, Chef du Service de Biochimie Médicale, Cliniques Universitaires Saint-Luc and Coordinator of the City-Labs project. On data sharing, he highlighted that, from basic examinations and health monitoring at home (e.g. via apps and wearable solutions) it can facilitate decision making for health institutions as to whether the patient will benefit the most from the treatment and when / if interventions are needed. Damien Gruson also stressed that AI innovation can be enabled only if the education of healthcare professionals, literacy as well as patients’ education are supported: “if you want a better implementation of treatment and prevention strategies that work, you should improve literacy. Today in Belgium, 50 % of the population suffers from a lack of literacy regarding health and prevention issues”.

The overall discussion pointed out the disruptive potential of innovative technologies and ICT solutions, while highlighting the key role of the human factor. Healthcare professionals, health providers and patients need to be educated and empowered to be able to guide the digital revolution and fully understand the potential benefits of digital innovation. From virtual nursing to administrative workflow assistance, AI applications can improve patient experiences, boost effectiveness of therapies and meet increasing clinical demand. Many are positive about the future of AI but there are still profound questions (both legally and ethically) that policymakers need to address quickly. Doctors must understand that they won’t be replaced, and patients must know that they won’t get everything needed for their health from a machine. A human element should remain if we want to build trust on AI solutions and data-driven transformation of healthcare system and moved toward an ‘augmented intelligence’ rather than artificial one.