H-INNOVA: HEALTH INNOVATION HUB 4th edition
On 23 May 2023, Nova SBE had the pleasure of hosting the 1st edition of THINK TANK "Science to Health to Tech", as part of the 4th edition of H-INNOVA: HEALTH INNOVATION HUB. Coordinated by PremiValor Consulting and with the participation of representatives from various institutions associated with the provision of health services, including Hospital Dr Nélio Mendonça (SESARAM), Hospital de Santa Maria, IPO Porto, Hospital Santo António, Fundação Champalimaud, etc. - and leading technology companies/organisations including VODAFONE, ROCHE, MINSAIT-INDRA, DELL, CELFOCUS, FUTURE HEALTHCARE, the main needs and expectations of hospitals and healthcare professionals in terms of keeping up with technological developments, including developments in data science and innovation-based solutions, were discussed.
Firstly, one of the main needs highlighted by the majority of hospitals relates to the use of technology to help speed up and optimise the work of healthcare professionals, in particular in order to free up time normally dedicated to mechanical and time-consuming tasks (e.g. recording patient data and clinical records) to carry out functions that take priority in the provision of healthcare services. To this end, the aim is to replace some of the administrative tasks that usually fall to doctors and nurses with Artificial Intelligence (AI) and Machine Learning, which would provide greater efficiency in the work process by promoting more efficient and user-friendly digital systems. To this end, the proposed solutions include, firstly, replacing typing systems with voice recognition and dictation systems ("Voice to Text"), with pilot projects already being implemented in this direction - namely, as mentioned by the IPO do Porto, the use of voice recognition systems through dictation software in the oncology area. In addition, the use of "Text Mining" has also been proposed for the collection of structured information in clinical diaries and reports, as well as "Voicebots" in telephone answering (already used at Hospital de Santo António) with the aim of reducing the number of unanswered calls, and the expansion of the use of "Voicebots" for scheduling and rescheduling appointments is a possibility to be considered.
Associated with the need for increasing interconnection between the use of innovative processes and the work of health professionals in order to make the provision of health services more efficient and effective, the potential for using Artificial Intelligence and technological innovations in disease prevention and monitoring should also be emphasised. In fact, the use of AI systems has been proposed for predicting and monitoring the evolution of the severity of certain diseases, particularly in the role of biobanks in analysing patient information and anticipating problems and exacerbations. In this regard, we highlight the use of various pilot applications that seek to monitor patients' symptoms outside the hospital context, thus promoting greater and more effective communication between doctor and patient, allowing a much more active and intervening role in the latter's clinical situation, as well as personalising the patient's journey. Examples of these applications include an application aimed at optimising the analysis and treatment of breast cancer, mentioned by the Champalimaud Foundation, or the FUTURE HEALTHCARE application ("tytocare") aimed at the prevention and management of chronic diseases (hypertension, diabetes, etc.). In addition, it's also worth mentioning the use of AI and clinical algorithms in disease prevention in the context of screening, whether by reading blood count data in order to identify individuals at increased risk of developing colon cancer ("colonﬂag", mentioned by ROCHE), or in the context of vision screening to detect glaucoma ("SmartGlauco", mentioned by Hospital de Santa Maria).
Along these lines, there is also the contribution that technological innovation can make to improving and making more efficient various medical procedures, particularly in surgery, with robotisation and virtual reality. In fact, robotic surgery is becoming increasingly common, facilitated by the use of 5G and allowing mixed reality in the operating theatre (e.g. Hospital de Santo António), encouraging collaboration and teleconsulting between surgeons who are in the operating theatre and those who are present remotely. In addition, virtual reality has also helped to improve learning for medical students by ensuring that surgeries can be broadcast in real time in the classroom. This raises the possibility of establishing a surgical metaverse in the future.
Likewise, the role of telemedicine in the context of teleconsultations (which have been expanding since the pandemic, and there is a need to rethink the model and adapt it to the post-pandemic reality), as well as virtual clinical trials and remote ultrasound scans (already implemented in Germany) should also be highlighted. Also worth mentioning is the potential use of virtual reality to track patients in the event of an accident before they arrive at hospital (pilot project using 5G technology). Nevertheless, with the growing role of technological innovation in helping to provide healthcare, there is a need for more intense intercollaboration not only between hospital units and technology companies, but also between healthcare professionals and users, and active participation and communication between the various players in technological evolution and adaptation to the new reality in healthcare is essential. To this end, it is essential to invest in the digital literacy of both patients and health professionals, which can be achieved through campaigns and training and information sessions, as well as through applications for mobile devices that encourage the sharing of information with patients and speed up the processes of scheduling and rescheduling appointments, for example (e.g. St Anthony's App). In fact, collaboration with patients should be fostered by including them more actively in the clinical process and decision-making, allowing immediate information to be shared through, for example, mobile platforms and applications, thus connecting the doctor and the patient remotely between appointments, allowing more direct and personalised contact and enabling faster and more efficient face-to-face consultations, with much of the information on symptoms and disease progression being communicated remotely a priori.
With regard to inter-cooperation between employees in the provision of health services and their active participation in the adoption of new technologies and willingness to contribute to improving the service provided by the hospital, there is a crucial need to promote an environment open to the sharing of ideas and the allocation of time to employees so that they can devote themselves to innovative projects. In order to promote their motivation and sense of belonging to the hospital unit's project, this can be done through public recognition in the form of honourable mentions for the effort dedicated to achieving a certain goal, or even through dedication on the part of senior management to promoting a balance between professional and personal life (for example, by considering the possibility of a day's teleworking when permitted by the task to be performed). Therefore, a cultural change in institutions that involves valuing the individual is fundamental at this stage.
Related to this need for inter-cooperation between the various players in the healthcare ecosystem, along with the exponential technological evolution, there is also the need not to lose the humanisation of direct contact between the patient and the healthcare professional, which could increasingly be called into question with the growing mechanisation of processes and the evolution of telemedicine. In fact, although the role of Artificial Intelligence and automation in the future of medical service provision is necessary and indispensable, it is vital to promote and foster a closer relationship between doctor and patient, who are often separated by computers and impersonal contact. To this end, it is crucial to encourage active and collaborative contact to share information, which can be streamlined, as already mentioned, remotely through digital platforms that bring doctor and patient closer together. At the same time, it is necessary to guarantee more personalised contact in the context of face-to-face consultations, which with the expansion of telemedicine will tend to be less frequent. In this sense, it is essential to rethink the doctor's office of the future, with the solution possibly being a less impersonal, more spacious environment, with computers separating patient and doctor being replaced by screens that allow for greater contact and more direct conversation.
On another front, the need to increase interoperability between health systems was discussed, particularly with regard to the standardisation of medical language and the implementation of a single clinical process. In fact, a relative portion of the time dedicated to recording patient data derives from the lack of intercommunication and cross-referencing of data between the various health units - whether between health centres and hospitals, or between public and private entities - which makes this process more time-consuming and repetitive than necessary. It is therefore essential to create a unique identifier for each patient that allows access to the entire clinical history - at which point the question arises of whether access to the clinical history is totally dependent on authorisation by the patient, who may or may not have the power to veto access to third parties. In line with this need, the compilation of unstructured clinical data in medical data libraries is crucial, and could be operated by transferring it to Research PACS for further structuring, allowing for the creation of digital data ecosystems that could potentially be used by healthcare professionals, universities, research centres and others.
However, there are at least two doubts and obstacles to implementing this objective. Firstly, although efforts to fully connect and integrate health units have already begun (e.g. BDAC Project in the Balearic Islands), the process of structuring data is still complex and difficult to implement in a fully optimised way, and there is still a long way to go before fully satisfactory results are achieved in this area. On the other hand, there is also doubt and uncertainty regarding access to and processing of the data collected, as well as ensuring its security and monitoring - who authorises its consultation and which entities should be allowed access.
This brings us to the final need to guarantee the security and confidentiality of the data generated, which is closely linked to cyber security issues. In this context, there are major doubts about the ability to guarantee total data privacy, with cyber attacks being an increasingly frequent possibility in the area (e.g. cyber attack on the hospital system in Ireland at the start of the pandemic), given the growing relevance that personal data is currently bringing. As such, the capacity for cyber resilience and constant monitoring in order to promptly detect anomalies in the system that may indicate data security breaches are key to responding to this need, even though they are difficult to guarantee given the unpredictability and speed of information leaks. In addition to this, there is the unknown question of how to manage access to the data generated, namely how to allow access only to certain entities, which also raises the issue of defining which entities can enjoy this access and the role of the user as the main person responsible for authorising this access. Finally, it is necessary to take into account the entire legislative context relating to data protection in force, and to understand how clinical data fits in (bearing in mind not only national but also European laws).
In short, it can be seen that a large part of the needs arise in response to the great and rapid technological evolution that has taken place in recent years, particularly with regard to adapting not only processes and procedures to this new reality and how best to incorporate innovation (Artificial Intelligence, robotisation, virtual reality...) into the day-to-day provision of health services, but also the health professionals and patients themselves, seeking answers to how to encourage them to collaborate and willingly participate in this project of growing innovation. There are also increased needs arising from the uncertainties and questions raised by this technological revolution, especially with regard to concerns about data protection and how to avoid the dehumanisation of healthcare.
As we have seen, various solutions have been put forward in response to these concerns and needs, some of which are already being implemented or are ready to do so (use of virtual reality, telemedicine, etc.), while others are still more distant from reality and still at an embryonic stage (data structuring and protection, interoperability of systems, metaverse, etc.). Thus, since solutions have already been devised for various needs, there is still a need for greater collaboration and exchange of ideas, not only between technology companies and healthcare providers, but also between healthcare units themselves. In fact, many successful projects have already been carried out individually, so the next step should be to compare the different methods used and the results obtained - competition from parallel alternatives being fundamental for progress - and then extend these processes with favourable results to other units.
There is also a need for a technological platform that can bring together innovative projects, considered best practice, developed by hospitals, universities, research centres and companies, which, with proper scientific curation, can be used by other hospitals wishing to implement innovative projects, starting from a base of knowledge and experience held by hospitals that have already implemented similar project(s), thus leveraging efficiency gains in terms of costs and time.
This is a challenge that the H-INNOVA: HEALTH INNOVATION HUB working group will be pursuing, and it is already receiving innovative projects from hospitals that will be evaluated by a Scientific Committee so that, if appropriate, they can be considered best practice.
Finally, it should be emphasised that the solutions that are found must have a potential global framework, aimed not only at solving local problems but also universal ones, with the capacity to be applied not only in the country but also abroad, ensuring the necessary scale for the survival of the solutions found.
Summary by Inês Lindoso (Nova School of Business and Economics)
Supporting notes by Inês Lindoso, Lígia Ernesto and Pedro Pita Barros (Nova School of Business and Economics)
Proofread by Pedro Pita Barros (Nova School of Business and Economics)
Reviewed by Telmo Vieira (PremiValor Consulting | ISEG -University of Lisbon)