Data availability, insights from data, data to train algorithms: during the keynotes that opened the ICT&health World Conference 2024 at the MECC (Maastricht), data was a clear thread, meandering between well-known concepts such as digitalization, AI, financing and collaboration. Under the leadership of chairperson and former journalist Maria Henneman, Bianca Rouwenhorst (CIO, VWS), Helen Mertens (CEO Maastricht UMC+), Lucien Engelen (CEO Transform Health) and John Halamka explained from their various perspectives how they use that common thread for the innovation journey in their organizations.
First of all, Bianca Rouwenhorst emphasized the urgency how the Ministry of Health, Welfare and Sport can stimulate digitalization by taking the lead in migrating from data exchange to data availability. She cited a typical example of a woman with an epileptic son who has 15 practitioners, from pharmacy to doctor to physiotherapist. They all have a partial view and knowledge of the treatment process, while the woman tries to get an understandable overall picture from 15 information systems.
“This perfectly illustrates the reason for my mission: future-proof healthcare for us and generations to come. An enormous task for VWS, the healthcare sector, insurance companies, patients, all with their own role. And we count on everyone to take their responsibility. I am therefore pleased to be able to welcome people from all over the world who came to gain knowledge at this conference.”
Same challenges
Because, Rouwenhorst stated, we face the same challenges all over the world, such as an aging population and a lack of healthcare personnel, every country and each region in its own way. More elderly people with more health issues, fewer healthcare workers. In 2040, provided nothing changes, 1 in 4 citizens will have to work in healthcare. An impossible task. And the costs are also rising to an unacceptable level.
“We need to innovate in all kinds of ways to prevent this, from prevention to the use of new technology. We really need to change. Data is a must here. Data availability, quality and solidarity are cornerstones of digitalization of healthcare.”
And, Rouwenhorst knows, that could sometimes be done a little faster. “But the Dutch may be a bit stubborn. Lots of local and regional initiatives, which is very nice, but it causes fragmentation and lack of cooperation between systems. And, a lot of retyping leads to errors and rising administrative costs.”
Reason for the Ducth Healthcare Ministry (VWS) to take more control 'by popular request' in data exchange and ultimately data availability: with the Wegiz and with the National Vision and Strategy. “And we must also do this internationally, at European level. Exchange best practices worldwide, and adopt them from each other. Learn, steal if necessary, take the lead in your domain and improve healthcare together.”
Current healthcare unsustainable
Helen Mertens, CEO of Maastricht UMC+, also notices it every day: the current form of healthcare is no longer sustainable. “What will it look like in 100 years' time: will we have virtual doctors, smart apps that treat us, robots that operate by themselves? Do we keep healthcare accessible and sustainable? And will that be the case in 100 years, or perhaps much sooner? ChatGPT is certainly not better at everything, but sometimes makes a better diagnosis earlier, or appears more empathetic than a doctor.”
And yet, many practitioners seem to lack a sense of urgency, as there was when video calling very quickly became common during Covid. But after the pandemic many doctors went back to the old situation, even though it turned out that video calling from home works much better than a consultation in the hospital.
Sense of urgency
“That sense of urgency must return, because there are still plenty of challenges, such as the well-known aging population, lack of personnel and rising costs. Especially here in Limburg, with higher rates of diabetes, obesity and depression. Plus, we need to work more sustainably to save the planet. That is why we are committed to a vision of 'Healthy Living': healthy and sustainable living.
And digitalization of healthcare requires, among other things, data-driven work and an underlying infrastructure. “Data for diagnostics, for science, via platforms such as Cumuluz - for better data sharing. It is important for the MUMC+ that we work with Epic.” A special data center collects and sifts through all this data for better insights, with consequences including fewer cancellations, shorter length of stay, acceleration of care processes, and better patient outcomes. The end result: more knowledge, better life, sustainable care.”
Life journey, not patient journey
As far as Lucien Engelen is concerned, all this sustainable care no longer has to take place in hospitals. In fact, only 6 percent of your health depends on healthcare, while 90 percent of the money goes to the ‘business’ of making people healthy. “We need to look at health more broadly, it is about more than the patient journey, it is about the life journey. Cheaper healthy food can have an impact on all hours in a year than that one-hour consultation with your practitioner.”
The same applies to providing care in other places, such as home monitoring or measuring blood pressure in a supermarket. This way you can keep care affordable and of a high standard. Technology can thus help to relieve the current, overloaded healthcare system. There are already devices for this that can quickly measure many body functions, but often in the hospital. “Take them to other locations so that the hospital is reserved for more serious help.”
In this context, Engelen points to a trial with 30 parties in a pop-up health store in a shopping center in Roermond. But he also talks about a toilet that can measure vital body functions, and he shows a fully robotic device for blood collection. This can be used in a supermarket or drugstore, after which the blood samples are collected to be analyzed in a lab. Simple care interventions close to people, can be combined with a retail visit.
“We don't know what healthcare will look like in 15 years,” Engelen concludes, “but from idea to rollout could easily take seven years. So we really have to get started now. And ultimately what matters is: “Better care is not about delivering better care, but about delivering better health.” You can watch Lucien's keynote below.
'I need AI'
Last but not least, John Halamka, the CEO of Mayo Clinic Platform, a basis for a collection of around 100 million patient files. This is also the basis for a growing number of AI applications that can use this data to gain insights from other data. “No hospital CEO wakes up and thinks: I need AI. They have different challenges: too much demand for care, too high costs, too few employees. Their question is: are there solutions for this?” Just like Engelen, Halamka believes that we must now start building sustainable healthcare for 20 years from now, otherwise it will be too late.”
Halamka already sees many great activities to achieve sustainable care in collaboration, also in the Netherlands. But, just as Rouwenhorst noted, there is still a lot of fragmentation. “I see many initiatives at local and regional level. Initiatives such as the AI Coalition, Health RI. What I don't see are comprehensive coalitions that everyone can benefit from.”
Growing cooperation
Although Halamka aims for the latter, Mayo Clinic is not there yet either. “We have data from 10 million patients, but that is not enough to develop algorithms that can be applied worldwide. That is why we are working with a growing number of hospitals in the US, Canada, Brazil and beyond on a federated platform of 100 million files from EPDs. And all with the right permission, the right privacy settings and governance.”
In short: collaboration is also a must internationally, to develop algorithms that can be used worldwide for prevention, treatment, research, etc. “And because circumstances are constantly changing, algorithms must also change. You have to take that into account. We had developed an algorithm for video calling that was launched in April 2020. When the penetration of video calling went from 2 to 90 percent within a few weeks, the algorithm was worthless.”
The most important thing is to continue to collaborate on an increasingly larger scale in order to use more and more data from more and more people to develop algorithms that are not only usable, but also adopted. “We now work in a Coalition for Health AI together with 2,500 organizations, and we share everything we do openly. My end goal is to collect data from approximately 3 billion patients worldwide. That is approximately all patients worldwide who are currently in an EHR, so that is a challenge.”
