In our latest HTN interview, we spoke with David Newey, interim chief digital transformation officer at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT), about the future of EPRs.

We discussed some of the challenges of successful EPR implementation, with a particular focus on the financial pressures within the NHS and healthcare and how vendors can better support this transformation. David also explored other areas of digital transformation, such as the future of AI and automation as well as how to drive cultural acceptance surrounding the use of this technology.

EPR implementation at Barking, Havering and Redbridge University Hospitals NHS Trust 

To begin, David gave an overview of his current position at the trust, stating, “my role is principally to oversee the implementation of the Oracle Millennium EPR and also devise their next five-year digital strategy”, before explaining more about the EPR itself, “it’s a shared EPR with Barts Health, so we’re joining that domain and we’re due to go live in September of this year”.

He went on to add how BHRUT are, “one of the last trusts in the country to move to an EPR”, highlighting how the trust has been “historically underinvested in terms of digital”, which has left them “playing catchup”. However, David noted the positive aspects of this, adding, “with that comes the potential to deliver a considerable benefit to the organisation”. He stated that “despite the fact they’ve got no EPR yet, BHRUT is probably one of the best performing hospitals in London, due to the hard work of all the staff” and that the addition of an EPR will only “increase productivity and efficiency in the long term”.

Challenges for a successful EPR 

Next, David highlighted some of the current challenges when it comes to implementing a successful EPR. He said, “I think it’s fair to say that EPRs are disruptive during a go live, but then when you factor in the current NHS focus on reducing costs and it impacts people’s ability to not only to envisage a digital future, but also to cognitively deal with the transition to the new EPR  when people are already working extremely hard.”

As an example, David outlined how BHRUT has been tasked with saving £61 million over the course of the next 12 months, before emphasising that the added pressures of “learning a brand new system can cause a considerable amount of organisational stress”.

What good looks like for the future of EPRs

After outlining some of the key challenges, David gave an overview of what good looks like for the future of EPRs. First, he outlined the importance of consolidating EPR maintenance teams, highlighting how “EPRs have a significant amount of overhead in terms of maintenance, so it stands to reason that they start becoming the lifeblood of an organisation and how it operates.”  He added, “if an organisation wishes to innovate and remain paper-free, then any new business processes or supporting forms that need to go with that, all need to be digitised.”

For David, the most sustainable way for the NHS to achieve this “is through collaboration, whether that’s a trust having a joint EPR maintenance team, or acute providers across an entire region having the same EPR and the same maintenance team”. He also recognised the importance of standardisation in this area as a way to “save money in the future” and that EPRs have got to “remain flexible and build that flexibility into their tool set to give organisations the ability to maintain and extend their own digital transformation”.

How vendors can support EPR transformation

David also spoke about cost considerations when implementing EPRs, stating that “the days of being able to spend millions of pounds on additional modules to replace ageing clinical systems are gone” and that instead “there needs to be an inherent toolkit within the EPR to provide that functionality in a more cost-effective way”. When discussing how to do that, David looked towards EPR vendors, suggesting that “they need to start enabling Trust’s to self-optimise and providing easy ways to perform upgrades to obtain newer features”.

He mentioned how the “NHS should be looking internally to see how it leverages off its existing functionality” and “start looking at its existing infrastructure and extending that in order to provide maximum clinical benefit to the wider NHS community”. As an example, David suggested “opening up the NHS app as a portal to clinicians to allow them to view patient records”. He also proposed “leveraging off the potential power of the Federated Data Platform and bringing it all together into one coherent strategy, to simplify reporting and data sharing for trusts”. David emphasised how this would help to “create one version of the truth and ultimately deliver information to both the clinician and the patients to help improve their care”.

Speaking further on what this strategy might look like, David highlighted the need for standardised architecture and datasets, adding, “the open EHR data repository has a whole series of artefacts that could be used, but it doesn’t have to be just that. We just need that standardised data dictionary, which I don’t think we’re a million miles away from at the moment”.

Wider digital transformation in health and care 

When speaking on the future of other areas of digital transformation, David highlighted the growing “cultural acceptance of the use of AI within the NHS”, particularly when it comes to supporting diagnostics and imaging. He noted how “ambient AI is clearly the biggest game in town in terms of transforming the way in which consultations take place and the efficiency by which clinical notes are made”.

For BHRUT in particular, David mentioned how they’re “very keen” when it comes to looking at generative AI for electronic discharge summaries, but he also believes that “proactive monitoring through wearables has got to be the future”. He discussed how “using an existing personal health record plus wearable data to proactively generate care pathways, is the way forward”, before predicting “advances in medicine through more and more use of AI in clinical research”.

David also highlighted how there are “a lot of trusts sitting on a wealth of data in their electronic document management systems and their archives,” and how AI can help with translating that information “into electronic metadata” to provide “much greater depth of research data, unlocking a massive treasure trove within the NHS”.

How to drive cultural acceptance of AI in healthcare 

Delving deeper into cultural acceptance of AI in healthcare, David stated, “when we move past using it for things like taking meeting notes and into real-world clinical decision support, it will generate a body of evidence that supports its use, which will increase the level of trust in this technology”. He added that “the propensity for people to continue to check and second guess what AI has done will gradually diminish,” but that it could take another 10 or 15 years for that to happen.

He also briefly mentioned the “fusion between AI and robotics, particularly with humanoid robotics” as an upcoming element that “will at some point impact the way in which we deliver care”. However, David also added that it’s “too far off at the moment” in terms of wider cultural acceptance.

Finally, David finished by emphasising the importance of innovation in the healthcare sector, stating, “I think if we don’t look at innovating and innovating radically, then we will risk having a healthcare model that becomes out of date and no longer fit for purpose”. Speaking on how to do this effectively, he added that there should be a focus on the core principles, to ensure strategy and transformation are always “clinically and operationally led”.

We’d like to thank David for taking the time to talk to us and sharing his expert insights in this area.

For HTN’s latest interview, we spoke with Julian Coe, managing director at X-on Health, to discuss the future of the digital front door in primary care, including what good looks like, the importance of the user experience and approaches to improving primary care. We discussed complicated vs complex in primary care, how best to serve people in a way they want to be served, and how to support primary care with change in the future.

To start us off, Julian provided his own definition of a digital front door as “a way that delivers a good patient experience and helps the surgery manage the demand they’re facing with the capacity they’ve got”, while adding that an advanced cloud-based telephony system “should absolutely be part of the digital front door”.

Complicated vs complex in primary care  

Julian then went on to highlight one of X-on Health’s key messages, which concentrates on drawing a distinction between the complicated and the complex when it comes to primary care. He explained that primary care is “complicated in that there’s a lot of demand and there’s a lot of parts to put together, but actually it’s not complex,” going on to state how “complex systems bring lots of unknowns”.

He expressed that the goal of all tech providers should be to make things easier, with a focus on “helping you get the answer you want first time as quickly as possible,” adding that solutions should also be “omni-channel with everything you want to know being accessible via your smartphone, if that is your preferred channel”.

Tackling the challenges of digital in primary care 

In order to tackle some of the more complicated aspects of digital in primary care, Julian noted how important it is to “serve people in the way they want to be served,” which to him means “automating all the different elements” and then taking the “simple steps of linking up all the automations to make the system work.”

However, he also recognised the extent of this undertaking, highlighting that in order “to improve the patient experience and improve access to primary care, you’ve got to help 6,400 surgeries in England.” But with a surprising number of these surgeries “only just removing fax lines,” Julian noted that “giving them a choice of 25 to 30 telephony providers, online consultation providers and website providers and then telling them to link it up to the NHS” just makes things more complicated, especially from the practice manager point of view. “You can introduce the fanciest bit of AI,” Julian added, “but it’s not going to be able to answer a question or do what you want unless you have someone there to hook it up and make it work.”

He went on to use X-on Health’s telephony system as an example, explaining, “we’ve got our telephony system in 3,600 surgeries and not many of them use it to the fullest extent. And that’s the same with any software system.” To address this challenge, Julian highlighted the team’s new “managed service ethos” in which they spend more time with each surgery “to take them through making simple changes in their telephony system”. This includes helping the surgery to switch on the features they need and understand how to “make use of it all”. 

Julian also outlined their three-pronged approach to delivering new systems, which includes bringing together technology, expertise and data to better “affect change” within these surgeries. 

Tudor Lodge case study 

To demonstrate the success of X-on Health’s approach, Julian used the example of their award-winning case study at Tudor Lodge Health Centre, where they performed a full audit looking at “how access was working for them”. This included reviewing the centre’s telephony data, their online consultation data and NHS app usage.

“We did a very large patient survey in multiple languages so people could answer in their own native tongue,” Julian explained, with the results showing “53% of the patient population who responded to the survey having never used the online booking solution”. In response to this, X-on Health looked at simple fixes to help improve the service, including the introduction of their chatbot and a dashboard that shows the flow of data, while also “providing them with a managed service” which focused on linking everything together.

The future of primary care and the digital front door 

Julian then outlined how X-on Health’s new approach and ethos fits in with the future of primary care over the next three years. He emphasised the need for guidance when it comes to implementing new tools and software, highlighting the fact that “there’s lots of tech that can change the world, but our strongest message overall is about deploying it”. Julian added that “self-learning is nowhere near as simple as being given a hand” and that there should be a particular focus on “helping the practice manager”. 

Julian then went on to speak about the importance of consolidating tech to “make it easier” for surgeries and practitioners to use these tools. Using the NHS App as an example, he said, “the drive to the NHS App is totally valid and it has all that fantastic functionality, but unless it speaks to you on an individual level and unless your surgery is using it to refer you to the right local services, you’re probably not going to use it”. He then emphasised the importance of using solutions that work “down on the ground. Otherwise, it’s just another bit of tech that’s procured centrally and does nothing.”

Julian also spoke about the introduction of AI voice agents as part of the digital front door, stating that “at the moment, you can ring up and speak to one of these voice agents in multiple languages and it will understand what you’re asking, but unless you’ve connected it to the patient management system, it has no idea what appointments to give you.” This linked back to his focus on consolidating systems, but also allowed him to emphasise the potential for this type of tech, especially when it comes to personalisation. He explained how “the ability to personalise is moving very rapidly, so we will have the perfect receptionist for you shortly,” referencing X-on Health’s plans to introduce their own voice agent as part of their offering. 

Building the case for change 

With all these challenges and ideas in mind, we spoke about how to implement the necessary changes within primary care and what the case for change would look like, with Julian stating that “there’s absolutely zero case for the current status”.

He expanded on this by using online shopping as a comparison to healthcare services, explaining that with online shopping we get “minute-by-minute tracking of where the van is and when the delivery is coming”, but we don’t get the same service when it comes to the more “important experience” with a GP. 

When considering how to address this, Julian explained that ultimately, “it’s not really a tech issue. It’s about how we use the tech to help the GPs provide the service to the patient.” From his perspective, Julian noted how “we should make the tools available to GPs to make it easier for them to provide that level of customer experience” and ease the burden when they’re already “tasked with managing their own business, managing complicated workflows and being fantastic clinical providers.”

Adding to this, Julian also highlighted that “one of the really important facets of improving patient access is that we return to healthcare professionals having more time to provide care and to achieve a more proactive healthcare model rather than a reactive one”. He emphasised how tech should help clinicians focus on “doing what they’re there to do rather than being workflow models”, which she said is “a real core facet of what we’re trying to achieve” at X-on Health. 

Key considerations for the future 

Julian’s final comments focused on the key considerations that should be taken into account for the future of primary care and the digital front door. He suggested that “people have got to start buying solutions and not individual point systems” which require them to “try and put it all together”. However, he also added that this should be beholden to the powers of the NHS who should only “procure solutions that deliver outcomes” and “make the tech providers responsible for delivering those outcomes rather than selling them.”

He emphasised the importance of digital for the future of primary care, stating, “I don’t want to underplay what technology can do,” but also added that their main focus will be on “trying to simplify and consolidate all these tools” in order to make things easier for the surgeries using it. Julian ended our discussion by reiterating the fact that introducing new tech systems is no good “unless you do the hard yards down on the ground and link everything up.” 

We’d like to thank Julian for taking the time to talk to us and provide their expert insights on this topic.

For a recent HTN interview, we caught up with Michael Wornow, a computer science PhD student at Stanford University to discuss some of his most recent projects, including his involvement with research on Advancing Responsible Healthcare AI with Longitudinal EHR Datasets.

Michael began by introducing himself as a PhD candidate currently in his 5th year, working on developing and operationalising AI models in healthcare under Dr. Nigam H. Shah (professor of medicine) and Dr. Chris Ré (professor of computer science).

He first highlighted key areas of their research, stating, “we’ve been very focused on not just making advancements on the methods side of things, but also thinking about practical deployment considerations, developing more rigorous evaluation frameworks, and publishing our research to make it more accessible”. Diving deeper into his own personal work, Michael shared how he has focused on “developing machine learning systems to improve how hospitals operate,” by using electronic health record (EHR) data.

He noted the two main threads underlying his research were: (1) how to improve the individual point decisions that clinicians make within larger workflows, and (2) how to understand and automate the larger end-to-end workflows that these decisions are a part of. When outlining the overall motivation, he narrowed it down to one core question: “How do we use AI to improve care delivery?”

The foundation model approach 

To explain the background of his research, Michael told us a bit about the “foundation model” approach to machine learning, where instead of training many task-specific models that are each specifically designed for one narrow task, you train “one big model on tons of unlabelled data” and then use that one foundational model to complete a variety of “downstream tasks”. Giving an example of this, he noted ChatGPT as “one of the most successful foundation models”.

When relating the foundation model approach to his research, Michael went on to say, “when our lab started this work several years ago, we hadn’t quite seen that translation to the EHR domain. So, one of the first questions we asked ourselves was, how well does this approach transfer to the clinical setting? And to better understand that, we needed more rigorous benchmarks.” Michael continued that, “Unfortunately, there’s only a handful of public datasets available to researchers. So, if you’re not attached to a large hospital like Stanford, it’s very hard to curate the scale of data necessary for training and evaluation.”

Even for those like Michael who are fortunate enough to rely on the data from a hospital, there are still issues to contend with, as he noted, “the data can be very messy and is not typically standardised across papers. Not only does that make it impossible to do science in the strict sense of being able to replicate findings, but it also makes it very difficult for people to build on each other’s work, which slows down progress.”

Michael compared the accessibility of pretrained models in healthcare to more general-purpose models like BERT or Llama, noting how they “will have millions and millions of downloads, since virtually anyone can work off these models and fine-tune them for their own use cases.” However, Michael noted that the same thing didn’t exist for healthcare “even though we know that foundation models are great and we’ve seen strong initial successes with them in the healthcare domain.”

Given these potential benefits, the question facing the team boiled down to, “Can we enable more open and reproducible science around foundation models trained on EHR data by publicly releasing better datasets, benchmarks, and models?”

Advancing responsible healthcare AI with longitudinal EHR datasets

To answer this question, Dr. Shah’s team released three different benchmarks and datatsets over the past year: EHRSHOT, INSPECT and MedAlign.

EHRSHOT explored how to model the “structured information within the EHRs of roughly 7,000 deidentified patient records,” Michael said. The dataset covers information such as procedure codes, diagnoses, lab orders, and more. Michael explained that “the most unique aspect of EHRSHOT is its longitudinal data, i.e. it covers the full health history of a patient (potentially over decades) rather than just being restricted to an ICU or ED visit like other public datasets such as MIMIC and eICU.” This was important because “some of the tasks we were looking at only made sense in a longitudinal setting”.

INSPECT was led by other students in Dr. Shah’s lab – namely, Zepeng Huo, Shih-Cheng Huang, and Ethan Steinberg – and focused on the multimodal nature of healthcare data. “EHRSHOT is focused on structured information like billing and procedure codes. However, INSPECT also contains images and text linked to the same patient”, Michael said. The third dataset was MedAlign, which was led by Scott Fleming and focused on text-based clinical tasks.

In addition to the data contained within these benchmarks, Michael highlighted how the team has also trained their own foundation models from scratch on “roughly two and a half million deidentified patient records at Stanford Hospital.” The team has publicly released ~20 EHR foundation models on HuggingFace, a community platform for AI researchers, “making it available for approved researchers to download and fine-tune our model for their own projects.”

Key findings and successes from the research study 

When asked about key findings from the research, Michael said that creating the foundation models and “putting them on Hugging Face” was one of the most important aspects of the work, as it will “hopefully encourage more sharing of trained models amongst healthcare researchers.” He added that “getting more raw data out there was also important” because almost everyone currently works off the same one or two public EHR datasets. He noted that this “makes it difficult for the field to learn generalisable, reproducible lessons, as the vast majority of research over the past decade is essentially based on one dataset of roughly 40,000 ICU patients from a single hospital in Boston”.

Michael emphasised that developing new datasets is not easy, noting how “it took about a year and half” and a “heroic amount of work by Nigam and Jason Fries, a research scientist in our lab, who both put a ton of effort into pulling together all of the papers, codebases, and stakeholders” for the team to publish their datasets. Ultimately, however, it was “worth it from the positive feedback we’ve gotten from a ton of people interested in this sort of data”. He added that “because of Jason’s and Nigam’s efforts, it will hopefully be easier for future dataset releases at Stanford as well.”

Looking ahead: the future of research in this area

When asked where this type of research will be in the next 5-10 years, Michael predicted that “AI models will be so good that it will be irresponsible for doctors not to use them.”

He went on to describe how these technologies could also help solve issues in healthcare inequality and accessibility, outlining how “many people don’t have access to a doctor, and even among those that do, there can be huge variation in outcomes. Infinitely scalable AI models trained on huge corpuses of medical knowledge can help level that playing field and give everyone access to state-of-the-art care.”

Lastly, he mentioned a recent effort towards fostering more cross-institutional collaborations to “create better standards for the deep learning for healthcare community” across evaluations, models, methods and frameworks. Michael highlighted the working group he’s been involved with called MEDS (Medical Event Data Standard), led by Matthew McDermott, professor at Columbia University, which encourages collaboration from across the globe to facilitate a standardised approach to machine learning for healthcare.

Other key areas of research

Finally, Michael spoke to us about other research areas and projects that he’s been working on, including the use of large language models to accelerate the process of finding eligible patients for clinical trials. He said this could help reduce the need for clinical research co-ordinators to “scroll through every patient record one-by-one and manually check them against a list of forty to fifty eligibility criteria.” Instead, using an LLM, “we can do that in seconds at high accuracy.”

Michael has also been looking at automating administrative workflows within the hospital. He highlighted some work on automating basic workflows in Epic and outlined a vision for reducing the manual burden on clinicians “so that instead of the nurses running back and forth between the patient bed and their desk to place an order, they could just click a button and the computer would be able to automatically place the order for them”.

When closing our discussion, Michael shared some insights on what excites him most about the future of this research area. “When you sit in the computer science building here at Stanford, you can literally see the future being invented around you,” he said. “The hospital sits right across the street. Despite being so close geographically, however, there remains a large gap when it comes to technology. Bridging this gap is what really excites me.”

Reflecting on their dataset releases, Michael added. “I’ve been fortunate to collaborate with some of the most talented people in the space during my PhD. However, there’s still a lot of work to be done. I hope that these dataset and model releases encourage more smart folks to work in the space, and that these resources help to foster the development of a larger community around open and reproducible deep learning for healthcare.”

We’d like to thank Michael for taking the time to talk to us. Find out more about his research here.

We caught up with Peter van Ooijen – professor of AI in Radiotherapy and coordinator of the Machine Learning Lab at University Medical Center Groningen, and former president of the European Society of Medical Imaging Informatics (EuSoMII) – for a recent interview, to talk about new technologies and future directions for medical imaging and radiotherapy. 

Offering a brief introduction to his current role and background, Peter shared that he studied computer science at the Delft university of technology in the Netherlands before moving into the field of computer graphics, completing his Master’s thesis on radiology data, which led him into the wider arena of medical imaging. “I’m from a technical background,” he said, “but I’ve spent my whole career working within hospitals, focusing on using medical imaging data to improve patient care.” 

In his current role at the University Medical Center Groningen, Peter is “on the one hand a professor of AI in Radiotherapy, and on the other hand the machine learning expert at the Data Science Center in Health (DASH)”, he told us. “DASH is trying to improve the level of data science throughout the University Medical Center,” he went on, “so we’re a group of people who work across different departments but dedicate our time to work on that at a central level.” That includes supporting people in a variety of projects, helping locate the right people, and working “a lot on education” which is something highlighted by the newly introduced AI Act as “a very important part now, for medical students, but also for biomedical engineering, and our employees from healthcare professionals to PhD students – everybody needs to learn about AI and how to use it”. 

Going on to talk about his voluntary work for EuSoMII, Peter said: “We’re focused on medical imaging, but it’s a bit broader than radiology, and we try to have a very diverse group of people involved, so we’ve got technical and medical people represented to get that interaction going, because we think it’s of vital importance to work together to get the most out of the technology that’s there.” At the moment, the “most promising” technology is AI, he said, “and we need to work together to build responsible AI that also has real clinical value”. 

As well as the society’s annual meetings, EuSoMII also runs challenges, according to Peter, “where teams of three people, including at least one clinical and one technical person, work on a challenge for a day – they get the data, they get a platform where they can train models, and they have to train models to perform certain tasks with AI and that clinical data. That helps them start to talk to each other and understand the different perspectives, and then they can learn from each other about the technical parameters and the clinical implications – we also try to get more ethical and legal people involved, as well as patients.” 

Sharing some of the research he’s been involved in recently using AI in medical imaging, Peter told us that his PhD students are working on a range of projects, looking at things like tumour segmentation and how to improve quality there, as well as explainable AI, “working on how we can build models in such a way that they’re also acceptable for medical experts who have to use them”. That can include developing attention maps or heatmaps, which help illustrate what the model does and how it produced certain outcomes. “We also need to show the uncertainty of the model, perhaps mapping that into the result, allowing people to better assess how certain that model is of a decision and to understand where they should maybe reconsider the AI decision or make changes to the result,” Peter continued, “so at what point are they not going with the model any more because it becomes too uncertain.” 

Research is also being carried out on predictive models, Peter shared, looking at using AI to “try to predict the future”. Whilst that is “a bit further away from clinical practice”, he explained, “we try to predict the outcomes of a specific treatment based on the data we have, what kind of toxicities the patient might develop, and so on”. The idea is that this information could be used to optimise treatment planning, he went on, “so you could even make multiple plans and select the best one based on those predictions, and when treating a patient, you could perhaps even predict the moment at which you need to change the plan to make it more optimal for that patient”. 

The challenge, Peter says, is considering how to communicate that process to the user, and how to ensure that information can be trusted. “Nowadays, a lot of AI is still required to have human oversight,” he said, “so there has to be a lot of checking – whether the segmentation was correct, if what the model did was acceptable – for predicting the future that’s quite difficult.” Overcoming these challenges would be worthwhile, however, Peter considered, “as you can really use that to optimise and personalise treatment”. 

Commenting on what technologies such as AI and machine learning can offer for the treatment of cancer and other diseases across the globe, Peter said: “If you look at radiotherapy, things like the segmentation of organs at risk and automated plan construction are moving into clinical practice – those things are in use, they’re on the market, you can buy them from different companies, and they perform very well. We all know that healthcare is in a difficult position with more and more people requiring care, and with less and less personnel to provide that care. Technology gives us more data about a patient all the time, but the people to act upon that data are not always available and it will be even worse in the future.” 

We need to take action to make healthcare more sustainable, Peter highlighted, “and we believe that technologies like AI can help to partly solve this problem and do the work that needs to be done, by automating steps within the process and allowing people to be faster and more accurate with what they do”. That’s why getting that technology actually implemented and into clinical practice is so important, he continued, “because that’s lagging behind, due to needing to ensure that everything complies with laws and regulations, and that requires some extra effort”. 

On what he’s most excited about relating to the use of technology in radiotherapy, Peter told us that “that’s changing all the time”, but that foundation models and large language models (LLMs) offer “so many possibilities” for healthcare. “We also see a lot of possibilities with synthetic data generation,” he went on, “and that’s something we’re still exploring in terms of how we could employ that within clinical practice.” The most exciting thing is “basically AI in itself”, Peter said, “and who would have expected a few years ago that we could do what we can do with LLMs nowadays? That makes our research exciting, and we try new models, we try to apply different things developed with AI into the clinical field, and if you see what is feasible sometimes that’s really very impressive.” 

Peter talked about his years of experience in the medical imaging field, stating that the amount of effort that had to be put into doing segmentations with conventional methods was “enormous”. The programming was very difficult, he shared, “and the development of the algorithms, especially when you wanted to segment multiple structures within a dataset, was a lot of work”. Now, we have AI models that can segment all those organs “really fast”, he considered, “and that’s incredible”. It’s impossible to say where medical imaging will be in ten years’ time, Peter said, “but I hope we will be able to do adaptive radiotherapy and optimise the treatment plan at every step of the way, that we can use AI to do that segmentation and everything we need to do in a very short time, so we can offer every patient the most optimal treatment individually”. 

Training and education will be central to ensuring that those working in the medical imaging field are prepared to be able to use these models and new technologies in their everyday roles, Peter told us, “and I think training in things like AI is something we have to do on a general scale, and additionally with specialties like radiotherapy we need to do it on a very specific level”. Every role in healthcare will change to some extent as a result of the impact of technology, he noted, and the ways radiotherapists work, the processes that are now in place, “will include more automation, more steps done by a computer”. Whilst AI won’t replace humans in the field, “it’s going to be a tool used to make decisions on treatment and during treatment”, he added. 

“I do think that certain skills will disappear,” Peter concluded, “with certain things becoming so good with the use of AI that you won’t need to do them any more yourself – which ones those are going to be is difficult to say, but the example we used of organs at risk segmentation – I think that’s something we won’t have to do any more.” He likened this to the introduction of satellite navigation, saying: “You cannot always rely on it, so you have to be critical about when you use it and the mistakes it could make, but for many people I think that being able to read an actual map is a lost skill. You need to know how to use it, because you need to know how to navigate on Google Maps and search for places; you need to be critical if you see something strange, or if a road it’s telling you to go down is blocked; but you don’t have to know the whole process any more. It’s taken time to get to where we are now with that, and that will be the same in healthcare with technologies like AI.” 

We’d like to thank Peter for taking the time to share these insights with us. 

HTN caught up with Matt Connor, group chief digital information officer for University Hospitals of Liverpool Group, consisting of Liverpool University Hospitals Trust and Liverpool Women’s and spanning multiple hospital sites. Matt shared insight into the importance of having a cohesive strategy for digital and his views on cyber security – the current threat landscape, priorities for the group, considerations to take around finances for cyber, and more.

Officially, the group was formed at the start of November, but in reality Matt has been working in the joint role since the start of February 2024, and took on the expanded role following five years as chief information officer for Liverpool Women’s.

The group way of working “offers a real opportunity to deliver digital at scale”, Matt reflected, whilst not losing sight of the collaboration taking place on a wider scale with local Liverpool trusts and beyond across Cheshire and Merseyside.

Digital priorities, and balancing innovation with operational needs

Matt highlighted the need to address ‘why’ digital innovations are needed and put in place, summarising: “We need to make life easier for our clinicians, regardless of what system they are using, and we need to remember that patients are always at the core of everything we do. We need to make it easier for them to engage with our services; and the complexity of the different systems across our different sites can make that really difficult. It can result in overly complex processes affecting patient care pathways, with patients having to tell their story more than once.”

“We cannot forget about getting the basics right, if we are to deliver effective digital innovation,” Matt continued. “If we can do things once and at scale, and get to a place where we reach a level of systems convergence and integration, then that will benefit both how we are able to deliver services to a high standard; but also provide a simplified digital and IT offer for our staff and patients alike.”

The “power of collaboration” is also a priority for the group; Matt shared the ambition to develop a single electronic patient record throughout Liverpool, with Liverpool University Hospitals Trust to be the first to implement that EPR in the group’s planned roadmap. Work is underway with NHS England to help this become reality, with the trust working closely with the national team.

In order to support staff in their roles and improve their experiences, the group will prioritise streamlining and simplifying where possible, with Matt acknowledging that whilst group working opens up plenty of benefits, it also brings challenges such as the use of multiple systems and duplicated governance procedures and policies.

“We need to optimise our time and resources so that we can make the most of what we have and make things more efficient for staff across both organisations,” he said. “This is particularly important when it comes to clinicians having a need to access different clinical systems – historically this has been extremely challenging, so we are working on a number of projects designed to improve IT access and simplify our standards across all the sites. We want aligned digital processes, and delivering a consistent reliable serviceand trying to unlock some of the benefits of collaboration between the two organisations.”

However, whilst simplifying is a core priority, Matt noted that it is important to take care that simplification does not take precedence over innovation, with too much focus on streamlining it may lead to missed opportunities to try something new. Here, he underscored the value of data and utilising business intelligence across both organisations as much as possible, to identify opportunities to improve patient outcomes across Liverpool and beyond.

Matt also emphasised the importance of having an engaged clinical workforce when it comes to innovation. “We really do rely on our strong clinical engagement network. We are lucky to have some really excellent clinical and nursing leaders within both organisations, and they help us to prioritise opportunities to innovate as they come along, because they can tell us what will be useful to staff. It’s a real team effort – it’s important to say that and to recognise it.”

Data at the heart of everything

Coming back to the topic of data, Matt reflected: “Data is at the heart of everything – it really reinforces why we do things, it measures our progress against an intended objective, it illustrates the benefits of an initiative or tool. Without data, it’s just a matter of perception, and that can be misleading at times.”

The biggest impact in this space has been seen when the group has “put data at the fingertips of those who really need it”, he continued. As an example, Matt highlighted that the group’s maternity assessment unit had a target indicating that 90 percent of patient triages should be completed within 15 minutes.

“The problem was, this data wasn’t in the hands of the clinicians and maternity staff, so it wasn’t being acted upon,” he said. “People were going about their daily business, doing their jobs and trying to achieve that, but without the oversight of where particular challenges lay when it came to meeting that target. We developed a real-time dashboard placed right in the centre of the department to help tackle this. It was interesting because at first, that dashboard was inaccurate. That was because the data in the system wasn’t always accurate – and that in turn was because the data hadn’t had this value placed on it before and staff are busy, so ensuring that data was inputted and correct wasn’t always prioritised.”

Having the dashboard in place “helped improve that, because staff could see the consequence and meaning of the data they inputted, and over time it had a real impact on the delivery of service. We are now exceeding that target and completing over 90 percent of maternity assessment triages within 15 minutes, consistently. The maternity team is rightfully very proud of that.”

As healthcare moves forward into exploring new ways of providing care, Matt added that population health data “is going to be so important. We need to be able to make the right decisions for our local communities with the funding that we’ve got, so that we can move away from being acute-focused and towards providing the right care in the right setting.”

Cyber security: optimising resources and building capabilities

Matt commented on the complexity of the current landscape when it comes to cyber security, acknowledging geo-political threats as well as the usual cyber threats that exist on a daily basis.

“If we are to be as successful as we can in reducing the risk and minimising the impact on patient services – because we can never truly eradicate that threat – we need to ask how we can make the best use of our resources. That includes staffing, knowledge and financial resource.”

If individual organisations all “go off and do their own thing”, there is a missed opportunity in Matt’s view. He pointed to the national NHS offer around cyber which includes a range of services from free on-site assessments to virtual perimeter security, stating that the resources are “really beneficial to strenhthening the cyber posture of organisations”.

From an ICS perspective, Liverpool has developed its cyber strategy aligned to the national strategy, with a view to making the best of what is already offered nationally and augmenting that to regional needs. “We know, for example, that third party supplier management is a key priority when it comes to cyber, particularly as we move into more cloud-hosted services,” Matt explained. “We are potentially being exposed to new risks in this way, risks we didn’t historically come into contact with. So there is an opportunity here to deliver some of that support at ICS level, and put in some principles around supplier managements. We can baseline where organisations within a footprint may have some commonality and provide economies of working together to address any gaps. We can also better understand risk, as we have a wider picture.”

In this way, the ICS focus on cyber security is very important in Matt’s view, and it comes down to having a clear strategy that organisations can align themselves to.

One programme the ICS has recently invested in, to support 14 trusts across the region, will see the introduction of a healthcare cybersecurity platform from supplier Cynerio. Matt noted this provides “comprehensive visibility into all networked devices across our ICS trusts” and forms part of investment in defences to better protect patient data, minimise vulnerabilities and reduce disruptions to care. Here, the platform is designed to offer continuous monitoring to detect and mitigate threats specific to medical and IoT devices within healthcare environments as well as real-time threat intelligence and automated response mechanisms, “helping us enhance our security posture” Matt added.

In Cheshire and Merseyside, the stance on cyber is that “you are only as strong as your weakest link”. Matt elaborated: “We live in an interconnected NHS world. I don’t think we should be focusing just on getting in tools and systems to solve problems, but rather focusing on developing some capabilities within the ICS to provide wrap-around support to local trusts, augmenting their own capabilities.”

Funding for cyber

Tying into this point, and picking up on the financial side of cyber, Matt noted that funding has typically been capital-fed, which tends to feed into plans to buy more tools. “We end up with a landscape of so many tools, increased complexity and not enough cyber staff to manage them; actually, what we need to do is develop the right capabilities so we can maximise with the resources that we’ve got. With this in mind, it would be more helpful if we had a revenue-based model that would allow us to build for the future.”

It’s not just for the national team to provide funding all the time, he pointed out. “Where we’ve got ICSs working on digital planning across a footprint, there needs to be a sustainable funding models that organisations buy into to allow a degree of centralised resource and capability within the ICS.”

Whilst on the topic of cyber funding, Matt considered how digital leaders can communicate the financial rationale between cyber security investments to colleagues who might not necessarily see the direct impact of the money spent.

“It’s about articulating the risk, and highlighting how it’s about clinical risk management ultimately,” he stated. “In particular, it’s key to have a strong route to the trust board, with strong cyber awareness and the risks articulated and understood at that level.”

Investment in digital tends to come hand-in-hand with a return on investment in terms of delivering perceived benefits, Matt said, whether that benefit is increased efficiency, quality, safety, or a financial benefit. “With cyber, it’s a bit different, because the purpose of cyber is to stop something from potentially happening. That’s why I think it’s a question of articulating that properly. You need to focus on the impact an attack could have on clinical services, and unfortunately the NHS has a number of examples from the past couple of years where clinical services have been significantly disrupted because of a successful cyber attack. Make sure you’ve got really robust cyber planning in place, that you can answer the ‘so what?’ question.”

Something else that can also be overlooked is “really emphasising the ‘secure by design’ principle when buying digital innovations”, Matt added. “When we buy new innovations, are we really considering the cyber requirements at an early stage?” As an example, he pointed out that where previously clinical systems have been hosted internally and locally across different organisations, healthcare is now moving towards convergence with a more centralised cloud-hosted offering capable of servicing the need of many organisations. “It’s good in many ways that this convergence is happening, but are we considering the cyber risk associated at every stage? If this centralised cloud solution is compromised through a cyber attack, the impact will be significantly greater than if an internally hosted solution was hit within one organisation.

Getting the most out of digital: advice for health leaders

When it comes to digital innovations and projects, there is a tendency to view go-live as the “defined outcome”, Matt reflected. “We staff and we fund for that period, based on a programme approach. But if we do that, we end up failing, because we don’t adopt and optimise those systems. When we put new systems in, we’ll get a lot right, but there will also be a lot that we need to shape as we move forwards. So it’s about being committed to digital as a way of life; seeing it as intrinsic and central to the things we do in terms of delivering care. We need to invest in sustainable digital teams for the long term.”

Matt also emphasised the need for collaboration along with the right to fail and try again. “It’s okay to make mistakes. It’s about being open and honest about where we could do things differently, do them better; learn from it.”

Leaders need to “stay true to the course, and see digital as a real enabler”, he concluded. “That means ongoing investment around staffing. That doesn’t just mean ‘digital’ staff, but all roles that have an important part to play in digital transformation moving forwards.”

Many thanks to Matt for taking the time to share his thoughts.

We recently had the opportunity to chat with Kumar Satyam (Satyam), digital health consultant and chair for the technical committee at HL7 India. Satyam discussed his views on the importance of interoperability and de-centralisation within healthcare, sharing examples of his work in this area in practice as well as his hopes for the future and his views on the digital healthcare landscape within India.

Starting off by sharing some insights into his current role and remit, as well as his career path to date, Satyam explained how he has previously worked with health tech start-ups such as Karkinos Healthcare, a cancer care start-up where his role as deputy chief product officer focused on standardising the technology platform and bringing different partners on board; and he has also worked for multinational companies such as GE Healthcare and Phillips.

“I am also the convener of the FHIR India Community – that’s a community of health tech enthusiasts primarily interested in interoperability and how it can shape digital health, as well as how the global industry standard FHIR can play a role in that. Like many other countries, India is backing FHIR; our national digital health mission has mandated it. Currently there are around 2,500+ of us within that community, and our aim is to come together and try to solve problems around interoperability. I have been involved in several projects of national interest as a FHIR India Community member, exploring the role of interoperability in Indian healthcare.”

Interoperability and data

What are Satyam’s key interests in this space? “I think it’s really interesting looking back on the history of health tech,” he reflected. “When computers were first introduced, people wanted their paper workflows to be translated onto computers. Paper files became computer folders. Digitisation, at that point, largely meant imitation of the physical world. But digital empowers you to do a lot more than that.”

Satyam noted that the healthcare industry as a whole “has got a bit stuck, particularly when you look to other areas such as e-commerce or finance. They have moved on, but healthcare has clung onto that idea that we just need to copy our physical processes into a digital format. With that in mind, something I find really interesting is the question of how we can liberate our data and de-centralise care. Patient data should move with the patient, irrespective of the patient’s location, and interoperability very much ties into that. The work and opportunity in this area fascinates me.”

A key challenge here, Satyam acknowledged, is that “all across the world we talk about interoperability. There are lots of initiatives trying to ‘solve’ it. But we are still scratching the surface.”

Pointing to the high levels of interest and discussion around artificial intelligence in healthcare, Satyam said: “At the core of this, the fundamental to AI is the data. We need to be looking at how we are going to liberate that data and use it. Interoperability plays a vital role in the revolution of AI because it ensures that your data quality is maintained and your data provenance is there. Interoperability is the key to focus on for all of this.”

He also noted how improved interoperability can help with progressing research, trials and the development of tools and systems, given that trials are based on the data that is available and that teams can get hold of, which may or may not be representative of the populations tools are designed to serve. “Bias inevitably gets introduced because somebody is processing the data, somebody is trying to label and make meaning out of it. If we get interoperability right, from the origin, it will try to maintain that source context. That has the potential to reduce a lot of bias that we see in system data.”

Interoperability in practice

Reflecting on his career in the digital healthcare space, Satyam highlighted two projects that stand out to him in particular with regards to their impact.

In a previous role, Satyam worked on getting the organisation’s legacy electronic medical record (EMR) system to a level of compliancy with US regulations, and to improve its interoperability. “The scope was small at first – we looked at the EMR, we looked at the regulation, and we thought that we could see how to make it compliant. But when we started the journey, we realised that the legacy system brought its own challenges – both in terms of the technology itself and the knowledge of the tech. As the tech was old, we were very restricted in terms of having people on-hand with an in-depth understanding of the system we were working with.”

However, whilst working on this transformation, Satyam’s team realised that updating the EMR held a lot of business potential beyond simply making the system meet a regulation.

“With systems such as EMRs, there are a lot of third-party providers out there who will take advantage of the software to provide value-adding services to your customers,” he explained. “But because these third parties have access to your systems, sometimes their activities can cause downtime. So when we were doing the modernisation, we identified this as a business opportunity: we could certify the third-party vendors by launching an official certification programme. In the first year itself the programme was a big hit; we got around 70 vendors to sign up and get certified. From a legacy modernisation project, which was a cost, we moved into a business revenue space.”

This project led to several other initiatives. Satyam said: “The learning here was that when you start something, it’s good to keep your mind open. Don’t focus solely on the task that you have come in to do and nothing else. Possibilities emerge, and you can look for ways to tap into them. If you can tap into them, this is an indication of your organisation’s readiness to change.”

Another project Satyam worked on “really highlighted the power of interoperability and de-centralisation,” he said. The project focuses on cancer care, with Satyam referencing for context the rising burden and impact of cancer. He noted that in India, there are “limited centres of excellence for cancer – but when somebody is diagnosed, they want to go to the place where they think they will get the best care. This intensifies the burden on that institution, it increases wait times, and cancer is not a disease that waits.”

Whilst cancer care does have largely standardised protocols, Satyam continued, his team at Karkinos Healthcare sought to standardise that protocol more. “We wanted to take the knowledge and guidelines around cancer and standardise all of it, making it accessible digitally, so that people can get the same high-quality care for their cancer regardless of their locality.”

Satyam described how he led a project to connect all of the data from specialty hubs and treatment centres as well as smaller care centres. “We needed to make sure that there was a network for all this data to come together to support optimised care. It comes back to that point about liberating patient data and making it flow through the network and system, so that wherever the patient presents, their information is there. So we took on that project to try and make all of that data flow through our network, and we were fairly successful with it – we had around 70 centres connecting, which is proof of concept. It showed that it can work.”

Satyam also highlighted an initiative that the government of India has been running, which involves an attempt to digitalise the Indian healthcare ecosystem. “They are trying to say that for a country of 1.4 billion population, you cannot have a central repository. The volume is too high to be managed centrally. India is large and diverse, so we need a de-centralised, federated network. This would mean that the health data remains at the source, but on demand it can be exchanged to the location where it is required. So that’s something we are working on in India at present. There are now around 350 million health records on that network.”

Digital health in India

The majority of the population in India have access to smartphones, Satyam noted, including smaller cities and villages, and data tends to be quite cheap with WhatsApp as the preferred mode of communication.

“This means that our population is quite digitally apt – they generally know how to operate a smartphone and use apps. E-commerce is a booming sector over here, so people are experienced with that. They also tend to be very mobile-first in their approach; most won’t use a laptop or computer. However, when it comes to healthcare, I would say that we are still lagging behind. The reason for it is not the appetite, but the lack of awareness for where they should go. People want to know about their disease, they want to manage it, but there is definitely a tendency to go to Google first and treat that as a diagnosis.” Ultimately, he said, it comes down to not having a proper trusted digital source for healthcare.

It is the same with staff, he considered. “Our workforce is definitely overworked. India has a huge population, and the ratio of healthcare staff to citizens is really low. It gets worse as you move towards the rural areas. In those areas, you’ll find several villages relying on one doctor.”

In line with this, Satyam continued, much of the Indian healthcare workforce prefers to communicate with patients via WhatsApp, to help them reach as many people as they can.

“I would say our staff are generally digitally savvy, but current user experience of digital health apps leaves a lot to be desired. There is a lack of infrastructure and a lack of digital solutions offering what our workforce actually wants. Tools don’t offer the same simplicity as WhatsApp, so why should they change what they are doing?”

However, Satyam said that India is a “fertile ground for innovation. If a digital solution comes along and it gives people what they want, it will be hugely successful.”

Learnings and advice for building a digital workforce

Satyam noted that digital healthcare “can have a lot of different personas, and each persona has a different requirement. Somebody working in the admin side has very different needs to a clinician or a nurse, and their digital literacy may also be different. When we are building our digital health enterprise, these personas and their requirements need to be identified. Crucially, you need to anchor the digital aspects of their roles around the benefits that they themselves will realise. If you’re anchoring to the organisation’s overall benefit, you may not get the right level of participation. They have their own day-to-day work to be done, their own responsibilities; they need to see the value first and not the additional work.”

Another key aspect of this, Satyam continued, is getting the right tools and training in place; so that people want to come on the journey, and feel supported in doing so.

In terms of approach, Satyam said that in his experience, “it’s best not to take on digital transformation through a big bang approach. I think big bang can look good on presentations in board meetings, but I don’t believe they yield the results people want in the timeframe they expect. I would advocate for localised communities of practice with local champions; empower them, get their processes digitised and get them on board, and then snowball it slowly.”

If you could fix one challenge, what would it be?

“If I could fix one challenge, it would be access to standardised care,” Satyam reflected. “The geography of India is so vast and diverse. People from the north and south of India can be as different as citizens from different countries. I would like to see all of these people having access to the same, standardised care near their home. There is a lot of variability in care out there, not just in India but particularly prevalent here, and it leads to variability of outcomes for patients. That, in turn, leads to lack of trust in the system.”

There are “islands of excellence” in India and other places, Satyam noted. He would like to see the processes from these facilities standardised and applied to all. “Then, using digital means, we can de-centralise. That would mean that whether you receive care in Delhi or in a small village, if the disease is the same and the patient demographic is the same, the treatment should also be the same.”

Being a leader of digital change in healthcare

“I don’t think that being a leader of digital change in healthcare is all that different to being a digital evangelist within another industry, in terms of the role. However, the complexity of healthcare lends challenges. In an industry like e-commerce, there is a set number of components such as the creator of an item, the buyer, the seller. The number of components within healthcare is much larger, and there is a lot of interplay between different companies – regulatory, security, digital, clinician, patient, carer, and so on. On the surface healthcare can look much the same as any other industry, and I have noticed a belief that this is the case from people who come into healthcare from other domains. They see the tip of the iceberg: it’s just digitising a patient encounter, what is the big deal?”

However, from there, the complexity expands. Satyam referenced factors such as drug interactions, allergies, individual medical history, legal cases and so on.

“As a digital leader within the healthcare space, the first thing you need to do is appreciate all of that,” he said. “When leaders don’t have a solid understanding of all this complexity, they can hit stumbling blocks and it can lead to false starts.”

You also need to have a cause to build your digital solution around, Satyam added. “Choose the patient as your central figure. My recommendation would be that the patient should be at the heart of your digital transformation. If you focus elsewhere, such as on finance or business operations, you may succeed partially; but it won’t succeed fully unless your tool, in some way, makes the patient’s life better.”

Many thanks to Satyam for taking the time to share his thoughts and experiences.

For a recent interview, we caught up with Harvey Castro, AI expert and AI advisor to the Singaporean Ministry of Health, to learn more about current projects, learnings, and predictions for the future of AI.

Harvey began by introducing himself, telling us about his current role as chief medical AI officer for Helpp.ai, and his interest in creating AI companies to address specific pain points in healthcare. With over 20 years of experience as a doctor in emergency medicine, Harvey outlined how he focused on combining those two worlds, setting him up as a respected international expert on AI in healthcare, and leading to his production of a Ted Talk on How AI and Humans Can Revolutionise Medicine Together.

Harvey’s entrepreneurial spirit even led to him setting up his own healthcare system, which he grew “all the way from zero to 350 employees across eight locations”. That included having his own staffing and billing companies, and allowed him insight into the C-suite and “the biggest pain points” from a business point of view, to compliment his experience as a clinician on the frontline.

The idea for one of the first apps he created, IV Meds, also came from his frontline experience, Harvey told us. “I was coding a patient in the emergency room, and asked the nurse to start a drug, which took her about eight minutes by the time she got the textbook, she went through it, she got the calculator and verified my doses. In the app I created, you tap it three times, it gives you the dose, and you’re away taking care of your patient. And it went viral.”

Venturing into health tech

“By 2030, the world will face a shortage of 10 million healthcare workers,” Harvey explained. “That’s why I see health tech as a magic bullet to bridge this gap.” He pointed to the Apple Watch as an example of proactive care, saying: “Imagine harnessing all that data to spot risks and intervene before patients even realise they’re unwell. It’s about moving from reactive to proactive care.”

AI also offers many opportunities for patient engagement and communication, Harvey considered, noting differences which may exist in the ways health messaging is communicated, and the potential for AI to help clinicians tailor their messages to patients. “I could tailor it to have a British accent, or if someone’s hard of hearing I could show the AI using sign language, really personalising their care. That’s how I see AI – let’s use these tools to help humanity,” he said.

A project Harvey talked about getting the most enjoyment out of is around using AI to improve communication with younger patients. “I can take long and boring discharge instructions, feed them into AI, and get it to create me a colouring book,” he shared. “Kids love it, they understand it, and they start realising things they normally wouldn’t if I put it in text. For older kids, we use comic strips for communication because teenagers respond better to that.”

Opportunities for digital and AI to make an impact 

When asked about the opportunities that arise from the implementation of digital and AI, Harvey explained, “I see predictive analytics being huge”. He went on to give the example of how predictive analytics can help identify new strains of the flu or similar viruses, in order to catch an outbreak early.

Harvey also explained further benefits of predictive analytics in a more administrative sense, especially when it comes to pre-planning. “If I know there’s an outbreak, I know I need to get certain supplies and medicine in place ready, or call in extra doctors and staff  before the outbreak hits us,” he said.

Discussing some of the apps he’s developed during his career, Harvey mentioned how focused he was on pain points and finding ways to address issues in clinical care. One of the outcomes from this came in the form of his stroke scale app. “We needed to know how bad your stroke was to help us treat you in the right way, so I created an application for the stroke scale to help with that,” he told us.

Another pain point Harvey wanted to address was the way physicians or healthcare professional might sometimes forget to update their credentials due to the busy daily landscape of their job roles. With this in mind, Harvey created an app that reminded physicians to update any certificates before their expiry date.

Suggesting that the best approach to app development in healthcare involves finding something you’re truly passionate about, Harvey said: “When you’re passionate about something, that’s what pushes you to think outside the box. If you break that mould then all of a sudden you find a solution.” Having someone “on the inside”, or on the frontline, familiar with the problem you’re trying to solve, is essential, he went on, “because programmers don’t see that, and they don’t see how the app is going to actually be used within a clinician’s role”.

Singapore’s digital transformation in health

Part of Harvey’s role with the Singapore Ministry of Health involves having conversations about addressing certain healthcare problems and looking at ways to leverage AI to make improvements. “It’s such a blessing,” he said of the role, “because they outline the laws and the sandbox we have to play in, and let me play AI doctor in terms of developing new ways that AI can help us tackle a certain problem they come to me with.”

He outlined some of the key ways Singapore has addressed digital transformation in health, stating: “The government is leading when it comes to backing AI in their healthcare system. They’re so united when moving things forward. The fact that they even have an advisory board for this particular problem, made me excited. That’s being progressive and thinking of the future. I feel so lucky to be a part of this group.”

In Singapore, a recent government initiative has also announced that “the country will pay for anyone over the age of 40 to be retrained in AI”, according to Harvey, “and I thought wow, what a leadership – if they see something they like, and want to push that throughout the whole country, they can literally do that”. This approach tends to make Singapore more “innovation friendly”, he considered, “for innovators like me to come in with their ideas”.

When it comes to the future of AI in healthcare, Harvey mentioned Elon Musk’s plans to introduce robots into the health workforce. “Robots will be one of the biggest changes in hospitals, starting from 2026/2027”, he predicted, “and that will be impactful in a number of ways, including helping retain an ageing healthcare workforce, who may start to struggle with the physical capacity required to move patients and that kind of thing. That might push them to retire early. With humanoid robots, the robot could do the heavy lifting for them, taking that physical strain away from physicians, and hopefully helping that workforce stay in their role for longer.”

Harvey also sees the potential for “AI to be in the eyes of robots”, enabling robots in the health field to pick up on details physicians might miss, take in information from a consultation, or even offer ideas for “next steps” in a patient’s treatment. “The big picture I see is robots combined with AI in healthcare,” Harvey continued.

Final thoughts on AI and digital transformation 

Harvey shared a few final thoughts with us on the topic of AI and wider digital transformation, including how AI and digital health may differ for each country. “I’m in the US, using data from the US, so the way we educate our physicians and healthcare system may not apply in the UK or other parts of the world. It’s important that we have our own models, created by our own institutes, with our own local data; that way it’s really representing the population,” he said.

Talking about concerns health professionals might have about AI replacing them in their roles, Harvey said: “You’re not going to lose your job, because that human touch you bring is too important. Let’s look at the repetitive tasks or the harder tasks that don’t make sense and put that into AI – that way you get more time to spend with your patients.”

We’d like to thank Harvey for his time in sharing these insights with us. Please feel free to check out his Ted Talk to find out more about his take on the future of healthcare.

For a recent interview, we caught up with Peter O’Halloran, Chief Digital Officer at the Australian Digital Health Agency (the Agency), to learn more about current projects and priorities, what’s in the pipeline for digital and data across the next five years, progress toward Australia’s National Digital Health Strategy, and more. 

Peter offered a brief introduction to his role and some of the recent projects he’s overseen with the Agency, saying “I’ve been at the Agency for about two years now, but have worked in healthcare IT for more than twenty years”. Referring to what he calls a “digital health revolution” in Australia at the moment, he told us that the Agency has a plethora of ongoing projects across the health and care space, adding “I’ve seen more activity in the last two years than I did in the preceding twenty years”. 

Specific projects under way at the Agency include “rearchitecting Australia’s entire digital health ecosystem”, modernising the My Health Records platform, and introducing a full national Health Information Exchange (HIE) which he estimates will take place over a period of five years. “We’re doing all of the design work for that now, and we start the first bit of coding in January,” he said. 

Another area of focus is healthcare interoperability, according to Peter, “so that involves a lot of work with national identifiers for healthcare providers, consumers and organisations, as well as with standards and clinical terminology – we have a FHIR accelerator, and although FHIR was invented in Australia we’ve done very little with it until now; now we’re trying to leapfrog everybody else!” 

Finally, Peter shared that the Agency is working on offering consumers choice, with the my health app that he describes as a “digital front door for all things healthcare in Australia”, and planning for a go-live this month for “the next big step”, which is e-prescribing. “That’s probably a decade’s worth of work we’re trying to get done in the next two or three years,” he added, “but the time has come, and we can’t wait any longer.” 

There’s work at the Federal level to bring in new legislation, Peter added, “which is set to mandate that pathology and diagnostic imaging test results must be shared with consumers through their My Health Record – with some exceptions based on consumer preference, clinical concerns, safety concerns, or technical issues – and there’ll be big financial penalties for diagnostic providers who don’t do that.” 

Collecting and utilising health data  

Peter shared with us some details around how the Agency currently collects and utilises data, pointing to the fact that most of the data currently collected is for primary use, through pathology providers, diagnostic imaging providers, hospitals, specialists and GPs sharing data with the national system. “That’s something we’ve been doing for well over ten years in Australia,” he said. 

Another important thing to consider for data is that “around 90 percent of Australians have a My Health Record”. A lot of the last ten years has been looking at how to ensure that includes “the right information”, according to Peter, “that can be surfaced at the right time, when that clinical care is being provided, to assist the clinician in providing exceptional care”. 

As a consumer, patients have the option to control who has visibility of information contained within their My Health Record, and can create an alert directly to their phone to let them know every time someone looks at their record, Peter said. “I could also go into my record and control which parts of my record are visible,” he continued, “so we have a really good mechanism in place for that, and the true power of that is in our strong consumer control legislation.” 

Updates to the My Health Record and my health app functionality 

When it comes to recent developments on My Health Record and my health app functionality, Peter talked about current modernisation efforts, including efforts in the last three months to introduce new functionality to enable aged support plans for those in residential aged care. “Those can now be shared with their clinicians and representatives through My Health Record,” he said. 

Peter’s team has also been looking at how paramedics “could better use the My Health Record”, he went on, “and whether we need to design something specific just for them”. Additional functionality has just gone live to enable patient data to be sent along with them in the ambulance for the paramedics when a patient is moved from aged care to acute hospital care, in the form of an Aged Care Transfer Summary, he said. 

“The my health app is even more exciting,” Peter noted, “and we’ve got upcoming work around medicines, emergency contacts – looking at our roadmap we’ve got about four years’ worth of work to do in the next twelve months!” Now is also the time, he said, to look at the functionality that consumers are wanting which isn’t available yet, “and we’re enjoying feedback which tells us how this additional functionality we’re putting in is making the lives of those using it much easier”. 

Industry collaboration and procurement 

“We’ve got a whole range of procurements happening at the moment,” Peter said, “and they’re looking at how we take everything we’ve got and modernise it”. Talking specifically about  a recent Request for Information (RFI)  put out for application support and maintenance, he told us that that was part of finding out from the software industry and vendors  “what the newest and greatest ways of doing things are, because ultimately, we’re not the source of innovation, we’re learning from our colleagues across the sector”. 

In parallel with that is the Agency’s work on consumer engagement, Peter told us, “because everything in the my health app is actually co-designed with consumers, patients, and carers. What we’re hearing from them about what they’d like to see from digital healthcare infrastructure is they tell their story once, to one clinician, after which everyone else just knows it and has all the information, so healthcare isn’t one of those things that takes time away from them enjoying their lives.” 

This engagement has led to procurement processes to see how the Agency can do that, Peter continued, “to bring all of that information together, allow data to be retrieved on demand, and build newer, better ways for our clinicians to view that information – it might be using AI to allow them to talk to the system and have it pull out the data they’re looking for – we want them to be able to just dive in and pull out the bits that they want. We’re hearing from that RFI now just how technically we can do that.” 

On whether he feels there is enough space for industry collaboration in Australia, Peter mentioned a recent briefing the Agency held for the healthcare and IT sector, in which it presented its vision for the future, took on board feedback, and “answered hundreds of questions”. A consultation document has also recently gone out with “about 140 pages of architectural genius, if I believe my staff”, he said, “talking about the architecture for the health information exchange”. 

All of this work has been directed at “getting the best out of industry”, Peter told us, “and we also hear regularly from clinicians and consumers on what matters to them – now we’ve got those ideas it’s about how we make it easier for industry to work with us, including publishing an annual procurement plan which lets vendors know what we’re looking to buy at various times across the year. 

“We’re also doing other things to try and encourage that digital healthcare ecosystem in Australia, embracing global standards, and remaining ruthlessly focused on ensuring absolutely minimal local customisation to allow companies developing in the Australian market to sell their products globally. We’re trying to reduce the time it takes vendors to connect to our national infrastructure and to My Health Record, down to one month,” Peter highlighted, “and we’ve already shaved nearly six months off that time.” 

Embracing industry in the health sector in Australia is integral, Peter said, “as there are so many problems to solve, and I don’t have enough smart people to do it – I need all the help I can get”. 

Progress toward Australia’s National Digital Health strategy 

Directing his attention to the nation’s progress toward its National Digital Health Strategy, Peter hailed some of the “great progress” to have happened over the last decade or so, saying, “we have things like digital radiology, digital pathology, an active EPR market, and some really strong legislation around data sharing – I think all of those things, plus our central My Health Records system have set us up well, but they’re only the foundational building blocks.” 

Implementation of the National Healthcare Interoperability Plan will take place over the next two or three years to “start to join all of that together”, Peter shared, “and then when we start working on technology modernisation and moving to FHIR, upgrading all of our systems; that’s when I think Australia will excel, because at the moment we have lots of islands of digital excellence, but they don’t operate as one system yet.” 

Joining all of those pockets of care together will be key, Peter went on, “whether that be disability care, care for veterans, or just day-to-day visits to a pharmacist, GP, or hospital – that’s really what Australia is focusing on now”. Within ten years, he said, “I hope Australia will be a nirvana for health tech globally. We’re embracing international standards; we have an aggressive plan to modernise; and we’re really looking to develop what we’re doing, working with industry and building on what we know about what consumers, patients, and clinicians want.” 

What that looks like in practice is “not talking about health tech, but just having that be a natural part of conversations about health”, Peter said. “So we won’t be talking about e-prescriptions or how one system talks to another; we’ll be talking about what clinicians are doing with data and how they’re treating consumers differently because they have access to all of these systems and services to facilitate that.” 

One of the major challenges in reaching that point will be the “vast distances” the Australian health system is required to cover, according to Peter, “because we have long distances from one part of the country to another, and it’s how we promote access to services, and how we use digital technology to reduce that distance and achieve health equity. It’s also how we use things like digital twins to allow clinicians to provide that next level of care, that precision medicine, but at a population level.” 

Looking ahead: Health tech in Australia over the next five years 

Peter told us that his team are currently doing the design work for incorporating data from wearable devices like Fitbits and Apple Watches into the My Health Record system. “Moving to FHIR will help us immensely with that,” he considered, “and we expect to have a FHIR-based database in place probably within 12 months.” That work will mean that consumers will be able to share data from their wearable devices with clinicians, “and they can also store it, because they might want to use it themselves in a few years’ time to interrogate”, he said. 

The Agency will be working to move “all of Australian healthcare” over to FHIR in the next five years, Peter shared, “so we’re looking at the substantial uplift of primary care systems across the sector, and they’re being rearchitected at the moment by the commercial suppliers – we’re also expecting those who provide the systems for acute hospital trusts or the equivalent to look at how we implement FHIR from day one.” 

A project Peter voiced his particular excitement for is the native integration of clinical terminology. “That means things like SNOMED CT and Australian medicines terminology being embedded natively into all of our systems, so we can put the “plumbing” in place technically to enable the data flow from Point A to Point B. Having the data used and described in the same way, using the same clinical terminology which is globally interoperable, means clinicians are comparing apples with apples.” 

The Agency is also active on an international basis, Peter said, “and I spend about half of my time working with development organisations globally and with other nations. At the moment we’re looking at how to implement International Patient Summary, so if someone travels from Australia overseas they can have their clinical records available through the app on their phone. If they need to share key data they can generate an International Patient Summary from their phone to be sucked in to the system of the location or clinician that’s treating them.” 

The Agency is also involved in work on the European Health Data Space, “and with America as they go into their next phase of the Trusted Exchange Framework and Common Agreement (TEFCA) – so there’s a huge amount happening in the standards space!” 

On interoperability, Peter highlighted challenges around implementing the  National Healthcare Interoperability Plan  for Australia, “a five-year vision with 44 actions addressing the steps we need to take – everything from changing legislation to terminology, identifiers, and even things like consumer engagement to ensure there’s actually a social license to share the data”. Today, however, “nothing is interoperable in many respects”, he said, “and we rely on HL7 version 2 messages that were cutting edge 30 years ago – the majority of information at the moment moves around by fax”. 

There are also challenges around primary care IT systems, Peter shared, “which probably aren’t as advanced as they are in the UK”, talking about the difficulties which arise “even in transferring data from one GP practice to another”. With all of the work going in at the moment around healthcare identifiers and standards, however, “we expect in the next two years to be in a place where all of our systems will actually be interoperable”, he noted. 

The limiting factor for many countries is national infrastructure, Peter observed, “and the hospitals themselves, rather than some of those new companies who are innovating and wanting to share this data more readily. One of the other things we’re working on is how to build a digital twin for every Australian – when looking into new and innovative treatments we can’t afford to do the traditional “try it and see how it works”; we’re looking at how to collect that data and make it comparable to get those digital twins in place for clinicians to run those scenarios and see what would happen with different treatment options.” 

Bringing all of this together over the next five years would hopefully mean “better care, better access, and better outcomes for patients”, Peter concluded, “and we can maybe move to address some of our workforce challenges alongside that with technology like ambient scribes, because we’re already seeing AI technologies being used in administrative processes. As a healthcare consumer, I’m a lot more comfortable that my GP appointment might be prioritised using something like that in the background than deciding what treatment I get.” 

Whilst this rapid pace of innovation is likely to lead to “some need for catch up” from a legislative standpoint, what the Agency is looking at is “how we can ensure some of those basic guardrails are there, so whilst we don’t have detailed legislation for some of these things yet, we have those broad parameters that everything fits into, that can still make it safe.” The exciting part, he went on, “is whether the government can keep up now the horse has already bolted to some extent”. 

We’d like to thank Peter for taking the time to share these insights with us. 

For our latest interview, we caught up with Neill Crump, digital strategy director at Dudley Group NHS Foundation Trust, for a chat about the digital methods undertaken by the Dudley Group and what these mean in practice; his belief in collaborative working and professional development; and the importance of personalising the patient journey with the support of digital tools.

On his background and how he got into digital, Neill shared that he has been working in the digital, data and technology world for nearly 30 years, with a background in commercial industries. This included a role in one of the largest cloud business software organisations, working within their centre of excellence and focusing on business transformation.

As time went on, Neill became a father. His little girl was born with additional needs, and Neill came to the conclusion that he could combine his skillset with his passion for making sure he was doing everything he could for her and others in her situation. His move to the public sector saw him take on a role in digital transformation for the local council and a multi-agency role spanning the local authority, NHS, police service, and more. He also gained experience from a role with a national housing association, which he credits with helping him develop his understanding of “how community really works, and how you can connect a community using digital, data and technology”.

Neill joined the Dudley Group NHS Foundation Trust nearly four years ago. He pointed out that whilst the NHS often traditionally likes to recruit internally, the health service can gain valuable insights and benefits when staff bring experiences from other sectors.

Digital methods at the Dudley Group

At Dudley, the portfolio Neill works in and around covers the streams of strategy, transformation, digital, data, technology and improvement practice. “You can see how they interlink, but in my experience, a lot of organisations don’t tend to group all of these things together in one place,” he said. “By doing this, you can set your strategy; get a transformation team to deliver on that; underpin it with digital, data and tech; and ensure a continuous improvement cycle in order to make it sustainable. We have a portfolio team and an informatics team who are there to guide our work.”

Building on that point, Neill reflected on how the Dudley Group has developed its teams from a digital perspective. “We have focused on getting all the basics right first; having clear methods in place, being transparent, and providing the right environment for a high-performing team. We want to attract, grow and retain fantastic digital, data and technology professionals. As such, we have implemented a skills framework called ”Skills for the Information Age”, so that we are very clear on the competencies that we require for each role, and we can look at the performance required to be effective in the role.

“Also, this gives something back to the individual themselves and helps with their progression. We have developed a number of case studies so that we can showcase this to the team; that has helped with building enthusiasm particularly among junior and middle ranking team members, because they can see a clear direction and that we are investing in people. We’re signed up to the Digital Skills Development Network in the Midlands, and we give them training opportunities through our different partners to help them modernise their skills.”

Another key focus for the trust has been ensuring that there is a digital steering group in place that is clinically and operationally-led; Neill himself chairs the group. “We’ve got a “pull” model in place; so it’s not me as a digital strategy director trying to push digital onto people. We take the approach of identifying clinical and operational problems and then looking into opportunities to solve them. It’s not an IT-driven project, and I think that is crucial; we really place the emphasis on clinically-led change.”

Developing digital maturity

Through transformation efforts and with the support of the steering group, the trust has been able to become “largely paper-free”, Neill continued. “We’ve still got pockets of paper which we need to get rid of, and we need to tackle our historic records, because we focused firstly on making ourselves more productive and efficient in the present, rather than going back to that historic problem as priority. But it certainly feels like we’ve made good progress on that journey to becoming paper-free.”

Next, Neill brought up the Digital Maturity Assessment and the national directive around this. “We’ve really embraced this at the Dudley Group,” he shared. “We wanted to understand where we were as an organisation, and the great thing about the DMA in my view is that it touches a lot more than just the EPR. It spans the whole of the organisation across seven different domains. We have spent a lot of time understanding that framework, and then making sure that it is reflected in our organisation, and also speaking to our frontline and operational teams about it so that they are better placed to recognise potential and opportunity.”

The Dudley Group is in the upper quartile within the NHS when it comes to digital maturity. “We’ve reached that place by making the right decisions,” Neill reflected, “and by getting clinical and operational teams engaged. And it’s about having that “pull” method and targeting what our staff want to do, and what they want to change in terms of improving how they operate.”

Sharing another example of the trust’s approach, Neill explained that when he worked with cloud business software, he became certified with enterprise architecture. “Following on from that, I have recruited an architect in my team and we have been using that knowledge to help achieve healthcare objectives through stronger decision-making,” he said.

The level of digital maturity that the Dudley Group has built up over the years enables the trust to take an innovative approach now, Neill added. “That gets very exciting. If you think of it like the periodic table, they spent all of that time understanding the foundations of that table and what was in it. Then they brought together lots of elements, and from there, you can put your existing components together and create something new. In our case, that translates to creating impactful changes which don’t always necessitate a nine-month, resource-heavy project.”

As a tangible example, Neill highlighted how rolling out EPR functionality across the trust and providing staff with the means and skills to utilise cloud analytics has meant that the Dudley Group can offer reporting on mobile devices. “It didn’t take an awful lot of effort – all the foundations were already in place. So we have been able to offer this simply by switching on the reporting function, knowing our teams are equipped to use it to plan their time.”

As an example of a data-focused project, Neill raised how the trust has been “undertaking research science on our digital projects, starting with digital health coaching. This saw the introduction of a digital perioperative pathway which features a digital health coach supplied via an app. Patients in perioperative care work with their health coach to understand their health and prepare for surgery.” Participants have reported “various long-term health benefits” as a result of this intervention, Neil explained, and the trust has also seen that the post-operative length of stay is 25 percent lower in those who took part and used the app, compared to those who did not. “We’re currently preparing a research article to publish, and we hope to scale this research science to larger-scale digital projects.”

Patient focus: journeys, engagement and personalisation

In terms of managing the patient journey, Neill noted that the trust tracks and monitors referrals through to treatment, supporting the management of the waiting list with oversight of all aspects including outpatient consultations, diagnostic tests and elective surgeries, as well as the optimisation of resources. This could mean recognising where scheduling could be altered to better fit need, or it could mean increasing capacity in high-demand areas. “It can also mean working with our partners in the Black Country,” Neill commented. “We might be able to take on work that reduces pressure for our partners and vice versa. It all comes back to sharing information.”

A particular focus for the Dudley Group has been personalising the experience for the individual. “We’ve been implementing a deteriorating patient pathway using data from our EPR. We’ve gained insights into the various steps involved in managing a patient, and if their condition deteriorates whilst they are in hospital, we can examine that patient’s journey and look for places where we can improve our care and focus on patient safety. There are various things we have done – one example is the EPR triggering thresholds for early warning scores, allowing us to put a treatment or escalation plan in place, if needed, before the next patient gets to a place where their condition deteriorates too much. Again, this is a case of a clinician-led project where our team worked out where they could make a difference to care using digital tools.”

This pathway has led to an increase in sepsis screenings, Neill added, along with other positive impacts. Red flag triggers are now reported to be “more accurate”, with 86 percent now leading to sepsis treatment; as opposed to 72 percent before the pathway implementation. Sepsis Six, the six medical procedures that can be performed within an hour to reduce risk of death from sepsis, has increased by 12 percent overall, with an increase of five percent within the ‘golden hour’ (the first 60 minutes following a traumatic injury).

Another related example revolves around Martha’s Rule, implemented this year to enable patients, loved ones or staff to request a rapid review of a patient’s condition at any point. “Martha’s Rule comes back to getting information, and ensuring communication between people and their clinicians. We’ve developed a system whereby we collect that information from the family of a patient, for example, and surface it in the EPR so that we can make sure it is seen, understood and acted upon.”

An area that the Dudley Group is beginning to explore lies with patients providing information themselves to the trust. “That’s about patients giving permission for the data they themselves hold to be used for things like long-term condition care – that will help us monitor them, track treatments and so on.”

Virtual wards: key to success

Speaking of monitoring and tracking patient treatment, Neill turned next to the Dudley Group’s paediatrics virtual ward.

When it comes to a successful virtual ward, Neill shared the view that virtual wards should not be seen as a digital programme in themselves, or run by the digital team with technology as the key success factor. “It’s about the collaboration between the paediatricians, the nurses and the community teams, in my eyes,” he said. “Really, we are talking about a change in how they operate and a change in the care pathway. As a digital team, I wouldn’t want to take recognition away from the work that they have put into that.”

The role of digital here is to provide an underlying, supportive foundation, he said. “That is a success factor, of course – but it absolutely doesn’t happen without frontline adoption and engagement. Those clinical and community teams put in so many design hours upfront to make our virtual ward work, figuring out how their standard operating procedures were going to be different and working out how they could safely deliver high-quality care. So actually, as a digital leader, I think it is about stepping back a little bit, and letting the clinical and operational teams own it.”

Advice for planning frontline digitisation 

The Dudley Group will have delivered on almost all of the capabilities of frontline digitisation by next March. Would Neill have any advice or learnings to share with other trusts looking to complete related projects?

“We feel confident that we have used the funding effectively to tackle all of the mandated areas, and I think it comes back to collaboration with clinicians and operational staff,” Neill reflected. “Engaging a wide range of different people and roles is really key so that you can understand how to form the plan.”

Collaboration is also necessary with finance colleagues, Neill pointed out. “You need to work out where the benefits are. Even though you get national funding, there is always a revenue consequence. You still need to make sure there is a return on investment. We managed to develop a business case which our trust board signed off that really shows where the benefits are; and then we have been able to track those benefits through to fruition.”

Priorities for the year ahead

With regards to the next 12 months, the priority for the Dudley Group will lay in finalising the work tied to the frontline digitisation programme, including upgrading and moving the trust’s EPR out to the cloud.

“We’re doing much more work on our data warehouse, making sure that we are using the information captured in the EPR, making it easily accessible as digestible insights for our frontline. We’re also going to be extending our patient portal so that we’ve got patient-initiated follow-up, and expanding the form functionality to gain a more immediate, targeted response between our clinical and operational teams and patients. We hope that this will improve communication and help with elective recovery targets.”

The Dudley Group has been rolling out e-consent to general surgery, with plans in place to roll the functionality out to other areas such as cardiology and dermatology. Neill also shared how the trust has partnered with a health tech supplier to work on “modern clinical communications”. This will support improved communication with numerous different roles within the frontline, Neill explained, and it will also support task management.

Clinical decision support is in the Dudley Group’s pipeline, with a focus on how services connect to primary care. The aim here is for primary care staff, when making referrals, to gain support around radiology decisions in line with established guidelines. “When staff are clicking through the referral process, the guidelines will be built in to help prompt them and suggest courses of action. So that will be great for the patient, I think, as they are more likely to get the right treatment in the first instance.”

Looking to longer-term plans across the next five years, Neill shared that the existing trust strategy runs up to 2024; and the digital plan runs until March 2025. A new three-year digital plan will be put in place to follow on from this.

“It’s important to note that we no longer need a digital strategy,” Neill observed. “We’ve done enough work and we have strong enough foundations in place to make a strategy redundant. A plan, however, is more action-based. It will be led by our clinical and operational staff, and we have used ten anchor points based on the What Good Looks Like framework to build around.” These include building confidence and trust in digital tools and processes among patients; supporting digital literacy and empowerment among staff; reducing costs and environmental impacts through digital means; and making best use of tech and data in order to improve and coordinate care pathways across the region.

“I’ve deliberately kept the plan simple,” Neill added. “I’ve not filled it with tech-talk. Ultimately, when it comes down to it all this work around digital is about highlighting the ways in which we can use technology to support staff, empower citizens and improve patient outcomes.”

Many thanks to Neill for taking the time to share his insights.

For a recent interview, we caught up with Dr Nojus Saad, president and CEO of the Youth For Women Foundation, France, and MENA digital healthcare researcher and ambassador. Nojus shared his experiences in digital healthcare spanning countries including France, Iraq, and India.

As a medical doctor with an MBChB (Bachelor of Medicine, Bachelor of Surgery) and a multidisciplinary background in digital health, Nojus explained that he has several years’ worth of experience in “multinational research, policy development, and social entrepreneurial expertise around digital healthcare, gender justice, and healthcare innovation; with a particular entrepreneurial and research interest in AI and Machine Learning, mHealth, and the internet of medical things”.

Digital experiences to date

Nojus’s experiences to date are varied and include founding the Youth for Women Foundation in 2018, now headquartered in Gif-sur-Yvette, France. The aim was to “to empower women and young people against the widespread gender-based violence and femicide in the rural and semi-urban communities of Iraq”, with digital access and literacy incorporated into the foundation’s projects “as the primary enablers of health education and empowerment for disadvantaged women and young people”. Numerous projects in this space have positively impacted the lives of “over 6,100 women, adolescents and young adults,” Nojus said, “in over 70 rural, semi-urban, refugee and vulnerable communities of Iraq, India and France”. This has taken the form of health promotion training, community-based research programmes, and national advocacy campaigns for policy reform.

In 2020, Nojus joined the Internet Society as the United Nations Youth Ambassador of the global UN Internet Governance Forum. He served as a Digital Policy Fellow at the Internet Corporation for Assigned Names and Numbers, co-developing and reforming global technical policies of the Internet’s DNS for a healthier, more inclusive and interconnected Internet for all.

Other experiences include working periodically with the International Telecommunications Union as an ambassador of the Generation Connect initiative, advocating for healthcare-inclusive digital solutions in the Western Asia and Northern Africa region; and working with Bond UK as an expert advisor on locally-led development. This role involved consulting with the UK government’s Foreign, Commonwealth and Development Office and the international development sector “on investments around rural research and artificial intelligence opportunities for international non-governmental organisations,” Nojus explained, “particularly focusing on healthcare transformation of rural and vulnerable communities of the Global South.”

Recent digital projects

Moving on to discuss more recent digital projects, Nojus shared how this year he was invited to join an executive programme on politics and diplomacy for health in Sweden, hosted by the Stockholm School of Economics and Karolinska Institutet.

“My research case study analysed the role of diplomatic relations in driving international collaborations on Al research and development for health equity and innovation in the Global South, with a specific focus on promoting knowledge sharing, youth-led social entrepreneurship, and health technology transfer,” he explained.

Nojus also recently helped to judge the 4HERPOWER Global Innovation Challenge at MIT Solve, a scheme supporting and investing in youth-led digital health solutions for advancing the sexual and reproductive health of Global South countries. Winners received a funding prize of $280,000 along with six months of technical support programming from MIT faculty and professionals.

In late 2024 and into 2025, Nojus told us that he and his team are planning to establish a telehealth hub “in one of the largest regional hospitals in Iraq”, to promote access to quality healthcare and consultation services from healthcare providers around the world.

Developing a blueprint for a digital-first health system

Nojus is a regional ambassador and a researcher on the Digital Transformations for Health Lab (DTH-Lab) in Geneva, which he described as a global consortium of partners working to drive implementation of a series of digital transformation recommendations made through ‘The Lancet and Financial Times Commission on Governing Health Futures 2030: growing up in a digital world’. We asked Nojus to share insights into his work in this space, particularly what the blueprint for digital-first health systems might look like.

Nojus described how he has been working on establishing and promoting the adoption of the blueprint, which aims to ensure that systems are co-designed and governed by young people; responsive to health needs; and strengthen digital health citizenship.

“I’ve also been supporting the implementation of a framework for governing health futures that provides governments, technology companies and various stakeholders with guidance on how to build a trusted and inclusive governance architecture,” he added, “based on data solidarity and Health for All values”. The blueprint is due to be launched in late 2025.

“In the first phase, we have recently launched the global interim report, ‘Building a blueprint for digital first health systems: Findings from Global Youth Consultations‘. This was the culmination of six global consultations with young people over a year and a half. In addition to the report, a collection of youth-authored essays was published as a partnering document to showcase key concerns from some of the DTH-Lab Regional Youth Champions.”

What has this research highlighted about the digital determinants of health?

“At the DTH-Lab, I’m helping to establish a sustainable platform for engaging multiple diverse stakeholders in the healthcare space to take coordinated actions to address the digital determinants of health; especially digital health literacy. We’re aiming to better understand the context of the major societal and structural changes that digital transformation embodies.”

At present the Lab is working on bringing together academics and practitioners from different disciplines, with the aim of developing a “conceptual framework for the digital determinants of health to guide policy action and future research priorities in the EU and internationally,” Nojus shared. “We are also generating new knowledge and evidence on how digital determinants intersect with other determinants to impact health and well-being and why they ultimately require new forms of governance.”

To address critical evidence gaps, the DTH-Lab is partnering with organisations in India and Nigeria to study young people’s experiences of digital determinants in different contexts.

Offering an example of a national project that the Youth For Women Foundation has delivered, Nojus shared some insight into the Digital Health Literacy Program in Iraq, which focuses on building digital skills and literacy across 15 civil society organisations and more than 75 young people. An example of a project here has seen the Lab encourage the programme to organise social media awareness campaigns for combating disinformation around COVID-19, which Nojus said has reached “hundreds of women and young people online, across Iraq.”

Adolescent digital health

In terms of his work on adolescent digital health, Nojus said that as well as contributing to the field of digital inclusion in adolescent healthcare by working with the World Health Organisation, he has also been working with The Lancet as a research peer reviewer in the Second Lancet Commission on Adolescent Health and Wellbeing, “aimed explicitly at contributing to the UN Summit of the Future in 2024″.

During the 2023 Commission Meeting in Cape Town, South Africa, Nojus put forward “significant insights on digital and commercial determinants of adolescent health, emphasising entrepreneurship and digital health innovation.” In this, he sought to foster a strong multi-disciplinary basis for an upcoming research report, scheduled for publication later this year.

At the Partnership for Maternal, Newborn and Child Health’s Global Forum For Adolescents, Nojus co-organised a workshop on embracing sexual and gender diversity in sexual and reproductive health and research. This aimed to explore how social media and digital technologies can positively transform mental healthcare for LGBTQIA+ adolescents and youth, worldwide.

Finally, Nojus shared how he had the opportunity to “champion Australian investments in adolescent mental healthcare, particularly through mobile health services, for young people in the rural and vulnerable communities of the MENA region”, as part of an advocacy fellowship at Orygen Global in Australia.

Experiences in other countries: France, Iraq and India 

We asked Nojus what he has learned about the state of digital health internationally through his career so far, as well as his thoughts on how France is performing in comparison to peers.

“The landscape of digital health reveals vast disparities that are shaped by various factors,” Nojus reflected. “First, adoption rates vary significantly, particularly between urban and rural/semi-urban areas. Major digital health technologies are predominantly concentrated in capital cities and large urban centres, significantly limiting access for rural populations.”

Nojus considered that regulatory frameworks play “a crucial role” in national digital health journeys, saying: “France exemplifies stringent data privacy laws (GDPR), and while this ensures security, they are also slowing down innovation. In contrast, Iraq and India are navigating evolving regulations that impact implementation and scaling of digital health solutions.”

Infrastructure is another challenge, Nojus continued, “especially in countries like Iraq, where conflicts have strained healthcare infrastructure. Limited internet connectivity and power shortages further hinder digital health adoption, particularly in remote regions.”

An issue that Nojus’s work has highlighted is that marginalised communities, including refugees, women, LGBTQI+, impoverished, disabled, and elderly populations, “face the greatest challenges in accessing digital health services”. Therefore, he emphasised that “overcoming digital illiteracy, language barriers, lack of awareness, and affordability issues are critical for ensuring inclusivity.”

Looking to recent technological innovations, such as AI-driven diagnostics, wearable health devices, and blockchain-enabled health records, Nojus noted that they have “the potential to transform healthcare delivery”. However, he said, “Trust remains an indispensable factor influenced by cultural norms and socioeconomic conditions. Building trust through community engagement and culturally sensitive approaches is essential for successful adoption.”

Nojus is a “huge advocate for investing in healthcare entrepreneurship, since it plays a significant role in driving innovation and addressing healthcare gaps. There must be substantially more investment opportunities for young entrepreneurs to deliver digital health solutions tailored to local needs, especially in expanding access to marginalised communities.”

Medical education can also play a part in this, Nojus continued, as it “must increasingly integrate digital healthcare to prepare future healthcare professionals for telemedicine, digital diagnostics, and data-driven decision-making, ensuring they are equipped to leverage technology effectively”.

Focusing on France, Nojus said: “The landscape of digital health adoption is rapidly evolving, fuelled by recent advancements that underscore the country’s continued commitment to healthcare innovation. A notable accomplishment is the nationwide rollout of the Dossier Médical Partagé system in 2018, an electronic health record platform which has profoundly impacted patient care by facilitating seamless access to medical records across healthcare providers, greatly enhancing care coordination and patient safety.”

Progress in interoperability and data sharing has been equally impressive, he said, “driven by initiatives spearheaded by the Digital Health Agency, which have not only ensured secure and efficient exchange of health information among healthcare professionals, but also bolstered informed decision-making and improved treatment outcomes.”

Telemedicine has emerged as a “transformative tool”, Nojus added, particularly in response to the COVID-19 pandemic. France “swiftly adapted regulations to enable widespread adoption of remote consultations, extending beyond primary care to encompass specialised services such as mental health and chronic disease management. The integration of telemedicine solutions under the Digital Health Roadmap 2023-2027 has significantly broadened access to healthcare services, particularly benefiting underserved populations and remote areas.”

Nojus also highlighted the Digital Health Strategy for 2023-2027, which outlines “ambitious objectives across four strategic pillars: prevention, patient care, access to healthcare, and fostering a supportive environment for digital innovation”, and “to empower individuals in managing their health, optimise healthcare delivery through digital tools, and cultivate an atmosphere conducive to technological breakthroughs”.

He also noted that tehnologies such as AI-driven diagnostics and mobile health applications “are revolutionising clinical practices and enhancing patient engagement… AI, for example, enhances diagnostic precision and tailors treatment plans to individual needs, while mHealth apps empower patients to monitor their health remotely, promoting proactive healthcare management.”

Nojus stated that he “firmly believes” that France’s holistic approach to digital health “harmonises stringent regulatory standards with pioneering technological advancements” and said that this “synergy fosters a healthcare ecosystem that places paramount importance on patient-centric care, equitable healthcare access, and continuous innovation.” Ultimately, “such steadfast dedication positions France at the forefront of global healthcare transformation, driving tangible enhancements in healthcare delivery and patient outcomes.”

Looking to the future

Finally, we asked Nojus for his thoughts on the biggest challenges for the advancement of digital health in France, and what he would like to see in this space over the next five to 10 years.

“Navigating the regulatory landscape in France’s digital health sector can feel like a complex puzzle,” Nojus acknowledged. “While stringent rules protect patient data and ensure safety, meeting compliance requirements demands considerable time and resources, which can be daunting for both startups and established companies aiming to introduce new technologies swiftly.”

Interoperability presents another major hurdle, according to Nojus, as “each healthcare provider operates with its own IT systems and data formats, complicating the seamless sharing of patient information. This fragmentation slows down care coordination and makes it difficult for healthcare professionals to access comprehensive patient data efficiently.”

Driving digital adoption in hospitals and clinics encounters resistance “due to the old ways of thinking”, and “since many healthcare facilities still rely on traditional pen-and-paper methods, there is reluctance to transition to digital solutions. Convincing skeptics that digital technologies can enhance patient care and streamline workflows requires persistent effort and evidence-based research.”

The digital divide is “evident”, he continued, especially in rural and underserved areas, and addressing these disparities is “essential to ensure equitable healthcare access for all individuals, regardless of their background or location.”

Equipping healthcare professionals with the necessary skills to navigate this digital landscape is also crucial, he said, and “continuous training and education programs are essential to empower them to use digital health tools effectively”.

Overall, he called for a balanced approach that involves fostering collaboration, streamlining regulatory processes where feasible, and incentivising innovation in digital health. “By adopting a more flexible strategy and making strategic investments, France can harness the full potential of technology to transform healthcare delivery and enhance patient care across the country.”

Looking ahead, Nojus shared his excitement for some of the transformations in digital health that he considers “could redefine healthcare globally”, including digital-first health systems in the global health which could potentially overcome longstanding barriers to access; people-centric and youth-centric healthcare, where healthcare “adapts to individual needs and preferences, making it more responsive, engaging, and proactive in promoting lifelong health”; and the integration of AI and machine learning. He also acknowledged the potential around VR and AR technologies for personalised therapies and interactive health interventions; and enhanced interoperability and international healthcare systems featuring the seamless sharing of data across borders.

“In realising these visions, I believe that fostering innovation, ensuring equitable access, and maintaining ethical standards will be essential keys. By embracing these possibilities, we can pave the way for a future where technology enhances human connection and transforms healthcare experiences for the better.”

We’d like to thank Nojus for sharing his insights and experience with us in the international digital health space.