Let’s take a look at some of the health tech news stories from across the world which have caught our eye over the last few weeks over on our sister site HTN International.

Insights from our international interviews

We’ve been speaking to a range of health tech professionals from across the globe, gaining insights around priorities and progress on digital healthcare in international contexts.

Our most recent interview saw us chat with Kate Renzenbrink, chief clinical informatics officer at The Royal Victorian Eye and Ear Hospital in Melbourne, Australia. Kate chatted about her views on innovation and change management, how data is used within her hospital, the wider digital health landscape in Australia, and more.

We spoke with Dr Nojus Saad, president and CEO of the Youth For Women Foundation in France, and digital healthcare researcher and ambassador across the MENA (Middle East and North Africa) region. Nojus joined us to share his experiences and insights from countries including France, Iraq, and India.

Another interview saw the HTN team chat to Cheryl Fenwick Evans, previous clinical documentation specialist with Te Whatu Ora – Health New Zealand. Cheryl talked about her experiences helping to launch the Clinical Documentation Programme, which aims to enhance the quality of health information produced by clinical staff. She also highlighted Māori views on data governance, and why she thinks the wider health systems across the world could learn from it.

Interested to read more international insights from health tech professionals? Other HTNI interviews include a chief information officer from New Jersey, a senior vice president and chief digital information officer from Florida, a vice president of innovation and partnerships in Ontario and a digital health economist in Spain. Catch up with all HTNI interviews here.

Strategy and transformation news from around the world

Several of our news stories from the last few weeks have covered the publication of new strategies, progress reports, or objectives for digital transformation in international health. Let’s revisit some of the highlights of our reporting in this space.

In July, the Australian Digital Health Agency shared intentions to source solutions and services in support of the vision to “transform national infrastructure and move to a contemporary, structured data-rich ecosystem capable of connecting systems across settings and supporting real-time access to information for the patient and the broader care team – anywhere, anytime”.

July also saw the government of Nova Scotia announcing the expansion of the YourHealthNS app to allow patients to access more information about X-ray results. Residents of Nova Scotia will now be able to access X-ray reports directly from the app, including any report findings, comparisons with previous X-rays, their medical history, and a summary.

Brazil’s Ministry of Health shared the news that it has begun the process of implementing a unified medical record, expanding its Meu SUS Digital app to facilitate access to health information, clinical history, test results, and more. With more than 50 million downloads to date, the app also features an interface for health professionals, enabling access to the unified electronic medical record.

International health tech funding, partnerships and procurement news 

July brought us plenty of news on international health tech funding, partnerships and procurements, including a $20 million donation to the Mayo Clinic in the US, which will support initiatives such as the development of generative AI tools for insight into individual risk of cancer.

Over in Spain, Spanish digital healthcare company Mediktor announced the acquisition of San Franciso-based Sensely, a provider of an “empathy-driven” conversation platform designed to support hospital systems and insurance services with member management. The merger aims to develop “one of the largest global AI-based solution providers in the healthcare ecosystem”, with the newly integrated company set to utilise Sensely’s platform to “help increase efficiencies and reduce costs”.

Staying in Europe, the Ministry of Health in the Netherlands issued a tender for the procurement of a platform, services and infection disease control system worth an estimated €100 million, as part of the Ministry’s aim to find “working pandemic-functional solutions” that can be used for infection and disease control applications.

And in Croatia, the Ministry of Health announced the installation of the first linear accelerator of 21 to be provided for citizens under the National Recovery and Resilience Plan, following a pledge from the government to invest €85 million in oncology treatment, and funding from the EU Recovery and Resilience Facility, designed to help member states overcome challenges resulting from the COVID-19 pandemic.

Other highlights from the world of health tech

That’s not all from HTNI! We also reported on news such as the implementation of endoscopy reporting software in Levy Mwanawasa University Teaching Hospital, Zambia, to support auditing and the uploading of information to electronic medical records.

Elsewhere on the African continent, we looked at key findings from a study highlighting gaps in regulation for telemedicine and digital health in Ghana, pointing to an increased potential for malpractice and an “amplified” risk to patient privacy and data protection. Noting the “increasing reliance” on electronic health records and AI-based systems in healthcare, the study cites challenges including ensuring the standard of care and liability for health professionals utilising telemedicine and associated technologies.

And for our final news highlight, we reported on the the entry into force of the European AI Act, a legal framework which seeks to address the risks of AI and place Europe “to play a leading role globally” by setting out clear requirements and obligations in support of “trustworthy AI”.

Keen to get the latest on even more international health tech news? Why not sign up for our Health Tech News International newsletter, to receive regular updates straight to your inbox.

For a recent interview we sat down for a chat with Cheryl Fenwick Evans, previous clinical documentation specialist with Te Whatu Ora – Health New Zealand. In this role, Cheryl was responsible for helping to launch the Clinical Documentation Programme, which aims to enhance the quality of health information produced by clinical staff.

Cheryl explained that she has always been interested in IT and originally worked in an IT department before she moved into nursing. Around six years ago, Cheryl made a conscious decision to move into the health informatics field.

“I’ve always gravitated towards problem solving and innovation,” she reflected. “I’ve always held an interest in systems, too – the organisation of information and bringing it together so that you can do something with it.”

Digital and data experiences

Until recently Cheryl worked at New Zealand’s largest teaching hospital, Te Toka Tumai – Auckland, as a clinical documentation specialist on the Clinical Documentation Improvement (CDI) programme. A programme like this had “never been done before in Aotearoa,” Cheryl explained. “Like with any new project, being pioneers brings its challenges. There was no roadmap, we had to learn our way through it.”

The focus laid specifically in the health information captured by clinical coders extracted from inpatient records, which accounts for around 30 percent of New Zealand’s population health data.

“There are many programmes that exist worldwide in this space, trying to improve clinical documentation – I think countries have all approached it in slightly different ways,” she said.

Cheryl enjoyed the CDI programme because “it wasn’t long before you could see the impact and the bigger picture – I could see the data integrity and the knock-on effect of our influence, from data quality to patient safety.”

The relationship between data and patient safety is “probably the least understood part of the system, I think,” noted Cheryl. “I don’t think that we, as healthcare professionals or as the wider system, always appreciate the nuance between the two. I don’t think there’s a solid understanding of the impact that we have, with our choices; what clinical staff do and do not record, for example, and the effect that can have on individual patient safety and wider risk management.”

In the years that Cheryl has worked in this space, she came to view this as an “untapped resource”; she could see the value of clinical coded data and how it could be used in care capacity demand management. To expand her own knowledge and understanding, Cheryl spoke with the founder of Trendcare, a workforce planning and workload management system used widely across New Zealand. “A nurse herself, she had also had the same realisation. In fact, they had already trialled the use combined coded data with Trendcare in order to better predict ward capacity and match nursing resource to patient needs.”

As an example of this in practice, Cheryl pointed to urology, where a proportion of inpatients present on multiple occasions. “We should be using this coded health data to predict healthcare need and balance the demands on the nursing team accordingly. For example, predicting patients with higher or complex health needs prior to ward arrival means co-ordinators make decisions earlier to balance capacity, skill-mix and overall improve efficiency.”

Improving the post-operative experience using data

Cheryl moved on to discuss a sideline project revolving around how data can be used to improve patient experience following surgery.

On how her team operated, Cheryl said: “We worked concurrently on wards alongside medical staff to improve the quality of the record there and then. It’s all about improving in that moment, whilst staff are entering information into the clinical record. I noticed that in the post-operative period, staff were seeking the on-call pain team because their patient’s pain was not well controlled.”

She explained that if a patient received care related to uncontrolled pain in the post-op period, a coder would capture that information and assign it a specific code. Using that code, Cheryl’s team could then identify where uncontrolled pain cases were arising. There might be five cases in one area, she continued, but 50 in another, which would then lead her team to explore the situation further and ask relevant questions. “Is that accurate? If not, why not? Are we capturing the clinical truth?”

The CDI team spent time with the pain team to explore the situation and realised that whilst staff were documenting the care they were giving, they were not always recording the reason why they were providing that care. “We are documenting, for example, that we have switched this patient to a different type of analgesia that is more likely to be effective. But we are not saying why. It comes back to linking data to a practical outcome and tying the two together, which I think is often lacking in the medical world. We aren’t always very specific, but specifics are key to obtaining quality health data.”

Cheryl and her team then worked alongside the pain team to work out a way to capture this information in a more useful manner. “After about six months of working to improve data capture in an area, you can view that data is reliable. Then you can start to look at patient experience, care provision and allocation of resource. Let’s use a maternity unit as an example – you could have a situation where a higher number of women, having underdone c-section, might be experiencing poorly controlled pain in the post-op period on certain days of the week. Using coded data, we can identify exactly when and where this is occurring. Identifying this unmet need could potentially be resolved by increasing staff on call during the weekend.”

Cheryl reflected that whilst the programme supported resource analysis, “more importantly it’s about the patient. I would hope that by working with the CDI programme, clinicians could reflect on these scenarios and start to think about the ‘why’. It all comes back to the patient in the end, we should all be trying to ensure that patients receive the best care possible.”

She added that exploring the relationship between clinical coded data and something like post-operative pain provides a measurable example of data impacting care. “I see the next step as exploring the patient experience for this particular group – has this actually improved the overall experience of undergoing surgery, and other health outcomes?”

Championing equitable outcomes

Cheryl highlighted that one particular area explored through the CDI programme was how better outcomes could be achieved for Māori and Pasifika peoples. “We need equitable outcomes,” she said, “because the disparities are quite shameful.”

Through the programme, Cheryl and her team looked into how they could support in this area. “We looked at the data and we could see that two areas standing out were diabetes and kidney disease. Where diabetes was poorly controlled, it wasn’t often recognised or well documented, and nor was their stage of kidney disease.”

As Māori and Pasifika peoples are over represented in this area, “they are more likely to be adversely affected by this oversight,” Cheryl continued. “So we focused on prioritising these patient groups in our reviews. I championed that within the team as I felt strongly that we had a role to play.”

Data sovereignty for Māori

Cheryl went on to share insights into the data landscape in New Zealand, particularly with regards to data sovereignty for Māori: the concept that Māori data should be subject to Māori governance.

“It’s important to acknowledge that Māori are tangata whenua – ‘people of the land’. Te Mana Raraunga, or the Māori Data Sovereignty Network, puts it like this: ‘Our data, our sovereignty, our future… Māori data should be subject to Māori governance, and Māori data sovereignty supports tribal sovereignty and the realisation of Maori and Iwi aspirations.’”

Māori data is also considered tāonga, which Cheryl translated as ‘sacred’. “It’s not just information. It’s personal. I can’t help but think that in healthcare we lose that sometimes – people forget that the piece of paper in their hand or the document on their screen is someone’s story. It’s about respect. That information is you, it is your life and information, and I think that the Māori view of data could help healthcare professionals better their understanding in that sense. A Māori view of data returns the person to the centre.

“I also think it’s powerful to hear: ‘Hang on, if this data is about us, then we want to know what it is and what you are doing with it.’ Māori are rightly saying that their data needs to be used for the better of Māori peoples across the land.”

The COVID pandemic brought more attention to Māori data sovereignty, Cheryl explained, as healthcare organisations led by Māori were struggling to access data from the rest of the system about their own people. “They wanted to help, and they were the best people to help, but they kept facing barriers into accessing in their own data. It was an interesting situation, and I hope Aotearoa will be able to evolve in this space as a result.”

Looking to the future

What is Cheryl looking forward with regards to data over the next few years?

“New Zealand is going through a lot, like many places right now,” Cheryl considered. “We have come through a lot of change. We’ve had COVID, and we’ve moved from a model of district health boards to a single national unit. That obviously comes with major change, but hopefully a better technology and data platform can arise from that. I like the opportunities that a single system affords us, like a national immunisations register – that’s one of the plans in the pipeline.

“There’s also going to be a child health platform which will map our children’s milestones. I think that will be really useful – we know that current systems are not working for our whānau (families) who need to re-locate. Our most vulnerable transient population is already more likely to experience deprivation and barriers to accessing healthcare, and too often our tamariki (children) are lost in our complex and disconnected health system. So a national platform focusing on children’s health will really help in that area.”

Cheryl also commented on the improvements around data sharing in general that she expects to see as a result of the national platform. “We have been so separate, working very much in silos; but we are working to make sure that all healthcare providers, especially in communities and rural areas have timely access to health’s records. “

Many thanks to Cheryl for taking the time to chat.

We sat down for a chat with Ryl Jensen, CEO of the Digital Health Association (DHA), the peak advocacy body for the digital health sector in New Zealand. Ryl described the DHA as not-for-profit “conduit between government and industry” and explained how her team works closely with government to disseminate information, helping to educate the sector on standards, interoperability, national programmes of work, and more.

Digital Health Association

To provide a flavour of the work the DHA does, Ryl said: “We send out a lot of communications and host workshops and networking events; we have quite a lot of hui with government so that they can impart their information. We also talk to and brief ministers about certain policies and correspond with them.”

As an example, Ryl highlighted that the DHA wrote a “significant submission” last year around the use of software as a medical device and New Zealand’s Therapeutic Products Act. The submission was based on global research and communication with Germany, America, Australia among other places. “It was really pivotal, and it did have an effect on changing the legislation.”

Ryl also shared how New Zealand’s new government has opened up a new position for a minister of mental health to give this area focus, meaning that the DHA has been able to deliver a presentation about a digital mental health and addictions hub, a concept that they have been advocating for, for around three years. “That provided an opportunity for us to take the conversation forward, and we have now been invited by the Minister to host a Digital Mental Health Summit at Parliament in November. I also believe enquiries are being made as a result of that meeting – so fingers crossed for movement in this space.”

Of her own approach, Ryl said: “I’m a real connector. It’s not just about me, it’s about connecting people across the ecosystem so that they can do good together. In my role I get a bird’s eye view of what is happening nationally and in pockets across regions. If I believe that somebody needs to speak to somebody else because it might create movement, or push things in the right direction, then I will connect them to try and make it happen. Those connections are absolutely vital to moving projects forward, both nationally and globally.”

Career reflections

Are there any projects that Ryl is particularly proud of from her career? “I’m proud of what we have been able to achieve as an organisation – we can help to shape what legislation looks like, and legislation is a key lever for so many things. If you get legislation right, then the policies and the regulation and everything else follows. However, you do need funding and political support to back it, and you need the legislation to be properly enacted.”

On a national level, Ryl stated that the government response to COVID was “pretty phenomenal”. Initially, she said, the government did not think that digital would necessarily form such a major part of the pandemic response, placing more focus on logistics and mobilising the workforce. “Then they realised that digital systems were absolutely required in order to keep track and monitor everything, from the virus itself to test recording to location of PPE. As a result, a spotlight was placed upon digital health, and it started to move the conversation forward. As the pandemic unfolded, you could see the benefits of digital rising, and you can’t underestimate the power of that. A lot of progress was made and whilst some of the push has slowed down now, I do think it left behind an understanding that digital is really crucial in order to enable the workforce and in order to enable efficiencies. “

A danger, Ryl added, lies in not getting the policy right – not funding change management properly, for example, or not placing enough emphasis on education of the workforce in digital technologies.

“If we don’t do that, then we could face failure,” she said. “But there are a lot of very clever people working on some really amazing things. And I think there’s a lot of desire to see digital make a palpable difference to health outcomes in New Zealand.”

Another achievement for Ryl has been the completion of her Masters of Health in recent years, which saw her write a thesis on the governance of digital health and developing a proposed framework for New Zealand based on interviews and case studies from Australia and America.

The framework suggests the establishment of a New Zealand Digital Health Agency as a Crown Entity to manage and govern digital healthcare in the country, with Ryl stating that this would “allow for the full democratisation of healthcare enabled by data and digital where consumers can participate in their own health. It would also recognise that data and digital are foundational and essential to the improvement of health outcomes of New Zealanders and acknowledge that digital health is no longer just an enabler but fundamental to operations, how our health system is run, and is an overarching function of all the different agencies governing the new health system.”

Priorities for the future

The DHA aims to continue to grow its ecosystem in terms of membership and reach, with Ryl highlighting that it will be particularly useful to further develop relationships with government, primary care and private care.

“We want to reach other areas, because we’ve all got to work together,” she said. “That will involve conversations about standards uplift, people development, cyber security, cloud, using FHIR, deploying SNOMED – all of those key enablers for interoperability. We’ve got to get the message out that governments need to be thinking about and enabling this.”

Providing context on New Zealand’s health landscape, Ryl explained that a shift has been made from a 20 district health boards to one overarching organisation: Health New Zealand | Te Whatu Ora. “That has proven to be challenging – our vendors used to be able to go out to district health boards and they would be able to purchase their own digital systems. Everyone had little silos and they all funded their own silo. Now we’ve got this one system and there are teething issues with it. It’s hard to get the procurement and purchasing in place, and there’s not a lot of purchasing going on at the moment because we’re in a very tricky economic environment. So, looking to the future, there are definitely priorities around this work.”

The other priority for the DHA, together with Health New Zealand, is to research and build a digital ecosystem map designed to identify “every player in the ecosystem. What have we got, where do they fit, what segment are they in? Those segments could be maternity, screening, patient management systems, for example. We want to categorise and build an electronic map that shows our global capability and also gives us a view of the system itself. This piece of work is under negotiation right now; I really hope we can pull it off because I think it’s an important thing to do, for government to be able to take a quick glance and know what is going on across the digital health ecosystem. It would be useful for vendors too, to be able to showcase all of their products.”

Interoperability and data sharing in New Zealand

“There’s been progress,” said Ryl. “For the past three years, we have had a project called Hira, which is a Māori term and means ‘to have a widespread effect’. Hira started as a national health information platform and has since developed into a programme of work to put in place a virtual electronic health record capable of connecting all of the disparate systems. “It’s quite common across the world that a lot of our care sectors don’t communicate with other care sectors. We have some referral and laboratory systems that will talk to each other, and with primary care we are quite well ahead with patient portals, most people in New Zealand have access to one of those. But there’s no connection between lots of providers and therefore there isn’t a continuity of care.”

At a national level, Hira has been put in place to tackle these challenges. The end of June will mark the end of the first tranche of the project. So far this has included the development and deployment of My Health Record, which allows citizens to view or book vaccinations and to update their contact information, something that used to be a far more complicated and manual process which inevitably led to errors and duplication. It builds upon work completed in New Zealand around 35 years ago – the creation of the National Health Index (NHI) number, a health record number for every single person in the country, applied retrospectively for the population at the time and from birth from that point on.

“It was amazing, and very forward thinking at the time; but we let it go and didn’t really advance from there,” Ryl reflected. “But now the NHI number provides us with a really good base to move from, because we’ve got this identifier for every single person with their health record, and it’s an incredible foundation for Hira.”

Ryl mentioned that that she appreciates the fact that Hira is “not just one big monolithic EHR. Your system might only be servicing a small community, but that community might really appreciate its presence and wouldn’t want to lose it. If the provider is therefore capable of connecting with Hira – if they are using the right standards, their cyber levels are appropriate and they are working in the cloud – then that disparate system can be joined up, but the provider can still work within their own system, they can still innovate and operate.”

Regarding tranche two of Hira, Ryl noted that they need to wait and see whether funding will come through. “I think it is an extremely important project, and the ultimate end state sees health providers anywhere across the country able to log in and view a whole patient health record,” she said. “There are so many benefits – for example, if someone is admitted with an allergy to a certain type of drug but they are unconscious when they arrive. It’s guess work for paramedics without access to that record, so something like this could really be life-saving.”

Another plan in the works is the National Data Platform, a data warehouse that will collect information, anonymise it, and allow it to be used to develop public health policies, answer questions and identify trends. “We’ll be able to look and see where the greatest prevalence of diabetes is, what policies we need, what our risk of heart attack is. All of that population health data is so important.”

The United Nations Digital Health Symposium

Alongside her work with the DHA, Ryl is co-chair of the United Nations Digital Health Symposium which she described as a “hugely important movement”.

Originally launched by Professor Martin Curley in Ireland, the symposium seeks to “champion a new era of digital health through collaboration, cooperation and change”. The group works towards the United Nations’ sustainable goal number three called ‘Stay Left, Shift Left 10X‘, which focuses on keeping people on the ‘left side’ of the care continuum – preventative and proactive care – and as such keeping them out of emergency and elective care. “It’s all about keeping people in their homes for longer, because global research indicates that people recover faster and do better at home than they do in hospital,” explained Ryl. “If they do end up in acute care, it’s about asking how we can get them home quicker.”

This work is underpinned by technology, with the aim to find 10 x technologies that can help keep people either on the left of the care continuum or moving in that direction.

“About 100 global digital healthcare leaders convene around the United Nations General Assembly. We’re in our fourth year now – we bring people from all over the world together to discuss this work, and I think it’s such an important programme to draw attention to, because ultimately we are trying to drive outcomes forward through technology.”

In 2022, the United Nations Digital Health Symposium developed the Manhattan Manifesto: 12 principles recommended by the group as guidance for policy makers, digital healthcare strategists and implementation teams, as well as health care professionals and the people they are caring for. The principles include keeping people at the centre; seeing healthcare as an “essential contributor to economic wellbeing and growth”; recognising healthcare challenges for women and girls in particular; and embracing the Health Data Governance Principles as a step towards global standards. Another two principles are directly attributed to Ryl’s own research: to seek government commitment to allocate at least six percent of public healthcare spending to digital health, and providing leadership through a national digital health body that is outcomes-orientated. The manifesto can be found in full here.

The symposium also provides an opportunity for discussion around topics such as regulation of software. “We can get together and really work out things like unintended consequences of policies or legislation. We need to challenge governments to think differently about all of these sorts of things, and it comes back to my earlier point around connectedness – it’s all about working together.”

Many thanks to Ryl for taking the time to share her insights.

We recently met Aaron Miri, senior vice president and chief digital information officer at Baptist Health in Jacksonville, Florida, to learn about the digital projects in his organisation, his experience at a national level, how technology is being used to support Baptist Health in making healthcare accessible, and more.

On Baptist Health

Aaron explained that Baptist Health serves the entire region, from south of Atlanta to north of Orlando and out towards Tallahassee. “It’s a giant swathe of the country – we are a very large paediatric and adult healthcare organisation with numerous levels of care. We are the preferred regional leader for our market, we’ve been in the Jacksonville area for over 65 years now and we’re growing fast.”

As the inaugural chief digital information officer at Baptist Health for the last three years, Aaron explained that he has been leading the journey to digitise and modernise the system, to take advantage of the latest technologies to benefit patients and providers.

“My role is the first chief digital and information officer for this health system, which is something that is really catching on across the United States. It’s not just about installing the technology and walking away, it’s about looking at how you can really gain adoption, market share, patient satisfaction and care quality and outcomes using technology. I’m looking at whether people are truly using the tech we put in place, and whether they are deriving joy in doing so.”

Experience at national level

Aaron shared some insight into his background and experience, starting with 2016, when he was appointed by the Obama Administration to the Health IT Policy Committee before being re-appointed in 2018 to Health Information Technology and Advisory Committee, or HITAC. Aaron was then elevated by President Trump and President Biden to become the co-chair of the committee. The committee advises the health and human services department on all things health IT, putting together standards and ideas and advancing development in areas such as cyber security, interoperability, public health and patient engagement.

“My projects there were numerous, from helping to construct the requirements and technical specifications for our national superhighway, which we call TEFCA (Trusted Exchange Framework and Common Agreement). I’d compare it to NHS Spine; you can get any information from it. But we had to start from scratch and build the specifications, look at how we could share information, how we could ensure it was secure, and so on. We looked at the NHS as a great example of things that had been done well and took learnings from the NHS experience. We really tried to be comprehensive about that; we wanted to learn as much as possible from our partners too. I’m a big believer in not recreating the wheel.”

Aaron explained that the committee also explores advancements within digital health, such as the progress around telemedicine during the pandemic; bringing together federal agencies to share information with each other and the public; and working with the White House to provide education on areas such as AI, to inform executive orders coming from the president in this space.

“All of these different projects, as a co-chair, member and volunteer for the committee, have been a tremendous highlight of my national work,” Aaron reflected.

At a state level, Aaron also serves on the Florida Cyber Security Advisory Council and has served on numerous other boards, supporting the governor locally across the state to advance digital health and lead efforts on the ground.

Working with CHIME

Aaron discussed his work with The College of Healthcare Information Management Executives (CHIME), an association of healthcare CIOs across the globe. He explained how CHIME seeks to provide an environment of learning, collaboration and partnership, to help the ecosystem navigate things such as the pandemic or AI or cyber security. Aaron has been serving for several years as a member on the board of trustees.

“CHIME brings CIOs together to help guide, teach, learn and network. It’s about putting the patient first. It’s about asking: how can we as CIOs and CDIOs work together and take on each other’s lessons? At any CHIME event you will get CIOs from the USA, UK, Germany, France, so many places; and we are often facing exactly the same challenges.”

Alongside his place on the board, Aaron volunteers by helping to teach CHIME bootcamps, which focus on teaching new CIOs who are rising through the ranks. He is also involved with the public policy committee, building on his experience with the White House to advise CHIME on future directions.

Recently, Aaron continued, CHIME has been working alongside the Florence Nightingale Foundation in the NHS to provide a programme of academies for the scholars, nurses and midwives in the digital health space. “It’s a phenomenal partnership, and I’m very proud of CHIME and the work that we are doing there,” he commented.

Digital focuses at Baptist Health

Moving on to focus on Baptist Health, Aaron explained that the system has undertaken a modernisation programme focusing on clinical systems, including implementation of a new electronic health record. “It was a tremendous planning effort, and it marked the beginnings of our investment into technology. Now, we are doing things with artificial intelligence that are being mentioned on national news and across the globe.” In 2023, CNBC visited Baptist Health to showcase how physicians are using AI software to generate patient consultation summaries, to enable physicians to spend more time interacting with their patients and reduce the admin burden.

Baptist Health is also focusing on using digital tools for patient education around proactive and preventative care, along with investing in its business and supply chain management systems to complement clinical efforts, which is scheduled to go live in 2026.

The work is diverse, Aaron noted, with his scope covering AI, machine learning, analytics and automation, to new technology stacks that will turn hundreds of different legacy systems into one enterprise system. “Essentially, it’s working out how to crack the walnut in a smarter and more effective way.”

Making healthcare inclusive with tech

Aaron said that the marketing department at Baptist Health deserves a lot of credit for the way they have partnered with the digital team to ensure that technologies are inclusive and supportive, from websites to mobile applications to engagement tools such as chatbots. “They’ve been a great help to us in making sure we are not excluding any population – whether that’s disabilities, languages or so on, any of the things you need to consider when you are serving such a huge proportion of people. They have worked with us on harmonising our technology stack to make sure it is as inclusive as possible.”

There can be “clunkiness” in health tech, Aaron acknowledged, because a lot of technology was not designed for the kind of user variety necessitated by healthcare. In some cases, he and his team have worked with vendors to help them understand the breadth of requirements that come with a health system like Baptist Health.

Baptist Health’s brand places emphasis on ensuring that people feel respected and heard, Aaron added, and this applies to technology implementations too. “Our mission is to be by your side the whole time, every step of the way. We want people to feel like we have their backs and that we are thinking about them, including with the technology we bring in; and that needs to be a very thoughtful, planned process. We look at it comprehensively, we are always re-assessing and surveying our patients. We ask how they feel when they engage with us – do interactions feel warm, or do they feel cold and robotic?”

As an example of this, Aaron described how his team is using AI prompts to respond to patient inquiries around things like refilling medications. The AI agent creates a message for the doctor to review and send once they approve. To achieve this, Baptist Health doctors gave 200 hours of time to the digital team to work on prompt engineering with them, ensuring the responses generated by the AI sounded “fair, inviting and warm”.

Aaron emphasised: “They were coming off a long day of seeing patients and then spending another couple of hours with my technical teams to help train the AI agent so it sounds human. We could have easily and quickly created some simple robotic responses, but that’s not delivering great patient experience; as a user it can feel frustrating and annoying. The physicians understood the need to take time on this, so that the technology doesn’t just work, it works well. It’s attention to detail; it’s a culture shift; it’s the right way of using tech. Our practitioners and physicians deserve a lot of credit for helping to drive that culture forward.”

Expanding the digital team

“It’s not too hard to recruit to a beautiful state like Florida – we’re full of sunshine and we have Disney World close by! But in reality, not-for-profit healthcare is always going to be competing with for-profit companies like Microsoft or Amazon.”

Aaron reflected that in his experience, younger generations such as Millennials and Gen Z “tend to want to do something for a purpose. Whilst a pay cheque is of course important in terms of wanting to be paid fairly, receiving higher pay from somewhere like Google may not offer the same intrinsic reward as you do when you help a sick person feel better. Working somewhere like Baptist Health, the technology you implement might help to save someone’s life, and you can see that impact, you can see people leaving the hospital and being able to go home to their loved ones. That’s a different level of reward.”

Healthcare systems should “stay true to what makes them unique,” Aaron suggested. “We’re not a technology company; we’re a healthcare company that does technology well. But we lead with healthcare. That resonates with people when it comes to hiring because they want to stand for something. It’s great to build widgets, but if you can make people better, that’s a return on investment for your time that very few industries can offer.”

Priorities for the future…

What are Aaron’s priorities for Baptist Health moving forward?

In the short-term, he said, the system will “continue our quest with digitisation – we want to digitise the entire spectrum and we want to push the envelope with our key partners such as Microsoft, Dell and Epic, looking at different ways of delivering care that haven’t been done before.”

The executive team and board of directors are very focused on patient and public health, Aaron added. “How do we help our communities, the region? How can we give back to our communities with things like preventative screenings? We have a lot of tech that we use well; how can we ensure that people are supported to use it and uplift Jacksonville?”

Aaron emphasised that Baptist Health is a regional health system, located amongst the people it serves in Jacksonville, and rooted in its community. “This is very different from many other leading organisations in this country – we focus on our region. We’re not listening to a corporate headquarters thousands of miles away in another state, taking direction from them. We’re listening to our people, because the needs of the North Florida population are different than the needs in St. Louis, for example. It’s about regional health, and I think that’s where the USA is going in the future; many people gravitate to a region because they want to be taken care of in that location, where the healthcare provider is attuned to their needs. It’s like the NHS in Scotland versus the NHS in England – they’re the same family, but they can be very different, because they have different needs and different focuses. That’s where our near-term focus lies – on our region, its people, processes and technologies.”

Over the next five years, one major priority will be on automation; “smartly and safely” leveraging AI; focusing on cyber security postures and how to defend against emerging threats; and workforce development and ensuring that the workforce is prepared for 2030. “I need to ensure my workforce who have been with us for a while don’t get left behind; that they have a future with us that they feel confident and comfortable with. I also want to create a pipeline for kids coming out of college, so they want to come and work for Baptist Health.”

Aaron also commented on a need to “navigate the headwinds that all of healthcare is facing” such as inflation, wage growth and the rising cost of materials, and working with vendors to minimise the impact of these factors.

“Technology is the central nervous system of a healthcare environment,” Aaron concluded. “If your central nervous system is acting up, then your body doesn’t function properly. I need to make sure that we are optimised to deliver the best possible patient care. As I said earlier, we’re not a tech company, we’re a healthcare company that does tech well. It’s vital that I orient all of our technology solutions to match that alignment.”

… and key predictions

“I think we are going to see an immersion of start-ups that truly understand healthcare workflow, because they came from healthcare,” Aaron predicted, “as opposed to giant tech companies looking to play in the healthcare space. I believe we will see more and more of these real health tech start-ups emerging and starting to dominate over the next few years.”

Also on vendors, Aaron foresees that companies who took advantage of healthcare providers during the pandemic and raised prices significantly to match demand will “lose tremendous market shares. CIOS are tired of being told they are being held hostage and must pay a heightened price. So, I think those two predictions will go together.”

Finally, Aaron shared a consideration for CIOs and people in similar positions, “Continue to better yourself, take advantage of opportunities for learning, and don’t close your mind off. When you don’t acknowledge and embrace the need to grow in your role, that is when your workforce may leave for CIOs who keep pace with the future. So keep an open mind.”

Many thanks to Aaron for taking the time to share his insights with us.

In recent weeks at HTN we’ve spoken with health tech leaders from across the world, to discuss innovation and new technologies, data and analytics in health and care, platforms and infrastructure, to supporting patient engagement and self-serve initiatives. Here, we share a selection of our recent international interviews.

Let’s take a look at some of the interviews we’ve published so far…

Siuwin Wang, director of business analytics and health information management at Orillia Soldiers’ Memorial Hospital, Canada

Siuwin joined us to share insights into some of the data-focused projects taking place at the hospital, his hopes for the future of data, what it means to be a leader of digital change, and more. He discussed how he developed the data analytics vision strategy for the hospital, his engagement work with staff, and the importance of tying data to clinical outcomes despite the fact that data teams are not patient-facing.

What does it mean to be a leader of digital and data change to Siuwin? “Embracing new technologies means changing,” he reflected. “Being open to this means you can always find ways to improve. It also means that change management is going to be an important focus for leaders in taking users with them on that journey, from an adoption and a utility perspective. You want technology to help people solve their day-to-day problems.”

Click here to read Siuwin’s interview in full.

Dr Zafar Chaudry, senior vice president and chief digital and information officer at Seattle Children’s Hospital

Zafar told us about his work at Seattle Children’s Hospital, a paediatric health system with 46 sites located across the states of Washington, Alaska, Montana and Idaho, where he runs the IT service covering “everything from infrastructure to informatics, through to digital health”.

In particular, Zafar highlighted the organisation’s strategy around Google Cloud: “We built a partnership with Google to move all of our analytics stacks over, so that we would have access to the cloud, as well as the ability to burst our capacity when crunching the numbers. We now have 116 plus data sources within Google cloud, with 69 data marts within that space. Within the platform we are using compute storage, networking, big data, ETL and query, and AI machine learning.”

The results of this, according to Zafar, include “99.99 percent uptime on our analytics platform”, and reductions in the time taken for SQL server cube refreshes from “about four hours” to “less than one hour”.

Read Zafar’s interview in full.

Keltie Jamieson, chief hospital information officer for Bermuda Hospitals Board

From Keltie, we heard about Bermuda’s digital priorities at health board and national level, her insights into the digital healthcare landscape on the island, and her own career path into this space.

Keltie explained that last year, the Bermuda Hospitals Board approved the BHB Digital Health Strategy which is founded on four pillars and focuses on growth from a digital perspective, with pillar one centring around IT uplift; pillar two around digitising operations; pillar three around digital evolution; and pillar four around digital innovations and insights.

“It has been developed to support the vision and mission of the BHB strategy and it considers how we implemented a full suite of Cerner products across our hospitals last October (2022), and the need to leverage the work around that,” Keltie said. “I also see the strategy as an integrator across Bermuda – we need to think about how we can connect the dots not only across Bermuda Hospitals Board but also out into the community, emphasising a people-centred care approach.”

Keltie’s interview can be found here.

Tino Marti, digital health facilitator at the European Health Telematics Association in Brussels, Belgium

Tino joined us to discuss his work with the European Health Telematics Association, which he described as a multi-stakeholder platform aiming to encourage collaboration between digital health players across Europe, along with his previous experiences in health tech management and healthcare administration in primary care and integrated care organisations across Spain’s health sector.

Referencing the “fragmented provision sector in Catalonia”, Tino told us about the development of the Catalan E-Health Infrastructure, which aims to decouple the data from services and “form a backbone for an entire system, and different healthcare providers will have to adopt this data backbone. Decoupled this way, the service that they are providing will use a common data model. It’s a long-term project that will take four or five years to deploy, but it will change the landscape and provide the opportunity to have data consolidated centrally with all the potential for innovation and research. At the same time, innovation will spread out much faster, as once you have developed a solution the shared data model means that it can be transferred from provider to provider a lot easier.”

Read more from Tino here.

Inderpal Kohli, vice president and chief information officer at Englewood Hospital, New Jersey

Inderpal shared how he has amassed more than two decades of experience in driving innovations and working on enterprise information systems, working within his current role at Englewood to provide strategic direction and oversight of IT functions, advance tech infrastructure, and support the growth of the organisation.

He described some of the main digital projects that have been undertaken at Englewood Health during his time as VP and CIO, including patient engagement and self-serve opportunities, the expansion of electronic medical records, imaging solutions, and medical device technology. One of the overall goals, Inderpal said, has been to “reach out to our patients and make their interactions with our system more digital, so that they can interact with us when, where, and how they want to interact with us.”

Click here to read Inderpal’s full interview.

We’ve got plenty more interviews lined up to publish over on HTNI in the coming weeks – we’ll be sharing insights from Florida, New Zealand, Austria and more – so don’t forget to bookmark the site to keep your finger on the pulse of international health tech.

This week we held our first international webinar since launching our sister site HTN International, where we were joined by a panel of health tech experts to discuss current digital capabilities, projects, and priorities from country contexts including Spain, Bermuda, and the UK.

We welcomed Keltie Jamieson, chief health information officer with the Bermuda Hospitals Board; Tino Marti, digital health facilitator at the European Health Telematics Association (EHTEL) in Spain; and Penny Kechagioglou, chief clinical information officer and deputy chief medical officer at University Hospitals Coventry and Warwickshire.

To begin, each of our panellists offered a brief introduction to themselves and their role.

Keltie talked about her last year-and-a-half within the health system in Bermuda, as well as her background as a CIO in Nova Scotia and Alberta, Canada, working on implementations including an EPIC implementation that she called “the largest in the world”.

Penny shared some of her work as a CCIO in the UK, sharing that her team is currently “about seven weeks away from implementing an EPR system”, and that her responsibilities on a day-to-day basis include overseeing the organisation’s digital strategy and transformation, quality improvement, and innovations such as using AI to improve outcomes, patient flow and productivity.

Tino took us through his current role collaborating with EHTEL, as well as his background working for the Department of Health in Catalonia, and as a technical officer in primary care for the World Health Organization’s European region, based in Kazakhstan.

Current levels of digital maturity

To kick off discussion, we asked our panellists to share a little about their region’s digital maturity and progress being made on digital transformation.

Tino talked about his experience of deploying digital healthcare initiatives in Catalonia, a process he pinpoints as “starting back in 1998 with the first primary healthcare record”, and advancements made around interoperability to help improve data flow between healthcare professionals and patients.

On the current situation in Bermuda, Keltie told us that when she arrived 18 months ago, “we were two months away from launching our electronic patient record, so it was a bit of a trial by fire”. As such she has led an implementation that is now largely complete alongside a “great team”, covering a population of around 65,000, and in the face of challenges around getting resources as an island.

From the UK perspective, Penny highlighted that the priority is for every trust to have an electronic patient record by December 2026, and that at the moment, the focus is on how data can be linked together, as well as “where we can use anonymised data for research and for clinical decision support”. She also highlighted work on the NHS’s Federated Data Platform, on citizen engagement, patient portals, and population health management challenges around inequalities.

Challenges in the digital healthcare space

Moving on to discuss challenges, each of our panellists shared details on some of the current challenges within their role or organisation.

Referring to the Catalan health system, Tino highlighted difficulties due to the “completely fragmented landscape of health information systems”.

He said: “We’re covering 7.8 million people with universal health coverage, and we have 65 acute hospitals serving this population, with 22 different hospital information systems. So now we have this fragmentation that is hampering how innovation can be scaled-up. If you have a good implementation in one hospital that integrates information with primary healthcare in this new solution, when you want to scale-up, you will have to make 22 different adaptations.”

Tino said that in tackling this challenge, the shared electronic health record approach, or having all hospitals and healthcare providers publishing information in a common layer, “is very good for exchanging data between healthcare providers – but it doesn’t look at the level of processes, so there is a need to do something else.”

A strategy formulated in 2018, he continued, was based around the idea of decoupling applications from data, so that “no matter who’s providing the service, they have to adapt to this common structure of data”.

From the European perspective, Tino told us that whilst “there is a lot of innovation and product innovation funded by the European Commission”, he views a lot of the projects as “not sustainable”.

Noting that there is currently discussion about how we can make innovation sustainable, and discussion about the methods to scale up that innovation, Tino shared: “We’re working on a project called Digital Health Uptake, where we’re identifying methodologies and tools that help implementers both from the supply side and the demand side, to implement and scale-up their solutions based on on good practice. There is a need to foster this innovation moving forward.”

Keltie raised the need to embrace failures, saying “innovation typically fails 50 percent of the time, and that’s OK, because when you fail, you learn and improve.”

She continued: “It’s about the lessons we learn and the research papers we write and taking things to the next level, because if we are always successful then I’d argue we’re not being innovative at all. There is a publication bias in that we only publish when it’s successful; and then we don’t have that possibility of learning. That’s disappointing, I think.”

Penny agreed with this point around the importance of failure, adding: “That goes hand-in-hand with the culture of organisations, allowing our people to innovate, and to try and fail. As innovators within the organisation, we have to give people that permission to fail. We have to say: that’s OK, how can we learn, how can we move forward? I agree fully with the point around publishing on that, too.”

Another challenge Keltie noted was around recruitment and retaining staff on the island, sharing that there is currently a lack of nursing and home care services. At present, she is working on “trying to use the data we have to determine where those tension points are around patient flow, and starting to give people a better snapshot of what’s going on in the hospital”.

From the NHS perspective there is also a challenge around very high demand for emergency services, Penny noted, with primary and secondary care also being “quite overloaded”. She expanded on this point, saying: “We’re trying to manage demand, and our healthcare records don’t cater for community and social care; so how do we ensure that what’s happening in the community is fed back into the electronic patient records?

“Interoperability is something else we’re trying to address with the Shared Care Record and the Federated Data Platform, and we’re also looking at upskilling the workforce around digital and instilling a digital-first attitude and approach.”

Improving interoperability

Focusing in on the challenge of interoperability, Keltie told us how in Bermuda, there is “very little in interoperability”. She also shared some of her insights from her work in Canada.

“One of the projects we’re just about to kick off is a new integration engine. Our current integration engine is antiquated, and is going to limit our ability to connect the way we want to with the community. So it’s mostly inter-hospital things and basic stuff,” she said.

“Canada also continues to prioritise interoperability, but if we don’t talk about how we’re going to standardise data and share data in a semantic way, we’re never going to be able to really share outside of the provinces easily.”

Due to Canada being “provincially controlled”, Keltie continued, “even if we get federal money to help us, the provinces don’t do things the same way; so we have a national drug information specification that’s implemented 12 different ways.”

“I think that’s the downside of having a provincial body and not a national body that has that governance. There’s a lot of clean-up to do before we’re going to be having any amount of interoperability between provinces. Within provinces, most of them have a drug information system and electronic master patient index and are exchanging data that way, and some have started to get more into the e-referral-type space. But I don’t think we’ve cracked the nut on real interoperability by any stretch.”

Tino talked about the current situation in Catalonia, noting that “it’s a challenge that has already been addressed, and the solution is pretty good in terms of collaboration between levels of primary and secondary care”, but that this is “only at regional level”.

“If you move from region to region, then you are facing interoperability issues, and if you cross the border from Spain to France, for instance, then it’s another completely different picture, so I think it will be never-ending unless there are new approaches and a common data model.”

In terms of news on this topic, Tino noted that European health data regulation is “now in progress” when it comes to providing common standards for EHR data across Europe, in the hopes that this might help with exchanging basic information for Europeans travelling across Europe.

“In Catalonia, we have implemented something where, through your personal health record, you can download your data from your mobile or computer, and this data can be exchanged with other healthcare providers as a way of getting around challenges with interoperability,” he shared. “I think this is a good opportunity to make systems more permeable to innovation.”

Patient involvement

On the topic of getting patients involved in the process, Keltie talked about her experience from Bermuda, where a national patient portal was actually purchased by the hospital within their EPR. However, she said, “We’ve been waiting to see what’s going to happen at the national level, so that we don’t end up with two patient portals on a small island. I’m hoping that we hear more soon so that we can move forward.”

Canada, she reflected, has had an “interesting path with patient portals. They seem to have figured it out a little bit better under the pressures of COVID; but actually some of the first patient portal projects that came into Canada were unsuccessful, because clinicians weren’t comfortable just blanket-sharing information with patients, they wanted to have a level of control over what was released. Now, however, i think most provinces now have some level of portal access.”

From the UK context, Penny shared that whilst having the information in the same place for clinicians to make decision about care “is vital – but also equally for managers, it’s important that they can understand what is happening within a system.”

Her trust is implementing its EPR in the same instance as its system partners, Penny continued, which is “very important because that goes back to interoperability. Regionally, we are very good at interoperability; but moving from one region to another, that is where it becomes difficult.”

Penny added that a lot of work has been done recently around process mining and AI “to try different things and understand what the impact is on patient flow and on DNA rates, and we have made some really good improvements by just using our data well, having clinicians working with data analytics, people working with user design.”

Making use of data for research and innovation

We took the opportunity to ask our panellists about any research projects they are currently working on in this area, and their findings so far.

On informatics, Keltie said that her team’s focus is first on the problem to be solved, adding that “too often, people come to us with solutions and that might not be the best solution; if we drill into the problem they’re actually trying to solve, we may be able to do it in a much more eloquent way.”

She said: “I think the research methodology around asking questions, co-designing, and documenting your findings not only gives you a framework for thinking about problem solving and design; but it gives you credibility as we start to publish, that we are a group that is doing that level of thinking. With the national digital healthcare strategy, if we can be seen as a place you can do research with – we’ve a very interesting, contained dataset of 65,000 people – are we able to partially fund our national strategy work out of research investment and economic development startups.”

The issue with this small of a dataset, Keltie continued, is that “most people know each other”, which makes the concept of someone doing research with their data “a little bit tense”. In response to this, Keltie’s team have been looking at de-identification and using synthetic data.

Tino echoed the challenges Keltie voiced around secondary use of data, stating that this was an issue faced in Catalonia some years ago, which led health authorities to “develop a sort of data space where only public health care providers and public research institutions have access to this data”.

He continued: “I think there is a moral obligation of getting value out of this, so facilitating access to this growth of data is something that is necessary. What is happening, in reality, is that because we have this fragmented system, we also see fragmentation in the use of data, with each healthcare provider having a unit of research, collecting data, and also using this common space facilitated by the government.”

Since the turn of the century, Tino noted that “the system has been thinking first in covering the need; but we’re leaving this footprint of data that now has real potential, as we’re discovering the possibilities with more data and more detailed data, of tailoring new services, implementing algorithms, developing clinical decision support systems, and so on.”

He commented that the current system was “inspired by the quality and outcomes framework from NHS England”, with a list of indicators developed that are automatically calculated based on the data you’re recording in your electronic health record. “You have access to this information at GP level, at primary care team level, and between primary care teams across Catalonia. But we have a huge opportunity to explore this data to improve the quality of services in many different ways now, so I’m very optimistic, and I think we’re just entering into this stage.”

Measuring success

Moved on to discuss how success can be measured in digital programmes, Penny considered: “It starts with a good vision and what outcomes you want to achieve; that’s a really important aspect for our teams, organisations and systems to set up from the beginning.”

For the UK, she drew attention to the What Good Looks Like framework, explaining that it is followed in terms of specific success metrics from an organisation perspective. “Success for me, though, is also the degree of engagement, ownership of change, innovation, and the outcomes we measure in evaluation, the benefits to patients and their experience,” she pointed out. “Having happy customers, patients and users, and achieving the benefits that were set out in the vision – that is a good measure of success.”

Keltie agreed with Penny on the importance of having a strong vision in place from the beginning, saying that one of the things she tells her team is that “we want our customers to feel supported, to know and trust that we are there; and that is the key tenet for me of digital transformation, around the connection, meeting people where they are, engaging in co-design”.

When IT and technology was new, she said, “it was very much that people were just lucky when we answered their call; whereas now it really is around making a stronger workforce, promoting better outcomes, and so on. It’s a real culture shift in teams that have grown up in the traditional model, to try to be pushed into this more engaged model. I like to say that my team is part of the clinical care team; we don’t touch the patients, but all of our tools do, and so we have to respect that important role that we have.”

Tino talked about the different measures of success around value, clinical value, social value, and economic value, highlighting the importance of being able to utilise these in demonstrating that “investment in digital healthcare has paid off”. If we can evaluate long-term trends and see how care has changed during different implementations, he said, we can measure improvements.

The future of global digital healthcare

To close the panel, our discussion moved on to consider the future of digital healthcare globally, and what it might look like in ten years’ time.

Keltie’s view of future digital health in Bermuda centred around creating “a cohesive record across the country”, which she highlighted as a “game changer”.

She said: “We have some of the highest rates of diabetes and kidney failure in the OECD countries, so there’s a significant value proposition for us to be able to share data in a much more cohesive way, and I think that’s really going to drive it home.”

Something that Keltie noted needs continuing focus is cyber security. “We can put in all the digital tools we want, but I think we are still going to be struggling with maintaining the security of the systems,” she acknowledged.

Tino talked about the potential for a “widening gap” in adoption, “because digital health is accelerating in terms of possibilities, but the adoption capacity of our institutions is very low.” He also considered that “we will probably see completely different speeds of uptake, depending on the flexibility of the organisation and how it can adapt to emerging technologies. But at the same time, since the introduction of digital healthcare, I would say that the way we work is pretty much the same. We have new tools that improve our way of working, but culturally I think it’s quite difficult to change within ten years.”

For the UK, Penny said, the digital future involves the better linking of data, and the use of data in predicting illness, treating people, addressing risk factors before illness happens; and understanding these risk factors at population level.

We’d like to thank Penny, Keltie and Tino for taking the time to share their insights and experiences with us for this webinar.

If you haven’t already, check out HTN International, where we share news, insights and interviews from the digital healthcare space on a global scale.

You can watch the session back here:

Over on our sister site HTN International, we shared our interview with Inderpal Kohli, vice president and chief information officer at Englewood Hospital, New Jersey, to hear his insights on digital transformation, projects, priorities and challenges in the digital health space.

Inderpal introduced himself by explaining how his career has been in the IT sector since leaving high school, including roles in programming and project management, and that crossing over into the health sector came up as a chance to work on a IT project for healthcare.

“I landed at one of the best places I could have, Columbia University Medical Center, where cutting-edge informatics research was taking place,” he shared, “and I got my first insight into how all of the innovations we were working on behind the scenes in the lab were actually delivered in terms of patient care by the bedside.”

Inderpal has worked in the healthcare sector ever since and noted that he had amassed more than two decades of experience in driving innovations and working on enterprise information systems, working within his current role at Englewood to provide strategic direction and oversight of IT functions, advance tech infrastructure, and support the growth of the organisation.

Digital transformation at Englewood Health

Inderpal shared some of the major digital projects that have been undertaken at Englewood Health during his time as VP and CIO, including patient engagement and self-serve opportunities, including the expansion of electronic medical records, imaging solutions, and medical device technology.

“One of our overall goals has been to reach out to our patients and make their interactions with our system more digital, so that they can interact with us when, where, and how they want to interact with us,” he said.

Inderpal commented that the COVID pandemic accelerated digital transformation in Healthcare, describing how his team “delivered three years’ worth of transformation in three months”, with the pandemic leading them to rethink their strategy and emphasising the importance of agility. It also had an impact on attitudes: “Most people now realize that virtual care is not a bad thing and that patients don’t always need to attend in person for many things.”

Recent digital projects

We asked Inderpal what digital projects he and his team had been working on recently. He talked about how one of his initial priorities was developing a comprehensive digital strategy for the organisation and a roadmap to follow, which formed a multi-year plan.

“One of our goals is to offer patients our services or interactions in the way that they want,” he said. “Healthcare is obviously more complicated than ordering food; but that doesn’t mean patients don’t desire that experience and that kind of ease. That’s our goal. We are focusing on that digital front door, on our outreach to patients, offering them solutions and service capabilities, and getting them engaged in their own care.”

With the organisation spanning 150 locations and over 600 providers across a range of specialties, Inderpal spoke of his hopes to provide a seamless experience for patients. “Once you are with us, my goal will be to take the best care of you whether you need a specialty appointment or a diagnostic test. We want to take care of that in a seamless manner for you.”

Inderpal also shared his aims to promote “a merging of analog and digital care,” creating a consistent experience between virtual and in-person interactions with patients.

“Remote patient monitoring is a program that we are expanding – we want to help you when you are not physically at one of our locations with technology-enabled care management outside of our four walls. We need to be nimble enough, and our execution needs to be nimble enough to roll in some of those digital initiatives. So far, our work in this area has supported this and allowed us to start working on including exciting initiatives like generative AI into our strategy.”

Moving on to discuss electronic patient records at Englewood, Inderpal told us that the organisation has a single patient record across the entire continuum of care so that “the experience remains the same no matter where staff is interacting with the patient”, and so that information is available wherever patients are in the organisation.

Using information and data analytics to inform decision-making is “inherent in how Englewood operates”, he added.

“We use data for running our operations and making strategic and growth-related decisions, and we also use it to identify gaps in our patient population, for improving patient experience and improving care quality. We look at infection rates, we look at patient satisfaction rates. Data drives a lot of decisions and our initiatives to make sure we keep improving our care and our care delivery to patients.”

Digital priorities for the next 12 months

What are Inderpal’s priorities for the next 12 months around digital and data?

On the continued expansion of the organisation’s digital front door and patient engagement initiatives, he said: “We’re working on various campaigns, whether it’s something like mammography or missed annual screening. Or if patients have not followed up on an order from their doctor, we’re looking at different ways to reach out to them and to make it really easy for them to schedule an appointment.”

Inderpal also shared priorities, including the expansion of the organisation’s generative AI tool, with plans to provide some level of automation, helping clinicians but also expanding it to offer more to patients in terms of capabilities.

“We’re looking at developing a generative AI-based virtual agent, where patients can have a normal conversation and get the information they’re looking for, to schedule an appointment, or ask to talk to someone on the phone. Then there’s the idea of running a large language model to synthesize a large amount of data within our patient record, to present relevant patient information to the clinician at a point of service.”

He continued: “We’re also exploring ambient charting, where instead of a physician sitting on a computer taking notes from conversations with patients, there’s an ambient listening agent. It will draft a fully structured clinical note for them to review in less than a minute, even suggesting coding or identifying care gaps. That would not only help physicians in their work but also give them more face time with patients.”

We asked Inderpal what role things like patient portals and mobile apps played in his organisation’s efforts to engage with and empower patients.

“Our digital patient portal is our first entry point, which holds comprehensive patient information, test results, visit summaries, doctor’s notes, imaging access, and appointment scheduling,” he shared. “The digital part of it goes beyond that, proactively sending text messages and emails to remind patients of upcoming appointments and such. The reality is that we all go and see someone when we’re sick; but it’s the preventative care that we need to focus on, and that will manifest itself in a healthier population.”

Ultimately, Inderpal said, his job is “to ensure that my organisation runs smoothly, balancing that with growth and supporting growth with technology. I go to technology to help me run my organisation as much as I can, automating monitoring, adding new tools. We need to make sure that when we build something, we can scale-up quickly, so that’s again the planning part of it, and transformation is key. Everyone likes the big transformations, but I feel the impact starts with small transformations – you build support, and then you can keep building from there.”

Sharing learnings

As a final thought, we asked Inderpal what piece of advice or learning he would like to go back and share with his younger self from his journey in digital health to date.

“In healthcare, technology is not the job,” he stated. “Technology is not the primary focus – it’s there to assist with the care of patients. So a tool or a solution that would be implemented in a few months in any other industry may take well over a year here, and for a very valid reason. The tool needs to conform to the workflow of taking care of patients. I learned this initially with some level of frustration on how much time we spend on optimizing workflows and optimizing the tool to meet the workflow needs. You need to be even more nimble about your approach and try something out to see if that clicks with your population, then expand it, rather than looking for a ‘big bang’ deployment.”

We’d like to thank Inderpal for his time and insights.

Interested in keeping up with digital health on an international scale? Don’t forget to bookmark HTNI, where we share daily news, insights and interviews on health tech from across the globe.

Last November we launched our sister site, HTN International (HTNI) – a place to share news, interviews, research and more on health tech from across the globe. Since then, we’ve looked into international health tech from Canada to New Zealand, South Africa to Norway; and now we’re hosting our first virtual panel, bringing together three health tech experts from Bermuda, Spain and the UK to discuss global learnings, innovations, and more.

We will be welcoming Keltie Jamieson, chief health information officer at Bermuda Hospitals Board; Tino Marti, digital health facilitator at European Health Telematics Association; and Penny Kechagioglou, chief clinical information officer and deputy chief medical officer at University Hospitals Coventry and Warwickshire.

The panel will take place via Teams at 10am (BST) on Wednesday 24 April: click here to register for your free ticket.

So what have we been sharing on HTNI in recent weeks?

Deep dive into digital healthcare transformation in Japan

The latest edition in our deep dive series sees us take a look at reports, plans, news and research from Japan to gain insight into the digital health landscape.

We looked at Japan’s digital policy, the Medical DX Reiwa Vision 2030 plan from the Japanese government, an update on electronic health records in Japan, and more.

Click here to read in full.

Launch of a smart AI health assistant

We recently covered the news that the World Health Organisation launched S.A.R.A.H (Smart AI Resource Assistant for Health), described as a “digital health promoter prototype with enhanced empathetic response powered by generative artificial intelligence”.

S.A.R.A.H can provide information across health topics such as mental health and healthy habits and is capable of engaging with users 24 hours a day, in eight different language. Powered by generative AI, S.A.R.A.H is desired to provide accurate responses in real-time and “engage in dynamic personalized conversations at scale that more accurately mirror human interactions and provided nuanced, empathetic responses”.

Find out more here.

$50m grant for Australian plans around a ‘Total Artificial Heart’

We shared the news that a $50 million grant has been given to the Australian Artificial Heart Frontiers Program from the Albanese government, with the aim of helping to develop and commercialise its ‘Total Artificial Heart’.

The heart utilises magnetic levitation technology, which is said to have improved durability, leading to hopes that the tech can support an improved quality of life for patients. The ultimate hope is for the artificial heart tech to “halve deaths from heart failure” globally.

Read the story in full here.

Opportunities for international start-ups

In the past week we have covered two international opportunities for health tech start-ups, including one from Tampa Bay Wave, a tech start-up support organisation based in Florida, which announced the opening of applications for its 2024 HealthTech|X Accelerator programme, aiming to “fuel innovation and support high-potential healthtech startups in Tampa and beyond”.

We also highlighted an acceleration programme for start-ups focusing on the femtech sector, launched by Italy-headquartered Zambon through their research venture Zcube. Applications are encouraged around the development of products and services to address “major medical needs” and improve women’s health and wellbeing, with targeted areas including gynecology, endocrinology, mental health, reproductive health, and more.

Digital Health Collaborative launches in the US

We reported on the launch of a Digital Health Collaborative in the US, which will bring together 14 organisations including the American Medical Association, the American Telemedicine Association, and the National Alliance of Healthcare Purchaser Coalitions.

The collaborative will share collective learnings and collaborate on research and programs to “help raise confidence and adoption in digital health”, as well as offering a Research and Impact Fund to offer funding to “aligned research and programs”.

Meg Barron, managing director of engagement and outreach at the Peterson Health Technology Institute, has commented that the new collaborative is “raising the bar for guidance, research, and resources that can accelerate the adoption of solutions that work and are worth it”, with a focus on “moving the industry forward at a critical crossroads”.

The full story can be found here.

Got an international digital health story you think we could cover on HTNI? Email amy@htn.co.uk to let us know.

Join HTN and health tech leaders from across the globe on 24 April for our first international panel discussion, focusing on digital healthcare across the world; click here to register for your free ticket.

Facilitated by HTN, the discussion will be held virtually on Teams and will feature Keltie Jamieson, chief information officer at Bermuda Hospitals Board; Tino Marti, digital health facilitator from the European Health Telematics Association in Spain; and Penny Kechagioglou, chief clinical information officer and deputy chief medical officer at University Hospitals Coventry and Warwickshire.

Our panellists will be discussing digital strategy, leadership, the challenges they face and how they tackle them, what ‘good’ looks like, and more.

Since we launched our sister site HTN.International in November, we have interviewed a range of individuals from across the globe to explore their insights into digital health, including Keltie herself – catch up with her interview here.

We’ve also chatted with:

• Ricardo Baptista Leite, Portugal: CEO at HealthAi, global agency for responsible AI and health and founder and president of the UNITE Parliamentarians Network for Global Health
• Sarah Jabbour, USA: PhD candidate in Computer Science and Engineering at the University of Michigan
• John Klepper, Switzerland: co-founder and CEO of PIPRA (Pre-Interventional Preventive Risk Assessment), a Zurich-based medtech company
• Wiktor Żołnowski, Poland: founder of start-up Health Folder, an app collating medical documentation
• Pouria Mireshghi, Iran: co-founder and CEO of deeptech/medtech company NerveAide, supporting neuro patients to regain their mobility and independence
• James Martin, US: CEO and founder of ezClinic, a Chicago-based med tech company supporting patient safety and risk management through AI and preventative monitoring assistance
• Dr Hugo Madeira, Portugal: dentist and head of surgery at Hugo Madeira dentistry clinic in Lisbon

We’ll soon be sharing an interview with panellist Tino as well – don’t forget to bookmark HTN International and keep checking back to keep up-to-date with health tech insights and learnings on a global scale.

As well as interviews, we share news, research, deep dives and more. There’s plenty to learn from in the digital health space from other countries, and plenty to be inspired by, so don’t miss out!

We recently sat down for a chat with Ricardo Baptista Leite about the potential and considerations for artificial intelligence, key learnings from his career and his thoughts on the digital health landscape in Portugal.

Along with his background as a medical doctor, Ricardo has experience in a number of settings including his current roles as CEO at HealthAI, global agency for responsible AI and health; founder and president of the UNITE Parliamentarians Network for Global Health; national spokesperson for health in Portugal’s Social Democratic Party; and guest lecturer at NOVA Medical School in Lisbon. 

Hi Ricardo, thanks for joining us! Can you tell us about your current role and background?

I came CEO for HealthAI in May 2023, but my first life was as a medical doctor trained in infectious diseases. I’ve served in politics as a four-term member of parliament in Portugal, I’ve been a city councillor and deputy mayor of my hometown and I’ve also had an extensive academic career ranging from global health, health politics and digital health.

In 2017 I founded a non-governmental organisation which I continue to preside over today – the UNITE Parliamentarians Network for Global Health. It is a network of current and former members of parliaments, congresses and senates from over 105 countries around the world. With the support of the World Health Organisation (WHO), our aim is to work towards science-based, evidence-driven policies for better health for all. 

HealthAI: the purpose 

We are a non-profit foundation under Swiss law, based in Geneva. Initially HealthAI was founded in 2019 under the name I-DAIR (International Digital Health and Artificial Intelligence Research Collaborative).

When I came on board, it was clear to everyone on the board and in the team that we needed to rethink our positioning as an organisation. 2019 wasn’t a long time ago, but the world has transformed since then. The pandemic saw acceleration of digital adoption and the widening of digital divides and societal gaps, but it also saw the rise of artificial intelligence from largely a research topic to a mass consumer product.

In the face of all of this transformation, HealthAI embarked on an in-depth process to speak to to governments, legislators, scientists, technologists and more, to hear viewpoints and considerations. One word kept coming up – fear. That fear was relating to AI and machine learning, and it stems from many factors, from lack of understanding of the technology to fear that the technology will take over jobs and human capacity. At the end of the day, it’s fear of the unknown.

Despite this fear, there is a lot of investment in the AI space for health in particular. But if people are fearful, whether it’s the regulators and policymakers or the citizen, this can lead to a brick wall where people don’t adopt the technology in the long run.

All this has fed into the thought process behind what HealthAI’s role is and where we fit in. We’ve designed a model in which we will end up with a global regulatory network for responsible AI in health, ensuring that each country has the tool to validate AI technologies in accordance with international standards. We’re not the ones developing those standards – that’s the remit of WHO and related organisations, and we have been working with WHO since we were founded.

Our aim is to make sure that the capacity exists in each country so that each country, with their own sovereign independence, can validate AI tools. We’re working to connect regulatory teams around the world into one global network, to allow sharing of knowledge to help accelerate the validation process safely and tackle any challenges that may arise – for example, through enabling the sharing of early warning systems to highlight issues or unintended effects. At its core, our work is about helping to ensure safe, quality, equitable and effective AI tools for all citizens when it comes to health; and it’s also about supporting investment and adoption of technology with the potential to improve health outcomes.

The potential of AI

My role at HealthAI has been a dramatic change of career for me, and that’s because I honestly believe that we now have the technology and computational capacity to embrace AI and machine learning and core related technologies, to actually transform systems and health in particular. We didn’t have that five or 10 years ago.

High-income countries have been pushing for what we call disease-driven models, in which we spend almost all of our resources reacting to diseases. The focus has been on people attending hospital when they are sick and healthcare systems trying to cure them or make them comfortable. But we know that if we address the multiple determinants of health early on and throughout life, in a consistent manner, we can transform that disease-driven model into a system that is focused on health, wellbeing and quality of life. We can lower the burden of disease on society, we can lower the demand on health systems, and we can free up resources to treat the people who inevitably will get sick.

The technology needed to do this was non-existent until very recently, and I think AI will play a very important role. We’re already seeing AI being used in many fields, with imaging probably one of the most advanced at this time given the way that it can perform analysis and detection on images. But there’s much more down the road in terms of population health, diagnosis, early detection and warnings, even prevention.

AI has a key role to play in freeing up time so that clinicians can get back into contact with their patients too. That may seem a contradiction, but I do believe that machine learning can help us re-conquer the compassion and humanisation of healthcare that we have in many ways lost. I read a study from the UK which said that 70 percent of the time, when the patient is in their GP’s office, they are looking at the back of a screen whilst the doctor is typing. We need to get that screen out of the way, we need to get back to face-to-face contact with eye contact, where doctors have the time to do a physical assessment and hold a proper conversation. Every big tech company is investing in what they call virtual scribes, which aim to collect all of the information about an interaction and process it for the electronic health record without the doctor needing to input the data themselves. There are a lot of things like this which I believe over the next few years will become standard.

The important thing is that we make sure that it is inclusive, that access is equitable. If we do that from the start – and that’s one of the advantages of being at the crest of this wave – it’s an opportunity to design this right from the start. That’s something we haven’t done with past technologies, and we need to learn our lessons from that. Ultimately, doing this will benefit everyone; because if we have a healthier population, we won’t need as many resources to treat such a high number of patients. Our healthcare workers, who are over-stretched and tired across the board, will have more time to care and will be supported to be more effective in their work.

This is the positive angle of what AI can bring to the health system – we just need to make sure that we mitigate the risks along the way.

UNITE Parliamentarians Network for Global Health: the role of digital

As a network of legislators from over 100 countries, we work with current and former policymakers. We focus on three main pillars: health as a human right, understanding the importance of strengthening health systems, and global health architecture and governance.

Digital has a presence across these three areas. The first pillar focuses around developing universal health coverage, and that involves trying to ensure access to digital in the most rural parts of the world so that people can use it to access healthcare.

For the second pillar, strengthening health systems, the role of digital is critical. As part of this work, UNITE has partnered up with Fondation Botnar (a Swiss philanthropic foundation seeking to improve health and wellbeing for young people across the world, advocating inclusion of young voices, equitable use of digital technologies, and supporting innovative programmes and research). We have created a digital health policy desk which is designed to promote good practices when it comes to policy and promotion of digital health. The initial focus is on several countries including India, Tanzania and Argentina.

It’s amazing to see the advancements that can happen just by raising awareness and building capacity. It has led to policymakers truly engaging and understanding that digital needs to be perceived not as purchasing computers and thinking that it will solve the problem, but actually using digital to make the transformation from that disease-driven model to one that focuses on prevention, quality of life and wellbeing.

Key learnings

Last year I read a book that really impacted me, called ‘Power and Progress’ (Daron Acemoglu and Simon Johnson). It looks at the evolution of technology over the last 1,000 years. The authors point out that every time a new technology has come out, the owners of that tech have said that it would change the world and enable everyone to live a better life. But most of the time, this hasn’t happened. In most cases, the technology has come out and benefitted the few rather than the many.

The few times that we have seen technology have a societal impact where even the most marginalised benefit, was when the technology was designed and deployed from the start to be fair, inclusive, equitable and accountable. These are the principles that we now transport into what we call responsible AI.

Technology is fascinating. Most of us who work in this space love it. But we need to have a very clear conscience of our history, as humanity, and how we have sometimes failed in the past. We need to make sure that we leave a better world for future generations, and to do that, we need to make sure that technology follows those principles that we call responsible. As well as making sure that they have the impact that they were designed to have, we need to make sure that there are safeguards and mechanisms in place to detect when we fail.

When I got into med school, one of the first things you learn as a medical student is primum non nocere – first, do no harm. This principle is also applicable to digital health. First, do no harm doesn’t mean avoid risk at all costs. It means mitigate all of the risk that you can and make sure that the benefits clearly outweigh the risks, just like with medicines. With medicines, there are adverse effects that we know about, that we tell patients about when we prescribe them. But we know that the vast majority will benefit from the potential good that the medicine will do, versus the minority who may experience side effects – and we make that prescription in the knowledge that the potential to benefit outweighs the harm that may occur. We need to use that kind of logic as we design new models for digital.

At HealthAI, we’ve been very much inspired by the medicines model. Before technology is deployed into a market, there should be a regulatory process, there should be an authorisation to access that market. It’s in the interest of companies too, because nobody wants to be liable of possible negative consequences of their own technology. If there are mechanisms and clear rules, it becomes easier for the companies to know what they need to comply with and how to get access to new markets. By creating a global regulatory network, we are hoping to learn from the lessons of things that perhaps weren’t done as well as they could have been with medicines regulations.

Digital health landscape in Portugal

Portugal is going through a tremendous reform in terms of its health system. We have upcoming elections so we still have to see how that will play out.

Looking back to the last decade or so, Portugal has been in the forefront in many aspects. Between 2011 and 2014 Portugal imposed a number of regulations which seem trivial now, but at the time they were quite groundbreaking. Electronic prescription of medicines was one; it is essentially the only way to get access to medicines these days in Portugal, and it was critical during the pandemic. There is home care for patients who are still under hospital care but monitored remotely via technology – we’re seeing those programmes advance a lot at the moment.

In terms of interoperability, about 15 years ago Portugal created a platform where every hospital, even if they are using their own electronic health record, can access patient data from a common cloud service.

There is some fear that a lot of the money being invested in digital, which is in the hundreds of millions of euros, is being used to update hardware. I would say that is a missed opportunity, if we are not able to use that funding, that one-shot opportunity, to make use of digital transformation to go beyond purchasing computers. We don’t just want to transform what we are doing on analogue and make it digital, we should be using that transition to reform and redesign the health system all together.

We have our own national health service in Portugal, some great past experience to build on and amazing healthcare workers. I think Portugal has the potential to do many things within its health system, but there needs to be clear vision. Let’s see what comes out of the next election.

What would be the one thing you would do, if you had the opportunity in the Portuguese health system?

I believe that if you have a role to change things in your health systems, you have to think of it from two levels. One is what we would call your emergency response – making sure that patients get access to a family doctor and that you reduce the waiting lists that are crippling health systems around the world, with Portugal no exception. For that, you need an emergency programme. But that does not solve structural problems.

The first structural thing I think Portugal needs to do is create a health data agency, where all of the health data is collected. It makes your health system much more efficient, because you are capable of following in real time the evolution of what is happening in the health system at the patient level and at the healthcare worker level, and you can perfect the system as you move forward. You can only fix what you measure and what you know.

Also, looking at the rise of technologies such as synthetic biology and precision medicine and machine learning, we know that the quality of data is going to be critical to success. It’s a question of being prepared and building that repository.

At the same time, if you want to ensure early access to the best treatments for patients in your country, then having a health data agency makes it much easier for clinical trials for example.

These are just some examples of how such an approach would put Portugal in the vanguard. Having a national health service of our own is a huge opportunity for change that may not be there 10 years from now. I believe we have what it takes; we just need the right vision and leadership.

Rounding off the interview, Ricardo urged anyone who may be interested in HealthAI to reach out. 

It’s very important that countries come on board – that anyone who has something to say about this is part of the process from the beginning. We are hoping to see countries validate AI tools from 2025 onwards; we’ll then have a global repository with all of the validated technologies. Hopefully, we can co-create globally and we can put AI to the service of the people. That is only possible if everybody chips in. Click here to find HealthAI’s contact details.

Many thanks to Ricardo for taking the time to join us.