Healthcare 4 6 Advancing Technology Digital Solutions Smart Hospitals

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hello everybody wish you a nice afternoon i  think it will be a very interesting afternoon   you you just saw the the panelists   welcome to the panelists from my  side so uh we have an interesting topic health healthcare 4.6 when i read it first  i also asked myself what do we mean by that   and uh so i thought what is health  care 5.0 you're obviously moving there   and from my point of view that is the right mix  of the real world physical interaction based   care and virtual care with the emphasis on  patient-centeredness on prevention and on   leading us to a personalized and precision  medicine i am convinced that many tools   for healthcare fight healthcare vibes  hero are available today in a high degree so all medical and diagnostic devices are network  ready and so on we are getting lots of data   and what's not so clear and what  we are lacking is the integration   is the integration of these tools the  implementation in a good organizational workflows   and to provide a comprehensive patient journey  for the patient uh himself there is a lot to do   and uh so we can discuss if we are at 4.6 or if we  are if we are still at 4.4 but that's academic so   this uh general managerial  and organizational readiness   is missing and uh when i look at the  panelists today and what they have   prepared i think we get some very interesting  views and we can discuss those views later on   we are talking about ethic ethics wolfgang is even  uh talking about consciousness that reminded me of   the book i published concerning the  subconscious mind of organizations in healthcare   and about hybrid intelligences so uh it's going  to be very interesting so stay tuned and i want to   hand over to our first panelist to uh  professor florencio travisio caviezo sorry   i have to read it and he will tell us  about uh blockchain and uh what blockchain   is going to uh to contribute to healthcare  where the potentials are we know blockchain from   bitcoin and so on that's not really  something you can easily trust   i think it's a a matter of distrust to to  governments and so on but uh the technology behind   this blockchain and um there is some there is some  benefit we can see we can expect from blockchain   and florence you will tell us about please start  your presentation thank you thank you verna for   for the introduction and thank you everyone in  healthmanagement.org for the invitation i'm going   to yes i'm going to share my screen probably as  as we hope we have all been doing it with uh zoom   sessions for the last year or so so i'm going  to go a little bit fast uh not fast fast but i'm   going to just to go to the point that where  we can discuss uh more so um so basically   this is what i think when i think about bitcoin uh  blockchain i think when we think about blockchain   i think everybody as verna has just said  we all think about bitcoin right so this   the whole thing that we discussed but it's  like a tip of the iceberg under under uh the   idea of bitcoin uh there is so much more uh  and from uh as we say from smart contracts   uh payments precisely the idea of blockchain  governance identity of persons and people   and so on many other things so the the the our  work is going to be to try to you know invade   and find out what's under the waters okay and when  i was researching for a while ago about blockchain   i realized that there is so much to to discuss  and in the article that i that i wrote uh   this last couple of months basically i was  thinking okay it's blocking a real a solution   it's really a solution it's just a mirage are  we going to are we being confused and and and   everybody is thinking yeah you know we are we  are we are hearing so much about the speculative   nature of bitcoin that we tend to think and  rely less on the capacities of blockchain   i'm not going to defend blockchain because because  from a legal perspective i'm a lawyer by train so   from a legal perspective there is a there's lots  of issues today about blockchain so basically   here are some questions that  we should ask and maybe we can   i you know include them in the discussion can  we trust the system can users trust the system   there's a lot of people trusting on on on  bitcoin we have seen it uh another type of cyber   currencies uh cryptocurrencies but can users  trust the system can this be a user-friendly   platform can we think of that is it is it  going to become a way to personalize medicine   maybe it is uh because it has a capacity of being  decentralized and centralized at the same time   right and this is my last point where we  talk about is it really patient-centric and   if it's really patient-centered it's going to  be that is going to be the revolution because   uh some that i mentioned in the article  and i've been thinking for a while is   if the patient cons concentrates or the absolute  level of power over the data that is being   specifically circulated then this is going to  be a real revolution so those there are many   ifs how many ifs but this is the one of the these  are the main questions that i wanted to discuss   i talk about the system i talk about the the the  capacities and i talk about the the user so i'm   not going to talk about per se what blockchain  is but maybe some of us or you do not know it   necessarily so blockchain is is exactly what  what it says is it's a block of change so it's a   lot of chains that are changed one to another and  basically the interesting thing is that each chain   each block is related to the to the previous  one so basically there's a code here that is   called a hash okay and the hashes are transported  from one block to the next one so basically this   block number two has the ha the original hash that  would be here the block number three is going to   be considered in the previous blocks the previous  hashes and so on so forth so basically you're like   piling uh hashes one to one one after the other  so that is one of the first characteristics   uh it is the same decentralized so it means  that the there's no one entity that controls   the the the process there is proof of work which  means that the league the the certainty of the   transactions is going to be um it's going to  be cons confirmed by the people operating in   the in the in the chain that is called the mining  okay we're going to be mining or verifying these   transactions how we're going to give the proof of  work we're going to give the okay and then we will   we move on if i transfer money from from myself  to verna somebody else will have to vouch and   confirm the transaction not just me or him uh and  then we have the practical immutability which is   very interesting because it means that nothing  in the chain can be changed nothing in the change   can be altered by no one okay so everything  stays so is a good it's a positive thing and   it's a negative thing at the same time okay so  these are three characteristics decentralization   no one has the upper hand over the data there  is a sort of global consensus on the certainty   of the data that is being centrally circulating  and three data cannot change the data can change   um so i'm trying to think about what are the  positive things the positive thing is that   when we think of the industry um blockchain can  be present in many layers of the health ecosystem   okay so it's very it's very versatile that's  very good thing so we can find it in many places   second we might be able to unify the identities  of patients through different platforms   which something that today we cannot do and it's  linked to the next point interoperability right   this is what we all want in the industry  to be able to basically connect all the   pieces of data that are circulating of users  okay so multiple identities centralized um   and then interpret interoperable removal  of intermediaries so this is going to be   good because it's basically the uh patient will  have more control ideally okay uh transaction   a consequence of this is going to be the cheaper  transaction costs okay so the system is going to   be technically cheaper and data can be updated  immediately okay that is also going to be a   positive thing so we don't need to wait for data  to be updated or corrected or verified and finally   it is a smart contract ready which means basically  the transactions can happen very fast uh and very   effectively because we have the technology  blockchain allows to make simple contracts   very fast and in terms of transactions for  healthcare that will be a positive thing to do um   and then last thing the supply chain control  okay that is going to be allow us to track supply   chain of medicines uh and avoid a counterfeit  negative things or questions or limitations   very recent technology that is linked to the  assimilation to cryptocurrencies we trust them   less okay uh there's an element of okay the big  groups are going to take over this technology   and they're going to do you know they're going to  monopolize again their power and the activities   and the power of users might be lost in a way  the other problem from a legal perspective is   that we cannot change we cannot change the  data and we cannot erase the data so there   is a problem because under gdpr the you know the  data protection regulation in the european union   we should be able to erase that data if we want if  users want to today with crypto with a blockchain   we might not be uh that might not be done so  uh so easily and lastly basically we have still   uh cyber security risks even even if  they say that it's very trustworthy   there are still issues of keeping networks and  databases safe quick conclusion it is good that   we can democratize the secretion of patients  data it is good that is a non-centralized   network because we place the user in the center  something that we have been discussing for a   while it is great that is is going to be agile  enough to be used for new problematics okay we   can use this to track certifications of you know  kobi vaccines if you want uh and it's going to   be basically in the end we hope that this is  going to be giving more trust to the patient and   and that's basically going back to the beginning  basically which is trying to develop more   more positive technologies so that's my quick five  seven minutes probably and i thank you so much   thank you very much uh very interesting  contribution so uh we will discuss all   contributions at the end so please  note your questions and or bring it   bring it in the chat so i would like to hand  over to our next panelist to die in white house   she will tell us about how to empower communities   uh to uh to support telemedicine uh programs  and from my personal experience in our group   it's really um easy to to to generate  the technology uh that you use for   uh that you need for telemonitoring but  to bring it to the people and to bring it   for them to use it uh is uh is a heart uh is is  a is a real challenge especially when you have   chronically ill patients so i'm very curious what  your views on that will be diane please take over thank you very much indeed thanks for the welcome  thanks to healthmanagement.org for the invitation  

um and thanks to uh helicht which is from saxony   germany and airtel for the support here uh well  from the technological start of this presentation   uh and the lots of numbers the 4.6 that verna  has so kindly started with we're moving to a more   social and societal uh angle and i think we will  see this kind of hybridization uh come to the fore   in the discussions that the other panelists  also uh follow on with um this presentation   is really about the work of dr leina otto from  dresden and focusing on telemedicine community   readiness models uh in particular the one  that she and her colleagues have developed   that's really beginning to prove its worth in  terms of its application in the telemedicine field   expanding telemedicine enlarging its use and  really encouraging its use we very much used   the current covert 19 pandemic situation as the  kind of threat and opportunity at the same time   and explored together the kind of barriers  and success factors that are at play here   um i don't have powerpoint slides nevertheless  i would encourage you to read not only our own   article but all the articles of our colleagues  which are generally short and brief and to the   point as well so we have looked a lot at hybrid  hybrid care the bringing together of virtual   or digital technologies and physical face-to-face  care as well in both health and in care   encounters so really integrating merging bringing  together blending the two and i think probably   today's challenge is what will happen next  not what will the swedish or new normal be   but what will the next normal be how will we go  ahead with this uh and i'm fascinated to know   that i have fellow panelists who will be focusing  also on smart hospitals and smart hospitalization   that's certainly an area that interests us in  airtel the european health telematics association   and interest many other people too so focusing  on this telemedicine community readiness model   it has several stages many of the  models that we're looking at today   have phases and stages i think that's a kind  of commonality to almost all of them and the use of telemedicine community readiness  models has been increasing and is in use   in example countries such as israel on the one  hand scotland in the united kingdom on the other   and also and we will hear more from a colleague  in portugal towards the end of this afternoon   um what do we mean by community we mean  both geographically located communities   our organizationally located communities but we  also mean communities that share certain concerns   and just on my side hearing an ambulance go by  there some of those shared concerns can indeed   be around particular conditions and  diseases including not only common ailments   but also rare conditions and rare  diseases so who can use this model almost everyone can just  about everyone nevertheless we   looked at how the model interoperates  with various personas personas classically   in the user-orientated area have focused around  patients very often as end users increasingly   and certainly lena's work looks at this have  been looking more at various professionals   including working adults and including  particularly young working adults so you will see   in our article that we draw on a very interesting  persona lena age 27 who really uses then the   community readiness model and is inspired by  getting more and more involved in integrated care   and in her own community uh in order to to  really bring virtual and physical together   um three sites worked with  lena uh to apply this model   one of the really interesting ones was an  australian example with a very diverse community   very racially diverse very socioeconomically  diverse another interestingly was from zagreb   the city of zagreb in croatia and last but  not least close to my own heart scotland   with its very interesting national scottish  government program and financing all were at   a fairly advanced level level four phase four  and all were inspired to want to go further   and to really mature telemedicine use  in their areas as a result therefore helicht h-e-l-i-c-t the local dresden and saxony   center of young researchers is really keen  to take exploration of this model forward   and we too and nettle are very happy to support  them on that um verna mentioned the word culture   um i can't say we explored that in any depth in  our article but i think particularly looking at   looking at areas of work like behavioral  science nudge theory and nudge techniques   and also not only economic incentives but  very much non-economic center incentives   are all areas that could be explored further  um we have many other um models and techniques   and instruments in our back pocket including  those of shiroko exchange including those of momentum um but nevertheless won't go into  those in detail now uh apologies from lena   that she can't be with us today but very  much looking forward to the dialogue   with colleagues here thank you very much indeed  thank you very much for uh your contribution so uh   we as i said we may discuss it after the address  is from the panelists so the next would be   fenner heining she will tell you tell us about  value-based care and about the full cycle of care   that's what i meant in my introduction  with integrated care with those uh the   crossover problems we have here so we are  very curious for your ideas please take over   yes thank you i will share my slice with  you thank you very much for the invitation   i do think that you rana and the previous two  speakers have already stressed the importance of   of integrated care and i would like uh to to add  my perspective to that i said i'm trained as an   internist i specialized in hematology and i would  like to start with this slide showing a quote from   atul gawande with whom i'm sure you are familiar  the famous surgeon um in the us and the well-known   keynote speaker he wrote this in his book being  mortal we've been wrong about what our job is   in medicine we think our job is to ensure health  and survival but really it is larger than that it   is to enable well-being and i think i couldn't  say it more concisely and precisely than he can   so i'd like to stress this quote during this  discussion and obviously the covet pandemic has   only stressed the relevance of this quote  one more time and then i'd like to jump   to slide number two which is also a quote or an  article by atul gawande which came out in 2018   and to be a little bit provocative in this context   he stated that doctors hate their computers  and he goes into details as to why that is so   in my environment it hit home doctors at least at  that time really emphasized and identified with   this statement of course seeing the benefits  of computers and uh emr systems but also   feeling in their personal workflow that they were  blocked rather than helped by the computer system   and feeling that it literally put a screen between  them and the patient so hence this question do   you recognize this still in your current work  environment or can we say okay that was 2018   and we live in a different era now and that has  become obsolete i'd be interested to hear from you   about that and then i'd like to switch to  slide number three which is an artistic   rolling into one of if you will the famous  value agenda by michael porter and elizabeth   tysberg which is a pentagram if you remember um  stressing to in my perspective the most important   fact as vanna said value-based healthcare  is looking at healthcare from the   over the full cycle of care and i think as diane  also stressed you could also propose the question   how wide is the domain of the full cycle we tend  to call certain things within the social domain   but one might say that should include the  cycle which we call healthcare delivery and   for example if you go for a run with your fitbit  and your smartphone and you put the data in the   system and in the cloud showing the rest of  the world how far you went how fast you went   is that personal data is that cataloging  your hobby or can we also interpret that as   metal data telling your physician very important  things about how well you're doing and the other   theory and line of thinking that i would like  to to stress here is the thinking of don berwick   he is a famous pediatrician also from the us  he later became the first president of the ihi   institute of health improvement he  was the one who wrote about triple aim   in 2015 he wrote an important  article discussing era 1 2 and 3. and in era 1 he describes it was the the era in  which professional dominance was how things worked   in healthcare doctor was god mostly they were male  they worked really hard they were always available   for their patients but discussion shared decision  making integrated systems were not very much   part of that thinking and then we moved into  era 2 which became the era of accountability   of measurements of focusing on process parameters  and to many professionals it felt like a loss   they lost their autonomy they felt they were  losing trust society didn't trust them anymore   so both camps they became camps a very strong  advocates and strong adversaries and don burrick   proposes and i couldn't agree with him more  to enter era 3 which he calls the moral era   in which we give back some autonomy back to the  professionals we do trust them we leave them   uh room to to you know be the professionals  that they were trained to be but we asked them   to allow a little bit of room for accountability  and measurements and i would call it in my words a   human ecosystem and i think back to technology  that cannot function at its best without   technology and all the possibilities that um   for example but not limited to digital platforms  can do if we we managed to integrate those two   and really look at this system  from an integrated point of view   we really and truly entered the uh human moral era  thank you that was my introductory talk for now thank you very much so uh you gave a  wide answer uh concerning the topic   of how to integrate technology in our daily work  especially from the physician's point of view   so um that's why it's going to be very  interesting what wolfgang schneider now tells us   because he's he will tell us  about artificial consciousness so   let's see what what is going to tell us please  wolfgang take over thank you vienna i will just share artificial consciousness or i would say beyond  artificial intelligence and uh so i have to go   to the next slide and i want to take a comparison  between natural human consciousness and artificial   consciousness and yes the humans we are the humans  the mind's eye the self the personal identity is   what we call natural human consciousness  and on the artificial consciousness side   we have a philosophical hypothesis that current  artificial intelligence without consciousness   will never create human-like knowledge  on the natural side the consciousness   has been developed by evolution genome  transcriptome proteome metabolism microbiome   and especially connectome and everything was  driven by self-organization everything on the   artificial side is driven by ideas and hypotheses  of scientific individuals and teams on the natural   side we have the brain the wetware the conic  dome and on the artificial side we have the   hardened software the artificial neural networks  and the upcoming neuromorphic hardware on the   human side we have general intelligence we  have the typical human perception imagination   emotions wishes and on the artificial side  we have lots of problems unsolved problems   the binding problem the representation of  mental states phenomenal consciousness the   guardia problem the intentional consciousness  but we are the real humans the experts and on   the other sides they are the robots in science  fiction or the digital twins what is the critics   healthcare today ignores widely individual  consciousness and personal identity why   because of course it's not necessary important  our medical data and its impact on healthcare   the medical success is dependent of evidence-based  diagnosis and well-proven therapy today healthcare   focuses primarily on medical statistics big  data massive data analytics pattern recognition   mathematics and algorithms expert systems machine  learning deep learning all fields of artificial   intelligence and the reasons are rene descartes  in the 17th century separated body and mind   and of course focus on consciousness is very  expensive because of cost intensive human   resources the holistic approaches are still seen  as nice but inefficient and counterproductive   what is open through think of esoterics the  future of healthcare is individualized medicine   this means that we are setting up digital twins  at which is a data set a data cube or a data lake   and data sets of digital twins are periodically  the digital self tracking and self measurements in   time and space what do you what do we mean by self  tracking 3d body scans the whole imaging and the   pictures of the radiolog radiologists quantifying  physical activity with watches the whole genome   sequencing the biological fluid testing like blood  urine sweat saliva sputum and so on the result   is a quantified self which is a historical and  real time data set as a real type in comparison   with a statistically accumulated healthy similar  digital twin to myself as an ideal type the   maxwell distinction for instance the next step  is the combination of the digital twin with an   artificial consciousness advisory system that  really knows about the meaning of the data   and guides you individually to change your  behavior what to eat how to move how to live how   to work how to sleep sleep and so on last slide  the evolution of doctors and health care yes today   we have the real humans who are certified  by the medical universities some net doctors   already use medical expert teams telemedicine with  real humans and colleagues in the near future we   have ai assisted doctors they are using expert  systems measuring and deep learning especially   pattern recognition of course and in the near  future we have the robot doctor generation one   without artificial consciousness of course and  no impact on personal identity but they simulate   already personal identity with chat bots which  know nothing of course but in the far future   we have the robot doctor in the generation  two with artificial consciousness and such   a system is able to mirror qualia to really  understand even psychiatric illness and disorder   being more a friend partner or better expressed  a guardian angel because he or she really knows   about your medical state mind and  body thank you for your attention thank you very much wolfgang for  your philosophical and far-reaching   views i'm 64 now i wonder whether a  robot doctor too if i ever will meet him   but i think it's a very good input  for our discussions later on and uh   now i wanted to check if uh our next speaker  henrik martins from lisbon is already here   yeah i'm here are you here welcome so thank you for uh taking part in  this in this discussion and we are   very curious what you are going to tell  us about the social network of health because for me social networks are  connotated very ambiguously so i'm   very much looking forward to your presentation  please take over well uh thank you very much i   have prepared a few slides uh on a slightly  different topic but but i i think i'm going   to do different without slides basically the  question right now is one of this information   there's significant problems on fake news and who  has called the infodamics problem um the question   at hand right now in the debate i i discussed in  the paper in this issue is the issue of the right   to freedom of speech and the fact that most of  our freedom of speech in social media is actually   moderated by private platforms so currently we  have most of our public speech online is actually   not public at all it is uh privately owned it  is run by a set of companies all of which are   outside the eu and and the question that i pose  and that that that contribution is whether um   the the way forward to really secure freedom  of speech and and the quality of information   is um to have the courageous uh theft steps  to use the new regulation currently being   discussed on the european health data  space and within that data space to   create what i call the health social space  so basically a sort of facebook of health   but the big difference about this is not  technological it is the ownership of the platform   and the rules in terms of conditions so right now  most of us have online presence by signing a term   and agreement with a private firm which then has  and holds the right to modulate many of our posts   there is actually very little state or eu law  controlling the way um private platforms moderate   public speech so i would actually argue that there  isn't in that sense um as it is in the street   because in the streets there is no one that  will take our voice away so in in conclusion   the idea that our outlined in that paper is that  um people say well it's too late most europeans   are already on uh on social media and on social  platforms in the us they're not going to use   a platform in in europe i i don't think that's  the case i think it is possible to create   a online publicly ruled space where  professionals patients associations   and patients individual patients if they wish  though uh collaborate as they collaborate today on   facebook or link the big advantage is  that the rules the terms and conditions   and and the way the system would be operated would  be governed with the participation of patients   professionals and and state authorities  and you offer to conclude this would   increase in my opinion two things the  quality of health related information online   and more importantly the traceability of those  posts and the auditability how to do this   actually it's not that difficult today most of of  people that collaborate for example with european   commission already have a digital identity to use  european commission oracles most professionals   could register voluntarily and this could serve as  an european-wide professional registry voluntary   professional registry and then patients as  well and finally this could be a platform for   patient donation not the donation if the patient  wishes to collaborate on data donation or data   funding let's call it this way uh crowd data  funding they could do so by aggregating their   data with their profile with selected groups of  patients on a trusted publicly owned platform   and not to do this on a privately owned outside  the eu platform that's kind of the challenge   and uh thank you very much for that for  the time and allowing me to share this   vision thank you very much so uh  we really have a very visionary views today to discuss and uh i would like to ask the audit auditorium to send me some questions  otherwise i will have to put some questions   because thank you for being so uh  so disciplined in terms of time   so we have now very much space to  discuss and to and and to conclude   which is a hard job to to moderate as i have  uh no questions up to now on the chat here i would like to ask uh florencio um   we know from bitcoin and bitcoin mining that  uh this is a very energy consumption business   when you envision your applications for blockchain  in healthcare do you think there will be a   discussion about that do or will these blockchain  applications uh be much less uh energy con energy intense uh compared to bitcoin because  i think it's probably not suitable for health   care to to consume such big energy resources  given for the question um it has been discussed the energy war quality of mining and it's um  and it's a very it's a very good topic however   to answer quickly and allow the  conversation to go on is that is that that   there are today uh simpler and less polluting  or consuming technologies are allowed to mine   in a more let's say green way i believe as well  that probably in the next 10 years there will   be ways to to to find more efficient and less co2  polluting methods to to do this today probably the   i think that today the goal the main goal for for  all the actors in the industry is to turn this um   to turn this uh i'd say this uh technology into  something uh in into something friendlier and   helpful and and and useful then we  will find out the solution i'm sure thank you very much so now i've got  i've got some questions one question is   when we implement all these useful  advanced technology in healthcare   including blockchain uh how much uh  the budgets would have to be increased   uh for the health care systems uh are there  any uh opinions on that in the in that board i can contribute to that at least from my previous  experience having digital health in portugal   many of our projects were actually cost effective  uh for example a nationally prescription project   we had to deliver uh important rebounds in the  national part of auditors and we showed savings   of millions i think it is possible to shift the  changes from the budget and definitely prevention   does work digital prevention saves a lot of  money anticipating for example re-treatment   so i honestly i think shifts in budget yes which  means we have to bluntly say it shifting lobby   and of course lobbying uh for fixing these shifts  and and avoiding shifts this is a big problem okay maybe i can add from  my point of view as former   ceo and now cio again at cargus a big  hospital provider with 17 000 people   covering a healthcare region of about  1.2 million inhabitants i think we are uh   quite advanced in the usage of these  technologies we are maybe at 4.2 not at 4.6  

but we currently have about 2.3 percent of our  annual expanded expenditure for the group for   all the hospitals 2.3 percent are our i.t costs  and i think there is some room left to shift data   and i agree uh i agree with henrique uh concerning  the the lobbies yeah and when you look uh when you when you take this course to an inpatient   uh it's about 120 euros per inpatient uh who  costs you between 2 000 and 8 000 or 10 000 euros   120 euros are for i.t expenditure so i think  there is room left to uh to augment this   but it's uh there's a lot of lobbying under  the way and i think the more digital digital   transformation strategies take place uh the  managements are more and more willing to   uh to invest so i have another  questions uh here on my on the chat is there a role for industry  how do we change the status quo   maybe somebody asked from from facebook if there  is a role of industry when i look at our last   presentation from enrique so uh has anybody in  the in the panel an idea to that diane please   i'm going to try to talk and hope that  i'm going to be hurt okay great perfect um   i i think i think we're talking more  about public-private partnerships yeah   uh and it's clear that industry has a role  to play as one of the many stakeholders   in the multi-stakeholder environment and a  multi-stakeholder platform to use enriquez view   i personally think the challenge if you want  is more about whether we're talking about   big industry or also micro enterprises  and small and medium-sized enterprises   i think all of us today at least on the panel are  european that's not necessarily true of all our   audience but we know what a large proportion um a  large role small and medium-sized enterprises play   not only in the european economy as a whole but  in health and care specifically i i think there's   a real set of questions there particularly when  uh our institutions are focusing more and more on what can we do with young entrepreneurs what  can we do with small businesses will they   really continue to survive into the future  is there a role for them there and i think   other people on the panel are probably more  skilled uh with their business or entrepreneurial   background to have a view there but i think  it's it's certainly an extremely moot point okay thank you some more opinions from the panel  i have a quick uh a quick comment if you if i may   basically they were asking what is the  place of the industry i was i would say   let's take the example of amazon and how amazon  in probably like 20 years ago shifted the way   retail was done in the usa and in the world and  basically now amazon is entering healthcare and   basically what if we will experience in the  next 20 plus years the same or even less   the same progress or progression of of  um simplification of processes and amazon   has an amazing or well assumed categories are  amazing just very strong supply chain capacities   so there's a block of the industry layers  of the industries that could be solved by   by the application of amazon i'm not saying  i'm not from amazon i have no shares there   but i'm saying that there is something to  pay attention to so i let everybody else to   to jump in basically what would be the role of  amazon in the industry how would that have changed okay from my point of view  uh we should be very careful   uh handing over health care to uh those  big monopolists i agree with taurizio   that amazon is absolutely strong in big data  is absolutely strong in the logistic chain and it would like to be very  strong in personalized services and   it clearly has the potential to uh to  to bring personalized medicine to a   to the patients but we always have to envision  uh do we trust this because is there uh is   is other um the idea of the uh offers uh  from amazon uh really just driven by the   the best for the patients or are  there other motives behind and i'm not sure that people will really trust  would trust such a monopoly system so i hope   that the public authorities uh stay in the  driver's seat and uh don't leave that to to   uh to to amazon google and so on i would be very  very careful there because i heard somebody saying   take amazon google or obey it's the end of of  markets because they are building up monopolies   and uh finally we will end up with innovation too  so uh fenner have your hand hands up yes thank you   i was actually interested in a question that came  in the q a are smart hospitals a solution or a   barrier for healthcare professionals but maybe  enrique should first do his comment referring   to the last question or no no no well it's a quick  thing just a provocation nhs in some countries is   also a sort of monopoly and sometimes monopolies  public monopolies are also not very innovative so   i think you know going back to diane's question i  think we need to start thinking i i would use the   word not just public pirate partnerships i would  say new innovation in public private relationships   i think we we need to reconceptualize the way  in health we we live with public and private   um and and i think and i think  this this calls for the regulators   in town which which have been absent you know  the so-called health regulators in many countries   and you know you have a strong ministries of  health in some places and national services   in other places strong insurance companies but  but the regulators i don't think they have been   they've been developed the regulatory function  perhaps what is missing in this ecosystem   so that's it over for me sorry anna go  ahead yes thank you um i think this is a   very interesting question i'll repeat it again  are smart hospitals a solution or a barrier for   health care professionals and tying into my  provocative slide from ato rwanda at least in   2018 many doctors state they hated their computers  so from that perspective it would be seen as a   barrier and i do recognize that sentiment in the  current day personally i think a smart hospital   which i interpret as mostly digital but surely  there is room for physical interaction between   health caregiver and the patient is a fantastic  solution but i think it's very important if we   change or transform one segment of the  full cycle of care that i talked before   and we expect the rest of the chain to stay as it  was it's not gonna function very well and i think   then all the other segments of the of  the chain will rightfully comment like oh   now i can't do my work anymore like i used to do  so if we if we change one thing of the balance i   think we must take a look at all the other  segments as well and ask the people who are   active in that segment of the journey what do you  need and if we work more remotely as caregivers   what can we change how can we make the case  complexity more interesting for the highest   trained doctor how can we make sure that everybody  gets to operate at the top of their license how   can we make sure that when you do see a patient  physically you have enough time to actually pay   attention to that particular person for more than  10 minutes and within those 10 minutes how can we   make sure that you're not typing away behind your  screen for 90 of that consult with the patient   all those things if you solve those problems  as yes in other sectors such as retail tourism   finance others have fixed then we are going into  the right direction thank you thank you wolfgang the problem is and vienna you uh stated this  about this this problem already the the main   question is who has access to the data of the  individualized uh identity of the human of of uh   who has the access and at the moment uh the  self-trackers and the self-measurers uh they store   it in the cloud so he or she is not the owner  and on the other hand there will be the doctor   in the healthcare system in the hospital but these  people have no access to this data and now a new   trend is coming up for instance the genome the  the full sequence sequencing of the full genome   which is now available inequality which is  absolutely incredible for under 1000 us dollar   and so people have now personal data about  themselves and uh now this is a treasure of course   uh for for for scientists for doctors but who  has access who can do something with this data   how can it be used for curing the people and this  i think will be one of the main questions and i i   discussed with people from insurance companies  health insurance companies and they discuss   already how they can set up own systems completely  distant from traditional healthcare systems thank you i know this these developments  there are some promising uh approaches   in europe with the eu health data space and when  you look for example to finland with the fin data   agency they have tackled this problem being  within the gdpr regulations so there are ways   but it's very hard to find ways in austria and in  germany due to our history in say in world war ii uh diane you uh raised your hand i i  did indeed uh and it relates back to   fenner and the coverage of private hospitals  the question posed in the public chat   i think what's interesting in terms of trends  and developments are when you look at what   what is happening in the new very large uh very  expensive hospitals uh with superb technologies   i'm thinking of a visit i made to an extension  of the karolinska in stockholm really uh you know   startling and impressive versus what's happening  in our local uh what might call them cottage   hospitals or local hospitals and this kind  of polarization that's occurring between   the large the wealthy the highly technological um  the other trend and i don't know to what extent   uh we've explored it in health management org  but it's really about hospitalization at home   so the shifting in fact of health and  care to our our own rooms our own houses   our own homes our own households um and how how  smart will they be able to be how smart would we   be as our own carers and our own um providers of  of support to ourselves so i think there are some   moral and ethical questions involved there  not only economic questions thank you   no i agree with you there are structural  problems in healthcare systems   in syria where i come from we have the university  hospital and the cottage hospital as you call it   in uh in one company so uh it's easier for us to  implement uh digital strategies in order to bring   the best knowledge to the uh to the  hospital bed somewhere in the rural area   that's our aim but to accomplish it is a second  yeah i think i'm sure that the technologies   will help us in that and uh i think with  our experience with covet the acceptance   for what you call hospitalization at home with  all those new technologies and diagnostics at home   there will be a movement in this direction and  the hospital providers will have to think about   uh what role are we going to play  what role are we willing to play   and uh i'm very curious what's going  on there in the next couple of years uh i think it's excellent to look at good  practices and you're citing your your own   region in stereo in austria uh so it's it's great  to look at where are the good examples that one   could explore and mirror abs absolutely yeah i  did hear a get a warning sign a couple of days ago   in in a conference uh that i think probably  enrique was in as well and i will not name   the very large very sophisticated hospital in  in the us um but the message from the audience   was things are very different there so let's  look at our own continent and our own examples   okay are there any more contributions enrique  because i would come to a some uh tries a summary   in the end because we are running out of time  and people are already leaving as i see in the   um so enrique please uh it's just a quick comment  to say that for example here in portugal we had a   national project which was stimulating hospitals  to move to digital and actually some of the   smaller ones did the better job the fact that they  were of course we needed some funding but the fact   that they were small enough they were able not to  just use the technology to change the processes   i think i think there are there are examples  of cottage hospitals who use your expressions   that that that make us think it's not just  that the id itself and sometimes a smaller   one because the teams are more close by  they do more hybrid to use the rockland's   expression they are not conscious of the value of  money and they they explore the technology better   and i think this is this is key exploration of  the technology will make future health better   not just having a lot of technology on your  shelves and i i would like to finish with this thank you uh florencia we down here there you go i'd like to fish  a question that was asked or relayed by   sherry says uh telemedicine has played a huge  role in provision of care during the pandemic   what do you think this is going to continue i  just want to give my two cents here of course   everybody used the the telemedicine almost you  know firstly uh but i think that there is a   big portion of use of climate change is always  what i'm saying is going to be kept and also it's   going to be complemented not only by new services  of telemedicine but also by add-ons there's new   technology that is being created to scan almost  wounds you can scan take a picture of your wound   and then it's going to be analyzed therefore  there's a whole business happening from distance   medicine more than telemedicine as a consultation  the whole care is going to be developed in   distance so we are going to be witnessing a  revolution in terms of spreading you know of   of uh applications in this sense okay so um thank  you very much i'll try to sum up it a little bit   uh we are we were talking about structures  in the in the last part of the discussion   uh in the structures from the provider side from  the market side but also from the hospital sides   and i think i'm very much with with fenner heining  when who spoke about the moral era we have to   keep in mind that the structures have to serve the  people and not people have to serve the structures   because from my experience we often do the  second thing we have to uh to shift it that   the structures serve people and not that  uh healthcare professionals are uh are uh have no freedom to act yeah and uh there is a  danger concerning with um with highly automated   uh procedures that they lose their freedom to act  and uh i think we have to keep an er equilibrium   there a balance to find a balance there so we also  spoke a lot about empowering hybrid care and we   uh discussed some aspects  where the word trust came in   uh what do we have to do that our healthcare  system can't be trusted can we trust   for example amazon i'm not against  amazon but as a passport can we trust to uh that the best it's the best for us  for the uh for the individual person and um   the blockchain technology may maybe help help  us to um to implement more trust and uh we   also uh heard about artificial consciousness  thank you wolfgang for your contribution here   and uh i'll bring it together with uh with  fenner again who spoke of the moral era   where trust is of high and accountability  and a giving room is very important and   then i i thank you wolfgang for uh this um uh this  comparison between artificial and uh and uh human   consciousness i think we will have to find  the right way in hybrid care and for all in   especially in the support of our  healthcare professions of the   healthcare staffs and i think when we come  to an era where artificial intelligence makes   human intelligence more valuable than ever then we  are on the right way but there is a lot of danger   on the way there and we have to be very careful  that we don't lose the right way to stay in the   driver's seat as humans and uh to really find  to the goal that artificial intelligence makes   human intelligence more valuable than ever and  that's i think a nice close-up for this discussion   thank you to all the panelists to take part in the  discussion thank you to the auditorium who stayed   to the end and thank you to healthmanagement.org  to organize that have a good evening goodbye

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2021-06-21

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