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
you
2021-06-21