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25 Jun 2024

How to approach digital transformation across global markets

Healthcare delivery varies around the world, from age-old practices to the latest digital innovations.

The COVID-19 pandemic accelerated the adoption of digital solutions like telehealth, remote monitoring, and virtual care but how do these technologies vary by region and what are the challenges and regulations involved in implementing them?

During this webinar you will gain a clear understanding of the benefits, obstacles, and key factors to consider to impact clinical care across borders.



 Okay, I think it's, it will be good to start as we have our panelists here and we're ready to go. My name's Helen Serrana. I'm an editor at BMJ. I'm one of the people behind this BMJ Future Health Concept, which this is the seventh webinar in a series that we'll be running up to our event in November, where we hope you'll join us.

But we're having a look at. a number of big issues affecting the future of health. And today's webinar is about how to approach digital transformation across global markets. And I'm delighted to say that we've got  a proper global discussion from three continents today, obviously not everyone, but it's a start.

We've got Rajesh Agarwal, who is one of our advisory board members. And we've got a great advisory board of which Rajesh is a, key member and he's the CEO of 2030 Health in, based in New York. Michael McDonald, who's the global head of healthcare and pharma partnerships with Humatherapeutics  and is based in London.

And Russell Gruen, who's the Dean of the College of Health and Medicine at the Australian National University, which is Australia Canberra, if I'm not mistaken. I'm going to I'm going to hand over to them to, first of all, really to introduce themselves because they've each got different, but really interesting backgrounds that have led them to where they are in the in the global health tech marketplace right now.

Thank you. So over to you, Raj, to start off with.  

And great to be here and excited about this webinar. So I'm Based in the New York and Philadelphia area,  but I'm originally from the UK and my background is as a GI surgeon. Spent most of my time doing a lot of surgery, but then also related to that doing a lot of research into innovative technologies robotics, virtual reality, and other surgical technologies.

And I've spent just over a decade here stateside and that's mostly been around the Philadelphia region, but I also spent a few years in Montreal at McGill University as well. And what I've spent on those last 10 years is really, how do we. Move from, the medical device, the the hard tech into digital transformation health IT, and also how do we move from these being  academic partnerships into more commercial partnerships?

And then that's led me to actually start my own company a couple of years ago called 2030 health in the obesity care space. And we can talk more about that shortly. So great to be here. And thanks again.  

Brilliant. Thank you. And Russell over to you.  

Thanks so much, Helen. And hello, everybody. I'm a trauma surgeon by training and spent many years in the ER and the OR dealing with bleeding and seriously injured patients.

I'm fascinated by the role of technology in improving access to time critical care and decision making. I'm also a health service researcher who spent a bunch of my years looking at how to improve access to care across large. Continents like Australia, and I'll talk more about that in due course.  


Thank you. And Michael.  

Hi, everybody, and thanks for the invitation to the webinar and to support the future health program. Fabulous to be here. I'm Michael. I think Russell just described me as the T shirt in the room. So the guy who looks most techie, even though these guys put on shirts to look to brush themselves up.

But actually, I started off as a health care guy. I started my health care career working for Tony Blair on his. Domestic reforms here in the UK. I'm actually Canadian by birth, which is why it sounds so weird to spend some time in Montreal as well. But rose up through NHS England became the national director of strategy there and and other roles.

And then became very interested in the technology space and how specifically to implement technology in the messy world of clinical and operational practice. spending some time at Google DeepMind before ending up at Humatherapeutics, which is a scale up for 450 people across multiple markets, which we'll talk about a little bit later too.

So pleasure to be here. Thanks.  

Brilliant. Thank you. And the way we're going to run this is as, as much as we can as a discussion between the three of you, where I will interject with my own questions, but also questions from any of anyone who's listening live to this webinar, obviously to, as a reminder, this is.

being recorded and will be available to watch afterwards. But if you're online please do introduce yourself in the chat and please do ask questions at any point. And I'll I'll endeavor to get them answered if they're appropriate at the right moment to the team. But to kick us off, we're just going to go around the houses again with our opening question, which is. 

It designed to bring out some discussion, which is, can you describe a meaningful and an impactful digital innovation that you have led or you've been part of and how that innovation was received in your region. So the focus of this is really about understanding those differences and what we can learn from each other.

So yes, an impactful digital innovation. Raj, would you like to start as I primed you to?  

I'd love to Helen and It's really from my time when I was at McGill University in Montreal. So I was there  for a handful of years and my main role was really to run the innovation arm of the health system. But I was also a GI bariatric surgeon.

So that's doing gastric bypass and sleeve gastrectomy surgery on patients. And  when we were at McGill, we had a relationship with The far north of Quebec and I didn't realize this till one of the folks that I was working with in Montreal told me, and I don't know, Michael, if you know this, but Quebec is such a big country that if you fly north from Montreal, such a big state, if you fly north from Montreal, as far as you'd fly south to Miami. 

You're still in Quebec, right? It's, it's mind blowing, right? And the reason I bring that up is we used to bring patients down from the far north, the the Inuit Eskimos that would need bariatric surgery. And so that was three plane rides and it really took them a couple of days to come down.

I would then, see them and do the surgery on them. And of course we wanted to make sure that they were safe to go back home. And, the easiest way to do that is just to keep them in Montreal for three months, right? But that's not reasonable. And we've heard, the reason why I bring this up is we've heard a lot about remote monitoring technologies and it's about getting the patient out of the hospital and being able to go home.

And, when we've done that in other health systems, it's generally that the patient lives, minutes away or maybe an hour away or so forth. These patients literally live more than a day away from where they had their surgery. And so  Not only for the patients, but for me as a physician, it was anxiety inducing saying, Hey, yeah, we're going to send you back.

I think everything's okay. And then call us if there's a problem, call us if there's a problem that means, Oh, okay. What's going to take us 36 hours to get you back. And what the trauma surgeons in Montreal and I know Ross, you know them Tarek and team had done is they'd set up a web link with the folks because they were trying to help them to do the pre hospital phase of the trauma up in the far north of Quebec. 

And so I started engaging with them and said, Hey, could we use that to start doing some training and then to start having some remote monitoring of the local community?  And  I'll  just say that  it gave so much confidence on our end in terms of our team that we had a little bit more insight into the patient.

But also it drove the engagement of the patients that it reduced their fear. Thank you. Of being able to come down having this major surgery and then being able to go back and still be monitored. And so I think, whilst we can talk about technology and its implementation and all that, what I really found is it created more confidence, more camaraderie, more engagement between the humans that were in Montreal and in the far north of Quebec.

And I think, always, Healthcare is human first and we leverage technology to create this kind of improved human interaction. So I'm very proud of that.  

Great. Thanks, Raj. Really interesting. Russ, have you got a, an example?  

I first want to challenge the, my, my province is bigger than yours idea here, Raj, Quebec and Australia chalk and cheese.

Let me just, go to, to show you here where we're talking big distances, right? This is purple, Quebec and orange Australia. But that's my point, right? That and this is. I'm actually coming to you from Port Moresby in Papua New Guinea. It's the capital city of this country of about 10 million people.

It's a bird of paradise painting up behind me here. And the country has over 600 islands. It's an archipelago and yet it only has about one health worker per thousand population.  And so part of the point of being here is To be working with the University of Papua New Guinea and the Papua New Guinea government on how do we address a critical workforce shortage in this country when the healthcare needs are scattered across islands and can't easily move around. 

And this is where  technology has a role to play.  It's always had a role to play  where I, I did a PhD  20 years ago, looking at specialist outreach services in Australia to remote Aboriginal communities. And we,  There really were only three ways of dealing with remote workforce shortages and access to health care.

One was to bolster  the health workforce residents in the area. The second was to have visiting or outreach services that would come intermittently.  And the third was telemedicine. And 20 years ago,  telemedicine was a phone or fax machine,  but actually only a couple years ago during the pandemic,  telemedicine was largely a phone,  maybe not so much a fax machine, but it was still  doctors, at least in Australia. 

Did not use more complex technology when COVID happened and consults were done remotely, they used the telephone. And so even while the policy framework shifted quite quickly,  the profession and its embrace of technology was slower and slow or behind,  but that has, I think, now changed somewhat dramatically.

And I do want to show.  A different picture.  This is a picture  from one of the remote Aboriginal communities that  I did my PhD in actually with one of my supervisors, but just one year ago when we went back this time with a Starlink set top box  to this community, which is 250 kilometers from Alice Springs, a long way. 

And we, it only had a single computer in it, about a hundred residents there, no permanent health worker in attendance. And we installed a Starlink set top box in the clinic  and put a mesh around it and went from having a dial up internet connection to being able to stream at 180 megabits per second. 

And in that instant,  we realized the concept of remoteness had radically changed and it changed forever  because, and this is Sam heard an it  focused general practitioner streaming on his phone in the most remote place in Australia with 180 megabit per second download. Now I'd love to, we'll have some more conversation about what that opens up.

But I, my point here is that. It's not so much the telephone or the fax machine or so on that really was the telemedicine that there was a step change. It's that real time broadband ICT now that allows virtually somebody to be in the room in a very far location. 

Great. Thanks, Russell. And Michael, over to you. Can you give us a, an example? 

Yeah. And it's there's something of a theme I think developing here too, because I'm going to talk a little bit about what we do at Huma. Provides remote monitoring or disease management and is one of the, one of the building blocks of this sort of remote care that I think that both Russell and Raj have been talking about in their examples.

And I like to think that Huma could help them out in the circumstances they described. We are we've got about 1. 8 million people using our platforms. Around the world and several different markets and we can get on to how those differ. But just so you understand these are, this is effectively a way of connecting with your care team on your mobile phone and following a digital care plan, but also being able to submit data be that Via wearables or peripheral data symptoms, vital signs using camera and other kind of passive data sensing on your phone, transmitted to your care team who can then make decisions about you or help you out outside of the kind of traditional bricks and mortar setup of a clinic or a hospital.

And of course, really importantly on the one hand, giving more data to those clinical teams or health care professionals than they'd ever have before about the 99 percent of your life that you spend when you're not in front of them, but then also empowering you to make better decisions and giving you the sort of resources that you may need be the kind of learn articles or other types of.

Other types of resources that help you take charge of your own care outside of the clinic or our hospital. And I think this is this has been taken up pretty widely across the world and Hume is obviously not the only one because it solves such important challenges or at least addresses such important challenges.

The first one being the one that Russell said of kind of workforce challenges. The just the lack of healthcare workers to be that because it's their remote or because there's just too few of them and these these platforms especially with AI and intelligence infusing them can help nurses and medical assistants and others be much more kind of productive than they could otherwise be. 

But also because it solves things like, over full hospitals and helps respond to consumer pressures that we're getting in different markets. I think the future of health is going to be very marked in terms of digital first care. And that's where Hume is making its biggest impact. 

Thanks. That's three, three really interesting examples. And I guess, as I think Michael really helpfully summarized there there's two issues that, that all three of you brought up. And that first one was the people involved and the second one was the technology. So I wonder if we could have a little bit of a think maybe about what.

The people first and what we mean when we talk about workforce. In terms of digital. What are the challenges around workforce? Obviously,  lack of means there's an opportunity for digital to come in, but actually when we are implementing digital solutions, what does that mean for the existing workforce and the future workforce in healthcare? And I think we'll go in the same order, but again, feel free to ask each other and interrupt each other.  

I'm happy to go there because I think this is, it's a critical workforce enabler in our context.  For a particular reason. Firstly the health workforce is a valuable and scarce commodity, right?

And I've, I think about myself as a trauma surgeon, right? I'm a very scarce commodity and usually I only hang out in the dungeons of an emergency department and operating theater, but actually early injury care happens at every roadside across the country. So how do I get my skills to that spot? So there's the first issue here is about.

Emergency care, time critical care, how can the tech help us get time critical care to a place where it's needed? The second is what about more routine care? Are there ways that we can think about the tech supplementing non, non urgent, but more complex care, more primary care? And what is the role of AI in that decision making?

And then the third piece is around, I think, how do we support health workers in remote locations? I think it's pretty lonely business for a nurse to go to a very remote roadside place in a troop carrier ambulance and come across a seriously injured person. And they need. They want support, they want education, they want training, they want debriefing and all the things that we take for granted in healthcare facilities across every town.

We need to be able to get that to people elsewhere. So those three contexts I think are where I start. One, one is the emergency context. One is routine.  Care day to day primary care. And the third is health worker education and support. And I think it has a real role in all of those things, the complex.

And that's really challenging place. I think is what Michael raised around AI. This is  it's one thing to have. Two human beings joined by ICT that enables a real time conversation at a distance. It's another to have a machine that's providing guidance that's not a, that's not a human being. And it might be really valuable and really important, but it raises a whole lot of other questions. 

Yeah. Russell, I'd like to jump in there on the routine care side.  Really focus on how technology has supported but also challenged the work of clinicians. And I was at a health system. So 2030 health is a comprehensive obesity disease management platform that helps patients go through the process, whether it's lifestyle therapies, medications, surgery and so forth.

We work with health systems, and we've probably been engaged with almost 100 health systems across the U. S. And yeah. There's a lot of opportunity there.  One of the things, and we'll come back to 2030 maybe, but one of the things that when we were at this health system in the Midwest of the country, they said, and it really struck me as one of the leaders of the system said, we are resource rich and coordination poor. 

And I thought that was just a really smart thing to say. And I've started using that in my narrative and just to give you an example, and we all know this, but and the audience probably knows this as well,  certainly in the U S just about 20 years ago, there was a massive uptake of the electronic health record.

And. We as clinicians and kind of innovators and technology first individual said this is  going to change our lives, right? No more paper files, no more lost records. And it's going to make everything easier and a lot more simple.  And, look, I'm not saying we go back to paper notes and the unreadable handwriting of many of ourselves.

But  it really has and again, we can go into this from a financial perspective. The implementation of the electronic health record has been  at a magnitude greater than what we thought it was going to be. And we had those similar issues in the UK with the NHS as well. And then secondly.

The impact has not been as desired. And now when we, and this is bringing it up to where we are right now, when we now go and tout new technologies to  healthcare systems, clinicians healthcare workers and so forth, there is so much pain that has come from the implementation of the electronic health record.

That it's hard for us to have credibility around beyond the pilot piece of, hey, this is going to work, whether it's remote monitoring or an AI technology or a diagnostic of how this is, I think this is the challenge that I want to bring up, how can we scale this to actually meet the needs of all of the stakeholders the clinician, the the patient, and also the payer from a government or a policy perspective. 

Maybe just to push that a little bit farther too. I it's interesting. I think one of the big challenges we have to get through when we implement our technologies, and this is no different with EPR, EMR as I'm up.  on a board of a hospital just about to implement one. And this is one of the key issues we talk about is that in the initial period, actually it puts a lot more burden on the workforce to implement.

And that tends to be a reason to reject digital technologies is actually, this is going to be too much work. I don't want to do this. It's too much change. I'd rather stick where I am. Even some of them will say, I can see that. Once implemented, there'll be great productivity gains or whatever, but I have no time tomorrow to do this.

So that, that really leads you to do very different things with your implementation approaches. So for instance, in what we do, we have had to bring on medical staff and in at Huma in order that we can monitor some of those patients from the outset. Be able to demonstrate we can take some of the burden away from the outset.

Otherwise, we just don't get the chance. We don't get the chance to play. So there's quite an interesting kind of curve there of initial kind of investment that's required before you get some of the payoff. And as you say, in EMRs, EPRs, we're still at the start of that curve, perhaps.  

Yeah, I think one of the things we want to dig into a bit more is that sort of, that implementation challenge.

And this is a really great example of the sort of I think where, as you mentioned, like the trauma that going through an EHR implementation has been for so many people has then given a negative experience of any other, or even an upgrade or any type of new technology. It comes with  big barrier to get through.

So Michael, you said one of the things that Huma does is bring in clinical staff. I wonder if Russ and Raj, you've got examples where that's happened in implementations in your regions or?  

We'll certainly have examples of the pain of electronic health records. And I do. I do struggle with the fact that has been such a common experience for rollouts and still is because you'd think  that the world was set up to do this.

Electronic records have been around for  several decades now, really. There are only two or three major market players. They tend, they have a well  trodden path of helping organizations and regions to roll it out. It should be.  So it should just happen, shouldn't it? And yet we hear so often about how difficult it is.

What's behind that Raj I'm really curious, is it just that people don't like to change the way they do things and especially healthcare workers 

or what is it? I have an opinion on this and I'm going to ask Michael a specific question in a moment from some of his professional background but  I think it's because we have the old God.

Within healthcare delivery, it's very much run by the clinicians. We have a hierarchical approach to, recruitment, training progression within the healthcare system. It's changing but slowly and the patient's kind of left behind. The patient as a consumer is not active. 

And so what I want to pitch to Michael here is that, You spent some time at Google, right? And I know it was DeepMind and but someone said this to me a  kid in rural India  can now look at Google Maps and decide how to go from place A to place B and, what restaurants, whatever else there is that he or she needs to engage with in the same way that a kid in Palo Alto does it.

A rich kid in Palo Alto versus a kid who's very poor in the middle of India or wherever else it is. So we managed to not only open that up from a consumer activation perspective from every other industry, quite frankly. And just the flippant thing I'll say here is my past boss when I was at Jefferson, Steve Klasko, used to say, we don't talk about telebanking anymore.

It's just banking. I can't remember the last time I went to a bank.  Why do we still talk about digital health or telemedicine, right? It's just health.  So why have we not  been able to transform the consumer experience, the consumer activation? That's where I want to go to. And, part of me is that because of the hierarchy, the old guard of the regulated industry and maybe Michael, you can help us with that with your experience at one of the big tech firms or any other experiences. 

Yeah look, I did. It's good. It's a good question. Russia. I love the kind of Google Maps example, too, because I think there is a sort of analogy here in health care, where why can't we get the same quality of health care in one place as we can in another? And what's opportunities is. Do we have in the way that Russ Russell described to, expand his expertise, make his expertise more democratized, more available are there to implement guideline driven care where it's not been implemented.

And so I do think that's a kind of really helpful example. We haven't unlocked consumer interest in this, and you can, if you look at the kind of most used consumer healthcare apps, like they're all wellness apps, they come and go, it really has not been, it really has not been.

Cracked. I don't think it can be just the old guard though, Raj. I think it's also something fundamental about the asymmetries of knowledge and healthcare and the need to trust a clinician, the need for hands on care. I think we just need to recognize that it isn't just like banking. Giving of care is always going to have some asymmetries of knowledge.

And does require and has care involved with it. Compassion hands on a kind of irreducibly limit physical aspect to it. So I think it behooves us to think about health care as a separate category, though. I do accept that having completely digital health talked about separately is that you make a good point there. 

It's really interesting. I heard recently someone say that a a poor process with some exciting new technology on top is a new poor process for doing something. And I think there's a a tendency for us to think the tech will fix the process, but actually it, it does.  We do need to improve our way we think about processes and implementations.

I've got a comment here from, 

that's absolutely right, isn't it? People just digitize their, they digitize what they're already doing and call it, transformation. That's, that's rubbish, isn't it? It's got to be much more fundamental than that.  

Yeah. Comment here from Katie Summers.

Thanks, Katie, for commenting. The implementation of EHRs requires a strong communication and engagement roadmap that flex to clinicians and managers and organizational needs, values, and objectives. And I think it's quite a sort of simple, straightforward question, but there's a lot of complexity there, isn't there?

And unpick that a bit, that even just that. A roadmap that flexes. Is that something that's easy for technologists to deliver? I don't know.  

So I'm not the technologist and I agree with Katie entirely, but I don't think that's an excuse, right? These are big companies who make a lot of money and they charge health services, a lot of money to roll out something.

They roll out all the time as their business. Why can't they do exactly what Katie says?  properly each time. There's something fundamental going on here, which is  really  challenging.  

Yeah, I guess that's right. But I do think that, when you implement something, you're doing a kind of handshake with the implementing organization and you need them to take ownership of this sort of, the implementation challenges, where I've seen it go well, it is led by clinical teams themselves with the support of operational managers, et cetera, but that can't be.

It can't be imposed on them, even if the recipe has been done perfectly a hundred times before, there's still something psychological about the need to do it yourself and be bought into doing it yourself. So I think, I don't know I interpret Katie as talking a lot more about the need to, engage the workforce, communicate with the workforce in the implementation challenge rather than putting it back on the vendor. 

And I'd like to jump in there, not to be self serving, but, we're a small company, 2030 Health, and almost half of our employees have a clinical background, whether as another physician or a dietician or a nurse and so forth. And  when we go to start working with the health system it's really a clinician first approach.

It's a clinician to clinician approach. Let's understand what your current care processes are. Let's understand. Where the opportunities are for improvement, but then also importantly, let's understand what you've already tried  versus here's a technology. You've already said it and shiny and it's all cool and we can sign this deal and get this activated.

So let's actually do that kind of front end as a process, as a design process of like, where are the gaps? Where are the opportunities? Is it the people? Is it the process? And what technologies have currently been used? And then what are the augment technologies that we might want to use?

And I think if I may to go one step further, that this for me is a call out to have more clinicians involved in technology. And whether you call them clinician entrepreneurs or other folks there's a lot of tech out there. And there ain't that many clinicians that are actively working to with their clinical partners to say, Hey, this is what we need to do.

And when we were at this one health system the clinical team said, wow, like this is exactly what we'd build if we were doing it ourselves. And I was like of course it is, because this is what I've done for 20 years as being a clinician, versus here's some, and I'm not saying that.

It's all got to be clinician first, but it's got to be that partnership between clinical and technology and device and innovation. And that's really, I think, how all of us have spent our careers, Russell and  Michael as well. So it's really a call out to get more clinicians involved  in the kind of technology and innovation process.


go on, 

Russell.  I was just going to say how I'm sticking with the  electronic health records. Discussion you, you mentioned about the consumer, where's the consumer in this? And I think a lot of the EHR discussion is really between the health service the vendor, and the clinicians. And the patient doesn't really feature strongly as a user or a motivator or how it affects them. 

Whereas I,  there are some examples of where the patient becomes much more central to EHRs and.  Go to the Australian government's My Health Record project, which is about giving consumers access to a portal where it actually draws information from a whole variety of sources about their health record.

And so it taps into registries, it taps into hospital data sets, taps into the primary care data sets.  So for the consumer, there's actually real value. A real value proposition to go to this EHR because they can't otherwise get all those things in one spot conveniently. And I wonder if we  re, re conceptualize  our efforts around EHRs with the patient at the center,  maybe we've got, maybe we'd have a different sort of driver that that has different types of outcomes. 

Yeah, I think that's a really great question. We can move on to that. I was going to say the UK experience has been up until really quite recently in the last couple of decades, it was, and maybe still some patients assume that their medical records aren't something for them. And yet And so engaging in what do you need out of it is a really difficult question, but I think now that's, that is changing, certainly in the UK with the help of technology, but maybe we could get some examples from around the world.

Like how's that different in the U S and how's that different in in, in, in Australia and other places. 

Can I just jump in on that? And it's not directly answering your question, Helen, but it takes me back to when I was at Imperial. Gosh, almost 20 years ago when I was doing my research, I'm very much focusing on simulation training to teach junior surgeons laparoscopy.

And so I'd set up this randomized clinical trial that was virtual reality simulation. And half of the surgeons would get the simulation training curriculum and the other half would get standard training, like we do on in the operation room. And. We did the study on patients. And so I had to go and consent the patients saying, Hey your data is going to be recorded from the operating room.

And, you don't know whether your surgeon has been trained on the on the simulator or not. And I got two very clear responses. One was, I want to be in the group where the surgeon is being trained with simulation. And I was like no, you don't get this is a randomized trial. And they're like no.

I want that guy. Or that that surgeon. And then the second was,  Why are you doing this study? Shouldn't everyone be doing this? And so I think there's a  lack of information. It goes to what you said, Russ. That  patients think we do all of this anyway, right? And they think that all the records, and, it goes back to, the work that Michael's done, but they think all the records are interoperable and available and all this kind of stuff.

We know all this. And it's almost like that black box of, Oh. Really? Yeah.  

I think it goes back to that coordination issue as well. I wouldn't say anyone in the NHS would say they're rich in resources, but I think most people within the NHS would say we're poor in coordination. Michael you're working mainly in, with the NHS a lot at the moment, or?

No,  we work across UK, US are two biggest markets, and then we work in Europe and the Middle East as well. So maybe 

you can compare. Yeah. 

Yeah. Yeah. Let me, yeah. So I would say on I'm particularly on the issue of kind of. Empowering patients are getting patients more involved with, the resources and then their own records.

It's, it is quite interesting to see how the kind of system determines the response a little bit or there's some path of dependency in the UK, as you say. Just now the NHS app is taking off 35 million people using it. Post COVID all started around vaccination records.

This now ends up being the kind of way that, they want to they want to encourage people to interact with their own healthcare. And it's a sort of state driven, NHS driven approach one, one provider on which, yes, there's an ecosystem around, but fundamentally borrowing the kind of reputation and trust of the NHS.

In the U. S., it's a completely different kind of set of dynamics, right? So when we work with many dozens of particularly respiratory and cardiology clinics, and now oncology clinics across the U. S., and there it's much more about buying power. And, making sure that they can keep their patients and making sure the patients are getting a good deal.

And, there's many more economic incentives in the U S on both sides that drive, the how patients are interacting with these sorts of resources. So I think it's fascinating that the kind of system itself shapes these sorts of resources.  

That's great. We've got a two questions in.

Katie Summers has come back talking about how important it is to have the systems fully engaged in implementations as well as the implement, as well as the providers. But she mentions at the end, the community of doctors, nurses, AHPs, and care workers. And Tomoko Sugiura has asked. If we, if you can talk a little bit about that multidisciplinary team and how he has digital tech in healthcare changed the way medical and health professionals are educated and trained where is the cultural change supposed to happen?

Is that, is it in the education settings? Is it in the utility sessions? Can that be?  These technologies be a force for that multidisciplinary working, improving. Russell, you're a surgeon. What do you, would you like to take this? Do you work with some other people?  

I work with Tomoko too.

Oh, there you go. Thanks Tomoko. Look, I think that there are a bunch of innovations around. Health care worker education, which are related here and one, one is a shift from problem based learning to team based learning, which by its very nature is  lends itself very well to multidisciplinary training.

It is about health care workers. Coming together  to learn as teams, to learn how to communicate, to learn how to collectively problem solve and all of those things. And it's very often technology enabled. We,  I recently had some time in Singapore, the new medical school, an Imperial College London medical school in Singapore, which was.

Entirely team based learning it through throughout the old way of doing lectures and classes and so on and said, you do your individual learning at home, whether it be reading or watching a lecture on an iPad or whatever you come to class to to work as a team. And that's what classroom is becoming much more common now.

And we're implementing it in Australia. And and I think it's a good thing. One of the interesting potential applications then is that you actually have teams combined in across time and space, or in particular space, and how do you do distributed learning that is actually tech enabled.

So you actually have teams based across home clinical schools and rural clinical schools and other things learning together. And I think that the options here, the opportunities here are many and rich. Thank you very much.  That's only one piece of the multidisciplinary side of things. And I think there's a, there's a real need for us as healthcare workers involved in universities and education to embrace multidisciplinary learning at a very early stage before healthcare workers get too siloed in their cultural groups and lose the ability to actually work across multidisciplinary teams really effectively. 

Michael,  any views on the multidisciplinarity of, Modern care. 

Yeah. I I guess I might, I look at these guys that actually deliver care, a much better place to that than me to comment on, but I think this is definitely one of those areas where. Technology can only help but be an enabler. There really is.

This is about a model of care meeting technology. And, there's, I don't know how many decades of good evidence that multidisciplinary team  decision making and certainly in certain specialties makes all the difference. Technology isn't, it doesn't drive that it may enable it, it may disable it.

I do think that we ought not to get too carried away what technology can do. And remember that care model change is also important.  

Yeah, definitely. Raj, have you got any examples? 

I just had really had a much, much broader perspective. When we think about care delivery or healthcare we focus on care delivery and the kind of tripartite missions of any.

health system is one academic, so the clinical research or even the basic science research, two is obviously the care delivery to the patients, and then three is the education. Both of the healthcare professions Russell's talked about this in a multidisciplinary manner, but also patient education as well, right?

And I'd just like to bring out, in a very specific sense, when I was, whether it was back in the UK or here, when we used to operate on cancer patients, we'd have the cancer NVT meeting, which back in the day was in a grotty room and we'd all get together once a week and then turned into, on a Zoom or on a video that kind of thing.

But what I really took from those is, that decision making of everyone around the table, the social worker, the radiologist, the oncologist, the surgeon, the palliative care team. But also it would bring in, Hey guys, have you seen this new trial? And it wasn't always necessarily a trial on chemo, but it may be a trial on a different way of MR imaging or Oh, and by the way how do we train folks to do this new thing?

And so I think  I'm probably asking a question rather than answering your question. Helen. But I think as we as we define health care, it's not just health care delivery. It's the research aspects as well as the education aspects.  

Absolutely. I think from my perspective, one of the things I've seen is with the exactly that sort of MDT meeting is  technology is changing the way we do things because if a patient wants to be involved in their MDT, the question is not it's in this room on this day, we can't change it.

But actually, It's just a zoom link. You're just a zoom link away and you should be involved in decisions about your care and that's slowly starting to happen. But I think it's really interesting how  the advent of bringing those meetings on to zoom more has encouraged that way of thinking. And we've, we're running.

We've not got long left and we've got a number of big topics on my list, which we were going to cover, which maybe have been too ambitious.  One of the things that people often talk about in terms of implementation is regulation  and how different countries and regions organize themselves in terms of healthcare is effects how easy or difficult it is to get new tech going.

So I just wondered if.  If we could just have a thought from each of you about the role of regulation in your different geographies and how that's affecting the speed of change and implementation, whether it's a, whether it's a challenge or whether it's whether it's a open gateway through which you stroll through happily. 

I'll just very quickly jump in there, Colin reminds me of. Back in 2001 when at Imperial we had the first da Vinci surgical robot come in. It was the first in the country.  There was no,  there was no handbook about how to how to implement this in the UK. And there was no regulations on how to do that.

So we were literally making it up as we were going along. And now robotic surgeries is everywhere. There's thousands of robots around the country. But even with that, And this is now to my experience of 2030,  every health system we go to, it's the funny thing people say is you've implemented at one health system, you've implemented at one health system.

And even the this one health system in South Carolina, we're working with, they've got three different sites. We're starting with site number one. So we do all the learning. And then we're going to go to site number two. And they're like, yeah, we're going to have to figure it out again. It's not just a rinse and repeat.

And my very much on the ground approach is that regulation is at a very high level. But, the actual implementation of new technology that they're often either isn't that handbook or you really need to be very reactive to the local needs to be able to implement. And we've already talked about change management as well. 

Maybe I'll just offer a few thoughts from our experience. So when Hume is a a software as a medical device it's called which, and it's regulated as a class two device in the U. S., class two B in the EU,  class two in the UK, it's Australia, Canada. So we've done I don't know, six, eight jurisdictions. 

I think it's, I think it's really easy to complain about regulation. And of course, they're like, the FDA is actually very good compared to others on specifically digital technologies, in my experience. And I'd love there to be more concordance between jurisdictions, but mainly we've invested in that because It is super important when you bring bring on board these sorts of technologies that people do have trust in their safety in the clinical evidence behind them, that there is a process for validating them.

So we think that regulation overall is something that good companies need to invest in and you can complain about the details, but the overall kind of need to make sure that it isn't wild west out there and that there is strong clinical evidence behind it just shouldn't be sniffed at.

I think 


an interesting, ironic situation where you mentioned the DaVinci robot, Raj, a piece of complicated robotic kit like that has a relatively simple regulatory pathway into into use at least prove that it's not putting patients at risk, but actually you don't have any of the drug based proof of efficacy requirements.

Whereas the sensitivities around data.  And personal data are so still so huge that they're, they feel like it might not be regulatory barriers, but they're ethical or other barriers that are in the way to rolling out data solutions where data transit is transmitted across platforms, across jurisdictions, across yeah, portfolios.

And I just wonder how you guys feel about that because that's the way it feels to me as a researcher and a clinician is that everyone's still very sensitive about personal data. I agree. 

Appropriately and it seems like one of those areas that where countries really are coming together and becoming  together more sensitive, used to be the U.

S. didn't seem to care so much. I don't, I think that's becoming less and less true over time. So I do think that. As providers, as regulators, as buyers, we've got to have, super close attention to this because it's going to be, it's going to be a hot button issue for ages. 

Thanks. That's really interesting. And I think, I feel like Mike, with your background, we could go really deep into some of the AI questions around data, but again, hopefully this is this is whetting your appetite for what will be coming. be coming up in the November event where we can go a bit deeper into some of these issues.

Just to sum up, and I'm sure we've got there's loads more things we could talk about. But what do you, from your experiences in the past and your sort of plans for the future what are the emerging trends in this space of healthcare that we're all in?

What's What are the big things in the next 10 years that are we're going to be looking back at and going, I can't believe we did it that way. What, what's going to change. Raj, I'll start with you. 

Okay, great. AI  is a hot topic. I think  rather than the technology we really need to be. 

impacting healthcare from a learning healthcare system approach. And, we've been talking about that for 20 years. And as you say, I've done my first surgery, I've done my 50th surgery, I've done my 5, 000th surgery, and yes, I'm getting better, but we're not really using all the data that's coming out of that to say, how do we do better and with the whole team and that kind of thing.

So I think it's really around, how are we learning to be better and using the data and the technologies around that. And, as has been mentioned, to do that in a regulated and trusted approach, and, my final thing I'll say is, first, do no harm.  

Thanks. Michael what should we be, what should we be looking out for?

One of the things I think we should be looking for is who's going to pay for this stuff. There's some countries that have got structured reimbursement models in place, CPT codes and in the U S or France is now implementing this Germany's got a version of it and others that are just completely here's a funds run a prize.

Cliff edge, the funding, leaves, leaves companies in the lurch. This is, that is no way to to to drive whole system change. People need to pay attention to how the money flows work. Otherwise there won't be many digital health companies left. And Russ. 

Wow. That sounds interesting.


look I, I want to celebrate the fact that, countries like Papua New Guinea  are doing this and they're putting the tech to work and they're getting great results out of it. I was talking to some guys today who were doing digital radiology on a small island and they. 

Had a PAX system and that the image would appear on all of their devices within 30 seconds of it being taken. And they'd get it read by somebody in Japan within, an hour. And, it really is. Game changing in a way that leapfrogs all of those clunky steps that we've been through in Australia, in the UK, in the US. 

And I love that concept of leapfrogging because it really is a great leveler. A great technology is helping equity like no other. There's no tomorrow. And it's just wonderful. We saw it in Myanmar with  mobile phones, so many communities in Myanmar had maybe had a single landline phone for the whole village for years.

They'd never had home based phones and stuff. And then all of a sudden they had 4G  and and they were able to communicate like  never been able to. And they didn't go through all of the complexities of rolling out infrastructure and telecommunication and stuff. They leapfrogged. We can do that with technology in health care and the world will be a much fairer place and access for  people who really haven't had access to good health care will be able to have it.

And that will be a great thing.  

I don't think I can. finish on a better note than that. I think that is our, all of our shared hope and dream for the future of healthcare. It just leaves me to thank the panelists. Thank you, Russell and Rajesh and Michael. Thanks for being involved in this webinar and thank you for your ongoing involvement with BMJ Future Health to remind everyone that this is one of a series of webinars.

We're running on a range of different topics, some sort of real thought leadership sessions like this, some deeper dive, more technical learning sessions, and they're all going to be available online. So if you enjoyed what you heard today or learn anything, tell your friends  to come and come to the BMJ Future Health website and watch this again.

I think there are two, yes, there are two QR codes up there that you have been looking at. I want to really stress the call for problems. We're really excited about running a call for problems rather than a call for answers or abstracts as we usually have at scientific conferences. This is, we want you to bring your early stage frontline issues and to see if we can match people up with the right advice and the right expertise to bring the right solutions into health.

Do get involved with that. And yes, the next slide is the next webinar, which is 3rd of July, where we've got Tricia Greenhouse talking and Emma Lads from her team as well, talking about making those organizational level changes to support remote consultation. So it's very much about going quite deep into one of these general implementations there.

challenges that we've been talking about today, about how to, what really works from the evidence and the expertise. So do join us for that. And thank you everyone for joining us today. 

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