Bringing the brains together that KLAS does has always been an amazing experience. The buzz about the event, the way people come together to share in an unapologetic, kind and considered way has always blown my mind, here we are again in 2023 with more people than ever before and an agenda and pace that is geared to allow people from across the globe to share what they are doing now, the success they have had in the last 12 months and new things to try to go after those wicked problems that are out there.
Opening with Adam Gale and his awesome stories of how we need to work through the mud together to get out the other end was really quite inspirational. When you see it written like that, I am sure you wonder what on earth this can have possibly been about. But the story centred on how no matter what the world throws at us if we have the end in mind and the right people around us, we can get there. I guess from my own point of view the analogy really works as it can and did feel on more than one occasion whilst working in digital health that the mud was really sticking to the trainers and getting between the spokes of the mountain bike and that mud was definitely there to stop us or slow us down. With that opening salvo from Adam did though was set a tone of hope and a hope centred around people. When you look around the room at KLAS and see some of the brightest brains in digital healthcare glancing back you can and should feel confident that collaboration for the good of healthcare delivery is alive and kicking and holds no boundaries, geographical or commercial.
Next up was Dr. Peter Gocke who took the entire room into the world of digital healthcare in Germany and in particular how, through sharing lessons, different countries have learnt that we can try to move this massive machine. Dr. Gocke spoke eloquently about the need to link investment in digital healthcare to the delivery of patient pathways that achieve defined desirable goals. He took the room through the mandate in Germany that states investment ‘has’ to prove that healthcare modernisation can be achieved. The way Germany has adopted a number of frameworks to measure this was fascinating as much in how these different metrics and measurements work together as the actual outcomes this achieved.
When Dr. Gocke set out the German timeline of achievement and the deliverables in that timeline the similarities to the UK became super obvious, aligning the UKs NPfIT programme of 20 years ago to the way in which Germany has invested was remarkable. His advice on always having national standards and trying to make them remain sticky for all created a wry smile across the room as more and more of the audience could see how this was applicable to their own area.
Being able to see the relatively new medical messaging capability deployed across Germany and how it links through FHIR standards and opens up meta data from within systems directly to the patient was (sadly) still a view of the future for those of us in the UK.
Dr. Gocke finished with a statement that we would hear run through the whole first day, collaboration is the most important work to be done across healthcare professionals, ‘vendors’ and patients need tis to be successful. (I still wish we could find a word for ‘vendors’ that was better though!)
Next up was the panel on regulatory oversight. On paper not always going to light the world on fire but played well to the audience as we are ‘all’ getting to a place where we know this is becoming the hard part of what digital health wants to achieve. Luke Readman jumped straight in with a portrayal of the WHO definition of digital health; start and finish with people, build for open data in safe ways and put learning and innovation at the centre of what comes next. You can’t always jump to large global announcements of what health systems should do, but it was awesome to have this put in front of us again and reflect on it as the goal we should all strive for together.
Another message from the panel was clarity around working together and the raison d’etre for doing this; value! No matter whether that is patient value, efficiency in the clinical journey that is driven through the use of tech or fiscal value to partners. No matter which bullseye is being shot at this must be at the centre of what we do. The honesty in this, and ultimately therefore the ownership that can be driven because of this is extraordinary!
A question from the floor hit the panel around UX and our collective ability to put this at the centre was, I guess, expected, but caused a debate that went wider. Should/can health tech solutions really expect to offer no training because the UX is ‘sooo’ good, or do we need to accept that once we digitise healthcare it becomes part of the learning process, as, after all there is a lot at risk if the use of the tech goes wrong once you are in healthcare.
‘The cow doesn’t get fatter by weighing it more.’ What a quote to start a question with too! The panel had to react to this though as the point was this is not new news, we need to find a new way to answer the old questions, and the panel came up with some awesome ideas on this. Three key take aways from this panel, get the law rightly (quickly), make delivery be outcomes focused from day one (and day two) and build a new national trust in delivery, funding needs to be placed at the point where care can be seen not envisaged and therefore technology people become part of the multi-disciplinary team!
Full disclosure on the next section, I believe in the Arch Collaborative a very large amount! One half of the entire room believe that the most impactful thing that can be done with policy is bringing transformation and delivery to the table with policy gurus, not specifically pointed to the UK I hasten to add, this was quite a generic view, policy, delivery, and transformation are way too far apart but a view that got many nods of agreement around the room.
Of all the things, buzz word bingo related going on in tech right now and in healthcare more generally, the clear focus made through the survey results wasn’t AI related or cloud, it was engagement and how to bring the implementation of policy closer to the definition of the same policy and the reactivity we must have within it today and tomorrow.
The room then became even more alive as we went into our themed groups to discuss tactics for working within such a regulated industry and what we needed to get right or do different to be successful. We tried to tackle leadership and representation first up, how do we put in place a leadership capability and understanding that isn’t overly commanding but still is able to steer the vast ship. We came back to the big word of the morning too, collaboration and how to ensure that stays constant throughout a regulation conversation. We touched on how success is born from cross-disciplinary understanding and how this needs to be linked to the ‘grass roots’ of what we are trying to achieve. I guess the biggest theme though was how important it is to play to the outcomes and if we get that right from the beginning then we will be on the right track together.
The afternoon sessions kept coming back to a common theme, training and what that means for the adoption of technology and the transformation of a healthcare system. At one-point stats were presented that were quite remarkable in showing the corelation between clinical time saved and amount of effort that went into training on a system. Closing the feedback loop between what colleagues think of a system and what changes can be made to a system was a detailed conversation that again caused a lot of nodding and agreement. When implementing digital health, the change request ‘show’ doesn’t really start until the system is being used and therefore the project doesn’t really burn rubber until the systems are actually in use. Tamara Sunbul from John Hopkins Aramco Healthcare uttered the words we have all been singing for some time, ‘Once you start investing in digital health there is no end!’ As I say we have all been on that flight path for quite some time, but it is still awesome to hear those words uttered form stage by someone with so much experience.
The panel also discussed different ways to land the message with a clinical team. Jeremy Theal from Alberta health services raised the point really well that we need to find ways to facilitate the clinical teams in believing in the art of the possible as a way to build confidence, knowledge, and the direction we all want to head in. The strength of the change agents you bring to the table has an identifiable and immediate effect on the success of the delivery you have in mind also got raised with the panel linking this need to how you measure and against what benchmark, referencing nicely our first speaker from Germany and the different blended benchmarks they had created to measure the drive to success in that system.
The agile vs big bang debate will always find a home at a digital health conference and a brilliant question from the floor took the room into this debate as this session closed off. One o f the theories around the optionality of this landed on how long can you afford for the ‘honeymoon period’ to exist which was a neat way of talking about it I thought.
The last big group session of the day focused on the EHR implementation in Amsterdam and was presented by two rock stars of digital health in Europe Saskia Roll and Viola Broumer. The title they wanted to go with didn’t translate in English they said, the Dutch translated into ‘Keep Them In The Wheelbarrow’ so they jumped to ‘Herding Cats’ instead, I quit liked the first version personally!
The implementation of Epic in Amsterdam utilised the outcomes of the Arch Collaborative survey to understand where to point the people and the money, I loved this as a real-world example of the beautiful tool that is the Arch Collaborative and how it can be used in ‘real life’. When the speakers got into the detail it was amazing to see the impact in relatively short periods of time this measurement and benchmark made. The Amsterdam model also showed how getting the floor walkers and training team was so important too; asking us to consider the language we use; training is what we do at the beginning of the implementation and education is what we do as we go forward with the system.
The team have also implemented ‘signals’ within their EHR, this allows the colleague sat at the machine to see what they are doing right and what they need to do differently to be the most efficient with this system, I loved this, a bit like Microsoft Clipy of yesteryears but for clinical workflow compliance and efficiency.
The closing comment though was superb, herding cats (implementing an EHR) takes stamina, hard work and determination!
There was one conversation in between the session on day one that I also thought worth capturing. The notion that what we get the most from events like this is assurance and reassurance. No matter how special, how different all of our systems are the problems are very similar, if we come together, we really can make a difference and take a short cut to the solutions. So many people were talking this up a huge amount.
My last session of the day was on security. I chose to go to this session purely down to how much of a live issue it is for us all right now. The speakers were from across commercial partners and colleagues with live experiences and the issues hitting healthcare in the last five years were discussed. I guess it always remains interesting when you bring CIOs together on this subject as they always know how important it is to invest but often land on the same problem, the ROI of investment here is super challenging.
Discussions around how to segment the cyber issue raged on; how to tackle the workforce (talent) issue, how to provide the right level of guidance and perhaps the hardest of all the issues, how to secure the supply chain. Reflections in the room were just how hard this is and how necessary that it has become.
I guess the closing statement from Simon Bolton ex CEO of NHS Digital was the one we need to take away, ‘Lets stop talking about Cyber Risk and start talking about the clinical risk’ the ubiquitous nature of digital health now means that if its not there for clinicians to use then lives are at risk. I wondered as he said this if this was the key to unlock a new type of understanding.
So that rounded off day one, a brilliant day of learning and sharing, collaborating, and growing. Lots of superb conversations and reflections and truly a sense of being ‘in it together’.
Day two kicked off with the very experienced and wonderfully open Penny Rae from the Alberta Health Services. Penny took the audience through the worlds largest single Epic implementation ‘warts and all’. When you consider the size of Alberta it is after all the size of the UK three times over you quickly realise the enormous digital transformation challenge that this was. The litany of disasters that went on around the Epic implementation could create a Hollywood disaster movie in truth. Covid, a huge administration industrial action episode, earthquakes, snowstorms, the return of Covid and the evacuation of 15 hospitals, keeping the lights on during those moments would have been a challenge never mind the migration to Epic at the same time.
Referencing how net-new clinical risks are created when we implement technology was something we heard on day one and Penny reiterated, I think this as a new way to think will really help build business cases for better implementation in the NHS and I am excited to see how the audience reacts to this. It kind of goes hand in hand with another comment she made about really believing in the fact that the EHR deployed must not be considered a replacement for the patient record, we are not simply moving paper to glass but redefining how technology supports new workflow and how access to data to create patient insight is so important for the future of healthcare delivery.
The acceptance of cloud in healthcare has been long and slow and hard but it’s definitely here to stay and has gone from hype-about to reality-lessons in let’s face it only a few short years. The next couple of sessions gave us all chance again to reflect on the journey and hear from best practice across the systems.
Two concepts that were brought up really early in to these two sessions; firstly to try harder to not describe cloud as an outcome but as a route to achieve business goals, being deliberate about this and ensuring that at all levels of governance there is enough understanding to drive engagement and secondly how to describe what is cloud to a user of your systems, we even went to the idea do we actually need to describe the cloud migration at all or ‘just’ agree its about the tin and wires of IT that comes with some added benefits!
A bit of a stumbling question that also came up was, ‘What is the exit strategy?’ It was fascinating to agree that the reality is we have all assumed we go on to cloud, we have to some degree taken a financial risk based on a promise and now we need to at least consider what an exit strategy may be if we are to end up having to come away due to the pressures on revenue funding. It certainly made a few of uncomfortable in our seats to think this may need to be true.
My next session was the word of the week, Artificial Intelligence. Fascinating to think how long this has been a hyped ‘thing’ in healthcare. It had been mentioned earlier in the week that we needed to desperately stop talking about AI in the generic terms, we need to start talking about the specific ‘breed’ of AI to make it real and to understand the actual risks.
Early conversations have always placed AI as a support function, an additional pair of eyes in imaging and that is clearly an ‘easy’ route to test and learn for anyone in this space. By making AI completely part of the PACS solution and place it looking at the structured data and images then it can be simply seen as an extra pair of eyes in the system. Capability for AI as a precision health framework that can exist in and outside of hospital is a growing hypothesis to be explored, certainly some of the examples led to a consideration that AI could perhaps be the tool that delivers integration across healthcare domains that so many of us have been trying to create for so long.
We obviously turned to the ethics of AI and its safety in healthcare. The phrases we have been using for a little while now; Explainable, Generalisable and Secure with privacy were used again as the framework to test the appropriate nature of AI in healthcare. If we can take a none IT governance function through each of these headings for each of the solutions, we want to go live with then we can and should be able to make the in roads we desire.
The five key take aways from AI implementations brought to the table that you need to consider at implementation were:
- What is the clinical use case or patient facing utility.
- Consider how to build the business case from the beginning
- Create security and clarity of the security
- Create transparency all the way through the stakeholder group including the patient.
- Ensure the full implementation plan is clear and has a link to testing too.
The AI session did finish on a high though, clarity and realisation that with AI will come a new business case for digitisation and maybe, just maybe the source of fixing so many legacy issues would get covered off here.
The last presentation of the day was me. I had been excited about this for more than six months being able to ‘take us out of the weeds’ and get into some themes and concepts from across my most recent experience. I was able to take the audience through my own personal journey with Boots in the UK and compare and contract it to the way we have been trying to land the digitisation of healthcare for so long. I took us to the SAMR (Substitute, Augment, Modify or Redefine) ladder (again), we went to the three most wicked problems facing us all right now and even managed to get cards against humanity into the mix. All in all, I loved it and there seemed to be some smile and nods in the audience too.
The beauty of this event is as much in the conversations too, after the event planning for an NHS Digital twin conversation got going; how could we create relationships between none ‘competing’ NHS organisations to allow sharing of knowledge, lessons learnt and simply a wall to lean against really got me excited too, I hope we can make that work.
What a conversation! That’s how I think of my three days at KLAS, not as a conference but one big conversation that ebbs and flows with knowledge and experience. A conversation that was honest had clarity at its heart and really and truly was there for the good of digital healthcare everywhere.
As always if you want to know more drop me a note and I can explain or make the connection, keep an eye out for the KLAS white papers published off the back of the content too as I am sure they will have a lot more detail than I have been able to land here.
Here’s to working together…