KLAS, the global conference, the gathering of minds comes together again to do what KLAS has become famous for, sharing stories, offering each other help and creating the greatest of support networks you are likely to come across.

Digital healthcare needs to lean on to itself. Those of us involved for decades have been saying for such a long time that we have what it takes to make a difference, we just need some of the ‘stuff’ that gets in the way to be moved. Sharing what has gone before us is so important and planning for the future together is what KLAS enables.

We (Sarah and I) are very lucky to have been asked by KLAS to do the very informal live write-up of the event. So let me and my partner in crime take you on the KLAS 2024 journey, hopefully, this will help you land the learning we have all heard when you are back in the office and the grind of everything we are responsible for starts to hit hard.

We are here to collaborate, to make sense of things and to enjoy each other’s company. It’s a KLAS event so we already know it’s going to hit the mark.

Benvenuti! As Everton bounced on stage, reminding us all that this is about sharing, learning lessons and taking the thoughts of the next two days home to make a difference in what we do in our own countries to inform the delivery of patient care.

We gain an understanding and further confirmation of the value that KLAS brings to the future of global healthcare with an introduction to their advisory board represented by over 10 countries.

Innovative Technologies – Best Practices – Strategic Investments – Strengthened Collaboration and Trust give us our themes for the days ahead.

Collaboration: The importance of working together to achieve goals and hard goals needs even more collaboration rather than more muscle power. Sometimes collaboration needs to be a hard decision to take too.

Having the right people but they can’t or won’t work together impedes progress and success. Even when the partners are unlikely the best collaborations can happen, and when you do it enables you to stand on the shoulders of others and never start from scratch again.

Adam Gale then took to the stage to get us started theme of collaboration resonated throughout but with an additional message to providers “Simplify, simplify, simplify” Providers to healthcare need to ensure we don’t add complexity to an already complex digital transformation and bring best practice to everything we do to ensure knowledge transfer is a constant in everything we do.

Next, we heard from Rosanna Intelisano, Director of Management Control and SIA UOC from Gaetano Martino University Hospital. A University Hospital covering almost every type of clinical speciality with 524 beds, 600 Doctors, and 800+ nurses, is simply huge!

In 2009 the hospital had the same common problems seen in so many large acute hospitals – and the key will always be how to build digital engagement.

The realisation was that a new approach was needed and that a new approach had to be about simplification and digitisation of clinical activities. Rosanna had to bring her ideas as to how to make this change happen at a new pace and with new technology and clinical collaboration.

The first fundamental step was to go to a single supplier to manage all the systems and interoperability across the whole hospital. Sought significant knowledge transfer from the supplier but at first, this did not work as colleagues in the hospital were not bought in, new engagement was needed and at pace.

They knew they needed change and the approach of making the training mandatory aided in the ultimate success of the programme

The second step was clinical engagement, achieved through passionate leadership from certain areas being able to champion the change, not just the new technology but the new safer and more efficient ways of working.

The third step was clarity on the benefits realisation using real experiences from different parts of the hospital and ensuring that all clinical teams could see the benefits and indeed now aware of the risks of not digitising the systems.

As a teaching hospital, they began to realise the power of having a full digitised record to influence learning, and analysis to better influence patient care.

Integration between health improvements and the economic change in the local area through better healthcare is now being realised. A new realisation too for new technology such as AI is starting to become a reality, the risks of AI are there though and responsible use of technology has to be based on service orientation that offers solutions, not just technology for technology’s sake.

Dont have a clear regulatory framework to be able to use Telemedicine technology and appetite is there but there is still a small appetite for risk of legal challenge.

We return to the challenge that Rosanna has experienced through the last 15 years which is the training of the clinical team and they have an ambition for this to be included in University pathways.

Next up is the KLAS Presentation: Global Healthcare IT Trends with the ever-wonderful Sidney Tate. This for me is always a highlight as it allows us to get into the world overview of what is happening.

2023 sees a significant shift in healthcare technology – Moving from firefighting during the pandemic, a slowdown in investment in strategy and an increase in tactical ‘quick’ spends. The shift now though is planning for that set-up for success.

Top questions – How to become more efficient – We need to manage with fewer people – We can’t afford to do what we need to do. More for less is a phrase being used everywhere.

How do we manage security and yet at the same time we need to create agility in all that we do? How do we “lighten” our technology stack so that we can better support, manage and reduce spend? Empower patients to help THEM improve their healthcare – They need a role in their care not ‘passive’ in what they do.

Even in 2024 EHR/Digitisation is still the number one investment area – 48% of organisations still see this as the top investment area. 23% see Cyber as their priority investment as they move through the year.

Is Data Analytics and Digital Health high on the list to see how AI can be a way to achieve goals throughout the system and the leap in focus on automation, does that feel like part of the AI march to the future too?

Interoperability trails slightly at 23% even though it still seems to be a hot topic and the belief that this is still a major key to a successful future in digital health.

Big and new questions are how do we optimise the investments we have made? Healthcare systems want more from what they have bought already, they don’t want to and maybe can’t invest more, there is a desperate need to optimise.

The journey to cloud adoption is still an area that many still take slowly and with trepidation, everyone realises they must have a plan and start the journey but still worry about what good looks like.

Interesting to see where organisations see themselves on the AI journey. 42% of hospitals have started to create a clear strategy for AI and yet 72% have started to invest in that area. Does this show that organisations are really in a test-and-learn situation? The investment priorities that have happened so far are still in Imaging and prediction. Fascinating that so many have concentrated on these areas. When we look at the future investment though that optimisation investment comes up again. This feels like that moment of allowing computers to do what computers do best is an area that is coming up a great deal.

What do you need from your vendors when you are looking at AI, “Budget is so limited that we now need to rely on our vendors for guidance, we can’t lean on the SI as much as we used to.” – The expectation is that vendors provide the systems AND the advice and guidance.

Patient engagement used to be about messaging before an appointment, in 2024 this has moved on and is based as much on the ‘ownership’ of the healthcare journey at a patient level. Patient-centred care is changing in its meaning to be as much about the patient’s involvement in their care as much as their input into their care.

How can we take advantage of technologies already in place, are there new problems to find or can we collaborate on the problems we have had for decades in a new and exciting way to be smarter at what we do?

We then moved to the Navigating Healthcare AI Tabletop Discussion

Once we got into the discussions we went straight into a brilliant set of wide perspectives from across the world and both partners and provider organisations. We leapt straight into both the worry of governing AI but also the concern that we could over-govern and stifle innovation way too easily.

We tried hard to capture the concept of AI as a triage tool with the human (clinician and patient) always in the loop and therefore not autonomously making decisions at any point. There was a rallying call that AI governance should be lodged within the current corporate governance and every effort should be taken to not create new governance for it to be successful.

Several voices in the room also shouted for better definitions of AI in healthcare, the family of AI tools is not insignificant and probably needs differing levels of governance dependent on the tool and its implementation.

What was apparent quickly though was the need for regulatory ‘containers’ across the world. A fascinating comparison was made to how we could use the model of drug regulation as a route to build on, the risk though would be the pace of change needs to be fast and drug discovery and regulation aren’t in that space.

The idea that we need to treat AI as a member of the clinical workforce was also considered which was genuinely fascinating. We think of it being entirely normal that clinicians need to revalidate their knowledge so why should we not seek the same consideration for LLMs driving the next generation of AI capability?

Our old ‘enemy’ grey IT was also raised with the consideration that if this does get coupled with AI then what we termed AI Mayhem will ensue. A terrifying prospect that our businesses and clinical professionals deploy AI unheeded and therefore run mayhem across our systems in an uncontrolled and unaware manner, maybe this is the march of the robots that some media have us consider AI will be.

On the other table in the room, we had a representative from most of the major regions across the globe, and the main theme across the table was that we have to accept its coming and we have to do it.

It became clear that every country is taking a different approach to the use of AI in healthcare, with Australia and Italy dictating zero tolerance to the use of AI. No one had a clear strategy, everyone was awaiting the government’s direction of use and the associated governance.

There were many examples of AI POCs across the table but that is what remains to be POCs as we lack appetite accompanied by high nerves from the clinical community to move out of POCs, the fear of wrong outcome from AI or losing their job was just two themes raised at the table.

The next Panel was Future Technologies to Advance Global Healthcare with

Helen Balsdon from NHS England, Jacques Rossler the CIO from Hôpital Universitaire de Bruxelles, Marco Forrachia – Azienda UDL, Italy, H.E. Dr. Mubuaraka Ibrahim – Emirates Health Services and expertly Moderated by Rebecca Hammond from KLAS.

The biggest priorities today are still about the digitisation of the front line, even now in 2024 this is still about moving away from paper! This has to be done to create a joined-up system. We need to also consider the people side of what we are doing, and how to make sure that we have the right people in the right roles. New ways of working are necessary.

Incentives to land new funding are interesting, investing in Cyber is ‘easy’ to secure. The evolution of the EHR is through integration in larger geographies. Focus the investment cases on the improvement of patient care, how do we ‘make’ IT people feel responsible for patient care?

Belgium – has seen its biggest improvement in the maturity of its EHR with the introduction of  FHIR, SNOMED CT and further regulations. Interestingly, these regulations were seen as an advancement in an EHR, and not as a fundamental prerequisite.

Italy has a focus on bringing the whole system to the same standard in two years, the disparity from region to region is significant and is something that is required to allow healthcare to move away from ‘just’ the acute hospital, private and public healthcare. The basic tools for telemedicine in Italy are coming from top-down standards, and yet the regional starting points are so disparate. Italy wants to be at the KLAS event next year to talk about the delivery that has been created, their ambition is huge and is grounded in patient-centred care for the whole nation.

AI in the UAE, 67,200 start-ups are trying to move forward with AI and the market prediction is billions of dollars, the UAE wants to be more than 8 times the global estimates. The UAE is testing and learning AI in Operational Efficiency, removing the burden of back office operations significantly.

Algorithm bias – If we are implementing AI how do we make sure that the bias is under control and how do we ensure ethics are considered? 80% of healthcare ‘consumers’ are worried about how data is used in AI learning in the UAE.

We shouldn’t just use it for the treatment of patients empower patients to use it to enable their wellness with the use of predictive AI with data from wearables etc

Clinician resistance seems to be a hot topic of the day and the nervousness around their job being replaced, or fear of AI delivering an incorrect diagnosis and how this reflects on the profession we have to deliver the message that AI is an enabler, not a replacement.

Let’s make sure that the clinical and digital partnership is front of mind. It should not matter if this is within the organisation or with partners, we don’t want to do AI for the sake of AI we want to do it to improve effective healthcare, to do that we need the right data strategy and we, as an industry have not always done that.

The pandemic is causing our activity to be about recovery, which requires different strategies. Through to workplace strategies, what does hybrid working look like for clinical leaders and when we do come together we must enable it to be the best experience for collaboration. How do we make it easy to do the right thing?

Jacques Rossler discussed how we will see the use of Telehealth evolve following its introduction and use during the pandemic. He stressed that we now have to continue to roll this out in further specialties where initially it was thought it would not work, and how we can optimise the current usage as the business process change required was not necessarily done during the initial introduction. Unfortunately, the biggest challenge now being experienced in Belgium is that funding is no longer there or has considerably decreased since the pandemic so the evolution has significantly slowed.

TeleHealth and its links to sustainability – 38 times more Telehealth increase post-pandemic numbers. 38 million Americans have received telehealth and 96 million telehealth visits since April 2022, Telehealth definition should not be just about clinical consultation, but how to use telehealth as a term for digital engagement with patients and their healthcare system.

Patient information being shared with the patient brings a new paradigm in the creation of a digital front door for health and care. How can we use data and new technology to create preventative options becoming more ubiquitous across the NHS? ‘Quick’ clinical conversations are happy to be done at any time, it no longer requires us to sit on a telephony line in a queue.

Patients with Long Term Conditions being able to use their data to create efficiency in the healthcare systems we all have will be the next big game changer and may be the only way the healthcare systems can cope.

What will be normal in 5 years?

1 – The patient journey will be digitally supported and will be accepted as unique every time, we will stop trying to shoe-horn patient experiences into guard-railed routes.

2 – Working beyond the hospital walls having a full digital relationship with private and community care to ensure the all-rounded patient record informs better patient care.

3 – AI will be everywhere. The attitude of every part of the healthcare system will change. Patients will become more demanding, they will want to know the cost of healthcare so they can add to the healthcare that they want.

4 – Consumerization of healthcare systems, deploy as an app using the technology in your pocket collecting data all the time. The quantified self becomes simply what we do.

5 – Data analytics to drive true personalised care

6 – Adding ambient not only into the hospitals but into the home to realise preventative medicine, and predict care needs.

7 – Using LLMs to drive down waiting lists, and keep patients out of the hospitals, to ensure physicians have the capacity to treat the sickest patients.


The challenge of a workforce that is not always there…

The Arch Collaborative is something I remain fond of even now, not being involved in Healthcare anymore it strikes me as such a brilliant idea, a way to compare implementations of like-minded organisations from across the world as a way to share what is working and reuse it. As the phrase in the NHS used to be ‘Do Once and Share.’ Connor Brice from KLAS was able to bring so much rich detail into the Arch Collaborative in a brilliant way.

The Arch Collaborative ‘tests’ the system usability, but what is fascinating is the scores for systems across the world are so varied and lead anyone to the conclusion that the Arch Collaborative has so much to do with the people on the other end of the system.

Highest satisfaction score of the EHR, Brazil with a score of 52 from a n equal to 346. The UK is still way behind with -9.7. We have to get better at that as digital professionals and realise that the EHR is a key tool for a modern healthcare delivery system that is efficient, accurate and facilitates a patient-centred view of the world.

The main factor behind these positive results is how the training in the EMR is carried out, it was proven during the survey that if you do workflow-specific training this sees an increase in engagement which then sees the usability score rise.

We have to ensure that there are different styles of training delivered classroom, e-learning, bitesize, and bespoke.

We see a huge disparity in the satisfaction scores for Clinicians and Nurses across the globe with Brazil and the Middle East achieving over 80%, this takes us back to why KLAS plays such a key role in helping other regions to understand what they are getting right.

Success Story Presentations: EMR Optimization

Tamara Sunbul, MD, MBA, FHIMSS, CPHIMS

Medical Director of Clinical Informatics 

Johns Hopkins Aramco Healthcare 

342 Beds, 80 remote clinics

They experienced, burnout, and staff shortage and this was fundamentality down to the use of the EHR, so after embarking

Yet again I was surprised to see how impactful what digital people do has such a significant effect on what clinical leaders can do, the way Burn Out is impacted so significantly by the digital solutions. It reminds me again how important everything we do is and in particular how we allocate the right resources to help clinical people use the system. We have spent so much time talking about UX and CX, that what we need is to make sure that people are supported at the right time by the right people.

  • Power in Policy – effective governance
  • Leaders Pave the way
  • Thrive training is a way to help people thrive in the role they do.
  • Personalisation capability – make it work and then it REALLY works
  • Train to triumph
  • Partnerships that propel
  • User-driven mastery – empowering engagement and ownership
  • Innovate and Create
  • Triple alignment – Synchronising people, processes and technology
  • Data Discipline – Ensuring quality and integrity
  • Support superheroes
  • Reach for the stars – Performance monitoring and benchmark, you can’t measure success without benchmarks

Next up was Fábio de Cerqueira Lario, MD, PhD the Chief Medical Information Officer from Sírio-Libanês. Not forgetting we had already heard Brazil has the highest satisfaction in their EHR by their clinicians.

A huge system-wide EHR has been deployed connecting so many systems to have summary care records available to a wide clinical base. The level of integration allows for significant capability across a wide range of clinical specialities. 

The system-wide solution was started in 2007 and has been a long evolution of systems. The system deployed has had to undergo significant changes along the way and this is how the clinical engagement has been achieved. Reliable, safe and timely seemed to be the keywords that were needed to build clinical engagement.

The three most important elements of the system:

  • Initial challenges faced together and co-creation of solutions.
  • Collaborative development as a constant theme
  • Agile methodologies – fast feedback always in place.

“ We need to build our systems around the people who receive care and the people who deliver it. We need to provide healthcare for humans.” C-Craig Joseph, Jerome Pagani.

Finally, we jumped to Aviv Gladman the CCIO from Mackenzie Health. Making the distinction between satisfaction and dissatisfaction. It’s important to remember current capabilities are probably best considered as to how we limit dissatisfaction the most. Such a different way of thinking about clinical engagement but it did make sense.

An EHR allows the journey to continuous improvement to be possible. Moving from paper clinical journeys in 2017 to the digital healthcare system that we see there today. They were able to go from HIMSS 0 to HIMSS 7 in the first year, when I hear this now I am still blown away by how quickly some hospitals have been able to step through the HIMSS levels and the good that has been seen because of it.

The EHR is not an IT tool, it is a clinical tool that makes clinical outcomes better.

Dissatisfaction comes from the never events that the project agrees to ignore. The things that rarely happen actually do still sometimes, when they do the workflow is broken.

I then moved onto a panel discussion discussing Command Centers to drive efficiencies to drive financial savings.

To improve the efficiency of healthcare delivery to bring better patient outcomes and improve population health, their command centre has two models that cover natural disasters and everyday operations.

There is a use of AI to improve decision making stressing to improve not making the decision, although still, this is evolving with a huge focus on governance.

Bree from GE highlighted that Command Centres can be used for many things imaging, virtual care, and A&E but the ambition should be to have a command centre in your pocket. The command centre should always be focusing on optimisation, and alert people to the outcome of decisions taken.

Femi – Command centres are being used to sit on tops of data lakes, to use that data in an effective way with 450 curated KPIs to drive the decision engine.

Bree –  Data rich and healthcare poor, change management is always called out as the most difficult thing to do in healthcare so how do we get this right with command centres, and make them the heartbeat, you have to find the hook i.e. improve scheduling, monitoring patient movement to get the clinicians on the journey, and you have to have the top down support.

When the command centre starts delivering these messages we then need to make sure we enable the associated change management, to change the processes you can’t tell people in A&E that you need to move patients quicker without helping them with the how.

The business case for an EPR is usually heavily based on the expected outcomes and then after procurement success, it moves to get the lights on, how do we make sure we don’t forget about the outcomes? How do we make sure this doesn’t happen with Command Centers? All lines on this seem to end with finance outcomes driven by how much will it save, Dr Dalia added that also safety is a big outcome how can the command centre improve patient safety along with the patient outcome.

If the outcomes don’t change what we do, go back to the problem statement where the key points are clear and understood, do we need to improve and change?

How do you start to think about the command centre, and know what to do first?

  • Don’t wait for perfection
  • Start with the best data centre
  • What is the need for the system and devise a pipeline starting easy and low-risk
  • It is a long journey and long partnership with your vendor- The theme of the day
  • People change as they observe so be prepared to change
  • Clinical leadership

What comes next for Command Centres?

  • Correct policies being formed
  • more of a focus on how it helps with Population Health
  • Supply and Demand management
  • Virtual care components
  • To bring that level of information to the patient complex care coordination

I was able to get to the Security Breakout Session whilst my co-author was at the control centre session. Our security session was with Cynerio which covered insight from Canada, USA, Germany, Belgium and Portugal.

Diving into a debate about what are the most significant security issues in a modern healthcare system was a big theme for all of the panel. Across Europe the view of cloud security is changing, not fast enough but with some detailed thought. The drive to cloud has been a catalyst for opening up the conversation about security. GDPR is still a discussion point today as to how compliance with it can be achieved.

As we have been saying for so long, cloud is a must-do because the partners for cloud can clearly invest so much more in security than a healthcare system can.

We do all need to be careful though, a cloud migration is not the answer to all security, even with certified partners. Cloud helps but we need to still own the protection, the review of the protection and remediation when it is necessary.

The German journey to cloud in healthcare is still immature. The key driver to cloud acceptance was to move from ‘walled gardens’ to enabling access to clinical teams from their homes during the pandemic. The levels of protection through governance and consideration in Germany are really interesting, keeping the CISO, DPO and CIO roles separate and in different lines of business.

The ever-expanding digital front door is never going to get smaller now, with this in mind we now must chase hard our ability to protect our data wherever it is and not try to shut the front door. The level of legislation relating to what must be done is very different across the world and we need to be mindful of how difficult it is to manage governance when things are so different from place to place. One size does not fit all.

Seeing things is not securing them – a great piece of advice, just because an audit has seen the issue does not mean it is ‘now’ secured. The audit, the act of seeing needs activity to happen and that will require investment.

Preventative maintenance needs to be done but constant monitoring is one of the most effective ways of ensuring the attacks are going to happen

Mail monitoring is having to ramp up so much, Phishing campaigns and education have to be done more and more, the volume of junk mail now flying around is huge and cyber-attacks can hide in the volume so much more. We need to hold to the mantra, not if but when.

When technology can work across the business to ‘insist’ on remediation of the unsupported and unprotected has to continue to evolve to create success in this space.

How do we make sure that the whole width of the organisation’s staff has some fundamental knowledge of Cyber basics? No longer a nice to have, an absolutely essential requirement now.

IoT hacking is now the biggest growth area for attack vectors. Gen AI is the route to hackers’ work to the power of thousands of people, so what does that mean, the cost of entry for a hacker has dropped through the floor, and this is why we now have an arms race.

Deep fakes and the sophistication they are creating in the ‘war’ is scary. The only way to compete in this space is the clear human-based process that can not be broken.

Healthcare data is now the most valuable data ‘on’ the market. The discussion on pay to recovery is far less black and white than even 12 months ago, to be prepared practice the playbook and make sure that the team is ready.

Day Two

We kicked straight not a somewhat new gear for day two with Linus Tham the Group Chief Information Officer for IHH Healthcare.  

Linus got straight into his presentation with a provocation on an area we don’t talk about enough why sustainability is relevant in healthcare. Healthcare would be the fifth largest impact in sustainability contributor if it were a country! And yet as leaders in Healthcare, we allow it to be a subject not often spoken about.

Patients, Public, People, Planet – How to consider all of these Ps and make sure that we do the right thing in each area. Building real impact from PROMs data is super hard, getting it into a system is even harder. If done right though this allows a real comparison and offers real views of ROI where the patient is a payer for healthcare.

What would happen if this was the same in the NHS ran through my mind and the patient was able to make a judgement call with their clinician on the ROI of the procedure or stay in hospital how would this drive behaviours, hard to consider but interesting too.

PROMs as a way of empowering patient choice, patient engagement and even the social care system was a goal for the IIH team and one they are well on the way with.

Healthcare is the only ‘business’ where the ‘customer’ does not know the outcome they will get when they step into the service, they may have hopes but they don’t have assurance or a guarantee of the outcome (or cost). This was the provocation that Linus wanted us to think through and even take away, It is sometimes hard to apply to the UK because of the language used but the core principles feel like something that we should consider more, it goes back to some of the Darzi talked about principles back in the days when Personal Health Budgets were all the ‘rage’.  

IIH are now using AI within their systems and this is starting to get to the stage where they can inform patients ahead of their interaction of the likely outcome and the patient can then judge if the outcome was met. The ability of technology to facilitate clinical teams to perform at the top of their licence remains a key goal for all of this change at IIH. The sheer size of what they do is huge and with that in mind, this has to be a core principle always.  

India does more transplants in one hospital than Singapore does across the whole country – what learning can we take from how this is achieved and the way the outcomes of this are measured? Are there any comparisons at all or is it so different that it is just a numbers game, it certainly felt like there was a lot to be shared and learnt.

We have to enable our workforce to be able to operate at the top of their licence to help with staff retention in a very competitive market by using technology to facilitate high-calibre training was how Linus returned to the subject of people.

And back on the planet, he pointed out, “One dose of anaesthesia is more damaging than the same volume of carbon dioxide and how many emissions are created by the Cloud for every organisation.” He wanted us all to remember our commitment to not just leap forward in how healthcare is delivered but also make sure that everything we do has the themes of sustainability and the nature of our planet at the heart of it. It was a question we need to come back to, when we all ran to cloud did we think of the sustainability of it enough, maybe not. As we all now run to AI we should try to get this right.

Consideration is not resolved on the environmental impact of AI and the compute ‘cost’ to the environment. We need to build efficient models; we need to offset the use of AI with environmental concerns and considerations and where we can share the load to reduce the impact.  

Managing a Legacy of Diversity – M&A growth has happened at IHH – Interesting concept to explore further – Tech Debt remediation and the cause of it in the first place could be considered as a need to plan more as M&A activity happens. How do we plan for Tech Debt remediation as trust boundaries are blurred or the creation of new organisational constructs happens? Should we place the cost of Tech Debt at the point of this business case to ensure it has a home where people will care about the ROI that they will get from this?

On the topic of the EHR of the organisation Linus was strong and quick to say – “Personalisation yes – customisation should be a no.” His view is this principle allows for the system to be the most appealing to its users and at the same time reduces the complexity of the system and allows economies of scale to be created from it.  

IHH have an in-house built EHR – The organisation has agreed it is ‘good enough’ to deploy across its global presence. They are making the system work for them. The key problem though is the ‘special’ customisation and they need to manage this hard to avoid complexity. Global standards for the organisation are key.

From Linus himself, as a new(ish) person in healthcare, there is a plea to continue to share and collaborate. A key message from across KLAS over the days was that we are in this together and by being together with a core theme of how to simplify what we do we can achieve a lot more. He coined a lovely phrase to ‘vendors’  seek to partner with us and stop trying to sell. Allow vendors to be firm with us and stop us from making things more complicated. It’s ok to say no!

The differences between Localisation, Customisation and Personalisation were got into too.  Localisation is unavoidable, Customisation is code for complexity, and personalisation is essential for clinical engagement and to allow the patient to be at the centre. I thought this was an awesome way to differentiate between them and a way that sets us all some guardrails for what we can and should do.

Next up was a KLAS Data presentation concerning Burnout. Connor Bice took to the stage again, Connor is a firm favourite with the crowd as he gets into the weeds of the findings in such an accessible way that we can all take something quite poignant back with us from the presentation.

Interesting to consider what ‘burn-out’ means in all jurisdictions, not just a US issue which is often where our heads have gone. We know we need to make systems with our clinical colleagues at the centre but in the NHS I don’t think we have had the same considerations around burnout until now.

What causes burnout – Frustration, increased expectation, staff shortages, administration taking too long. How do we consider the use of a role such as a Chief Wellness Officer in an organisation to keep a lookout for colleagues and their situations at work? The protection of clinical wellness needs to be an organisation-wide responsibility, the stats show us that currently, digital solutions are to be both part of the solution and part of the problem.

The US believes it has an increasing burnout issue in its clinical workforce. Academic systems are ‘worse’ than healthcare-only systems which everyone in non-US found fascinating as there was a feeling this would be different in the UK. Interesting to see Brazil with the lowest burnout remembering that on day one Brazil also had the highest satisfaction with their system.

The ownership of wellness in many organisations has been decentralised which makes people believe it’s someone else’s problem. Over the conversation on this subject, we heard several times a plea to do more to protect the need to ‘fix’ this.

EHR as an inhibitor to efficiency and quality features in the reasons for burn-out. The ability to be more efficient through the use of technology should be considered, fix these two issues and there could be a way to deploy colleagues more effectively. It kept bringing me back to day one with the call to action on simplification, if systems were simple would burnout relating to the same systems be removed?

How do we move the EHR structure to be more effective at sharing information – why is it still quicker to use a pen and paper than using digital methods was an open question and one I can see when I visit clinical systems in the UK, answer, its instinct but digital will become second nature eventually to.

The Arch Collaborative is now putting a dollar value on clinical burnout and relating it to the way an EHR is used. Fascinating to see the way EHR is at the core of the digital experience. If the solutions that get the clinician on to the system are poor then that surely can be the key to frustration. Simply put, is the tin and wires up to the job now that the EHR is so ubiquitous in our healthcare systems. Digitizing the front line may well require a refresh of the traditional IT elements as well as a rethink of the principles of digital healthcare in the hands of our clinicians.

Human interaction is a huge contributing factor to burnout, when clinicians don’t believe their voice is heard, if they have no alignment with their leaders and have no autonomy over their daily schedule we see a sharp increase in burnout rates. In so many ways this applies to what we used to call ‘knowledge workers’ across any system, we need to ensure that our ‘users’ have as much personalisation and control as possible. Control and the lack of it for the clinical team is also a contributing factor in the burnout of clinical teams.

Next up was a Clinician Wellbeing Tabletop Discussion with a wide and diverse set of views my table got into some depth about the whys and what fors. It was interesting to see the research that KLAS had presented backed up by the conversations at the table.

The general consensus was that since the pandemic the clinical ways of working have changed hugely and that the way our systems support this change has not kept at pace. The need to offer clinicians ways to be more collegiate could be added to the digital systems deployed more, as how can technology facilitate the growing personal need for relationships and sharing.

The need to move from novice to expert in so many disciplines was also flagged, and turnover and the interest in widening clinical expertise has meant that many health systems on my table feel the systems in their clinician’s hands need to facilitate access to more clinical best practice and knowledge wherever possible. This felt to me a more advanced ask of the clinical system and maybe one that generative AI is the key to.

A phrase was picked up, how can we make it easy to do the right thing and much harder to do the wrong thing thus making the clinical system a line of defence in the way care is delivered in stressful situations?

Next up is the all-new Patient Voice Presentation discussing trends in patient engagement including diverse learnings live from the front line. The team presenting included Annie Howitt from Royal Women’s Hospital, Benita Butler the Acting Director EMR at the Royal Melbourne Hospital and Kath Feeley from The Royal Melbourne Hospital and Steph Chau from Peter MacCallum Cancer Centre, Victoria Australia. The passion, knowledge and willingness to share everything was so impressive.

Sweden, the US and the UK held up as examples of sharing data with patients but in varied ways. There is no international normal or standard yet and maybe there needs to be, this new forum though will allow systems to at least share best practices and experiences.

Over 90% of patients have access but only 25% of people are actually looking at it with any regularity in March 2024. The same question globally comes up, how do we make healthcare Apps ‘sticky’ and

Parkville Precinct is a system that is coming together to share information and offer ways of accessing different types of care across the system. The whole system went live big bang right at the height of the pandemic, which must have been so hard to do. 18k users and HIMSS accreditation in place in the first year and a complete system change was achieved. The story here though was about joining up systems across an urban and rural mix and the expectation that citizens had of the healthcare system, fascinating to see how successful the team made this journey and the work they did on citizen engagement as they delivered, promoting the success of the journey and what difference it made to patients was huge.

Health Hub is the brand for the tools: Medications, Clinical Summary, Letters, Results, and Appointments are all available and now PROMs have recently been added too. These were prioritised by the user group and then built across the system and rolled out to all 151k patients on the portal.

Clear goal of being transparent with healthcare information for patients. Positive impact on consultations and creating a different level of ownership. 70% agree that technology improves their overall health and 86% agree that technology facilitates healthcare ownership. Seeing these stats was amazing and verified what was being said by the clinical teams.

How could the UK learn from the Australian example and increase citizen take-up of the NHS App by including more information in it, in particular, the way cross-system data could be made available? The personalisation capability that is being grown inside the app seems to be the answer to stickiness, if we link this to recent digital retail experiences around app creation the logic seems to stand that the more personalised the patient experience the more ownership of what is in the app will be created.

There were some surprises in the stats too 82% of those over 55 thought that technology was very helpful for them, the change was described as significant in how they interacted with the healthcare system with an app in place. The survey was accessed through technology in its own right though.

The team have delivered over 100 languages in the translation bank but the majority of people were happy with English as the language of the app. First Nations people found the technology was very or somewhat helpful in how it was offered to them and they were not worried about language. This again felt like a place where AI could be super helpful in the future.

Accessibility in its core meaning (ie. network availability) is something that has an impact on patient access. It’s interesting to think where this gets resolved and how.

Patients want a voice in their healthcare- The health system needs to commit to listening – Shared information WILL improve the delivery of care and 91 % of patients are happy with the patient portal they now have. The team will not rest there though and can see how more ‘edge case’ additions will continue to add to that satisfaction.

The four hospitals had to get unanimous agreement on the creation of the portal and the sharing of the medical records. Decisions are made at the ‘lowest’ level possible to ensure that the engagement happens across the whole joined-up system. The whole build was known as Connecting Care which was the goal of the project in reality. This felt painful to put in place at first but the rewards of engagement were so significant.

And for us that was the end of KLAS 2024. It had been an amazing experience, for me the third time of attended and so powerful to spend time with experts to share stories and to truly look across the world and learn lessons.

What happens next to the EHR market is a huge question, changes and developments in technology feel like they will disrupt the marketplace place and the culture that was being talked about the most across the attendees leads me to believe that the patient at the centre of whatever comes next will be key, as will making sure that the user experience, the personalisation of the systems deployed will be the key to success.

So many new connections, so many opportunities to share after the event and time to reflect that when we come together digital leaders in healthcare are a formidable force.