Interview with Miguel Amado, Business Consulting Leader, EY, Portugal
EY co-organised the European Private Hospital Awards 2023
EY is actively involved in the organisation of the European Private Hospital Awards. What is EY’s involvement in Portugal and Europe in the health sector?
Around the world, the health care sector is being rethought in the face of ageing populations, the rising prevalence of chronic diseases, the growth of emerging markets and changing reimbursement models. Healthcare organisations, both public and private, must meet these challenges while mastering digital innovation, which offers both opportunities and threats. Technology empowers patients, real-time analysis improves care and enables a shift in thinking towards prevention – but it also opens the door to new, non-traditional competitors and unexpected collaborations.
At EY, we work with our clients to reposition and optimise their business models, people strategies and operational structures to address cost pressures, while leveraging the potential of analytics and technology to improve the quality of care.
We also promote the creation of collaborative platforms for long-term value creation in an intelligent healthcare ecosystem, helping healthcare organisations to remain competitive and deliver better patient outcomes.
We bring together our enormous experience around the world to connect the dots in this complex and ever-growing ecosystem, to build and share thought leadership and to support the transformation of their organisations. We don’t just want to reimagine the healthcare sector, we want to help rebuild it.
EY supports healthcare establishments to ensure they are prepared for future challenges. What are the main issues affecting the healthcare industry?
A number of factors are influencing the healthcare sector, which will lead to paradigm shifts in many areas. Firstly, from a socio-economic perspective, the share of healthcare expenditure in GDP will inevitably increase as obesity, chronic diseases, ageing populations and health disparities become more pronounced. All these socio-economic forces will require a greater proof of value of healthcare expenditures
Secondly, we are seeing a growing engagement of patients, who are connected, better informed and more open to smart devices and new models of care delivery. This will require changes in business and clinical models.
At the same time, we are facing staff shortages and we estimate that there will be a shortfall of 18 million healthcare professionals by 2030, leading to more virtualisation, automation and AI. The integration of technologies will also require new capabilities, as healthcare interactions gradually shift from a physical model to a virtual, personalised, on demand and preventive one.
Finally, there is also a huge pressure on finances, where healthcare organisations are being urged to do more with less money. This demand for capital efficiency will require constant assessments of productivity.
Is the current debate all about technology and data, leading to more innovation?
Health data is growing at a much faster rate than data generated by other industries and 80 % of patient data lies outside the clinical record.
Advancements in sensors are rapidly creating a new Internet of Medical Things (IoMT) … “inside” us and “on” us (smart patches, smart clothing, sensor-embedded pills, bioelectronic implants, nanobots, bioinformatic tattoos, smart dust…). Then IoMT will extend into our homes (sensors to measure the air quality, connected appliances, virtual assistants, motion sensors…), and beyond, to specialist care facilities (24/7 virtual monitoring, always-on-access to multidisciplinary care teams, AI-enabled robot…).
To move from data to value, it is still a long way to go but the journey from data to actionable insights and then health value must be made.
Today, we have a large number of different systems, all with bound data logic and applications. From a technological point of view, we need to move first towards information and API connected dynamic infrastructure built around existing systems, and then to platforms (in 2+ year) that will allow superfluid access and processing to enable real-time operations, open and “of value” to all users.
Governments, public and private health systems need to be working toward several interoperability objectives: make data discoverable, liquid and actionable.
Innovation arises from the transformation of data into value, and is a continuous, non-linear journey that benefits from connected, end-to-end thinking.
What are the main challenges?
Data lacks the depth needed to be truly game-changing. The default standards for organising and sharing data between different systems and applications don’t capture all the nuance and detail needed in a clinical setting. Medicine is semantically rich, because our lives and bodies are complex; data standards need to reflect this depth of complexity. We need to capture the patient’s medical history over decades, which means the data protocols must be designed to last.
Secondly, technology infrastructure doesn’t allow for easy connectivity. Data is often siloed in systems that don’t easily connect. This makes it harder to deploy new technologies, to analyse data, and to bring new players into the ecosystem that serves the patient. We need an open architecture one with agreed protocols and interfaces that help enable applications to talk to each other and share data.
Future health care models will need better quality data. Poor data platforms aren’t just a technical problem. The future of health care is all about finding smarter ways to serve the patient better. That technology will be hungry for data. Inadequate data doesn’t just impact the quality and efficiency of health care today, it will limit what an organisation can do tomorrow.
Besides, the health language contains hundreds of thousands of terms in a complex interlinked universe. We need a durable open data layer capable of dealing with this kind of semantic complexity whilst providing simple and powerful APIs to create applications for tomorrow’s smart health ecosystems.
Today, most of the health data is locked in proprietary data models. Tomorrow’s smart health ecosystems require securely connected platforms based on pull communication and standardised datasets.
Do openEHR solutions have the power to drive innovation in healthcare?
Data is the pillar of all current innovation, and the ability to use it determines its speed. Breaking down silos means breaking down the barriers that hold back information and is therefore essential for driving innovation, and healthcare is no exception.
OpenEHR is an opensource technology and a sophisticated set of clinical standards based on a clear separation of concerns – Applications, Logic and Data. OpenEHR facilitates the sharing of electronic medical records by providing a universally applicable international health data standards capable of accommodating the intricate semantics of healthcare. Even if the data resides in different systems, we can access it using the same concepts, meaning that any app can be built to use this data, regardless of the vendor. For innovation, it is the best as it allows and encourages to share information and provides a common understanding of concepts that enhances and promotes integrated care solutions. Firstly, within the same organisation, then from one organisation to another and finally across geographical borders. A truly human-centred approach to healthcare, with the patient and his or her data at the centre.
The openEHR specification has been developed by clinicians for over 20 years and the international openEHR community is growing. Besides, there are already a large number of reference projects worldwide that implement Open EHR, also in Europe (Charité in Berlin, Karolinska in Stockholm, Catalonia region in Spain, London region…). The movement is launched and gains momentum. If we want to be patient-centred, we must, together as a healthcare ecosystem, nurture it and ensure that it thrives.