Something new at Eucomed's MedTech Forum (also about the Recast)

Right after the event I wrote about in my previous post I visited the Eucomed MedTech conference in Brussels on 12-14 October 2011. At the end of conference I did learn something new about the Recast: the likely date that it will be published. Can’t wait and read the rest first? Then scroll down to the end, but you’ll miss something interesting.

At the heart of the conference was Eucomed’s ambitious programme in the framework of its continuous mission to show the added value of medical technology in the provision of healthcare, the Contract for a Healthy Future in which it outlines the role industry must play in steering healthcare systems onto a sustainable path. As is clear from “Future-proofing Western Europe’s healthcare” the report prepared by the Economist’s Intelligence unit in connection with the conference, healthcare systems must be efficient, effective, integrated and informed to meet the challenges of the future.

We know what these challenges are: healthcare systems have to achieve more with less as the population ages and more and more people become dependent on the same healthcare systems. The Economist’s report shows that member states have very different approaches to the problem, not all of which work (yet). The figures show that medical technology accounts for only 5 % of total healthcare spending. 70 % of healthcare spending goes into healthcare overhead.

Let me give you my candid and frank opinion as someone that specialises in medical technology legal issues and spends time in hospitals supporting hospitalised family members that thank their lives and health to medical technology. I’m necessarily biased that way, of course, but I do have an opinion. If one thing is clear for me with the provision of healthcare it is the glaring lack of process and result oriented organisation. The only way to cut down on overhead is to make healthcare providers think like companies in the way that all resources must be deployed to play a role in support of the key process. The key process should not be sustaining the number of available beds in your hospital – that would be like a car manufacturer aiming to sustain production lines without paying any attention whatsoever to demand and to what cars people want to have. Makes no sense, right? Yet this is what most healthcare systems have promoted and still largely promote. Since every organism has a tendency not cut in its own flesh when it gets in trouble, a common reaction is to try to spend less on technology (part of the solution) and leave legacy bureaucracy (part of the problem) untouched.

How can we solve this? No one will deny that better technology will improve healthcare. The excuse is just that it’s too expensive and complicated. I always learned that expensive is a relative term: expensive compared to what? Compared to the billions and billions of Euros that go into overhead supporting process that makes no sense, spread out over different member states with different solutions that are each not future proof in their own unique way? The Economist report and the Eucomed materials show that the big wins can be made by reforming the way healthcare is provided.

That may be difficult at first, but my feeling is that the paradigm shift will be more difficult for the healthcare providers than for the patients. For example, my mother in law was immediately convinced that she needs an iPad when she found out she can video Skype with her grandchildren as much as she likes. She bought her iPad2 before I had one (that hurt!). She will have no problems with telemedicine solutions when she will need them. I saw other interesting mHealth applications from Denmark demonstrated at the conference. Denmark is one of the few EU member states that got the implementation of electronic patient files and associated telemedicine right on a national level and should be an example to others.

Research shows that even the oldest people accommodate to mHealth and eHealth solutions easily, provided that the technology is user friendly. I was struck by an analogy that Petra Wilson of Cisco used when speaking about privacy and e/mHealth: if we trust to get money from a hole in the wall, why don’t we trust our health data in networks? When I thought about this a bit more I realised that this analogy is relevant in another way too: electronic banking has shown that it is perfectly fine that consumers of services take over processes from service providers. Indeed, no-one will deny that it has been enabling for consumers of financial services. I don’t want to give up electronic banking again. So why should I not be able to manage my own health records or plan my own treatment agenda or talk to my doctor via videoconference? Same thing, same development – same paradigm shift. Who still goes to the bank building for things that do not require actual human intervention? I would be crazy to. Waste of time and resources.

Imagine how much administration can be done away with if I can plan my own visits in the hospital system and decide what treatment and visits should happen where and when, all of course within a quality system that makes sure that I don’t make choices that are bad for me, mind you. Then imagine that this would work as you are used to your credit card and debit card working – internationally and 24/7. That will be another – in my view necessary – step, because so far the Commission is taking careful steps not to overstep the boundary of exclusion of healthcare from the Treaty on the Functioning of the EU. If member states are brave and need to revise the TFEU anyway to beef up oversight on member states for the Euro, please remove this hurdle too. I don’t care if the surgeon that puts a new hip or heart valve in me speaks Portuguese or Finnish as long as (s)he is competent. I can speak to my own doctor by videoconference before the procedure and consult him at home for reassurance and would rather not have him or her operate if I can get someone more specialised or with better facilities. If I can get my replacement sooner in another country, I will do it.

So, summarising – two in essence simple paradigm shifts:

  • integrated and process oriented healthcare provision (figure out how can we help someone as quickly and seamlessly as possible and send them home as soon as possible and then deploy all resources with a view to achieving that goal)
  • outsourcing/administration of administration and planning tasks (what can a patient manage his or herself)

all seen in the context of what function can be taken over and simultaneously improved by technology (for example, what do you prefer: wait for a consult with the doctor in a waiting room after travel, or in your own living room?). One could say that this dehumanises healthcare. I don’t agree. The banking experience has improved with electronic banking. I am happy that an autopilot flies the airplane these days. I allow my car to stay in lane by itself and adjust speed to traffic. And frankly, I trust diagnostic expert systems more than doctors because they make demonstrably less mistakes in diagnosis. For example, my father for example would have been happy with an expert system that would have spotted his Lyme disease symptoms immediately or at least would have offered that indication as something to exclude. Now he had to be treated for developed neglected Lyme disease, undergo expensive antibiotics therapy and suffered a drop in quality of living as a result. All preventable with good technology.

And are doctors so much more “humane” in the end? A brief while ago Ms. Schippers, the Dutch Minister of Health was quoted in a Dutch paper (NRC Handelsblad) saying that she was baffled by the utter lack of emotional intelligence of physicians vis-à-vis (in that case breast cancer) patients. At least you can program machines to care and, as Agent Smith says in the Matrix about software and machines running the show: “It is inevitable.” That much is clear from my personal experiences above only. And there is no excuse for healthcare provision that is overly expensive but underperforming at the same time. We do not accept that in other areas, so why in healthcare? It is time to face the music and ‘jump over our own shadow’. It’s good that Eucomed is prodding us to do so, and shows that it is an EU wide problem.

One more thing. I was touched by the story of a special guest at the conference dinner, Hylke Sieders, a brave guy that made a remarkable comeback from an almost full paralysis caused by a spinal cord bleeding between the C2 and C3 vertebrae. Hylke’s present quality of life is better than it could be as a result of medical technology, but it might be a lot better because many of the devices that he uses can be improved, in particular his wheelchair. Indeed, Hylke is an intelligent guy with very interesting opinions about usability engineering of medical devices. He is looking for contacts with manufacturers and resellers of any device relevant to persons confined to a wheelchair to help them improve their products so everyone can benefit. And remember, manufacturers are obliged to consider usability engineering for the technical file of their devices and talking to Hylke would actually be good post marketing surveillance, another important manufacturer obligation. So, legally you are actually doing yourself a favour by taking to him, that is my free legal advice here. If your company is interested, please contact Hylke himself, Eucomed or me.

Right, and then the Recast, as promised. In her speech Ms. Jacqueline Minor told us a lot that we know already, good summary though, but there was one easter egg in it: the Commission has not really written down anything yet, and has been busy evaluating the different policy approaches to the problem. They seem to have decided what course to take now (which one remains somewhat unclear, but will fit in the scope of the Council Conclusions earlier this year) and will publish the draft Recast in April/May 2012.

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