Silvia Piai on digital health innovation

Guest interview: Silvia Piai

The research director for IDC Health Insights in Europe reflects on the health tech response to Covid-19 and how it has played into longer term trends that are leading to a shake-up of the IT market; and new opportunities for vendors.

Silvia Piai is research director for IDC Health Insights in Europe. Her role involves monitoring health tech, market and implementation trends across the continent, in order to provide strategic advice to both vendors and end-users.

Needless to say, she has been keeping a keen eye on IT developments over the past nine months. While European and Nordic countries have all faced the same challenge from the novel coronavirus, their response has been very different.

In Finland, for example, there was a hard, early lockdown and the country looks set to emerge from the pandemic with the lowest death rate of any European country. Denmark had an experience that was more like the UK’s; except that was strikingly good at treating the disease (fewer than 5% of patients admitted to hospital with Covid-19 in the first wave died).

Yet, just a few hundred miles to the south, Belgium struggled with repeated, limited lockdowns, that left its hospitals so overwhelmed that some patients had to be airlifted to Germany for treatment. “We have a privileged view of the geographies,” Piai says.

“What we have seen is that central leadership is critical to dealing with Covid-19. So is listening to public health experts and using data. All the countries that did well in the first wave, like Germany, were data-led.”

Health tech matters

Piai studied international and diplomatic relations at the University of Trieste. So, she didn’t join IDC, which provides market intelligence to IT vendors and leaders in a range of tech markets, with the expectation of becoming a health expert.

“I joined IDC from a government standpoint,” she laughs. “They wanted somebody who understood the business processes of government; but there was this vertical that was overlooked that was called ‘healthcare’ so I started writing about it.

“The first thing I wrote about was the French national strategy for health records, which they still don’t have in place – or they have only got partly in place.”

Like many others who get involved with health, Piai became fascinated by the sector. “I really fell in love with health, because its technology is all about empowering people to look after others’ lives,” she says. “Integrated care is especially close to my heart. I think it is the future of healthcare.

“With Covid-19, we have really seen the importance of being able to follow-up with people at home. To do it, you need infrastructure. In those countries that do not have that infrastructure, Covid-19 has been a case point for showing how the system at the moment does not work.”

Models converge on integrated care

Integrated care matters because, if countries across Europe are dealing with a common challenge in the coronavirus, they are facing another common challenge in the longer term: providing healthcare for populations that are both ageing and living with more long-term conditions.

Their general response has been to move towards models of support that aim to limit expensive hospital stays, treat people ‘closer to home’ and encourage them to actively manage their own wellbeing whenever possible. Piai points out that this is making what were quite distinct approaches to health and care more similar to each other.

“Europe has two models: the Beveridge model [tax funded, state run] in the NHS, Spain, Italy and the Nordics, and the Bismark model [insurance funded, with a more diverse slate of providers] in Germany and France. They have been modified over time, but they are also converging. They are becoming more homogeneous. And that’s because they have the same issues.”

Those issues also include a shortage of staff. “An over-worked workforce is a feature of almost every healthcare system, whether that’s the NHS or the German or the Italian system,” Piai says. And it’s a feature that “Covid is not helping” as the second wave arrives with colder, winter weather.

In response, most healthcare systems are looking for technology that can make the most of the medical time available; which means more interoperable, more user-friendly systems that can automate workflows and generate data for analysis and decision support.

What differs is the starting point and the approach taken; which varies not just from country to country but, in countries with a more decentralised approach to government, region to region.

Broadly, though, countries that had already reformed their healthcare systems and put digital platforms in place were able to use them during the pandemic, while countries that had ducked the reform question and struggled to invest were left playing catch-up.

For example, Denmark had one of the most integrated and digitised healthcare systems in the world at the start of the outbreak, so its major tech response was to roll-out video consultation platforms for specialists and GPs that were already in hand.

Holland had a less integrated system but digitised hospitals, so the government turned to Philips to build a portal to share information about Covid patients. While back across the North Sea, some English hospitals had to scramble to deploy electronic patient record systems to support Covid patients, and there was a general scramble to get basic remote working and digital consultation technologies in place.

Learning the lessons of Covid

The challenge now is to learn lessons from the pandemic, and to use the investment that has been made in IT over the past nine months to prepare for that more integrated, place and person-based future.

“Some countries, like Germany, quickly realised that those hospitals that did better were those that had the ability to act on data,” Piai says. “So, they are looking at that lesson and changing their strategies and plans. In France, e-prescribing had never really taken off, but now it is the focus of attention.

“If there is some silver lining to Covid, it is an understanding that to run a modern health and care system you need a healthcare data platform; not just an EPR, but an open platform that can be used to share information and allow organisations to build new capabilities to support different workflows, without reinventing the wheel.

“Also, virtual consultations have gone from thousands to millions, but staff still need to be trained on how to run them effectively. They also need to be targeted to the right population groups, which will mean building them into patient pathways.

“So, decision support is something that suppliers should be focusing on. Decision support and workflow automation, not so machines can do the job of humans, but so they can handle some of the administration and repetitive processes.”

An exciting, but dynamic market

This big, converging agenda is leading to a shake-up in the European health tech market. In the EPR space, US giant Epic is winning a lot of big contracts in cities where hospitals are consolidating and regions where integrated care systems are being introduced.

That includes England, where Epic has won tenders in London and Manchester this year, and the Nordics, where it is working on huge projects in Copenhagen, Helsinki and Trondheim in Norway. Faced with this challenge, the big European providers are consolidating.

Dedalus, which was well established in Italy and France, is expanding rapidly; it has just bought DCX Technology’s healthcare business in the UK. CompuGroup, a leading player in Germany, has been buying smaller companies, and Cerner has acquired Soarian in Germany and Selene in Spain.

Piai says there is no doubt that this poses a challenge to smaller, indigenous providers. “I am not one of those analysts that thinks they have no chance of surviving, but they need to rethink their strategies,” she says. “They need to think about moving to cloud-based infrastructures. They need to go into the industry cloud and become a player in the ecosystem. They also need to move faster than they are doing.”

At the same time, the emergence of cloud-based health data platforms is encouraging new players into the market, excited by the potential for patient engagement within integrated care systems. Possibly too many with too-similar offers. “I have lost count of the number of patient chatbots I have seen,” Piai says, with some resignation.

These small players could be up against another challenge, though: the arrival of big consumer giants in healthcare. “I see big tech companies targeting health,” Piai says. “AWS is very active in this space, Amazon is focusing on wearables, smart assistants , natural interfaces, Apple has just launched its Health Records app in the UK.”

Future trends

Overall, Piai says, Covid has underlined how the existing pattern of health tech adoption has varied across Europe. However, their technology response has been similar and is now driving the trend towards creating more integrated care systems with more direct patient engagement.

All of which is leading to a “lively market” in which there is both consolidation and an influx of small specialist providers and big consumer tech cos. “It is very exciting,” Piai says, when asked if she ever regrets ending up as a health tech specialist. “I still love it, because it is very exciting, and it really can make an impact on individuals and their communities.”

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