 Good afternoon everybody. You're very welcome here today. I know you're not distracted by Black Friday so it's great to see you're all here. My name is Joyce O'Connor and I'm the chair of the Digital Futures Group. I'm really pleased to welcome our speaker, Francesca Colombo and I'll introduce her to you shortly after we go through a few Housekeeping Matters. Felly, wrth gwrs, mae'n ei cynnig ydych chi'n gweithio'r rhai o'r ffordd yn Llyfrgell, ac dwi'n fwy o'n gweithio'r cyfnodd yn IIEA. Mae'r gweithio'r rhai o'r gweithio, ond y Gweithio'r Gweithio'r Gweithio'r Gweithio'r Rhai o'r Gweithio'r Gweithio. Yna, byddwn i'n ffrif fedw i'n gweithio ar gyfer gweithio'r cyfnodd a'r gweithio'r newydd. Mae'r bwysig y gallwn gwirionedd yn chweithio i gynllunio. Ond rwy'n gofynol, mae'n gwirionedd i'r rai ffordd o'r cyfrigau. A gynhyrchu ymlaen i'r Prifysgol Cymroedd yma, ymddiolol o'r OECD honno, ymddir iawn i ddefaelch yn ysgrifennol yma o LSE, ac ymddirio i'r Fygen i'r ysgrifennol wedi'u gymuno dechrau i Llan. Mae yna'r cyfrifiad o'r 20 yma o'r gweithio ond hwyl iawn iawn sydd. A fydd yw'r oecd hefyddon yng nghylch, Francesco yw'r oesid. Yn oed yn yr un o ddiddordeb ym 3 o'r ddweud o ddates, ddysgu o'r ddataeth o'r hwyl iawn, yng nghymhwyl iawn, cymdeithasol o ddaleu hwn, ag unig o'r cyd-farlwgol yw'r cyfrifio gyda'r cyfnodol, ac y cyfnodol, o wahanol i'r gwneud o'r dyfodol, i gyd yn byw'r gyfrifiad honi'r sylfaenol. Fy fyddai Francesco yn ystod ydych chi'n gweithio'n cyfrifio, y ddych chi'n mynd i ddigitaliaethau, ac dwi ddweud yw'n cyfrifio cysylltu'r cyfrifio'r dynnodau, ac rydyn ni'n gwybod eich ddweud o hollu digital ac mae'r ddylch. Francesca, rydym yn gwahanol ar y pryd. Yn ddigon i'r ffordd. Yn ddigon i'r ffordd, mae'r ddigon i'r ddweud, sy'n ddigon i'r adael ar y cyfans. Mae'r ddigon i'r ddweud wedi gweld o ddweud. if I may say, Heath is lagging very much behind, it' probably about a decade behind other sectors of the economy in really leveraging data to transform health system for improved consumer surplus for you improve, the wellbeing for making systems work better. So I will try to address what are some of the challenges of health system, why health is lagging behind, what are the potentials for health ac y gallwn ni'n rhaid i'r enwod i gyd yn cyfathu'r gwaith, ac oes o'r rhaid i'r cyfrifio lle gyda 10 ysgol a'r ysgol. Yr mhwn yma e, mae oedd hynny'n gweithio'n gweithio'n gweithio ffasg, ond mae'n gweithio'n meddwl y gallwn yn cyfleoedd digitaliaeth, hwnna i'r gweithio'n gweithio'n gweithio'n gweithio'n gweithio, mae hynny'n gweithio'n gweithio'n gweithio'n gweithio. Rydyn ni wedi cael ei wneud am ysgolio cyflugwyr, a'r dyfodol ysgolio gymunedl, ychydig yn gael. Mae'u prifysgol yw'r cyflugwyr ymddangos cyflugwyr? A'r hynny'n ysgolio gyda'r prifysgol? Felly, rydyn ni'n ffawr o'r cyflugwyr ymddangos cyflugwyr sy'n ei wneud. Mae'r cyflugwyr yn cael eu bod y gallu gwirioneddau mawr, ac mae'n ddiddordeb yn fawr, sy'n tynnu'n cyflugwyr a'r cyflugwyr yn cyflugwyr. As societies are ageing, as the epidemiology of disease is changing with chronic conditions, as people demand more and better care, as their income becomes higher. So we look at some of the projections, and there are some recent projections that we have made for all the OECD countries. Health spending is projected to go up, and that's total health spending. Arnan is a little bit close to Portugal and Israel. It's beyond, it's less than the OECD average, but the increase in health spending between now and in a few decades, 2030, is going to be quite significant. It's going to be for more than 1% of GDP. So even if there's been a slowdown in health spending in a number of countries during the crisis, soon after it has started to resume growth at a higher rate of growth than GDP. So that is something that makes health system a little bit worried. How do we pay for the needs for the future? But we also know that health system actually do have a lot of things which are not delivering anything good. And it's a little bit of a sad news, but we have estimated about 20%. So one in five euros is ineffective at best or could be even harmful. So we call this sort of waste in health system. It's both clinical waste, medical errors or adverse events that could be prevented, like one in ten hospitalisation on average across OECD countries. I'm warranted and unexplained variations in the way medical practice is done, from the way need replacements and cardiac procedures, inappropriate prescription of pharmaceuticals, particularly look at antibiotics for example, emergency, visit to emergency departments which could have been avoided and so forth. So there is ample, ample, ample evidence of things in which we could be doing better and arguably obviously with better use of digital we could address some of those ways. And I will mention a few things moving forward. What happened? Yes, there you go. Wrong bottle. But the other fundamental things which is happening is that the expectations of societies and patients and citizens more broadly is changed. The model of care that we have at the moment is something like this one. The patient comes, sits down, the doctor examine the patients, and at some point the patient is trying to say, let me know if you want to know why I am here. This model of healthcare has been predominant in the past in which the doctor knows best and the doctor in a way plug that knowledge onto the patients is really called into questions right now. Individuals do want to have a voice. They want to have choice of health services. They want to be part of the co-production of health as well. They want to have a conversation with the doctors and be able to co-create the health that they need and the future. So there is really a striking difference between how we have built the health system so the past and what is the expectations of citizens for not even just the future. It's really for right now. So in all of that, actually digital can come with some help but it can make also some of those pressures a little bit more evident and more urgent. So how can intelligent use of data and technology help to address some of these challenges which I just described? What are really the benefits of digital? Now in other sectors of the economy is quite dramatic how digital has transformed everything. If we look at the aviation industry, the use of digital and of data in particular has come in a way to transform completely not just the experience that an individual has. You buy your own ticket right now online. You go and very quickly go through the security systems. While you are flying, a lot of data are being collected by the plane. These data are then transmitted, centralized to analyze all the processes to prevent future issues and to ensure that there are no accidents or things like that. I mean, it's quite well known. This is obviously not happening in health. Even if health is inherently a risky business in a way. But also like any other way, the way individuals can get their own services very easily buying them online, education and so forth. That is why we are trying to make our products better services much more efficient and higher consumer surplus. These opportunities apply to health do exist. The one way to categorize what could be those opportunities is shown in this graph. There are opportunities for having much better clinical care. Really trying to have a much faster use of the clinical information which is critical information and having more effective and efficient healthcare. Clinical optimizations. There are some wonderful examples in some OECD countries. If you take, for example, in Israel, which is a system based on a series of competing health insurance and club leads, which is one of the biggest insurers, and really invested in pulling together all the data and trying to develop some algorithms for trying to prevent when people will be at risk of hospitalizations, particularly elderly people, and really reduce the readmission to hospitals. It's really an example of clinical optimizations which is quite striking. Or if you look at Finland, it's got something called in Ulu, which is one of the city. They have an online platform where they plug all the different data that individuals have. They can also interact with those data, adding any information and clinical observations that they have. They can connect through telemedicine also to their doctor in a way that allows them to not go and needs the doctor to go and see the doctor unless he's really needed. The doctor can focus much more on critical cases. This has been used also as a way to reduce the cost for health system. There are some really wonderful examples. That's one first big area. The second one is system management and really managing the performance at the system level. I must say that probably that's where not much is happening at all. How do we monitor performance better? How do we reallocate resources better, understanding where the resource needs are, the planning of services that's again in another important area where there is very, very little which is happening. Surveillance is a third important area. It has to do, for example, with surveillance of products like pharmaceutical products or medical devices, real-life surveillance of the performance of the products, but also population health. Think about the occurrence of an epidemic or so forth, the ability to predict when those epidemics might happen and emergencies. Then there is the use of using that for research and innovation. We're leveraging really the statistical power, getting varied data sets all brought together to really understand what new treatments are needed. I mentioned the issues of people-centred health care. I think it's quite fundamental. If we look at the data in Ireland, it's unfortunate a little bit on the right side in terms of the percentage of audits who sought the health information online and how it has over the years really escalated. It goes back to the issues of individuals who want to be empowered, want to know their data. In many cases, they demand even the ownership of the data, although I'm a bit sceptical about the individual own their own data. They are used for public reasons and they should be made more available to everybody's use. But there are definitely opportunities that exist for much more personalised services and people-centred services by leverage data that individuals themselves do want and demand. The last example is the use of data and big data to have ensure that we have a more predictive public health model. The ability really of pulling together data that could be also genetic data, like Estonia has done, that puts together data from GPs together with genetic data to identify individuals who are at risk of cardiovascular disease and also breast cancer. That's really something which allows a predictive type of model in public health. Or even there are some pockets and there are pockets that are not system-wide examples by the United States trying to use not just health data but also broader data about populations which could be also social data or other data sets to identify households that can have children at risk, for example in this case, of lead poisoning or even to understand which food establishment might be at risk of safety violations. So the idea really of bringing not just the health data together but health plus social policy data plus all sorts of other data. Or again the issues of trying to understand safety aspects of medicines like in Australia that is really bringing together all different data sets to do so. So those are pockets of good examples and there are many of those in many different OECD countries we found that. However, my main argument is that health systems they are incredibly data-rich but they are quite information poor and they are also not using data really to transform the health system for the better. So let me have some reflections about some of these issues. One good thing that is happening is that the health system is rapidly digitalising. I mean this is an upshot of all the countries and it shows the percentage of primary care physicians and acute care hospitals which are using electronic medical records. I mean I must say that Arnold is a little bit again on the right side and it's particularly in terms of the hospital data but most of the countries are actually moved towards in a way if you want one of the first steps. Let's digitalise the system, let's have electronic medical records. This is happening but even for the countries the hell all of that 100% there is a huge but that we'll focus on digitalising the services by having electronic medical records in itself is not what really make the magic trick and achieve all of the benefits which I talked at the beginning. So let me elaborate a little bit on that and some of the things which are not necessarily happen and which are fundamental to happen. The first issue has to do with exploiting the data and by exploiting the data when speaking in health is really the ability to take all the different data sets I'll explain this, it's a little bit difficult to read so I need to explain to you but what essentially it is is taking all the different data sets that might exist in the hospital sector in primary care in biobanks, in the safety of medicines and medical devices all these different data sets very often I just individually left they are not brought together, they are not linked at the individual level for different reasons so what this graph shows is that it looks at all the different countries the blue line looks at the availability of national data sets at two different points one point was in 2013 and then recently in 2019 it's based on a survey that we have done with all the countries and what it shows is that for the majority of countries in between those two years there has been an increase in the availability of the data so there are more national data sets which are available in all countries and we look at the other issues which are those data sets regularly linked we see a much worse picture we see that there is less regular linkages we also see that over time it has actually slightly gone down which essentially if you look at Ireland which is the second from the right we see that in terms of availability there has been tremendous increase in improvements in terms of regular linkage of these data sets this is not happening unless those linkages are occurring some of the benefits which I spoke about at the beginning are very very difficult to realise another issue has to do with the use of electronic medical records so not just you have the electronic medical records but then you use them for what is called the secondary purposes secondary purposes include surveillance of disease or also research and we have searched and looked at countries in terms of the readiness to use the data contained in electronic medical records for those secondary purposes along those two lines one the axis on the X is the technical readiness and that explains to you and the Y axis is the governance readiness so the technical readiness has to do with things like are the data in the electronic medical records of a good quality are they complete, are they accurate is there interoperability standards so that you can bring those data together so that's the technical aspects the data governance aspects has to do more with a legal framework for safe use of the data and it has to do with things like the possibility to create new even data sets for research purposes or even existing of national governance and planning for those data so that's the governance aspects and we see that it's only a pocket of countries like about 10 countries and it's a usual suspects the Nordic countries and New Zealand you have Singapore which is a known OECD country who really have those readiness in place and Ireland is unfortunately getting a little bit on the lower side another issue which is fundamental and a possible application is the use of data and particularly routine health data so data which are collected in routine encounter of the health system for managing medical technologies and we have done a service of countries to what extent those routine data are used for a number of things and we see that in most of the cases they are used for monitoring trends in medicine use and also for monitoring spending but the very, very advantage of evaluating the cost effectiveness and the effectiveness the comparative effectiveness of medicines or even to monitor patients adherence to those treatments is done much, much, much less so the data in a way do exist but we don't make use of them we don't link them we don't prepare them in a way which can realise all the important advantages which are talked about talking about self empowerment of individuals themselves obviously people want to have access to their own data much, much more and 17 OECD countries either have already are planning to allow people to have access to their own medical records however only less than half of those countries allow individuals and patients to interact with the record so to add perhaps their own observations monitor some of their vitals and include them into the system so it's a, you know, not getting there in a way and we know that people want, you know they have an appeal to monitor themselves but why don't we allow that to happen through the lotronic medical records systems which is where most of the health data are contained and last things is the health workforce it's not ready for digital so we have done a survey of all the professions and looked at the skills of all the professionals including the health sector and what we found that depending on the country depending on the sector between 30 and 70% of health professionals reports that they have critical shortages related to digital tools and data analytics so in a way the workforce in a sector which is very much and fundamentally labour intense is not ready for digital there are also updated work processes and a lack in general involvement as well, most of the professional think that digital tools are a black box or data are really a black box for them so my argument is that what we need for the future is not just spending more there is probably a little bit of spending more that is needed I'll show some slides but fundamentally we need that complete transformation a digital transformation so it's not just digitalisation but thinking about the processes thinking about the governance thinking about the structure which is really what is needed now a few words about investments it is true that health is lagging behind again other sectors these are graphs pulling across different data sets at OECD but it looks at the ICT expertise and how it is in short supply compared to other sectors so these are specialist as a percentage of total ICTs specialist as a percentage of total employment and we see the health is very much towards the right pharmaceutical is a little bit more on the left but in terms of the health systems very few people with ICT expertise or even when we look more generally at investments in information management so the investments in software for example as a percentage of gross fixed capital formation on the left we see health again which is the red one being among the lower investors and the same in terms of purchase of ICT services as a percentage of output so definitely there is an issue of investments the health is somehow investing less than other sectors but as I said it's the issues of digital transformations it's much more than just investing in the hardware it has to do really with critically changing the strategy the governance and the capacity including on the health workforce so it's the digital transformation if we think it's not just digitalizing processes it's really something which is quite complex it's really something which is system-wide and require really a sustainment investment in things which are way beyond the hardware so you really need to think about how to change the processes how to change the workflows into the health system how to modernize policy how to get the data governance rights which are fundamental to achieve that transformation so it's really an institutional and policy change overall which is needed now we have made some heroic I would say efforts at calculating what would be the return on investment for that and based on our calculation for the OECD countries as a whole for each dollar or euro which is invested in digital transformation intended in this way not just in terms of hardware investment but more broadly in changing the processes and the governance you could count on a return of around three euros so it's a return investment on one, two, three and those returns are in terms both in terms of efficiency dividend so that waste that I talked about at the beginning that could be reduced at least part of it but also in terms of the health dividend so better therapies or previously unmet needs which become addressed so it's a huge opportunity for the health system it's obviously not an easy one to get to so in conclusion there is a digital transformation that it's out there in a way that technologies is there that can produce that health is lagging very much behind about ten years behind other sectors of the economy but to address that it really requires a fundamental policy change and what I think is really critical to do that is not just digitalizing the system that you have right now if you just digitalize what you have right now you might not have that critical transformation but rather changing the strategy the governance and the capacity overall so in terms of our calculation we see that this more smart way of investing will lead actually to quite healthy economic return and with that I'll finish with this just quote the key barriers to building a 21st century healthcare systems are not technological they are in the institutions, the processes and workflows that were forged before the digital era that's just the cover title of the publication that we just released on the topic and with that I'll thank you very much