 Ladies and gentlemen, please welcome Omar Ishrak. Thank you all very much and it's a real pleasure to be here. And I'm looking forward to moderating the session, but let me start with a few things. This session is about technology, technology in healthcare. And the uniqueness of technology in healthcare is that in this situation, the actual difference that technology makes can actually be measured and seen. That's not, that's in many ways different from general technology that we all use every day in our day-to-day lives, where it's an emotional assessment of the value of technology. Here it's real. It's real, but we don't always make it real because we don't measure it in quantitative terms and we don't deploy it in quantitative terms. But the fact is that technology in healthcare always is a purpose, a very definitive purpose that's meant to help people. And this video that you just showed put in another angle to that. It said that while all of that is true, there's true emotion involved in everything that we do in healthcare. It affects people and we heard a very touching story there from Matt who I'm going to welcome here in a minute. But it is about people. It's about inspiration that we all get from helping other people and it's about making a real difference in people's lives. So, you know, we stand in healthcare in an interesting position where we apply technology expertise. You know, many of us are deep in technology. We get interested in it. We have fun with it. And that in its own right is a great experience and something that people live their lives developing and enjoying and contributing. But at the same time, it makes a measurable difference about which there is no question. And associated with all of that, this true inspiration, emotion died with it. So we live in a unique industry. The other thing that I'll say before I invite everyone over is that the confounding thing about this industry which seems to be so, you know, such a great place to work in and contribute and only do good things and valuable things is that it's viewed as a cost burden to the entire world. It's viewed as a problem. It's viewed as, you know, you're making people better but it costs more money. And I think that's because we don't look at it comprehensively. We don't look at data in a very specific way. We don't measure outcomes systematically. We don't apply the right therapy to the right patient in a systematic and disciplined way. And because we don't do that, there's a lot of variation. And that variation causes the cost to escalate and instead of healthcare being viewed as an economic driver for the world, which it should be, it's viewed as a cost burden. And I really place it on all of us in our own way to first be cognizant of that and then address it. Address both the value that we create in terms of better outcomes but also the cost that it requires to create that value. And in fact, it should be lowered with better outcomes as opposed to an inherent belief that technology simply costs money. So that's some words and we'll talk much more about that. Before I invite the panel over, I do want to recognize Joe, Joe Chiani, who launched this movement. And, you know, over the years it's gathered more and more steam, Joe. It's becoming, it's highly recognized right now. This is the first time it's international. And so you should be proud. You should be proud of what you've done here. And thank you, Joe, for creating this. Thank you. So with that, let me ask the panel to come on over and take a seat and then we'll start from here. Okay, so welcome to all of you. And let me spend a few minutes saying a few words about each of our panelists here. Let me start with Matt, Matt Darling, who we just saw in the video. But, you know, Matt's a serial inventor and the co-founder of Smart Ward, which is a company whose mission is to improve patient safety and job satisfaction of all clinical professionals. And I think you saw, I got a hint of what he does in the video that we just saw. By background, Matt has had a long and successful career in IT and he's worked in a range of commercial projects and also been a senior advisor to the government. You know, people often ask why healthcare, why health spends so much money on IT systems without seeing any benefit. And the answer is that, like I mentioned earlier, health is unique in that the technology will continue to change. And I think Matt has recognized that and he's built a system in Smart Ward that is flexible and that's moving along using the latest technologies and artificial intelligence, which we'll hear about soon. So welcome to the panel, Matt. Second, I have Dr. Charles Murphy, who's the Chief Patient Safety Officer at the Nova Heart and Vascular Institute in the United States. Dr. Murphy is a Duke-trained cardiothoracic surgeon and a critical care physician. And after being a cardiothoracic surgeon for 17 years, he returned to Duke as the medical director of the cardiac ICU and step-down units. He also served as a physician lead for quality with the Duke Heart Center in the Department of Surgery. He then became Associate Chief Patient Safety Officer for the Duke Health System, and he's currently the Chief Patient Safety Officer at the Nova Heart and Vascular Institute. And he continues to be active in the direct patient care in the critical care settings. I know Nova very well and it's a great institution and it's a pleasure and honor to have you here. Next, I have Franz van Helten, who's the CEO of Royal Philips, and it's a position that he's held since April 2011, and he's also the Chairman of the Board of Management and the Executive Committee. Franz is passionate about innovation, but also about entrepreneurship and business transformation, and he certainly led Philips through a lot of change. But in it, it's very clear that his dedication to leadership and healthcare technology and to make the world healthier and more sustainable, that's very clear. They've got clear goals at Philips, a very impressive one of improving 3 billion lives by the year 2025, and I think Franz himself set that goal and passionately believes in it and drives towards it. By way of history, Franz first joined Philips in 1986, and he held multiple positions in the company, including Co-CEO of Consumer Electronics. He also led the successful Philips spin-off of NXP's Semiconductors, and then he did some consultancy. He was a Senior Advisor to the Board of Dutch Financial Services Business, the ING Group, where he was responsible for the separation of the company's banking and insurance activities. Since then, Franz has been running Philips, and he's got this Accelerate program focused on customers, but the thing that I've seen the most from Franz is that he's got a real focus on healthcare and making Philips into a broad-based and dedicated healthcare company in a very impressive and forthright fashion. So thank you, thank you very much. And then finally we have Anders, and Anders and I go back a long ways. I've known Anders for many years. He's currently the, let's see, the official title is President and CEO of Clinical Care Solutions at GE Healthcare, and it's a $5 billion business with 5,000 employees worldwide. The Clinical Care Solutions provides clinicians and frontline caregivers with a variety of medical solutions, including ultrasound, which is the most important one, and monitoring technology. That's only because Anders and I worked in ultrasound for many years. That's just a joke. Monitoring technology, material infant care, anesthesia, respiratory care, and cardiology. Anders joined GE in 1998 through the acquisition of Dysonix VingMed ultrasound into GE, and he's got a lot of experience in the ultrasound industry. Traveled around the world, lived globally in Singapore, Paris, and Norway. He was named the President and CEO of the Clinical Care Solutions business in 2016, but prior to that, since 2009, he played a leading role and led the ultrasound business. I also have to mention that, you know, Anders is actually celebrating because Anders used to be the coach of the Norwegian ski team, and the Norwegian ski team has had a field as it always does in the Winter Olympics. So that's what he does. Thank you. So with that, let's get down to a discussion. And I'm going to start, actually, by, you know, reflecting on the perspective that I just gave about healthcare being a broad-based technology that's affecting patients at different stages. And I'm going to start with Franz, because Franz, you know, you see healthcare both from a consumer angle. You see healthcare in a critical care angle. You see healthcare after the patient has left the hospital. So you have a pretty good view of the entire spectrum, especially as it relates to patients and their journey through the system. So maybe a few words to your own reflection and thoughts about that. Thanks, Omar. Yeah, back to the introduction. We decided to dedicate Phillips to health technology only because there's so much to do. So we got rid of all our other businesses, but we kept hospital and consumer health technology because in our strategic vision, which we adopted several years ago, we said we need to put the patient at the heart of everything we do. And if you see health as a continuum from healthy living to preventative situations, to diagnosing first-time right to, let's say, a intervention that is first-time right, and then the transition back to the home that needs to be again seamless and safe and then help the patient recover back to a healthy life, I've now laid out a continuum thinking that is centered around people rather than around institutions. If we think of the world as institutions, then there are walls, then there are departments, then there are divisions. Even within our own companies, there are divisions. So that's, by definition, wrong. But if you take a philosophical point of view that it's us, people, that somewhere through our lives we transition from healthy to sick back to healthy, then we need to enable those transitions to go perfect. And this is where we have said we need to work much more horizontally rather than vertically. You still need to have your expertise, let's say, in ultrasound or in MR machines or in surgical equipment. But if we can enable that flow of the patient is faster, better outcomes, lower cost, in fact, embracing the quadruple aim, then you go a lot better. So what we have then, of course, discovered is that data is essential and data needs to flow easily, and we will talk about interoperability in a moment. Because along all those stages and departments and expertise that needs to be brought together, we need to have a seamless collaboration between specialists in an appropriate contextual manner. So Philips has evolved into much more a health informatics company where now over 25% of the company is around integration of data supporting care flows and care pathways and supporting and enabling people to live better. So come back to the consumer versus hospital. It is all about the person and if the world cannot afford to pay for acute care as much, then we need to put in more money and more resources around prevention and chronic disease management. And that is happening around people's homes. And then we need to adopt behavioral science and even gamification to influence how people live because then is how you influence them on maybe a different lifestyle or on medication compliance. And then we need to find ways to connect doctors to patients in new ways. And you know what, we live in a digital age so it's fascinating because now finally we can tear down all the silos and all the walls and make people more effective. So that's in a nutshell. That's good. That's a good broad overview of what we face, both the opportunity as well as the challenge of overcoming some of these barriers. Let me go to Dr. Murphy because you know while you can have a perspective I'm sure you're occupied as a clinician in the moment on an individual patient on a very specific problem and at that point how the patient was managed before or how the patient is going to be managed after is almost secondary to you because you've got to save the patient's life there and then. So how do you drift in and out of that focus and time and at the same time have time to think about you know some of this happened because you know the progression was wrong or I'm going to release the patient and then I don't know what's going to happen. So your thoughts on this whole well I'd like to share a bit of a vision to highlight some of those issues. So in health care the vision is that we'd love to see safety built into and designed into the system. So I think about human factors being incorporated and I think that's exceedingly important. We don't have that to the same level as other safety critical industries have. Number two I think that we want technology really help us provide better care so we don't want siloing of information and we don't want to have onerous burdens of documentation. We want excellent early warning systems and my teams want more time with the patient and the families. We need great teamwork and communication we need excellent clinical decision support. We need transitions and handoffs that work across that care continuum. We need increasing use of simulation so that we've practiced things before we see these things occur. We need to have monitoring across the care continuum into the outpatient world and then we need to have timely intervention so that we get better outcomes. We also, you know, ever since the Institute of Medicine report came out we need a global reporting system where we can learn from harm and near misses and I hate to say this one but we actually need for people to do hand hygiene every time and then finally, you know, I do have a vision where we do have a world with zero preventable harm based on those things and I think having that shared is very important and the nice thing for the audience is that everyone on the panel is helping that vision become a reality. Thank you. So we've heard about in many ways a need which was described very well by both France and Dr. Murphy. But you've got to fulfill the need and I'm going to turn to Matt first and then Anders but Matt, you know, as you've already sort of stated in the purpose of your own company that you need a system which changes over time because not only of new technology but because every patient is different and because, you know, there's a lot of data that's fluid today how do you in fact use that data for it to become an advantage in treatment as opposed to a handicap because you just got too much information and knows what to do with it and what's your approach towards customizing the data so that it really makes a difference in every patient who's different by themselves. Yeah, thank you. I think that there's some very complex underpinnings to the nature of the problem. What I saw was a system under stress where people were working extremely hard and yet people were not really able to deliver the care that they needed to and that was because of a fragmented information environment and in the time and motion studies we've done in our research over the last nine years we've uncovered some really amazing statistics and one of them is that the fragmentation in the information environment has led to a number of really troubling elements and one of them is that people need to work around rather than work with the system so there's a big systemic problem and that work around and I alluded to in the video around how there were records there that did not reflect the care that had been delivered and that was basically regarded by people as a necessary evil in order to get everything done so systems have to be made that people can work with instead of around and through that prism we can make improved data quality greatly. For me the necessity of workflow to provide the support so that people know what to do when and to whom without having to think too hard about it is like really vital because if we can do that then we can have accurate data and accurate data is really the key to unlocking this whole puzzle if we want to move to zero deaths by 2020 I think it's achievable but only if we have accurate data and so information systems have to be there to remove the levels of admin so if you look at a hospital it's overall resources more than 50% will go on admin and that's because of that fragmentation that I mentioned we need there have been so many fantastic ideas at this conference but the system is really really burdened with a lot of busy work it's not adding enough value and in order to see those ideas implemented we actually have to create some flex and the way we can create flexes by automating admin through you know simplifying the information environment with good IT systems and intelligence it's just built into those IT systems I assume to make it fluid so the system needs to present the information the user needs at the time you can't have the user burrowing a lot of the current IT systems represent what I would depict as a mechanization of a process so it's a computerized version of a paper thing but computers are infinitely more powerful and subtle than that if they're used correctly I'll come back to some of that but let me go to Anders next because you know we talked a lot about data about overall patient management and about the flow of the patient through a health care system but health technology in the end is technology you're inventing something or coming up with something that affects a patient in a very specific way what difference that actually makes in the overall care of that patient can sometimes get lost and that it gets so enamored with what one new type of measurement or data gives you in the quality of that that the relevance of that in the overall system can get buried so how have you learned to manage that and therefore select which technology is important which is not and how do you optimize these things it's a good way of putting it and I think goes back to a little bit of the sidewall we have single data spot data spotting and very often decisions are made too late at the point where it's too late and you have a single parameter etc. we are not able to put those parameters together so that's one area so if you want to take all the data make it liquid as much as we can and put them together if you can do that and then take a few steps back and build an artificial intelligence to make it predictive so you can early do the early warnings and I would say that's probably one of the better ones and for instance we have a project going on with Rosh which is really not a device company they are sitting basically in another side and getting a ton of clinical data well we have imaging, we have monitoring we have anesthesia a lot of different things we have this project trying to solve the mostepsis which is an individual kind of loss control in infectious disease and if we then build a backbone, a digital backbone with multi-parameters to do early predictions that's where we can put these data together to make to help the nurse basically make an early decision or an early warning today they are like 85% of all the alarms are unnecessary the nurse walks 3 to 4 miles every day so it's part of Matt's your problem they didn't have time because they were attending 85% unnecessary alarms so if you can do early prediction and put multi-parameters together we have a chance to do this drive more efficiency efficacy we will go up and it will help us in many ways so that's from the data point of view that's an example how we work and think about it how do you link that to the technology creator some new sensor or something like that that comes up are you finding a way in which you evaluate if you have to invest in one version versus the other do you have methods through which you link back to the difference it will actually make in the world before you start investing in that are those mechanisms fluid it's not so fluid but I have to thank the audience here in many ways because the real work is happening at the clinical side and there is a ton of data where each individual parameters are being investigated we have new parameters almost every day new things we want to track and trace and get data into the system every bed generates one megabyte of data every day so we're not utilizing it so how can we do that better from the investment point of view look at every single one and then try to track it back to disease or combine it so we can have more data points and that's how we will start to invest in a different way and drive productivity from that perspective I mean companies like ourselves of course we'd like to dominate but that is not the solution here so it is absolutely mandatory to have an open environment where systems integration can be achieved and where different equipment from different vendors can be interoperable and for sure hospitals need to demand that but it goes wider it goes even beyond the enterprise so interoperable interoperability very important open EMRs so that you can write and read to and from the EMR in a contextual way at the point of care again very important it needs to be patient centric because that in the end makes it relevant to the care point there are going to be multiple inventors in the world that will contribute a new piece of technology that will have to be integrated in that existing environment for it to work well and the testimony that we are sitting here with competing companies because we believe that this interoperability and systems integration effort is needed and we have all pledged as part of the patient safety movement that we will adhere to that interoperability and I think we need to lift that even higher I would like to add to this point that since the movement started here there has been a lot of discussions in our company and I think in the industry in general how we kind of missed the whole thing because we have been so device focused and very individual focused on different points so in what really happened here is that if you really look at the data and this is just take us as the proxy every day there is about 700 people dying because of patient mismanagement in some fashion regardless what is that that's one jumbo jet that we are rushing every day do we have the same awareness? No you put that data back to yourself to your families whatever you realize that there is no other question that patient safety is trumping every agenda item so that's what we have done from a leadership point of view and lifted this all up and I can't agree more this has to be an industrial kind of action to be taken and to do that maybe regulatory framework to force a little bit more this to happen think about what happened with HL7 didn't work for anyone DICOM worked in ultrasound but it took multiple years to do that it was basically forced by regulatory committees and I think maybe the movement here and scientific committees to create standards that's really what we have to do Dr. Murphy first you were going to say something? No I think I agree with the creating standards I think it's very important I think it's another brilliance of Joe is that we really do need patients and families industry providers and governments working together to solve these problems Matt another fundamental issue at stake here which is one of the first questions I had to ask myself was why has IT failed to deliver in health what has been achieved as was mentioned on the first day in things like automotive and in aviation and part of it is the ongoing complexity the continuous change 80% of what we recognise as established clinical practice today is going to change within five years and when you are building an IT system you are effectively codifying that you are codifying that information in a way that can create a terrible burden in terms of maintaining it, keeping it safe so a coefficient is needed of safety criticality on the one hand and adaptability on the other hand to keep pace so I think new technologies are emerging but they like really asking IT to deliver the same things up until now has been kind of impossible I'm going to go back to you Matt right now on that subject and the interoperability which we'll come back to and the overall leadership that's required to another subject that I've at least been very curious and interested in and have put some thought into it but the usage of artificial intelligence in healthcare that's one and you're beginning to do that but healthcare is behind other areas like in automated cars there's all kinds of different places where artificial intelligence has been used healthcare has been tended to be at least from what I've seen conservative and that is a data quality issue because of data quality well you can't build an AI like you can't get a machine to learn but in the consumer world people are using imperfect data all the time and they're doing all kinds of things it depends how imperfect it is I think it's entirely possible to do it but you need to have well defined data and these predictive algorithms around patient safety predicting sepsis predicting heart attacks you can do that hours in advance already today we do that with our with our guardian software and clinically validated with data sets from Mayo and many others and curated and flexible because I take exception that IT is always hard coded and therefore from the last century in the case but you need so AI is being used now AI could be used more so it's not black and white it's being used it could be used more there is schizophrenia certainly in Europe around patient data if you go if you're born in one province in Germany and you want to get taken care of 50 kilometers further you have to be completely re-scanned because it's so hard to move the data just from one hospital to the next that's crazy and where we entrust our financial health to the cloud already for 20 years we don't do that for health so I think we really need to grow up and make data more accessible because then I think the advancement of AI can move and we can do much more I'd like to draw a distinction which I think is very important and that's the difference between device data and data that comes from human created records which is a huge volume of the information and that's really my focus so you have standards ISO 13485 and so on and this hasn't been the case with a lot of other health IT EMR, CDSS and so on haven't been developed with the same rigor and I think that's because of this tension between making something adaptable and agile versus making it safe so in terms of kind of the question I was really trying to focus on on this sort of delivery of care which is we had a lot of time and motion studies and we found that the records that were created we had people literally following and recording creating our own record of care of what was happening and it was 10% accurate what actually made it into the official record but I have a slightly different view as to what are the hurdles because you can say technology is the hurdle I'm not so sure many hospital systems still buy technology by department and if you buy it by department you get a departmental solution department is a silo and many of the EMRs were not originally set up for patient safety, they were not set up for really patient care we need a care coordination layer in order to bring all the data from all the disparate sources together and that care coordination needs to be even to extend beyond the four walls of the hospital towards the skilled nursing facilities towards the home because care coordination is a flow and you want to avoid that something goes bad in the transition from an ICU to the general ward from the general ward to discharge that's where things go wrong and again therefore we need to think much more horizontally I think also an opportunity to take with telemedicine to take specialist outlying areas to give that expertise and I was thinking when you were talking Omar I agree more opportunity for AI particularly clinical decision support so you know one of the things we haven't talked much about the last couple days is diagnostic error but if I don't consider a diagnosis the likelihood that I'm going to provide the right treatment of that patient is very low and so there's real opportunity to improve clinical decision support let me throw out two other points that I'd like your comments on questions here that I'll go through some of them but there's two things I'll throw out and then each of you feel free to comment on it the first question that I have is to do with machine learning in other words as opposed to generic data which is then used to stratify and target certain care pathways if you then track the journey of a specific patient through the healthcare system and the uniqueness that that patient may have and then the care that's then provided deviates from the standardized care pathway in a way that's customized to that individual based on their ongoing learning even during that fairly temporary period that the machine can have that's been talked about in other areas and I think that's still early even in the consumer world but what are your thoughts around machine learning that's one question, machine learning is there as it's applied to individual patients and the care pathway deviating because of machine learning the other question that I have is non-clinical data, socio-economic data whether a person is rich or poor whether they're family or not how effective and how important will that information have to be in deciding the care pathway in addition to the clinical data if you feel free to comment on each one okay, we'll start with one I think it's a monumental challenge here we have to divide it up in pieces today we do nothing and patients die every day so we have to make certain that even just at the ward itself or in ICU or a very basic thing let's start with simple coupling a couple of parameters and track start with that before we do the whole care area from patient to individual patient we have to start with basics and see if it works we have the challenge with getting data from everywhere okay maybe we'll start in the institution start maybe in the broader area walk before you run, just get basics talk to each other first, get basics things done don't worry about all those fancy things make certain that self-driven ICU actually works first in the basic area and then expand and maybe pick a couple of care areas first and that's what we did picking one difficult example to understand what challenges we have I think that's at least what we try to do and we will need to work very closely with the clinical environment regulatory environment because many of these parameters have never been experienced these decisions are made today by individual physicians or nurses, just by experience and there is no real scientific process behind it so let's do that first, and then we could I have to say, I think our care is evolving too, now we try to surround the patient with multiple clinical experts that can use algorithms, use evidence-based practice to provide the best care to that patient at that time with that condition so I think we're evolving as well but I think this idea that we can support that with machine learning and such is very powerful and will help us even be better to me, the challenge is actually the wide end of the funnel, it's actually collecting data that is high quality to underpin all of this machine learning all of this AI that really is the challenge because the data quality is pretty poor because people have to work around the record keeping systems and this generates a systemic problem, we kind of have to solve you need to have authenticated data we need to know who is entering the data we need to know where they're entering the data who is with them when they're entering the data how long it took to complete the task and if we can do that then we can provide a level of assurance around that data so that we feed in clean information to systems so that we don't get machine learning that has a defect. And then there's lots of data and what I need is actionable data I need and it needs to be presented in a fairly simple way I mean I am busy as heck with crashing patients and I need it to sort of hammer me over the head of Dr. Murphy you need to consider this now. Yeah that went back to my earlier question to you that in the moment the doctors don't care about any of that they've got a patient to deal with and the crisis situation that they have with that patient is the everything. But also the strength of the team because my team will help me and they'll speak up and say Dr. Murphy you know we think yesterday we had presented that maybe the team would say this patient needs a tracheostomy right now and so there's that strength of teamwork as well. So I see an evolutionary path to adopt machine learning and artificial intelligence and anybody who would say you know replace doctors overnight that's not going to happen. We need the doctors to be front and center with the patient but the variance in any institution is huge one doctor versus the other even within the same institution that variance is huge. So if you can through analytics provide a faster learning curve and reduce that variance it's going to be great for patient safety if you provide clinical decision support systems with you know smart checklists and discerning the deviation from what is good so that you can pick out the patients that require that extra support then I think that is going to help tremendously to improve patient safety but also reduce cost and outcomes but it will require a data architecture in your institution that is going to be holistic because you cannot do what I've just said you know silo by silo you will not move the needle enough and here is where I think we all need to move from a transactional relationship you know you have a call for tender you buy a piece of equipment I guarantee you will prolong the status quo versus a deep partnership approach where we say okay you know let's reformulate what is your challenge okay you have quadruple aim so how can technology help with that that is a different question than that historically you may have asked as professionals around well I need a piece of kit and by the way I need some IT and then I'm going to put it all together well good luck you will propagate the past right so here we need to think of a much more wide holistic architecture in how you deliver care and then you come to the next challenge again not a technology challenge and that is change management we are all people we all have our habits we've all learned it in some way and now we need to change okay and that is again a collaborative effort where we need to say what got us here will not get us there all of these much more human sides are more fundamental than you know what is the next wave of AI or machine learning because I think it will have far more impact on what we all want to accomplish but you guys didn't answer the second question that I had the socio-economic status and certainly both France and Matt probably have a strong view on that especially with your experience in the consumer world where you must be marketing in different ways and you must have learned Elmar we need to distinguish between the healthy person who becomes sick and the chronic patient who has a known condition so to start with the letter the chronic condition we have over a million patients on COPD and sleep apnea through the cloud connected to our AI engines and we can every night see you know adherence to medication you know was the mask leaking and we can connect that to the payer and to the provider you can imagine that if you apply that to a COPD pathway then you can avoid re-hospitalization so but this is a relatively curated environment where the data that comes from the home and comes from the patient we know it has relevance and we can stratify it and then decide what needs to happen for that patient if you think about the patient who says oh I'm not exactly feeling right I'm going to google around my condition I think what we hear from many of you is that actually creates a lot extra work now I think we need to find a way to bring that into into workflow I think it's going to help eventually but I also hear people struggle with that but we do need to provide better decision support to patients and families and have that be high quality and sort of for that individual as well and I think that will help actually it will help a lot as a provider I love to have patients and families come with information absolutely and in what format an iPad that's a great question I don't have an answer for you Marta any views yeah I think the kind of things that we're talking about at the moment we have to acknowledge where we are today and today we have a huge number of expert systems and this leads to this fragmentation of this information environment you need a complete picture and the question of how to get there is sort of a vexed one but I think it does require a couple of things we need a system for people to focus on patients rather than the administration exactly and if we can do that then we basically free up the time to do all of these improvements at the moment we're kind of asking people to do things they're locked into a tactical frame it's like saying to someone devise me a strategy while they run up a hill naked and storm a machine gun post they're under constant fire they're under constant pressure strategically in that moment is incredibly difficult and there is it was Dr. Scheinman the other day who said he'd like to see patient safety at the centre of healthcare and I think when did it become not the centre and why and the answer is that this fragmentation of the information environment has actually led to admin being more than 50% of the resources that go into caring for patients in a hospital and you got to ask yourself how did that happen Omar can we switch and talk just a tad about leadership in this arena because I think that's a critical issue and I think we need literally hundreds of thousands of leaders and we need them across the spectrum the people that are in this room and we need them not only at a global level we've had some great global leaders over the last couple of days but we also need every nursing and physician unit director to also be leaders in terms of patient safety and what that means you know I'm sort of a Cousins and Pozner type of person so I think modelling the way is very important inspiring a shared vision questioning the status quo appealing to the heart are very important things and then empowering everybody else on their team to make a difference but we really need a widespread leadership to really get to the place where we have zero harm I would like to add one point on this one because maybe we are missing some components and some contributors to this I'm thinking our devices and what other regulatory bodies involved here we get out of trouble from the regulatory by being very stringent with our development and adhere to all the quality things etc etc but what happens with the equipment devices and all of that same thing on the hospital side we don't fail as a device manufacturer provider but we'll fail at the patient side so how can that be so we are missing a complete regulatory overlook of the whole pathway maybe the horizontal pathway nobody's really looking at that whole story I don't want them as part of the team to work because I think it's silenced so much across the board if we can get that operation going and that's part of the leadership you're bringing up that's the leadership challenge I think we have more because within the businesses and industries at the clinical side I think there's more than enough knowledge that we need to open that pathway so let me just pivot to a question which is linked to that you know there's many questions here I certainly can't go through all of them but there's one overriding theme across many of them which is the connection to the EMR systems and that historically there's a view that the EMR systems were customized and not interoperable and they're viewed as as an issue and none of you represent you know whole-scale EMR companies they're two big ones so what in the US in the US that's correct sorry there's a world outside of the US in the US that's very true and we are outside the US right now but but on that point can this really be done without getting the EMR companies on board in this in this table? Well I think speaking about regulation I think it needs to be mandated that all IT vendors whether it's an EMR company or us in patient you know critical care that you have open APIs so that there is no locked-in situation but you know we've been talking historically the EMR let's say was designed much more from a claim perspective and so where did we lose the patient that's where we lost the patient and the provider now as we as we see that's a hospital consolidation the bill that comes with let's say the EMR integration is huge and sad because that money is not necessarily going to better patient care and we have made it not a secret to say that we advocate for a thin layer of care coordination as in IT layer above the EMR so that every enterprise whether it's a primary care or an emergency responder or a hospital they can have their own let's say administrative environment but somewhere we need an interoperable patient care coordination in order to go across and I think that is what in your nice movie you vocalized well yeah I think over nine years of research the importance to me is very needs to be focused on evidence if you look at the there was a report done by Ostrowski at L out of MIT and they reviewed the top 103 IT projects in the US and found that there was an evidence base for the claims they made about their benefits for only two now that's a problem because you have an excellent salesmanship and poor delivery and those things you know that's a diabolical combination and it has led to a lot of money being taken away in my view from patient care well it's time to wrap up I'm going to just go around the the panelists here with a very simple question that I request you answer really in a summarized fashion and the simple question is this that you know we've talked a lot I mean if there's one big theme that came out here it's interoperability working together working as a as in changing the way in which we deal with each other not only in this panel but with providers with governments in a more holistic way I think everyone signed up to that in principle but it isn't that easy to do and so the question that I have is that in your own estimation how long a journey is this before we really move the needle in being able to work together is it a year is it five years is it ten years so you want to start Matt look I think we can start today when will you reach the end that's what I mean or reach it when it will never be an end because as data quality improves and research gets better there'll be finding you think all the time what's the difference I think that's yeah I think that's right I think that people are making steady progress at the moment but quantum quantum leaps are needed in terms of you know this element of data quality adaptability and that's how long away do you think yeah it is for sure there are systems that can triple the amount of time being spent on on patient care and the ward just by automating the admin that's been proven in research how about you and I don't know that I really can give a time frame I think it'll be a steady steady change steady journey over time but I'm optimistic and and that we can get to the goal of zero preventable harm how about you friends what do you think well I'm optimistic about healthcare systems hospital systems getting a handle on this yeah but let's face it much of the patient safety issues are not in the hospital but also outside and in emerging markets and I think I'm a little bit less optimistic about you know how fast a capacity will be rolled out in emerging markets where still you know a mother and child infant infant mortality in Africa is six seven percent you know I think it will take ten years before let's say in the sustainable development goals of nations you know we get every mother every child access to the care that they need so I make a distinction between hospitals I think we are out of the gate we are working well home let's say in developed markets awareness is growing a long journey and then in developing markets much longer much longer and so much money is needed to build it there how much you understood what you think I think we are well on the way on the journey in many ways I think we can do much more as an industry maybe we can force it more by in this industrial committees and the standards for instance and I totally agree it's going to be different by different segments of the market whether you are in the developed world developing or even private and even by nations it's going to be a little bit unfortunately different but I think the commitment starts with us and partly with the providers and everyone and I think actually patients can make a difference there if patients start to push harder on the outcome because they are not really present in many environments that can accelerate this one and I think this movement includes that and for us to put it on the top of agenda will help excellent well I could talk for a lot longer but it turns up and I want to thank each of you for contributing for a very lively and fruitful discussion I'm sure the audience enjoyed it so let's give our panelists a round of applause