 So I want to talk about digital transformation in the HSE and the HSE traditionally has been seen as like a super tanker, very slow to change, but I think there's a new HSE emerging and in the crisis that we have in front of us, I think our CEO Paul Reed is inspiring confidence in terms of the approach, but I think everybody will see actually a new more agile HSE than you've ever seen before and digital is a key part of that. So I have more slides than I have minutes to talk so I'm going to move quite quickly but hopefully some of the slides will leave impressions with you that will help us all work together to actually deliver a better national health service. So we're going to talk about how to scale innovation faster for patient and population benefit and digital transformation at HSE. Over 150 years ago, Abryn Lincoln said the documents of the quiet past are inadequate to the stormy present. I think we'd all agree actually this is probably as relevant if not more relevant today than when it was said 150 years ago and this is a headline from 6 a.m. this morning, 33 cases of coronavirus are confirmed on the island of Ireland. No doubt actually the number is more, it's a rapidly evolving and unprecedented situation as our CEO Paul Reed has said, but in this there is the opportunity for digital. Francesca Colombo who gave a talk here a couple of months ago and I know Ronnie, she's a past associate of you, she talked about health care being 10 years behind all other industries in terms of digital transformation and there's been a recent report from the OECD health care in the 21st century that clearly positions Ireland really as a laggard behind the European peers were probably five years behind the broader industry. We can make progress fast, I was speaking to George Crooks a couple of weeks ago, he leads the digital care institute in Scotland and he said actually we'd love to be in Ireland's position and I asked why and he said because you're so far behind and you can take advantage and leapfrogs using some of the new technologies that are available. In this the digital transformation function which is a small function within the HSE, this is kind of the central premise of what we do in an unstable complex system which is the national health system, small islands of coherence have the potential to change the whole system, so small islands of coherence have the potential to change the whole system and I want to give you some examples of that. So this is the way actually today HSE are recording COVID information and there's been several interventions or several iterations of this form and our challenge was to actually go from something like this to move to something like this, so we started last Wednesday to talk with the clinical lead for the national, for primary care and he was talking wouldn't it be better if we had some sort of app and the HSE tends to outsource a lot of software so the initial feedback from some of the big iron companies in Ireland was about three weeks to develop this app, so I picked up the phone to one of my team, a guy called Ross Cullen in Galway and within two hours he actually had the prototype app, the following day he actually had this fully digitized and here's the application, it's very simple, so for the HSE to take just two days, 48 hours to move from actual manual recording to actually digitized recording I think is remarkable, now what we're trying to do, we have to industrialize this, so a guy called Tom Laffin is working to actually integrate this and other components so we can have a system that can scale at an industrial level. Here's another application that is being developed by a company in Ireland in Digital Hope, they've specialized in caring for post lung transplant patients but they also pivoted, last Wednesday this didn't exist and Amy Costello the CEO of Patient Empower he gave me a call, I think we might have something that could help here, so the strategy as you know is you deploy home or to have people at home that have mild and moderate symptoms and to use an app to actually manage them remotely, so there's a process, the patient is first registered by the clinical team and receives an email or SMS to set up the account, they complete registration, now it turns out this is a pulse oximeter and it turns out this is the thing that is most critical in terms of managing patients that have COVID-19, WHO have done a study and they've looked at 40,000 data points from patients, 45,000 patients in China and the pulse oximeter or the saturation level, the oxygen saturation level is the number one sort of indicator when things are getting bad, so if your oxygenation level drops between, it'd be low 93% and you need to be hospitalized, so the idea is and you know they have built sort of an application which allows real-time collection of the oximetry reading and then it is posted to a clinical portal, so I'm going to do a live demonstration, so the HSE, we normally take a year to build an app but I just picked up this device on my way to the presentation here, it just shows how quickly you can move if you have agile partners working with you, so this is the app, this is pulse oximeter, it's something that you would see in any hospital, it's now turning on, it's checking my pulse and I'm going to ask it to take a reading, so it's now waiting for a connection, you know you can see here it's showing 97% and so it's now taking the measurement, it's reading the measurement from the oximeter and they're showing actually, obviously my pulse is a bit high because I'm nervous presenting it, it's 113, but my the saturation, oxygen saturation is 97%, so this is a technology that didn't exist last Wednesday and is now available and we have a crisis management team that will be making a decision after this afternoon, how this can be integrated into the model of care, so we met earlier this morning with Siobhan Ibrahim who runs, she's the lead for integrated care and she's very much on board and thinks this can be a very powerful response to remote management of COVID-19 patients, so the strategy is to try and keep people in their homes and then if an intervention is needed, if the oxygen saturation level drops below 97%, so well actually let me give you one other demo, so this also happened kind of in the last hour or so, we work and we work with a small company in the Digital Hub and we do try and do a live demo now and what they have developed is a secure video link, so if a patient calls into the call center and needs a consultation, they're sent a link and they click on that and essentially it opens up by a secure video link to a clinician who can guide them, I'm just going to see if this will work. Hello Donald, good, can you hear me? Yeah I can hear you okay, you're talking in front of an audience here at the IIEA, say how's my COVID-19 symptoms going? Slight to right throat because I'm presenting in front of a tough audience here, okay well I think it's great Donald, well look we'll close it there, I think but this is just an example of the kind of innovations that we can put in place that will help with COVID-19, so you take our screening app, you take remote management of COVID using the oximeter and this kind of video link capability and you actually get quite a good response and we'll hopefully we should be in good position to deal with it with the coming wave. Okay thank you Donald, I'll talk to you later on, all the best, bye bye. So we have a big challenge in Ireland and we sort of took on the metaphor of John of Kennedy, so we choose to digitally transform our health care system not because it's easy but because it is hard and what we want to our vision is that Ireland could be a European digital health leader within five years, we could be the company the country that is best positioned to respond to COVID-19 because we're applying digital technologies and our vision is that we could be a global digital health leader by 2030 and we're very blessed in Ireland we have a digital health ecosystem more than 200 companies and I want to give a couple of examples of the companies that we're working with that can actually bring genuine transformation to the health care system. So this is a capability maturity framework and I've already said in the OECD report actually clearly shows that we've got a very low digital capability and what we want to do is jump to maturity layers to become a European leader by 2027, 2025 to 27 and we want to move health care from where it's perceived as a cost center where it becomes an investment center so for Ronnie Downs this would be a remarkable mind set that health care is an expense but there actually could be genuine return on investment here so when we talk about digital transformation and digitization is a conversion of analog or physical information into a digital format. Digitalization is the use of digital technologies to enable or improve business processes or outcomes but what we're talking about is digital transformation, coordinated digital change effort at scale throughout all aspects of the organization and the ecosystem so driving one project isn't enough, ten isn't enough, maybe twenty could actually move the needle for us. We're at a unique point in time where we have multiple disruptive technologies all showing up at the same time. In the past whether it was the railroad, the internal combustion engine it drove a great wave of change but today we have cloud, we have machine learning and artificial intelligence, social media, we have internet of things, we have big data, blockchain is coming and then the next big thing it's all adding up to a perfect storm and we have a choice we can either be overwhelmed by all of these technologies or we can proactively respond and the choice we're making in the HSE is to be practically respond and be an early adopter and do disruptive things based on the technologies that are coming. The CEO of Ericsson once said the pace of change will never be dislodged and I think that's particularly apt and true. So we're on a transformation journey from analog to digital health care and I think Donal is still dialed into, he's probably hearing the rest of the talk, let me just remove him, from analog to digital health care and from reactive to proactive health care and we'll talk a little bit more about that in a second. We're seeing the opportunity for digital health to actually bend the cost curve. We'll see that we can have a real time help system. Obviously Apple watches and other capabilities have the ability to detect in real time the onset of atrial fibrillation, which I learned recently was also a big predictor for a stroke. So if you have a watch and Huawei and other companies are also coming to the market with these kinds of capabilities that detect immediately you have an AFib problem, you can really get things fixed in real time. So avoiding the cost, but particularly the difficulty of actually having a stroke. We're moving to where solutions are citizen-centered and more and more users are being brought into the innovation processes and companies to actually learn how to, products will be used and influence the innovative features that are used on new products. And then we will get to a phase where there will be data-driven innovation and we'll be able to make large scale public policy or public health policy decisions based on data that we collect based on consented data. So as part of our digital transformation we have five vectors and I want to talk you through these five vectors. The first is our digital academy. So the UK have built a digital academy and they have about 110 people go through a postgraduate diploma in digital health. We've made a decision to do something a little bit more expansive. The flagship of what we're doing is our master's in digital health transformation and I'll talk about that in a second. But we're also creating a digital health passport. It's almost like a sheep dip. If anybody's working in digital health they take this for our training and it takes them from sort of level zero knowledge to level four and level five knowledge. We're working with the Matter Hospital and I mentioned that briefly but there are other offerings and this is basically a maturity curve. But the key area where we're focusing on right now is creating the digital health leaders that will help drive the transformation that we need to embark on. Last April we pulled together all of the professors in the field of digital health and we invited them to Manuth University and we actually co-designed a new curriculum for digital health based on the best of what was available in Ireland. That was last March and we said we had a stretch goal of setting up in January. A lot of people said we were insane but in middle December we were able to actually hold the first induction for the students of this master's and we have 50 people in the class. 44 of them are from the HSE and six others. We've recently been talking with Northern Ireland and I think this master's is unique in that it has every university in the country actually contributing including TUD but we have a lot of interest and Marshall Connors facilitated this discussion from Northern Ireland to make this an all-island master's and have some of the teaching happening at UU and Queens. What's different about this master's instead of actually having to write a 30,000 word dissertation, students will be asked to take on a digital change master's. So we hope to have our program project I mean excuse me. So we'll have 14 to 16 digital simultaneous digital change projects ongoing. We're just in the process of selecting the final project. Some of the ideas came from the students, some of them came from top down, some of them have come from the middle of the organization. So this will become the digital change, the primary digital change mechanism for the HSE over the next couple of years. We have a collaboration with the matter. I'll talk about what a living lab is in a minute but what we've been doing there, what the team have been doing there is surveying the nurses and the HSEAs and looking at their digital skills proficiency and then we're providing a response so that we can actually close any gaps and we want to plan to use this as a national model. So we have some PhDs that are working on research. So from feet on the street to the master's through the research, I think we'll hopefully build a formidable digital capability. Our second pillar is open innovation. So open innovation was introduced into the academia in 2003 when Henry Chesbro from the University of California at Berkeley wrote a famous book on it. But we think we have to go beyond open innovation to something that we call open innovation 2.0 and Eric Topol has written the next one book, The Creative Destruction of Medicine. So the creative destruction of Schumpeter, he talks about a new model of medicine as being induced by the digital era and the altered way in which information is flowing. I was privileged to lead some efforts with the European Commission over the last five or six years. And I authored a book with Bror Salmon from GG Connect talking about this phenomenon. But essentially we have a new primordial soup where everybody is innovating together. We have large companies, small companies, universities, patients, parents all innovating together. And if you look in Ireland, we actually have a remarkable ecosystem of players with an interest in digital health. We have the universities. We have the large tech companies. We have a lot of the big pharma companies. And we also have a very vibrant startup community. So what we want to try and do is orchestrate this ecosystem. And we've come up with a concept we call Stay Left, Shift Left, which is a way of describing sloucher care in four words. What we want to do is first keep well people well in their homes through stuff like lifestyle education, nutrition and so on. Or also if I have a chronic condition that I'm best managed in the home. So that's Stay Left. And then Shift Left is about trying to move people from an acute setting to community setting to a home setting as quickly as possible. And one example of a technology innovation there is the Da Vinci robot in Limerick. It takes an eight to ten day colorectal resection procedure and turns it into a day and a half. So the patient is home in a day and a half. It loses a lot less blood. So this is an example of Stay Left, Shift Left. And we've already started to work with the ecosystem and we have companies proactively coming to us who are saying, well, here's how we're helping somebody Stay Left, Shift Left, Silver Cloud. They do a lot of CBT for mental illness patients. Medics note have come up with this is getting quite a lot of adoption in the UK and in Ireland. And it is bot technology. It actually replaces WhatsApp. It's secure. It's a secure WhatsApp for clinicians. The third area that we're working on is digital labs. And as Joy said, I used to run into labs Europe. So we're trying to take a similar approach and set up a network of labs, digital labs for the HSE. This is Ross Cullen, actually a gentleman that developed the app I showed earlier. We're tracking over 50 programs and projects that have capability to actually transform our healthcare system and each project goes through four phases research, pilot, demonstrator, and then ultimately broad adoption. And what we noticed is that actually our innovation process was broken in the HSE. We had a lot of SMEs coming to us and even the large companies saying it's so hard to sell into the HSE and they would be having a lot of international success. So we're trying to create a unified pathway to adoption. And what we want to move to is a network of living labs where we're testing different technologies in different areas. So we have users, we have public actors, we have private actors, and we also have the universities involved. So just late last week we turned on a living lab for something called vital signs automation and I'll mention, I'll tell you what that is in a slide or two. But what we've tried to do is create this new innovation pipeline. I was talking with Dermot Mulligan earlier. So one of the sources of innovation in the system is the health innovation hubs. Other sources are the Spark programs. We have internal processes. We have a quality innovation corridor. But regardless of what the source is we're trying to actually get everything to come through this process. And you might get 50 ideas here. You know 20 might graduate to here and four or five get to here and get to broad adoption. So for the first time we're trying to manage the innovation pipeline in the health care system. So we have a portfolio and on the X axis we have benefits and on the Y axis it's the durability of a solution. So you might have a solution that has huge benefits but it's not accomplishable because of infrastructure, because of spend. But what we really want to look at is the solutions that have lots of benefits and are also doable. So I want to give you an example of a couple of those at technology. So the first one is vital signs automation. And essentially what this does, this is sort of a standard Welsh Alan piece of kit that takes blood pressure and temperature etc in the ward. And we're working with a company from the west of Ireland that put a smart tablet onto that and it basically automates the collection of data but also the computation of something called the early warning score, the national early warning score. A pilot was run with this device about a year and a half ago in a hospital in Lentster. Can anybody guess what the error rate on the national learning warning score was? This is the score that is used to track if a patient is deteriorating. Well I won't say it and I won't ask you again but it wasn't good. So what we can do with this kind of technology is you can eliminate the errors to zero. So there are no errors on the national early warning score can be used as a reliable source of actually saying whether a patient needs further help or not. This same company have run an extensive pilot in Golden Jubilee in Glasgow and it is found to be very beneficial. And once the data is collected it's displayed in a national, a new scoreboard like this that is in the Ward Central Station and a little while ago I was down in Bonsecure's Hospital in Galway and they have this running on a ward. I was talking to the ward manager and she said this isn't safer, it's way safer and it's something we absolutely need to do. So what we see in terms of, we talk about what we call value dials, we're trying to come up with a consistent way of valuing business cases. So what we see in this case the early warnings error rate goes to zero, escalations to ICU go down, the average length of stay goes down, staff productivity in nurses 1.6 times more productive using this kind of approach patient welfare which is probably the most important thing goes up. So we can detect unanticipated cardiac arrest or the likelihood of that happening. We can detect early onset of sepsis and so on but perhaps one of the most interesting things is bed capacity goes up. So in Golden Jubilee in Glasgow the supplier saw the early war or the average length of stay go down from somewhere between 15% to 35% and this directly translates into increased bed capacity. So we just did a quick calculation and we looked at if we were to do this nationally, maybe it cost 10 or 20 million, but we would have four times as many beds available as the amount of people on trolleys at the peak of the account. So of the account that happened sort of in February I think. So this is sort of a breakthrough technology and something we're thinking seriously about how we could roll this out nationally. We have our digital academy forum on Wednesday in the digital hub and this is a small device called a food marble and it is very powerful. What we see characteristics of digital solutions is that sometimes they're able to deliver capabilities that are one tent of the cost. This device is one 100 of the cost. It's used for somebody that has irritable bowel syndrome and it replaces a device that call costs 15,000 euros in a hospital. This costs 169 euros. So it's about at one 100 of the cost. And it essentially allows somebody with IBS they have a device in the connected app and they can log their meals, they can run a breath test and then it actually gives them a score. So from one to 10 that represents the level of fermentation that's going on in the gut and you can actually find your triggers. You know, cucumber triggers me or whatever. But this really allows the trend of actually better self management in the home. So once a year the IBS software might get to use this device in the hospital. Today they can use it multiple times a day and come to the clinic with much better data than the clinician ever had. This is another solution that we're working on. This is a smart sharps box. The product is called a health beacon and you can see the box here. Somebody's injecting himself with a biologic like humera for rheumatoid arthritis. We actually don't know how much of that medicine is actually used and we spend about 800 million on high tech medicines a year. This box will actually remind the patient today is the day you need to take your medicine. When the patient has injected themselves they put the syringe into this lid here, a picture is taken, it goes up to IBM Watson and the clinician can then see through a portal while this patient is taking their medication. What we've seen is that the adherence rates have gone from about 50% to about 70-75% which is actually a massive jump. I know we have some pharma companies here and that kind of level of adherence rate jump is kind of unheard of. So this is a technology solution that is part of the digital innovation portfolio. We're really pleased one of the pharma companies ABVI actually sponsored the initial trial and about 3,000 patients in Ireland have a health beacon today. So it's one of the largest internet of medical things, pilots are living labs in the world. Here's a really simple technology but it has massive benefits. It's mobile x-ray. So today if somebody falls in a nursing home or in their home they have to get transferred to the hospital. They may be wait 4 or 6, 8 hours to get an x-ray and then they have to be transferred at home. This basically reverses the flow as patient-centric and brings the x-ray machine to the patient and reports are typically available within 1 to 2 hours. Hospital-grade x-rays. The company, Mobile Medical Diagnostics, they have run a pilot of about 90 people have used the service. The average patient age was 86% but as a result of it 85% of those people actually avoided a transfer to an ED. And the motivation of the founder, Mary Maloney, she actually experienced waiting 8 to 10 hours with both her father and mother in a hospital waiting for an x-ray and she said there has to be a better way. So this is another example of a simple technology but if we deployed it it would really lead to a digital transformation. Our fourth vector is the Digital Academy Forum. So think of this as kind of TED Talks for healthcare. It's about socializing and sharing some of the leading thinking and practice in the country and from abroad. We've had some, you know, Paul Reader, CEO, kicked it off. Michael Harding, who chaired the Eructress Committee on Help actually was a very passionate advocate of open systems and as a result of his intervention actually our Digital Academy Forum this week will talk about electronic health records and we have people from Slovenia coming over to talk about how the Children's Hospital in Slovenia adopted an EHR. We have people from the UK and people in Ireland. We've had an epilepsy EHR lighthouse, you know, running for almost, you know, 15 years and there's some tremendous learning from that. We'll hear from Colin Daherty, is a doctor in St. James's and we'll also Professor Tom Thy. We have, we're signing a collaboration agreement with the RCSI around open electronic health record systems and looking at how we'll be able to integrate the individual health system identifier. We last time round, we actually focused on female digital leadership and it's remarkable how many digital female leaders there are in the health system and they're providing great momentum and impetus to us. This is just as an example. This is a lady from Chiron Medical and they're using artificial intelligence for breast check solutions and this looks very promising the trials that they're doing in the UK. Our last factor is focused on digitization and robotics process automation has become very hot. Robert Watt, who leads of C-Deeper, has, you know, and government actually made it, has been a strong sponsor and driver of this and government made a decision in December that we, every public service organization should be adopting this. So this is from HSE is led by Lorraine Smith who is at the back of the room and we've been working very closely with Deeper and Deloitte who are the companies that were chosen on the framework to look at how we can apply RPA in the health service so this is digitization of the health service. We held a symposium on RPA at the end of January. We've kicked off two pilots one of them, for example, is Garda Vetting and we have a backlog of about 40 candidate projects that we can, we're going to tackle. So our next step is to run a boot camp for HSE employees and tackle different projects and we're really pleased very positive response from HSE employees wanting to get involved in this and robotic process automation what you're looking for is processes where an analog process that can be made digital. There's it's rule-based there's high volume there's low variability and it's error prone and when you have these characteristics you get very good RPA solutions and we'll be looking at four different areas for RPA in the health service patient access which is hugely important consultation and care revenue cycle and then finally supply chain. We're working this is a maturity model from one of the key RPA vendors but there's a maturity that model and the journey that we're going to go on and right now we're here in the health service we're in the very early stages of adopting RPA but we expect over a two to four year period actually we can get a lot more mature and we'll be up kind of at level five maturity. I want to finish with two quotes this is a key quote from this health in the 21st century report from Francesca Colombo was one of the co-authors the key barriers to building a 21st century health system are not technological they are in the institutions processes and workflows long before the digital era and I think that's really true and what I'm seeing culture is hugely important this report talks about culture the way the HSE is responding to the current crisis shows that actually people are very open to the adoption of new solutions and particularly in the interest of patients so I'm very encouraged by that and the next slide kind of I think hopefully defines the response of what the HSE is actually doing in response to the COVID-19 crisis on Winston Churchill you make a living by what you get you make a life by what you give so let me stop there and thank you for your attention.