Smart Tech Made In Erasmus

In July 2022, Erasmus Medical Center—the largest scientific University Medical Center in Europe—established Smart Health Tech Center (SHTC). It’s a hub, laboratory and accelerator in one aiming to co-develop, test and validate technologies for health in real-life settings. I visited Margrietha (Greet) Vink, Director of SHTC, to find out what opportunities SHTC offer for medtech developers.

Before we discuss SHTC, I would like to get a big picture of the innovations in Erasmus MC. From May 2022, Erasmus MC switched to digital invitations for outpatient appointments. Previously, the hospital had to send out about 900,000 letters annually. What other parts of the patient journey has Erasmus MC digitalized?

Innovation has always been at the heart of ERASMUS Medical Center’s activities. For many years, we’ve been using Big Data analysis, Virtual Reality (VR), prediction models, Artificial Intelligence (AI), robotics and many more technologies that support patient care.

Let me give you some concrete examples that demonstrate the scale of this innovativeness:

• Fast delivery of test and examination reports in electronic patient records (EPR)—patients can view them if they wish before they see and meet their doctor and have more time for questions and discussions on their therapy.

• Rob Taal from Erasmus MC investigated the effect of a warning system based on big data analyses of the heart rhythm in 1,200 young patients. The system can estimate early whether a baby may be developing sepsis. The results are hopeful. According to Taal, the number of babies dying from sepsis appears to be more than a quarter lower compared to the years before we used the warning system.

• Our scientific researchers, Nick van de Berg and Laurie van de Weerd, are working together on the development of software for a hyperspectral camera. This will allow surgeons to see where the healthy tissue ends and tumor tissue begins during an operation.

• With VR glasses, children can play virtually in a playground, visit Efteling—a big Dutch theme park—or swim with dolphins. These applications help to reduce pain and stress and help children in the hospital move, learn, and play.

• Nico Bruining is our expert on digital cardiology. His latest project is interpreting ECGs with artificial intelligence (AI). The idea is that a computer can assess several ECGs of the same patient at lightning speed and detect details that remain hidden to the human eye.

• Care monitoring from home. More and more patients with chronic kidney disease are monitoring their blood pressure, body temperature and oxygen saturation at home. It is part of nephrologists’ strategy to centralize care around the patients, so they become in charge of their own health. This process started due to the COVID-19 pandemic and is now becoming a common practice. We are currently working on an interactive platform (digital verbonden, Eng.: digitally connected).

This is really impressive! What I want to focus on is the recently established Smart Health Tech. Center (SHTC). SHTC—let me quote—is to connect innovative companies with the right people and facilities at Erasmus MC for co-creation, testing, validation, experimentation and demonstration of smart technologies. What is the goal of the investment in SHTC and how will Erasmus MC, healthcare professionals and patients benefit?

SHTC aims at the integration, development, testing and validation of technologies for health, such as advanced AI-based technologies—for example, the Internet of Things (IoT, medical Internet of Things (MedIoT), Active and Assisted Living Technologies—robotics technologies, sensor and monitoring technologies.

We assist in providing physical and digital access to resources to start-ups, SMEs and knowledge institutions, enabling them to test, validate and experiment with their products and services in clinical– and hospital– or patient–home settings. We also offer support to commercial innovation and research partners in finding the right setting and experts, clinical expertise, expertise in AI and robotics, data and training for health care in Erasmus MC.

Our team at SHTC assists staff in spearheading innovations and creating an entrepreneurial and solution-oriented creative culture within Erasmus MC. Through these services, we facilitate the rapid development, testing and implementation of new co-created ideas to reimagine health care and care delivery. In addition, marketing, communication and dissemination activities are a fundamental part of the work of SHTC to maximize the impact of SHTC.

The effectiveness, resilience and sustainability of health and care systems in the Netherlands, Europe, and globally are increasingly challenged from three directions:

• The demand for healthcare services exceeds the current capacity for health and healthcare due to a combination of aging societies, pandemics, non-communicable diseases, climate change and war.

• Traditional approaches to health and care are not improving health outcomes for people with lower socio-economic status. Overall, health inequalities are estimated to cost €980 billion per year or 9.4% of the European GDP.

• By 2030, it is projected that around 40 million new health sector jobs will have to be created due to this increasing demand, while it is already, and will remain, very difficult to attract and retain well-trained healthcare staff: the workforce challenge.

Against this backdrop, the emphasis is on solutions and investments that reduce the need for—or length of—hospitalization. Specifically, solutions that take a more proactive approach to health are needed to work toward a healthier population. We need to innovate healthcare delivery to ensure good access to high-quality, affordable healthcare, including for populations with a low socio-economic status, living in unhealthy urban regions, and rural and/or remote areas.

Technological innovations will play a key role in solving the big health and care challenges society is facing. While the COVID-19 pandemic has been a big disrupter in terms of the continuity of healthcare services, it has also hugely driven technological progress, e.g., related to diagnostics, therapy, telemedicine, remote care and home use, as well as increased acceptance of these technologies.

SHTC not only wants to maintain this momentum but further boost it by enabling companies to demonstrate the positive impact of technology in health(care) and supporting the faster implementation of this technology. And in order to achieve this, we will follow a unique approach.

What do you mean by that?

We will involve our already established innovation communities of practice. Innovation Communities of Practice (ICPs) consisting of technical and clinical resources as well as patients will provide the expertise to assess, prior to testing and experimentation, whether a technology to be tested addresses a need in the field, whether it will fit into the existing workflows, will add value to current clinical practice—both from a clinical and patient perspective—and if there is business potential, allowing for adjustments to be made prior to testing and experimentation.

This approach is beneficial because it ensures those much-needed innovations get to market faster while preventing too much strain on an already struggling workforce by only asking them to test innovations for which there is a clear need. In short, we will work from a need perspective.

SHTC has also introduced the so-called “fast track procedure” to validate digital health innovations in real-life. How does it work?

Successful innovations in the health and healthcare field need to be driven by human-centered designs. Therefore, SHTC will apply Design Thinking methodologies during the testing and validation to bring together what is desirable from a human point of view with what is technologically feasible and economically viable, fine-tuning the value proposition of innovative solutions supported.

All-in-all, insights gained from real-world experiments provided by SHTC will increase innovations and outcomes that fulfill a real need and that benefit the end-user: citizens, patients, medical staff and healthcare workers. And that is what will drive their market uptake and societal value.

SHTC has established a fast-track procedure, with a form on the SHTC website, via which a smart health tech company can request services. Each request will be assessed against the degree of innovation, need and prospective added value of the technology. Based on the assessment by the innovation communities of practice, each company request evaluated positively will be offered a service package to fit its needs and requirements. This may involve pre-testing consultation for solutions at a lower Technology Readiness Level (TLR) to ensure a better fit and readiness for testing and verification at a later stage.

Real-life testing involves healthcare personnel, patients, healthy volunteers, etc., with inherent limitations and burdens. To make the best possible use of real-life facilities and services, we will prepare companies beforehand. SHTC also offers a 1-day pre-testing—in terms of technology and clinical benefits—consultation during which innovation communities of practice experts examine the technological question of an entrepreneur joined with the company.

On the one hand, the company will get advice on the feasibility of the innovation within a hospital setting or medical sector, technical aspects, and systemic and organizational conditions. On the other hand, it will also be briefed on the requirements and boundary conditions for the eventual testing so it is better prepared and takes the most advantage of its real-life testing. 

So SHTC is a connector between the technology developed in a laboratory and real-life settings, engineers and healthcare professionals. There are many breakthrough technologies developed for the healthcare market. Could you please give some examples of solutions that medicine needs most and that have a chance to scale?

Artificial Intelligence is going to play a major role in tasks such as automated image analysis—in radiology, ophthalmology, dermatology and pathology—and signal processing—electrocardiogram, audiology, and electroencephalography. In addition to its implementation in test and image interpretation, AI could be used to integrate and array results with other clinical data to facilitate clinical workflows and speed up processes. Again, radiology and pathology are often mentioned.

I think a field like emergency medicine could benefit tremendously from AI in different phases of patient management, such as the improvement of patient prioritization during triage, analyzing different elements of the patient’s clinical history, and so on.

Also, surgery decisions sometimes need to be taken under time pressure and conditions of uncertainty concerning patients’ diagnoses and expected response to treatment. AI tools could provide diverse sources of information—such as patient risk factors and anatomic information—that could assist with the development of better surgical decisions.

In addition, the field of mental health is an area with the potential for AI to advance the support of mental health patients and alleviate the effect of the scarcity of mental health workers. Developments such as digital tracking of depression and mood via keyboard interaction, speech and voice and interactive chatbots are underway.

It’s time to face the realities of the market and answer the million-dollar question: “Who will pay for it?” Payers that are still not really enthusiastic since the cost-effectiveness is not as easy to measure as for classical interventions or medicines? Patients who are not willing to pay because they already pay insurance premiums? Then who?

We hope that health insurance authorities will pay in most cases since the innovations could be part of the therapy or reduce costs compared to the traditional way of working. On top of that, hospitals also need to invest since it will be impossible to have a bigger healthcare workforce—the solution to this challenge will have to come from smart health tech.

The use of smart tech does not automatically mean things get more expensive. For example, before COVID-19, Dutch insurance companies had difficulty reimbursing telecare services. But when the pandemic hit Europe, there was no other way to assist patients. So now, remote consultations are seen as a routine procedure in the patient journey.

We’ve been talking about all these fascinating technological advances in healthcare, but let me ask you a more personal question now. What technologies fascinate you most in healthcare?

The answer is short: AI and robotics. We are starting to explore the opportunities that AI create and I’m sure there is much more to come soon. Let me give you a few examples. Firstly, AI has the power to move care from hospitals to patients’ hands. There are already solutions that identify skin cancer in an early phase or predict your risk of developing skin cancer. All you need is to take a picture with your smartphone. What’s more, you can even get individualized advice on how to protect yourself.

Secondly, we can now perform long-distance surgeries. As a result, people can access world-leading expertise and better healthcare without having to travel.

Thirdly, medical education and training using VR. Students can practice their skills in a secure setting with no stress, wherever they are—all it takes is to upload a training programme with different clinical cases. We are talking not only about practicing diagnosis, treatment or surgery but also about communication with the patient.

There is a visible gap between fast-growing digital technologies and their uptake in healthcare. SHTC wants to address this. But what else must be done so all European patients can access the most innovative solutions?

Digital technologies should be developed by manufacturers based on co-creation—through strong and continuous collaborations through design thinking between developers/designers and the clinical end-users, as well as medical ethicists, legal specialists and social experts—across all stages, from the design and development of the smart health tech solution to its validation and deployment. This is the only way that smart health tech solutions better reflect the needs and cultures of healthcare workers and patients and detect and address potential risks at an early stage.

Let’s get specific. What challenges does Erasmus MC face that, in your opinion, could be addressed using the right technology?

First of all, the healthcare staffing shortages that I mentioned before. Health tech could assist with automation and tools to predict, analyze and diagnose faster. Innovations can pave the way to more quickly, more effective and less time-consuming forms of communication between the various specialities.

Well-applied technologies have the potential to relieve healthcare staff of administrative burden and extensive reporting. And last but not least, digital transformations introduce personalized diagnosis and treatment. We will be able to predict upfront which treatment suits the patient best.

What else with regard to the patient journey and hospital workflows?

I think direct communication with healthcare workers via digital tools, 24/7, is a game-changer. Let’s be clear: many patients end up in emergency departments or family doctors due to a lack of communication.

Often, the questions come after you have visited the doctor or received a diagnosis. It is always very difficult to get reasonably quick access to your medical specialist/doctor to get the right answer or advice quickly. It might save a lot of unnecessary doctor visits and stress when you could ask your doctor—for example, using a secure mobile app—and receive a response more promptly than currently. Also, patients and healthcare staff are better prepared for a consult.

How do you see SHTC 5 years from now?

SHTC should develop into a National and European Experimental Twin Hospital setting—with future radiology, surgery, OR, ICU and ER monitoring—assisting healthcare workers in co-creation with companies to develop need-based applications of smart health techniques.

Thank you for your time!

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