5. strategic conference Value of innovation

Continuing insufficient role of data in deciding on innovations in healthcare, with more than enough arguments in favor

Ljubljana, 11 October 2016 – The development of policies in healthcare and decisions on the inclusion and financing of innovations should be supported with evidence in all areas to assure sustainability and quality of the healthcare system and based on coordinated data collection between all institutions and the findings should be made available to a wider audience, including healthcare service users.

Demographic indicators and increasing disparities between needs and available financial resources are one of the key challenges of healthcare politics. The fact that current finances no longer suffice for all available healthcare technologies, let alone the coming ones, has been the reality of our healthcare system for some time. It is therefore more important than ever for decisions to be deliberate and adopted on the basis of different data on their effectiveness and the economy of their introduction in the widest sense. At the 5th Value of Innovation Strategic Conference that took place today in the hall of the National Council of the Republic of Slovenia, developers of healthcare policies, representatives of institutions involved in data collection, keeping and processing and patients or civil society agreed that there is sufficient data available in the form of studies and registers in certain areas, but that there is plenty of room in other areas for improved monitoring of treatment outcomes and thus more deliberate further decision-making.

The first speakers to offer their view of the collection and importance of data in deciding to introduce and finance innovations in healthcare were President of the National Council Mr. Mitja Bervar and Chairman of the Committee on Health Mr. Tomaž Gantar. In his introductory speech, the President of the National Council emphasised the importance of information as the basis for the development of fundamentals for further decision making, whereby good quality and timely information is of key importance to assure that healthcare politics do not lose their effectiveness or degrade into conflicts. Regarding the role of the National Council in this process, Mr. Bervar said that practical experience shows the Council as an organisation with close ties to civil society. Chairman of the Committee on Health Mr. Tomaž Gantar believes we have finally reached a point where we need to decide how to proceed in the future and find solutions for the current state of the healthcare system so that we can take the same pride in the results as we do today over the coming ten or fifteen years. Of course, this requires increased investments, in part due also to increased numbers of patients with non-infectious illnesses.

State Secretary at the Ministry of Health Ms. Sandra Tušar stated that evidence, data and correct methodologies bring rationality, consistency and enable a systematic approach to the decision-making process and policy development in healthcare. As Tomaž Gantar before her, she too touched on the fact that the decisions made today will have a great impact on the health parameters of the future. It is therefore prudent to approach every decision making process with the question of which evidence to use and when to include it into the process. Ms. Tušar also mentioned the fact that there is plenty of data being collected in different fields within healthcare, but the links between them is far from optimal. According to Ms. Tušar, the Ministry is open for suggestions that would improve the process of linking together various databases. In the introduction of Health Technology Assessment elements into the decision-making processes, the Ministry of Health sees itself in conjunction with the National Institute of Public Health as the body coordinating different stakeholders involved in the process.

Mircha Poldrugovac from the National Institute of Public Health brought forth the importance and methodology of bringing various stakeholders into the discussion. The process of evidence supported decision making has a tendency to degrade into confrontation, a debate instead of the necessary dialogue. He emphasised the opportunity offered by EVIPNet (Evidence-informed Policy Network) for strengthening knowledge transfer mechanisms and promotion of evidence supported decision making along with the potential the bridging of the gap between researchers and decision makers could bring. All with the goal of creating good quality and useful starting points for the decision making process.

The role of patients is becoming increasingly desirable and accepted in the (collaborative) decision-making, but the voice of civil society is often ignored in practice and, in terms of providing different data, often also undervalued. Matija Cevc, President of the executive board of the network of non-governmental organisations in public healthcare 25 x 25, sees the role of non-governmental organisations in providing suggestions to decision makers, establishing dialogue and exchanging best practices. Optimal patient advocacy also requires access to data and findings. According to Mr. Cevc, the data platform exists, but one needs to be an expert in order to gain anything from the data as it is heavily fragmented. Truly accessing the data also requires certain specialised skills, so patients are hardly able to use them.

Guests of at the round table discussion, including Stanislav Primožič from the Public Agency for Medicinal Products and Medical Devices and Marjan Sušelj, acting Director of the Health Insurance Institute, agreed that plenty of data is already available and much more could be monitored, but the main challenge remains the connectivity of varying data. All participants expressed a hope that the introduction of HTA elements into the decision making process will optimise the exchange of information. The European Union requires all member countries to establish a body for the evaluation of healthcare technologies and its inclusion into the European network, but as Stanislav Primožič emphasised, the question of who will take over and manage the implementation of HTA at the national level remains open. Participants at the round table agreed that the range of innovations in healthcare will continue to grow, but the needs of insured persons are growing much faster than the abilities to introduce new healthcare technologies, particularly with the limited budget available for their inclusion into the public financing scheme. According to Tomaž Ganter, other more pressing issues are currently moving the discussion on the introduction of innovations further into the background in spite of evidence and arguments between decision makers.

Professor Nils Wilking from the Swedish Karolina Institute presented the newest report and overview of the treatment of cancer patients across Europe and in Slovenia and a comparison to the prior report. It is interesting to note that in spite of a 30 percent increase in the occurrence of cancer in Europe between 1995 and 2013, the introduction of new therapies led to an increase in mortality of only 11 percent while also extending survival. On average, the costs of cancer care and treatment remained at the same level at 6.7 percent of total healthcare expenditures. Mr. Wilking’s report also notes on differences in access to medicines and therapies in various countries and supports a well planned and transparent collection and processing of data on incidence and treatment outcomes. The field of oncology is growing ever more complex due to the introduction of new healthcare technologies, so permanent solutions must be found for its financing with the cooperation of all stakeholders in order to assure sustainability.

Data being collected by various public institutions, programs, studies and trials and through civil society structures is an excellent and necessary source of information for forecasting trends and reviewing of evidence on the effect of individual innovative therapies, thereby allowing for efficient and well substantiated introduction of innovations into the healthcare system with regard to limited resources. However, certain steps should be made towards better possibilities for linking data with a view to improve transparency and quality and such steps require accurately defined roles and competences, as well as a common will and use of modern technologies.

Maintaining a focus on evidence can assure the introduction of appropriate organisational, technological and other innovations. Access to appropriate data and information maintains access to high quality and effective treatments and reduces costs in the system that often occur due to arbitrary decisions and resistance to the introduction of new solutions. Innovative medicines and other innovations in healthcare have an important influence on the quality of life of patients with formerly untreatable and unmanageable illnesses, they extend life expectancy and quality and reduce direct and indirect costs of society in the mid and long term. But only if patients and healthcare workers can actually access them.

10th Value of Innovation strategic conference

Digital transformation for informed decision-making in healthcare

Ljubljana, 7 October 2021 – The covid-19 epidemic has exposed the issue of non-systematic approaches to digitalization in healthcare systems around the world, and Slovenia is no exception. If we want a high quality, responsive and sustainable healthcare system, one of the key solutions is clear: systematic digitalization with unified logging quality processing of data. This was the topic of debate for eminent foreign and Slovenian experts at the Value of Innovation Strategic Conference, organized for the tenth year running by the Forum of international research and development pharmaceutical companies (Forum).

The fact that health technology is developing ever faster and is being increasingly influenced by artificial intelligence was emphasized by Michael Strübin, director of digital health with Medtech Europe. The devices we wear on our bodies today to monitor movement and detect falls, measure physical activity, heart activity and even forecast its failure are proof of this rapid development. Mr. Strübin noted that artificial intelligence and medical technologies could save 40 thousand lives per year, making up for 200 billion Euros or worth of savings each year which corresponds to 12 percent of all health expenditures in the EU. “Artificial intelligence saves us 1.8 billion hours per year. This equates to five hundred thousand additionally employed healthcare professionals. We are not talking about replacing medical technologies but rather making them available for interacting with patients in areas where a human is better than a machine,” added Strübin.

Of course there are certain obstacles, particularly legal, regulatory and financial, but with good organization any healthcare system can become more accessible and personalized, noted leading health data expert from the Finnish innovation foundation Sitra, dr. Minna Hendolin. In spite of its small size, Finland is at the top of the European countries in terms of digitalization of healthcare services. In 2014, Finland adopted a comprehensive healthcare strategy that has so far survived three different governments. The aim of the strategy was to transform Finland into an internationally recognized powerhouse in the field of research, innovation and development, as well as investments into the health sector. The strategy emphasized the importance of using data for secondary purposes of research, development, innovation and policy development, but the success story could not start without a profound renovation of legislation, which proved to be the difficult part. Dr. Hendolin described the national service KANTA that was established to become the backbone of the data and healthcare ecosystem: “It is a repository of patient data, social and health data, data on prescriptions and a type of data bank. Stored data is accessible to healthcare professionals that use the service to store health records and prescriptions, but citizens can access the data as well.   KANTA also provides a service platform that is a very important part of Finland’s healthcare infrastructure,” emphasized Minna Hendolin.

The opinion that Slovenia is investing much too little in the digitalization of healthcare and building a common database was echoed by all Slovenian speakers at the conference. Bogdan Tušar, Director General of the Healthcare System Development Directorate at the Ministry of Health, reported that only a single percent of all funds earmarked for healthcare is allocated to digitalization. The percentage abroad is four times as high. But we are already carrying out measures and taking first steps towards more innovative healthcare. The Ministry has formed a new directorate to focus on development issues ranging from legislation, health protection, long term care and digitalization. Metka Zaletel, head of the Health Data Center at the National Institute of Public Health and Anka Bolka, head of the Directorate for Development and Analysis at the Health Insurance Institute of Slovenia, both reported that Slovenia is already collecting data and classifying it into useful databases.

One of the most challenging issues in Slovenian healthcare, as emphasized by Gregor Cuzak, co-creator and co-organizer of HealthDay.si, is also the fact that we invest into healthcare personnel for ten years or more, only to have professionals leave the country. Personnel issues could partly also be addressed by using artificial intelligence. The Conference saw a presentation of Frida – a commercial model of a humanoid robot. Dr. Izidor Mlakar from the Faculty of Electrotecnics, Computer Science and Informatics of the University of Maribor and University Medical Centre Maribor reported that the robot follows the vision of an open and comprehensive platform that could integrate various aspects of artificial intelligence into clinical care. Frida could be used to assist healthcare staff in various tasks, particularly in nursing care.

The healthcare sector in Europe has a turnover of 140 billion Euros and employs 760,000 people. Most of them, as many as 95 percent, work in small and mid-sized companies linked with the healthcare sector. Nathalie Moll, Director General of the European Federation of Pharmaceutical Industries and Associations (EFPIA) sees digitalization as the backbone of modern healthcare. She believes that digital health solutions and data will steer the development of life sciences and healthcare in the future.

“The epidemic has shown us how important it is to study diseases in a wider area, not only in individual countries. Countries must share their health data, establish a so-called federative architecture and begin analyzing mass data,” noted Dipak Kalra, President of the European Institute for Innovation through Health Data. It is health data that promotes innovation in healthcare. We must be aware of inequalities in the field of healthcare in different countries, but if we want to establish equitable access to health services, we must first establish appropriate data foundations, noted Dr. Kalra and emphasized the importance of data, that is essential for improving the quality of care and even finding out which areas require improvements.

The Conference also saw presentations of breakthrough therapies and technologies that will fundamentally change the way patients are treated. Prof. dr. Roman Jerala presented the importance and mission of the National Institute of Chemistry in the expansion of knowledge and linking with various stakeholders to transfer innovations into practice, including the development of new antiviral therapies. Prof. dr. Borut Štrukelj presented the future of RNA technology and the potential for developing new medicines using the technology.

Experts in the fields of healthcare and pharmacy agreed that digitalization of healthcare and a common European health database should be at the forefront of Europe’s efforts. If we want to have a high quality and sustainable healthcare system, a systematic digitalization is essential because a better integrated healthcare, remote or in person, brings long term savings and contributes decisively to greater resilience of healthcare systems.