Prof. Dr. Nick Alexander Guldemond, Pripravila: Tonja Blatnik, iUFC
Prof. dr. Nick Guldemond z Medicinskega centra Univerze Leiden na Nizozemskem je diplomiral iz medicine in elektrotehnike ter doktoriral na Univerzi v Maastrichtu. Bil je izvršni direktor in ustanovitelj Medical Field Lab, tj. prvega mednarodnega primera »živega laboratorija« v univerzitetni bolnišnici, posvečenega znanosti, inovacijam in vplivu na družbo. V tem obdobju je eksperimentiral z zgodnjimi univerzitetnimi koncepti odprtih inovacij, soustvarjanja, gradnjo inovacijskih ekosistemov. Opravil je prelomno delo z razvojem prve tehnologije nizkotemperaturnega 3D-tiskanja kostnih struktur, mobilnih sistemov za spremljanje različnih bolezni in zgodnje oskrbe na domu, ki temelji na smartTV (2007).
Prof. dr. Guldemond je dejaven tudi kot klinični raziskovalec na številnih projektih zdravstvenih inovacij, ustanovil je dve podjetji, je strokovni član delovne skupine Svetovne zdravstvene organizacije za digitalno zdravje, Panevropske komisije Svetovne zdravstvene organizacije za zdravje in trajnostni razvoj. Poznamo ga tudi kot koordinatorja EU EIP o zdravem in aktivnem staranju, kot strokovnjaka pri Svetovni organizaciji družinskih zdravnikov (WONCA) in kot strokovnjaka za implementacijo človekovih pravic v biomedicini pri Evropskem svetu. Je pridruženi urednik revije Journal of Integrated Care in član uredniškega odbora European Medical Journal.
INTERVJU:
Sredi junija ste obiskali Slovenijo. Udeležili ste se mednarodne konference “Voditeljstvo v zdravstvu v dobi novih tehnologij”, ki je potekala na IEDC-Poslovni šoli Bled. S kakšnimi vtisi zapuščate Slovenijo?
Konferenca je imela impresiven nabor govorcev, bila je vsebinsko bogata, dialog je potekal odprto, celo s kančkom humorja. Konferenca je dokaz ambicije, da bi tehnologija delovala v prid boljšega in trajnostnega zdravstvenga varstva, vključno s preventivo. Udeležili so se je relevantni predstavniki z ministrstev, akademskih krogov in industrije, tako da menim, da je bila zelo dobra osnova, da slovensko zdravstvo dvignemo na višjo raven. Vizija in ambicije, kot sta jih izrazila oba ministra, so velike, no, uspeh pa je v uresničevanju.
Nekoliko nenavadno je brati vaš življenjepis. Kako to, da ste združili medicino in zdravstveno nego s tehnologijo? Kje se prekrivajo farmacevtski, medtehnološki, zdravstveni, IT in finančni sektorji?
Zahvaljujoč mojemu usposabljanjem iz inženiringa (najprej) in medicine (pozneje) je moje razmišljanje o teh različnih temah steklo naravno in intuitivno – tako pri delu v klinični praksi kot pri raziskavah in inovacijah. V svoji karieri sem izkusil vse večjo konvergenco in integracijo diagnostičnih pristopov in načinov zdravljenja z medtehnologijo, farmacijo in upravljanjem s podatki. Enako zbliževanje se dogaja z disciplinami in strokovnim znanjem. Finančno gledano smo v zadnjem desetletju priča trendu plačevanja glede na rezultat. Tudi to je nekakšna konvergenca stroškov v enem plačilu. Po vsem svetu so proračuni za zdravstvo pod pritiskom in izbira, kaj povrniti in kam vložiti, bo vedno težja: časi »nebo je meja« za drage inovativne izdelke se končujejo in potrebne so nove poslovne strategije.
Na seznamu vaših »strank« najdemo tudi države – od Moldavije, Ukrajine, Savdske Arabije, Brazilije do Kitajske. Kaj počnete v vlogi strokovnjaka za digitalno zdravje in integrirano oskrbo za različne vlade na različnih celinah, nevladne organizacije, multinacionalke in start- upe?
Na kratko: zastavim kritična vprašanja. Nato s primeri in pridobljenimi izkušnjami pomagam pri razvoju strategije in načrtov za uresničitev. Razvijanje strategij vključuje upoštevanje celotnega zdravstvenega sistema na različnih ravneh (od politik do operativnih procesov) in več domen (storitve, tehnologija, upravljanje, zakonodaja/predpisi, finance) ter javno-zasebnih vidikov, makroekonomskih in političnih izbir.
Moja prilagodljivost pri razmišljanju o različnih temah med povečevanjem in pomanjševanjem vladam pomaga razumeti kompleksnost. Brez razumevanja tega, tudi dileme, kako zasnovati strategijo in katere konkretne odločitve sprejeti, ne moremo odpraviti.
Kaj je ključno za digitalno zdravstveno strategije države?
Politično vodstvo – brez tega je nemogoče vzpostaviti koherentno nacionalno vizijo in strategijo. Politični voditelji morajo zagotoviti smernice za izvedbo na nacionalni ravni kot tudi specifične ukrepe za regijo, prilagojene potrebam lokalnega prebivalstva. Strategije bi morale vključevati paciente in vse ustrezne deležnike. S soustvarjanjem bi morale zagotoviti razvoj konkretnih akcijskih načrtov, ki upoštevajo lokalne potrebe in kontekst. Tako bodo ljudje strategijo vzeli za svojo, jo posvojili.
Na konferenci na Bledu je bilo zelo dobro videti, da sta obe ministrici (o.p. dr. Valentina Prevolnik Rupel, Ministrica za zdravje, dr. Emilija Stojmenova Duh, Ministrica za digitalno transformacij) predstavili vizijo tega pristopa. Postopoma je treba izvedbene načrte izvesti s konkretnimi ukrepi, podprtimi z naložbami, koordinacijo. Ter napredek nenehno spremljati.
Kaj topogledno manjka Evropi?
Evropska komisija dejansko zelo dobro uspeva s celovito evropsko vizijo o digitalno podprti oskrbi, hkrati pa vzpostavlja zakonodajo in predpise (akti AI – Medical Devices Regulation, EHDS – The European Health Data Space, GDPR – The General Data Protection Regulation, MDR – Medical Devices Regulation). Prav tako podpira programe financiranja raziskav, inovacij in izvajanja.
Glavni izzivi in težave so na nacionalni ravni. Večina držav (vključno z Nizozemsko) nima skladne strategije digitalizacije, koordinacije, ustreznih naložb, pogosto osredotočenih na pilotne in posamezne projekte itd.
Nam zaupate kakšen dober primer?
Najbolje je pogledati po regijah, saj je zdravstvo v mnogih državah organizirano na regionalni ravni. Nordijcem gre na splošno zelo dobro. Na Finskem zdravstveno in socialno varstvo upravlja eno ministrstvo in rezultat vidite v njihovem digitalno omogočenem integriranem pristopu, usmerjenem v skupnost. Španske regije, kot so Galicija, Katalonija in Baskija, so dobri primeri, medtem ko tudi Združeno kraljestvo ponuja dobre prakse.
Tudi naše združenje SIS EGIZ, SRIP Zdravje medicina, deluje na področju prenosa inovacij v zdravstveni sistem. Zakaj se moramo v času starajoče družbe digitalizirati, da »ostanemo zdravi«? Kateri so glavni stebri sodobnih zdravstvenih sistemov? Katere od njih najbolj zanemarjamo?
Največja korist digitalizacije v zdravstvu je izmenjava informacij: brez izmenjave informacij je težko sodelovati in zagotavljati celovito oskrbo, osredotočeno na potrebe posameznika. Izmenjava informacij je bistvena za varnost, učinkovito delovanje in upravljanje ter spremljanje in upravljanje zdravstvenih sistemov. Potencialno bi lahko digitalizacija izboljšala dostop pacientov, samooskrbo, zdravstveno pismenost in veščine, ki so pomembne za zdravo življenje in preventivo. Bistvena stebra učinkovitega in visokokakovostnega zdravstvenega varstva sta: a.) učinkovit sistem, ki temelji na primarni oskrbi s pristopom, usmerjenim v skupnost, osredotočenim na preventivo, digitalno omogočenimi integriranimi storitvami, osredotočenimi na osebo, in b.) plačilni sistem na podlagi uspešnosti.
Vemo da so socialno-ekonomski dejavniki pomembni za splošno zdravje prebivalcev in vzdržnost zdravstvenega sistema. Ta pa je odraz vrednot in načel držav: v tem pogledu se zdi Slovenija odličen del sveta!
Preberite več tudi o projektu HealthChain I3 (Interregional Innovation Investment), ki spodbuja uvajanje digitalnih rešitev v medicino. Evropski projekt HealthChain za Slovenijo koordinira Slovensko inovacijsko stičišče, ki vodi strateško razvojno inovacijsko partnerstvo na področju zdravja in medicine (SRIP Zdravje – medicina), sodelujejo pa Kirurški sanatorij Rožna dolina ter IT-podjetji Gospodar zdravja in Parsek. Ključni cilj projekta je preseči vrzel med informacijsko komunikacijskimi tehnologijami in medicino in tako pomagati bolnikom do boljše in hitrejše oskrbe. V okviru projekta smo skupaj s hrvaškimi partnerji GIU 25. aprila 2024 v Zagrebu soorganizirali mednarodno konferenco za pospešitev prenosa inovacij v zdravstvene sisteme z naslovom ” Boosting the Interregional Healthcare Value Chains”. Našemu povabilu za glavnega govornika na konferenci se je odzval ekspert prof. dr. Nick Guldemond. Več o konferenci si lahko preberete tukaj.
English version:
The times of ‘the sky is the limit’ for expensive innovative products are ending
Prof. Nick Guldemond hold degrees in medicine and electric engineering and a PhD from Maastricht University. He was the CEO and founder of the Medical Field Lab (early 2000) i.e. the first international example of a university hospital based ‘living lab’ dedicated to science, innovation and societal impact. In this period he was experimenting with early days university based open-innovation concepts, co-creation, service design and building innovation ecosystems. In doing so, he performed groundbreaking work with the development of the first low-temperature 3D printing technology for bone structures, mobile monitoring systems for various diseases, early days smartTV (2007) based blended homecare, virtual surgical systems with augmented reality and haptic feedback as well as innovative care service concepts: diabetes, oncology and frail elderly.
He is also Professor for Public Health and Healthcare at various universities and holds a position as a Senior Researcher at Leiden University Medical Center in the Netherlands. During his career, Prof. Guldemond worked as a clinical researcher on numerous health innovation projects, often in collaboration with partners in the pharmaceutical, medtech, health IT and finance sectors. He has successfully managed various multidisciplinary/multicultural teams and established two successful companies. As a key expert on Health and integrated care, he is an Expert Member of the WHO Working Group Digital Health, WHO Pan-European Commission on Health and Sustainable Development and a consultant for Health programmes and medical curriculum development in various countries on different continents, NGO’s, multi-nationals and start-ups. Prof. Guldemond also served as the coordinator of EU EIP on Healthy and Active Ageing, as expert at the World’s Organisation of Family Doctors (WONCA) and as an expert implementation human rights in biomedicine at the European Council. He is associated editor for the Journal of Integrated Care and a member of the editorial board of the European Medical Journal.
What are your impressions from the conference “Leadership in Healthcare Amidst New Technologies”? Any special take-aways, impressions?
The conference had an impressive line-up of speakers, was rich in content, there was an open dialogue (with humour), was a proof of ambition to make technology work for better and sustainable healthcare including prevention. Relevant people were there from ministries, providers, academia and industry. I think this is a very good basis to take Slovenian healthcare to the next level. So, the vision and ambition as expressed by both ministers are great, but the success is in the implementation.
It does feel a bit unusual and surprising to read your CV. How come that you combine Medicine & Care with Technology? Where do pharmaceutical, MedTech, Health IT and finance sectors overlap?
With my training in engineering (first) and medicine (after), my reasoning with these different topics goes so natural and intuitive when working in clinical practise as well as research and innovation. In my career, I experienced the increasing convergence and integration of diagnostic approaches and treatment modalities with MedTech, pharmaceutical and data. The same convergence is happening with disciplines and expertise. Financially, you saw over the last decade a trend towards outcome-based payment, which is also a sort of convergence of costs for different activities, services and products in one single payment. Globally, healthcare budgets are under pressure and choices what to reimburse and where to invest will increasingly more difficult: times of ‘the sky is the limit’ for expensive innovative products are ending and new business strategies are needed.
You worked also on national levels – with Moldova, Ukraine, Saudi Arabia, Brazil, China etc. What do you do in the role of expert on Digital Health and integrated care for various governments on different continents, NGO’s, multi-nationals and start-ups?
Basically, help them with developing their own strategy and plans for realisation with critical questions, examples and lessons learned. Developing strategies comprises the consideration of a whole health system on different levels (from policies to operational processes) and multiple domains (services, technology, governance, legislation/regulation, finances) as well as public-private aspects, macro-economic and political choices. My flexibility to reflect on the different topics while zooming-in and -out help them to understand the complexities and dilemmas by which choose a strategic direction and make practical decisions.
What should digital health strategies of the countries (if you know enough of Slovenia, please refer to Slovenia) contain?
Political leadership is important for establishing a coherent national vision and a strategy for transformation. Political leadership should provide guidance for implementation framework and region-specific actions tailored to meet the needs of local populations. Strategies should involve patients and all relevant stakeholders through co-creation should ensure the development of concrete action plans that consider local needs and context which, in turn, will increase the support for adaptation. At the conference it was very good to see that both ministers presented vision along this approach. As said, eventually implementation plans should be executed with concrete actions supported with investments, coordination and monitoring.
What does Europe lack in this perspective?
The European Commission is actually doing very well with a comprehensive European vision on digitally enabled care while establishing legislation and regulation (AI act, EHDS, GDPR, MDR) as well as supporting research, innovation and implementation funding programmes. The main challenges are at a national level. Most countries (including the Netherlands) lack a coherent digitalisation strategy, coordination, adequate investments, often focused on pilots and single projects, etc.
What are the best examples of social based healthcare that you advised in various countries?
Best is to look at regions since healthcare is in many countries organised at a regional level. The Nordics are doing overall very well. In Finland, health and social care is managed by one ministry and the result you see in their digitally enabled integrated community-oriented approach. Spanish regions like Galicia, Catalunya and the Bask country are doing very well while the UK also provides good practices.
In Slovenia, SIS EGIZ, SRIP Health Medicine, works on transferring innovation to healthcare system, on healthy aging. Why do we need to digitalize in order to stay healthy? What are the main pillars of modern health systems – which of them do we neglect the most?
In general, the best benefit from digitalisation in healthcare is information exchange: without information exchange it is difficult to collaborate among professionals, organisations and provide integrated person-centred care. Information exchange is essential for safety, efficient operation and administration as well as monitoring and managing health systems. Potentially, digitalisation could improve patient access, self-care, health literacy and skills which are important for healthy living and prevention. Cornerstones/pillars of efficient and high-quality healthcare are a primary care-based system with a community-oriented approach focused on prevention, digitally enabled integrated person-centred services and performance-based payments. Obviously, social-economic factors are also important in the overall health of populations and the sustainability of such a health system. Interestingly, often health systems are a reflection of a countries’ values and principles: in that respect, Slovenia seems a very good place to be.