8.4 Himss Insights Ebook Covid19

GLOBAL NEWS EDITORIAL OPINIONS COMMUNITIES
INSIGHTS 8.4
JUNE 2020
COVID-19
AND
BEYOND
Digital health applications
enter regular care, and the
coronavirus could help open
the doors.
‘FLATTENING THE COVID-19: THE HOW HEALTHY

CURVE’ WITH VIRTUAL ULTIMATE TEST FOR DIGITAL ARE HEALTH
CARE IN AUSTRALIA HEALTHCARE SYSTEMS? APPS?
WELCOME 2
A virus –
and an engine for change
also speeding up efforts to develop contact trac-
ing apps and digital tools for quarantined citizens
during the pandemic, not only for medical needs,
but to help access critical information, guidance,
and advice.
Hal Wolf
COVID-19 has not only accelerated digital trans-
President and CEO formation, it has also unmasked areas in which
HIMSS there is still work to do – standards and interop-
erability, for example, but also cybersecurity, and,
of course, cloud-based electronic health records.
Some months ago, we would not have imagined The latter becomes crucial when and if a health-
that a single virus would fundamentally change our care system suddenly has to shift to offering most
world. Among the shifts taking place globally, is of its services remotely.
accelerated need for healthcare digitization. There
is no longer a question as to whether we should In this issue of HIMSS Insights, experts and journal-
implement telehealth services. The prominent dis- ists from all over the world take a look at challenges
cussion now focuses on the speed with which we can and digital solutions for a world now defined by
introduce technology to help connect and provide COVID-19. This issue also feature topics relevant
critical information pathways to support care. prior to the pandemic, including digital health
technology assessments and reimbursement mod-
Across the global health ecosystem, physicians els for digital medical applications.
and clinicians are turning to patient engagement
models, video-consultations and integrated infor- Enjoy reading, and above everything else, stay
mation. Hospitals are embracing telemonitoring healthy!
solutions to stay in close contact with their patients
and monitor them safely from home when pos- Be well.
sible, so as to keep them from having to enter
overwhelmed hospital systems. Governments are Hal
HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

CONTENTS 3
8.4
WELCOME
02 A virus – and an engine for change
THE BRIEFING
04 Beyond the Virus
THE PERSPECTIVES
06 What are the top 3 IT tools that you’ve used to
manage COVID-19?
07 COVID-19: The ultimate STRATEGY
litmus test for digital healthcare 07 COVID-19: The ultimate litmus test for digital
systems? healthcare systems?
15 Pandemic management – room for improvement at
ground control?
POLITICS & ECONOMY
25 TV How healthy are health apps?
TECHNOLOGY UPDATE
33 The rise of the dashboard
39 Why a data security sting lurks in COVID-19’s long tail
24 How healthy are health apps? GLOBAL TRENDS
46 COVID-19 and the future of care delivery
51 Data protection laws in times of COVID-19
54 New Zealand’s covid-crushing effort
57 Lessons from SARS
62 TV
‘Flattening the curve’ with virtual care in
TV Australia
LEADERS OF CHANGE
HIMSS TV features program- 67 TV Does the pandemic change the rules?
ing from major HIMSS events
MARKET MAKERS
and many of the industry’s 72 Up close and personal: Is it time to know your patient?
thought leaders.
COMMUNITY
SEE LATEST COVERAGE 78 Be a changemaker; contribute to shape the workspace of
tomorrow
GET IN TOUCH
UPCOMING EVENTS
TO APPEAR ON HIMSS TV
80 Your chance to network, connect and innovate

THE BRIEFING 4
BEYOND THE VIRUS

FOR HEALTHCARE, THE COVID-19 PANDEMIC IS MORE THAN A MILESTONE.
TELEHEALTH SERVICES WERE HIGH ON THE AGENDA IN MOST HEALTHCARE
SYSTEMS ALREADY. BUT IN FEBRUARY AND MARCH 2020, THEY BECAME
INDISPENSABLE WITHIN WEEKS. HERE IS WHAT HAPPENED.
BEFORE SARSCOV2
Health facilities say that they use:
74%
LIVE VIDEO-CONSULTATION
40% of health facilities and

technology vendors who offer patient-
REMOTE PATIENT MONITORING
facing telehealth services target
43% CHRONIC PATIENTS
TELE-TRIAGE 42% use them

34% for ACUTE CARE
DIGITAL TOOLS FOR TRAINING AND EDUCATION
53%
Source: HIMSS; eHealth Trendbarometer; “Telehealth Adoption in Europe”; April 2020

THE BRIEFING 5
AFTER SARSCOV2
Nearly 20,000 DOCTORS

AND PSYCHOTHERAPISTS IN PRIVATE PRACTICE
The US Health Maintenance Organization Kaiser
Permanente dispensed
registered for video-consultation services in the
German healthcare system in March 2020, AN 3.6 MN DIGITAL PRESCRIPTIONS
> 1000% 61% from March 2020.

INCREASE OF in April 2020, UP

compared to January/February 2020.1 In addition, >30,000
VIDEO-BASED CARE VISITS were done per day,
The number of new users on PING AN GOOD

which is
approximately 75%
OF THE OVERALL
NUMBER OF
900%
DOCTOR, a Chinese healthcare services platform, CARE VISITS.3
ROSE NEARLY

80%
in January 2020.
DOCTOR ANYWHERE and MYDOC, both based Thanks to COVID-19, of

in Singapore, witnessed an INCREASE IN DAILY HEALTHCARE START-UPS have seen an INCREASE
and 147%156%
ACTIVE USERS by
respectively in March 2020.2

in how frequently customers use their products. And
82%

see COVID-19 as a
BUSINESS OPPORTUNITY.4
1 Kassenärztliche Bundesvereinigung, April 2020, Germany; 2 Kapur V/Boulton A; Bain & Company; April 27, 2020; COVID-19 accelerates the adoption of telemedicine in Asia-Pac countries; 3 Kaiser Permanente; May 21, 2020;
COVID-19: The latest information; 4 strategy&; April 2020; Will COVID-19 jumpstart the digital healthcare revolution?

THE PERSPECTIVES 6
Q. WHAT ARE THE TOP 3 IT TOOLS THAT

YOU’VE USED TO MANAGE COVID-19? ?
TV TV
UK SPAIN
CUSTOMIZING THE ELECTRONIC THE EMR HAS BEEN THE MOST IM-
PATIENT RECORD PORTANT TOOL DURING THE CRISIS
Alerts in the EPR highlight high-risk patients, while analytical Remote working, AI projects and access to interoperable clin-
reports help support patient flow during the pandemic, says ical data has been imperative for optimum patient care during
Dr. Afzal Chaudhry, CMIO, Cambridge University Hospi- the pandemic, which has been enabled by the EMR says Juan
tals NHS FT, UK. Luis Cruz, CIO, Hospital Universitario 12 de Octubre, Spain.
TV TV
UK US
DIGITAL TRANSFORMATION WILL DEALING WITH COVID-19
BE ACCELERATED IN THE RECOVERY WITH DIGITAL TOOLS
PHASE OF COVID-19
Clinicians at the UK’s University Hospital Southampton have Contact tracing, telemedicine and a syndromic surveillance
managed to utilize an extendable EPR, which has improved tool were all approaches which helped in the battle against the
workflows – while video-consultations have also ensured coronavirus for Aaron Miri, CIO at Dell Medical School & UT
more structured patient care during the pandemic, says the Health, Austin, US.
trust’s CIO, Adrian Byrne.

STRATEGY 7
COVID-19:
The ultimate
test for digital
healthcare
systems?
The COVID-19 pandemic has tested
Spain’s healthcare system, while the
effectiveness of its electronic patient
records system has also been brought
into sharp focus. It has underpinned the
necessity to improve interoperability, and
to connect social and health care data to
avoid catastrophic scenarios.
BY MÉLISANDE ROUGER

STRATEGY 8
S
tandards for data exchange between systems have
been used for quite some time in Spain. Its electronic
patient record (EPR) system relies on DICOM, HL7
and most recently FHIR to share medical images and health
care data; coding standards like SNOMED CT or CIE-10
are used to share clinical data; and standards for clinical
archiving such as CDA, CCR and CCD have also been
implemented broadly.
Interoperability is only possible using standards for infor-

mation representation - for example ICD-10, LOINC or
SNOMED-CT that are used in hospitals. But typically, clin-
ical information is registered in a non-structured way and
often in free text - and when information is structured, it is
The biggest challenge
only through local terminologies that are not being shared was to obtain and analyze
with other centers. complex and relevant data
to alert professionals,
A huge effort is therefore needed to harmonize information quickly take clinical
models that share data and are linked with standard termi- decisions, organize care
pathways, and create a
nology, both for primary use in care and secondary use in pool of knowledge about
research, according to Juan Luis Cruz Bermudez, CIO of the virus, with data-based
Hospital 12 de Octubre in Madrid. research.
Juan Luis Cruz Bermudez,
INTEROPERABILITY DEFICITS UNMASKED Hospital 12 de Octubre in Madrid, Spain
“Spain has a high rate of EPR deployment, as defined by

HIMSS Europe standards. Every public hospital in Madrid
has an EPR system. Our hospital has even achieved stage 6
of HIMSS Analytics EMRAM. But interoperability between
these hospitals is not well developed because we lack these
information models. Interoperability today is more a ques-
tion of governance than technology,” he said.
Hospitals in Madrid use tools that help with this missing

interoperability between systems, for example tools for
appointment management and consultations between pri-

STRATEGY 9
mary care and the hospital. There is an EPR viewer on the

national and regional level, but this is far from being enough.
“In general, the connection degree between hospitals across
the country is quasi null and even very much reduced within
the same region,” he said.
The COVID-19 coronavirus epidemic hit Spain in mid-Febru-

ary and things deteriorated quickly. And it placed a spotlight Spain
on the current interoperability failings in the country.
“The pandemic put unprecedented strain on hospitals, with

needs for hospitalization and intensive care that completely
overwhelmed their capacities, but without reliable data on
how to best manage patients. This was while trying to main-
tain a level of care for other pathologies with a reduced
workforce, since the virus spread among healthcare profes-
sionals, who were in the first line of fire,” Cruz said. In terms of COVID-19: HOW THE
systems interoperability, things went too quickly to prepare CORONAVIRUS
adequately. “Interoperability is a process that takes years and
CRISIS WILL CHANGE
THE CARE MODEL
can’t be fixed within days,” he said.
THE REMAINING WORK TO FULLY DEPLOY

THE EPR
The experience has been a test and a realistic assessment
of what is still missing in that area. “We still have a long way
to go to obtain the expected results. We need a clear ori-
Spanish CIOs from major hospi-
entation as to what clinical value IT can bring and adequate
tals explained in a HIMSS Europe
funding,” he said.
webinar how they are handling
the extreme situation caused by
Carrying on with operations, establishing new care pathways
and obtaining information to support decision making for
prioritizing and planning actions and resources were particu- READ MORE
larly challenging tasks for IT services. Another challenge was
to try and cope with all the requirements to extend care areas SEE THE FULL RECORDING
OF THE WEBINAR
or include new buildings. For example medical hotels offer

STRATEGY 10
new telework capacities to guarantee the pursuit of opera-

tions in both care and management, and implement new care
processes such as home hospitalization.
The biggest test, Cruz believes, was to obtain and analyze

complex and relevant data to alert professionals, quickly take
clinical decisions based on multiple data, organize the hospi-
tal and its care pathways, learn how to best manage patients
and create a pool of knowledge about the virus, with data-
based research.
On the plus side, the crisis expedited the adoption of new

tools like video-conferences and teleconsultations, and has
facilitated the introduction of new remote monitoring tools.
We need to start
It also eased new data register along standard models, so as connecting long-term
to investigate data from different hospitals. “What used to social care with health
take years in other pathologies took weeks for COVID-19,” care. We cannot have
said Cruz, who also acknowledged the help received by ven- elderly patients in nursing
dors to quickly develop solutions. homes and not know what
is going on with them.
Rafael Bengoa,
Regarding authentication and security issues, there wasn’t
public health expert,
time to introduce changes in the technological strategy or Spain
try out new technology that had never been used before.
“But we’ve saved time in implementing new tools that were
already part of our strategy. For example the antivirus plat-
form update and collaboration and video-conference tools
deployment and VPN licenses,” Cruz continued.
CONNECTING SOCIAL AND HEALTH CARE

DATA
The pandemic has also highlighted an overdue conver-
sation about the integration of social data and health care
data. Two thirds of deaths in Spain have been citizens over
the age of 70, many in nursing homes. Clearly this demo-
graphic were biologically the most vulnerable group, but that

STRATEGY 11
doesn’t explain the whole picture, according to Rafael Ben-

goa, a public health expert who served as health minister in
the Basque Country and as an adviser to many governments
across the world.
“A huge flaw in this crisis was the structural exposure of the

weak relationship between health and social care. We need
to start connecting long-term social care with health care.
We cannot have elderly patients in nursing homes and not
know what is going on with them. They need to be better
protected,” he said.
The Basque Country has been looking for ways to combine

the data of both worlds for the past 10 years and their most
Social services are very
recent advance has been the electronic social health patient fragmented. So rather
record. The idea is to regroup all the data available from the than introducing one
social spectrum, which involves multiple agents at the munic- more tool that would
ipal or departmental level, and combine it with the existing be time consuming,
EPR of Osakidetza, the Basque public health care system. systems should be made
interoperable.
Alfredo Alday,
This advance could potentially have a significant impact if a
Basque government
pandemic were to hit again and presents multiple benefits,
especially as Basque people live longer with diseases and the
society has changed profoundly, according to Alfredo Alday,
who is head of digital innovation and change management in
social and healthcare environments at the Basque government.
“Combining these two aspects has become increasingly

relevant. More people are care-dependent and the issue
is gaining momentum in political agendas. There are sev-
eral factors behind this phenomenon: increased survival
to diseases and incidence of chronic diseases; but also a
major shift in family structure, with an increasing number
of households in which both parents work outside and less
generations live under the same roof. This has reduced

STRATEGY 12
personalized care traditionally provided by families, espe-

cially women,” he said.
61%
OF THE BASQUE
About 61% of the Basque population had at least one chronic POPULATION HAD
disease in 2019, according to the last population stratification. AT LEAST
Complex chronic patients represented 3% of global popula- one chronic
tion, about 69,628 people. Twenty-two per cent of Basques
are over 65 and life expectancy is 83.6 - higher than Spain
disease
IN 2019
(83.3) and Europe (81).
According to a study from Washington University, Spain will

become the country with the highest life expectancy in the Complex
world by 2040, before Japan. chronic
patients
CONSTRUCTING A NEW ELECTRONIC SOCIAL REPRESENTED
3%
CARE RECORD
To build a new electronic social healthcare record, the Basque

social health care committee has launched a dialogue with OF GLOBAL
all involved stakeholders which focus on five areas: technol- POPULATION
ogy, functionality, jurisdiction, administration and ethics. It’s
imperative that all of these areas are tackled to determine
the situation of the different systems that are currently being
used to ensure that everyone can access them. LIFE EXPECTANCY
IN
Interoperability once again takes center stage, especially Basque

since social systems are widely different depending on their
origin. There is no point in putting all the information under
83.6
one roof, when all systems could be made to communicate
Spain
83.3
without impacting workflow, Alday explained.
“Social services are very fragmented. So rather than intro-

ducing one more tool that would be time consuming, systems Europe
should be made interoperable. It’s complicated but that’s
the only way; professionals must go on working with their 81
STRATEGY 13
own tools, we shouldn’t disrupt workflow. And as citizens we

shouldn’t even notice a difference between social and health
care; the service should come as one,” he said.
So far the committee has found that many of the healthcare

players already use standards to share information (HL7) -
but not as many social services. “Not every party involved will
take part in this social healthcare coordination at the same
speed. There are different levels of digitization. Some have a
longer way to go than others,” he said.
By 2020 the committee plans to finish its interoperability

diagnosis of the different institutions involved, and define
a functional model. Over the decade, the social health-
care electronic record will request that each administration
allocated funding to planned development of its systems’
interoperability, according to a commonly established plan.
Integrating social determinants of health with clinical data is

a key aspect for the future and must be led at a national and
regional level, but not local, both Alday and Cruz insisted. It
is not as much of a technology issue as that of a governance
issue regarding information and interoperability of different
systems from social services, primary care, and hospital care,
they agreed.
The COVID-19 crisis has clearly magnified many pertinent

issues. “This is our opportunity to help the most vulnerable.
People don’t just die of diseases, they also die of loneliness,”
Alday concluded.

STRATEGY 14

STRATEGY 15
Pandemic management –
room for improvement
at ground control?
Infection surveillance and
infection control are part
of what makes countries
successful that manage
to keep the SarsCoV2
pandemic in check. Properly
implemented, digital solutions
can help a lot with testing,
tracing and isolating. Striking
the right balance between
meeting public health
requirements and upholding
privacy is not easy though.
BY PHILIPP GRÄTZEL
VON GRÄTZ

STRATEGY 16
W
ith the first wave of the COVID-19 pandemic
tapering off at least in parts of the world,
governments in many countries are working There is a tension
towards providing a framework of infection surveillance and between what might
infection control measures that hopefully allow to restart be desirable in terms of
public health and what is
economies and lift most of the lockdown measures that were necessary to protect an
implemented in March and April. The minimum goal would individual’s privacy.
be to move from an undifferentiated national lockdown to a Philipp Grätzel von Grätz,
more flexible, more regional, more data-based approach that HIMSS Insights
is chiefly about cluster containment and does less harm to
the economy and society.
Whether or not – and if so, how – digital solutions can con-

tribute to this pandemic transition phase is among the most
interesting questions that the COVID-19 pandemic poses
from a digital health point of view. It is also a difficult one,
first because there are very different ‘ground control’ require-
ments in infectious disease prevention and surveillance that
could be covered or partially covered by digital solutions,
and second because there is a certain tension between what
might be desirable in terms of public health and what is nec-
essary to protect an individual’s privacy.
INFECTIOUS DISEASE SURVEILLANCE BY

SOCIAL MEDIA MONITORING?
So let us take a closer look. Most importantly, there are very
different types of COVID-19 related public health apps. At
least some of the recent COVID-19-related privacy discus-
sions come down to misunderstandings of the purpose of
certain types of applications. And some politicians would
have been well advised not to associate different public
health goals when pushing for COVID-19 apps.
The first type of digital solution that has been mooted to

help contain COVID-19 is in fact much older than the cur-

STRATEGY 17
rent pandemic. These are infectious disease surveillance

applications. They don’t aim to manage individual human
beings with or without infections. Rather they are early warn-
ing tools, geared at detecting increases in disease activity on
a population level.
There are different approaches towards this goal. A famous

one that looked very promising in the beginning but proved
error-prone later on was Google Flu Trends (GFT), launched
in 2008 and abandoned in 2015. GFT tried to predict influ-
enza prevalence based on search engine queries and social
media content. It turned out that, used as a stand-alone tool,
GFT was considerably less accurate than conventional influ-
enza surveillance. Nevertheless, social media surveillance is
among the approaches that many “conventional” surveillance
systems have been adding to their tool kit in recent years.
Therefore, while GFT is dead, its vision is alive and continues
to be researched. Thryve published an app called
‘Corona-Datenspende’
ACTIVITY TRACKING AS AN ADDITIONAL
TOOL
The COVID-19 pandemic somewhat coincided with a
different, more sophisticated concept of digital disease
surveillance, one that doesn’t use social media data but wear-
able data, specifically fitness tracker data. Not anticipating
COVID-19, scientists such as Jennifer Radin, Eric Topol, and
Steven Steinhubl from Scripps Research in La Jolla, Califor-
nia, published a research study in January 2020 that analyzed
de-identified sensor data from 200,000 Fitbit customers.
Participants wore the device for at least 60 days and used it

regularly over a two year period between March 2016 and
March 2018. Data analyzed included resting heart rate and
sleep measures. The scientist could show that in US states
with a high number of participants, analyzing abnormalities

STRATEGY 18
in the Fitbit dataset significantly improved the prediction

of influenza-like illnesses – by 6% to 33% – compared to a
baseline model that used data from the Centre for Disease
Control and Prevention (CDC) only.
THE SPATIAL RESOLUTION PROBLEM

In March and April 2020, researchers from the German
CDC equivalent Robert Koch-Institut (RKI) together with
the Berlin-based digital health startup, Thryve, decided to
apply the Scripps-approach to the COVID-19 pandemic.
They published an app called ‘Corona-Datenspende’ (corona
data donation app) that collects data from different types of
smartwatches and fitness bracelets in order to look for early
warning signs that could make a second or third COVID-19
wave visible before infection rates go up and before labora-
tory statistics start looking suspicious.
According to RKI, within six weeks, more than half a million

wearable users have downloaded the app. If the user gives
their consent to the data donations, the company algorithms
can access step counts, resting heart rate, and movement-re-
lated data and analyze whether there are regional patterns
suggesting clusters of infected people that would feature an
increase in resting heart rate and/or a decrease in movement.
This type of analytics is obviously not specific to COVID-19.

However, it could help pinpoint regions that require more strin-
gent COVID-19-testing. While convincing in theory, there is a
spatial resolution problem in reality. With half a million down-
loads, it means that, at the moment, only one in 160 citizens in German Bluetooth-based,
mostly decentralized tracing
Germany is using the app: “Provided we had only 1,000 new
app ‘Corona-Warn App’
infections per day, the number of data donors would be too
small to make regional clusters visible,” says RKI researcher
Dirk Brockmann. There are limits for early recognition as long
as the number of data donors or wearable users is low.

STRATEGY 19
DIGITAL CONTACT
TRACING: THE HOLY
GRAIL?
Another type of digital health
application that many think could
be among the keys to unlock the
doors back to a somewhat nor-
mal life in times of a pandemic
are contact tracing applications.
Nearly all countries that were
heavily hit by SarsCoV2 have
started contact tracing app devel-
opment programs or launched In Norway, Smittestopp was withdrawn in June because of privacy
such apps already. These apps concerns and because it was not considered successful.
inform people about whether

and when they might have had
contact with someone who later
tested positive for SarsCoV2.
The goal is to warn people who
might have been infected as
early as possible.
Some of these contacts will be identified by conventional,

manual contact tracing anyway. For them, the app should
generate a warning that will typically arrive two to three days
prior to the phone call of the health authority responsible for
the manual contact tracing. Others, who may not have been
identified through manual contact tracing at all, would receive
a warning. “With conventional contact tracing, we lose many
people because we cannot inform them, for example fellow
passengers on a bus or on a train,” say Gottfried Ludewig,
head of digitization and innovation at the German Ministry
of Health. Ludewig is in charge of the German SarsCoV2
tracing app ‘Corona-Warn App’ that was made available for
app store download in the middle of June.

STRATEGY 20
There are problems with digital contact tracing apps

though. A number of evaluations have shown that many of
them don’t really work from a public health point of view.
Among the difficult issues is adoption. Coronavirus tracing
apps tend to be voluntary. In Norway, one of the forerun-
ners, only one fifth of the population was actively using the
tracing app ‘Smittestopp’ at the end of May. There were
also severe privacy concerns that led to the project being
cancelled in mid June. In Singapore, among the poster child
countries for digital healthcare and no stranger to citizen
surveillance, the local tracing app called ‘TraceTogether’
was adopted by only 25% of the population in May, two
months after its launch. This low uptake, again, is consid-
ered by local experts to be related to privacy concerns.
Iceland, too, is among the countries that started digital con-

tact tracing early. The adoption rate there is 40%, more than
anywhere else, but still not that impressive in a country with
In Singapore, the TraceTogether
a population of only 340,000. Iceland is also among the app is adopted by one fourth
countries that openly admit the app had not been as helpful of the population only.
as anticipated. In an interview with the Technology Review,
Gestur Pálmason from the Icelandic Police Service said that
the ‘Rakning C-19’ app was useful in a few cases but far away
from being a game-changer.
IS PRIVACY A SUCCESS FACTOR OR A RISK

FACTOR?
Around the globe, there are different strategies to improve
digital contact tracing. One school of thought says the appli-
cations should be mandatory. This is the road that was recently
taken in India, a country with high numbers of infections in
some parts of the country and a fairly draconian lockdown
that left many people stranded away from home. In India,
people who want to travel to or enter their workplaces have
to download the government’s ’Aarogya Setu’ tracing app.

STRATEGY 21
India’s tracing app, like the one in Iceland, uses GPS technol-
ogy. The app had come under scrutiny in early May, when the
French IT expert Robert Baptiste, a ‘friendly hacker’ who calls
himself Elliot Alderson on Twitter, claimed that he was able
to identify infected people based on the location data that
the ‘Aarogya Setu’ app is collecting and which are stored on a
central server. This led to discussions in India about whether
the app should be made open source for better transparency,
and whether mandatory use should be abandoned or at least
restricted to certain areas.
Next to India, Singapore is another country that is toying

with the idea of making digital contact tracing mandatory.
In the earlier phase of the pandemic, leaders of Singapore’s
Coronavirus Taskforce have repeatedly said that they
wanted everybody to use the tracing app once the technol-
ogy was ready. But this didn’t quite work. By early June, the
new goal was to replace the ‘TraceTogether’ app by a Blue-
tooth-based wearable that would be mandatory to wear and
serves the same purpose. The advantage, according to the Iceland - ‘Rakning C-19’
Singapore government, is that a separate wearable can also

be used by people without a smartphone. Furthermore, a
separate wearable might be more socially acceptable, since
tracking it might be considered less intrusive than smart-
phone surveillance.
THE MORE TRUST, THE MORE VOLUNTARY

ADOPTION
In fact, many countries outside of India and Singapore
are trying to boost adoption rates of contact tracing apps
or contact tracing wearables not by making them man-
datory, but by applying unusually high transparency and
privacy standards, and by using technology that makes
the applications less prone to fraudulent use. While, for
example, the contact tracing apps in South Korea and Ice-

STRATEGY 22
land use the GPS signal, and thus could, in principle, be

misused for location tracking, most of the newer apps that
are being developed and implemented now are based on
Bluetooth signals.
Bluetooth is not particularly suitable for location tracking. It

also provides a more accurate depiction of contacts, since
truly close contact can be identified more accurately, and
time of exposure to an infected contact can also be quan-
tified better. Advanced pseudonymization technology and
decentralizing large parts of the applications are other tech-
nological approaches that aim to increase trust. One example
is the UK, that had originally planned to inroduce a centralized
contact tracing app infrastructure. In the midlle of June, the
government suddenly announced that it would instead back
the contact tracing model favored by Apple and Google and
use their interface for the national contact tracing app that,
so far, is not yet available. India - ’Aarogya Setu’
Germany is also using the Apple and Google interfaces for

its contact tracing app. There was a representative survey
made by the Nürnberg-Institut für Marktentscheidungen
among 1,500 people in Germany shortly before the German
healthcare system started rolling-out its Bluetooth-based,
largely decentralized and fully open-source contact trac-
ing app, developed by SAP and Deutsche Telekom, in the
middle of June. The survey asked whether people would be
willing to install contact tracing apps of various types.
A hypothetical app that only stores data on the mobile device

and nowhere else, that is completely voluntary and evaluated
continuously by independent researchers, received the high-
est approval rate, an impressive 69%. Contact tracing cannot,
by definition, be fully decentralized. But the results indicate
that transparency and privacy will very likely increase the will-

STRATEGY 23
ingness of citizens to install a contact tracing app on their

mobile devices – and thus increase the likelihood, that such
an application will make a real public health difference.
This is also true for other digital contact tracing that do not
rely on peer-to-peer recognition. Singapore again: The city
has rolled-out its ‘SafeEntry’ application in late April. This is
a QR-code based check-in system which replaces hand-writ-
ten lists of people visiting certain location. Citizens entering
hotels, supermarkets, hospitals and offices are required reg-
ister upon arrival and departure.
BEYOND EXCEL: HOW TO MANAGE INFECTED

PATIENTS AND CONTACT PERSONS
Finally, successful coronavirus ground control is also about
managing infected people and their contact persons. This has
nothing to do with digital contact tracing per se. It is rather
more about process management tools for local government
health agencies that, during certain phases of the COVID-19
pandemic at least, have to deal as efficiently as possible with
hundreds of cases and contact persons in parallel. Each of
these patients or contact persons has to be accompanied for
14 days typically. In many countries, the method of choice for
healthcare workers or COVID-19 tracing staff is to use Excel
sheets. This works reasonably well in, say, meningitis outbreaks
with a limited number of infected children and a limited num-
ber of contact persons. In the case of SarsCoV2, it is different:
Excel-based administration of infected persons and contacts
can quickly become a process management nightmare.
Interestingly, dedicated outbreak software has been existing

for years already, but it is typically not used in industrialized
countries. A prime example is a software called ‘SORMAS’
that was developed in Europe and installed in hundreds of
local health centers in the Ebola regions in Africa, covering a

STRATEGY 24
population of more than 140 million citizens in several coun-

tries. ‘SORMAS’ provides digital pathways for managing
patients and contact persons more efficiently than can be
done with spreadsheet software. Recent add-on apps also
allow communication with infected persons and contacts
digitally, replacing the need to do daily phone calls and ask
for symptom development.
The last category of digital applications for infectious dis-

ease control is quarantine surveillance tools. These are in use
in only a few countries now, since in many parts of the world,
they are perceived as some kind of electronic ankle bracelets
and as such somewhat too intrusive in a public health context.
The prime example of this app is the South Korean ‘Self-Quar-

antining Safety Protection’ app that visitors to South Korea
have to install for 14 days when entering the country. Kerala,
a province in Southern India that has contained COVID-
19 with relative success, used a similar tool, the app ‘Covid
Safety’ to enforce quarantining in one heavily affected
region, Kasargod, and later in another city, Kochi. This app
informs the local police when a person quarantined is more
than 50 meters away from home. Interestingly, though, the
app is voluntary, but seemed to work nevertheless. Speak-
WHAT DO
ing to the Times of India, Kochi City Police Commissioner
YOU THINK?
Vijay Sakhare said: “People in quarantine should realize that
What is the key factor
a mistake could put the lives of our elderly and others in
in achieving high
society at risk.”
contact tracing app
uptake?
GET IN TOUCH
TO LET US KNOW
YOUR THOUGHTS

POLITICS & ECONOMICS 25
How healthy are

health apps?
Digital health applications
are starting to make their
way into regular healthcare
provision. But how should they
be regulated? Digital health
technology assessment (HTA)
is increasingly recognized
as an important pillar on
the way towards universal
reimbursement.
BY CORNELIA WELS-MAUG

H
ealthcare systems around the world are entering a
new era in which digital healthcare applications are
increasingly becoming part of standard medical care. All apps in the NHS Apps
Whereas medications must undergo a strict regulated process Library are rigorously
of testing before they are approved and eventually reimbursed, tested and assessed to
ensure they are clinically
a similar process for digital health apps has only recently started effective, safe to use,
to emerge. Some countries are pushing ahead now with digital secure and protect patient
HTA. They could become trailblazers. data, to a recognized
national standard.
The consumerization of healthcare has increased the develop- NHS Digital spokesperson,
UK
ment of apps in the healthcare space exponentially. According to
the IQVIA Institute for Human Data Science’s 2017 publication
The Growing Value of Digital Health, more than 200 health apps
are being added daily to the top app stores globally, with over
318,000 health apps available in 2017 alone. These apps address
a wide array of health issues geared to prevent, manage, or treat
a medical disease or disorder.
THE NEED FOR A FRAMEWORK TO ASSESS

HEALTH APPS
With the number of available healthcare apps on the rise, so
are concerns about their effectiveness and safety. What is the
evidence that they do what they claim to do and are there any
side-effects associated with their use? Given the rigorous assess-
ment pharmaceuticals and medical devices must undergo to be
licensed there is an increasing call to apply the same rigour when
it comes to mobile health apps to ensure the adoption of state-
of-the-art-technology into healthcare.
HTA coins the attempt to establish such a systematic evaluation

of the properties, effects and impacts of health technology. It
looks at the safety of an app, how securely it handles data, its
clinical effectiveness and usability and considers legal aspects,
among others.

THE HEALTH APP TV SEE LATEST COVERAGE

TRAILBLAZERS
A few countries are push- SHEBA’S PURSUIT OF PERFECTION IN ISRAEL
ing ahead with HTA on
a national basis, with the
UK being the first to have
published a catalogue of
assessment criteria, Ger-
many taking the lead in
integrating health appli-
cations into standard care
and Finland currently work-
ing on a national HTA
framework. Although Israeli
health institutions are using Dr Nathalie Bloch of the ARC Innovation Center at Sheba Medi-
health apps extensively to cal Center, Israel, discusses the use of AI in dealing with COVID-19
improve customer service, patients, among various other innovative tools, in this episode of The
there is no set of nationally Alessi Agenda.
agreed criteria for health
app assessment in place.
THE UK: MARSHALLING APPRAISAL OF APPS

The UK has been a role model when it comes to assessing health
apps in Europe. NHS Digital, the national information and tech-
nology partner to the health and social care system, has defined
a set of criteria that apps must be fulfil to be listed in a catalogue,
the so-called ‘NHS Apps Library’. The latter was set up in April
2017 and currently includes 92 apps.
“All apps in the NHS Apps Library are rigorously tested and
assessed to ensure they are clinically effective, safe to use, secure
and protect patient data, to a recognized national standard. As
there are a wealth of healthcare apps in the current market, the
Library is available for health professionals and patients to have
a resource of trusted, high-quality apps that they can choose

from to support them in meeting their clinical needs. We sup-

port developers to have their apps accepted into the Library with
guidance and feedback and encourage them to submit their apps The NHS would
for assessment,” says an unnamed NHS Digital spokesperson. not usually reimburse
patients for choosing
a paid-for app.
To establish what this assessment process entails, NHS Digital
NHS Digital spokesperson,
has published the guidance for health app developers, commis- UK
sioners and assessors. A core part of the evaluation are the ‘Digital
Assessment Questions’ (DAQ), a set of criteria that serve as a
national standard that NHS Digital published in February 2017.
“While it references other frameworks, legislation and best prac-
tice where appropriate, it is a unique set of assessment criteria
that app developers must evidence adherence to in order to be
included on the NHS Apps Library”, states NHS Digital upon
request (see Fig. 1).
In the evaluation process NHS Digital examines, “whether apps

are clinically effective, safe and easy to use, interoperable with
current NHS infrastructure, if appropriate, and hold a high
standard of data security,” explains the press team from NHS
Digital. The actual reimbursement is not something NHS Digi-
tal gets involved in, “this choice is down to the developer,” says
one of its press officers and adds: “The NHS would not usually
reimburse patients for choosing a paid-for app.”
Figure 1
Once an app is successfully

appraised, it becomes part of
the NHS App Library. It will
remain in the Library indefi-
nitely unless the developer asks
for its removal or in the case a
developer does not make the
required changes to remain in
line with current legislation, says
NHS Digital. Source: NHS Digital

GERMANY THRIVES TO INTEGRATE APPS

SWIFTLY INTO STANDARD HEALTHCARE
DELIVERY So far, no European
Although Germany has lagged behind digitizing its healthcare country has developed a
delivery, the ‘Digital Healthcare Act’ (Digitales-Versorgungs-Ge- structured way to bring
digital innovations into
setz), a law that came into force in January 2020, marks a turning mainstream coverage.
point. Amongt other innovations, it enables doctors to prescribe Dr Henrik Matthies,
digital health applications (DiGAs) for the first time. The costs health innovation hub,
Germany
are to be covered by the statutory health insurance companies
over an initial 12-month-period during which vendors must prove
that the app improves patient care. Prior to prescription, an app
needs to be approved by the Federal Institute for Drugs and
Medical Devices (BfArM) for functionality, data security and
data protection within a so-called ‘Fast Track’ procedure. If an
app satisfies those criteria and fulfils a test concept to prove a
positive effect on healthcare, it will be included in a health app
library, the so-called ‘DiGA directory’.
“So far, no European country has developed a structured way

to bring digital innovations into mainstream coverage,” says Dr
Henrik Matthies, MD of the health innovation hub (hih), the
arm-length body of the Federal Ministry of Health that is tasked
with developing ideas and concepts for the digital transformation
of healthcare. “The Digital Healthcare Act paves a clear, struc-
tured and fast way to evaluate and – if positive - integrate digital
health applications into the German statutory healthcare sector,
all within 15 months,” Matthies comments.
THE FAST TRACK PROCESS

For a DiGA to be included in BfArM’s DiGA directory, it must
be CE-certified to start with. Developers must submit applica-
tions via BfArM’s portal that has been operational since 27 May
2020. The BfArM has three months net for appraising a submis-
sion. In case of its acceptance, the DiGA will be provisionally
included in the directory. Thereafter, it can be prescribed and will

be reimbursed at a price set by the vendor for this initial period. If

positive health effects in terms of medical benefits or procedural
and structural improvements of a patient’s care can be confirmed
during this initial period via a comparative study, a DiGA will be
permanently included in the directory. At that point, the ven-
dor must negotiate a price with the federal representation of all
statutory health insurers. If both sides cannot agree on a reim-
bursement price after a year’s negotiation, an arbitration body
can be involved.
Currently at least 15 companies have submitted an application,

Jari Haverinen, Specialist Digital
according to the Spitzenverband Digitale Gesundheitsver- Health Solutions’ Assessment,
sorgung, an association of organizations active in the eHealth DigiHealth Hub at the Faculty of
Medicine, University of Oulu
domain. This means the first DiGAs could be preliminary listed
as early as August/September 2020.
FINLAND WORKING ON AN HTA FRAMEWORK

There had been no dedicated HTA framework for digital health-
care services or products until the Finnish Ministry of Social Affairs
and Health commissioned one recently. “The Finnish Coordina-
tion Centre for Health Technology Assessment (FinCCHTA) is
the key player and is also responsible for liaising with international
HTA bodies”, explains Jari
Haverinen, Specialist Digital Figure 2:The Digi-HTA process in Finland
Health Solutions’ Assessment,

DigiHealth Hub at the Fac-
ulty of Medicine, University of
Oulu, who has been part of the
HTA development effort.
The University of Oulu and

FinCCHTA published the
so-called Digi-HTA framework
in November 2019, see Figure 2
for its schematic depiction. Source: Jari Haverinen and Veera Virta, both DigiHealth Hub

“Our goal is that Digi-HTA becomes a guideline for developers

so they know which issues they should consider in a healthcare
context”, Haverinen adds, so that they can determine how suit- Three years ago, Israel’s
able their products are for use in healthcare. “After assessing a prime minister invested
product, we will give a recommendation; the key criteria being a substantial sum to
advance innovation in
its effectiveness, cost, safety, usability and accessibility as well digital health, focusing
data security and protection”, he shares. on data security and
telemedicine services.
The framework addresses not only mobile apps, but digital Dr Eyal Zimlichman,
Sheba Medical Center,
healthcare services such as artificial intelligence (AI) solutions Israel
and robotics. It is currently being piloted. However, apps have
not been assessed to date, but pilots will commence shortly
assures Haverinen. It is planned to update Digi-HTA in the
light of changes in specifications or regulations and after the
introduction of new technical features.
ISRAEL: HEALTH APPS INSTRUMENTAL TO

COMPETE ON CUSTOMER SERVICE
Digital health is an important aspect of the healthcare provi-
sion in Israel. “Three years ago, Israel’s prime minister invested
a substantial sum to advance innovation in digital health,
focusing on data security and telemedicine services,” says Dr
Eyal Zimlichman, chief medical officer and chief innovation
officer at Sheba Medical Center.
Healthcare is delivered by four health maintenance organ-

izations (HMO) - Clalit, Maccabi, Meuhedet and Leumit.
Although citizens are mandated to take out health insurance
with one of them, they can choose freely and switch provid-
ers. This is operational on account of all healthcare providers
sharing patient information on a single platform.
These HMOs operate their own medical facilities but must

offer a uniform list of health services. However, they differ in
terms of customer service: “Each institution has its own por-

tal to compete on customer service,” says Zimlichman: “The

portal gives patients access to a unique set of apps e.g. those
for accessing lab results or X-rays or for booking appoint-
ments with doctors,” he outlines. In fact, apps are a means to
give a healthcare organization a competitive edge. However,
this is not helped by the fact that HMOs do not support inter-
national standards like HL7 or FHIR: “This is a big issue for
integrating medical systems and apps,” according to Dr Gidi
Stein, co-founder and CEO of MedAware from experience.
Although there is widespread use of healthcare apps in Israel,

Dr Gidi Stein, co-founder and
there is no national HTA scheme in place. “Other than com- CEO of MedAware
pliance with data security and protection regulations, health
apps are not regulated,” says Stein. “In addition, app develop-
ers must negotiate with each organization the specifications
of the app and its price. Sometimes this includes sharing rev-
enue,” he explains.
Apps have already become an integral part of our daily lives;

wellness and fitness apps have opened new opportunities
to care for our wellbeing. Building a regulatory assessment
framework for health technology similar to that of tradi-
tional pharmacological treatments will reap health benefits.
Furthermore, and perhaps most importantly, it will ensure
that these apps are secure for users to utilize.

TECHNOLOGY UPDATE 33
The rise of the

dashboard
Visualizations are receiving considerable attention in the age of COVID-19,
but is there more to them than meets the eye?
BY TAMMY LOVELL
Credit: Bertram Solcher/Asklepios

T
he COVID-19 pandemic has put the use of health-
care dashboards under the global spotlight. Each
day, the global cases and deaths dashboard created The pandemic gave us
by the Center for Systems Science and Engineering at the US’ a push and proved that
John Hopkins University, receives around 1.2 billion requests. the technology we’re
using is able to connect
Created by Professor Lauren Gardner and her graduate stu- the different hospital
dent, Ensheng Dong, the public-facing tool aggregates data information systems.
from multiple credible sources to track the spread of the virus Henning Schneider,
in near real-time. Asklepios,
Germany
Within healthcare, dashboards have also been utilized for

tracking resources during the pandemic. Henning Schneider,
CIO of the German hospital chain Asklepios oversaw the
creation of a dashboard covering the group’s 65 hospitals,
which provides an overview of available hospital beds and
ventilators, as well as the number of patients in intensive care
units (ICU) or who need ventilation or cardiac support.
To help define what visualizations would be included, a crisis

team of specialized intensive care doctors was formed. With
this input IT staff were able to swiftly create the dashboard,
based on a business data warehouse with standardized cus-
tomizations they had already set up for reporting on financial
overviews and key indicators such as patient admissions, ser-
vices and staffing.
“The pandemic gave us a push and proved that the tech-

nology we’re using is able to connect the different hospital
information systems,” Schneider tells HIMSS Insights.
One hurdle was persuading each of the hospitals to define

beds in the same way in order to define a central process
for the clinical information system. In the past, staff had pre-
ferred to rely on local systems, but the emergency situation
made them more willing to cooperate.

“Suddenly there was something more important,” says

Schneider. “This is the biggest thing that has changed –
understanding that if staff do the right thing in the local I can pull a report out
system it will be transferred in the right way to the central from our electronic
system and can be used as a data source.” medical records, but then
we also do a physical
walk and count to re-
The dashboard has been successful in providing early indi- verify that information is
cators for when hospital occupation rates are becoming too accurate.
high and Asklepios plans to use dashboards in the future to Mark Brown,
replace spreadsheets for quality indicators such as hygienic Good Samaritan Hospital,
US
protocols, infections and death rates.
‘ONEROUS TASK’
However staff are not always so enthusiastic about such dash-
boards. Santa Clara County in the US has created a publicly
available tool with visualizations including acute hospital bed
availability, ventilator availability, total number of cases, and
deaths form the virus.
But Mark Brown, chief nursing officer at the state’s Good

Samaritan Hospital says the tool would need “more work”
before being useful for health institutions.
“It’s useful for the public, but not so much for the hospitals,
as the data is only as good as who is submitting with no inde-
pendent verification,” he explains.
Although Brown concedes the dashboard is a “nice first step

to gather all the data in one warehouse,” he adds that some
hospitals may over or under report statistics and the data
gathering has been “an onerous task” for staff.
“I can pull a report out from our electronic medical records,

but then we also do a physical walk and count to re-verify
that information is accurate,” he explains.

TRAFFIC LIGHT SYSTEM

Wolfgang Jentner, chair for data analysis and visualizations
at the University of Konstanz, is part of a team of 25 PhD We wanted our tool
students which created Germany’s CoronaVis data map. to be immediately
understandable
because in a crisis the
The publicly available resource uses a traffic light system to doctors don’t have a
show availability of ICU beds and ventilators at 1,321 reported week to learn it. We
facilities nationwide, with data provided by the German Asso- needed to reduce the
ciation of Critical Care and Emergency Medicine (DIVI). probability that it can be
misinterpreted.
The data map is typically viewed around 500-700 times a Wolfgang Jentner,
University of Konstanz,
day, but Jentner points out there is information that could Germany
make the model more accurate, which has not been provided
for political or financial reasons. Although the German DIVI
Intensive Register Regulation brought in during the pan-
demic obligates hospitals to reveal if they have beds free, he
says they are not keen to reveal the exact numbers.
“Hospitals can lose money by keeping beds free, so they’re

not interested in a computer which means that competitor
hospitals will take their patients because they’re nearly full,”
he explains.
DAMNED LIES AND STATISTICS

As well as political issues, human bias has to be taken into
account when creating visualizations. “Every one of us is
biased and if you have a very strong opinion you will try to use
statistics or visualizations to prove you’re right,” says Jentner.
The brain can easily be manipulated by the use of certain

images and patterns, such as flashing lights or red. Although
from a purely scientific view, green and red are not the best
colours because they are difficult for people with colour
blindness to detect, it was important that CoronaVis could
be quickly interpreted.

TV SEE LATEST COVERAGE
COVID-19 EXPOSES NEED FOR REAL-TIME

ANALYTICS
“We wanted our tool to be
immediately understanda-
ble because in a crisis the
doctors don’t have a week
to learn it. We needed to
reduce the probability that
it can be misinterpreted.”
Jentner is now working

with a ventilator manufac-
turer to create a proof of
Medicomp CEO Dave Lareau discusses how his company made early
concept on whether data
coronavirus-specific changes to its database and AI engine as the pan-
can be extracted directly
demic took hold in February and has continued to innovate since then.
from medical devices.
“This visualization could be used for any crisis in the world.

If a lot of people need to be hospitalized, we think we can
extend our tool not only to ICU beds, but to other things that
show a hospital’s capacity.”
However, dashboards are not suitable for all projects. If a

project is too general it can become overly complicated,
whereas if there is not enough data it will not be possible to
capture randomness.
“There are certain pre-conditions for machine learning. The

data has to have a certain quality and standardization,” Jent-
ner explains. “Some companies have a lot of data but don’t
have specific problems. If you get data with no direct goal,
the machine can find a lot of spurious correlations which
actually have nothing to do with each other.”

Aside from COVID-19, Jentner has worked on several

EU-funded schemes including Primage, an ongoing project
in medical imaging, artificial intelligence (AI), which aims
to support decision making in the clinical management of
childhood cancers Neuroblastoma (NB) and Diffuse Intrin-
sic Pontine Glioma (DIPG).
“It’s not easy to use the standard AI approach, because fortu-

nately there are not many cases of these types of cancer. We
work very closely with end users like doctors, medical imaging
people and radiologists to learn what’s important and try to
make an optimal visualization dashboard for them,” he says.
Although computers are good at processing large amounts of

information and making predictions, human input is needed to
detect patterns and consider context-based information.
“What we’re trying to do is build tools that work together

with humans to help them make the right decisions. A lot
of people think AI can save the world or their company but
that’s not true.”
To this end, Jentner believes that more education is needed

about statistics and programming.
“With the internet and social media we have an information

overflow. It’s difficult to distinguish whether a source of infor-
mation is real or not. People try to lie with charts and because
the public can’t understand this they can easily be manipulated.”
Ultimately dashboards can offer an insight into statistics, but it is

still the human interpretation that makes them truly effective.

Why a data
security
sting lurks in
COVID-19’s
long tail
Hospital executive minds have
understandably been distracted
since the start of 2020, but the
impact of the emergence of
SarsCoV2 has not been limited to
its physical toll. It has also torn
into data security defenses and
exposed patient privacy to a new
round of opportunistic cyber-
attacks.
BY PIERS FORD

T
he word ‘unprecedented’ seems to have been used on
a daily basis during the COVID-19 pandemic, par-
ticularly when it comes to the impact of the virus on Hospital CIOs are
patients, clinicians, resources and care delivery. But it has reso- pulled between two
nated equally strongly with hospital chief information security worlds – security on
the one hand
officers (CISOs), with its power to either stiffen resolve or and accessibility
ratchet up already stretched nervous tension as data security on the other.
faces a whole new scale and level of cyber threats. Matt Lock,
Varonis, UK
Far from arriving alone, the virus was accompanied by a host
of cyber aggressors with an eye on the vulnerabilities that
would almost certainly be exposed in the armour of health-
care institutions while attention and energy were diverted to
the frontline of patient care.
Threats descended from all directions as organized cyber-

crime breached hospital defenses to launch ransomware
attacks. Some agencies even identified the hacking of corona-
virus research lab systems by rival states as a real and growing
threat. At the same time, the rapid rollout of new telehealth
systems to reduce physical contact by enabling virtual patient
communications and consultations was opening up a whole
new front in the health data security war.
CYBER-ATTACKS ON THE RISE

Within weeks of the WHO declaring a pandemic on 11 March,
the organization itself was reporting a five-fold increase in
cyber-attacks on its own systems. In the UK, the C5 Cap-
ital alliance of cybersecurity businesses had already noted
a 150% increase in attacks on healthcare systems between
mid-January and March.
A series of high-profile incidents also made headlines. Access

to systems across Brno University Hospital in the Czech
Republic was disrupted and coronavirus test results delayed

CYBERSECURITY LEADERS’ ROLE IN A CRISIS
Mansur Hasib, also known as “Dr. Cybersecurity” and author of the

book Cybersecurity Leadership, discusses what CIOs and CISOs must
do during such crises as pandemics and hurricanes.
by a ransomware attack on the hospital’s research lab. In

London, Hammersmith Medicines Research fell victim to a
similar attack. And in the United States, the US Health and
Human Services Department was hit by a DDoS assault.
By May, agencies including the National Cyber Security

Centre (NCSC) in the UK and the Cyber Security and Infra-
structure Security Agency (CISA) in the US were advising
healthcare staff to change passwords and implement two-fac-
tor authentication in the face of a rising tide of password
spraying attacks.
Given the scale of this onslaught – and the potential value

of a rapidly accumulating and immensely valuable volume of
patient data – it would not have been surprising for any insti-
tution to find itself caught on the back foot.

“Hospital CIOs are pulled between two worlds – security on

the one hand and accessibility on the other,” says Matt Lock,
technical director UK at data security expert Varonis. “Medi- With telehealth,
cal staff and other personnel require access to patient records we have many
for care and book-keeping, but this exposure comes with more devices and
connections now
added risk. Secure networks, long passwords, and employees involved with
following IT and security best practices are good in theory. healthcare –
Still, they are often far from reality when unpatched and out- every one is a
dated systems, shared logins, and even passwords scribbled new way in.
on sticky notes leave information exposed and vulnerable. Patricia Carreiro,
Carlton Fields, US
JUST ONE MISTAKE

“The NHS, or any organization, could have strict security pro-
cesses in place. But it only takes one employee and just one
click to open the door to a cyber-attack. Cloud collaboration
platforms have introduced additional risk by giving employees
a variety of new ways to copy, save, and share data with just
about anyone. Many organizations are behind on their cyber-
security checklists on a good day when it’s business as usual.
Add a global pandemic to the mix, and it’s a recipe for disaster.”
In the stretched, stressed and distracted environment of a hos-

pital at the height of the pandemic, the possibility of even one
individual taking their eye off the data security ball and using a
short-cut to access information could be just the weakest link
the cyber aggressor is looking for. And the more sophisticated
threats don’t announce themselves with a grand-standing
ransom demand. They sneak in, establish themselves and qui-
etly work their way around hospital systems, applications and
devices, exploiting weaknesses and gathering information until
they are in a position to cause maximum damage.
TELEHEALTH STRESS
“With telehealth, we have many more devices and connec-
tions now involved with healthcare – every one is a new way

in,” says Patricia Carreiro, a data privacy and cybersecurity

litigation attorney at Carlton Fields, a national law firm in the
US, where the Office for Civil Rights (OCR) has temporarily Many organizations
relaxed some security requirements. She says this means that are behind on
valuable healthcare data is now being transferred over less their cybersecurity
checklists on a
secure technology. good day when it’s
business as usual.
“Healthcare data carries an extraordinarily high value on Add a global
the black market, typically worth 10 to 40 times more than pandemic to the
a credit card number,” she adds. “Transferring such valuable mix, and it’s a
recipe for disaster.
information over unencrypted technologies, as now tempo-
Matt Lock,
rarily permitted, creates a situation ripe for hacking. Hackers
Varonis, UK
can simply insert themselves in the unsecured communica-
tion, take the information they desire, and proceed to sell the
information to perform various types of healthcare fraud or
identity theft.”
More broadly, says Carreiro, hackers are increasingly target-

ing healthcare providers, looking to take advantage of any
unpatched systems or similar vulnerabilities.
“Perhaps one of the largest vulnerabilities caused by COVID

is a particularly distracted/stressed workforce, who may be
increasingly likely to fall for phishing emails,” she continues.
“One wrong click, and an entire hospital system could come
screeching to a stop. And the increasing need for technol-
ogy and medical services only gives hackers more leverage to
extract hefty ransoms from hospitals looking to regain access
to their data and systems.”
At Varonis, Matt Lock says the range of data contained in

hospital systems makes them prime targets for an equally
wide range of threats, from well-funded attackers looking
for medical data to steal, to hackers demanding ransom pay-
ments to decrypt patient data.

The nature of new applications – tracing systems, for exam-

ple – that might link into healthcare systems is also adding to
the value of the data, inevitably raising privacy issues. COVID-19 related
information is
“COVID-19 related information is typically personal health typically personal
health information…
information,” says Mike O’Malley, VP carrier services at Personal data such
security and network specialist Radware. “Daily temperature, as this is very
flu symptoms, underlying health conditions (heart disease or valuable on the
diabetes for example), insurance provider if applicable, as dark web both for
well as GPS and daily movement data about the subjects and identity theft as
well as mass illegal
where they are tested each day, who they interact with, who surveillance.
those people interact with and so on. Personal data such as
Mike O’Malley,
this is very valuable on the dark web both for identity theft as Radware
well as mass illegal surveillance.”
According to Lock, for the hospital CISO tasked with keeping

on top of all this, fire-fighting means that proactive manage-
ment tends to take a back seat – as do security audits. In
the UK, NHSX has even pushed back the deadline for NHS
organizations to complete their Data Security & Protection
Toolkit (DSPT) submissions until the end of September.
While this keeps CISOs free to focus on the wider COVID-19

response, delayed updates could open up new vulnerabilities
in hospital defenses – and store up legal problems for the
not-too-distant future. Patricia Carreiro says the implications
of this fall into two types: those related to litigation and those
that are more operational.
Operational implications relate to policies, notices, con-

sents and contracts. Carreiro says that healthcare providers
should verify that the changes they quickly made to meet the
demands of COVID are reflected in their privacy policies
and notices, that they are providing all required disclosures,
and that they are securing all necessary consents.

“In addition, they should verify that any new contracts they
quickly entered meet their legal obligations and plan for how
these contracts may need to be amended after COVID,”
she says.
These will vary in different countries but in the US, while

healthcare providers may not currently need a business asso-
ciate agreement with their telehealth service provider, they
almost certainly will once COVID passes. Given the increas-
ing number of attacks on healthcare providers, an immediate
update and rehearsal of the organization’s incident response
plan is also recommended.
LEGAL STING
There is also the danger of litigation following a breach. Glob-
ally, healthcare data breaches cost the industry billions each
year. Again in the US, Carreiro explains, even beyond repu-
tational harm and lost business following a breach, hospitals
and health care providers face reporting obligations under
state and federal law and expensive litigation from regula-
tors, contractual relations, and impacted individuals.
“While some falsely take comfort in HIPAA not having a

private right of action, patients whose information is compr-
omized can sue providers under a number of theories, most
notably, negligence, unfair trade practices, and, in some
instances, fraud,” she warns. “While OCR may not prosecute
healthcare providers for using some less secure technologies,
[it] has not given providers a pass on all HIPAA obligations,
and nothing stops others (like consumers) from suing if their
information is compromized.”
In other words, for hospital CISOs everywhere, data secu-

rity could yet prove a sharp sting in the very long tail of the
COVID-19 pandemic once the reckoning begins.

GLOBAL TRENDS 46
COVID-19 and the

future of care delivery
It was quickly recognized all around the world that the COVID-19
pandemic requires tools to provide safe access to health and care at
a distance. But often there is a gap between ‘recognizing’ and ‘doing’.
Scotland is demonstrating how a rapid and sustainable telehealth
transformation can be achieved in times of crisis.
BY NESSA BARRY

GLOBAL TRENDS 47
T
he opportunity to deliver a session for new healthcare
students on the subject of telehealth is an enjoyable
one. However, these sessions usually begin with a hurdle
to be overcome – that of terminology. Discussion on the defini-
tions for telehealth, telecare, telemedicine and other terms under
the digital health and care umbrella is always required.
We start with a graphic that shows citizens accessing health and

care at different points along a continuum of care. The contin-
uum runs from the home or community setting – through to an
acute hospital setting. In these conversations about how technol-
ogy might be used in different scenarios, and the terms that are
applied, we always emphasize that the prefix ‘tele’ simply means
‘at a distance’ and that students should focus on the intervention,
the health and care being provided. I have repeated that sentence
many times over the years and it comes to mind now, more than
ever, as we look for tools to maintain and provide safe access to
health and care services at a distance.
SHIFTING THE PERCEPTION OF DIGITAL HEALTH

AND CARE
Without doubt, the crucial requirement of us all, as citizens, to be
physically distant as part of the response globally to COVID-19
has resulted in a significant shift in how we think about technology
as a tool to overcome distance. In our personal, leisure and work
lives, as well as how we access health and care services, the use of
technology has (largely) been viewed as a positive.
It is impossible to
underestimate the
When it comes to the conversation around telehealth, the mes- importance of the years of
sage that staying home will help to protect our own health, the collaborative groundwork
health of those we care for and those who are vulnerable, has been undertaken in Scotland
highly successful. The message that adhering to this request, and on the digital health
and care agenda.
using other tools to communicate, to help to protect our health
Nessa Barry,
and care systems has been understood and accepted by the vast Digital Health and Care Directorate,
majority of citizens. Scottish Government

GLOBAL TRENDS 48
Prior to the declaration of the COVID-19 virus as a pandemic by

the World Health Organization in March 2020 Scotland, in com-
mon with most other countries, had been working to implement Changing the way that we
and embed proven digital health and care solutions and to signifi- work in health and care,
cantly extend the numbers of people benefiting from technology and making these changes
stick, requires the right
enabled care and support. It is impossible to underestimate the technology and, equally
importance of the years of collaborative groundwork undertaken important, the right
in Scotland on the digital health and care agenda, driven by health people with a clear remit
and care integration policy. to do the work.
Nessa Barry,
Digital Health and Care Directorate,
SCALING UP TECHNOLOGY TOOLS Scottish Government
One factor that we have in common with many countries, and that
is often discussed with our colleagues in the digital health sphere,
is the frustration felt at times due to the slowness of scale up and
the challenge to embed the new ways of working that come with
digital transformation.1 The deployment of technology as a tool
to enable us to bridge the distance that COVID-19 has imposed
has also been accepted with an immediacy and a unity of purpose
by health and care providers.
The latest policy framework for Scotland guiding this digital trans-
formation work is the Digital Health and Care Strategy from 2018.
The strategy seeks to strengthen all of the elements of service
delivery that are essential to sustainable digital health services and
locates digital health and care within the citizen-centred service
redesign narrative. In Scotland, leaders across the key stakeholder
groups have been aware of the potential value of digital health
and care for some time. The essential groundwork undertaken
over the last 15 years has no doubt helped us to gain support from
the stakeholders (politicians, policy makers, budget holders and
industry partners) who make rapid scale up possible.
Since the declaration by the WHO on 11 March 2020, the Scottish

1 Scotland’s Digital Health and Care
response to the COVID-19 pandemic has included plans for the Strategy: enabling, connecting and
Scottish Government’s Technology Enabled Care, Digital Health empowering (2018)

GLOBAL TRENDS 49
and Care Directorate to work in partnership with health, social

care and housing partner organisations (public and third sector)
and industry partners, to support the rapid roll-out and expansion
of digitally enabled services.
From the outset, the public-facing advice and guidance in

response to COVID-19 has been provided by NHS 24.2 NHS 24
is the national provider of healthcare information and advice, by
telephone and online, to Scotland’s citizens. In addition to the
111 telephone number, COVID-19 specific advice has been pro-
vided through the NHS inform website and via chatbot, 0800
helpline and App.
In March 2020, the Scottish Government produced advice and

guidance on Information Governance to support the safe deploy-
ment of telehealth. This assurance has given clear support to the
use of technologies such as mobile messaging and video-enabled
services, for example.
Staff leading on the implementation of digital health, who are not

working in front-line service delivery, have been given dedicated
support and had their teams expanded to deploy digital health
and care services in response to COVID-19 in areas including:
primary care, care at home and public health.
One example is the creation of an expanded team with capa-

bilities in technology roll-out, change management and health
improvement, which has led to the expansion of video-enabled
consultation. Referred to in Scotland as “NHS Near Me”3, this
service was part of a long-term implementation program and, by
February 2020, there were approximately 300 video-consultations
per month. With added support in response to COVID-19, this
has grown exponentially. The milestone of 100,000 video ena-
bled consultations between March-May 2020 has been reached. 2 https://www.nhs24.scot/
Over a third of which were carried out in General Practice. 3 https://www.nearme.scot/

GLOBAL TRENDS 50
Another example, which recognizes the value of connection

between patients and their families in Intensive Care Units (ICU),
has included a compressed 9-day national roll-out of a secure Opportunities to expand
video messaging system for ICUs in all Scottish Health Boards. workforce capabilities
with a COVID-19 lens
will undoubtedly help to
CULTIVATING THE RIGHT CULTURE shape not just the present,
Other responses to COVID-19 have included working with as we deal with this crisis,
national partners to review and improve procurement and design but the future of how
processes for key digital services, such as remote health moni- health and care services
toring. Furthermore, being able to maintain service levels for will be delivered.
vulnerable citizens who are recipients of telecare in their own Nessa Barry,
Digital Health and Care Directorate,
homes is vital when reinforcing the public health message to stay
at home and stay safe. Thinking differently about how to use
existing services to keep in contact and support people at home
is another strength of this work.
With these examples of rapid roll-out, as with others, it is important

to acknowledge that merely recognizing telehealth (and digital tools
more widely) as useful, is not enough. Changing the way that we
work in health and care, and making these changes stick, requires
the right technology and, equally important, the right people with
a clear remit to do the work. A supportive environment, creating
the conditions for success, which includes clear leadership, more
Learn more about the
rapid procurement processes, the production of clear (profession
Digital Health and Care
or domain focused) guidance provides staff with the supporting
Directorate, Scottish
protocols and permission to use telehealth effectively.
Government during the
‘Telehealth Implemen-
Whilst the focus on delivery of front-line services is rightly drawing
tation Masterclass’ at
most of our attention, it is also noteworthy that, since March 2020,
HIMSS & Health 2.0
the number of knowledge exchange sessions, webinars, online
European Digital Event on
instruction etc., has grown significantly. Staff in all sectors have
8 September at 11am CET
demonstrated abundant goodwill in shared learning. Opportunities
to expand workforce capabilities with a COVID-19 lens will undoubt-
edly help to shape not just the present, as we deal with this crisis, but LEARN MORE
the future of how health and care services will be delivered.

GLOBAL TRENDS 51
Data protection laws

in COVID-19 times
Brazil is among the countries most heavily hit by the COVID-19 pandemic.
With its GDPR-inspired data protection law, the country was among the
forerunners in regulating digital privacy in 2018. Now, a postponement
looks likely for fear of overwhelming the industry.
BY CLAUDIO GIULLIANO

GLOBAL TRENDS 52
T
he world saw in 2018 data protection laws being
approved on both sides of the Atlantic. In the US,
the ‘California Consumer Privacy Act of 2018’ was
adopted, and in Europe the ‘General Data Protection Regu-
lation’ (GDPR) came into effect. Brazil was also among the
global leaders in privacy regulation, the ‘Lei Geral de Pro-
teção de Dados Pessoais’ (LGPD – 13.709/18) was approved
in August 2018.
The new law is a specialization for other specific laws such as

the Código de Defesa do Consumidor (Consumer Defense
Code). Meanwhile, LGPD has seen several adjustments on
its content and effective date. After having considered post-
poning the effective date of LGPD due to the COVID-19
pandemic, on 19 May 2020, the Senate approved a recom-
mendation. It was presented by Senator Weverton Rocha,
for the effective date to be established for August 2020.
This last recommendation is currently waiting for the presi-
dent’s approval.
The main goal of the LGPD is to guarantee the privacy of

people’s personal data and allow greater control over them.
The law preconizes norms, standardization and clear rules
for the processes of collection, storage and sharing of this
information. In addition, the law aims to help to promote
economic and technological development. Somewhat simi-
lar to GDPR, the Brazilian LGPD law applies to all sectors of
the economy, and it is mandatory to Brazilian companies but
also to foreign companies that operate within Brazilian bor-
ders. Rules include the holder’s right to rectify, cancel or even
request deletion of their own personal data. It also includes
the need to create a National Data Protection Authority
(ANPD). LGPD also makes it mandatory to notify affected
individuals in case of any incident involving personal data.

GLOBAL TRENDS 53
The drafting of the Brazilian LGPD was clearly inspired by

the European GDPR. But it is important to note that there
are also some differences. For example, holders’ right of
information, personal data consent and proof of consent
obtention as well as security parameters for treatments, stor-
age and handling of data are topics that are dealt with by
the LGPD and are very similar to how the European GDPR
addresses them. Differences, on the other hand, can be found
with regard to specific types of data – health, biometric,
and genetic data, among others. Most of these differences
relate to the differences in the legal system between Europe
and Brazil, with Brazilian law being less specific in areas like
healthcare that, in Europe, is regulated in great detail on a
national level.
Overall, the main challenge for making the Brazilian LGPD

a success is investment. The reality on the ground is that,
two years after it was approved, many companies still don’t
comply with the LGPD rules. Among the reasons for this are
not only adjustments in software, but also in security tools,
security processes, and privacy-related staff training. The
recent recommendation for postponing the effective date
of the LGPD was due to the impact of the COVID-19 pan-
demic on the Brazilian economy. There is clearly the fear to
overwhelm companies if one more challenge is presented in
such a short period of time.

GLOBAL TRENDS 54
New Zealand’s
covid-crushing effort
The response by the New Zealand government to the COVID-19 pandemic,
including closure of the border, a national lockdown, widespread testing and the
uptake of technologies, has brought the crisis there under control. HIMSS Insights
spoke to Shayne Hunter, deputy director general of data & digital at the New
Zealand Ministry of Health about how their strategy and implementation.
BY LYNNE MINION

GLOBAL TRENDS 55
O
n 8 June, as most nations continued to grapple with
COVID-19, Prime Minister Jacinda Ardern announced
New Zealand no longer had any active cases of the
virus. The country had recorded a total of 1,154 confirmed cases,
including nine deaths, before it had ’eliminated’ the disease.
How vital has technology been in New Zealand’s

response to COVID-19?
We have been able to maintain services while the bulk of
the workforce is working and collaborating from home. This
would not have been possible otherwise. Had this occurred
five years ago it would have been a different story. We did
have Skype but the advent of tools like Zoom and Teams,
and the investment in moving to Cloud services along with
high-speed internet, have been significant enablers. Data was vital to
supporting the
Data was vital to supporting the management of COVID-19, be it management of
COVID-19, be it in
in modelling, reporting, surveillance and contact tracing, etc. modelling, reporting,
surveillance and
There are many other examples. For instance, over the past few contact tracing, etc.
months, we’ve seen first-hand how New Zealand’s GPs have Shayne Hunter,
tackled some unique challenges head on, leading to the wider New Zealand Ministry of Health
utilization of things such as remote consultations.
So I would simply say it’s been absolutely vital to the response.
Can you describe the speed at which innovation has

occurred, and what that has entailed in terms of exper-
tise, stress, fraternity and government support?
We have achieved in months what would have taken years.
Some important foundations were in place or in the process
of being put in place, which helped considerably.
But for me there were a number of important – in fact, critical

– contributors. People came together and there was great team-

GLOBAL TRENDS 56
work and collaboration. There was total commitment to the

cause, going above and beyond, being decisive and accepting
that we may get it wrong but that we can fix it or pivot, access to We have achieved in
funding but also the generosity of people (offering their skills and months what would
time) and suppliers (heavily discounting their charges and offer- have taken years. Some
important foundations
ing great value add). were in place or in the
process of being put
Will this lead to a watershed in terms of technology in in place, which helped
healthcare? considerably.
For sure. I was very clear with my team as we started respond- Shayne Hunter,
New Zealand Ministry of Health
ing to COVID-19 that if we go through this situation and end
up in the same place we are now, we have missed out on an
opportunity to make enduring improvements to the health
and disability system. I think that we have made gains, great
gains in some cases. What will be important is to lock in the
gains we have made and to build on these at pace.
We can do it and I believe there is a genuine desire across the

board to do what is required, be it about models of care/service
design and the associated funding and regulatory changes, tech-
nology enhancements, acceleration to cloud, and embracing
more agile/iterative solution delivery, etc.
Which companies in New Zealand have been key to the

achievement?
Ones that come to mind for me include Microsoft, Deloitte,
PWC, Salesforce/AWS, Rush Digital, Web Tools, as well as COVID-19:
the many digital/ICT folk in the Ministry of Health, DHBs, ACKNOWLEDG-
primary and community care and the central agencies, all of ING THE NEED TO
whom play a critical role in support our digital efforts. But I ADOPT DIGITAL
must stress that there are many others that have been key to HEALTH IN NEW
the achievements. ZEALAND
There is a lot to celebrate in terms of how we came together in READ MORE

response.

GLOBAL TRENDS 57
Lessons
from
SARS
During the COVID-19 pandemic,
hospitals in South-East
Asia had an advantage over
medical institutions in other
parts of the world, since they
had dealt with a SARS virus
in 2003 already. So what do
they recommend in terms of
outbreak prevention? And are
there similar efforts underway
elsewhere?
BY PHILIPP GRÄTZEL VON GRÄTZ

GLOBAL TRENDS 58
H
ospital outbreaks of SarsCoV2 are considered
important ‘milestones’ on the road from an unpleas-
ant but manageable regional SarsCoV2 outbreak, The most important
to a major healthcare disaster with overcrowded hospitals and factor for outbreak
excess mortality. Once out of control, hospitals tend to act as prevention is staff
surveillance, since it is
super-spreaders and contribute to, rather than help contain usually members of
the infection chains. Preventing hospital outbreaks, thus, is staff, not patients,
among the most important individual measures to contain who carry the virus
the SarsCoV2 pandemic. from ward to ward.
Philipp Grätzel von Grätz,
HIMSS Insights
It will be impossible to prevent every single SarsCoV2 infection
in a hospital. But there are options to reduce the likelihood of
major hospital outbreaks, most importantly minimize the risk of
infection and transmission, and optimize the way an infectious
or potentially infectious patient is dealt with within an institution.
Digital tools are important elements in this agenda, said Benedict
Tan, chief digital strategy officer at SingHealth, one of the big-
gest healthcare providers in Singapore during a HIMSS webinar.
SingHealth is running four hospitals with around 250,000
in-house patients per years. The organization also takes care of
several million outpatients annually.
ALGORITHMS CHECK TEMPERATURE OF STAFF

MEMBERS
The most important factor for outbreak prevention, according to
Tan, was staff surveillance, since it is usually members of staff, not
patients, who carry the virus from ward to ward and from patient
to patient. SingHealth hospitals perform laboratory screening on
their staff, but they have also implemented a digital temperature
measurement scheme. Every staff member is obliged to take
their temperature two to three times per day. The value is stored
in a surveillance system automatically, and algorithms analyze
the fever curves and generate an alarm when the value exceeds
the normal variation.

GLOBAL TRENDS 59
“We do that in order to identify fever clusters on wards as early

as possible,” said Tan. It has been shown that such a tempera-
ture screening is not totally reliable, since there are infected
persons who transmit the virus before becoming symptomatic.
However, 100% safety is not what these types of measures are
about. Measures like taking temperatures are about decreasing,
not eliminating risk, and thus about reducing the likelihood of a
disastrous hospital breakdown.
WANT TO VISIT? ASK THE AUTOMATED VISITOR

MANAGEMENT SYSTEM FIRST!
SingHealth hospitals also use IT systems for decreasing the risk
of transmission on the side of patients and visitors. In the emer-
gency units, every patient who is capable of doing so completes
an online questionnaire in order to document symptoms and
the individual medical history. This information is immediately
available to the ER doctor or ER nurse as part of the electronic
medical record. According to SingHealth chief medical infor-
matics officer Goh Min Liong, this policy reduces the contact
time between staff and patients and thus – again – mitigates the
risk of virus transmission from patient to staff member.
Another key application, according to Liong, is an automated vis-

itor management system (AVMS) that was developed in recent
years as a direct learning from the 2003 SARS epidemic. In con-
trary to policies in many other countries, Singapore generally allows
visiting friends and relatives in a hospital during the pandemic. But
everyone has to register at the AVMS before entering the hospital.
Visitors fill in a questionnaire on symptoms and risk factors, and

they have a temperature check. The AVMS then calculates a
risk score. A low-risk visitor can enter the hospital pretty quickly,
wearing only a face mask. A higher-risk individual will be given
additional personal protective equipment first. The AVMS also
makes sure that no more than two or, in less critical times, four

GLOBAL TRENDS 60
people visit a ward at the same time. This makes it possible for
ward staff to keep an eye on every individual visitor.
Unlike many other
TWO IT DEPARTMENTS ARE BETTER THAN ONE countries, Singapore
Since the digital infrastructure has to work as reliably as possible generally allows visiting
friends and relatives
in times of a pandemic, 24/7 availability of qualified IT staff is in a hospital during
another success factor to keep a hospital running. This is why the the pandemic.
SingHealth IT department has switched to a specific staff roster Philipp Grätzel von Grätz,
for the time of the pandemic. In essence, there are two separate HIMSS Insights
teams, members of which work from different locations and do
not mingle at all. This will help to offer IT services even in situa-
tions in which there is an outbreak within the IT department that
results in quarantining of staff members.
Measures like the ones mentioned above have been copied by

hospitals in many places all around the world now. The team-
based approach to staffing, for example, is used in a lot of ER
units and surgical departments in regions heavily affected by
COVID-19. There is also an increasing number of digital infec-
tion management tools that help hospitals recognize and track
infection chains should they occur despite all preventive efforts.
Three German university hospitals in Göttingen, Hannover and

Berlin, for example, are currently piloting a computer-based early
warning system for infections and suspicious cases called ‘SmICS’.
SmICS is short for Smart Infection Control System. It was developed
in the context of the ‘Medical Informatics Initiative’, a government
funding program for healthcare informatics. SmICS brings together
data from the medical history of patients, virus and laboratory infor-
mation, and data on the movement of patients and staff. Algorithms
are analyzing cases daily, and visualizations are used to backtrack con-
tacts of infected patients. SmICS is a tool that was available before
the COVID-19 pandemic already. It could be adapted to SarsCoV2
with its specific characteristics within weeks – another useful example
for how a pandemic virus is driving healthcare IT innovation.

GLOBAL TRENDS 61
In summary, digital tools offer huge opportunities for helping

in the containment of the SarsCoV2 virus and other future
infectious disease outbreaks. Discussions in recent months
have largely focussed on tracing apps, but there is much to
win in other areas, too, specifically IT solutions that make the
management of infected persons and contact persons more
ADDRESSING
efficient. Whether, beyond process management, a digital
THE PANDEMIC
surveillance of quarantine is desirable is a question for which
THROUGH TECH-
different societies will find different answers. Democratic soci-
NOLOGY AND
eties should probably works towards voluntary tools with a
DIGITAL HEALTH
strong focus on privacy to boost acceptance and supplement
non-digital contain efforts.
LEARN MORE
DEALING WITH THE COVID-19 PANDEMIC

THROUGH DIGITAL HEALTH IN APAC
There is a lot to learn from Asia when it comes to
dealing with pandemic viruses. Colleagues from our
sister publication Healthcare IT News have compiled
an impressive eBook that gives an overview on how
some countries from the Asia-Pacific region have used
digital tools to confront SarsCoV2.
TAKE A LOOK HERE!

GLOBAL TRENDS 62
‘Flattening the curve’

with virtual care in
Australia
When Paul Roseworn flew out
on holiday to Ireland and the
UK in February to watch the
Six Nations Rugby, he didn’t
realize he would be caught up
in a global pandemic. But by
the time he’d arrived back in
Australia three weeks later, he
had contracted COVID-19.
BY LYNNE MINION
Paul Roseworn at Murrayfield

Stadium, Edinburgh, for the Scotland
v France Six Nations Rugby game
on 8 March 2020, days after noticing
mild cold-like symptoms.

GLOBAL TRENDS 63
I
just had an inkling. It felt like a cold but slightly worse.
There was something a bit off about it,” Roseworn told
HIMSS Insights.
The 52-year-old company director was tested a day later and

spent the next three and a half weeks “hospitalized” in his home
thanks to the remote care provided by one of the nation’s major
health facilities, Royal Prince Alfred Hospital (RPA) in Sydney.
“There were a few days there where it felt like I had a weight
sitting on my chest. I wasn’t wheezing, it just felt hard to expand
my chest for a few days,” Roseworn, who is asthmatic, said.
“And I had a pretty bad dry cough so it sounded antisocial.”
We very quickly had
Keeping patients safely isolated while monitoring their symp- to redesign. So within
toms, RPA’s “virtual hospital” has been key to efforts to flatten
a week, we did that.
the curve. Miranda Shaw,
Royal Prince Alfred
Hospital’s RPA Virtual,
“I couldn’t believe the level of care I was getting,” Roseworn Sydney
said. “I was truly gobsmacked.”
RPA Virtual was initially launched in February to care for

people with cystic fibrosis and palliative care patients – then
the COVID-19 crisis escalated.
“We very quickly had to redesign. So within a week, we did

that,” director of RPA Virtual Miranda Shaw said. “And we
were able to support the discharge of six patients from the
intensive care unit here at RPA to home because we were
able to provide that safe level of care.”
Using pulse oximeters to measure oxygen saturation levels

and heart rates, and armpit patches to track temperature,
data is transmitted via an app on patients’ phones to RPA
Virtual for 24/7 monitoring. Twice daily video-consultations

GLOBAL TRENDS 64
ROYAL PRINCE ALFRED HOSPITAL’S

RPA VIRTUAL
Amwell President and CEO Dr. Roy Schoenberg describes how the
public health crisis is impacting his telehealth company and is rewriting
the expectations for virtual care.
allow clinical staff to monitor coronavirus sufferers’ physical

and mental health.
Of the 475 COVID-positive patients monitored by RPA

Virtual by the end of May, only 51 needed to attend the bricks-
and-mortar hospital when their conditions had changed.
Eighteen of those were admitted, with 15 placed in ICU. One
83-year-old patient with comorbidities died in hospital after
rapidly deteriorating.
So high has the quality of care been for RPA Virtual

patients across Australia, it has led to a boost in support
from clinical staff.
“There was a level of cynicism about the effectiveness of

virtual care and susceptibility and how safely it could be

GLOBAL TRENDS 65
delivered,” Shaw said. “But thanks to COVID, in many ways

we’ve really managed to turn that around. And now we have
If I look at my digital
enormous support and we can see the cultural change that’s strategy, things that I
happening across the system.” thought we might get to in
year five of that strategy,
Technology has been integral to Australia’s response to the dis- we’ve done in 10 weeks.
ease, with federal funding fueling a dramatic uptake in telehealth Richard Taggart,
Sydney Local
nationally and the swift roll-out of electronic prescriptions. In
Health District
April, the COVIDSafe contract tracing app was released.
By 1 June, there had been 7,195 infections and 103 deaths nation-
wide, with just 12 new cases detected in the previous 24 hours.
Chief information officer of the Sydney Local Health District,

Richard Taggart, who leads the team behind RPA Virtual,
said while innovations had been adopted at speed to help
fight COVID-19, technology was already being integrated to
help contend with growing healthcare pressures.
“Healthcare has been lurching towards this crisis of sustain-

ability for so many years where we have more demand than
we can possibly deal with,” Taggart said. “And we can’t just
RPA Virtual clinical staff conduct video-consultations Remotely monitoring patient data at RPA Virtual.
with each patient twice daily.

GLOBAL TRENDS 66
keep building new hospital beds and opening new hospitals

because we’re not going to have the resources to fill them
and provide the care that we need to.” Things that you would
expect to see in the future
For RPA, the coronavirus has fast-tracked the use of tech to ease have now arrived, and
they are being used and
those burdens, introduce efficiencies and aid in quality care. they are a part of everyday
life. It’s been quite an
“If I look at my digital strategy, things that I thought we might extraordinary experience.
get to in year five of that strategy, we’ve done in 10 weeks.” Richard Taggart,
Taggart said. “Things that you would expect to see in the Sydney Local
Health District
future have now arrived, and they are being used and they
are a part of everyday life. It’s been quite an extraordinary
experience.”
DEALING WITH THE COVID-19 PANDEMIC THROUGH

DIGITAL HEALTH IN APAC
Following a lengthy consultation process, the tions for certain categories such as software
Australian Government introduced new legis- used by clinicians, claiming the new rules
lation in December 2019 increasing regulation will dramatically increase the costs and time
of software-as-a-medical-device by the coun- required to get innovations approved and into
try’s Therapeutic Goods Administration. patient care.
Within the changes, software used directly in “Never before has this industry’s ability to
patient diagnosis or treatment could be classi- coalesce and get things done been so evident
fied at the highest level of risk. as during the bushfires and the COVID-19
pandemic,” the MSIA said in a submission to
The changes align with regulations in the the TGA in May. “Australia should not now
European Union, but are more rigorous than jeopardise the safe innovation, productivity
those in the US. and efficiency which it has enabled. We need
to avoid the unintended consequences of this
The Medical Software Industry Association regulation, empower health professionals and
(MSIA) in Australia has called for a 12-month facilitate the benefits of standards over regula-
pause in implementation, as well as exemp- tion.”

LEADERS OF CHANGE 67
Personal privacy –
Does the pandemic
change the rules?
The debate around the use and visibility of personal data has
never been out of the news, and that was in the pre-COVID
days. The pandemic has inevitably made discussions about
the use of data even more urgent as we strive to find solutions
to dilemmas around managing personal privacy and the
requirements of tracking and tracing individuals that have been
potentially infected.
BY DR. CHARLES ALESSI

I
t is helpful to explore this dilemma a little bit further. Rules
and legislation around the right to personal privacy is at
the heart of our standing and relationships within com-
munities. Given the extent to which the use of devices is now
ubiquitous, as well as the potential for data associated with
these devices to identify individuals and when aggregated with
other data, to provide a fuller picture of an individual’s habits,
the fact that there is strict legislation controlling this is a posi-
tive factor.
In different jurisdictions, there are different rules that manage

these data flows. In the US it’s Health Insurance Portability and
Accountability Act (HIPAA), in the European Union it’s the
General Protection Data Regulation (GDPR) that regulates
the use of data and this is mirrored to a greater or lesser extent In looking around the
in most of the other countries in the world. While the interpreta- world at which countries
tion of data legislation is often a contentious issue, and in places have been particularly
successful at managing
there are instances where it impeded, not assisted data transfer, the first wave of
the mainstream judgement is that these rules are worthy as they COVID-19, they tend to
protect us, the citizens, from the indiscriminate use of our data be ones which instituted
by everyone from major corporations to governments. processes around test,
track and trace early and
comprehensively.
The pandemic does introduce another dimension into this dis-
Charles Alessi, HIMSS
cussion, however. It is widely acknowledged that for effective
management of outbreaks, it is necessary to identify, then track
and trace every individual who is potentially at risk of devel-
oping COVID-19, specifically when individuals could well be
shedding virus and be infective prior to the development of
symptoms. In looking around the world at which countries
have been particularly successful at managing the first wave
of COVID-19, they tend to be ones which instituted processes
around test, track and trace early and comprehensively. To
do this with the requisite speed and scale, it is beneficial to
use electronic means to contact trace, as happened in Taiwan,
South Korea, Singapore and a host of other countries.

The implication is that TV SEE LATEST COVERAGE

people’s right to personal
privacy around data is DIGITAL TOOLS CAN PROVIDE A SILVER
then secondary to the LINING TO CORONAVIRUS
right of citizens to be pro-
tected from a contagion.
These dilemmas are not
new in medicine. Patient
confidentiality is sacro-
sanct in medical practice
unless there is a duty to
protect others that could
be harmed. There is even
a process to notify author-
ities of diseases which have
There will be a new way of living in a post-coronavirus world – but
the propensity to infect
digital tools, including apps and telehealth, can play a significant role
populations quickly, like
as we continue to fight COVID-19.
typhoid and conditions
such as yellow fever.
There are some sound principles, however, that could be

deployed to try to ensure as much confidentiality and privacy
as possible to the citizen, while satisfying the need for public
health systems to perform the functions they need to imple-
ment, to limit the spread of contagious disease. These include:
1. Safeguarding privacy
There are various initiatives available today which make it
possible to preserve privacy and ensure there is no potential
for data to be misused. The most topical one is the Apple,
Google initiative. This is a process where data is never cen-
tralized, lives on your phone, is automatically erased and
cannot thus be misused, even being inaccessible to others
by court order. This initiative has now become the basis for
a whole group of countries within the European Union and

beyond and it’s an unusual example of major corporations

working together for the common good. There are two
countries in Europe which are adding a centralized database
Patient confidentiality
to this approach, France and the United Kingdom. It is still is sacrosanct in medical
unclear whether the applications produced here will afford practice unless there is
the citizens enough confidence that large enough numbers a duty to protect others
will download them and make the apps useful. that could be harmed.
Charles Alessi, HIMSS
2. Sunset clauses
Unless one is using the decentralized methods described
above, it is helpful to have enacted a “sunset clause” in legis-
lation to ensure personal data will no longer be available once
the emergency of the pandemic is over.
3. Secondary use of data legislation

This is always a contentious subject but there are examples of
countries that have found solutions to utilize aggregated data-
bases. FinData, the Health and Social Data permit Authority
in Finland is noteworthy in this regard as an example of trans-
parency and excellent practice. Set up in 2019, it regulates the
use of data stored by various other national controllers includ-
ing private controllers and stored in Kanta services (as of 2021).
4. Foresight
South Korea has much to teach us here. Following the MERS
coronavirus outbreak in 2015, legislation was implemented only
to be used in a pandemic emergency, then rescinded. This leg-
islation really changed the existing strict data guardianship rules
when implemented as it allowed for an extremely comprehensive
strategy for contact tracing, whereby anyone who has interacted
with an infected person is traced and quarantined. This included
allowing access from credit card companies, and location from cell
phone carriers. This was implemented as soon as the pandemic
reached South Korea, and together with other robust measures
successfully protected the population from the first wave.

5. Establishing trust
This is the most valuable of all the principles and the most
difficult to maintain. Populations tend to be compliant with
requests from governments if significant trust exists between
the citizen and the government. This is supported by a well-de-
veloped communication strategy underpinned by the use of
transparency in the way data is presented.
The balance of views suggests that we are likely to see a sec-

ond wave and it is essential we prepare for the second wave
to ensure we manage to shield our populations better. These
debates around privacy and the duty of each citizen not to
harm others through contagion should be taking place now if
they have not taken place previously, as this will enable us to be HOW TO BRIDGE THE
in the optimal place when and if the second wave strikes. We HEALTH DATA INFOR-
must use this time wisely. MATION GAP AFTER
COVID-19
Learning from the pandemic

quickly, in order to take the digital
health standard forward globally,
was the sentiment voiced by lead-
ing stakeholders in a recent World
Health Assembly virtual panel
hosted by HIMSS.
Watch now
Read the summary

Pushing healthcare to new boundaries

All over the globe, innovative thinkers and doers are working to improve health and
care through IT and technology. Get to know some of them.
TV TV
EUROPE US
INNOVATIVE DIGITAL TOOLS TECHNOLOGY’S ROLE IN ADDRESSING
MAY BE A SILVER LINING TO COVID-19 SOCIAL DETERMINANTS OF HEALTH
Digital tools, including apps and telehealth, can help signif- Deep Dive: Barriers to care can be traced to SDOH, and
icantly as we continue to fight COVID-19 and prepare for a technology has a role to play as the best solution that con-
new way of living in a post-coronavirus world. nects data between providers and the community.
TV TV
SINGAPORE US
HOW SINGAPORE IS ASSESSING THE CYBER-THREAT
ACCELERATING DIGITAL TRANSFORMATION LANDSCAPE DURING CORONAVIRUS PANDEMIC
In this episode of The Alessi Agenda, Woodlands Health HIMSS Director of Privacy and Security Lee Kim offers
Campus CEO Dr. Jason Cheah discusses how global exam- insights for health systems as they defend against both
ples of EMRs, robotics and telehealth helped shape the COVID-19 and the opportunistic cyber-attacks that are
digital transformation and patient journey in Singapore. using it as cover to sow chaos.

MARKET MAKERS
Up close and
personal:
Is it time to know
your patient?
In the age of COVID-19, with virtual consultations now reaching a new peak,
protecting patients and the healthcare organisations they work with from
cybercrime and fraud is becoming a top priority for CIOs on the frontline.
BY TONYA STEWART

MARKET MAKERS 74
E
arly in April, Interpol alerted police forces in 194 countries
to the increasing threat of cyber attacks against hospi-
tals, saying it had detected a significant increase in the
amount of attempted ransomware attacks against institutions
and infrastructure involved in the virus response. “Cybercrimi-
nals are using ransomware to hold hospitals and medical services
digitally hostage, preventing them from accessing vital files and
systems until a ransom is paid,” the organisation warned.
On April 1st, Italy’s department of welfare and social security

(INPS) website was attacked while about 339,000 applications
for the €600 in benefits for VAT-registered and self-employed
Italians were being processed. Meanwhile, hospitals involved
in coronavirus testing in the Czech Republic were also being
targeted. Experts have also pointed to attacks on healthcare
organisations in the UK and other parts of Europe.
But of course, healthcare data breaches are not new. Over the
past decade, there have been over 3,000 such breaches impact-
ing more than 500 million medical records, according to the
HIPAA Journal. And this trend has been escalating year-on-
year, with 2019 seeing more data breaches reported than any
other year since its records began. According to a 2019 C arbon
Black survey, 83% of surveyed healthcare organisations said
they’d seen an increase in cyber attacks in the previous 12 months.
Because of the large amount of personal information involved,

health records command a high value on the dark web – often
ten times more than the average credit card data breach record.
Once they have this information, cybercriminals can then easily
impersonate legitimate patients. And the consequences of med-
ical identity theft can be devastating – not only for the patient
who is being impersonated, but also for healthcare providers and
insurance companies.

MARKET MAKERS 75
THE RISE OF KNOW YOUR PATIENT

“It’s not just billing data that hackers seek from the healthcare
sector,” says Robert Prigge, CEO of global leader in online iden-
tity verification, Jumio. “Medical records on individual patients
often bring top dollar on dark web marketplaces. The data can
trigger identity theft, credit card fraud and much more. Stolen
health insurance details can also be used to obtain free medical
or dental care.”
It is time for CIOs to ensure procedures are in place so that doc-

tors know their patients are who they say they are — and this is
PHOTO: JUMIO
the domain of the emerging field of Know Your Patient (KYP).
“Healthcare provider organisations need to adopt identity safe- Robert Prigge, CEO of global leader
in online identity verification, Jumio
guards, similar to the Know Your Customer regulations adopted
by the financial service industry in recent years,” says Prigge. “The
basic premise is that institutions should know their customers by
verifying identities, making sure they’re real, confirming they’re
not on any prohibited watch lists and assessing their risk factors.”
“By having customers verify themselves, these institutions have

been able to keep money laundering, terrorism financing and
more run-of-the-mill fraud schemes at bay,” says Prigge. “And
the healthcare industry, which is just as vulnerable to data
breaches as the financial services sector — perhaps even more
so — needs to adopt similar Know Your Patient procedures.”
VIRTUAL APPOINTMENTS: EXPOSING A

VULNERABILITY IN THE SYSTEM
If the last decade has taught us anything, it’s that a per-
son’s online identity isn’t always what it appears to be. Data
breaches, phishing schemes, identity theft, money laundering
and other digital scams have wreaked havoc on organisations
from every sector of the economy — from financial institu-
tions to dating sites.

MARKET MAKERS 76
And this is no less true of healthcare. And, with the rapid growth
of diagnosed cases of COVID-19 — and the consequent eas-
ing of regulations restricting telemedicine services around the
globe — virtual doctor appointments are being embraced like
never before, says Dean Nicolls, VP of marketing at Jumio.
While this may be a godsend for patients and clinicians wanting
safe, risk-free consultations — and for health services seeking to
find ways of managing a higher than usual volume of patients
— it is also leaving the unprepared healthcare organisation wide
open to cybercrime and fraud.
PHOTO: JUMIO
“Healthcare data breaches commonly include first and last
names, addresses and other contact details, but they also include
Social Security numbers, email addresses and other personally Dean Nicolls, VP of marketing at
Jumio
identifiable information. So cybercriminals can buy much of this
data online and masquerade as legitimate patients or leverage
this information to take over their online accounts via credential
stuffing attacks,” he says.
And to what effect? “The repercussions of not identifying

remote patients are numerous. It may mean the physician
divulges personal health data to bad actors,” says Nicolls. “It
may mean pharmacies give prescriptions, potentially addictive
ones, to people who, in turn, sell them to criminal agencies. It
opens them up to payment and insurance fraud.
“There are presumably other risks that we will discover over the
next few weeks and months — many of which could have been
averted with sensible identity verification.”
TAKING ACTION: VERIFYING THAT PATIENTS

ARE WHO THEY SAY THEY ARE
So what can healthcare institutions worldwide do to ensure that
they are not used by criminal elements and do not become vic-
tims of fraud at this challenging time?

MARKET MAKERS 77
“A Know Your Patient approach starts by adopting an online

digital identity verification system that verifies that a patient is
who they say they are by comparing a photo of a patient’s gov-
ernment-issued ID to a live selfie,” says Prigge.
“This allows hospitals, offices, clinics and pharmacies to approve

or deny online accounts and attempted purchases. After an
online account has been approved, medical offices and phar-
macies can approve future online prescriptions and treatment
requests by requesting a new selfie of the patient and using
online identity verification technology to automatically compare
it to the selfie (technically, a 3D face map) captured at enrol-
ment to authenticate the patient.”
“As you move your in-clinic practices online, you will need to think
through the online experience and how you are identity-proofing
your online patients upfront. Have they implemented measures
to know with a high degree of certainty that the person is who
they claim to be?”
Merely asking their name, physical address, Social Security num-

ber and email address, says Nicolls, is not enough: “Much of that
information is already available on the dark web anyway,” he says.
Once an online account has been approved, medical offices

and pharmacies can then approve future online prescriptions
and treatment requests on an ongoing basis, by capturing a new
3D face map of the patient and using online identity verification
technology to automatically compare it to the 3D face map cap-
tured at enrolment to authenticate the patient.
Supported by
Learn more about how Jumio is helping healthcare companies
on the frontline to protect themselves and their patients from
cybercrime and fraud.

HIMSS INTERNATIONAL COMMUNITIES 78
Be a changemaker; contribute to
shape the workspace of tomorrow.
provide professional resources and greater recognition
of women leaders making significant contributions to
the healthcare industry. In order to build a more cre-
ative, innovative and diverse healthcare workforce,
we need valuable insights from our communities and
partners. Therefore, the HIMSS Women in Health
IT (WHIT) Community has launched the Annual
EMEA WHIT Survey to raise awareness of the issues,
We believe it is our priority as a thought leader to needs and opportunities women have leveraged
address the gender gap within the healthcare indus- along their career paths. Do not miss this opportunity
try, to drive awareness of gender-related issues and to to participate and make your voice heard!
HIMSS Telehealth
Community
This fall, HIMSS will be launch-
ing the Telehealth Community
with the goal of creating a uni-
Nominations 2020 fied voice for the telehealth
Following two years of excellence in engaging over 100 healthcare professionals across all health-
IT leaders internationally, the HIMSS Future50 Community will be care fields. The community
launching the Call for Nominations for the next cohort of 50 leaders will share knowledge and best
to join the HIMSS Future50 Class of 2020-21. The Call is open for practice to promote person-en-
nominations from the UK, Europe, Middle East, Africa and Asia-Pa- abled health and underscore
cific regions. The HIMSS Future50 Community will be encouraged the critical role of telehealth in
to share expertise, collaborate across borders and foster innovation the future healthcare delivery.
both individually and as a group. HIMSS will provide the community It will serve across the EMEA
with a platform to achieve this and with a mechanism to promote the regions and engage in innova-
eHealth agenda at an international level. The community members tion activities spanning sectors
are expected to attend quarterly online meetings, participate in joint in the field of remote healthcare
activities and leverage their expertise as content leaders within the services, continuing medical
existing HIMSS framework. Learn more about the activities of the education and training, techni-
community and current cohort. cal standards, and policy.

HIMSS INTERNATIONAL COMMUNITIES 79

UPCOMING EVENTS 80
Your chance to network, connect and innovate

JOIN OUR EMEA EVENTS TO MEET THE PEOPLE WHO MATTER IN HEALTH IT
HIMSS & HEALTH 2.0 EUROPEAN- DIGITAL EVENT

KOPFZEILE
7 – 11 September 2020
Date
The HIMSS & Health 2.0 European Digital Event from 7-11 September
Quatiamus. Elicil
2020 will bring theex erum
best as autem
of both worlds:rem eium earundae
HIMSS’s knowledge, vitexpertise
desci quias-
and
pernam harum undaeceptate dissitas et debit, officab il intis
thought leadership in healthcare digitisation and Health 2.0’s network of esequid
untureped quame
entrepreneurs sitatur a volupit
and investors, et eatthequilatest
showcasing ipsanto cus.edge
cutting Olest,
andconem
inno-
veniminctum volupta simolor.
vative health tech solutions.
JOIN US
HEALTH – THE DIGITAL FUTURE
9 – 13 November 2020
Health-The Digital Future is the leadership platform of the health sector
in Germany bringing together national and international pioneers to take
a controversial look at the digital future of healthcare. The Handelsblatt
conference will take place in cooperation with HIMSS from 09-13 Novem-
ber 2020. It will be hold as an online health week with LIVE meetings and
various networking opportunities.
JOIN US
HIMSS SAUDI ARABIA 2020
29 November – 3 December 2020

We look forward to welcoming you and more than 1,500 digital health professionals
29 November – 3 December | Riyadh
from the Middle East and beyond on 29 November - 3 December 2020 in Riyadh.
HIMSS | Health 2.0 Kingdom of Saudi Arabia Health Conference & Exhibition
2020 will host some of the most knowledgeable speakers from across the globe,
featuring a number of educational sessions, workshops, award ceremonies and an
interactive exhibition floor showcasing the latest innovations in health tech.
JOIN US

CONTRIBUTORS 81
Philipp Grätzel von Grätz (Germany) specializes in medicine,

health policy and, in particular, eHealth and IT in healthcare.
He is one of Europe’s leading journalists in the field and author
of the German book C onnected Health.
Piers Ford (UK) has been an IT journalist since 1988, unravel-

ling the mysteries of technology for professional readerships in
the healthcare, commercial and financial sectors. Vice President for International
Programming and Content
Pascal Lardier
Tammy Lovell (UK) is a freelance journalist and former BMA
Editorial Director
feature writer, specializing in health policy. Her work was com-
Philipp Grätzel von Grätz
mended in the Guild of Health Writer Awards 2016 online
category.
Managing Editor
Dillan Yogendra
Lynne Minion (Australia) is an author and journalist who has
Art Director
worked for Fairfax Media and ABC, and was founding editor
of Healthcare IT News Australia. In 2019, she was a finalist for Anna Winker
‘Best Technology Issues Journalist’ in Australia’s Samsung IT
Journalism Awards. Graphic Designer
Anna Trautmann
Managing Director,
Melisande Rouger (France and Spain) is a journalist with a Executive Vice President for
keen interest in healthcare, IT and medical technology. She International
has been writing and talking about health for the past ten years Bruce Steinberg
and enjoys learning and updating her skills constantly.
Advertising and Sponsorship
Ivana Stojanoska
Nessa Barry (UK) is currently knowledge exchange manager istojanoska@himss.org
with the International Engagement Team, Digital Health and +389 78 252 779
Care Directorate, Scottish Government. She has also worked
for the Scottish Government, eHealth Directorate and NHS
Education for Scotland. SIGN UP
Claudio Giulliano (Brazil) holds a Master of Science in health

informatics by State University of Campinas and Certified Pro-
fessional in Healthcare Information and Management Systems
(CPHIMS). He’s the former president of the Brazilian Health Infor-
matics Association (SBIS) and is currently CEO of the FOLKS
Health IT Consulting and leads HIMSS Analytics Latin America.

PREVIEW 82
GLOBAL NEWS EDITORIAL OPINIONS COMMUNITIES
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ISSUE 9.1
DIGITAL HEALTH BEYOND BIG DATA, AI, AND

COVID INTEGRATED CARE
With the world trying to adapt to what ‘the new Artificial intelligence is not an end in itself, but
normal’ will be for the years to come, we take a an underlying technology. It is assisting on every
look at the economic impact that COVID-19 is level of medical care – very much like glue that
having on different sectors of the digital health holds the digital healthcare ecosystem together.
industry. Who is winning? Who is losing? And A journey into AI applications in chronic dis-
what are the major trends in times of a pan- eases, emergency medicine, logistics, and
demic? medical technology that also looks at the chal-
lenges that developers and regulators face when
they want to make medical AI work.
DO YOU HAVE AN EXCITING STORY TO TELL OR AN

EXPERIENCE TO SHARE? WOULD YOU LIKE TO
GET IN TOUCH
CONTRIBUTE TO OUR UPCOMING EDITIONS?

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GLOBAL NEWS EDITORIAL OPINIONS COMMUNITIES

‘FLATTENING THE COVID-19: THE HOW HEALTHY

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

BEYOND THE VIRUS

40% of health facilities and

TELE-TRIAGE 42% use them

DIGITAL TOOLS FOR TRAINING AND EDUCATION

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

Nearly 20,000 DOCTORS

> 1000% 61% from March 2020.

The number of new users on PING AN GOOD

DOCTOR ANYWHERE and MYDOC, both based Thanks to COVID-19, of

respectively in March 2020.2

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

Q. WHAT ARE THE TOP 3 IT TOOLS THAT

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

Interoperability is only possible using standards for infor-

“Spain has a high rate of EPR deployment, as defined by

Hospitals in Madrid use tools that help with this missing

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

mary care and the hospital. There is an EPR viewer on the

The COVID-19 coronavirus epidemic hit Spain in mid-Febru-

“The pandemic put unprecedented strain on hospitals, with

THE REMAINING WORK TO FULLY DEPLOY

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

new telework capacities to guarantee the pursuit of opera-

The biggest test, Cruz believes, was to obtain and analyze

On the plus side, the crisis expedited the adoption of new

CONNECTING SOCIAL AND HEALTH CARE

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

doesn’t explain the whole picture, according to Rafael Ben-

“A huge flaw in this crisis was the structural exposure of the

The Basque Country has been looking for ways to combine

“Combining these two aspects has become increasingly

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

personalized care traditionally provided by families, espe-

According to a study from Washington University, Spain will

To build a new electronic social healthcare record, the Basque

Interoperability once again takes center stage, especially Basque

“Social services are very fragmented. So rather than intro-

own tools, we shouldn’t disrupt workflow. And as citizens we

So far the committee has found that many of the healthcare

By 2020 the committee plans to finish its interoperability

Integrating social determinants of health with clinical data is

The COVID-19 crisis has clearly magnified many pertinent

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

Whether or not – and if so, how – digital solutions can con-

INFECTIOUS DISEASE SURVEILLANCE BY

The first type of digital solution that has been mooted to

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

rent pandemic. These are infectious disease surveillance

There are different approaches towards this goal. A famous

Participants wore the device for at least 60 days and used it

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020

in the Fitbit dataset significantly improved the prediction

THE SPATIAL RESOLUTION PROBLEM

According to RKI, within six weeks, more than half a million

This type of analytics is obviously not specific to COVID-19.

HIMSS INSIGHTS 8.4 | COVID-19 AND BEYOND | JUNE 2020