The patient perspective is much more important and valuable. If we are thinking about more what patients need, we would know better on what solutions and product to focus on providing.
Nick Guldemond is a Professor healthcare and public health affiliated to Gdansk Medical University Poland and Leiden University Medical Center in the Netherlands. He hold degrees in medicine and electric engineering with a PhD from Maastricht University. He is an expert in the field of digital health, eHealth, and healthcare innovation. He is known for his work in advancing the use of technology, particularly digital and data-driven solutions, in healthcare to improve patient care, population health, and healthcare systems. He was the CEO and founder of the Medical Field Lab (early 2000) i.e. the first international example of a university hospital based ‘living lab’ dedicated to science, innovation and societal impact. Nick Guldemond has held various academic positions and has been involved in many research projects related to digital health and healthcare innovation. He has also been a speaker, panellist at numerous international conferences and forums. He is an advisor for many governments, WHO, the European Commission and industries across the globe.
- As a well-established name and leading expert in the field of digital health and innovations in healthcare in general, what would you say has been the biggest drive to you during the years of your professional development?
My path as a digital health expert is not necessarily the typical one. Before going to medicine, I was actually an electric engineer. After a while, I decided that I want to do something which is more related to people. Being involved in sports on an international level, I had always been busy with my body and performance myself. This made me naturally more inclined to understanding the processes in people’s bodies, so I decided to study medicine. My technical background helped me understand better the mechanisms in the human body – this was where the more technical aspect came from in my healthcare career.
When I was finished with my studies, I decided to specialize as a neurologist. I was working as a research assistant on a neurology project, looking into brain cancer. Later, I also worked with diabetes, amputation preventions, etc. It was where I learned about the complexity of healthcare and about the needs of people, and how you can better address them to improve their lives. This is where my ambition to do something more and beyond came from. I realized that If I want to do something truly meaningful for people, I should take a broader approach, not just follow some guidelines and protocols – most of the problems required prompt reactions on spot and this, on its side, required a lot of creativity. Being a quite emotional and life-changing period for me, it made me think about how I can use technology and more alternative tools to be as meaningful for people as possible.
When I started working at a hospital in the Netherlands, my boss provided me with the opportunity to build a department, called Medical Field Lab, which looked into these kind of complex challenges. I created a desk where my colleagues from the hospital would come in and share when they have an idea, solution or just a problem that needs to be tackled. And the same goes for external parties e.g. industry who were in need for a clinical environment for their research and developments. I had a team of experts working together with these people to create solutions for these problems based on the co-creation method. This creative department became e real success and is actually one of the first examples of “co-creation” in healthcare on an international level. This was a huge success, keeping in mind it was early 2000s. We developed the first 3-D printer that can print bones, worked on remote patient monitoring together with NASA, and many more meaningful projects that changed lives.
- We, at The DHI Cluster, know how dedicated you’ve been for years to contribute to the modernization and digitalization of healthcare systems in SEE (Southeastern Europe) – what are the lessons/examples that the healthcare systems should take from the developed western European countries? What are our shortcomings here, what we should work on more; what we are doing well so far?
It’s true that there’s the perception that Western European countries are more structured in the sense that they have developed healthcare structures and organizations that provide more direction and support, as it is with the example, I gave with the Medical Field Lab we established in the Netherlands. But we have our problems, too , though they might not be so obvious. Exactly this structure, sometimes is, what stagnates the development process. Why I became so interested in SEE is because there are still many opportunities to explore – things are not so overregulated and there is room for growth. People are curious, in the sense that they want to improve regardless of how difficult might be. This is totally the opposite if you look at countries like the Netherlands – they are already so well-organized and efficient, that there’s hardly any room for improvement, or at least this is the perception. This way of thinking makes the healthcare systems of developed countries very unsustainable, as they must put a great deal of effort to change the status quo and start addressing current problems, using new approaches. Change itself is very difficult in western countries. In the case of SEE, it is the opposite – it’s quite fun because there are still many challenges to address, and you have the freedom to do it in the way you want.
- What is the importance of building innovation ecosystems for creating and sustaining a thriving healthcare system?
If you want to work on solutions, particularly in healthcare, you need multistakeholder involvement. When you want to create a new solution or improve an already existing one, you need to change many things process wise, and this involves different actors that need to work together. Some would help identify and articulate the problem, others would be more involved in the implementation itself. Also, there are not only different aspects for a given problem but different aspects for a given problem in a given place. Meaning, the same approach wouldn’t necessarily help address the same problem in a different location, culture or context. It’s a complex process in general and if you want to build the right solutions, you need to have the right people, which leads us to the concept of the healthcare ecosystem.
If you want to capitalize on the local expertise, facilities, the population, their needs, and the potential solutions for them, you have to build some sort of an ecosystem that includes people working together to make the change happen. And sometimes it might be difficult to balance the expectations of different parties involved. That’s why for an ecosystems to function properly, there’s a need for a supporting organization, as it is the case with the DHI Cluster. That’s what we actually try to do – be supportive to different actors with different interest to find “a point of intersection” and work effectively together for building a better environment where healthcare innovations can thrive.
- Recently, everyone has been talking about AI in many fields including healthcare. In your opinion, what are the pros and cons of using AI/ML in healthcare? What are the future trends related to that? What does “human-centric AI” exactly mean?
The concept of the use of artificial intelligence (AI) in medicine, is actually not very new. It’s already been used for a long time. Back 15 years ago, companies were already presenting their algorithms for detecting breast cancer. The use of statistics and clever analysis of data made things faster and smarter indeed, which is the positive thing about AI. Since healthcare is a very information-driven process and there’s much data in this sector, the optimization of gathering and analyzing data, undoubtedly, becomes easier by using tools such as AI. However, what we shouldn’t forget is that AI is not “a golden bullet” that can solve all our modern healthcare problems. Unfortunately, this is exactly what industry is promoting through creating this buzz around AI as they want to sell their platforms and solutions. The truth is that the final conclusion and decision still remains in the hands of the healthcare professionals, in the human.
Talking about the negative side of AI, I can also say that it can generate more work for doctors, rather than helping them reduce it. For example, when you use AI for smart diagnosis, it generates many more examinations and tests that need to be considered by the doctors apart from all the other aspects that they need to take into account. Paradoxically, technology rises the healthcare cost without necessarily providing the best possible outcomes. Sometimes doctors are really confused because they have so much information to process, and they become less confident. So, there’s a risk that we generate more complexity rather than it makes it simpler by using AI. But of course, this discussion has many angles. We need to be very careful how we regulate AI in order to prevent the negative influences. That’s why we are currently in a development of making the best use of AI in healthcare.
If you really want to improve health of people, you have to pay attention to different aspects along the healthcare process to make the overall improvement and here comes the human-centric element. The patient perspective is much more important and valuable. If we are thinking about more what patients need, we would know better on what solutions and product to focus on providing. We are too product and solution driven. We should start with the question and putting the patient in the center rather than “look what algorithm or product we have.”
- What are the biggest problems, we face with digital transformation of healthcare and what is the way forward?
First of all, it is really important that we start with the needs of people in order to know how to build a strategy for digitalization and how to align different aspects to address these needs. Here, patient-centeredness, human-centeredness is critical for building the proper roadmap for digitalization that would work FOR people. That’s sort of a principle starting point.
We have to do something about fragmentation because if you have data and solutions in healthcare, they should be able to link with social care, hospital solutions, primary care, nursery care. Nowadays, they are all fragmented and not communicated, don’t work with each other. But for improving healthcare efficiency and to make it possible for people to navigate through the healthcare system, we have to link up the different aspects of healthcare organizations.
Third aspect would be how to make the interest of all stakeholders and actors align, so that everyone does what they need to do in order for digitalization to work. This includes industry, medical practitioners, authorities. The difficulty with change is often in the human factors – financial interests, egos, not my job. This is not easy to manage at all. But with good vision and project management, this is feasible.
Looking at countries like Bulgaria, Romania, Serbia, etc. I’m quite enthusiastic about what is to come as you are doing quite well over the past decade. There are a lot of opportunities to explore and a lot of expertise to be and good energy that needs to be put in the right things.