Our values as a society are reflected in digital developments. For me: the Hippocratic Oath

By Gabriëlle Speijer

 

During the industrial revolution, urbanization produced diseases like cholera and typhoid fever that put enormous pressure on public health through contaminated drinking water. The obviousness of the provisions we have made socially for pure drinking water for all will have to become analogous to how our society takes control when it comes to data and technology in the current technological revolution.

 

Awareness of the foundation
In society, the awareness that technology is already continuously intervening in our daily life appears to be lacking. We conduct transactions on the Internet without any certainty about everyone’s identity. Personal information is frequently used for financial gain behind the scenes without clear agreements. Organizations seem to be facing more and more challenges in representing a common mission. We see that responsibility based on function or role increasingly shifting to a set of rules and protocols. All this justifying leads to an increasing administrative burden and burnout. While more health data than ever before is being aggregated, healthcare is not escaping this either. And despite all this, technology is still not part of the standard training package for healthcare professionals.

 

Hippocratic Oath
Based on the mindset in our society that everyone should be able to contribute with his or her exclusive insights, it is possible to use technology together to determine how we can bring these insights to value on data. My conviction is that this interaction between mindset and technology for health (care) can lead to enormous breakthroughs in a global learning healthcare system, but we must tackle this together.
Our Hippocratic Oath forms the direction for every physician’s action, the deepest value of which technology is also a part today.

 

The Hippocratic Oath means for us as physicians that we specify technology and harness the connective power of technology to bring together those insights from our practice to value for individual and public health. While constantly insisting that confidentiality between us and the patient is respected, this also should be transparently verifiable! That way we can ensure the best health and care in confidentiality. And that’s why I founded the care innovation company CatalyzIT on top of my work as a medical specialist in radiation oncology, to catalyze this, also outside the hospital walls!

 

“Now technology imposes thresholds, it’s about putting the right thresholds in the system so that we can live up to our values and work together in this.”

 

Sustainable care
Just as sewage produced health benefits and substantial savings, the expectation is that the literal release of data will lead to enormous financial gains. Because by means of cooperative peer review you can raise quality and analyze the same data much more often and worldwide.

 

I also envision my practice as a doctor in such a way that what you collect in a consultation is of value to many more people at the same time. I bring in my insights directly and simultaneously obtain real-time intervision while we together feed the system with shared knowledge in an increasingly sustainable manner.

 

Paradoxical situations as a wake-up call
Interoperability problems threaten direct care
In the Netherlands, a temporary exception was made to open the medical summary of patients who had not (yet) given their permission via the LSP (National Exchange Point) during a visit to a first aid department, based on the need to be able to quickly proceed to effective treatment. In the US, we saw a simultaneous relaxation of privacy legislation HIPAA.
Everyone can conclude that problems in the exchange of healthcare information have existed for a long time, they affect everyone’s immediate safety in receiving care. Apart from awareness of the importance of confidentiality when it comes to your healthcare information, the solution is not workable for us as healthcare professionals. Just before the pandemic, the federation of medical specialists made an emergency call about the threat to patient safety posed by inadequate data exchange.

 

Using data for quicker disease insight
An inventory of AI applications in health and care in the Netherlands in 2020 by KPMG, commissioned by the Ministry of Health, Welfare and Sport, already showed that there’s still something to be gained in several areas. Many initiatives aimed at combating the covid pandemic are fascinating to highlight, such as the use of intensive care data for quick insights with the help of machine learning. An important observation here is the drive of doctors in times of crisis to show how cooperation can lead to bundling of insights and learning from each other’s practice variation with the integration of technology under high work pressure. Nevertheless, many points remained open during the discussion. For example, how to arrange permission to use data in the development of technology (an algorithm). What to do about additional administrative burden in the current work process with systems from which data are usually difficult to retrieve (irrespective of the quality, integrity, provenance, availability and so on), the importance of prospective randomized research in the way in which data are now made available retrospectively. The importance of a joint, seamlessly, and sustainably supported data curation process is thus clearly on the agenda.

 

“Embed the Hippocratic Oath integrally as technology design principles.”

 

Cybercriminals force us to step out of neutrality
European frameworks and legislation such as GDPR can help maintain confidentiality in the doctor-patient relationship. Various forms of breach can be identified: from data breach such as failure to deliver (on time), loss, unauthorized inspection, use or misuse for purposes other than primarily providing care without consent, varying from research, quality registration to development of services in the broadest sense. One step further and we come to cybercrime. The cybercriminal also seemed to plunge into healthcare during the pandemic, unfortunately not with the best of intentions. Healthcare had the highest number of data breaches of all sectors in 2020 , Based on the 2021 Identity Breach Report, the healthcare sector did experience a 51% increase in the total volume of records exposed when compared with 2019. Our profession is threatened by the cybercriminal who operates in a purely financially driven way, as well as public health. The most important areas appeared to be ransomware and disinformation in the era of digital everything, which puts public health and my profession at great risk.
Digital pandemic preparedness turned out to be an issue. Just think of some examples like the PII breach at the GGD, the organization of the entire process of testing and vaccination, misinformation about vaccination and social distancing, digital delivery of covid passports, adoption of covid contact app Corona Melder1 and the Apache Log4j vulnerability found just before the end of 2021.

 

Measure everything?
Until now, the privacy of the employee has remained underexposed. Installing a temperature scan at the door, logging activity in applications, up to and including a smart toilet and a genetic test ‘from immense involvement’ of the employer. In addition to weighing up the importance, it is important to carefully discuss the objective and conditions. Ideally, the stakeholders themselves determine how they can improve quality in their work. A good example is how doctors in the group of Professor Adler-Milstein at UCSF measure their own behavior while working with the EHR (electronic medical record) to build supportive tools, e.g. decision support.

 

Connect everything?
Smart devices, and certainly medical devices, are under a lot of scrutiny. Sensitivity when going online and the associated cybersecurity risk, but also from the point of view of functionality and what we expect in terms of medical performance. A hospital secures its devices, but what about these beyond the bricks and mortar? And what about updates of these devices? And what to do with the emergence of all these ‘stupid devices’ at home connecting to the internet posing a risk of a security breach for the medical devices as well? Will an act to the Radio Equipment Directive adopted by the European Commission do enough in this?

 

“In the design of the ecosystem, the patient, who’s obviously central,
will find himself all alone if we don’t co-orchestrate the doctor.”

 

From protocols, seals of approval and occasional audits, technology will help us make the move to transparent 24/7 data-driven performance while maintaining confidentiality at the levels where it should, but it will take us as doctors to make it happen.
Organizations with digital strategy will take over
For all the above reasons, the organization with digital strategy will have the best chance of attracting the best healthcare professionals. All stakeholders in the network must be continuously aware of the ‘why’ behind the deepest values of his or her contribution. In this way, the organization consciously distances itself from the inattentive employee with a ‘neutral attitude’ as well as the money-grubbing cybercriminal. Healthcare professionals expect the organization in which they work to be able to focus purely on care, with maximum support from technology. Just as, for a few decades, we expected the hospital to meet the requirements of hygiene and safety.

 

Confidentiality by design
Still, there’s a lot to do when it comes to our society and patients becoming aware of the importance of health(related)data and its correct use. More integral stakeholders in the broader health and care landscape should keep in mind the purpose of their work, our Hippocratic Oath, and values. Because I need the overview of the complete health situation of my patient both physically as well as socially and mentally, it means confidentiality of this information should always be guaranteed. It’s a prerequisite for openness, interaction, connection while building upon the trust relationship. In this digital era, we need to have a clear insight where health information is flowing and that based on the (reversible) consent it can or cannot be used for certain purposes. This can upgrade the doctor to a trusted link now that technology supports us in our profession.

 

Gentle healers
In conclusion, gentle healers, stinking wounds! As a stakeholder in the larger healthcare landscape, it’s crucial that the Hippocratic Oath is also carried out.
In the design of the ecosystem, the patient, who is of course central, will be on his own if we do not orchestrate the doctor. This is not obligation-free but the starting point. Let us realize and establish this together.

 

In short:
• Digital developments ask us about our value as a society. For me as a doctor, that is the Hippocratic Oath.
• There’s a lack of awareness in society that technology already interferes with our daily life.
• Sustainable care is about orchestration of people, technology and data. The essence is to be able to provide care in confidence. That means that we openly and transparently stack knowledge and insights. We need to build these principles into a healthy ecosystem now!
• In the design of the ecosystem, the patient, who is of course central, is left all alone if we don’t orchestrate the doctor.

 

1 https://www.knvi.nl/nieuws/326554/Boek-‘Multidisciplinaire-aspecten-van-COVID-19-apps’-nu-verkrijgbaar-

 

About the author
Gabriëlle Speijer is Radiation Oncologist at Haga Teaching Hospital and founder of health innovation company CatalyzIT. She is trained in radiation oncology at the Netherlands Cancer Institute. Together with the CatalyzIT team, Gabriëlle provides tailor-­made training on mindset for digital transformation for ventures, professionals and advises on digital strategy in healthcare.