Episode #5: Digital transformation in healthcare has been saved
Episode #5: Digital transformation in healthcare
Life Sciences Connect
Healthcare systems across Europe face rising pressures – particularly the increasing healthcare needs due to growing and ageing populations, multi-morbidity, and public expectations of more personalised and convenient services. Many clinicians are struggling to cope with increasing workloads, and the gap between the supply of resources and the demand for healthcare is widening. Consequently, most countries are looking to digital transformation to close this gap but progress has largely been slow, and the digital maturity of providers, both within and between countries, varying widely.
While COVID-19 has accelerated technology adoption and all countries can point to examples of good practice, there is scope for lessons to be learned more widely and for many of the alliances and partnerships that have been established over the past few months to become a driver of new models of outcome based care and shape a more predictive, preventative, personalised and participatory future.
In the fifth episode of Life Sciences Connect, we explore the challenges facing digital transformation in European healthcare, how things have been changing as a result of COVID-19 and how we should proceed into the future.
This episode is led by our host Karen Taylor. Karen is joined by Dr Lloyd Humphries, Head of Europe for SilverCloud Health, and Lars Dahle, founder and CEO of Dignio.
This episode explores:
- The rationale for healthcare’s digital transformation
- The adoption challenges facing clinicians and patients and examples of good practice in overcoming these challenges
- The impact of COVID-19 on technology adoption and the factors shaping the future of health in Europe.
Dr Lloyd Humphreys
Find out more
If you are interested in any of the topics discussed during this episode, please find useful links below:
- Digital transformation: Shaping the future of European healthcare
- Shaping the future of UK health care
- Realising digital-first primary care
- The future of health
Stay up to date with Deloitte Centre for Health Solutions
Karen Taylor (00:00:03): Welcome to “Life Sciences Connect”, Deloitte’s Podcast on the Life Sciences and Healthcare industry. This series features conversations with leaders from across the health ecosystem sharing their insights on the critical issues facing the industry today.
Karen Taylor (00:00:27): Hi, my name is Karen Taylor and I lead Deloitte Center of Health Solutions, an independent research hub that supports Deloitte’s Healthcare and Life Sciences industry teams. One of the most fascinating aspects of my job is being able to meet industry leaders and gauge their views on the critical challenges that are affecting their businesses and to explore potential solutions to these challenges. In today’s conversation, I am joined by Dr. Lloyd Humphreys, head of Europe for SilverCloud Health, a digital mental health platform, and Lars Dahle, founder and CEO of Dignio, a company that connects patients and healthcare professionals through a digital platform. Lars, would you like to introduce yourself and say something about your organisation’s vision and ambition for healthcare.
Lars Dahle (00:01:10): So Dignio is founded on the belief that there is a shift going on and transform of the healthcare delivery where we today only see patients being treated in the hospitals and clinics, and go back to the patient’s home. We have an ambition that we would like to transform how we treat people with chronic diseases primarily and elderly. These patient groups – they use something like 75 percent of our total resources in today’s healthcare. So we believe that that’s a good place to start. We would like to be a category lead in how we treat these patient groups on a global basis in the future.
Karen Taylor (00:01:58): Thank you Lars. Lloyd, would you like to say something about your organisation’s vision and ambition for healthcare?
Lloyd Humphreys (00:02:04): Sure, thanks very much Karen. So SilverCloud is a digital mental health platform that provides internet-based cognitive behavioural therapy for people with mental health and well-being challenges. SilverCloud provides this to health systems right across Europe and North America, and that’s to both health systems, companies, insurance, organisations, etc. So our vision really is to get evidence-based mental health and well-being solutions to as many people as possible, so they can get the right support anywhere at any time they needed so that they don’t feel that they have to go through these challenges to their emotional well-being alone.
Karen Taylor (00:02:43): Thank you Lloyd. So in today’s podcast we will be discussing some of the key findings from our report ‘Digital transformation: Shaping the future of European healthcare’. The report focusses on the current state of digitalisation in healthcare across seven European countries: Denmark, Germany, Italy, the Netherlands, Norway, Portugal and the UK. We explore the rationale for healthcare’s digital transformation, the adoption challenges facing clinicians and patients, and examples of good practice in overcoming these challenges, the impact of COVID-19 on technology adoption, and finally the factors that will shape the future of healthcare in Europe. Both Dignio and SilverCloud feature as case examples in our report. Dignio on the work they are doing in Norway, it is a Norwegian company. And SilverCloud on some of the work they are doing across a number of European countries. What we were gonna discuss is the challenges that are facing Europe, the pressures of increasing healthcare needs, the increasing demand for healthcare, the public’s expectations of more personalised and convenient services and a growing gap between the demand and the resources available to meet that demand. While COVID-19 has accelerated technology adoption between countries, the actual digital maturity of providers both within and between countries varies widely. All countries can point to examples of good practice but there is scope for the lessons to be learned much more widely, and for many of the alliances and partnerships that have been established over the past few months to become a driver of new models of outcome-based care and shape a more predictive, preventative, personalised and participative future. Lars, was there anything in our report findings that surprised you and if so what and why?
Lars Dahle (00:04:29): So the interesting part about this report was that you made it across different countries in Europe, and I would actually expect there to be more differences between the countries. When we ask and talk to people from different countries, they claim that their country so special. When we look at the statistics here why the adoption hasn’t been greater, I think the similarity of the answers speak to itself – the bureaucracy, the cost and finding the right technologies all comes to in all the countries.
Karen Taylor (00:05:07): I can understand that and I have always felt – I have done a number of reports across Europe and I have seen in those reports that there is as much in-country variation as there is between country. And yes there are differences in the way that healthcare is funded, in the way that priorities are decided but the similarities are, I suppose at the end of the day, we have clinicians, hospital doctors, nurses and other healthcare professionals providing care to patients with similar demographics. So it’s hardly surprising at the end of the day really. Perhaps Lloyd, could you answer that same question? Was there anything that surprised you about the report?
Lloyd Humphreys (00:05:48): What I found really interesting about the report, and particularly across the broad range of case studies, is to see how different countries are focussed on digitising in different ways. So some are focused on digitising the system from a top-down approach, so for example making sure that electronic medical records are fully digitised and that data is available at all parts of the system whereas others are focussed much more on digitally enabling citizens by empowering them to manage their own healthcare – whether that’s gonna be owning their own data, carry around their information or actually about giving them accessible treatments, accessible interventions to help them manage some of the things that they might be going through. So that top down and bottom up approach for me was very interesting within the report. And both approaches have their merits but each face very different barriers when you look to scaling. So I think there are very different lessons that we can learn from the various countries that were represented in the report.
Karen Taylor (00:06:55): In our report, a key part of our methodology was a survey of 1800 clinicians across the seven countries. And they did identify very similar top challenges. And they were: Bureaucracy in healthcare, the Cost of technology and Finding the right technologies. But a couple of other countries did mention in their technologies – Training staff to use the technologies and the Challenges in sharing patient data. Patient data and access to data is clearly important for digital transformation, but is one of those barriers that continue to thwart us. Lars, Dignio operates in the UK, Norway and in China. What have you found is the solution to the adoption and access to patient data?
Lars Dahle (00:07:38): Well first and foremost we started our company based on the belief that the data really belongs to the patient himself. So, we designed the system accordingly that everything written, noted down, all data are immediately in real time shared with the patients. We found that the engagement that we get from patients doing that is very interesting and very helpful. The second thing is that the laws and regulations of Norway are quite strict in this area. So when we designed our systems, in the beginning of lets say 2010-11, we have to kind of design within the principles of privacy and security. So I think that when we got out in the other end with a finished system that we were already adhering to a lot of the regulations and rules governing that. So, we have a lot of kind of the functionalities that is there just to be compliant to all these regulations.
Karen Taylor (00:08:46): Lloyd, SilverCloud works with over three hundred organisations, is used by over 75 percent of NHS services to provide access to digital mental health support. Clearly during these unprecedented times the demand has increased significantly for mental health support. How have you overcome the data interoperability challenges to meet this increasing demand?
Lloyd Humphreys (00:09:07): We have seen over four hundred percent increase in usage of SilverCloud over this period. In fact within the NHS, we found that the primary care mental health services which are delivered through improving access of psychological therapies or IAPT services went from a round about of about seven percent utilisation of digital technologies using SilverCloud to almost 30 percent of all appointments, all treatments of mental health delivered by SilverCloud, which is a huge shift in terms of digital provision that puts this on a par with physical face-to-face treatments as a core treatment intervention. In terms of interoperability, we are already integrated with a number of different electronic medical record solutions. For example, in mental health, in IAPT, IAPT PCMIS, in the US we are integrated with APAC etc. So, that interoperability challenge is there for some supplies and obviously there is a broad range of different solutions. For us, one of the key things is not just in terms of data exchange though, but it is also about accessibility, ease of use. So for us actually single-sign-on is absolutely critical so that people aren’t having to use multiple usernames, passwords and things like that. So we do use single-sign-on and I think that is the minimum standard that solutions should be focussed on that actually it’s about being able to kind of join up what could be a fragmented digital ecosystem into something that is easily used by the patient, by the end-user.
Karen Taylor (00:10:44): What about data privacy? That seems to be something that concerns the public. How do you assure patients of the privacy of their data?
Lloyd Humphreys (00:10:53): For us, it’s really important. So for us, we only hold fully anonymised data. So for us that is really key. Data does go back into the systems as mentioned, so really the preservation of data privacy resides with the data controller, the organisation that is providing that service. But that data privacy is one of the key aspects for us, particularly when we are thinking of mental health sensitive information, etc. So we only collect the very very minimum data in compliance with GDPR principles, the very minimal data required for people to use that service.
Karen Taylor (00:11:37): And just before we leave this issue of data security and privacy, you both worked in a number of countries. So Lars is there anything you’ve seen in any particular country that you feel could be more widely adopted in terms of access to data. Or is it similar wherever you are?
Lars Dahle (00:11:58): Well I think that in Norway what we have seen is that the strict regulation of health data is sometimes slowing down the innovation and pace of adoption. So in Norway this make all the systems more silo-based and in some instances the clinicians they claim that it is actually putting patients in danger. So I think that we should have reflect this both ways – one is to protect the data of the individual and the other thing is to help them get, achieve the best possible healthcare, which is often to combine data from different sources, which is then kind of a not being held by the current regulations at least in Norway as we see.
Karen Taylor (00:12:50): Lloyd, is there any country where you would point to as an exemplar in data sharing?
Lloyd Humphreys (00:12:57): Well I think the UK is getting much better at data sharing. So when we have a look at the Local Health and Care Records exemplars or the LHCRs within the UK, there is a big push from the UK government to be able to share data right across different systems. And that’s really important because I think when we look at even individual hospitals, they can have sometimes hundreds of different systems. So being able to not only connect internally but also between hospitals, between different health systems is absolutely kind of key. So, we can see that there are good examples of this. This is still early days but there is definitely a move, and a definite kind of shift towards making that data available wherever that patient presents himself.
Karen Taylor (00:13:47): And as I have said we can’t really have this podcast without talking about the impact that COVID-19 has had on services. And as we know billions of citizens, millions of healthcare staff across the world have seen and continue to see their services and lives disrupted by the pandemic. Healthcare providers had to respond very quickly into a massive change management process in a matter of days with many impressive benefits being seen from working differently but also a number of challenges that have had to be overcome. One positive has been the acceleration in the adoption of digital technologies as our survey respondents told us with most countries seeing significant increases in the use of technology to help clinicians to support them to work differently but also to help patients to access services and receive support despite the fact that we have had to introduce initially lockdown and then social distancing. So Lars how has Dignio’s technology been adapted to help healthcare systems respond to the COVID pandemic?
Lars Dahle (00:14:47): Well I would say in two different ways we’ve been seeing good results. One is of course to try to protect vulnerable patients as much as possible. So a lot of the patients using our solutions are elderly or people with comorbidities and stuff. And it makes it possible for them to have fewer visits and fewer home nurses and also being able to manage themselves more in these times. So that’s one aspect of it. But the second aspect I think it’s much more impactful. We saw early since we don’t have a good cure for this disease the recommendation is to stay at home as much as possible to isolate yourself. The healthcare system, at least in Norway and the UK where we have experience, doesn’t really have a good tool to see how you are, how you are going through this disease at home. So this is where our solution for remote patient monitoring was really helpful. They, the city of Oslo, they provide all the infected patients with our app which has a special questionnaire targeting the COVID-19 infected patients. Through the systems they are now able to monitor all the patients that have had the disease as they go through it. And they can pick out easily the ones that have exacerbations and can help them in much quicker. So the solution before was that they had to call all of these patients and ask them about their conditions which was kind of unreliable and it was chaotic with the number of infected. Now they say they feel much more relieved and safe that they can actually look after all these patients in a good way, and the second kind of outcome of that is they also slow down the admissions of patients to hospitals because now they can safely monitor them at home much longer and know exactly at which time they should be admitted to hospitals. So I think that, I wish we could be of more help but the places that have started to use our systems we have really seen good outcomes of that.
Karen Taylor (00:17:36): That’s really interesting and something that I think most countries have been looking for, something that helps them monitor patients and keep them at home for longer. Lloyd from your perspective, what has been the most memorable thing that you have experienced during this pandemic? And that has happened to your services as a result?
Lloyd Humphreys (00:17:54): I think the most memorable thing is that it has really shone a spotlight in terms of the benefits of that digital transformation, the ability to rapidly mobilise a digital service to often replace a physical traditional way of delivering mental health support. And we’ve seen that rapid mobilisations within a couple of weeks. SilverCloud was able to mobilise to make available to over 180 million people across North America and Europe, access to SilverCloud mental health support. So for us that really kind of highlights the ability for digital to meet the needs in those circumstances. And also therefore to almost sometime replace those traditional forms of therapy without necessarily a drop in outcomes for the patient. So our recovery rates have maintained being the same. And so the ability to mobilise, ability to kind of have outcomes similar to traditional forms of intervention, has really been very memorable for us. And when you take that in conjunction with some of the cost-effectiveness profiles and you mention this in terms of one of the barriers in Cost of technology, SilverCloud has gone through a nice MedTech evaluation and what that MedTech evaluation, done independently, studied by NICE, has shown that actually digital is the most cost-effective form of treatment even compared to guided self-help. So if you can compare that in terms of the ability to mobilise, the ability to kind-of maintain those outcomes, for me that is kind of the holy trinity in lots of ways. So I think for me it has really been the coming of age for digital therapeutics. So yeah.
Karen Taylor (00:19:46): Digital therapeutics, a lots been talked about that and we have seen a lot more use of that during the last six months or so.
Karen Taylor (00:21:06): Thanks Lloyd. I mean I am a non-executive on a hospital board and I know that my trust did take advantage of being able to use SilverCloud and I did hear really positive feedback on both the access but also some of the other systems they were putting in place to transform staff’s mental health and well-being. Not to forget the way that the community responded as well to try and support their well-being by providing them with nourishment and access to food at a time when it was quite difficult for them to get it. So, there are lots of lessons we can learn for the future going forward on that. I just want to change slightly the focus. Even before the pandemic, one of the trends we were seeing is that people are no longer a passive recipients of care. They expect quick, convenient and trusted services and are happy to shop around if they need to. They are used to getting instant accesses to services like Amazon to be able to book their own travel arrangements etc. So they do expect to have more convenient access to services and they are also willing to interact with the healthcare system in new ways. We are seeing that the appetite for digital innovation increasing and where in the past people pointed to resistance of patients to engage through technology, we’ve seen that change significantly. Yet three-tenths of Europeans lack basic digital skills and there are some eighty million Europeans who have never used the internet. So, how do we ensure that these innovations as a result of digital transformation don’t increase health inequalities and that we address this digital exclusion challenge. Is there something that you are doing yourselves about this? Maybe Lars if you can start with that.
Lars Dahle (00:23:00): Sure, so we have been working very closely with our customers to overcome this exclusion. I clearly recall the first patients that we got with the city of Oslo, the manager in charge there he told us that you don’t need many patients, but I will hand you ten patients to start with. They will be old of age, they will have no digital experience and they will have serious conditions of chronic diseases, multiple such. And he was right. That’s exactly the kind of patients he gave us. And we spent a lot of time understanding how they would relate to a service like this and how we could design the user interface for these patients. And we ended up with something that maybe some of the designers would say is not kind of according to the best design rules but it certainly works with this patient group. I think that has been one of our differentiators over years that we started doing studies of how these groups that often fall outside of these digital tools, now can be included. And today we have patients over the age of 90, which have not a clue to be honest about digital tools, and they are still using our system on a daily basis. So I think it is possible to overcome but I think you have to have a lot of attention to it and I think you need to work closely with that particular patient group in order to overcome it.
Karen Taylor (00:24:45): Lars, one of your technologies is the smart medication dispensers, which are specifically aimed at older people in general. How does that work? And how do you ensure that some of the frail oldest people can still use them?
Lars Dahle (00:25:04): Exactly. So again when we tested out different technologies – how to provide medication in a safe way, assure that they get the right medication at the right time. So we tested different technologies that was exactly what we were looking for, something that is easy enough for them to master. So in Norway we are lucky enough to have a well built out system of home nurses. So they will come to your home and they will do the training of the patients, they will also refill the dispenser on a regular basis. But then the patient is on his own of operating it, which means that there is a sound going off every time that they need to take their medication and there is exactly one large button to push on the device. And it is kind of, that button is blinking, so it is extremely easy for them to operate the device and then the medication is fed out. If it doesn’t happen, if they don’t feed out the medication there is an alarm going off to the home nurses, to the primary care nurses so they can act in and check out what’s going on with the patient. So actually we’ve seen very few patients that don’t master this technology on their own.
Karen Taylor (00:26:24): And that’s a great example of the fact that technology is not replacing people but its augmenting and supporting staff to be able to work more efficiently. So thank you for that. Lloyd, in terms of mental health providers what can digital mental health providers do to ensure they create technologies that are inclusive? And what have you yourself done?
Lloyd Humphreys (00:26:48): Yes, I think when we look at digital exclusion it’s a really important area but I think we need to be very specific when we look at digital exclusion what we mean by that. I like to think about this in three broad categories: firstly accessibility, then about usability, and then about making sure that it is marginalised or excluded groups from different cultural backgrounds can be able to kind of use the solutions. If we take accessibility, we have done lots of work, work alongside homeless shelters and other kinds of groups where you might have perceived that the access to technology is reduced. Actually it isn’t a factor that, actually most people do have access to technology. What we find though is actually it’s the cost of data that is really important. That actually it’s the cost of being able to use data with the technology solutions those there are that use the internet for example that is a significant barrier. The ability of free Wi-Fi, hotspots and things like that, are really key but also for technology solutions to make sure that their solutions have low bandwidth. And that’s what we have done in terms of our solution is to make sure that it is not data heavy. When you think about usability, you mentioned digital literacy, and that is really key. But also those with disability, the inability to see a screen or hear what might be spoken in videos for example. Those are really key. When you think about the older group though, for SilverCloud the over 65s actually show some of the very best outcomes through mental health support. They have the time, they have the ability to access it on web-enabled devices like tablets for example and actually we find that some of the older age range actually benefit most from digital technologies. And then when we think about exclusions from different cultural backgrounds, actually one of the benefits of digital is that it can overcome some of the stigma associated with mental health. Lots of different cultural backgrounds people might feel that they should not speak about mental health or their well-being, there is a stigma associated there. So actually being able to access something anonymous by themselves in their own time can actually break down some of those barriers. There’s still lots to be done, there’s still lots to be… you know particularly when we think about those with disabilities, those that might kind of have access problems. But I think when we… digital exclusion, there are lots of different things that we can kind of do.
Karen Taylor (00:29:34): Thank you. I think that is very reassuring. I would like to use the last few minutes that we have to look at the future and on a number of fronts that COVID pandemic has caused the health sector to leap one or even two innovation cycles ahead in a remarkably short time. But in other areas action is still needed to embed and sustain technology adoption. Despite the challenges our survey respondents actually felt very positive about the adoption of technologies and feeling empowered when they are adequately trained to use them. They also expect to be involved in the development and the implementation. Likewise technology is developed without inputs from patients it has less chance of being successful. The majority of our survey respondents think that it will take less than five years from now to achieve a fully digital healthcare system. Question to you both, do you agree? And if so, why? And if not, what’s your reasons?
Lars Dahle (00:30:34): Okay so if I am allowed to go first, I will say that we’ve been having some experience in that area because the solution you mentioned about the medication dispensers has really been recommended by our health authorities for more than five years now. And they had an ambition similar to what you say. And we’ve been quite diligent of developing the solution together with the healthcare personnel and the patients, so check on that. We have kind of gone through all the bureaucracy, and all of that to get to the right procurement procedures and everything so that majority of Norwegian primary care providers now are able to buy and use and scale up our solution. But still we see very little adoption in many of these providers. And we have asked ourselves the same question. Why is that? And we see that in a very very busy every day, the healthcare personnel doesn’t seem to be able to pick up new stuff. So someone said that no organisation naturally drift towards change and we have certainly experienced that here in Norway, and we see some of the same things going on in the UK. So we actually believe that the key to this is how the leaders are pushing change through the organisation and these leaders and managers, I believe they often listen to kind of the money, the money trail. So I think if I were given the magic wand, I think I would do something about how we finance and incentivise the adoption of new digital healthcare technologies. And I think that would certainly make a change where we are operating currently, see better motivation through getting, let’s say, a good financing of services if they are using the digital tools. And we are seeing a slowly change towards that in Norway now and I think it has to come into place before we can see this wide adoption of this new digital healthcare services.
Karen Taylor (00:32:59): And what about you Lloyd? Do you agree with that, or do you have a different perspective?
Lloyd Humphreys (00:33:03): I think for the, to achieve a fully digital healthcare system with five years is possible but there are certain big things that need to kind of change. You have mentioned interoperability. I think the underlying infrastructure and common standards, kind of data exchange, all of those things are big problems, big rocks to be able to kind of shift. Those are in flight in the present times, so I am confident that there is movement towards that. But when we think about a fully digital healthcare system – are we meaning a digital first approach where the front door to healthcare is digital, I think that is certainly possible, or are we talking about digitally embedded services. So the use of technologies and digital are fixed within an existing pathway and existing kind of healthcare model. And I think that is already happening, so we can see that within the UK in terms of improving, as I say, psychological therapies, which I think is probably one of the shining examples of digital transformation, they have full kind of digital case notes and EPR, they have kind of digital firsts in terms of treatments and self-sign ups, and that needs to be replicated right across the system when we think about mental health. So we can see some countries are going through this in different ways. So we can see that some countries are going through this in different ways. So we can see that the UK is kind of leading in this way, Germany with their DVG process and the ability for technologies kind to become registered DiGA, and the ability for that to be fully reimbursed at a national level. So we can see that there are countries that are moving towards that five year horizon. The biggest barrier though for this, for this adoption is awareness. We know at SilverCloud that actually when people are aware of the services, those people who find us over 80 percent will then register and use the service. So it is not a problem in terms of people using the systems. It is about knowing that it exists. And we can see this with utilisation and adoption rates. So when people know it’s there, they use it. But there are sometimes and often people aren’t aware that this service exists for them. So that has to be the big drive. And not a big bang kind of marketing where it then kind of fades and peter out. We need to have that constant drip awareness that help and support is available for them again anytime and anywhere they need it. And I think this is going to be the big kind of need to have that adoption.
Karen Taylor (00:35:38): And Lars you actually jumped ahead and answered my magic wand question. But I am still going to ask you both the question again. You can say if you don’t feel like there’s anything else to add Lars, but what one thing would you want to change to ensure a digital future for the healthcare system.
Lars Dahle (00:35:56): I think I am going to repeat the last answer there to change the incentives to start using these digital technologies in a more scaled up fashion. I think that will be my you know big wand wish.
Karen Taylor (00:36:11): Haha, thank you. Lloyd what about you? What do you think?
Lloyd Humphreys (00:36:14): Yes, I would agree with the incentives because often there are disincentives to use digital technologies when you look at reimbursements and all of that. So I completely agree with Lars on that. And also then going back to my point around awareness. I think for me that’s the magic wand – that people know that there are solutions for them, healthcare doesn’t have to be an on-off, you are in treatment or you are not. Its that it can be available for you wherever and whenever you need it at the touch of a button. So for me that is the kind of the cultural shift, that people don’t have to wait, that there doesn’t have to be a waiting room, there doesn’t have to be a waiting list, that actually those digital technologies can then demolish those barriers to access evidence-based health immediately. And that’s not just in terms of kind of therapeutics, digital therapeutics, but it is also in terms of access to GPs, access to emergency services. I think digital has a role to play right across the system.
Karen Taylor (00:37:14): That’s definitely the conclusion and the view that we hold. Is there anything you would like to add that you haven’t had the chance to mention, is something you feel strongly about that you would like sort of the readers, listeners to this to take away with them. Again Lloyd maybe start with you.
Lloyd Humphreys (00:37:34): For me its about realising that digital has the potential to have the same parity with other forms of services. So digital is not the lesser to other forms of interventions, services, etc. Often, we can believe that obviously digital might be someone trying to divert away from a service or divert away from a particular kind of treatment modality. So for me it’s about making sure that there is parity of esteem. And that parity of esteem is not just in terms of digital but also in terms of mental health. When we think about COVID-19 these are the biggest emotional mental health challenges that we will face in our lifetime. There is the global trauma of kind of going through local lockdowns, dealing with grief and loss, and so for me we also need that parity of esteem between those physical treatments that we can kind of see with managing a virus but also, we need to kind of look at the mental health impact as well. And we need to have parity with that. Otherwise we will be facing a tsunami of mental health next year and the years going forward.
Karen Taylor (00:38:50): And Lars, is there any other last takeaway you would like to give our listeners?
Lars Dahle (00:38:55): Well I would like to maybe hold out the view of the patient here. I think that in many of these discussions and places where I go, I think that the voice of the patient is kind of not heard as much. We have so many feedbacks from patients that they really feel more safe, they have a better quality of life after they receive this digital home monitoring solution, and I think that kind of the, all the stakeholders that are doing anything holding it back or anything to stop the wider use of this, I think should consider one more time, you know, the voice of the patients, who am I really doing this for. Because they are certainly being kind of a hold back in many areas as we work currently.
Karen Taylor (00:39:49): So I think the voice of the patient, that’s an excellent place in which to draw this conversation to a close. I would like to thank Lloyd and Lars for sharing their insights today. And thank you also to all of our listeners. For more insights on digital transformation in European healthcare, you can find a link to our report in the about section of this episode. And I hope you will join us again for our next episode in the Life Sciences Connect podcast series. For now just saying goodbye and thank you for listening.