NHS CyberSecurity lessons arising from the worldwide ransomware attack that occurred on the 14th of May is already prompting much debate for the NHS, much of which focuses on the failure of affected organisations to ensure adequate levels of investment on IT systems to mitigate the risk of this event.
The ransomware exploited a known issue with Windows XP, for which a patch had been issued earlier in the year. The biggest news headlines here in the UK concerned the impact this exploit had on the NHS, with a great many organisations appearing to have been caught out by the Windows XP vulnerability.
As is the case when the public sector suffers an adverse event, the call goes out for lessons to be learned, usually with an assumption that these are all new, but inevitably there will be those lessons that have already been learned, but just not put into practice.
Those that have been around NHS IT for a while will remember the last elected labour government’s implementation of the National Programme for IT (NPfIT) tasked to deliver a standard national NHS IT system. Regardless of what is thought about the success or failure of the programme, it did leave a lasting legacy long after it was cancelled.
Not least with those NHS organisations that had progressed to implementing NPfIT systems and solutions and in doing so, had tied themselves to technology standards defined by the program that could not be easily changed. In the commentary on following the ransomware event it has been highlighted that the legacy of NPfIT Windows XP implementations was the reason so many organisations were adversely affected.
In September 2011, the government announced the acceleration of the dismantling of the National Programme for IT*. Whilst at the time the impact of this decision was not significant, because NPfIT technology was still current and thus supported by providers, it should have perhaps been better recognised that this state was not sustainable in the long term. Especially for Windows XP, because the next version Windows 7 was already available (released Oct 2009) and being adopted across health in non NPfIT legacy environment.
Things finally came to a head for XP when Microsoft announced that it would be ending its patching and maintenance support for the platform in April 2014. Thankfully in acknowledging that there was still a dependency on this technology platform, the government took steps and signed an extra-ordinary deal with Microsoft** that secured continued support for XP across the UK public sector for another 12 months.
Critically, a condition of this agreement, was that any public sector body wishing to take advantage of this extended support arrangement, had to commit to development of a “robust plan” to move off Windows XP, Office 2003 and Exchange 2003 within the year.
Roll forward to 2015 and the next government decision on the matter was just as they had advised, that they would be closing down this extra-ordinary support arrangement ***, and is has to be said for good reason, on the basis that it was felt that continued central government funding of this deal was not consistent with the need to encourage organisations to urgently upgrade or migrate.
The question here however has to be, “was it reasonable to expect trusts to be able to find the funds for wholesale upgrade of unsupported operating systems in such a short time frame (this being equivalent to a single financial year)?
To further compound matters at the time, NHS organisations had been shielded from the full cost of wholesale systems upgrade throughout the time of NPfIT. A national licencing deal with major suppliers like Microsoft, removed the need for software costs to be met locally by NHS organisations ****.
It is accepted best practice that when a pre-existing programme or project is to be closed down, an impact assessment of the consequences should be undertaken. Not least so that the risk can be properly understood and adequate mitigations planned. If nothing else there is nearly always a financial consequence to closing programmes and projects and this is a very good example of one.
The NPfIT programme along with central licensing deals transformed the model of IT investment within the NHS for a decade. Switching these off and closing down the national deals the programme created was inevitably going to have consequences for participating organisations.
Some will argue that the implementation of the extra-ordinary support arrangements for legacy software was an act of risk mitigation. However, was it reasonable in 2014 to expect affected organisations to plan and implement an upgrade or migration of XP in a single financial year, without any additional financial support being provided?
The NHS had already been managing financial pressures for a good number of years before the decision to end XP support was taken. Certainly long enough for organisations to flag this to be a risk of significance, that without additional and extra-ordinary financial support, there was no way they were going to be able to take the steps needed to address the situation accordingly.
In summing up, it is clear that although the NPfIT national licencing deals themselves had been closed down some years earlier in 2010, the impact of this decision on local investment plans going forward, was never properly qualified or understood, and that further opportunities to address this in 2015 were missed and all the way up to 14th of May this year, 7 years on!
As an acknowledged risk, the XP issue should have been raised on the Information Governance (IG) Risk Register and flagged as a serious concern to the Senior Information Risk Owner (who by now and as a result of improvements to NHS IG standards) was a role assigned to a senior management representative on the board of the organisation.
Additionally, given the dependence on technology in meeting clinical outcomes, the risk should have also featured on the Clinical Risk Register, which would have flagged it up to the Chief Medical Officer, also a member of the board.
Just a cursory glance at most organisations annual reports and board papers will expose the fact that IT barely gets a mention, certainly any reviewer will be hard pressed to find any mention of XP specifically in the dealings of the boards in any one of the organisations affected, at any stage of the timeframe of this being an ongoing concern.
This therefore exposes a potentially bigger issue in that information technology investment and dependence is not a matter adequately represented at the board level, then or now.
This clearly is a matter of concern, given as the recent event exposed the criticality of the services dependence on the information technology in the performance of its primary function, delivery of treatment and care.
Frustratingly some of the commentary on the event included the phrase “IT is not the primary business of the NHS”, suggesting therefore it is not the NHS responsibility to ensure the reliability and safety of the tools it uses to deliver care, this is clearly nonsense.
It is perhaps partly this attitude that has excluded proper IT representation at the board level? Given the next stage of investment required and proposed by “paperless at the point of care” and “integrated digital health and care plans” and additional dependence on technology this will deliver, it is now time for IT to have a seat at the top table.
The NHS has an excellent online tool and system of guidance and assessment addressing information systems, security and good practice management standards (NHS Information Governance Toolkit). The tool is well established having been around and in use for more than 15 years with NHS organisations status reports openly published and available for review.
In April 2014 in a blog article entitled Patient Record Access – A Perspective 2 Years On I set out the more fundamental data protection and information governance challenges that the NHS needed to address to maximise the benefits potential of digital engagement. Not long after the original 2015 target for achieving patient record access was deferred to 2018 and linked to the “paperless at point of care” requirement.
Then and still today, technology innovation is widely acknowledged and accepted to be the primary method by which transformation of current health and social care models, and opportunities to deliver service effectiveness improvements and efficiencies at a substantial scale (£20bn+) going forward is to be achieved.
NHS 2020 digital roadmaps across the country outline ambitious plans addressing technology integration and innovations requirements needed to achieving “paperless at the point of care” and “integrated digital health and care record”. The levels of investment are significant, but then so is the benefits potential. For the first time in the history of health and social care, the technology to support transformation to a more pro-active and well-being orientated model is possible.
Success however will be heavily dependent on the digital engagement of patients and their carer’s and how effectively this is achieved. In this respect information governance will be a key deliverable and factor in how much and how quickly the benefits of patient digital engagement are secured and maintained going forward. Patients will need ongoing assurance that digital engagement is safe, and that their right to privacy is being properly protected.
Of the 33 major NHS organisations (community and acute hospitals) identified to have been affected, all have reported a “satisfactory” rating in the information governance self-assessments completed in March this year, in particular for the following requirements:
|Information Security Assurance|
|14-301||A formal information security risk assessment and management programme for key Information Assets has been documented, implemented and reviewed|
|14-307||An effectively supported Senior Information Risk Owner takes ownership of the organisation’s information risk policy and information risk management strategy|
|14-309||Business continuity plans are up to date and tested for all critical information assets (data processing facilities, communications services and data) and service – specific measures are in place|
|14-310||Procedures are in place to prevent information processing being interrupted or disrupted through equipment failure, environmental hazard or human error|
|14-311||Information Assets with computer components are capable of the rapid detection, isolation and removal of malicious code and unauthorised mobile code|
|14-313||Policy and procedures are in place to ensure that Information Communication Technology (ICT) networks operate securely|
The recent CyberSecurity event serves to remind the NHS, that despite all the good work done in the development of the information security and governance standards and despite all the resources that have been provided to help organisations get good at this, there is so much more to be done, and this too is going to require additional investment at the local organisational level.
Links to Articles
By 2018 patients should have access to their medical records online. By 2020 this should have evolved into a digital patient engagement solution as health and social care achieves “paperless at the point of care” working practices. But is it just about engagement, or should we be preparing more for active participation and ownership of health concerns and issues.
Most concern I have had shared with me is that the NHS 2020 Digital proposals are still not making adequate plans to exploit the opportunity provided by Internet of Things (IoT), Wearables and Assisted Living technologies at the earliest.
The current focus is being given to resolving internal data integration / flow issues which do need resolving. Acknowledging that there are clinical and information governance concerns as well as care benefits needing to be addressed. But whilst these in the main deliver service quality and improved workflow for people already in the system. Their support for delivery of a transformed and more sustainable service delivery model is limited.
Transformation of the service delivery model and improvement in future sustainability of any significance for health and social care, is largely dependent on the digital patient engagement (or better – participation) and capabilities delivered by technology innovation incorporated to support pro-active participation. The opportunity and benefits potential is significant, when the service delivery model evolves from one that is largely re-active and after the fact, to an alternative and more sustainable pro-active and well-being orientated model.
These benefits are only going to be enhanced by any ability to integrate and exploit technology innovations and automation delivered by IoT, wearables, assisted living and health and care / well-being monitoring innovations and solutions. Adoption of these technologies will increase as they become more capable and with this increase the range of proactive information and data supporting opportunities for further cost saving interventions and / or preventions will also increase.
Consequently the long-term objective of any digital health and care engagement solution, should be about providing the means to help us to live well, and if we are unfortunate enough to have one or more long term chronic conditions or disability, to be empowered to manage our situation as much and as well as we can. It is never though just about us and individuals, we pretty much all care for or are cared by somebody else. So we should be able to gain access to others information too.
All of the above inevitably leads to an explosion of information becoming available, and of the most personal and sensitive kind! Consent, data ownership / management quickly become the most important considerations in any engagement solutions design that needs to be open to accommodate future technology innovations delivering on the pro-active health and well-being opportunity.
It is, however, widely acknowledged that local developments and deployments are not being guided by core common engagement and consent model or universal data flow / integration standards, of concern consequently, the progress to a better model of health and care continues to evolve with massive variations in capability delivered differently across regions.
Until the need for core common standards on data consent, governance and interoperability are fully addressed, then the participation of patients and citizens with the digital solutions will likely remain inhibited, subsequently the opportunity to achieve the £20b of universal benefits from a transformed service delivery model by 2020 will very likely remain an elusive and much less assured target that it could otherwise be.
Article produced in response to news item Health wearables firm Fitbit holds talks with NHS published by Digital Health
Cybathlon, the first Olympic Games for bionic athletes was hosted on 8 October 2016, in Kloten, Switzerland. This world premiere saw 74 international disabled athletes – kitted out with bionic prostheses and brain-computer interfaces – compete with each other at the specially created events. These modern-day cyborgs from 25 different countries competed in 59 different teams from all over the world.
The initiative was launched by Robert Riener, a professor of sensory-motor systems at ETHZ. “One of the goals of the cybathlon is to encourage researchers and developers to work on robotic technologies that can substantially improve daily life for people with disabilities.”
The unique competition for people with disabilities will continue!
The six disciplines from 2016; Brain-Computer Interface Race, FES Bike Race, Powered Arm Prosthesis Race, Powered Leg Prosthesis Race, Powered Exoskeleton Race, Powered Wheelchair Race, will remain in the Cybathlon 2020 programme. The tasks will continue to be relevant to everyday life, but will reflect advances in research. The main goal of the Cybathlon 2020 is to push the development of assistive devices for people with disabilities.
Due to the very successful Cybathlon event in 2016 and the feedback received, the Organising Committee plans an even bigger event, breaking it up into two days. There will also be an attractive secondary programme, wherein the visitors can try out the disciplines for themselves (hands-on demos) and understand the issues surrounding disability in a practical way.
A smart city (also smarter city) uses digital technologies or information and communication technologies (ICT) to enhance quality and performance of urban services, to reduce costs and resource consumption, and to engage more effectively and actively with its citizens. Sectors that have been developing smart city technology include government services, transport and traffic management, energy, health care, water and waste. Smart city applications are developed with the goal of improving the management of urban flows and allowing for real time responses to challenges. A smart city may therefore be more prepared to respond to challenges than one with a simple ‘transactional’ relationship with its citizens. Other terms that have been used for similar concepts include ‘cyberville, ‘digital city’’, ‘electronic communities’, ‘flexicity’, ‘information city’, ‘intelligent city’, ‘knowledge-based city, ‘MESH city’, ‘telecity, ‘teletopia’’, ‘Ubiquitous city’, ‘wired city’.
The Smart City Expo World Congress is the only international event on the smart cities’ calendar bringing together over 400 cities around the world, more than 200 companies, 400 speakers and the leading institutions and experts in urban transformation.
You might be interested (and a little surprised) in knowing the extent to which cities around the world are collaborating with the Smart City Expo World Congress.
Its still early days as far as development of smart city innovations go, but if yours is not on the list, you might want to ask the powers that be why it is not? Because given the rate at which things change, now would likely be a good time to jump on board this initiative!
Spain and Israel seem to have a fervour to develop their Smart Cities in a very big way, with a great many of these countries cities taking part.
India and notably South American countries Argentina, Mexico and Brazil feature as close runner ups, with the USA and European countries making up others that have a good number of cities engaged, though in some case not as many as you might expect?
The UK seems to have only what might be considered a reasonable rather than exceptional number engaged on this initiative, with notably only one in Scotland and none in Wales or Northern Ireland. My home city of Exeter in Devon is not on the list either, so some lobbying to be done here!!!! Good luck to anybody else who takes up the cause for their home city (or even town).
Source: Cities involved in 2014
|Bahía Blanca, Buenos Aires, Cañada De Gómez, Casilda, Chaco, Chanear Ladeado, Córdoba, Hughes, La Plata, La Rioja, Mendoza, Resistencia, Rosario, San Cristóbal, San Telmo, Santa Fe, Totoras, Tucumán, Vicente López, Villa Cañás|
|Australia||Melbourne, Newcastle, Parkville, Sydney|
|Austria||Grödig, Innsbruck, Vienna|
|Belgium||Aalst, Brasschaat, Brussels, Genk, Gent, Gial, Heverlee-Leuven, Knokke-Heist, Kortrijk, Lokeren. Mechelen. Mol|
|Brazil||Belo Horizonte, Brasilia, Cantagalo, Casimiro De Abreu, Curitiba, Divinopilis, Guaruja, Macaé, Porto Alegre, Resende, Rio Das Ostras, Rio De Janeiro, São Bernardo Do Campo, São João De Miriti, São Paulo, Sete Lagoas, Três Rios, Vitoria|
|Canada||Chambly, Kingston, Montreal, Toronto, Wolfe Island|
|Chile||Santiago De Chile, Villa Alemana|
|China||Beijing, Chongqing, Nanjing, Hong Kong, Qinzhou, Shanghai, Shenzhen, Shijiazhuang|
|Colombia||Barranquilla, Bogotá, Ibague, Manizales, Medellín, Pereira|
|Croacia||Dubrovnik , Sesvete, Zagreb|
|Czech Republic||Brno, Prague|
|Denmark||Aarhus, Albertslund, Charlottenlund, Copenhagen, Gentofte|
|Ecuador||Durán, Quito, San Gregorio De Portoviejo, Yachay|
|Finland||Espoo, Helsinki, Mikkeli, Sipoo, Tampere|
|France||Bordeaux, Issy-Les-Moulineaux, Lyon, Nantes, Paris, Perpignan, Roubaix, Toulouse,|
|Germany||Berlin, Bremen, Cologne, Dortmund, Freiburg, Hamburg, Hannover, Oldenburg, Potsdam|
|Greece||Igoumenitsa, Larissa, Patras|
|India||Ahmedabad, Ajmer, Allahabad, Amritsar, Bhopal, Chandigarh, Delhi, Hyderabad, Jaipur, Mumbai, New Delhi, Pimpri Chinchwad, Pondicherry, Ranchi, Thiruvananthapuram, Vijaywada, Visakhapatnam|
|Indonesia||Banda Aceh City, Jakarta|
|Iran||Bandar Abbas, Esfahan, Teheran|
|Ireland||Dublin, Galway, Naas, Phibsborough, Portlaoise|
|Israel||Alfei Menashe, Ariel, Ashdod, Ashkelon, Bat Yam, Beer Yakov, Bnei Ayish, Bnei Brak, Eilat, Eilot, Gedera, Geva Carmel, Gush Etzion, Haifa, Herzliya, Holon, Hurfeish, Jerusalem, Katzrin, Kfar Saba, Kiryat Arba, Kiryat Gat, Luzit, M- Yehuda, Ma’Ale Edumim, Mateh Yehuda, Modiin, Natanya, Ness Ziona, Netanya, Petach-Tikva, Raanana, Ramat Gan, Ramla, Rehovot, Rishon Lezion, Savyon, Shoham, South Hasharon, Tamar, Tel Aviv, Tel-Mond, Yakum|
|Italy||Amaro, Turin, Gènova, Lecce, Milan, Pordenone, Povo, Rome|
|Japan||Fukuoka, Kumamoto, Kyoto, Tokyo, Yokohama|
|Mexico||Álvaro Obregón, Colima, Guadalajara, México, Puebla, Toluca, Zapopan|
|Netherlands||Alblasserdam, Amersfoort, Amsterdam, Assen, Eindhoven, Eursing, Groningen, Rotterdam, Schiphol, The Hague, Tilburg, Utrecht, Zoetermeer, Zoeterwoude|
|New Zealand||Auckland, Wellington|
|Nigeria||Abeokuta, Isolo, Surulere/Lagos|
|Norway||Asker, Oslo, Stavanger|
|Portugal||Gondomar, Lagoa, Oeiras, Portimão, Porto|
|Russian Federation||Moscow, Saint Petersburg|
|Saudi Arabia||Jeddah, Riyadh|
|Solomon Islands||Solomon Islands|
|South Africa||Cape Town|
|South Korea||Daejeon, Seoul, U-Sung|
|Spain||A Coruña, Amposta, Artà, Artesa de Segre, Badalona, Barcelona, Begues, Berga, Cambrils, Castelldefels, Castellón, Cerdanyola Del Vallès, Cornellà De Llobregat, Dénia, Donostia-San Sebastián, Esplugues de lobregat, Figueres, Gavà, Gijón, Girona, Granollers, Jaén, L’Hospitalet de Llobregat, Lliçà d’Amunt, Logroño, Madrid, Málaga, Malgrat de Mar, Manresa, Mataró, Mollet del Vallès, Móstoles, Ordis, Palma de Mallorca, Pamplona, Reus, Rivas Vaciamadrid, Sabadell, Sant Adrià del Besós, Sant Climent de Llobregat, Sant Cugat del Vallès, Sant Esteve Sesrovires, Sant Feliu de Llobregat, Sant Just Desvern, Santander, Santiago De Compostela, Santpedor, Sevilla, Sitges, Tarragona, Terrassa, Valencia, Valladolid, Vic, Vigo, Viladecans, Vitoria-Gasteiz, Zaragoza|
|Sweden||Gothenburg, Kista, Malmö, Lund, Stockholm|
|United Arab Emirates||Abu Dhabi, Dubai, Zaabeel|
|United Kingdom||Birmingham, Bristol, Clevedon, Edinburgh, Glasgow, Greenwich, Leeds, Liverpool, London, Manchester, Milton Keynes, Peterborough, Redruth, Southampton, Swindon|
|United States||Boston, Boulder, Charlotte, Denver, Fort Lauderdale, New York, Orlando, Philadelphia, Portland, Raleigh, Redmond, San Francisco, Seattle, Washington, Wayland|
|Venezuela||Catia La Mar|
Healthcare technologies that have potential to really shape the way medicine and healthcare is practiced and delivered is explored by Dr. Bertalan Mesko, PhD, The Medical Futurist, author, keynote speaker, geek doctor with PhD in genomics, science fiction fanatic who shares his thoughts on his favorite technologies in this video.
More from Dr Mesko can be found at https://www.youtube.com/user/medicalfuturist/featured
The Internet and digital technologies are transforming our world – in every walk of life and in every line of business. Europe must embrace the digital revolution and open up digital opportunities for people and businesses. How? By using the power of the EU’s Single Market. Today, the European Commission unveiled its detailed plans to create a Digital Single Market, thereby delivering on one of its top priorities.
At present, barriers online mean citizens miss out on goods and services: only 15% shop online from another EU country; Internet companies and start-ups cannot take full advantage of growth opportunities online: only 7% of SMEs sell cross-border (see Factsheet for more figures). Finally, businesses and governments are not fully benefitting from digital tools. The aim of the Digital Single Market is to tear down regulatory walls and finally move from 28 national markets to a single one. A fully functional Digital Single Market could contribute €415 billion per year to our economy and create hundreds of thousands of new jobs.
The Digital Single Market Strategy adopted today includes a set of targeted actions to be deliveredby the end of next year (see Annex). It is built on three pillars: (1) better access for consumers and businesses to digital goods and services across Europe; (2) creating the right conditions and a level playing field for digital networks and innovative services to flourish; (3) maximising the growth potential of the digital economy.
Commission President Jean-Claude Juncker said: “Today, we lay the groundwork for Europe’s digital future. I want to see pan-continental telecoms networks, digital services that cross borders and a wave of innovative European start-ups. I want to see every consumer getting the best deals and every business accessing the widest market – wherever they are in Europe. Exactly a year ago, I promised to make a fully Digital Single Market one of my top priorities. Today, we are making good on that promise. The 16 steps of our Digital Single Market Strategy will help make the Single Market fit for a digital age.”
Vice-President for the Digital Single Market Andrus Ansip said: “Our Strategy is an ambitious and necessary programme of initiatives that target areas where the EU can make a real difference. They prepare Europe to reap the benefits of a digital future. They will give people and companies the online freedoms to profit fully from Europe’s huge internal market. The initiatives are inter-linked and reinforce each other. They must be delivered quickly to better help to create jobs and growth. The Strategy is our starting point, not the finishing line.“
Commissioner for the Digital Economy and Society Günther H. Oettinger said: “Our economies and societies are going digital. Future prosperity will depend largely on how well we master this transition. Europe has strengths to build on, but also homework to do, in particular to make sure its industries adapt, and its citizens make full use of the potential of new digital services and goods. We have to prepare for a modern society and will table proposals balancing the interests of consumers and industry.”
The Digital Single Market Strategy sets out 16 key actions under 3 pillars which the Commission will deliver by the end of 2016:
The Commission will propose:
1. rules to make cross-border e-commerce easier. This includes harmonised EU rules on contracts and consumer protection when you buy online: whether it is physical goods like shoes or furniture; or digital content like e-books or apps. Consumers are set to benefit from a wider range of rights and offers, while businesses will more easily sell to other EU countries. This will boost confidence to shop and sell across borders (see Factsheet for facts & figures).
2. to enforce consumer rules more rapidly and consistently,by reviewing the Regulation on Consumer Protection Cooperation.
3. more efficient and affordable parcel delivery. Currently 62% of companies trying to sell online say that too-high parcel delivery costs are a barrier (see the newly released Eurobarometer on e-commerce).
4. to end unjustified geo-blocking – a discriminatory practice used for commercial reasons, when online sellers either deny consumers access to a website based on their location, or re-route them to a local store with different prices. Such blocking means that, for example, car rental customers in one particular Member State may end up paying more for an identical car rental in the same destination.
5. to identify potential competition concerns affecting European e-commerce markets. The Commission therefore launched today an antitrust competition inquiry into the e-commercesector in the European Union (press release).
6. a modern, more European copyright law: legislative proposals will follow before the end of 2015 to reduce the differences between national copyright regimes and allow for wider online access to works across the EU, including through further harmonisation measures. The aim is to improve people’s access to cultural content online – thereby nurturing cultural diversity – while opening new opportunities for creators and the content industry. In particular, the Commission wants to ensure that users who buy films, music or articles at home can also enjoy them while travelling across Europe. The Commission will also look at the role of online intermediaries in relation to copyright-protected work. It will step up enforcement against commercial-scale infringements of intellectual property rights.
7. a review of the Satellite and Cable Directive to assess if its scope needs to be enlarged to broadcasters’ online transmissions and to explore how to boost cross-border access to broadcasters’ services in Europe.
8. to reduce the administrative burden businesses face from different VAT regimes: so that sellers of physical goods to other countries also benefit from single electronic registration and payment; and with a common VAT threshold to help smaller start-ups selling online.
The Commission will:
9. present an ambitious overhaul of EU telecoms rules. This includes more effective spectrum coordination, and common EU-wide criteria for spectrum assignment at national level; creating incentives for investment in high-speed broadband; ensuring a level playing field for all market players, traditional and new; and creating an effective institutional framework.
10. review the audiovisual media framework to make it fit for the 21st century, focusing on the roles of the different market players in the promotion of European works (TV broadcasters, on-demand audiovisual service providers, etc.). It will as well look at how to adapt existing rules (the Audiovisual Media Services Directive) to new business models for content distribution.
11. comprehensively analyse the role of online platforms (search engines, social media, app stores, etc.) in the market. This will cover issues such as the non-transparency of search results and of pricing policies, how they use the information they acquire, relationships between platforms and suppliers and the promotion of their own services to the disadvantage of competitors – to the extent these are not already covered by competition law. It will also look into how to best tackle illegal content on the Internet.
12. reinforce trust and security in digital services, notably concerning the handling of personal data. Building on the new EU data protection rules, due to be adopted by the end of 2015, the Commission will review the e-Privacy Directive.
13. propose a partnership with the industry on cybersecurity in the area of technologies and solutions for online network security.
The Commission will:
14. propose a ‘European free flow of data initiative‘ topromote the free movement of data in the European Union. Sometimes new services are hampered by restrictions on where data is located or on data access – restrictions which often do not have anything to do with protecting personal data. This new initiative will tackle those restrictions and so encourage innovation. The Commission will also launch a European Cloud initiative covering certification of cloud services, the switching of cloud service providers and a “research cloud”.
15. define priorities for standards and interoperability in areas critical to the Digital Single Market, such as e-health, transport planning or energy (smart metering).
16. support an inclusive digital society where citizens have the right skills to seize the opportunities of the Internet and boost their chances of getting a job. A new e-government action plan will also connect business registers across Europe, ensure different national systems can work with each other, and ensure businesses and citizens only have to communicate their data once to public administrations, that means governments no longer making multiple requests for the same information when they can use the information they already have. This “only once” initiative will cut red tape and potentially save around €5 billion per year by 2017. The roll-out of e-procurement and interoperable e-signatures will be accelerated.
The Digital Single Market project team will deliver on these different actions by the end of 2016. With the backing of the European Parliament and the Council, the Digital Single Market should be completed as soon as possible.
For more information:
“Today’s 3D printers are great for building plastic stuff, things like toys and musical instruments and even shoes. Some can also print metal objects, like car parts and jewellery and, well, guns. But Jennifer Lewis helped create a new kind of printer, one that can print electronics, such as, ultimately, hearing aids and other wearables.”
Advances in 3D printing capabilities combined with affordability, could impact traditional consumer models in a potentially significant and positive way, especially for the public service providers such as those delivering health and social care.
One particular area of activity that could most benefit from this technology is with regard to the utilisation of health monitoring, condition management and assisted living devices, designed to improve the ability to monitor and support patients and their carers in better managing conditions ‘closer to home’.
Presently, most health monitoring and condition management is achieved through tele-health / tele-care (contracted) services, with which a wide variation across the country in the range of services, and technologies available exists. Patients moving from one area to another frequently find services that were available in one, are not available in another.
Procurement of tele-health and tele-care services has also proved to be problematic. As well as being a lengthy and complicated process, contracts are also implemented typically under arrangements within which it is difficult to innovate, change or extend service offerings.
This has had a negative impact on the rate of adoption and utilisation of these services across health and social care service provision, and critically patients, carers and service providers are all missing out on some potentially very significant benefits.
At eCulture we believe that the rapidly evolving advances in wearable / assisted living devices and technologies, in particular those purchased independently by service users, are already challenging current health and social care delivery models, by the creation of a demand for a more proactive, rather than reactive service delivery model.
This demand is somewhat exacerbated by the fact that the largest proportion of investment in the devices and technologies is by those classified as ‘the worried well’, individuals with a proactive attitude to their own well-being.
This means that for those responsible for health and social care service provision there is already a user community with which to engage, in the development and proofing of new digital services. One that is most likely willing to help shape new services, not least because they themselves could possibly have a need for these services later in life!
Here in the UK, NHS England has also very recently announced that it intends to establish some new test beds across to trial new technologies, digital services and other innovations. Tony Young, NHS England’s clinical director for innovation, said the work was consistent with NHS England’s Five Year Forward View, highlighting:
‘We are looking for test beds, four to six areas in the NHS with populations of around 1m because we want to be a good place where you can come and test and trial. There will be funding to help make that happen. We are looking for willing clinicians able to test and trial anything.’
It is clearly a good thing if those with oversight responsibility for health and social care service provision are beginning to recognise the potential positive benefits Wearable / Internet of Things / Digital Health / Assisted Living technology innovations.
But they are not ahead of the curve, and there are a couple of problems that have already materialised:
The combinations of the above have great potential to significantly impede public service realisation of the benefits of new technologies innovations. Critically, the establishment of a common approach on data interoperability standards and informatics systems, that are better capable of utilising the data generated from emerging health and well-being devices becomes something more significantly difficult to achieve.
As 3D printing technology advances and innovations in the ability to print electrical circuits matures, the potential inhibitors and barriers to being able to exploit the benefits of the technologies become easier to overcome. Specifically from a public sector perspective, because ownership of the device simplifies the ability to establish data interoperability, integration and accessibility standards and potential for reduced implementation time frames.
It establishes also the basisfor health and social care services to move beyond the “worried well” and onto the potential to transform the experience of those patients living currently, with one or more long-term chronic conditions.
Imagine the difference when devices and wearables that can help a patient, their carers and / or health professionals in the management of conditions can be produced, relatively easily, on a as needed basis, straight from 3D printer, maybe even within the hour and dispensed from the local pharmacy?
Building on this scenario, it could be that a device design library, hosting essentially templates ready to be printed, could be centrally managed by the central healthcare standards or management organisations, and 3D printers within service provider organisations would access this library to obtain the information it needed to produce a new device.
Entrepreneurs and innovators working with and within health and social care, could submit new designs and solutions templates to a service overseeing the library, for validating, testing and formal release, into the library to become widely available to all healthcare organisations for use.
A health SDK would set out standards for data interoperability and more e.g. Wifi / Internet connectivity / security protocols etc., data transmissions and most importantly the frameworks addressing how monitoring data is to be incorporated into existing healthcare provider systems, or at least made available in a manner that permitted pro-active use in the management of a patients condition.
In 2011, I co-authored a business paper that examined potentially positive impact of moving to a pro-active service model, especially when this was implemented in a manner that extended support beyond just the patient, and onto the patients personal care circle. Those family and friends that make up the 7 million carers here in the UK alone.
Wearable, IoT / Digital Health / Assisted Living type technology innovations offers great potential to transitioning health and social care service delivery models from being largely re-active, to something significantly more pro-active, with health and well-being concerns being more easily detected and then managed going forward.
These technologies delivering only a modest increase in the ability to better support interventions being made by carers, looking after a small percentage of 15 million patients suffering from one or more long-term chronic conditions, translating into:
Establishes the potential for annual cost savings and efficiency gains in excess of £2.5bn per year across the UK, and this would be just for starters.
Tele-health in particular has not had an easy start here in the UK, mHealth is increasing, but for the moment remains mostly focused on improving clinician access to information on the move. If this does not change then the ambition to deliver significant cost and efficiency savings will remain just an ambition, and most importantly the opportunity to transform the health and social care delivery model will stay out of reach.
3D printing of electronic healthcare devices could open up new ways of working and engaging with patients and importantly their carers, if the service can take ownership and the right degree of control over it, without impeding the ability for innovation to prosper, then the transformation could potentially begin in earnest, with maybe the service could additionally benefit from the licencing revenues device designs used outside of the NHS!
Its still early days but nonetheless, an opportunity worthy perhaps of some investment, of at least time if not money?
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