Internationale Perspektive, System der Zukunft
Rishi Das-Gupta über Gesundheitsinnovation, KI und die Zukunft des NHS Warum die Umsetzung wichtiger ist als die Idee
Rishi Das-Gupta ist Arzt und Chief Executive des Health Innovation Network South London. Zuvor war er als Strategieberater bei McKinsey tätig. In Folge 162 von Visionäre der Gesundheit fragt Inga Bergen, Expertin für KI und Digital Health und eine der führenden Stimmen für die Zukunft des Gesundheitswesens, warum die Umsetzung von Innovationen oft schwieriger ist als ihre Entwicklung. Das-Gupta erklärt, warum Gesundheitssysteme von einem push zu einem pull Modell wechseln sollten, bei dem der Bedarf die Lösung bestimmt. Er zeigt am Beispiel von DiGA, warum Deutschlands Erstattungsweg enttäuschende Adoptionsraten liefert, während England ohne diesen Pfad besser skaliert. Er erläutert zudem anhand von Ambient Voice Technology, wie Vergütungsmodelle für Ärzte den Business Case für KI Anwendungen verändern. Das Gespräch verbindet Praxisbeispiele aus London mit Fragen zu Finanzierung und Regulierung.
Warum das Thema wichtig ist
Alle sprechen immer vom Vorteil des ersten Anbieters, aber als Zweiter zu kommen bedeutet, dass man sehen kann, was andere bereits gelernt und getan haben.
Der Umsetzungsstau bei digitalen Gesundheitsinnovationen kostet Systeme wie NHS und GKV nachweisbar Geld und Versorgungsqualität, etwa wenn virtuelle Betten pro Patient rund 2000 Pfund sparen und trotzdem nicht skalieren oder wenn Deutschlands DiGA-Erstattungsweg an geringer Adoption scheitert. Relevant für Klinikleitungen, Kostenträger, Regulierer, HealthTech-Gründerinnen und Gründer sowie politische Entscheidungsträgerinnen und Entscheidungsträger, die Finanzierungs-, Beschaffungs- und Skalierungsmodelle für Digital Health verantworten. Im Zentrum steht die Frage, ob Gesundheitssysteme von einem angebotsgetriebenen zu einem bedarfsgetriebenen Innovationsmodell wechseln können und welche Rolle unabhängige Evidenz, Vergütungslogik und regulatorische Vereinheitlichung dabei spielen. Inga Bergen, Expertin für KI und Digital Health und eine der führenden Stimmen für die Zukunft des Gesundheitswesens, ordnet diese Systemfrage im Gespräch mit einem Praktiker ein, der Innovationsdiffusion in einem Zehnmillionenmarkt selbst verantwortet.
key take aways
Zentrale Erkenntnisse
Left Shift bezeichnet die Verlagerung von Behandlung zu Prävention im Gesundheitswesen.
Virtual Wards sparen nahezu 2.000 Pfund pro Patient gegenüber einem Krankenhausbett.
Deutschland führte mit DiGA als erstes Land einen Erstattungsweg für digitale Gesundheitsanwendungen ein.
Flock Health behandelte über 90 Prozent der Rückenschmerzpatienten ohne physischen Physiotherapeuten.
Das One London Data Programme bündelt NHS-Versorgungsdaten von zehn Millionen Menschen.
Die Gastgeberin
Inga Bergen
Expertin für Digital Health & AI I Moderator | Founder | Angel Investor
"Visionäre der Gesundheit " Gründerin Inga Bergen ist eine der promintesten Stimmen für eine menschzentrierte Digitalisierung des Gesundheitswesens. Seit 15+ Jahren an der Schnittstelle von Technologie, Medizin und Gesellschaft. Im erfolgreichen Podcast und Newsletter "Visionäre der Gesundheit" ordnet Inga die digitale und KI-Transformation des Gesundheitswesens ein.
Der Podcast
Visionäre der Gesundheit
VdR - einer der meistgehörten Health-Podcasts in Deutschland mit über 1 Mio. Streams. Wir sprechen mit Ärzt:innen, Unternehmer:innen, Forscher:innen und Entscheider:innen über Innovationen, digitale Transformation, interkulturelle Medizin und die Zukunft der Versorgung. In über 170 Folgen, beleuchtet Inga Bergen mit ihren Gästen, Perspektiven, die Mut machen – und zeigt, wie Wandel im Gesundheitswesen wirklich gelingt.
Episoden BESCHREIBUNG
Innovation im Gesundheitswesen erfolgreich umsetzen: Rishi Das-Gupta über Skalierung, Daten und den Weg von der Idee in die Versorgung
In dieser Folge des Podcasts Visionäre der Gesundheit spricht Inga Bergen, Expertin für KI und digitale Gesundheit und eine der führenden Stimmen für die Zukunft des Gesundheitswesens, mit Rishi Das-Gupta, Chief Executive des Health Innovation Network South London. Inga Bergen hat ihn eingeladen, weil kaum jemand die Umsetzungslücke zwischen vielversprechender Technologie und tatsächlicher Versorgung aus so vielen Blickwinkeln kennt: Das Gespräch macht deutlich, dass die eigentliche Herausforderung selten die Innovation selbst ist, sondern ihre Einführung in den Versorgungsalltag. Als Arzt, ehemaliger McKinsey-Stratege, früherer Krankenhaus-CIO und Startup-Gründer vereint der Gast klinische, wirtschaftliche und technologische Perspektiven und kann daher wie kein anderer erklären, warum Gesundheitssysteme so langsam adaptieren und wie sich das ändern lässt.
Was macht das Health Innovation Network in London eigentlich?
Das Health Innovation Network unterstützt Innovatoren in drei Bereichen: bei der marktgerechten Produktentwicklung, bei der Verbreitung neuer Lösungen im gesamten Gesundheitssystem und bei der unabhängigen Evaluation, die neben der Wirksamkeit auch Gesundheitsökonomie, Implementierungsfaktoren und Nutzerzufriedenheit untersucht. Dabei arbeitet das Netzwerk nicht nur mit klassischen NHS-Einrichtungen zusammen, sondern auch mit privaten Anbietern, der Pflege, Schulgesundheitsdiensten und sogar mit der Gesundheitsversorgung in Gefängnissen.
Der Gast beschreibt zudem einen grundlegenden Strategiewechsel: Statt Erfindungen mühsam durch das System zu drücken, soll das Gesundheitssystem künftig seinen Bedarf präzise formulieren. Wenn klar ist, was gebraucht wird, existiert die passende Lösung meist bereits irgendwo auf der Welt oder lässt sich in Partnerschaften schnell entwickeln.
Warum will London eine koordinierte Gesundheitsinnovationszone werden?
Die neue Life-Sciences-Strategie für London soll drei konkrete Probleme lösen, wie im Gespräch deutlich wird. Erstens geht es um die Finanzierung: Viele Innovationen verursachen im ersten Jahr Kosten, entfalten ihren Nutzen aber erst später und oft an anderer Stelle im System, etwa wenn Prävention in der Primärversorgung die Krankenhäuser entlastet. Zweitens soll die Beschaffung verbessert werden, damit sich bewährte Lösungen mit minimalem Aufwand von Ort zu Ort ausbreiten und je nach Bedarf für eine Million oder zehn Millionen Menschen eingekauft werden können.
Drittens braucht es einen besseren Austausch von Erfahrungen bei der Verbreitung. Hier liegt eine Spannung, die der Gast als Kliniker selbst kennt: Ärztinnen und Ärzte tragen die Verantwortung für die Sicherheit und wollen deshalb mitentscheiden, welche Innovationen sie einsetzen. Das kollidiert mit dem Wunsch, Lösungen flächendeckend und einheitlich auszurollen.
Woran scheitern Digital-Health-Startups bei der Skalierung am häufigsten?
Der häufigste Fehler ist laut dem Gast die Überanpassung an den ersten Kunden: Ein Produkt löst das Problem einer bestimmten Einrichtung perfekt, funktioniert im Nachbarkrankenhaus mit anderen IT-Systemen und einer anderen Patientenpopulation aber nicht mehr. Der Accelerator Digital Health London bringt Unternehmen deshalb früh mit unterschiedlichen Versorgungsformen zusammen, damit ihre Lösungen breit übertragbar werden.
Ein zweiter Knackpunkt ist die Integration in bestehende Systeme. Im Gespräch wird deutlich, dass deren Bedeutung vom Anwendungsfall abhängt: Bei einem Werkzeug für seltene Fälle genügt ein schneller Zugang, während eine Lösung für die Mehrheit der Patientinnen und Patienten nahtlos in die täglichen Arbeitsabläufe eingebettet sein muss.
Welche Rolle spielen Gesundheitsdaten bei der Bewertung von Innovationen?
Daten sind der Schlüssel, um Wirkung nachzuweisen statt zu spekulieren. Über das One London Data Programme lässt sich erkennen, wer eine neue Leistung tatsächlich nutzt und ob bestimmte Gruppen abgehängt werden, etwa ältere oder weniger digitalaffine Menschen. Weil Südlondon sozioökonomisch und ethnisch außergewöhnlich vielfältig ist, lassen sich dort gewonnene Nachweise gut auf andere Regionen und sogar international übertragen.
Aus seiner Zeit als Krankenhausmanager berichtet der Gast außerdem, dass er Herstellerdaten ohne unabhängige Validierung stets skeptisch begegnet ist. Deshalb setzt das Netzwerk auf eigene Evaluationen oder vermittelt unabhängige Prüfungen durch Londoner Universitäten, denn extern bestätigte Belege zu Wirksamkeit, Wirtschaftlichkeit und Patientenerfahrung überzeugen Einkäufer deutlich stärker.
Warum rechnet sich KI-Dokumentation in Europa anders als in den USA?
Am Beispiel der Ambient Voice Technology zeigt das Gespräch, wie stark Geschäftsmodelle vom jeweiligen Gesundheitssystem abhängen. In den USA werden Ärztinnen und Ärzte pro Patient bezahlt, weshalb gesparte Dokumentationszeit direkt mehr Einnahmen bedeutet und hohe Lizenzpreise rechtfertigt. Im NHS mit festen Gehältern liegt der Wert dagegen in besserer Notizqualität, schnellerer Weitergabe an die nächste Versorgungsstufe und mehr Blickkontakt mit den Patientinnen und Patienten.
Bemerkenswert ist auch der Ansatz bei der Erprobung: Statt die Technologie nur in ruhigen Ambulanzen zu testen, wie es die Hersteller bevorzugten, wurde sie an acht Standorten in ganz unterschiedlichen Umgebungen eingesetzt, vom Rettungswagen über die Notaufnahme bis zur Hausarztpraxis. So bestimmt das Gesundheitssystem selbst, wo der Nutzen am größten ist, und setzt Maßstäbe, an denen sich neue Anbieter messen lassen müssen.
Was lernt Großbritannien von der deutschen DiGA?
Deutschland war mit den digitalen Gesundheitsanwendungen weltweit Vorreiter bei einem Erstattungs-Fast-Track, doch die Adoption blieb hinter den Erwartungen zurück. Der Gast sieht darin einen klassischen Second-Mover-Vorteil: Wer als Zweiter kommt, kann aus den Erfahrungen der Pioniere lernen. London plant deshalb, verordnete digitale Produkte verpflichtend an die zentrale Datenplattform anzubinden, um Nutzung und Nutzen über die Zeit zu verfolgen, und die einheitliche NHS-App zur Identifikation geeigneter Patientengruppen einzusetzen.
Wie sieht die Zukunft der Gesundheitsinnovation in Europa aus?
Der Blick nach vorn fällt optimistisch aus. Einheitliche Datensätze zum Testen neuer Produkte entstehen bereits in mehreren Ländern, wobei Dänemark und Estland als Vorbilder gelten, und die weitgehend harmonisierte Regulierung in Europa erleichtert die Verbreitung zusätzlich. Die größte Hürde bleibt, dass sich die Versorgungssysteme und damit die gesundheitsökonomischen Rechnungen von Land zu Land unterscheiden.
Entscheidend ist für den Gast ein Perspektivwechsel: Viele technische Risiken digitaler Produkte lassen sich nur durch organisatorische Prozesse auffangen. Zukunftsweisend sind deshalb Anbieter, die nicht bloß ein Produkt liefern, sondern einen sicheren Gesamtservice mit begleitender Versorgung. Genau diese wachsende Reife im Aufbau sicherer Systeme stimmt ihn zuversichtlich, dass Europa in wenigen Jahren über große Erfolge bei der Umsetzung von Innovationen sprechen wird.
Im Gespräch mit
TRANSKRIPT
00:14
Co-Moderator:in
Rishi Dasgupta ist Arzt, Innovationsstratege und Chief Executive des Health Innovation Network South London. Tagtäglich beschäftigt er sich mit einer der wichtigsten Fragen im Gesundheitswesen: Wie schaffen wir es, dass Innovationen nicht nur entwickelt, sondern auch erfolgreich in die Versorgung gebracht werden? In dieser Folge von Visionäre der Gesundheit spricht Inga Bergen mit ihm über die größten Hürden bei der Einführung neuer Technologien, den Einsatz von künstlicher Intelligenz im Gesundheitswesen, die Skalierung erfolgreicher Start-ups und die Bedeutung von Daten für bessere Entscheidungen. Außerdem geht es darum, was Gesundheitssysteme in Europa voneinander lernen können und warum die eigentliche Herausforderung oft nicht die Innovation selbst, sondern ihre Umsetzung ist. Ein Hinweis vorab: Diese Folge ist auf Englisch.
01:05
Inga Bergen
So, I am super excited and welcome you all to today's episode of Visionaries of Healthcare about my guest today, who is in London right now, Rishi Dasgupta. He's Chief Executive of the Health Innovation Network in South London. He has a very, very interesting background we will talk about today, and I'm super excited he'll be my guest today. Hi, Rishi.
01:35
Rishi Das-Gupta
Hi, Inga. Lovely to join you today. It's a pleasure to speak with you. I am Rishi Dasvikar, as you said, and I'm Chief Exec at the Health Innovation Network based in South London. And it might be worth us starting off by a little bit about what Health Innovation Networks do and how we fit things together.
01:55
Inga Bergen
That would be interesting for us to learn. So what do you do?
01:59
Rishi Das-Gupta
Well, so really there are 3 broad areas we work in. So the first is helping innovators to develop their products and develop products that fit the market well. And the second bit is thinking, how do we get those products adopted and spread across the network? And across the whole health ecosystem. And the third bit is actually a really important part of that for us in London, is that often people develop a lot of evidence for how things work in terms of their, the efficacy of a product. But actually, when you think about how you're going to implement it, what are the success factors for implementation? What are the health economics of that product? You know, what are the customer satisfaction around the product? It's often researched in a little bit less detail. So we do quite a lot of the evaluation element of things that fit along alongside that in order to make that work. And examples of that are around, well, we can go a little more into depth on that later, can't we? But those three elements, and because of that, we are working primarily with a health system, which is traditional providers within the National Health Service in the UK, sometimes private providers, social care providers who in our economy are somewhat different but equally important. And then some providers who are thought of as a bit more niche, so like school nurses, schools providers, community health. We even have the largest prison health service in the UK is headquartered out of South London. And there are all sorts of challenges with providing health in prisons that are somewhat adjacent to the rest of healthcare. So all of those elements come into it. And what we chose to do in England about almost 15 years ago was in thinking through how our health systems were. A lot of systems think about kind of a push model of innovation of how do I come up with an invention and then how do I develop it to the next stage and move through to the next stage and then scale it up, which I think works quite well in pharmaceuticals and That's where we drew it from. But when we think about other types of innovation, particularly med devices, digital health, even like changes to the way that administrative processes or pathways of care work, that model of pushing things through the system is less well suited to it, I think. And in that world, I think we are in the process of moving from that model to a pull model of saying, here's what our need as a system is. Now, you know, you can kind of, in digital, you've done digital companies in the past, haven't you? It's sort of, you can kind of build anything if you know what you're aiming to build. So if the system can articulate what it needs really well, then the innovation, you know, either exists somewhere in Europe or somewhere in the world, or it can be built relatively quickly through a partnership. So I think that's where we've seen a difference.
05:04
Inga Bergen
That is so, so interesting because now in the age of AI, innovation is becoming so fast and healthcare is adopting so slowly, kind of. It's, I mean, it's a fact that patients adopt AI so quickly and we have shadow AI in the, you know, and it's just one symptom of, well, a system that is super slow on the one hand side and people having a need and just using technology. So I come from the world of technology, so that's usually the use case that interests me the most. And you explained it, you see it very broadly whom you integrate into your network and then you try to, well, to come up with needs and try to find the innovators that you can then integrate and you help them to build a product and to create a product accordingly. I find this so interesting. Because the City of London has just declared, well, a strategy and becoming or wants to become a coordinated health innovation zone. I'm thinking, why do we need a health innovation zone? And what, why is a network like that, you know, of benefit for really accelerating the speed?
06:31
Rishi Das-Gupta
I think that's a really good question. So the, as you highlighted, the Life Sciences Strategy for London was published yesterday and builds on our national strategies for life sciences and for the NHS's 10-year plan. So NHS London and the Mayor's Office have worked together to try and work out what would accelerate innovation in London in healthcare to improve the development of products, but also to help improve the health of Londoners. The mayor's very committed to making London the healthiest global city in the very near future. So those documents are all published. Yeah. Those documents are now published. I think what we've noticed is that innovation happens often at different scales. So it's quite, It's quite— the advantage of London is there's sort of at least one of everything somewhere in London because it's 10 million people and has a large tech industry and has good talent and has good access to finance and good data and a health system with specialists in almost anything you can think of. The difficulty is, of course, navigating that. So, you know, there is at least one of everything, and there's probably three kinds of specialist neurologists in whichever field you want to work with. So which of them would you choose to work with if you're developing a product? And so signposting that is one of the elements of it. But we've really identified three areas we would like to improve in London. One is around the way that we finance healthcare and new products. And moving— often some of the new products we see cost something in year 1, but then release additional value in year 2, 3, 4. And taking a multi-year view of it is helpful. And often they release benefits in different places. So there's a lot of conversation in London at the moment and in the UK more broadly around what we're calling the left shift from treatment to prevention.. And if you do more prevention, then often it's a different group of healthcare providers or a different part of the system that is benefiting in addition to the patient. You know, you may make a change in primary care that reduces the need to access secondary care, and therefore the financial benefit is in secondary care, but the cost is in primary care. So those financing issues are one of the areas that we're focusing on. The second area is around procurement. And actually, I think Germany has done very well on procuring digital pieces through DIGA. We can talk a little more about that, but the, and some of the things we're learning from you guys, but thinking through procurement, both in terms of a model where things can diffuse quickly and move from one, proving in one place, moving to the next place and the next place and the next place with the minimum effort. And then secondly, procuring at scale, because one of the advantages of having a population of 10 million and all the providers that we have is if something is best procured at a 1 million scale, we can do that in London several times. If it's best procured at a 10 million scale for a digital platform, for example, for our genomics platforms, we can do it once across London. And so it gives us the kind of some of the agility of being a smaller environment in a city kind of scale and some of the advantages that you would normally associate with, you know, countries around Europe. So I think putting those two together is useful. And then the third problem that the strategy is aiming to solve is around how do we share learning about the spread? Because I suspect we'll go into it in a bit more detail as well. I'm a clinician as well, and I think all of us would feel that we want to have autonomy over the way we practice, and we're responsible for safety, and ultimately the buck stops with us. Therefore, we have to have— in order to make that real, we have to retain some ability to say yes or no to particular innovations and whether we want to use them. And that often comes into a direct conflict with well, we want to roll this out at scale across the whole, you know, the whole city or the whole country. And the simplicity that patients rightly demand for, you know, knowing what comes next.
11:10
Inga Bergen
I think that's so interesting because, I mean, two of the three topics you mentioned are organizational and are processes, and one is actually evidence. You know, and the systems we have in place, they are too slow, as I said, for the speed of innovation that we also need. I mean, we have demographic change, we have a lack of personnel in healthcare, and the problems the NHS and the UK has are pretty much the same that we have in Germany. And you've been, you mentioned it, you have been a doctor. You have been a strategist at McKinsey. You have been a hospital CITO, information and technology, and you have been a startup founder. And now you run an organization that probably most people outside of the NHS have never heard of. That's true. Yeah. With, and I find this so interesting because you have seen so many different angles from How well do we prevent our systems really to adopt innovation that could help to reach that bold vision, you know, making people more healthy? And we definitely need that in all the mature healthcare systems. And now you're bringing together all these perspectives. Well, in order to change the system, it's real. I mean, it could be a really powerful, powerful thing if it works out in the end. I mean, London, you said it has 10 million patients. You have 3 of the top 15 research universities in London. You have, I think, 2,700— I looked it up— life science companies. And still lots of challenges in day-to-day healthcare.
13:11
Rishi Das-Gupta
Yeah, and I think so. And I think I sometimes, I'm, you know, I'm by nature an optimist. So I try and look at where is innovation spreading really well and really quickly. And I think that where I see it spreading very quickly is in areas where there's really good specialist care, because then you've got, you know, the patients you're seeing on a day-to-day basis, if you are an oncologist or if you are, or a specialist neurologist or something like that, you're often seeing similar kinds of patients. And if an innovation comes along that affects most of your patients, you're very quick to adopt it. I think, I think where I see it being more, needing more support to spread innovations is where there is real heterogeneity of practice. So like very different ways of practicing across a specialty, or where it's really generalist areas. So, you know, in paediatrics, if there's something that affects only 1 in 20 of the patients that I see, then the amount of effort and bandwidth I can get to adopting a new way of doing things for that 5% of the patients is necessarily more challenging and therefore needs a bit more support. And that's where we come into things with the adoption work that we do. And then I think the other bit that I see quite a lot of is a lot of colleagues who get very excited when they see the newest, shiniest thing that is at the cutting edge. And so that's again why it gets adopted, new things get adopted quickly into specialist care. But of course then there's quite a long way, you know, it goes from being the sprint to being the marathon to actually get that adopted everywhere for clinicians who see fewer of the patients who'll benefit from that. So, you know, that long piece. So I think the talk I'm doing Health this year is the conference is around that adoption challenge, which for me is one of the one, you know, that's why I got excited and involved in management was actually from doing just clinical, from doing purely clinical practice to doing, to try to make sure that we change the whole pathway for all patients feels like a really big challenge that not that many people focus on, I think.
15:28
Inga Bergen
Yeah, totally. And I love that you reframed from using the word just to pure clinical practice. But, but I mean, that's always the point. And I mean, you're excellent to, to have people on board who really understand how it's implemented into day-to-day life. And I, I love how you frame it because it's, it's really a big difference if you have a specialist Or if you have somebody working in emergency care, you know, with hundreds of people queuing outside, it's just a completely different way of approaching medical care or healthcare. And it needs different answers when it comes to implementing innovation. So your accelerator has at this point already put, I think 160, that's the number I found, companies through the system. And, um, there are several hundred contracts. Um, and, and there are, uh, 3,500 NHS pilots. Mm-hmm. Um, now there's so much innovation. Um, and I come across so many startups and there, there's so many people who say, I have been a patient, or I have been a I'm a doctor and I saw this problem and this is the product I built to solve it. And I always question, okay, can this approach really work? So what is your learning? What separates companies that really scaled from the ones that, that didn't really work, work out then in the end?
17:09
Rishi Das-Gupta
So, so I'll take off my one of my hats and put on two others. So the one around Digital Health London, which is one of the accelerator programs that we run. Overall, we support early-stage companies, mid-stage, and then the accelerator focuses on late-stage companies which are ready for adoption, usually have been in one place already, but need to scale and go to multiple organizations. So there are a few pitfalls to avoid in that world. The first is that often we see a lot of companies have in a way, overfitted to their first customer. So they've really got an exact problem that solves just the customer, that particular customer's problem absolutely perfectly. And then they go to the hospital down the road, which has a slightly different catchment population and maybe slightly different IT systems and different providers. And then it's no longer perfect. And so there's a challenge then for adoption. So what we often encourage companies to do is once they've got their proof of concept, to then try and work with a variety of different providers providers to solve it, solve their problem there. And you've worked in other industries, as have I. It's sort of, if you were doing this in retail, you'd be, if an idea is really good, you'd want to see that it works in, you know, multiple cities and maybe works in, maybe works in an airport environment and in a city environment and a shopping center environment. So that's the way retail would approach this. And I don't think we necessarily help our companies and innovators to do the same thing, which is, you know, let me introduce— you've got something that looks like a good idea, let's introduce you to multiple types of organizations and then try and help you to solve the problem that will have broad generalizability. And that's one of the things that the Digital Health London Accelerator does quite early on. And then I think the second bit is to do with that integration of how the data works, and particularly for digital products, is how will this be implemented? What systems does it need to integrate with? What integration is essential versus a nice to have? And that varies again quite a lot operationally is my perspective on it. It's, if you, to my point earlier, if you see a patient file with a condition 5% of the time and there's a platform for it, if it doesn't integrate perfectly, it's not the end of the world. I'm actually more I care more that I can log into it really quickly, find it quickly, and log into it quickly. And then I can copy my findings or notes into the system I use for all of my patients. Whereas if it's something that affects 95% of the patients that I see, then I'm really quite keen that it works smoothly and seamlessly as a digital product. And I think the same thing happens with, you know, med devices or with pharma products. It's sort of, there are different approaches, aren't there? Is that what you found, Inga?
20:09
Inga Bergen
Yes. Yes. It's, it's really interesting because now I, I'm, I quit. I have, my question is, um, if you need a product that works for everybody, how do you get there? Because there are problems that are so specific, um, very often, and you need to ask questions very differently. And what I always think, you know, when I see pitches or when people approach me with a startup idea, I often say, just, you know, use your Claude or ChatGPT or AI to bring in a McKinsey perspective, which would be, you know, this very strategic, systematic, like market analysis, really understanding, you know, what are different needs and how could more global approach look like? Because it's a kind of really different approach on innovation.
21:11
Rishi Das-Gupta
I think so. I think I'm, I don't want to be too overly positive about it. This is one of the areas I think we could improve in the UK a little bit because I've worked in the US as well and worked with colleagues in Germany and Switzerland through the SIANA programme. Because the NHS in England treats about 90% of patients through its services, and the services are often geographically linked, it's less of a challenge in London. It's, but if you were in a rural area of England, then the service that you get in your local hospital is probably the only one you can provide. We spend quite a lot of time rightly thinking about how do we address health inequalities? How do we make sure that everybody can access the services in an equitable manner, in an equal way? And that sometimes means that we are more thoughtful and slower about adopting new innovations because we think, well, it isn't yet at the stage where everybody will benefit from it. Therefore, we won't won't roll it out for all our patients yet. Whereas if we're in economies that have a bigger private provider landscape or a mixed provider landscape, and in Germany, you know, where there are individual providers with a single insurance system, then there's a bit more emphasis on making sure that you provide a really good service and provide something, you can provide something different to the person next to you. And work through. Now, one of the advantages for us working in London is that we have all of the data that is generated through, particularly all of the NHS work, available to us through the One London Data Programme, which means that if we put in a new approach to treatment, a new pathway, a new product, we can see whether or not that is having a differential impact on different groups. Be it based on where they live, on socioeconomic grounds, on ethnicity, on gender. These are all things that we can look to see who is accessing that service. And there are kind of two examples which jump out immediately for me. So one is whenever we talk about digital services, people get anxious that maybe this will mean that people who don't have access to unlimited smartphone data and are paying on a metered basis get left behind, or people who are less digitally literate are older, access those services less. And it gives us an option to say, well, actually, as part of the rollout and piloting of a product, why don't we look at who is using it, who's getting left behind, rather than trying to speculate on it? Obviously, we do a design as well as we can. Yeah. Why don't we—
24:06
Inga Bergen
Question. If you, if you can see who is using the service, can you also in all the data, can you see the benefit? Because if an innovator now can within your network prove the value once they can be recognized as, uh, an innovator across London and, um, and get reimbursement. Um, and you got every buyer, you know, uh, in the capital in to accept, well, somebody else's homework. So how do you measure that?
24:35
Rishi Das-Gupta
So you've hit the nail exactly on the head, and this is, um, one of the key bits, which is we can do that because we can look at all the usage data across London and build a health economic case from it. Alongside that, that population is actually often quite diverse from an ethnicity point of view and from a socioeconomic point of view. In South London, we have some of the richest and the poorest neighborhoods in London. And we have over 60% of people in London identify as not being white British. So it's a very diverse population. And therefore demonstrating that value in our environment translates across to the rest of London, the rest of the UK, and actually internationally quite well. And so that's the power of using that data approach. I have to say, with my other hats on, so you mentioned that I was CIO and CITO at an NHS trust, and I was also COO at a trust before. I'm very skeptical when vendors come to me with their own data, which has not been independently validated. I always used to be because people come with a sales pitch and you kind of, it, that has its value, but it's nice to have some independent validation of it. And so that's part of the reason that we either do evaluations ourselves or point to universities in London who can do an evaluation for you on a, on a kind of independent basis, because it's much more powerful to have information about efficacy, health economics, patient experience, which has been independently validated, than the company comes and says, oh, 9 out of 10 of our customers were happy and, you know, happy with the product. And then you say, well, how reflective are your customers of the general population?
26:28
Inga Bergen
And that's so interesting because, I mean, then also, even in the NHS, there are really numbers that are super promising. For example, if we look at what I find interesting in the NHS are virtual wards. And they save nearly £2,000 per patient versus a hospital bed, and they still struggled to scale. Well, until someone built a cost model or like ambient voice technology where we see really a quarter more time with patients or, or even more, you know, so there are numbers already. So what is still stand— between trial and then consulting every patient with that kind of, you know, technology.
27:16
Rishi Das-Gupta
So I think, I think, um, we've spoken a little bit in, in various bits of this conversation about the importance of health economics in all of this. And a health economics analysis will always compare, as, as you know, will compare a new system of care versus something else. You can only ever compare one thing with another. And so often that needs to be done a little bit locally. And if I draw some of the differences for ambient voice technology, which we've just run the largest procurement of ambient voice technology in the UK, in South London, doing the whole of Southwest London in one go. So 20,000 emissions accessing. The business case in Europe is quite different to the business case in the US. And in the UK particularly, I think, because In the US, people had adopted health, electronic health records early and were spending quite a lot of time inputting data. And the argument was, if I give you less time to input data, you as a clinician can earn more money seeing more patients and it's less stressful. So, and what we had seen in the US was that clinicians were often employing somebody else to input the data for them. So they had, real human scribes entering data, and they were then replaced by an AI scribe, which covered it. So in the US, ambient voice technologies are usually called AI scribes. But in the UK, we have a much lighter way of documenting, which is designed, you know, I want to document for the benefit of the patient and for the benefit of the next clinician to see the patient, or me in 3 months' time when I see the patient. So we particularly don't document as many negative findings. We you know, is very similar to in Germany, I think. We're much more judicious about what we put in. So the business case doesn't stack up to the same exact, to the same value as in the US. So in the US, I think they were charging, you know, Microsoft, when they launched their DAX product, were charging several hundred pounds per clinician per month, because that's the value and you're paid per patient. In the UK, the clinicians are not paid per patient. They're paid on a salary basis and employed by an organization. And so then you've got to say, well, actually, what am I adding? I'm adding quality to the note that's produced. I'm giving it to the patient sooner. So actually, if I'm a patient and I walk home with the note that summarized the consultation, that has some value. It can be shared more quickly with the next setting of care and, you know, maybe remove a day or two's worth of time for dictation. It improves the experience of the clinician who's actually doing the consultation. The patients, what we found was that one of the huge values was that clinician actually spends time looking at the patient. You know, I'm listening and speaking to you, right? It's, I'm not looking at my computer off to the side. All of those things have a value associated with them that we can work through. And then work out what the business case is against it.
30:27
Inga Bergen
And yeah, brings us back to what you initially said. You need to start with a problem that the healthcare system really has and might be different just from the setup, just from the processes that we have installed. And that are people, well, used to, and even the business model, you know, that a system is running on. So that's really an interesting example.
30:52
Rishi Das-Gupta
If I pick that up, that's the ambient voice technology is another great example of that as well, because from, there's a disconnect between what the vendor might want to do and a producer of the system versus what the health system might want to do. So when the first 3 products were launched in the UK, all 3 of the vendors for them wanted them to be rolled out in an outpatient environment for outpatient clinics, because then you're saying, well, I'm I've got this AI scribe, which is working on a microphone. I want to be sure that the quality is good. So, if it's in a quiet room environment, then that's probably a good place to be doing it, and it— the product will work well. But as a health system, we were saying, well, this probably has the most value in accident and emergency, where you're seeing lots of patients one after another, and you've got to document quickly, and someone else is going to use that note very shortly afterwards. So we ran our pilots in this in, in 8 different sites in London with a single product. And we tested it in a variety of environments. So ambulances, in the back of an ambulance, in someone's home, in the accident and emergency department, in mental health, in general practice, in outpatient departments. And we ran it across all of those systems to say, well, actually, where is the benefit greatest to our system? Rather than the product, you know, that meets the acceptable quality standard for this product. And that is a different approach to implementation than you would get if a vendor was saying, I want to roll my product out and these are the places I think it adds, you know, safest to roll it out. So that's why I get excited.
32:34
Inga Bergen
I had a podcast with one of the vendors in the NHS, Heidi Health, and they just told me that they launched a portable microphone toolkit that can work in emergency environments. Yeah. Which then closes the cycle. I mean, that's kind of interesting. I have another question. I mean, you already—
32:58
Rishi Das-Gupta
if I, if I, if I, just from the spirit of like, how can the system be better at this? In choosing to do that with a single product across multiple settings, it gave us comparability of where it's useful. And then the onus is on— the system we tested it with was not Haidi, but then the onus moves to the new providers coming in to say, well, my system works in an accident and emergency as well, doesn't it? Because otherwise, when you go out to procurement, you're saying, well, that company has evidence that it works in all these environments. Where's your evidence? So we can, as a health system, we can adapt what products are developed for our benefit, can't we? Which is, I think, a useful useful way forwards.
33:40
Inga Bergen
Yes, you can. And then, I mean, you already mentioned from the 3 things that you are providing or that you are solving, one is reimbursement. And you mentioned DiGA, that apps on prescription, digitale Gesundheitsanwendungen, as we call it in German, Germany. And Germany was actually the first company building that reimbursement fast track, but the adoption totally disappoints. And in practice, it's, it has becoming, it has become really difficult for vendors to go through that process. And England and the UK has no such pathway, but scales much better in pockets. So what does this paradox tell you? I'm asking.
34:38
Rishi Das-Gupta
Well, that's a really, really interesting one, isn't it? And we are quite keen because you've, I think you're probably about 18 months to 2 years ahead of us and you've been through one cycle of products at the end of their 18-month period having to be continued or not continued. And I understand a lot fell over at that point. I think first off, I think it is helpful to have a standard way of prescribing digital health products. And we have some requirements in London around if we're choosing to prescribe products. We currently don't have a single way of doing it, but we do have, we have 4 ways of doing it across London, about across the 10 million people. So it's not, they're not inconsiderable sizes of markets. We have a single way of validating and regulating the products, but we don't have the reimbursement model exactly the same. So that gives a bit of local scope to selecting products to roll out. The second bit, I think, is that we are quite clear that for the products that go down that route, we need to be able to get the data back into the London system, so that One London platform, because otherwise we can't really do comparisons of how the usage of the product is over time, how long they continue to use. So, one is that it has to feed data back into One London. And then the one that we're trying to add now, but it's taken a little bit longer, is that we have a single NHS app which authenticates the patient as well.
36:07
Inga Bergen
Oh.
36:08
Rishi Das-Gupta
And that means that it's a little bit like an insurer's health platform, but with a lot of functionality in it. It means that that will then let us identify which patients would benefit from particular products. So, those things together are the bits that we are hoping to do differently But we're certainly looking or have been looking at DiGA as a route to what should we learn and what pitfalls there are. I have a long-standing piece, and we'll come into innovation strategy in this, but there really is a second mover advantage in a lot of these things. So people always talk about the first mover advantage, but going second means you get to see what others have learned from what others have done.
36:50
Inga Bergen
Yeah. I think in healthcare, the second mover advantage is totally real. And also, I mean, it helps to have an overall strategy with an overall goal that you want to achieve, you know, because just having digital therapeutics is not helping anything if you don't, if they are not integrated in an overall plan and if they're just seen or perceived as a cost factor. And that's kind of happened in Germany a little bit, even though, like, when you compare them with other medication or therapies, it's like a tiny, tiny number. Yeah, but still, you know, all these, I mean, having this one strategy and this one bold vision and goal is really, from my point of view, the key to then sort What kind of innovation do you want to integrate and how? And what kind of data does this innovation need to deliver? So, I'm—
37:57
Rishi Das-Gupta
But I think what you're describing is really important. You know, a lot of the digital health platforms that came early were about long-term condition self-management. And it wasn't linked to what is the impact on my accessing of healthcare providers and medicines elsewhere in the system. And I would compare that with something like, um, one of the companies that went through our accelerator a couple of years ago is called Flock Health, which did an AI-based, um, physiotherapy for back pain. And really what they demonstrated is that they could see over 90% of patients without them seeing a physical human physiotherapist, and it reduced the number of appointments that were needed. And therefore, that's where the value is generated. But again, we're, a lot of this comes back to health economics, doesn't it? So I wish that back at, if I had known now what I know then, maybe I'd have done a health economics degree back then.
38:56
Inga Bergen
Yes, makes total sense.
38:59
Rishi Das-Gupta
That's what I'm telling my children.
39:02
Inga Bergen
Yes, combine both. I mean, even when you, maybe not in the NHS, but when you work in a when you have your own practice, you need to have, like, even if you're a doctor, you need to understand health economics. But you also need, and that's what I learned really from this conversation, you need the broader perspective. You need to have the data and you need to look at the processes independently from the, well, the little brick the organizational brick you are in within the whole system during the patient journey, whether it's a clinic or it's even a prison or an elderly care or whatsoever. And that's what I find really, really interesting, like bringing all these stakeholders together and then being able, you know, as an accelerator, as a, as a network, as an innovation network, really opening all the doors to, you know, the different stages in this journey. And that's super interesting. Do you think we will see a UK innovation zone or a European innovation zone? We will see that in the next couple of years more, having these like sandboxes? It's almost like a sandbox.
40:37
Rishi Das-Gupta
I think we are, and I think we're already beginning to see that in some places. So, creation of single datasets that you can test on and model whether your product works well are happening in the UK, but they're also happening in other parts of Europe and particularly places where they have good datasets, Denmark and And Estonia have kind of always come to the top of the list when you talk about it. I think the second bit that really makes it work well across Europe is the fact that there's a single regulatory system for the products. So when meeting the digital standards and the regulatory agency standards, having that unified across Europe, and the UK is actually very similar in many ways. Is really helpful as well. I think the bit that always— I think the bit that is perhaps more challenging to get to a single platform is this difference between the health systems themselves, the delivery systems, means that the health economics are somewhat different in each geography that you go to. And also there's, I think that there's a difference in the emphasis that we place on different areas. So as we've both talked about it, and we both design and build products as well, we I think our language shifts towards processes and how we think about the operations of it. And if we were in a retail environment, we'd be talking about patient experience and clinician experience. And if we're balancing that, we'd also talk about risk and who, you know, what risk is there and how is that mitigated and worked through. And one of the things that I think we're facing a lot in the UK that has slowed innovation and the spread of things is that A lot of the risks that appear are technical risks, but a lot of the mitigations for those risks are operational processes. And so to be able to develop a product requires the person who's adopting the product to build their operational processes in a way that mitigate those risks. And what I've seen quite a lot of recently, more recently, is individual providers setting up to take on and deliver a service so that it's not just a product on its own. It's a product plus the wraparound care, which means that you've got a safe service as a whole rather than thinking in terms of safe products. And that's a very different— big difference between pharma medical devices and digital health. And I think that's where I get excited, is that the broad thing for spread and development of products is really well set up because we've had common processes for pharma and medical devices for quite a long time. And the sophistication that we're building in many places around Europe, London being one of them, but not the only one, around how do we develop those safe systems around it and how do we spread those systems is what gives me a lot of hope for the future. So I hope that we're here in a year's, two years' time talking about how massive successes in all these areas.
43:44
Co-Moderator:in
Yeah.
43:44
Inga Bergen
Thank you so much for this optimistic outlook. I am really looking forward to meeting you at the Health Europe Conference. And it was super interesting.
43:53
Rishi Das-Gupta
And I think I'm talking about the dullest topic that's there, right? Which is about adoption. So if anyone else is there, then, you know, see you next week.
44:01
Inga Bergen
Yeah, that's the headline you got. So, so I don't think so. I think implementation is really crucial and super interesting and also most challenging. So thank you so, so much for the conversation. And, um, yeah, good luck for everything to come.
44:21
Rishi Das-Gupta
Great. And it's lovely to have a chance to speak with you today, and I'm, I'm looking forward to seeing you next week.
