ADHW 2024 - Meeting of the ecosystem for the implementation of digital health transformation projects in Greece & Europ e🎉

ADHW: Meeting of the ecosystem for the implementation of digital health transformation projects in Greece & Europe

Athens Digital Health Week 2024 has emerged as the new networking hub for the implementation of digital health innovation in Greece and Cyprus. The enduring message of the ADHW 2024 meetings, articulated by the three chairs of the Organising Committee, Panagiotis Bamidis, Christos Schizas and Niki Tsouma, is that the era calls for continuous consultation, collaboration, and co-creation to achieve ambitious goals. The Ministers of Health of Greece and Cyprus, the Greek Minister of Digital Governance and the Deputy Minister of Health welcomed the event and underlined the importance of digital transformation in health for the well-being of citizens. They further pledged to support the necessary legislative changes and reinforce them with the necessary resources. One of ADHW's central objectives was to activate and affirm the ecosystem that will support the implementation of digital health transformation projects in Greece to then become active through actions such as the National Interoperability Framework in eHealth.

IDIKA SA—Electronic Governance of Social Security—was co-organiser of ADHW together with the National e-Health Authority—NEHA—Cyprus, with the cooperation of HL7 Hellas, which hosted the events at the Royal Olympic Hotel from 15 to 19 January. Two leading organisations from Greece and Cyprus joined forces under the auspices of the Ministries of Health and Digital Governance of the Hellenic Republic and the Ministry of Health of the Republic of Cyprus. By all accounts, a remarkable conference was organised with more than 650 participants from 24 countries, including 135 speakers in 25 sessions, 11 workshops and 32 programme tutorials. In the framework of ADHW, representatives of 22 organisations and 11 research projects met at the foot of the Parthenon. It was a diverse conference with inspiring speeches by experts accompanied by workshops and dialogue sessions, with exchange of experience, expertise, as well as maturation and joint shaping of positions. The week was a breeding ground for new partnerships, synergies between individuals, institutions, and organisations working with the common goal of promoting digital innovation in health, in an ever-evolving environment with constantly increasing demands.

The National e-Health Authority of Cyprus (NEHA) as the competent authority for the implementation of e-Health, develops the standards and specifications of the personal Electronic Health Record with a focus on the citizen. Cyprus, through the NEHA President, Professor Christos Schizas, coordinates the Joint Action Xt-EHR of the EU Member States for the implementation of the Regulation that will govern the European Health Data Space for primary use in support of the European Health Union.

During the ADHW the cooperation on digital health between Greece and Cyprus was presented and further consolidated between the Ministries of Health of both countries, the Ministry of Digital Governance of Greece, IDIKA, and the NEHA of Cyprus. The axes of cooperation concern the use of health data for primary and secondary use and in relation to the National Contact Points for cross-border healthcare, as well as the new joint European action on the e-vaccination platform. The pioneering legislative work that has been carried out in Cyprus on e-Health was also presented. As underlined by all sides, the cooperation between the two countries is ongoing and is already being discussed in international fora as a model bilateral cooperation that can be extended to include more European countries.

As part of ADHW, the Joint Initiative Council of 13 global health standards bodies held one of its rare meetings in Europe. This was followed by the HL7 National Chapters Council in Europe and the first HL7 Europe and FHIR Marathon working meeting, with 19 of the 22 countries of the organisation in attendance. Meetings and projects with a total funding of more than €100 million sent a clear message that Europe can lead in the area of interoperability standards, as the European Health Data Space (EHDS) sets the framework for the data economy, with safe use of artificial intelligence.

The development of HR skills is one of the major issues raised during the ADHW. Panagiotis Bamidis, Professor, Aristotle University of Thessaloniki and President of HL7 Hellas is leading the European project ManagiDiTH —Master of Managing Digital Transformation in the Health Sector—aiming to create a postgraduate programme for the development of skills of health professionals in the field of digital health, in order to fill a gap both in our country and across Europe and to support the implementation of the European Health Data Space (EHDS). In the context of the relevant sessions, parts of the project were also presented in cooperation with the international non-profit organisation IHE.
More specifically, IHE-Europe hosted two ManaGIDITH training sessions: The first one to understand the role of IHE governance in healthcare interoperability, providing participants with examples to navigate governance structures and understand interoperability frameworks. Additionally, it aimed to foster comprehension of the testing continuum and an understanding on how to develop effective specification and test plans for healthcare interoperability initiatives. The second one to have a better understanding about IHE best practices and experiences, targeting industry professionals and users alike. Key objectives included understanding the structured methodology of IHE, showcasing successful implementation projects across Europe (with examples from Switzerland, Austria, France and Belgium), and enabling participants to apply these insights in their contexts for advancing healthcare standards and interoperability.

As emphasised in her opening speech, Niki Tsouma, Chair, Board of Directors & CEO of IDIKA SA, the continuous dialogue, collaborative work, exchange of views, know-how and best practices are prerequisites for the completion of the complex operational and technological project of health services digital transformation in Greece and Europe.

The main themes of the event were access to health data and interoperability, aiming at equality and better health care. Dan Vreeman, Chief Standards Development Officer, HL7 International, spoke about interoperability and referred to HL7 FHIR® (Fast Healthcare Interoperability Resources), a standard for sharing healthcare data among different systems and platforms. Its implementation enables fast and efficient exchange of healthcare data, including clinical and administrative data, across geographic or other constraints, for optimal design of digital health services. Already through this global standard, collaboration between governmental and non-governmental organisations is possible in many European projects and also more widely in the health sector.

The international movement of patients makes it necessary to collect and exchange data. The pandemic caused a great deal of change. The need arose for reliable data and dissemination of experience directly and globally. Two million European citizens move across borders in the European Union 27 Member States, creating a need for cross-border health services. An Electronic Health Record that can be used across borders is a first step towards a global patient EHR. This was highlighted in his speech by Ian Green, Customer Relations Lead, Europe & Global Clinical Engagement Manager, SNOMED International, talking about interoperable health, with strict standards and specifications to ensure privacy, security, and accessibility.
A common thread in the presentations of all prominent speakers Robert Stegwee, Chair, CEN/TC251 Health Informatics; Herco Cooman, International Digital Health Coordinator, Ministry of Health, Welfare and Sport of The Netherlands; W. Ed Hammond, Emeritus Chair, HL7 International; Petra Hoogendoorn, Lead expert CEN-ISO/TS 82304-2 & Coordinator Horizon Europe project Label2Enable; Andreas Klingler, Vendor Co-Chair, IHE Europe; Marjorie Rallins, Executive Director, Health Data Standards, LOINC, is that the pandemic has highlighted the interoperability of health systems as a paramount need, and therefore the creation and implementation of global standards for digital health services leads to improved services and equity of access.
Niki Tsouma, Chair of the Board and CEO of IDIKA SA, referred to the Digital Transformation of Health projects implemented by IDIKA and funded by the RRF, with the close cooperation of the Ministry of Health and the Ministry of Digital Governance. She also highlighted the challenges inherent in the project of integrating raw information, at the level of primary and secondary health care, public and private sectors, which requires a huge digital infrastructure space to be utilised by health services.
Aris Angelis, Secretary General for Strategic Planning of the Ministry of Health, referred to the e-governance of the Ministry at a critical juncture for the digital transformation in our country and the resources (€400 million) available through the Recovery and Resilience Facility. He underlined the requirement for smart and integrated planning and not just technical solutions.
Alexander Berler, Vice-Chair at HL7 Hellas, underlined that the enactment of the European Health Data Space (EHDS) for primary and secondary data use will be complete within 18 months after its adoption by the European Parliament and the Greek adaptation will commence. He also said that a common European format, with structured information on the health history of the citizen, is needed for free movement between countries. He particularly emphasised the joint participation of IDIKA SA and NEHA Cyprus in the XtEHR project, which will assist the European Commission in the certification of specifications and standards, as the European format should be implemented compulsorily in all EU member states.
Representatives of the Greek digital services ecosystem spoke about the opportunities and challenges in the digital transformation of healthcare in the country, and presented in detail the major projects that are currently being implemented.
IDIKA SA played a major role in the organisation of the above meetings, making use of its considerable knowledge, as it designs, implements, and operates productive national Digital Health Transformation projects and participates in the implementation of many European eHealth projects, such as cross-border health myhealth@EU, Xt-EHR, XpanDH, xShare, UNICOM, GR-HDAB, ORION, JAPreventNCD etc.

IHE-Europe was thrilled to be part of the Athens Digital Health Week, surrounded by a diverse community of enthusiasts and experts from across Europe and having the opportunity to attend several events and workshops. Andreas Klingler, IHE-Europe Vendor co-chair, during the ADHW opening, participated in a panel on Standards and Stakeholders, highlighting the significance of global interoperability standards and cautioning against external product certification by notified bodies.

In the session on the European Healthcare Data Space (EHDS), Andreas Klingler, at a keynote address, emphasized IHE's role in reducing risk and expediting eHealth project implementation, particularly within the EHDS framework. He also spoke about the interoperability issues and the need for a testing strategy, which IHE is looking at and the specifications necessary to develop optimal solutions in the best possible time, with the aim of reducing the implementation time to operate digital products and solutions that have been tested and certified to international standards. Christos Schizas, President of the National e-Health Authority of Cyprus, during his opening speech, referred to the necessity of the European Health Union to prepare countries to protect the health of citizens and prevent future pandemics. He stressed that the creation of the National Electronic Health Record will provide reliable data for primary and secondary use and that it is funded by the European Commission to organise a Europe ready for the digital age. Lorena Androutsou, Project Officer, European Health and Digital Executive Agency (HaDEA), described the services offered by HaDEA and said that between 2020-2027 €20 billion in funding is planned, with most of the amount going to projects that promote health (such as EU4Health), protect against serious threats, ensure that medicines are accessible to citizens, giving a clear message that public health is a priority for the EU.

The session "Artificial Intelligence (AI) in Health Standards" on the role that AI will play in digital health standards gave an insight into the future of the health sector. The session was moderated by Catherine Chronaki, Secretary General, HL7 Europe and scientific coordinator of xShare, and was addressed online by Charles Jaffe, CEO, HL7 International. Julia Skapik, Chair, HL7 International, spoke about the high expectations everyone has of AI but also the scepticism and conservatism surrounding its use. She further analysed the next steps needed to apply AI to the development of standards, tests and reference models by HL7.
Elena Petelos, Researcher, Chair, Real-World Evidence and Artificial Intelligence IG, HTAi & President, Global Health initiative, EUPHA, spoke about the regulatory challenges in the application of artificial intelligence (AI) in healthcare internationally. She mentioned the rapid increase in ethical abuse of AI and the key points for developing solutions. Alain Labrique, Director, Department of Digital Health & Innovation, WHO, highlighted the need for accessibility to AI tools and spoke about the role of WHO in advocating for safety in AI implementation. Ricardo Baptista Leite, CEO, HEALTHAI, reported on the global market sizes of AI in health care services. There are more than 3,000 start-ups and emerging companies, and the number of published patents for AI doubled every year from 2015 to 2021. He also highlighted the need for processes to ensure that the AI development landscape is not anarchic. Henrique Martins, Associate Professor, ISCTE & Coordinator of XpandDH, speaking on health diplomacy and the Global Electronic Health Record, underlined the need for a "Global Digital Health Treaty", which would establish global rules for telemedicine, for the coding of medicines and devices and their use, and for detailed reporting and information sharing on cross-border health threats.

At ADHW, together with the HL7 Europe working groups and the HL7 FHIR Marathon, the 2nd European Meeting of the Vulcan Accelerator, which aims to connect health care with clinical research through the HL7 FHIR standard, was held. The specific topic of the meeting was the development of regulatory policies and flexible implementation of the HL7 FHIR standard in Europe and internationally. Approximately 25 speakers from Europe and the Americas participated and the discussions held will influence strategic priorities for Vulcan and the clinical research and secondary data use community.

What distinguished Athens Digital Health Week - ADHW from other conferences was the fruitful interaction between flagship initiatives and projects in alignment with the European Union's overall digital innovation strategy. In this context, the eCAN, Gravitate-Health, Label2Enable, ManagiDiTH, OneAquaHealth, XpanDH, XShare, Xt-EHR and UNICOM projects came together.

The xShare project was officially launched its consortium of 41 partners on January 17th, during the Athens Digital Health Week. The project kicked off with a public event presenting the consortium and partners as well as collaborations with the XpanDH project and Xt-EHR initiative. The two following days the xShare consortium met and partners got acquainted and started working on shared visions for the "Yellow Button"—intended to give patients access to their data in the European Patient Summary— business use cases, industry involvement and the EHRxF Standards Hub. One of the strengths of this project is that the key standardisation bodies are on board as well as leading industry actors, who will actively help bring the "Yellow Button" to market and make it a reality.

XpanDH ‘Expanding Digital Health through a pan-European EHRxF-based Ecosystem’ successfully participated in the ADHW 2024. The event showcased XpanDH's commitment to advancing digital health solutions. XpanDH, with a mission to empower individuals and organizations in adopting digital health solutions, organized workshops, including the X-Bundle Retreat and the XpanDH Readiness Model Workshop. These sessions fostered collaboration, aligned strategies, and raised awareness about the European Electronic Health Record Exchange Format (EEHRxF). A highlight was XpanDH’s participation at the joint launch event of the xShare project, a significant milestone demonstrating real-world experiments with early adopters of EEHRxF. XpanDH’s presence at the ADHW underscored its dedication to fostering interoperability and innovation in digital health.
Moreover, in collaboration with the XpanDH project, IHE-Europe animated a workshop on the XpanDH readiness model. The workshop aimed to familiarize participants with the developed readiness model, emphasizing its relevance for upcoming projects, especially within the xShare framework. Representatives from various stakeholders, including the European Commission, users, and vendors, provided practical insights on aligning and benefiting from the EEHRxF and the XpanDH readiness model, fostering a collaborative environment for exploring its reuse in future healthcare projects.

A glimpse into the future was given at the awards ceremony of the Gravitate-Health Hackathon, an innovation and technology competition for personalised digital information for patients on their medication, organised by the European project Gravitate-Health. 12 teams from all over the world participated in the Hackathon from 17 to 19 January; Two Greek teams and one team from Brazil were awarded prizes. The creation of a community within Gravitate-Health project to include all the teams that participated in the Hackathon was announced, to continue working on the proposed solutions and towards the project’s vision.

Last but not least, a meeting of the IHE-Europe Executive Committee with members of the HL7 Europe board was organized to foster collaboration in the following years. To summarize the events of the week, IHE-Europe vendor co-chair Andreas Klingler said: "The Athens Digital Health Week proved again that interoperability is about people, not technology."

Athens Digital Health Week, by the general consensus of the participants, acted as a working pocket for all those involved in the digital transformation of health services. It brought together projects implemented in Greece through the Recovery and Resilience Facility with European expertise, enhancing interaction and exchange of best practices. The next goal of the organisers is to repeat the event and establish it as a regular meeting point for European organisations and projects.