KPMG Budget 2025 briefing session

KPMG Budget 2025 briefing session

[pac_divi_table_of_contents _builder_version=”4.24.3″ _module_preset=”default” global_colors_info=”{}” theme_builder_area=”post_content”][/pac_divi_table_of_contents]

KPMG Budget 2025 Briefing

Was pleased to attend the annual KPMG budget briefing on Wednesday momning, 2nd Oct. at The Mansion House.  Big turn out as usual. Excellent presenters as usual: Matt Cooper , KPMG partners , Dan O’Brien and Gillian Tett .

Matt Cooper

As per usual Matt Cooper kept the pace lively and the topic interesting.  Clear that Cost of Living has been the principal issue to be addressed (not dissimilar to concerns in many countries after the long inflation run). Reminded us also of the theme of ‘politics of envy’.  (I think of Margaret Thatcher who dismissed egalitarianism as “the politics of envy, the incitement of people to regard all success as if it were something discreditable”). Seems satisfied that his fellow podcaster Ivan Yates has got things right – and that an early election will now be required to leverage the giveaways in this budget.

Dan O’Brien

Dan O’Brien drew attention to Mario Draghi’s excellent recent paper addressing EU challenges: The Future of European Competitiveness . Just also watched Emmanuel Macron at Berlin on the subject of Europe’s role in a multi polar future. . DOB is satisfied that ‘inflation is done’ and lower interest rates will follow. Interesting slide showing that our pharma exports to the US now exceed out total exports to UK. Obviously were we to see any significant attempt to relocate jobs back to the US (in particular likely to be good rather than services) this would pose a threat to ongoing corporates tax receipts. For now we are on of the very few EU countries operating with a surplus.  And while government expenditure has moved ahead significantly not on a par with the madness of the Celtic Tiger.

KPMG and Budget 2025

KPMG provided an excellent summary of the changes being included in Budget 2025– and a document summarising all of this.

Gillian Tett

Gillian Tett’s theme was ‘Life beyond the Balance Sheet’. Generaly economic outlook is positive – with some concerns re China.  US going well and looks like achieving a ‘soft landing’. But for the accountants in the audience she reminded us that the drivers of the economy have changed and are different to what we have learned. The US ‘C-suite’ are now preoccupied with new risks: geo political, political, climate, environment, medical and AI. None of this is reflected in traditional Balance Sheet thinking. Floods are now reckoned to cost the US economy $0.5tn per annum.

GT referenced four factors for growth which we have focused on: globalisation, free market capitalisation, innovation and democracy.  But these have been going in the wrong direction (think back to post WW1). She referenced growth in populism, competing memes of ‘Joy’ and ‘anger’ in US politics – although policies converging, lots of protectionism (and industrial policy) emerging – not just in the emerging economies, centralisation of power may impact innovation and autocracies ‘infecting’ democracies. All of this leading to great uncertainty – FED not clear on what policy making will look like until post election. Ireland will continue to be subject to vagaries of uncertain world – but will continue to rely on its strengths: flexibility and resilience.

Where to from here?

Difficult not to see us having an election next month – we’ve just seen a fair amount of give away in this Budget 2025. However I think what we have been hearing from Mario Draghi and Emmanual Macron should give all of us in Europe concern.  We need to catch up and work more effectivly together – be that on capital for investmentin infrastructure, energy, healthcare, innovation, artificial intelligence.

I have a particular interest in healthcare.  We recently saw the publication of the Digital Health Strategic Implementation Roadmap.  This aims to digitalise public health and deliver EHR across the country.  But in there are major resourcing and investment challenges.  Not sure the €3bn for health provides very much os what will be required to achieve this – given 50% of it is to clear up 2024 overruns.  When Draghi and Macron talk about getting ahead, innovating, investing in infrastructure, are we going to get this done in healthcare?

 

Digital Health Strategic Roadmap – Ireland – 48 projects to win

Digital Health Strategic Roadmap – Ireland – 48 projects to win

[pac_divi_table_of_contents _builder_version=”4.24.3″ _module_preset=”default” global_colors_info=”{}” theme_builder_area=”post_content”][/pac_divi_table_of_contents]

 

Digital Health Strategic Implementation Roadmap

This Digital Health Strategic Roadmap was published in July this year.  I took a few hours over the weekend to review it.  While I might like to see a little more emphasis on use of AI to drive more innovation it is fair to say the document does not lack for lots of ambition.  The document also is clear on the resources and challenges associated with this proposed 7 year implementation effort.  Having worked in the sector over the last 15 years (in private healthcare) I have had first hand experience of the challenges associated with the required levels of change. 

Interestingly the outline budget requires IT spend to go from 2.2% of total healthcare spend to 4-6%. Given current pressures on healthcare spend this would most likely require additional funding – at east until we begin to see payback in terms of efficiency post implementation.

The Summary – Digital Health Strategic Roadmap

At summary level the Roadmap aims to integrate digital technologies into Ireland’s healthcare system, promoting a patient-centered, digitally enabled environment. This roadmap aligns with key frameworks, including the Department of Health’s “Digital for Care” framework, the Sláintecare Action Plan, and the Digital Ireland Framework. It emphasises six core principles:

  • patient empowerment,
  • enhancing workforce and workplace,
  • enabling digitally connected care,
  • using data-driven services,
  • fostering a digital health ecosystem and innovation, and
  • establishing secure digital foundations.

The roadmap outlines 48 strategic initiatives over seven years, focusing on improving access, efficiency, and quality of care. It seeks to empower patients by giving them greater access to information and enhancing the healthcare workforce’s digital capabilities. Key outcomes include seamless data sharing, better patient involvement in care, and enhanced decision-making through data and analytics.

The roadmap stresses significant investment in digital infrastructure and skills, collaboration across healthcare systems, and robust governance to support this transformation. The goal is to create a more resilient, efficient, and high-quality healthcare system, benefiting patients and healthcare professionals alike

My ‘top 5’ projects

The following five projects – of 48 in total, caught my immediate attention:

  1. Electronic Health Records (EHR) Deployment: This project focuses on developing a national EHR system that provides seamless integration of patient data across various healthcare settings. This includes creating business cases, establishing standards, and setting up a procurement framework to ensure the EHR system is interoperable and secure
  2. National Shared Care Record (NCSR): Aimed at integrating health information to provide a holistic view of patient care, this initiative seeks to establish a unified care record accessible to healthcare providers across the country. This will enhance care coordination and improve patient outcomes by ensuring all relevant health data is available to caregivers
  3. Integrated Community Case Management System (ICCMS): This project aims to implement a system that supports the management of complex care cases within the community setting. By enabling better data sharing and coordination among community healthcare providers, this system will improve patient care and reduce the need for hospital admissions
  4. Digital Front Door and Managed Health Content: This initiative involves creating a central digital platform to provide health information, access to services, and digital tools for self-management. It will act as the primary entry point for patients to engage with the health system, facilitating easier access to care and information
  5. Cybersecurity Enhancement Program: Following the cyberattack on the HSE, this project is designed to bolster the digital health system’s cybersecurity infrastructure. It aims to protect patient data and healthcare systems from future cyber threats by implementing robust security measures and continuous monitoring​

Risks to the Implementation Roadmap

  • Cybersecurity Threats: There is a significant risk of cyber attacks, as demonstrated by the 2021 ransomware attack on the HSE, which disrupted patient care and access to health records. To mitigate this, a dedicated cybersecurity program is proposed to enhance the cyber resilience of the health system​
  • Funding and Resource Allocation: The roadmap requires substantial and sustained investment, estimated to be between 4% and 6% of the overall healthcare expenditure annually. Securing this funding is critical for the development of infrastructure, digital tools, and workforce skills
  • Change Management and Adoption: Successfully transitioning to a digital health system involves overcoming resistance to change within the workforce and ensuring that patients and healthcare professionals are adequately trained and supported. Effective change management and leadership are essential to facilitate this transformation
  • Data Quality and Integration: Ensuring high-quality data and seamless interoperability across various healthcare systems is crucial. Poor data quality and fragmented data sources could hinder effective care delivery and decision-making​

Other points of interest in the Digital Health Strategic Roadmap

EHR implementation

There are a range of ERP products already in place. Cerner (now Oracle Healthcare) is in the Maternity Hospitals, the National Labs and James’.  The Children’s Hospital recently selected and is implemting Epic.  Many of the other hospitals have developed and implemented other solutions over the years. On the private side MEDITECH seems to have the bulk of the market (Beacon, Mater Private, Bons and Blackrock Health).

Given the objective appears to be to have one patient recrod – sourcing data from both public and private – will be interesting to see how this unfolds in the next 2 years. With this in mind also to be noted that the private sector in general is not coding diagnosis and treatment (will this be a requirement in order to develop an effective patient record?)  Who will provide the budget for this, if required?

Digital Maturity

Strategy includes an outline digital maturity assessment – this assessment is directy relevant to the abiility of the healthcare system to take on board the level of change associated with the listed 48 projects. If the objective, as it should be, is to improve digital maturity there may be a significant requirement for development/ training/ building of sustainable teams.

Artificial Intelligence

This is addressed in a number of places in the roadmap.  In fairness digitalisation (and availability of digital data) is a prerequiste for deployment of AI.  However I suspect there are lots of opportunities to front load some of the AI delivery – even leveraging what’s available digitally now.

Shift Left, Stay Left

Great to see this called out in the roadmap – essential to move as much as possible out of acute care and back to community and/or home.  Digital plays a key role in making this happen.

What are the next steps?

A roadmap without resources (cash, people, partners) is only a roadmap.  Presumably now critical to approve funding to enable the healthcare digital transformation accelerate (and finalise the deliverables and timelines). Given pressures on staffing and resources critical to drive forward with this scope of work.

 

Love 12 hospital digital transformation spends

Love 12 hospital digital transformation spends

[pac_divi_table_of_contents _builder_version=”4.24.3″ _module_preset=”default” global_colors_info=”{}” theme_builder_area=”post_content”][/pac_divi_table_of_contents]

 

12 places hospitals are spending their hospital digital transformation budgets

Interesting research just released by McKinsey about hospital digital transformation spend. And it’s not all about EHR – but I think that’s probably because most have already done this.

The Summary findings:

  • The survey indicates a significant interest in digital transformation
  • Despite recognising AI’s potential, there is a gap in investment
  • A shift towards more patient-centric and decentralised care approaches

Think through why?

Key Insights:

High Priority on Hospital Digital Transformation: 75% of health system executives recognise digital transformation as a priority but face resource constraints.

Not that surprising: limited budgets, insufficient skilled personnel and competing priorities within healthcare organisations, making it challenging to allocate adequate resources for comprehensive digital initiatives. May also struggle to attract and retain top digital resources around Data and AI, given competition for these people.

Potential of Artificial Intelligence: 88% of healthcare leaders see AI as the technology with the most potential, yet less than half have made investments in it.

The slow adoption of AI may be due to high upfront costs, lack of expertise (clinically, administratively and IT wise), concerns about data privacy and uncertainty about the return on investment. There are lots of papers out there researching impact of use of AI in healthcare. But perhaps not enough published examples of how AI has actually improved patient safety and driven cost savings in the business.

Investment Areas in Hospital Digital Transformation:

  1. Virtual Health to Enhance Patient Experience and Access: 76%
    • Investments in telemedicine and virtual care aim to improve patient interactions with healthcare providers, increasing accessibility and convenience for patients, especially in remote areas. This is generally in line with general ‘Stay Left Shift Left’ philosophy.  Virtual care also has potential to free up much needed capacity for more complex procedures/ care.
    • Technologies such as video consultations, mobile health apps, and online patient portals are central to these improvements.
  2. Revenue Cycle Management and Back-Office Automation: 70%
    • Focusing on automating administrative tasks to improve efficiency, reduce errors, and lower operational costs, thereby streamlining financial and administrative processes in healthcare organisations.
    • This includes improved integration and adoption of standards, the use of robotic process automation (RPA) and machine learning algorithms to handle billing and claims processing.
  3. Digital Front Door: 62%
    • This is a basic recognition of the patient as a digital consumer – who is expecting a very different experience to the traditional ‘at the beck and call of the hospital/ consultant’ approach. Enhancements in digital access points for patients, such as online appointment scheduling and patient portals, aim to simplify and improve the patient experience from the first point of contact.
    • Patient engagement platforms including CRM and chatbots are key technologies driving these enhancements.
  4. Acute Care Workflow and Throughput: 58%
    • Investing in technologies to optimise patient flow and care delivery in acute settings, reducing delays and improving overall hospital efficiency and patient outcomes.
    • Real-time location systems (RTLS) and electronic health records (EHR) systems are pivotal in these initiatives.
  5. Ambulatory Care Management: 55%
    • Hospital Digital Transformation solutions for managing outpatient care enhance coordination, monitoring, and follow-up, leading to better patient outcomes and more efficient care delivery.
    • Technologies such as electronic medical records (EMR) and care management software play a crucial role.
  6. Remote Patient Monitoring: 54%
    • Technologies that allow continuous health monitoring outside traditional healthcare settings enable proactive management of chronic conditions and early intervention.
    • Wearable devices, IoT sensors, and remote monitoring platforms are integral to these efforts.
  7. Contracting or Value-Based Care: 51%
    • Implementing digital tools to support value-based care models focuses on improving patient outcomes and cost efficiency, aligning provider incentives with patient health.
    • Analytics platforms and population health management tools are essential for these models.
  8. Virtual Health to Address Labor Shortages: 48%
    • Utilising virtual health solutions helps mitigate the impact of healthcare labour shortages by extending the reach of existing healthcare professionals and services.
    • Telehealth platforms and virtual care coordination systems are key technologies in this area.
  9. Advanced Analytics, AI, Machine Learning, Generative AI: 45%
    • Leveraging advanced data analysis technologies aids in clinical decision-making, operational efficiencies, and personalised patient care, despite current investment gaps.
    • These technologies include predictive analytics, natural language processing (NLP), and AI-driven diagnostic tools.
  10. Cross-Site Capacity Management: 45%
    • Managing resources and patient flow across multiple sites improves capacity utilization and ensures that patients receive timely care in the most appropriate setting.
    • Cloud-based capacity management systems, control rooms and inter-facility coordination platforms are vital technologies.
  11. Robotics or Physical Automation: 40%
    • Investing in robotics and physical automation enhances surgical precision, logistics efficiency, and overall operational effectiveness within healthcare facilities.
    • This includes surgical robots, automated guided vehicles (AGVs), and pharmacy automation systems.
  12. “Hospital at Home”: 36%
    • Providing hospital-level care at home reduces the need for hospital stays, increases patient comfort, and can lead to better health outcomes through personalized, convenient care.
    • Remote monitoring devices, telehealth platforms, and home health software are critical components.

Conclusion re Hospital Digital Transformation

There is no doubt that healthcare providers are switched on to requirement for digital transformation (and the associated investment).  For now, while AI may be seen as representing the biggest potential impact, investment in AI would appear to rank behind a number of other initiatives: in particular: virtual care, revenue management and digital front door. However it should also be noted that all of the vendors being used across any of these initiatives are looking to embed AI in their own applications and tools.

Top of Form

Bottom of Form

 

IT Strategy – 5 elements

IT Strategy – 5 elements

[pac_divi_table_of_contents _builder_version=”4.24.3″ _module_preset=”default” global_colors_info=”{}” theme_builder_area=”post_content”][/pac_divi_table_of_contents]

 

IT Strategy – designed to generate Business Advantage through Technology

Over the last several years we have worked with a number of businesses to develop it strategy and business strategy. Sometimes this has resulted in one inclusive document, on other occasions standalone, but cross referenced, Business and IT Strategy documents.

In any strategy work over the last several years I have tended to assess our approach against Richard Rumelt’s framework (outlined in ‘Good Strategy, Bad Strategy’).

Have always liked his approach to business strategy and it also lends itself well to IT Strategy work.

There are five elements:

  • Diagnosis
  • Policy
  • Coherent actions
  • Execution
  • Continuous improvement and learning

 

DIAGNOSIS

You are not going to develop worthwhile thinking and planning re IT without understanding the business and its challenges and opportunities.  In completing a diagnosis would look to address the following:

  • Understand the business: business environment, market trends, customer requirements, competitors. Readiness/ willingness to change.
  • Stakeholders – identify (shareholders, management, employees, customers, regulators, etc) and understand expectations, attitude to change, competition, adapting.
  • Assess current IT – including infrastructure, processes, data management and support for informed decision making
  • Research industry trends as may impact company competitiveness – data analytics, artificial intelligence, robotics, etc
  • Identify opportunities/ challenges for the business which can be addressed through IT enhancement/ innovation

GUIDING POLICY

  • Align to business priorities – including innovation, agility, customer centricity – recognising importance of data
  • Define core principles and values that guide IT decision-making, while ensuring alignment with stakeholder expectations and company values. Consider cybersecurity, Mobile, Data, Artificial Intelligence, Build v. Buy, Platform centric, Interoperatibility, Cloud/ On Prem/ Hybrid – emphasise flexibility, adaptability and responsiveness to the market and competition.
  • Prioritise initiatives that supporting strategic objectives, drive operational efficiency, and enable the company to exploit opportunities.

 

COHERENT ACTIONS

  • Develop required actions/ projects to address the key business challenges and opportunities
  • Prioritise these actions in context of impact for the business, while understanding any interdependencies across the actions/ projects
  • Align resources in line with prioritisation – designed to deliver innovation, growth, competitiveness with a focus on data and analytics to identify/ uncover additional actions of value to the business.

EXECUTION

  • Deliver business advantage. Execute the identified projects in line with the agreed prioritisation. Demonstrate tangibl benefits to the relevant stakeholders..
  • Communicate with all relevant stakeholders while executing each project. Ensure timely feedback and understanding of changes/ impact across the business.
  • Capture and use data to demonstrate project progress and to measure actual Business Advantage delivered.

CONTINUOUS IMPROVEMENT AND LEARNING

  • Feedback – gather feedback from users and stakeholders – to identify further opportunities for improvements and /or innovation – potentially at policy level, with respect to completed or ongoing projects or identification of potential new projects.
  • Promote culture of continuous improvement and innovation – ensuring understanding of the business in IT and across the business the capability of emerging technologies. Encourage experimentation and data driven research.
  • Monitor emerging business and technology trends – to identify further opportunities to drive efficiency, grow the business and improve customer experience.

FITTING WITH OUR APPROACH

While strategy may be determined over a fixed period of time the dynamics of the current business environment very much drive the requirement that the strategy is a living strategy – and Rumelt’s inclusion and emphasis on Continuous Improvement and Learning speaks well to this.  Typically we see the Section Guiding Policy as being critical to providing the framework for ongoing IT decision making.  It too may be subject to change – given the velocity of new developments e.g. Generative AI. We typically look to capture the ‘Coherent Actions’ in a Tech Roadmap – agreed jointly between all relevant stakeholders.  Typically we are looking at 18 to 24 months for such a roadmap – and within this time it may itself be subject to review and/or overhaul.  For us critical that the Execution of the prioritised projects delivers the targeted Business Advantage. Communication, Data and Feedback are all key to this.

What are the 4 main points of IT strategic planning?

In developing an IT Strategy we are looking to use IT in a business to achieve business objectives.  So the main points are:

  1. Understand the business objectives and the business itself (how it operates)
  2. Prioritise/ focus efforts on IT according to its potential to drive achievement of those objectives
  3. Manage/ develop IT in such a way as to provide the required flexibility to support the business as it reacts to the marketplace, new trends, competitors
  4. Manage data as a stratgic asset of the business

CONCLUSION

We have found Rumelt very useful in it strategy development – driving the focus toward Coherent Actions, aligned with Business Priorities and which will drive realisation of Business Advantage through Technology.

 

 

 

EHR now paying multiple dividends

EHR now paying multiple dividends

[pac_divi_table_of_contents _builder_version=”4.24.3″ _module_preset=”default” global_colors_info=”{}” theme_builder_area=”post_content”][/pac_divi_table_of_contents]

 Have EHRs been good for patients?

Good piece by Giles Bruce in Becker’s Health IT last week: ‘Have EHRs been good for healthcare?’ And interesting commentary by Kelan Daly of KPMG on Linkedin same week referencing KPMG partner Alberto di Negri in Italy, rolling outRegional Electronic Health Records in Italy’.

Having spent 15 years or so working with Electronic Health Record deployment in Ireland found all of this interesting and encouraging. And AI is now offering the opportunity to leverage the data in EHR solutions and driving the demand for EHR where hospitals continue to operate in paper based or hybrid mode.

Sample EHR Benefits quoted (US) by Becker’s Health

Clearly the ‘meaningful’ use initiative and associated major government funding program of 15 years ago in US gave EHR deployment and adoption a real focus.  Interesting to hear the views expressed by representatives of a number of the major providers in the US.  In Ireland we trail the US in EHR deployment but are now seeing significant projects underway.

Sandra Hales, associate vice president for IT clinical applications at Phoenix-based Banner Health. “Patients now have timely access to records and data that is simplified for understanding, and there’s a level of inclusivity and responsibility for patients to engage in their own careLives are saved from simple human error.”

Laura Wilt, chief digital officer of Sacramento, Calif.-based Sutter Health “While there is always room for improvement within our field, EHRs have helped propel medicine and patient care into the modern era.”

Kaiser Permanente Chief Medical Officer Andrew Bindman, MD: “Our EHR system enables our teams of experts to seamlessly collaborate and coordinate care across departments and specialties and has fueled transformational health research and clinical practices that continue to improve patient outcomes.”

Dan Roth, MD, chief clinical officer of Livonia, Mich.-based Trinity Health, said the industry is at an “inflection point” with AI, where the technology has the potential to reduce clinicians’ documentation workloads rather than add to them.  Still, he said, EHRs’ benefits have been indisputable with medication safety having improved dramatically via barcode medication administration and care gaps being narrowed by electronic data exchange.

EHR has not been without its challenges

On the flip side, she said EHRs made everything in healthcare seem like an “emergency,” since patients and colleagues can easily send messages at any time, regardless of the acuity of the issue. She said EHRs were also designed for documenting appointments and not the holistic, patient-centered experience that the industry hopes to move toward.

She doesn’t expect anything to replace EHRs anytime soon, as they do an adequate job of safeguarding data and boosting patient safety in a litigious healthcare industry. But she said the EHR experience could inform healthcare’s shift to the next big technology. “One of the things that we missed out on with EMR implementation was really getting the clinical voice in the design of it,” she said. “We should not make that mistake when it comes to AI.”

EHRs, meanwhile, have given way to the larger “digital transformation” in healthcare, which aims to address some of the issues where the technology fell short, including interoperability and connectivity, clinician burnout and patient “stickiness,” he said.

“On the input side, ambient listening is a total game changer,” he said. “I think the core record stays the same … but what we put around the record changes substantially in the next five to 10 years.”

Vinay Vaidya, MD, chief medical information officer of Phoenix Children’s, said early EHRs were “clunky,” comparing them to the first iPhone. But they became pretty consistent about eight years ago.

Progress since 2018

1n October 2018 I was blogging, while a CFO in private healthcare in Ireland, on the subject of generating an ROI on investment in EHR – although clearly noting that EHR had become a ‘given’, a basic requirement (6 years ago). ‘Looks like the industry, the regulators, the public, science – all demand the availability of an Electronic Health Record.  “We work in an industry which is highly dependent on technology  – be that radiology, robots, theatres, measuring and recording of vital indicators.  Patients are all using very powerful technology (on their mobile phones and/or laptops) all day, every day – leveraging the latest in cloud, artificial intelligence and mobility.” And I also referenced ownership of the data (since covered off very clearly by GDPR): “Traditional thinking means that providers sometimes struggle to recognise that the data is really the patient’s data – even if the provider needs to make major investments to receive basic patient data, generate and record lots of data with respect to the treatment of the patient and provide this back to the patient (and her doctor as may be required).  But I think we’re not far from the idea of patients choosing providers, making data available to providers on a temporary basis, updating the data with data from the provider and then taking the data with them (potentially not leaving a copy with the provider)”.

I returned to this subject in 2022: ‘Where is my electronic medical record’ – from the perspective of an individual (me!) not having a consolidated electronic medical record of their various treatments.

The paper by Alberto Di Negri (referenced by Kelan Daly) addresses my exact point (and frustration): ‘Historically, as patients have moved between these settings, the data collected and generated by clinicians in each care setting has not followed the patients’

Regional EHRs

In Italy they are looking to achieve regional EHRs: ‘Across the country, the Italian government is working to realize the vision of digital interoperability and single, lifelong patient digital identities through the expanded use of EHRs. The goal of this undertaking is to empower patients, support healthcare service planning and population health research and management’.

The key ‘takeaways’ from this project are:

  • Establishing regional or national EHRs are key to supporting service design, coordinating care between settings, and improving patient and healthcare professional experiences. However, lack of interoperability between digital systems is a barrier to transformation for many healthcare systems around the world.
  • Projects of such immense scale will likely need to be driven by governments, regulators or payers who demand interoperability, strict privacy compliance and cybersecurity capabilities.
  • EHRs need to be designed with the end users and their experiences in mind. These systems should be designed to help healthcare professionals do their jobs or lighten their workloads. Patients need systems that make accessing services and their health information easier.

Conclusion

In Ireland we have seen EHR initiatives in the HSE in respect of Maternity Hospitals, National Children’s Hospital and several at individual HSE hospitals.  In the private sector we have seen significant developments at Blackrock Health, Bons and Mater, amongst others.  Unfortunately as of yet I do not have any sight of my one electronic medical record, owned by me, shared with any provider I choose to use and updated by that provider.  What I see being reported in Italy – with EU funding – looks like the right direction.  And for society and provision of improved, affordable healthcare we need, inter alia, the ability to share medical records in a secure way to support research and development.

 

 

Cybersecurity 1 – Beware – the hackers don’t go home at 5…

Cybersecurity 1 – Beware – the hackers don’t go home at 5…

[pac_divi_table_of_contents minimize_toc_as_icon=”on” opened_icon=”||divi||400″ _builder_version=”4.24.3″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” theme_builder_area=”post_content” spacing_above_heading=”30px” sticky_enabled=”0″][/pac_divi_table_of_contents]

The hackers don’t go home at 5…

Businesses have gone digital – staying paper based is no longer an option. A business’s data is one of its most valued assets. We see large enterprises implementing comprehensive cybersecurity frameworks.

Small business and cybersecurity

How do these cybersecurity steps scale to a small business (say less than 25 employees, less than €1m turnover)? If you have digital assets you need to protect them.  But where to start?

You are another target on the web for any hacker out there.  The implications for you of any such attack may range from financial losses to reputational damage to closure of your business.  You may not have the resources available to you to recover from a significant cybersecurity attack. And insurance is not the answer (even if you can get it and can afford it).

Cybersecurity risks

What are the cybersecurity risks your business?

  • Ransomware Attacks: Malicious software that locks you out of your system and data until you pay a ransom.
  • Phishing Scams: Efforts to steal sensitive information via emails and messages.
  • Insider Threats: Risks from you employees or your contractors misusing their access on your systems to harm your business.
  • Supply Chain Vulnerabilities: Cyber risks in respect of third-parties on whom you depend e.g. service providers, software providers, etc

You need to:

  • understand the significance of cybersecurity and the emerging risks to your business, and
  • implement robust protective measures to safeguard your assets and the continuity of your business

There are a number of excellent frameworks to assist you in developing a comprehensive cybersecurity defence.  And there is an ever-increasing list of vendor products.  But what should you do first?

Top 7 Cybersecurity Recommendations

  1. Strong Password Policies and Multi-Factor Authentication (MFA) – Use complex passwords and MFA to secure user identities and enhance defense mechanisms.
  2. Regular Updates and Patches – Maintain up-to-date software and operating systems to protect against known vulnerabilities – apply patches on a timely basis
  3. Employee Cybersecurity Training – Raise awareness with all your employees and contractors on cybersecurity best practices, including recognising phishing attempts and the requirement to protect sensitive data.
  4. Regular Data Backups – Backup critical business data in a secure, off-site location to minimise the impact of data loss.
  5. Comprehensive Security Suite  – Deploy security software offering including: antivirus, anti-malware, firewall, and web filtering – to protect against various threats.
  6. Limit Access to Sensitive Information (‘need to know’) – Apply the principle of least privilege, ensuring that employees have access only to the data necessary for their jobs.
  7. Incident Response Plan – Develop a plan to address potential cyber incidents and regularly conduct drills to test scope and readiness.

Is this all?

No – and far from it.  But, in the first instance, make sure you have these seven steps covered off. 

Lots more to be considered – including the various frameworks (ISO 27001, CIS Controls, NIST Cybersecurity Framework), Zero Based Trust, End Point Security, Security Incident and Event Management (‘SIEM’), Security Operations Centres. 

You depend on your information systems.  Your employees, customers, partners, regulators, shareholders have expectations of you with respect to protecting these assets. When you go home the hackers don’t. Review the seven steps as an immediate initiative – then a broader risk assessment may inform/ direct further actions

 

 

Thinking AI – why is AI so hot? (AI -1)

Thinking AI – why is AI so hot? (AI -1)

[pac_divi_table_of_contents _builder_version=”4.24.3″ _module_preset=”default” global_colors_info=”{}” theme_builder_area=”post_content”][/pac_divi_table_of_contents]

Artificial Intelligence is not new

So, why is AI so hot? What is driving the market? What has changed (As an undergraduate engineer in Trinity College Dublin in the early 80s I was learning LISP and writing programmes in Pascal to do basic image recognition (limited to recognising geometric shapes))?  We have had Natural Language Processing solutions and Robotics since the 1950s, Computer Vision solutions since 1960s and Expert Systems since the 1970s.

Machine Learning through to Generative AI

Machine learning (building systems that can learn from data) initially emerged in the 1950s. Within this field there has been very significant progress through the last 60 years in neural networks (designed to mimic neuron structures of the brain) and more recently in processing power to support their deployment. We have seen largescale deployment of neural networks within various AI solutions (including NLP, Computer Vision, Expert systems and Robotics). In the last 18 months the excitement has centered on Generative AI solutions, creating new data – text, image, sound – based on training data sets.

AI for everyone

When I was learning LISP artificial intelligence seemed to be something limited to programmers. Now people have ChatGPT on their phones – with a simple to use interface, access to limitless amounts of information and processing power to deliver real time answers.

I remember concerns when internet access was being rolled out in corporates – how will we prevent people spending all their time scrolling though websites. Web2.0 brought even more concerns with social media platforms and the read/write web. As a consultant and a CIO I was often pulled into discussions about ‘shadow IT’. Now we have ‘shadow AI’ – ChatGPT and its competitors being used widely.

How do we leverage AI without throiwing out the baby with the bathwater?

We are putting together a number of posts re Artificial Intelligence to provide background information, context and a framework for evaluating modern AI’s relevance and potential deployment in your organisation. Like the internet, it’s not going away. But what are the things in your business that you might do differently, better, more efficiently using some of these tools and platforms? And how will you do this without damaging your business or your team?

Other AI posts:

Human centered AI – Dr Fei-Fei-Li

Artificial General Intelligence – are we seeing it now?

Hinton on AI and the existential threat

 

Human centered AI – promoted by Dr. Fei-Fei Li

Human centered AI – promoted by Dr. Fei-Fei Li

Dr. Fei-Fei Li: The worlds I see Curiosity, Exploration and Discovery at the Dawn of AI

 

Dr. Fei-Fei Li is one of the academics very much at the centre of developments in human centered AI in the last 15 years.  She is currently a Professor of Computer Science at Stanford University. She is probably best known for her work on Imagenet (https://www.image-net.org/) while at Princeton University (she developed a large-scale, structured database used to improve object recognition algorithms – core to development of deep learning solutions in AI).

The book neatly intertwines three themes: the immigrant story of the young Chinese girl and her parents making their way in the US, the emergence of artificial intelligence from the 1950s through to the present day and Dr. Fei-Fei Li’s own role in and contribution to human centered artificial intelligence.

[pac_divi_table_of_contents opened_icon=”||divi||400″ included_headings=”on|on|on|off|off|off” level_markers_1=”icons” icon_marker_1=”$||divi||400″ _builder_version=”4.24.3″ _module_preset=”default” global_colors_info=”{}” theme_builder_area=”post_content”][/pac_divi_table_of_contents]

 

Human centered revolution

The book opens with her arriving to testify at the House Committee on Science, Space, and Technology on the topic of artificial intelligence, June 16, 2018. Her own thoughts ahead of the Committee were: ‘I had one idea to share today, and I repeated it in my thoughts like a mantra. It matters what motivates the development of AI, in both science and industry, and I believe that motivation must explicitly center on human benefit’. And she was clear on the scale of change: ‘I believe our civilization stands on the cusp of a technological revolution with the power to reshape life as we know it… This revolution must, therefore, be unequivocally human-centered’

Immigrant story

The immigrant story is yet another reminder of the contributions made by immigrants in all societies.  And she has a number of interesting insights. ‘What made the work draining was the uncertainty that hangs over the immigrant experience. I was surrounded by disciplined, hardworking people, all of whom had stories like mine, but none who’d escaped the cycle of scarcity and menial labor to which we seemed consigned. We’d come to this country in the hopes of pursuing opportunities that didn’t exist elsewhere, but I couldn’t see a path leading anywhere near them. As demoralizing as our circumstances could be, however, the lack of encouragement within our community was often worse’.

She recalls one case of an immigrant being assaulted and her own helplessness to assist: ‘I wanted to say something, even if it was nothing more than a single-word plea for the violence to stop, but I noticed something strange: in the confusion of the moment, I didn’t know which language to use’

The immigrant story also has so many positives – the openness of teachers, the opportunities, the huge support and encouragement of one teacher and his family, her parents getting going in work. ‘There were moments that I had to step back and simply watch. These were the people I grew up with in China: strong, resourceful, impressive. It’d been far too long since I’d seen them. I was proud to witness their return’.

Development of AI

The history of developments in artificial intelligence is well documented in many places.  But Fei-Fei Li captures the momentum and the hiatuses – from Turing (“Instead of trying to produce a programme to simulate the adult mind, why not rather try to produce one which simulates the child’s? ”) to McCarthy, Minsky, Rochester and Shannon (Dartmouth), Feigenbaum (knowledge engineering), Rosenblatt (perceptron), Hubel and Wiesel (visual cortex of a cat), Fukishima (multiple perceptrons), Rumelhart and Hinton (backpropagation) and many more.

Academic development

And then her own academic development.  The difference between Chinese and US school styles (moving between class rooms).  Her first-hand experience of discrimination against girls in education (‘I asked the girls to leave because the time has come to tell you that your performance as a group is unacceptable . As boys, you’re biologically smarter than girls’).

Fei-Fei Li’s original love was physics – but she notes from history how many great physicists became fascinated by biology.  She develops this interest in the brain and has the opportunity while an undergraduate to participate in a key research project at UC Berkeley. And eventually computers and computer science attract her attention – leading ultimately to this combination of neuroscience/ cognitive science and computer science.

Light

Chapter 5 is a great explanation of the importance of light and vision in the development of the human brain. ‘The perception of light was the first salvo in what would become an evolutionary arms race in which even the slightest advantage — a nominal boost in depth or a near – imperceptible increase in acuity — could propel its lucky possessor and its progeny to the front of the pack in an eternal hunt for food, shelter, and suitable mates’. And ‘Intrinsic to this astonishing progression, even now, is our sensory connection to the world.’

Scientist

We see the scientist at work and her original thinking.  There was so much focus on development of brilliant algorithms – but Fei-Fei Li’s contribution was to realise the importance of data – data to be used to train, test and ultimately improve these algorithms.  We also see her persistence – when having developed one dataset she realised the requirement for a much larger data set (‘Biederman’s number — a potential blueprint for what our ambitions as researchers demanded — was big, Really big. It wasn’t 1,000, 2,000, or even 5,000. And it certainly wasn’t the 101 we spent months cataloging. It was 30,000’).

And the initial disappointment when expected improvements did not occur. But if at first you don’t succeed, try again – and she did. ‘ImageNet was more than a data set, or even a hierarchy of visual categories. It was a hypothesis — a bet — inspired by our own biological origins, that the first step toward unlocking true machine intelligence would be immersion in the fullness of the visual world’. ‘The winner was dubbed AlexNet, in homage to both the technique and the project’s lead author, University of Toronto researcher Alex Krizhevsky.’

Human dignity and human centered

And there are other very significant research projects – both at Google and Stanford. But what really captured my attention was the feedback – from her mum in hospital: ‘ You know, Fei – Fei, ” she said softly, “ being a patient … it’s just horrible…It’s not just the pain. It’s the loss of control. It was like my body, even my mind, didn’t belong to me in that room. There were all these strangers — doctors and nurses, I know, but they’re strangers to me — and that expectation to follow their every order … It just became intolerable…My dignity was gone. Gone.’  And from this her clear conclusion: ‘But the deepest lesson I’d learned was the primacy of human dignity — a variable no data set can account for and no algorithm can optimize. That old, familiar messiness, reaching out to me from behind the weathered lines and weary eyes of the person I knew best and cared for the most’.

Li is confident that we can get AI right – not without risks.  She reminds us: ‘The common denominator to all of this, whether it’s addressing the bias in our data or safeguarding patients in hospitals, is how our technology treats people. Their dignity, in particular. That’s the word I keep coming back to. How can AI, above all else, respect human dignity? So much follows from that.

The future

She concludes on a cautious, but positive, note: ‘The future of AI remains deeply uncertain, and we have as many reasons for optimism as we do for concern. But it’s all a product of something deeper and far more consequential than mere technology: the question of what motivates us, in our hearts and our minds, as we create. I believe the answer to that question — more, perhaps, than any other — will shape our future. So much depends on who answers it. As this field slowly grows more diverse, more inclusive, and more open to expertise from other disciplines, I grow more confident in our chances of answering it right.

AI4ALL – another element of human cetered AI

In 2015 Dr. Li cofounded AI4ALL  with Dr. Olga Russakovsky and Dr. Rick Sommer, now a national nonprofit with the mission to make AI more diverse and inclusive.

The Inner CEO – how to take control of you

The Inner CEO – how to take control of you

Shane Cradock – ‘The INNER CEO – True Success is an Inside Job’

I think when I was given a copy of this ‘The Inner CEO‘ I assumed I would be reading another book about CEOs – how they at first failed and finally succeeded.  But the bye line ‘True success is an inside job’ – was the hint I missed. Having picked up the book at the weekend I pretty much devoured it – and my preferred bye line would be ‘take control‘ rather than ‘true success is an inside job’. The author is very much vested in the book – and starts out with his own very serious life experience. And this sense of commitment to what he puts forward is consistent throughout the book – and lots of examples drawn from his considerable experience working with business and sports people.
 

Timing for me

Perhaps the timing was right for me.  Almost two years ago I came across August Bradley and his ideas around Life Design – tracked through the Notion product. And I used this to put some structure around objective setting, daily planning and review, habit tracking, etc. and somewhere around this time I also began to build meditation into my daily routine. So when I read ‘The Inner CEO’, while I took some comfort from some of the changes I had previously made, I also saw a more holistic model for what I am trying to do – or looking for.  This book rang bells and is full of practical advice and ideas. The purpose of this review is not to summarise ‘The Inner CEO’ but to give you some sense of where it caught my attention and imagination. These days as a business advisor difficult to get away from Artificial Intelligence, ChatGPT, etc – today that included an excellent MIT lecture on fundamentals of foundation models, recording of Rishi Sunak interviewing Elon Musk and recording of the opening presentation at Gartner three weeks ago – AI, AI and AI.  More information overload.  And, of course, Shane references this under the ‘brains can’t cope’ topic with which we are all too familiar.  But the real point is his reference to  the ‘ability to be present and have clarity‘ as being the key skill for the 21st Centriy – for any of us.

Knowledge and AI

As I have researched AI recently I have spent considerable time thinking about learning, knowledge and ‘wisdom’ – in the context of trying to understand where we may be headed with AI – and the ongoing discussion of whether we are already seeing the first signs of Artificial General Intelligence (‘AGI’). Just reread Simon Winchester’s excellent ‘Knowing what we know – the transmission of knowledge from ancient wisdom to modern magic‘. In many ways it forms an excellent background to many of the challenges we all face in achieving ‘true success is an inside job’. When the author introduced the concept of seeing yourself as an ‘observer’ of your own mind and thoughts I was at first taken aback.  But as he explains the cocept it seemed to make complete sense. And he develops this beautifully in the book – with examples and ideas around why you want to do this and how you go about it. I remember 45 years ago learning Latin: a very smart teacher and his insistence that we did not use a dictionary in working through previously unseen texts.  Learning to sight read for piano exams something similar is required – some ability to relax and go with it (get in the ‘flow’).   Or, although was never a great cricketer, when I did get runs it was like you could not miss – felt like the bat was twice as wide and you could hit the ball anywhere. Good discussion of similar ideas in the book – and explanation of the ‘flow’. The Inner CEO has a number of ideas for assessing and addressing your mood – we all have swings (both directions).  Loved his idea about a ‘slow walk’.  I used to walk the dogs with my headphones on – listening to Audible, Spotify or podcasts.  My daughter told me that when walking the dogs I should listen to them – and be available to them.  So right – and, in many respects, this becomes the ‘slow walk’. On something similar had a discussion last week with an old friend – dumbfounded we spend so much of our ‘travel time’ listening to paodcasts – wanted to know when we listen to music.

Good models and practical advice

The Inner CEO has a number of models which I think explain why so many of us are not in control – when you read the book lookout for Projectors, Missiles and Icebergs. All good ways to explain challenges and opportunities to take control.  Each section finishes with ‘Some things to reflect on‘ and ‘somethings to sit with‘.  I am already sitting with a couple of things referenced and a couple of the ‘things to reflect on’ will be factored into my current daily and weekly reoutines. There are also a number of links to supporting tools and materials – I look forward to checking these out as I look to drive success through the inside job.          
Project Management in SMEs – get it right!

Project Management in SMEs – get it right!

Does project management require a project manager?

Seems to be a regular enough assumption in small and medium size enterprises that a business or line manager has the skills to deliver project management.  And, from what I have seen, this assumption has often proved costly.

What are the skills of a project manager and why it it so often assumed that any manager can manage a project?

Project manager activities

Generally a good project manager will:

  • Understand the principles of project management e.g. PMI
  • Understand where you are (A)
  • Understand where you are trying to get to (B)
  • Work out the jobs to be completed to get from A to B
  • Allocate the jobs to competent people
  • Track progress – managing the critical path
  • Communicate with all relevant stakeholders
  • Ensure project is closed out

And use his/ her experience to deal with issues as they arise and manage them within the original scope, timeline and budget – including agreeing any changes to scope/ timeline/ budget with the project sponsor.

There are lots of reasons a business/ line manager may struggle to do all of this.

Issues for the business/ line manager acting as Project Manager

  • Too busy managing his/ her area of the business
  • Struggle to manage resources within the business outside direct control
  • Not familiar with tools of project management – resource plans, budgets, gantt charts, etc
  • Unable to secure additional resource as may be required
  • Inexperienced in managing multiple vendors – likely to include IT vendors (applications, implementation, infrastructure/ cloud
  • Inexperienced in testing – systems testing, user acceptance testing
  • May not have required communication skills
  • Inexperienced in change management
  • Inexperienced in addressing interdependent issues as they arise – resulting in scope/ time/ budget changes – tracking these and staying on control of the project

The time commitment (which varies as the project prgresses or stalls) – is probably the single biggest issue. There will be line managers who would make excellent project managers – but only if they have time.  And whereas a PM is focused 100% on delivery, a line manager’s first concern is with his/her department and the department’ responsibilities and personnel.

The Vendor Project Manager

Another even more risky strategy is relying on the PM from the vendor to perform the PM role.  This ignores the fact that the client and the vendor have different commercial objectives.  The client needs their own PM assessing the performance, inter alia, of the vendor (and the vendor’s PM activities as they relate to the overall delivery of the project).

The preferred option

The project manager should have experience in the discipline of project management. If the PM role is to be played by a line manager – then this person should have the appropriate experience, skills and available time.  Lots of things may occur during the life time of the project, including:

  • Realisation that original analysis has missed something – or led to an unworkable design
  • Key people leave – within the company or within one of the vendors
  • Unexpected delays – resourcing challenges, delays in software modifications, unanticipated issues with data migration
  • End users change their requirements/ expectations as they see the capability of the new system
  • Requirements to reduce expectations where evolving timelines and budgets prove problematic
  • Increased supervision by senior execs and/or board – where there are issues impacting delivery
  • Potential required to switch to a phased delivery – or changes in phases and or scope of what is delivered in each phase
  • Commercial changes in the contract arising from scope changes

Often the administrative effort is underestimated:

  • Managing internal resources from several departments – multiple meetings/ workshops through the week – tracking the outcome of these
  • Reporting to a project Office, CIO, COO or CEO
  • Managing multiple vendors
  • Preparation for USer Acceptance Testing (Strategy, resourcing, training, scripting)
  • Scheduling of User Acceptance Testing and Ebd User Training

If the company does not have internal PM resources – then there are many options for contracting in PM resources.  But the company is missing a real opportunity to develop skillls and knowledge inhouse by not dedicating appropriately trained, internal resources.  Which ever option is pursued – either is better than thinking the vendor will PM or that a ‘light touch’ from a line manager will suffice.  So many failed and late projects to prove this. Even when you structure and run a project ‘according to the book’ there will be issues and risks to be managed.  Critical to have experienced people in charge – witht the time to resolve issues and achieve successful outcomes,