HIHI Dublin Manager, Eimear Galvin, writes about making Ireland a centre for healthcare innovation
Access is the bedrock upon which HIHI is built. Prior to this in Ireland, the enterprise of health and the health system existed in silos. Ireland haemorrhaged healthcare industry talent as companies looked to the US and the UK for product development – countries where integrated clinical practice, education and research is the norm. A number of years ago Health Innovation Hub Ireland (HIHI) set about changing this. Driving innovation, HIHI acts as a broker between industry and the healthcare system. At a cultural level, the hub engages directly with the healthcare community to embed innovation through support and education.
As a precursor to HIHI, as we know it today, the Action Plan for Jobs 2012 demonstrator project was formed to test at a regional level how a national hub might work. A project team based in University College Cork (UCC) delivered a demonstrator project connecting six innovative Irish healthcare companies with the health service. It provided dedicated contact points, project management, office space, advice and crucially, access to the hospital and primary care and pharmacy systems in Cork.
The six companies taking part in the demonstrator project – the first ever HIHI clients – were selected on the basis of potential efficiencies to the health system as well as the economic impact in terms of company growth, including export potential. Of the companies chosen, Radisens Diagnostics, an innovative blood-testing device, had faced difficulties in formally engaging with the HSE. Being part of the HIHI demonstrator project granted the company access to primary care, physicians, central laboratory and healthcare management. HIHI supported Radisens in their device development, offering integrated engagement with the local health service.
The ambition in the 2013 ‘Action Plan for Jobs’ was to establish a world renowned Health Innovation Hub and in doing so Ireland as a leading location for start-ups and growing medtech and healthcare companies. The demonstrator hub provided a scalable and clinically credible environment in which to launch Health Innovation Hub Ireland (HIHI) in 2016, in Cork. UCC leads a consortium of partners, Cork Institute of Technology (CIT) National University of Ireland Galway (NUIG) and Trinity College Dublin (TCD). Therein lies the genesis for the national hub expansion witnessed last year when HIHI opened doors in both Dublin and Galway, trebling its staff numbers nationally.
As a joint government initiative of both the Department of Business, Enterprise and Innovation (DBEI) and the Department of Health (DoH), funded through Enterprise Ireland and supported by HSE, HIHI recognises that collaboration with business can benefit patient care, patient pathways and outcomes. A neat example – Irish company ViClarity has a tool that monitors compliance with regulatory standards, originally designed for the financial services sector. In late 2016, ViClarity engaged with HIHI to define a pilot study in Killarney Community Hospital, focussed on improving the manual auditing and compliance measurements, within the hospital. Traditional paper based audits were built into system workflows and automated and the workflows assigned to relevant staff members within the hospital.
Staff used the ViClarity tool to complete audits, gather related data and input this directly into the system. Through the HIHI study, Killarney Community Hospital transformed a time consuming paper-based system to computer-based auditing. This means instant results, immediate compliance status visibility and ownership of audit responsibilities. The switch saved significant admin hours, freeing up staff time. For ViClarity, HIHI secured their first clinical pilot in a public hospital. The company continues to leverage the overwhelmingly positive results of the HIHI study both in the domestic and international markets, when making the ViClarity pitch.
HIHI connecting products with people qualified to test them – industry and clinical teams – through usability, pilot and validation studies, supports the development of new healthcare technologies. Just as with Radisens and the demonstrator, multiple companies are now gaining access to invaluable insight and authoritative feedback on how their product works or may require modification. Since 2016, HIHI has managed 200 company engagements, 72 companies received follow up support and 25 HIHI studies completed in Irish healthcare settings. Each hub operates an open door policy but also issues an annual national call. Last year saw a 58 per cent increase in applications to this call, compared with 2016.
Of 70 applications, 40 made it through to the competitive pitch panels late last year, which included experts from HSE, EI, Health Research Board (HRB), DBEI, DoH, clinicians and industry. There were 25 winners and HIHI is currently matching companies with relevant clinical teams, to oversee a study of each product in an Irish clinical setting. The winning companies range from self-funded to current revenue generators. Others such as ILI – Independent Living Ireland Limited, a digital re-enablement pilot programme, which allows older people to return home sooner from hospital – have €65K seed funding from Cork County Council SBIR programme. Feeltect, a medical device company producing an adjustable, ‘smart’ compression device for venous leg ulcers (VLUs) is funded through an EI commercialisation fund and engagement platform myPatientSpace Limited won the EI competitive start up fund last year. Full list of winners here.
HIHI does not provide any funding; rather the currency is access, which is invaluable to companies developing healthcare products. Incidentally, opening up the health service to industry does not always require a full-scale study. HIHI can facilitate mid-development feedback, therapy area/market exploration, gauge clinical appetite for research partnerships, industry/clinician funding potential and focus groups. In fact, the latter is where HIHI adds value for competitive pitch winner, Feeltect. The company wants to run focus groups with its end users – community nurses – prior to embarking on a full-scale clinical trial this year. Working with HIHI Feeltect can make any adjustments now, saving time and money in advance of the trial – a costly endeavour in itself.
HIHI and its partners, not least among them the HSE, want to look at solutions for the long-term, not just to get by in the short-term. If access is the bedrock upon which HIHI is built, then the healthcare community is the fundamental component to ensure a sustainable culture change. HIHI is an open door in Cork, Dublin and Galway for staff from all parts of the health service that have ideas and solutions to problems they encounter in their work. HIHI assesses ideas and concepts for healthcare innovation from all staff – clinical and non-clinical, acting as mentors and advising on taking an idea and developing it into a service or product.
The first step is an online assessment, which will crystallise the idea. It may be a local process innovation which requires support to create the case or it may be a device or product based solution that could impact on a given therapy area and generate commercial return. HIHI will explore the idea and work it through over a six-week workshop period with each individual. At the end of this period, an idea is developed to the point of ‘next steps’. Next steps may be identifying an industry partner to build a beta product for testing, apply for an Enterprise Ireland commercialisation fund, or approach a pitch a solution to a localised challenge.
To create a truly sustainable culture of innovation within the Irish healthcare system then HIHI needs to reach everybody, not just those with product ideas and this can only happen through education. Of the four HIHI academic partners, Trinity College Dublin (TCD) has specific responsibility for the delivery of educational products that will stimulate a culture of innovation within the HSE. A connected series of five, CPD accredited, ‘Innovation Workshops’ kicked off November 2018.The workshops are open only to those working in the HSE, voluntary hospital and relevant primary care settings. Each one-day workshop has been developed to build insight into the latest thinking on practical implementation of new process ideas, new product ideas and creative approaches to re-thinking healthcare from within.
The five workshops, delivered as continuum learning, guide and encourage participants to explore the potential for innovative approaches within their own healthcare environment. Workshops 1 – 4 set the overall context for innovation and deliver hands-on, concrete learning. Participants are encouraged to identify and develop their own ideas individually or in groups throughout this period. Those who engage on this will be eligible for Workshop 5. Here participants are coached and mentored to convert their researched ideas into a coherent presentation, delivering this to a panel of healthcare leaders and experts for critique. Upon completion of Workshop 5, the HIHI ‘Certificate of Healthcare Innovation’ is awarded. The certificate recognises a “Healthcare Innovation Ambassador” and each is encouraged to develop their idea further through their local hub. The overall aim is to embed these ambassadors of innovation within the healthcare sector and build a national network of alumni who will foster an internal ecosystem of innovation and entrepreneurship within the HSE.
The second education programme is a more formal offer, open to all – a TCD Postgraduate Diploma in Healthcare Innovation, one-year course. It is anticipated that those who complete the workshop programme may well pursue the Diploma, as a natural next step. The Diploma comprises eight modules: six taught foundation modules and two project modules, including methodology workshops and a practical field project. The programme will offer fundamental grounding in key subjects: design thinking and embedding a culture of innovation; process innovation; lean thinking; social innovation and health economics; innovation and leadership. The practical project will help students to identify and plan an innovative solution applicable to their workplace, with a view to implementation. This Postgraduate Diploma will be a catalyst in transforming the innovation mind-set within the Irish healthcare landscape. Graduates are expected to lead the adoption and embedding of innovation in the Irish health system. The Diploma will run its first cohort this September 2019, with applications opening in the coming weeks. There are up to 24 places with a mix of both open/industry and HSE places.
Our health system is sometimes seen as being a slow adopter of innovations. While there may at times be arguments for taking a cautious approach, it also means delayed patient benefits, clinical teams feel frustrated by not having access to innovative technologies and burgeoning industry is shut out. HIHI seeks to open up the health service to industry partnership through a measured and controlled system of engagement, increasing access for both sides. Simultaneously, HIHI is encouraging an entrepreneurial mind-set by providing a space and dedicated system for ideation development from within the Irish healthcare community. Through education, HIHI seeks to achieve a lasting behaviour and culture shift that ensures those in Irish healthcare are the lead architects of positive change and accelerate our system to one with innovation at its core.
Originally published in The Medical Independent – here