Faces of Digital Health

When prevention works, nothing happens. That's why it gets cut. Joanna Lane on financing prevention as long-term investment.

Health systems in Europe spend a small fraction of their budgets on prevention, and that fraction is renewed annually and cut first when treatment costs rise. Joanna Lane has spent decades working on health and regional development across Europe, and argues that prevention should be reclassified from expenditure to capital investment, financed the way we finance energy grids, transport and pensions. In this conversation she explains what the Horizon Europe project Invest4Health learned from eight regional testbeds, why Public Health Wales disinvested around £10m to reinvest it, how health systems' own procurement and hiring can improve the determinants of health, and what finance ministers need to hear before they will treat prevention as an investment. We also discuss wearables and the longevity trend, where personal responsibility ends and public policy begins, and a three-layer model for funding prevention at scale.

GUEST

Joanna Lane — Managing Director, Stichting Health ClusterNET; Chair, FH Europe Foundation; Invest4Health (Horizon Europe)

Host: Tjaša Zajc

WHAT THE CONVERSATION COVERS

- Why the benefits of prevention stay invisible in health budgets

- Why local prevention and health promotion budgets are the first to be cut

- Invest4Health: eight regional testbeds for financing health promotion and disease prevention

- Smart capacitating investment and the EU high-level task force on social infrastructure

- Why a single financing template didn't work across regions

- Financing toolkits and competence building for regional health authorities

- Reclassifying prevention as capital investment and soft infrastructure

- Public Health Wales: disinvesting from health promotion to reinvest around £10m

- Prevention spending during and after COVID, and the pull back to acute care

- Defence, energy and climate competing for health budgets

- The ripple effect of health spending: local procurement, inclusive employment and NEETs

- How to make the investment case for prevention to a finance minister

- Local Multiplier 3 (LM3) and the return on local procurement

- 20-minute neighbourhoods and multi-use community hubs for older people

- Remote monitoring for independent living: the SMILE project

- Wearables, longevity and the retention problem in consumer digital health

- Personal responsibility vs public policy: school food, screening and familial hypercholesterolaemia

- Three layers of prevention finance: protected budgets, social outcome funds and patient capital

- Metrics for treating prevention as investment in national statistics

CHAPTERS

2:00 The Finance Minister Anecdote
3:18 Welcome & 40 Years in Prevention
3:54 The Invisible Challenge of Prevention
6:12 The Invest for Health Project
10:47 Financing Toolkit & Training for Regions
12:02 Prevention as Capital Investment
13:03 Bold Examples: Disinvest to Reinvest
16:44 COVID's Regression in Prevention
18:04 Healthcare's Ripple Effect on Local Economies
20:50 Engaging Finance Ministries
23:25 Evidence for Return on Investment
25:07 Community Design for Prevention
27:34 Longevity & Digital Health Solutions
33:11 Personal Responsibility vs. Systemic Prevention
36:11 A Three-Layer Financing Model for Prevention

MENTIONED

Invest4Health — Horizon Europe project on financing health promotion and disease prevention

High-Level Task Force on Investing in Social Infrastructure in Europe (report, January 2018)

Syreon Research Institute, Budapest • Public Health Wales • Local Multiplier 3 (LM3)

SMILE project (Innlandet Hospital Trust, Norway) • FH Europe Foundation • EU Safe Hearts Plan

Earlier FoDH episodes: Herko Coomans on interoperability as an infrastructure funding problem [LINK] • Henrique Martins on twenty years of EU health data projects [LINK]

FACES OF DIGITAL HEALTH

Website: https://www.facesofdigitalhealth.com

Newsletter: https://fodh.substack.com

LinkedIn: https://www.linkedin.com/company/faces-of-digital-health

Spotify: https://open.spotify.com/show/4cElKJHrauyP6QJQaCkvdY

Apple Podcasts: https://podcasts.apple.com/gb/podcast/faces-of-digital-health/id1194284040

#prevention #publichealth #healthfinancing #healthpromotion #diseaseprevention #Invest4Health #healthpolicy #healtheconomics #socialinfrastructure #healthinvestment #digitalhealth #FacesOfDigitalHealth

Nearly €200m, twenty years of EU health data projects. Henrique Martins on what they built and what EHDS needs next.

Before the European Health Data Space became law, the EU had already funded two decades of cross-border interoperability work: epSOS, EXPAND, Trillium Bridge, JAseHN, eHAction and more. Henrique Martins has worked on most of them. In this conversation he explains how those projects became MyHealth@EU, why the European EHR exchange format matters for every hospital and IT vendor, what digital health authorities and health data access bodies will do from 2027, and how far patient control of health data can realistically go. He also argues that Europe is not behind on cross-border exchange, that slow national progress is ultimately a political choice made by voters, and that 2027 will show whether the EHDS implementing acts can actually be applied.

GUEST

Henrique Martins — Associate Professor, ISCTE – University Institute of Lisbon; coordinator, i2X (Intelligent Implementations of the European EHR Exchange Format); former President of SPMS, Portugal's national digital health agency; former Member States co-chair, EU eHealth Network

Host: Tjaša Zajc

WHAT THE CONVERSATION COVERS

What nearly €200m in EU interoperability funding bought over twenty years

How epSOS, EXPAND and OpenNCP became MyHealth@EU

Cross-border ePrescription and patient summary: who exchanges data today

The European EHR exchange format (EEHRxF) and why discharge reports still don't travel

Transformation layers: wrapping HL7 v2 messages in FHIR

AI and natural language processing to structure clinical data at the point of care

Trillium Bridge: EU–US patient data exchange, and why it couldn't be funded today

Xt-EHR and how joint actions shape the EHDS implementing acts

Digital health authorities vs health data access bodies: why one versus many

Patient rights under EHDS: access, download, correction and upload

Health data activism and patient health literacy

The xShare Yellow Button, MyHealth@MyHands and the EU Digital Identity Wallet

i2X: 35 pilots, 12 member states and 3 million citizens — and everyone else

Is Europe slow? Cross-border exchange compared with North America

The EHDS test for 2027: implementing acts and demonstration sites

CHAPTERS

03:00 Fifteen years of European interoperability projects
03:36 €200m over twenty years: what EU funding built
06:38 FHIR, implementation guides and the European exchange format
10:10 From drop-down menus to AI: structuring health data
10:48 epSOS, eHAction and the projects that shaped EU digital health
14:02 Trillium Bridge: when the EU and US exchanged health data
15:58 Xt-EHR and why joint actions shape the implementing acts
18:58 Digital health authorities and health data access bodies explained
23:13 Patients and EHDS: access, correction and health data activism
29:04 Is Europe too slow? 3 million in pilots, 400 million waiting
39:08 The best case for 2027: implementing acts that work

Recent FODH episodes on interoperability and EHDS:
Herko Coomans on interoperability [ • Interoperability Isn't Failing — It's Unde... ]
• Nils Hellrung on openEHR and EHDS [ • Just Connecting systems isn't interoperabi... ] • Karlien Hollanders, The Agentic Patient [ • "I stopped letting AI read my daughter's m... ]

FACES OF DIGITAL HEALTH

Website: https://www.facesofdigitalhealth.com
Newsletter: https://fodh.substack.com
LinkedIn: / faces-of-digital-health
Spotify: https://open.spotify.com/show/4cElKJH...
Apple Podcasts: https://podcasts.apple.com/gb/podcast...#EHDS #EuropeanHealthDataSpace #interoperability #digitalhealth #healthdata #MyHealthEU #FHIR #ePrescription #healthpolicy #EEHRxF #patientdata #FacesOfDigitalHealth

One ultrasound tech, four scanning rooms. NVIDIA's David Niewolny on what "augmented autonomy" asks of clinicians.

NVIDIA is best known for GPUs, but its healthcare strategy is a full stack: compute to train models, compute to run them at the point of care, and simulation to generate the data that medical robotics lacks. In this interview, David Niewolny explains how that stack underpins autonomous X-ray and ultrasound with GE HealthCare, surgical robotics simulation with Johnson & Johnson MedTech, and the Open-H surgical robotics dataset. He argues that open models are a regulatory necessity in healthcare, that software-defined medical devices will shrink innovation cycles from years to months, and that the path to autonomy in surgery will follow the one taken by autonomous vehicles, one level at a time. We also press on the parts that remain unsettled: whether AI efficiency turns into clinician burnout, whether synthetic data reflects real patient populations, and what could still stall adoption.

GUEST

David Niewolny — Senior Director and Global Head of Business Development, Healthcare & Medical, NVIDIA

Host: Tjaša Zajc

WHAT THE CONVERSATION COVERS

- NVIDIA's healthcare strategy: training, simulation and edge deployment for medical AI

- Why open models and open datasets matter in regulated healthcare

- Autonomous X-ray and ultrasound with GE HealthCare: one technician, multiple rooms

- "Augmented autonomy": keeping a clinician in the loop

- AI efficiency, cognitive load and the risk of a new wave of clinician burnout

- Ambient clinical documentation as the clearest efficiency case

- Surgical robotics and the autonomous-vehicle model of stepwise autonomy

- Why robotics costs are falling, and what it means for hospital ROI

- Synthetic data for healthcare robotics: Cosmos-H, Isaac for Healthcare and the Open-H dataset

- Can simulated data reflect a local patient population?

- Model drift, verification and validation, and governance of AI agents in healthcare

- Is healthcare worried about superintelligence?

- Software-defined medical devices and the FDA's predetermined change control plan (PCCP)

- How regulators are adapting to AI-enabled devices

- Change management and ROI as the real barriers to adoption

CHAPTERS

02:00 NVIDIA in healthcare: more than GPUs

03:03 The full stack: training, simulation and edge deployment

08:46 Why open models matter in regulated healthcare

10:51 Autonomous X-ray and ultrasound: one technician, four rooms

14:49 AI augmentation and clinician burnout

18:16 What NVIDIA looks for in a partner, and the surgical robotics bet

23:38 Cheaper robots, more competition, clearer ROI

27:37 Synthetic data, Cosmos-H and the Open-H surgical dataset

31:43 Does simulated data reflect the real world?

34:37 Model drift and governing AI agents in healthcare

38:03 Superintelligence, change management and the autonomous-vehicle analogy

43:10 Software-defined medical devices, the FDA's PCCP and regulators

49:54 A golden age for medtech? What could still slow it down

MENTIONED

NVIDIA Isaac for Healthcare • Cosmos-H • Open-H-Embodiment dataset • NVIDIA Nemotron • BioNeMo Agent Toolkit

GE HealthCare • Johnson & Johnson MedTech (MONARCH platform) • Abridge • Aidoc • OpenEvidence • Sword Health

FDA Predetermined Change Control Plan (PCCP)

FACES OF DIGITAL HEALTH

Website: https://www.facesofdigitalhealth.com

Newsletter: https://fodh.substack.com

LinkedIn: https://www.linkedin.com/company/faces-of-digital-health

Spotify: https://open.spotify.com/show/4cElKJHrauyP6QJQaCkvdY

Apple Podcasts: https://podcasts.apple.com/gb/podcast/faces-of-digital-health/id1194284040

#NVIDIA #healthcareAI #medtech #surgicalrobotics #physicalAI #digitalhealth #medicalimaging #syntheticdata #openmodels #FDA #medicaldevices #healthcarerobotics

Most interoperability debates focus on exchange formats. In this discussion with Dr Nils Hellrung, medical informatician and CEO Strategy & Operations at vitagroup, Nils focuses on the need for shaping hospital IT with governance and financing.

Linking proprietary systems through standards, he says, will always lose meaning, which is why he backs openEHR as a vendor-neutral clinical data core, with FHIR used for exchange. vitagroup in providing the data platform for Catalonia, and just signed a contract with a large hospital group in France. The discussion touches different market approaches to interoperability and challenges of markets such as Germany, where each federal state has its own authority to regulate and implement as they please. Tjasa Zajc and Nils Hellrung talk about what "AI-native" data integration means in practice, why 95% accuracy of AI is not good enough in healthcare, and whether Europe ends up with monolithic US EHRs or open platforms.

This episode is supported by vitagroup.

GUEST

Dr Nils Hellrung — CEO Strategy & Operations, vitagroup; medical informatician; co-author, "Health Information Systems: Architectures and Strategies"

Host: Tjaša Zajc

WHAT THE CONVERSATION COVERS

Why hospital IT architecture reflects governance, trust and financing: three professors, three PACS

Billing versus therapy: why German hospital and ambulatory systems don't talk to each other

AI in healthcare: the widening gap between what is possible and what happens in practice

Why Europe doesn't have to be slower than the US in digital health

Data availability as the main barrier to digital health implementation

openEHR vs FHIR: clinical data repository vs communication standard

FHIR version changes and national profiles: the semantic interoperability problem

Is European Health Data Space (EHDS) interoperability achievable, or only for a core data set?

Catalonia's single patient record on openEHR: 18 months to go-live and the next step to an open health platform

Why Catalonia's single health system makes adoption easier

Germany: 16 federal states, 17 data protection authorities, and a 20-year-old electronic patient record (ePA) programme

Alliance SIH in France: competitors agreeing on a shared health data layer

AI as a translator between clinical data and clinicians

AI-native vs AI-enabled software, and why data pipelines must stay deterministic

Deskilling risk: clinicians who stop thinking because AI seems to have the answer

Epic at Charité, monolithic EHRs vs open platforms, and European digital sovereignty in healthcare

Europe's health IT ecosystem in 2036: best, worst and realistic scenarios

CHAPTERS

02:30 From textbook to practice: 15 years of health information systems
03:00 Why hospital IT looks the way it does: three professors, three PACS
06:50 Is AI speeding up healthcare? The gap between possible and real
10:39 EHDS and data availability: the biggest barrier to digital health
14:00 openEHR vs FHIR: how health data normalisation works in practice
16:40 Is European interoperability achievable? The semantic problem
20:00 Catalonia: why a single health system makes adoption possible
26:48 Germany: 16 states, 17 data protection authorities
30:45 France: Alliance SIH and a shared data layer
32:14 The data layer as Europe's AI advantage
35:38 AI in data integration: why "convincing" is dangerous
41:48 Agentic AI, guardrails and the risk of deskilling
45:00 Europe in 2036: Epic, open platforms and a "very nineties decision"

FACES OF DIGITAL HEALTH

Website: https://www.facesofdigitalhealth.com
Newsletter: https://fodh.substack.com
Spotify: https://open.spotify.com/show/4cElKJH...
Apple Podcasts: https://podcasts.apple.com/gb/podcast...
LinkedIn: / faces-of-digital-health #openEHR #EHDS #interoperability #digitalhealth #healthdata #FHIR #healthIT #healthcareAI #EuropeanHealthDataSpace #Catalonia #vitagroup #FacesOfDigitalHealth

She has 408 of her daughter's medical documents. She stopped letting AI read them — here's why.

Karlien Hollanders is a pharmacist who became her daughter's medical record. When her firstborn went into complete renal failure at two months old and was diagnosed with primary hyperoxaluria type 1, she spent three years moving between Belgian specialist hospitals that could not exchange data with each other. Eleven years later, 408 documents sit on a national platform that can be filtered by doctor, hospital and date — and nothing else. This episode of The Agentic Patient is about what happens when you actually try to put AI to work on a real, fragmented, non-anonymised medical history: what it organised, what it got wrong, and the reason she has stopped.

GUEST

Karlien Hollanders — Patient expert and caregiver; consultant to the Belgian federal health service; pharmacist by training

Host: Tjaša Zajc

THE AGENTIC PATIENT

A Faces of Digital Health series on how patients and caregivers actually use AI — which tools, which prompts, which guardrails — and what that does to the clinical relationship.

Series hub: https://www.facesofdigitalhealth.com/agentic-patient

WHAT THE CONVERSATION COVERS

- Being your child's "walking medical record" across five specialist hospitals

- Why case management exists for cancer and diabetes but not for rare disease

- 408 PDFs, three filters: the missing-metadata problem in national health data platforms

- Federated health data explained — and why you still download your records one click at a time

- What AI document tools did well: organising records by organ and producing specialty-specific summaries

- The timeline AI could not build, and why copy-pasted clinical letters break text-layer summarisation

- Why internists and orthopaedic surgeons need the same records and completely different queries

- The 15-minute consultation and the unprepared specialist

- Local bulk de-identification: the tool that does not exist, and the vendors who could not supply it

- A child's medical data on third-party AI platforms, twenty years forward

- Patient summaries and cross-border care: what an emergency room in another country actually needs

- EHDS versus AI extraction — structuring data at the point of documentation instead of after it

- SNOMED CT and structured entry that clinicians do not know they are doing

- ZAS Antwerp's AI-generated patient-friendly discharge letters, already in production

- Why a shared medication scheme can be five years out of date in a country with electronic prescribing

- Personal health vaults, EU wallets and itsme: identity is not the same as data portability

- Practical advice: how to assemble your own records before letting AI near them

CHAPTERS

03:00 A caregiver's view of patients using AI

04:28 Renal failure at two months: primary hyperoxaluria type 1

10:43 Ten years on: what has changed in Belgian health data sharing

13:04 408 documents, three filters: the metadata problem

15:03 Downloading a federated health record one PDF at a time

17:20 What AI document tools organised — and the timeline they couldn't build

22:27 Same records, different questions: internists vs orthopaedic surgeons

26:38 Not a technology problem: incentives and the missing business case

30:18 AI as a better Google — and where that gets dangerous

32:30 The anonymisation gap: why she stopped feeding AI real data

36:10 Patient summaries, EHDS and structuring data at the source

41:46 ZAS Antwerp's AI-written patient letters, already in production

47:49 Preparing for a specialist visit when your records are scattered

MENTIONED

European Health Data Space (EHDS) — Regulation (EU) 2025/327

ZAS (Ziekenhuis aan de Stroom), Antwerp — AI-generated patient-friendly letters

FACES OF DIGITAL HEALTH

Website: https://www.facesofdigitalhealth.com

Newsletter: https://fodh.substack.com

LinkedIn: https://www.linkedin.com/company/faces-of-digital-health

Spotify: https://open.spotify.com/show/4cElKJHrauyP6QJQaCkvdY

Apple Podcasts: https://podcasts.apple.com/gb/podcast/faces-of-digital-health/id1194284040

#TheAgenticPatient #digitalhealth #healthdata #EHDS #patientdata #caregiver #healthAI #rarediseases #interoperability #healthtech #patientempowerment #medicalrecords