Karolinska leading figure in EU-supported innovation projects

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Two new innovation projects are challenging the market to find new solutions to healthcare problems. Karolinska is leading the hunt for digital tools to help reduce complications following surgery and for mobile vital parameter monitoring.

"Karolinska will be a leading figure in the development of modern healthcare practices, helping to show others the way," says David Konrad, Function Head of Perioperative Medicine and Intensive Care at Karolinska University Hospital.

For the first time, Karolinska is the coordinator for a project that is being funded as part of the EU Framework Programme for Research and Innovation. As if that were not enough, LIVE INCITE (Lifestyle intervention in the perioperative process through digital service) was ranked top of the project applications to receive support from the world's largest research and innovation programme, Horizon 2020.

The aim of the project is to solve a well-known problem within the healthcare sector that both medical and psychological science have so far failed to overcome – how to encourage patients to change their lifestyle prior to surgery. Only around 1 per cent of patients change their habits in order to reduce the risk of complications and mortality, despite the fact that this actually does reduce the risk of mortality and complications.

"We know that there is a much greater chance of patients doing well if they stop smoking or lose weight prior to surgery, for example. Although we have been sharing this knowledge with others for many years, it has had very little impact," says David Konrad, Function Head of Perioperative Medicine and Intensive Care at Karolinska University Hospital.

"How can we create traction among patients, providing them with enough motivation to want to change and pursue a lifestyle that reduces the risk of complications? It is this problem that we want to find a solution to by challenging the market."

Strengthen patient involvement

The solution must strengthen patient involvement in the care chain, which is in line with the paradigm shift that is occurring within the healthcare sector, in parallel with technological advances. Patient empowerment, eHealth and network-based healthcare are important aspects of Horizon 2020.

Martina Ahlberg, Project Manager for LIVE INCITE at the Center for Innovation, Karolinska University Hospital

"The solutions we are interested in must encourage and empower patients to participate and get involved in their care," says Martina Ahlberg, Project Manager for LIVE INCITE at the Center for Innovation at Karolinska University Hospital.

Since there is no tool or IT system that meets this need available on the market, it is possible to use a process called precommercial procurement.

"We will present this problem to the market, with the stipulation that we must be able to predict, measure and observe the effects of introducing their solution. The goal of the procurement is either a finished commercial product that anyone can purchase or progress that brings us a great deal closer to a finished product capable of solving our problems," says David Konrad.

Expertise to procure innovation

Karolinska has developed the expertise needed to procure innovation. Prior to the procurement of medical equipment for the new hospital building in Solna, a related process was employed – competitive dialogue. The current project is now drawing on this previous experience.

"However, we have never before conducted a precommercial procurement with the kind of support provided by this EU mandate," says Martina Ahlberg.

The total budget is EUR 4.2 million, of which 90 per cent is EU funding, with the remaining 10 per cent coming from the members of the consortium.

"We are approaching the market with the message that we will pay a portion of development costs in order to develop conceptual solutions, i.e. a description of how the manufacturer intends to solve the problem," says Martina Ahlberg.

The consortium then chooses the participants and contributions that are considered to have the greatest potential. In the second round, the selected parties are able to build prototypes. During the final round, the participants must be able to show that they can mass-produce the prototype, and a pilot study will be conducted to test preferred solutions.

"The major challenge is scalability. In the case of hip and knee surgery there is strong evidence when it comes to the link between certain lifestyle factors, such as smoking and alcohol, and complications, but we also want to be able to use the solution for other surgical procedures and other factors, such as depression and physical activity, for example," says David Konrad.

Horizon 2020 is aimed at small and medium-sized enterprises with innovative commercial concepts, something that Martina Ahlberg is very positive about.

"We want to reach players other than the large companies that have traditionally supplied medical equipment to the healthcare industry."

The project is also innovative in terms of the parties from Karolinska who are participating in LIVE INCITE. Medical and behavioural science expertise is represented in the group, with experience from both clinical and research activities.

"Tackling healthcare problems using an interdisciplinary approach is still rare, but we are operating on the border between medicine and behavioural science," says David Konrad.

David Konrad, Function Head of Perioperative Medicine and Intensive Care at Karolinska University Hospital

Nightingale, a project with similar approach

Another project taking a similar approach is Nightingale, the project application which came second to LIVE INCITE in Horizon 2020's ranking. David Konrad is the person leading the work at Karolinska. David believes that, like LIVE INCITE, Nightingale has emerged from a distinct clinical problem.

"The background is that physiological parameters are not being monitored at the same rate as before, despite the knowledge that blood pressure, respiration and pulse can often predict whether patients will be affected by complications and premature death."
The goal of Nightingale is to develop a solution for mobile vital parameter monitoring in order to be able to reduce mortality and morbidity in surgical patients irrespective of their location. The ambition is for the technology to be in place by the time all the units have moved into the new hospital building.

"We want the market to develop a wireless, reliable and safe monitoring system that can work outside of hospital too. That way more patients can return home after surgery, and if something happens we can contact them. For admitted patients, the system can alert a mobile intensive care team."

As there appears to be a similar trend worldwide, a great deal of benefit could be derived from an innovation of this kind.

"There is a common thread in what we are trying to achieve as hospitals – to encourage the market to pursue development that benefits our patients – not what is already available. Karolinska will be a leading figure in the development of modern healthcare practices, helping to show others the way," says David Konrad.

Parties from three countries involved in LIVE INCITE

Horizon 2020 is the world's largest research and innovation initiative, with a budget in excess of EUR 80 billion. The programme focuses on the challenges facing society and creates conditions for new solutions involving research and markets.

LIVE INCITE (Lifestyle intervention in the perioperative process through digital service) is based on the development of a solution to support patients in changing lifestyle factors and their behaviour. The aim is reduced mortality and fewer complications, which benefits both patients and the healthcare system. It must also be possible to use the solution after rehabilitation, thus contributing to improved public health in general.

The project runs from November 2016 to June 2019. The consortium, which will include parties from at least three countries, comprises, in addition to Karolinska University Hospital, the Capital Region of Denmark (Bispebjerg), Hospital Clinic Barcelona, Karolinska Institutet, and the Swedish Rheumatism Association.

Fewer complications following lifestyle changes

A number of studies indicate that preoperative intervention methods in the perioperative process are effective. Abstaining from smoking and alcohol from as short a period as four to eight weeks prior to surgery reduces the incidence of a number of serious postoperative complications, such as wound problems, cardiac complications and infections.

The organ functions affected by smoking are usually pulmonary function, cardiovascular function, immune response and tissue repair, which all have a huge impact on the surgical result. Programmes to help people stop smoking 6-8 weeks before hip and knee surgery halve the risk of complications, from 40 per cent to less than 20 per cent.

In cases of risky use of alcohol, a four-week programme reduces complications to less than half following colorectal resection. In addition to impaired hepatic and pancreatic function, unhealthy alcohol consumption also leads to a number of other postoperative complications, such as impaired cardiac function, immune response and muscle function, as well as metabolic stress.