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Interoperability Engineer

UpHill enables health teams to improve outcomes and streamline care by applying evidence-based knowledge through stepwise clinical pathways.

UpHill Health

Throughout UpHill’s history, there has been a common denominator: each year surpasses what we had planned for. This is a function of our work — our unique collective force —, as it is a function of how humanity really needs what we are building.

These two elements serve as the key contributors that have brought us to this moment when 

we joyously celebrate our Series A funding round

. Following a remarkable year that showcased 

UpHill's capacity to deliver journey-based care that enhances healthcare capacity and elevates patient outcomes

, and launching Liber — an innovative digital service poised to transform the healthcare landscape — we stand ready to embark on the next chapter by scaling our impact through journey-based care.

Our solid journey to increase healthcare access at scale, steered by evidence, and in compliance with industry standards.

UpHill was founded in 2015 with a clear mission: 

to empower people to provide and receive the best care

. This mission has taken several shapes and, fast forward to today, UpHill stands out as

 the most highly invested care orchestration company in the European Union

. A milestone that attests to the robustness, safety, and efficacy of our technology, as well as our clinical knowledge, setting us apart from other players.

UpHill improves lives with care orchestration software that works both for healthcare teams and patients. During a turbulent period, when the healthcare system grappled with significant challenges in meeting population needs, UpHill was established as the “second brain” behind care provision within major institutions.

Together with the pioneering, dedicated, and talented frontline teams, we are successful in designing, implementing, and delivering novel journeys for the most challenging conditions.

The impact of what we have done together is refreshing:

Throughout our journey, we've come to understand that issues impacting healthcare institutions, such as growing demand and insufficient capacity, are often tied to lacking alternatives that enable individuals to avoid using these services for all and every reason. In essence, healthcare systems are marked by uneven participation from both healthcare professionals and patients.

Healthcare professionals shoulder a heavy load, from diagnosing and treating acute illnesses to managing daily administrative tasks, preventing diseases, and overseeing chronic conditions. Conversely, in most cases, patients find themselves detached from their care journey, lacking information, and without the necessary tools to proactively engage in health promotion, prevention, and disease management.

This is why in 2023 we invented the next-generation care model: 

Liber provides better care, faster, and at a lower price. Liber members can quickly solve acute health issues by interacting immediately with Liber doctors, and enrolling in disease prevention and health promotion programs. All happens at the pace of a high-tech, premium, and personalized service running on the UpHill platform, which accelerates both members and doctors, building on structured medical knowledge.

As I am writing this, people are still awaiting help for hours long in crowded hospitals and primary care centers. From here across the globe, those in need have to wait years for surgeries, many months for appointments, and too many hours for acute care. This is unbearable. This is why UpHill exists, and this is why we are just getting started: our platform is the care orchestration software for the decades to come.

As we continue to solidify our presence in the Iberian market, 

UpHill is set to expand its footprint by opening offices in new locations such as UK and Spain.

With plans to double our team by the end of the year

we are on the hunt for the most talented people with a drive to change healthcare globally

we are in the business of improving life. 

We believe every patient must be on a well-defined, high-quality care journey.

A journey that augments healthcare workers' capacity, enables people’s self-efficacy, and streamlines healthcare systems coordination.

This is how we will achieve access to high-quality care at scale.

UpHill raises €7M to scale journey-based care

O ano que passou ficou marcado pelo anúncio da nova vaga de Unidades Locais de Saúde (ULS) pela Direção Executiva do SNS. Uma medida que expressa a aposta num modelo de prestação de cuidados integrados, onde os centros hospitalares, hospitais e os agrupamentos de centros de saúde, de uma área geográfica, funcionam em rede. 

A 1 de janeiro estas unidades foram formalmente constituídas, passando a contabilizar-se 39 ULSs, de norte a sul do país

. De fora ficam apenas os três institutos de oncologia (IPO de Lisboa, Porto e Coimbra) e o Hospital de Cascais, o único gerido em parceria público-privada.

Melhorar o acesso e diminuir a burocracia, facilitar o percurso dos utentes no SNS, melhorar a eficiência e potenciar economias de escala, evitando redundâncias e repetições de atos clínicos, são apontados como as principais vantagens. No entanto, 

será a formalização das ULSs, a par das reformulações que este modelo envolve em termos de financiamento e gestão das unidades de saúde, condição suficiente para garantir tais benefícios?

Neste artigo exploramos quatro desafios que persistem e apontamos as soluções para uma transição bem-sucedida.

1. Implementar Percursos Assistenciais Integrados para garantir integração clínica

A integração, aplicada aos cuidados de saúde, pode assumir diferentes níveis, desde a elaboração de políticas centradas na coordenação de estruturas e sistemas entre organizações, passando pelas funções não-clínicas de suporte e back-office, no sentido de partilhar dados e sistemas de informação entre as organizações, e pela coordenação de diferentes serviços, através de equipas multidisciplinares e estruturas únicas de referenciação, até à integração clínica.

Tal como o nome indica, a integração clínica diz respeito à 

, quer entre diferentes profissionais, quer entre diferentes níveis de cuidados. Neste nível inclui-se o desenvolvimento de 

 partilhadas, protocolos ou jornadas de cuidados, comumente designados Percursos Assistenciais Integrados (PAIs).

Os Percursos Assistenciais de Cuidados funcionam como documentos que coordenam a organização dos cuidados, tendo em conta a perspetiva clínica – isto é, a prestação dos melhores cuidados, de forma atempada, pelas equipas mais bem posicionadas para o fazer – e a perspetiva de gestão – ou seja, garantindo eficiência na utilização dos recursos.

Assim, a definição de uma percurso assistencial ultrapassa a designação de processos clínicos, que dizem respeito à conceptualização daquilo que deve ser feito. Por sua vez, 

o PAI corresponde à transposição das boas práticas, tendo em conta a realidade local, e devem incluir, de forma clara, a definição do papel de cada profissional interveniente na jornada, em cada nível de cuidados que constitui a ULS, bem como os mecanismos de avaliação.

Através da digitalização e da introdução dos dados de saúde do doente, cada percurso assistencial transforma-se numa jornada personalizada 

que é permanentemente atualizada de acordo com a evolução clínica de cada pessoa. 

Além disto, a digitalização está associada a um conjunto de benefícios, entre os quais a visualização global e sequencial da jornada de cada doente, a identificação de bloqueios e constrangimentos e a sua otimização através de funcionalidades de suporte à decisão, comunicação e automação que serão detalhadas mais adiante.

2. Assegurar o acesso a informação atualizada em tempo real

A prestação de cuidados de saúde, num contexto marcado pelo aumento das doenças crónicas e multimorbilidade, é particularmente desafiante. Esta complexidade resulta da necessidade de equipas multidisciplinares, onde profissionais de diferentes especialidades, equipas, serviços e instituições colaboram, enquanto lidam com uma variedade de sistemas de informação.

A diversidade de plataformas e softwares utilizados adiciona dificuldades na troca e interpretação de dados, originando 

silos de informação que persistem e dificultam a fluidez dos cuidados, as decisões atempadas e informadas, enquanto perpetuam o desperdício associado à duplicação de atos

A digitalização da jornada de cuidados e a sua atualização automática, de acordo com a informação recebida de diferentes sistemas de informação, proporciona o acompanhamento do progresso do doente em tempo real, partilhado com equipas de diferentes níveis de cuidados.

independentemente do contexto em que se encontram, os profissionais de saúde são guiados por uma única fonte de verdade,

 permanentemente atualizada, no que diz respeito às necessidades e história clínica de cada utente.

A interoperabilidade é essencial para garantir que as equipas de saúde têm acesso às informações mais atualizadas sobre os doentes, sem duplicação de tarefas - aspeto fundamental para a prestação de cuidados de saúde de qualidade.

a capacidade de agregar e analisar dados de diferentes fontes, trocando-os de forma adequada, através de catálogos padronizados

, como LOINC, SNOMED-CT e ICD-10 - (interoperabilidade semântica); a capacidade de garantir os aspetos técnicos subjacentes a esta troca, como o transporte, o formato e a validação (interoperabilidade técnica); 

e a capacidade de interpretar os dados trocados

, compreendendo a sua estrutura, utilizando um formato normalizado, como XML ou HL7FHIR (interoperabilidade sintática) 

são características fundamentais a procurar num software de orquestração de jornadas de cuidados

3. Alocar os recursos certos a cada utente

Em saúde, a eficiência alocativa diz respeito à capacidade de aumentar os benefícios globais produzidos pelo sistema de saúde através da realocação de recursos.

No contexto atual - em que as ULSs têm de acompanhar o aumento exponencial da procura, mantendo os mesmos recursos - 

a eficiência alocativa está intimamente relacionada com a estratificação e priorização dos doentes

, decidindo quais devem ser atendidos, quando e em que contextos.

Tal afirmação, não significa deixar utentes sem vigilância ou em autogestão, mas sim ajustar os níveis de resposta a cada pessoa, de acordo com o seu risco.

A existência de critérios de referenciação claros, além de uma jornada de cuidados pré-definida, 

garante que os doentes são encaminhados para os especialistas ou níveis de cuidados mais adequados

, minimizando as referenciações injustificadas e melhorando a eficiência do sistema de saúde.

Se a jornada de cuidados é o mapa que define as etapas pelas quais a pessoa deve passar e o que acontece em cada uma delas, os critérios de referenciação funcionam como as regras de trânsito que ditam quando deve (ou não) o doente avançar ou recuar para a etapa ou nível de cuidados seguinte.

Um sistema de suporte à decisão é particularmente relevante para 

aumentar a autonomia e resolutividade dos cuidados de saúde primários

. Com base em clinical pathways baseados na melhor evidência, estes sistemas fornecem um apoio à tomada de decisões clínicas abrangente e em tempo real, que facilita o estabelecimento de diagnósticos precisos e a definição de planos de tratamento adequados.

Por outro lado, são a garantia de que a jornada de cuidados previamente definida é efetivamente implementada e, consequentemente, que os critérios de referenciação são cumpridos.

Conectividade, rede, tracking são apenas três exemplos de palavras que invadiram o discurso comum e têm que invadir também a forma como os cuidados de saúde são pensados. Neste caso, referimos, particularmente, a necessidade de 

encarar as jornadas de cuidados como processos contínuos e evolutivos, que acompanham os utentes além dos momentos episódicos de prestação de cuidados

Assim, a capacidade de acompanhar os doentes, rastrear a sua evolução, identificar potenciais sinais de alarme e antecipar cuidados são fundamentais para resolver, por exemplo, 

a sobrelotação das urgências hospitalares ou a rehospitalização de doentes após a alta

O primeiro passo para melhorar a continuidade dos cuidados é a monitorização contínua ou periódica do progresso do doente, através da implementação de 

seguimentos automáticos capazes de identificar automaticamente sinais de alarme

 que denunciem, atempada e convenientemente, a deterioração do seu estado de saúde. 

Assim, sem adicionar volume de trabalho aos profissionais de saúde, as instituições têm total visibilidade sobre os doentes que apresentam sinais de alarme e necessitam de cuidados especializados e, simultaneamente, a garantia de que os restantes estão efetivamente bem.

 dar um significado acionável aos dados recolhidos

. Com base nas respostas dos doentes, os doentes devem ser estratificados de acordo com o seu risco, atualizado o seu status na jornada e sugeridas as próximas ações (ou mesmo automatizadas quando aplicável). 

Garantidas todas as premissas referidas anteriormente, esta abordagem garante que cada etapa da jornada de cuidados é ajustada de forma, rápida, flexível e automática de acordo com o progresso e as necessidades do doente em cada momento.

Para mais informações sobre como estas soluções se integram no software de orquestração de cuidados da UpHill, 

. Veja também o projeto em desenvolvimento na 

Unidade Local de Saúde do Litoral Alentejano

ULSs: quatro desafios para ultrapassar em 2024

Despite centuries of seeming imperviousness, the healthcare field is now embracing advancement and the start of a significant metamorphosis.

As we bid farewell to 2023, it's impossible to overlook ChatGPT, the artificial intelligence (AI) large language model that has been developed by San Francisco based OpenAI using natural language processing and trained on conversational data (reinforcement learning from human feedback) obtained from the internet. One year after exploded onto the scene, ChatGPT has over 180 million users, including healthcare professionals and is already upending health care — an industry not exactly known for its speedy adoption of tech — while accelerating questions about Artificial Intelligence promises and limitations.

In this article, I explore industry trends, anticipate the themes that will define 2024 and raise some questions for consideration.

One of the most urgent challenges confronting healthcare is the ongoing scarcity of proficient professionals. The World Health Organization's Regional Director for Europe emphasized that Europe's healthcare worker crisis, once a "looming concern", has manifested as a "stark reality", leaving the sector in dire need of reinforcement. This declaration

 followed a report highlighting a concerning trend: 

over 40% of doctors are close to retirement age in one third of countries in Europe and Central Asia,

 posing a substantial threat to the workforce's sustainability

An ageing healthcare workforce was a serious problem before the COVID-19 pandemic, but is even more concerning now, with severe burnout and demographic factors contributing to an ever-shrinking labor force. Another key finding of the report is the poor mental health of this workforce in the Region.

In Medscape’s Physician and Burnout Report 2023, a whopping 

79% of physicians stated that the pandemic had affected their work-life happiness

 at least somewhat in the past year. For physicians, the top contributor to burnout is “too many bureaucratic tasks”, followed by “Lack of respect from coworkers” and “Too many hours at work”.

In response to such challenges, technology is stepping in to bridge this gap. Virtual assistants, clinical decision support systems, medical record keeping or translation, medical writing and documentation are some of the most developed areas. Beyond task substitution, we're witnessing a paradigm shift concerning the role of healthcare professionals, as detailed later in this article.

2. Artificial intelligence and Language Learning models bridging the gap.

Automated patient journeys, powered by cutting-edge algorithms and AI-driven systems, are enabling streamlined and efficient care delivery. These advancements free up healthcare workers' time, allowing them to focus on critical tasks while ensuring patients receive timely and personalized care.

Much have been done (and published) in 2023, from 

a machine learning model foreseeing weight-loss patterns post-bariatric surgeries

a natural language processing tool pinpointed social determinants of health for Alzheimer's

a user-friendly 'smart' stethoscope achieved a 90% accuracy rate in identifying heart failure cases

 have highlighted the potential of AI in distinguishing whether lung nodules, abnormal growths spotted on a CT scan, are cancerous

. Each compared their technique to the standard Brock score recommended by the 

 and both types of AI predicted cancer more accurately than the Brock score. These findings suggest that AI could assist clinicians in making more timely decisions, potentially enhancing patient care and outcomes.

While numerous other examples could have been listed here, let’s look into two clinical trials, identified by the experts consulted by Nature

 as among the most promising in their field.

The first one,  a randomized control trial, tests if artificial intelligence applied to chest X-rays as soon as they are taken shortens the time to a CT scan and time to diagnosis. 

Researchers demonstrated that prompt reporting of chest X-rays by radiographers significantly reduced the time to diagnosis, nearly cutting it in half from 63 days to 32 days

 and have a new hypothesis: AI may identify lung cancer earlier and reduce time to diagnosis as much as 50%. 

The second one is a prospective multi-center, randomized, open-label, non-inferiority pilot clinical trial of risk-score assistance to clinicians in the emergency department. 

It aims to evaluate the use of an AI model in assisting clinicians in the emergency department by predicting the 31-day mortality risk 

At the rapid pace of evolution, both within and beyond hospital settings, thought-provoking questions have emerged regarding the role of AI in medicine: "Can AI replace doctors?" and "Will doctors utilizing AI supersede those who do not?"

To shed light on this debate, a recent article

 focuses on emphasizing the augmentative role of AI in healthcare. It emphasizes that AI is designed to enhance rather than substitute doctors and healthcare providers. 

The core solution lies in the collaboration between humans and AI, merging the cognitive strengths of healthcare providers with the analytical capabilities of AI

human-in-the-loop (HITL) approach ensures that AI systems are directed, communicated with, and overseen by human expertise

, thereby upholding safety and quality standards in healthcare services.

To put it simply, there are routine and less impactful tasks assigned to highly skilled yet often overburdened professionals. Therefore, 

contemplating the potential of technology for a healthier, more effective, and specialized future is only worthwhile if the fundamental approach to providing care is also revolutionized

. This would involve freeing up doctors, nurses, and other healthcare professionals from routine duties, allowing them to concentrate on tasks that hold greater significance and yield higher impact. 

And I’m thrilled to shout out that UpHill solutions are playing their role to make it happen

, I’ve drawn attention to the significance of care journeys in reshaping the roles of healthcare professionals, particularly doctors and nurses. Their involvement in designing and overseeing these journeys not only enables them to pinpoint where technology can be optimally employed but also allows them to delegate tasks effectively, ensuring a more efficient allocation of responsibilities and greater control over the care process.

Lastly, research firm McKinsey & Co. estimates that globally, 

jobs in healthcare could grow by 50 million to 85 million by 2030

 Without a doubt, tech will influence a great deal of these, by creating new types of employment such as 

the virtual hospital manager, 3D printing surgeon, health data analysts, algorithm trainer or lifestyle strategists

4. Integrating preventive apps to meet new expectations on health and wellness

Lifestyle strategists? It appears to be precisely that.

In recent years, there has been a significant shift in healthcare towards a proactive approach focused on prevention rather than reactive treatment. This change has been influenced not only by 

evolving consumer expectations and behaviors

, where individuals prioritize their well-being and seek proactive health maintenance, but also by a 

heightened public awareness regarding the impact of lifestyles

Apps play a pivotal role in meeting these expectations, serving as tools that offer tailored guidance, track wellness metrics, deliver timely reminders for health screenings or activities, and provide educational resources to foster informed decision-making. Consumers are embracing these apps as proactive companions in their daily lives: 

currently there are over 400.000 health apps available on app stores worldwide

 Chinese and Indians are the most eager users of healthcare apps worldwide, followed by Australians and Americans. So far, 

the European Union has the lowest number of healthcare app usage, with only 22 to 40% reporting using one

Moreover, the rise of preventive health apps isn't just meeting consumer demands but also fostering a cultural shift towards wellness and self-care. The ease of access to health information, coupled with personalized recommendations, motivates individuals to adopt proactive measures, whether it's maintaining fitness, monitoring dietary habits, managing stress, or scheduling routine check-ups.

 The issue of fragmentation persists among health apps, hindering seamless communication and data exchange between different platforms, impeding a cohesive and comprehensive approach to personalized healthcare management.

“Improving cost of capital, increased management team confidence in the ability to forecast, and narrowing price gaps between acquirers and targets support a more active healthcare services M&A environment in 2024”.

 This forecast stems from Lazard Frères & Co. and has been validated by the latest reports. 

The second quarter of 2023 experienced a considerable surge in hospital mergers and acquisitions, reaching the highest count since the beginning of 2020

 Significantly, this closely resembles statistics from the pre-pandemic era.

This trend signifies a significant shift and revival in the consolidation and restructuring of healthcare entities, illustrating a transformative shift within the industry's landscape, as organizations seek to integrate care across the continuum, increase patient/resident access to providers, form stronger partnerships among practices and facilities, and enhance market share through consolidation.

Although healthcare integration creates larger and more financially liquid organizations, these transactions do not necessarily translate into better patient care

Failure to do so may lead to a wide range of clinical, operational and liability problems, including:

Uncharted territories: questions that still to be addressed.

2024: a sneak peek into the biggest challenges and main opportunities

Healthcare in 2024: a sneak peek into the biggest challenges and main opportunities

Cancer presents as a multifaceted condition, often demanding diverse interventions from numerous healthcare professionals over prolonged periods of time. In one UK study, it was found that patients, who had been treated for cancer for less than a one-year period, saw 28 doctors on average, and the minimum number of doctors met was 13.

 A value that mirrors the intricacy of these journeys and the diverse array of professionals involved, even only considering medical doctors.

On the other hand, time stands as a critical factor in the journey of an oncology patient: every month delayed in cancer treatment can raise risk of death by around 10%.

 Thus, swift, and precise interventions significantly impact prognosis, intensifiyng the pressure to orchestrate timely and well-coordinated care.

The Agency for Healthcare Reasearch and Quality states that: 

Despite the widely acknowledged importance of care coordination in care delivery, and the progress that has been made, achieving this coordination remains an ongoing challenge, especially within oncology journeys, which can manifest in different scopes:

In fact, research indicates that patients, caregivers, and clinicians are extensively engaged in significant 'invisible work' to facilitate care coordination. This invisible work involves spending time navigating system barriers such as non-interoperable medical record systems, inadequate decision support, suboptimal communication systems, and expanding panel sizes. These barriers hinder effective coordination among the network of health systems, clinicians, patients, and caregivers responsible for coordinating care collectively. The costs and benefits of this unseen effort on the quality of life, productivity, and other outcomes for patients, clinicians, and health systems have not been thoroughly quantified, but they are likely unsustainable.

A lack of coordinated care can lead patients getting "lost" in the system and failing to access appropriate services, as well as more unplanned health utilisation.

Intelligent, automated, and evidence-based care journeys guiding care

, we delved into the significance of bridging the gaps within healthcare systems and outlined the crucial prerequisites for accomplishing this feat. It all begins by delineating comprehensive and multidisciplinary care journeys. These tools function akin to a map, interlinking multiple system points and directing the course of care. Ultimately, this works like a multidisciplinary consensus ensuring that every patient receives precisely the right care at every juncture.

Moreover, care journeys foster coordination among various levels of care and healthcare professionals, bridging the gaps that often lead to disjointed care, facilitating seamless transitions between care settings, ensuring that vital information and treatments are consistently communicated and executed.

 is a stepwise multidisciplinary care plan guiding patient progression through a sequence of milestones translated from guidelines or evidence into personalized contexts, allowing decision support and digital automation of clinical activities, and aiming to standardize care and improve patient’s outcomes and experience.

Hence, we are referring to a care orchestration system that integrates decision support tools and communication with automation capabilities. This system uses automation to handle administrative or repetitive clinical tasks, enabling healthcare providers to amplify their efforts and focus on specialized tasks, catering to the intricacies of complex patient needs.

Furthermore, it establishes an accessible channel for engaging with, monitoring, and providing care to patients during intervals between standard care interactions. This system utilizes gathered information to automatically update the patient's journey status and promptly alert healthcare professionals about any warning signs.

Interoperable and robust technology ensuring patient traceability

When discussing the necessity of care coordination, it is unavoidable to recall the four levels of care integration outlined by the Nuffield Trust.

The clinical case of Ms. Helen Fisher

Learning goals

Phases

Key medication

References

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