IGF 2021 – Day 0 – Event #52 Are we shaping the digital market to all citizens?

The following are the outputs of the captioning taken during an IGF virtual intervention. Although it is largely accurate, in some cases it may be incomplete or inaccurate due to inaudible passages or transcription errors. It is posted as an aid, but should not be treated as an authoritative record.



>> Wow, good afternoon, everyone.  It is a pleasure to be here today on behalf of the ‑‑ I know for several of you participating this won't be an interactive because you're in Poland watching this or following on YouTube but even if you cannot send us your questions, we'll try to keep this session as lifestyle as possible, and, wow, make it worthwhile for you to be following it.

      Before I start introducing the panelists for this session, I would like to introduce you, Karolina Mackiewicz, who is the Innovation Director at ECHAlliance European Connected Health Alliance and Project Manager at MyData Global.  And Naftali Horwitz, a senior project manager.  They will be both following the session with us and, of course, bringing any updates as necessary. 

      They will also be posting on social media with our other colleagues so please follow up on that as well.  And to, let's say, make the first connection to the content of this session.

     Well, you have seen the title and the truth is this is something that we have been following very tentatively throughout the last year

      Before that the COVID pandemic there were a number of issues, but we're connected to the needs to keep everyone connected with the innovations that suddenly come into our life evidence‑based on technological disruptions, but the truth that the COVID pandemic exposed a lot more the critical need the typical every day as we are doing today a hybrid event, for example, and the fact that there may be a set of measures partly to be put in place to make sure that everyone can participate. 

      Of course, this goes from a number of broad areas such as digital inclusion digital technology, so we have a number of different areas that are very important to make sure that no one is left behind

      And today we will be mainly discussing three broad issues.  Let's say:  How can we implement the digital European society that is inclusive and sustainable? 

      Secondly, are we sure that digital products and services that are developed every day are accessible and fit to different target audiences? 

      And what are the key priorities that we need to scope, search and prioritize for the next few years?  Is it infrastructure, digital health information, online education, literacy and skills?  Equal opportunities regardless of gender, race, disability, adequate protection of workers’ rights, what else? 

      So to answer these very, let's say, difficult questions, but at least some attempts to bring some key ideas to the discussion, we have the pleasure to have six wonderful panelists with us today. 

     We have the Secretary of HL Europe and the president of European federation informatics today she will ‑‑


>> House project, but she will connect with you with all discussions.

     Also Karolina Mackiewicz is a digital strategy and business development advisor and, of course, the very experienced project manager in European Union, an expert and also to bite computer and in that we have also representing the H2020 smart project in our discussion today. 

     We have Federica Porcu Rivera from the University Dublin, and she will give us a little flavor of her projects.

     George Valiotis many thanks for joining us.  He's the, and he can't have the European health management association, and you will also bring us today some parts of their project such as the Erasmus+DISH.

     Alexander Peine has a very long resume, so I'll make it associated at the Utrecht University and a chair of the social and technology chair and others.  He's here also here today on behalf of the gatekeeper project.

     And last but surely not least Merie Kannampu, innovation project manager at the United Nations global post Finland.  UN initiative on artificial intelligence for public good.

     I hope I didn't leave much behind and if I did, please feel free to share informally what we intend to have a small presentation by each of you in the beginning of this session but then to keep it open, informal and have as much discussion as possible.

      Considering the initial approach to this discussion, I would ask George if you are open to start and share with us your thoughts.

     We discussed a lot on the EU approach to digital transformation and health is an area of interest to us.  Are we sure that we are actually including everyone in this digital transformation of health?  Can you talk to us a little bit about the European Union approach on this and, of course, also I'm fully aware how do we address its complexity?  Let me start with the background of what we're observing across the European Union we've seen that the European Union have highlighted three major objections for digital transformations for health systems.  The first one we're seeing ‑‑ giving citizens better access to their health data.  This is going to be a really big issue that needs a lot of thought, but it's one of the policy drivers is access to health data.

     The next one will be the use of digital tools to empower citizens and facilitate person‑centered care, so you can see this theme of citizenship coming through and making sure that individuals have their rights protected and the information about themselves protected and access to their own information.

     And finally, we're seeing the need to connect and share health data for research, faster diagnosis and better health outcomes, so this last point is about pushing into the next dimension, which is you've got your data, you've got access to your data.  You know that your rights have been protected, and now we need your trust to share this information, so it can be applied for bigger uses such as having the mass data to make better understanding of diseases, better understanding of well‑being outcomes because we need mass data to do that, but we can only get that mass data through collaboration and trust with all the citizens of Europe.

     Now I'm ‑‑ that's what we've observed as the policy context.  These are the themes that are coming out in a lot of the EU policies as well as the calls for it.

     Now, what if we think about EMSHA and what we believe ‑‑ so these are the themes that have come out of our conferences and some of the outcomes of our projects works.  Firstly, we're seeing that it's people that drive change so don't get lost in the digitization on those.  This is always about people, so digital transformation has to be built on trust.  It's the single most important thing.  And any time we see this digital implementation go wrong, it's because trust has gone wrong, so there's your starting point.

     On to Point 2, we know that patients should be clearly informed about the use of their data and aware of the benefits of sharing their data for improving care.  That's clearly touches on the points I mentioned on the previous slide.  And, again, it's that trust.  Trust openness, communication.

     Point 3 the adoption of new processes tools and models of service‑delivery should have accessibility and inclusivity as leading factors.  So Carina, I know I'm almost being over simplistically because you asked me what can be done you said make sure it addressed.  Make sure you address it.  It's not an answer, is it?  I want to talk to you more about the role of health managers and health managers really play this halfway point between policymakers at one end and the person receiving the care the citizen at the end of the spectrum there, so they're in the middle their job is to transfer all that policymaking into practice.  They help guide the thinking; they help guide the practice, so it's really about the role of health managers.

     And then finally Point 4.  It's morning health managers it's that everybody has a role in digital health literacy, so we want to see a literate society of digital health but to achieve that you can't just focus on citizens and keep saying:  We need our ‑‑ we need patients; we need residents to be more health literate.  If you want to achieve that, you need organizations to step up that might be a hospital or primary care unit.  That could be a public health institution.  That could also be NGOs.  It can be the role of government ‑‑ all of the organizations have a role in supporting the digital literacy not just of ourselves but also of ultimately the patient who's benefiting from this care. 

      That includes careers, and it includes healthcare professionals.  All of us need to be learning together in partnership.

      Finally, I'm going to give you three small examples.  You did mention at the start that I would reference the DISH project, and I'm going to do that because it's a really important project that absolutely addresses health literacy.

     The way it does it's been funded under the European commission to look at all of these ‑‑ great digital innovations.  They exist in plain to fullness but not being implemented by health systems and the reasons being they're busy.  They got a lot going on.  And in order to develop the skills and the practice and the approach to take or these digital innovations we need a special way of doing that training and doing that implementation.

      DISH is helping us to through a series of different test cases of implementing these technologies.  Now, that requires health management leadership.  It requires practitioners, educators.  It requires engagement with patients, so DISH has been really important in piloting these implementations, and we're learning about how do we make sure we make the most of these digital innovations?

     And, Carina, you can see how it puts into practice that trust, that relationship building that we're all involved.  The DISH project focuses on the workplace and the health professional, but it benefits ‑‑ for the benefit of patients.

     Finally, I just tell but Rebecca and heart.  They're also two projects funded by the European commission Under the Horizon 2020 program, and they're quite interesting because they're using wearable technologies.  Both of them use it a bit different, so Rebecca uses it for breast cancer survivors, so they're using wearables they're minimally intrusive we can connect real world data and input data, and we want to learn about their overall well‑being, their medical status as well as their emotional and mental well‑being, and we're using it to better understand how patients are living in their in post‑breast cancer recovery, so that we can help make better decisions and give them better quality of life.

     Heart is also using wearables to look at green and blue areas, so green being forests and parts and blue water resources like as well as, lakes, rivers, and it's trying to triangulate two areas how do people track these two areas so tracking these wearable devices and secondly what does that impact ‑‑ could that potentially be having on general health and well‑being bike cardiovascular health and diabetes, and the reason why it's important ‑‑ it recognizes that the health system is overburdened.  It can't meet its full demands, and so we need to make it more accessible and understand health in its broader sense and if we can design ‑‑ if we can do better urban design to help us better to keep people healthy that means the hospital or the primary care industry doesn't become the bottleneck for well‑being it makes it available.

     That's a short summary, and I'll be happy to talk about that more as we walk through that session. 

>> Thank you so much, George.  It was very clear and very illuminating as well.  I do already have a number of questions in my mind for this discussion part but if you all agree, we will then have this first row of each panelist to put forward some ideas, and then we can discuss them all together.

      Departing also from what George brought us, I would ask you, Carina, if you can bring us a little bit of your knowledge on how national governments are tackle these challenges including those brought by the pandemic. 

     Addressing these challenges ‑‑ so I know you have some interesting experiences to share with us.  Either from projects and thank you ‑‑

(Technical difficulties.)

>> It's great to be in front of panelists of great characters.  Yeah, really interesting topic today.  As part of my role as a project coordinator, as you very elegantly said, in the beginning it's also in my capacity here at the ministry of digital governance that I can bring some insight also with respect to the angle of digital skills, which is also quite a critical element in how, you know, inclusive and accessible these elements of policy design per country level is focused on.

      Let's start with designing a digital strategy for emphasizing digital skills on behalf of on the governmental level, and this is quite an interesting topic because back in 2019, when this latest government was elected, they started re‑enhancing the digital strategy here in Greece well before the pandemic.  And one of the major initial goals, we have set was to build the updated Greek digital social transformation or the digital transformation bible here between 2020 to 2025. 

     And not surprising we can see this was based on 7 critical goals and 6 strategic pillars.  As you can see, digital skills was and still is one of the key elements in ‑‑ as we have seen making any digital strategy transformation successful.

     So the design was focused on the philosophy of connectivity focused on infrastructures, on digital skills as I mentioned before, and we will focus a little bit more on that later on ‑‑ or digital innovation, testing new technologies.  To be embedded into public service‑delivery creating a much better, mature and digitally literate state providing a wide range of public services, and then focused on two other elements which were kind of important the business sector and other areas such as George pointed earlier on the justice system and so forth.

     If we look a little bit more also on the goals, we can see that the overall approach is emphasizing on the citizen as well, to serve the needs that the citizens have through a digital state to promote the development of digital skills, to support innovation and to make businesses more digitized, have open data, publicly available data and integrate all these modern technologies into the sectors of the economy, and so forth and digital skills is a critical factor because we've seen, for instance, as an example that we developed the technology before the pandemic we started becoming a digital state just before the pandemic, and we're providing digital services to the general public and to citizens but many of them were not able to use these services because they were not as advanced in terms of digital literacy, so it was really a baffling element, the fact that we needed to also invest on digital skilling so forth in order for them to be able to utilize through a better extent the services provided.

     So the strategy had one important element which was to improve the digital abilities and the digital skills for everybody and to that end, we started working also on national digital academy in order to, you know, bring educational aspects, digital literacy much closer to all age groups and unable them to acquire new skills, and this also one of the slides I'm going to bring up later on.

     So the whole digital transformation strategy was guided by the user centered approach, and it had some very basic principles such as developing services that are digital by default, creating omnichannel services and one key element that's linked ‑‑ it links everything together is the fact that services and the principles behind the strategy had the element and the notion of inclusiveness and accessibility.

     Apart from other elements transparency, integrity, you know, giving the citizens to provide only once most information they had.  So as you can see it all started to line up together leading us to the national digital academy as I mentioned before.

     This was a pilot project that started in the early days of the strategy, and now is evolving into a much more wider version of this platform, so it's the citizens digital academy, which is developed by the ministry of the digital government but basically provides online educational services free for all citizens and accessible for all citizens just to improve the digital competences, and now we're moving into the second stage, which is becoming much wider.  The ministry is starting to develop its own courses, and we're looking also at the competence framework, which is standardized in order to fulfill and close up the circle behind the services.

     Now, how are these all related to SmartWork, which is my experience and my capacity as the project coordinator?  On this very interesting project, which was focusing primarily on a specific target group of aid workers between 55 and 65, in order to try to assist them on services to keep them in the professional life and independent life as well as creating a well‑being notion it make it much more healthier conditions and much more productive and towards that we developed this AI system that was worker‑centric also including other stakeholders, key stakeholders, into the whole healthcare pathway such as the CARES and also since we're talking about workers bringing on the ‑‑ the ‑‑ the coworkers, the ‑‑ the managers of these people into context.

     And, therefore, we developed a set of services ‑‑ I'm not going to go into all of them, but let's focus on one of the key services which was the work code services which focused exactly on the topic that we're talking about today:  How to improve skills for aid workers.  How to promote re‑skilling, upskilling based on the evolving needs of both of the company, of the technology the technical competences we want to promote and the needs behind the teams that are created in the working environment, so this is a very interesting service focusing on the personalized aspects of rescaling and upscaling.  Preponderance it has an impact on many levels.  We're not talking only about the older office worker or the employers in the CARES.  We also have an important impact on other limits as does the healthcare system by reducing expenses on the scientific community by bringing new novel devices of tools based on AI technologies and other forefront technologies that also seem rising in Europe and digital programs for the commission.

     And finally some very important impact on the society level such as enhancing innovation capacity, increasing the economic dependence, and so forth.

     I mean, towards this end, all these combined bring the needs behind making digital scaling or upscaling more accessible, and they're very important elements both at the governmental level and on research level that promote these aspects, so thank you very much.

>> Thank you so much, Juan Luis, for this first introduction.  I think you brought up a very -- areas that we will for sure discuss afterwards namely the role of governments and also this very interesting perspective on how perspective or niche perspectives can grow and impact so many areas of society.  That is very interesting.

     So we have been discussing mostly EU projects and EU initiatives, but we have a the whole world beyond you, and I know Merie, who is with us today, will bring us a bit broader ‑‑ beyond Europe because a lot of the challenges we are discussing today are worldwide and namely misinformation, disinformation and a lot of this affects especially people that are in more vulnerable context or more marginalized.

     I know you are developed a very interesting project that goes through social media and goes to Africa.  Can you share these examples and enlarge the discussion?  Thank you very much.  Merie?

>> Are you able to see my screen?

>> Yes, we are.

>> Okay.  Excellent. 

      So thank you so much, Carina for inviting us.  Apologies.

     Are you seeing my presentation?

>> Yes, we are, your first slide, you mean?

>> Excellent, that's what I'm sharing.


>> Thank you, Carina, for inviting my views on the important topic of shaping digital market accessible for all citizens.

     The previous panelist George and Merie before me have focused on relevant issues of digital inclusion in the whole of Europe as well as digital transformation in the context of it.  I will focus on the global perspective.

     I work at the UN Global Pulse, our Finland location, which is our ‑‑ it was originally established in 2009.  It mainly focused on utilize the power of big data and artificial intelligence in the context of humanitarian and development areas that various UN agencies were.  It's a global network of labs with offices in New York, Kampala, Jakarta, and I'm based in Helsinki.

     We have developed our different kinds of projects.  The project I'm dealing with is related to infodemic.  Infodemic as you all know is ‑‑ has been widely happening in the era of COVID‑19 pandemic leading in February, 2020, WHO chief announced we are not really dealing with the pandemic.  We are dealing with infodemic.

     Infodemic mainly involves all the evidence of digital as well as nondigital spaces where people are present often accompanies some acute health event similar to the COVID‑19 pandemic we are in.

     It often involves fake news, misinformation and disinformation.

     The problem is that it's not really somebody spreading some lies across different platforms.  It directly affects medical decisions.  It has a direct impact on physical and mental health of individuals.

     In addition, it also erodes trust in respected institutions offering healthcare service to people.  Often marginalized communities are the ones that disproportionately affected by an infodemic. 

      We are living in an era of digital transformation.  If you look in Europe, we have like 90‑person coverage of internet in houses across Europe by the statistics from 2020.

     However, when you look at a global scale, 38% of people in the world do not have access to the internet, and there's are around 7,000 living languages around the world, however, if you look at the digital content that is available in internet, 10 languages represent 80% of total digital content available online.

     And out of this, English and Chinese form almost half the whole content that's available on the internet.  If this is the case, how do we make sure that the voices of the languages that are not represented in the digital world or the people who don't even have access to the digital world or internet ‑‑ how do they have access and how do we ensure that we have no voice left behind? 

      At UN Global Pulse, since 2013 my colleagues at Pulse lab Kampala has been looking at radio data and working with various UN agencies to predict broad problems in agriculture, water supply and different issues.

     I am managing a project for WHO where we are integrating online radio information to help WHO fight its infodemic ‑‑ infodemic efforts.

     In many of the African countries, people get their news from radio, and they talk in radio chat shows about their concerns and questions, so this project allows to develop a platform where WHO officials could see what are the main concerns that people are raising, so that they could plan their campaigns to address these concerns.

     In addition infodemic is not the only matter that is affected by this unrepresented group in internet.  How do we reach out to these communities?  There must be ways in which we can utilize mainstream languages and people's concern who speak nonmainstream languages.  There needs to be ways to reach out to people in channels other than social media.

     The discussions in social media are guided by people who have access to internet, and this privilege have having internet.

     In addition, a very important thing ‑‑ the fellow panelists George already mentioned digital literacy.  There is also the need for media literacy where people are told to critically sustain information that they and see facts from lies and make their own decisions, thinking in a logical manner.

     In addition, it's also important that when countries are planning any campaigns to inform people, this information and digital tools made to citizens are made in nonmainstream languages. 

      Carina, I have some other points to elaborate, but we could take that in the discussion. 

     Over to you.  Thank you. 


>> Carina, can you hear me? 

>> Okay.  I hope we didn't lose Carina.  Carina, we cannot hear you. 

      All right.  That's a small technical issue.  You're on mute, Carina.

>> Yes, can you ‑‑

>> Yes, we can hear you now.

>> I'm having a storm here, and I had some disruption in my connection.


>> Okay.

>> It was a bit sudden, but I think I'm back now.

(Talking Simultaneously.)

>> That's a quick recovery.

>> Yes, let's see ‑‑ let's see if it holds.  I hope so but care Lena ‑‑

>> Yes, I will be. 

>> Sorry, I'm sorry, Merie, can you end it?


>> Yes.

>> Sorry.


>> Yes, yes.

>> Okay.

>> Yes, I ended it.

>> Thank you so much.

>> We can continue more questions in the discussions, Carina.

>> Yes, I think that I accompanied what you already said, and I already know your presentation from before, so thank you very much.  I think this was really interesting it was the last part that I heard the question of literacy not only be in terms of the digital but media the content that are broadcasted, so you don't ‑‑ it is not enough to be able to access the tools, but the question of understanding what is actually correct information or many times fake news makes a ‑‑ is requiring difference and even if I acknowledge that in some countries, the tools used may be very different from others.  For sure the concerns are probably very similar.


>> So thank you so much, Merie.  I think you can stop sharing your screen, if possible.

>> Oh?

>> Because I would pass the floor back to another panelist, in this case, Catherine. 

      Catherine, you also have a stronger focus in Europe, but I know your work also goes beyond and in this framework, we have been discussing perhaps on different levels, I would very much like to ask you now if you could talk us a little bit how standards can help us in the challenge of ‑‑ of being sure that no one is left behind.  Thank you.

>> Sure.  Thank you very, very much for this invitation, and I'm really glad to be part of this panel with the distinguished speakers that covered the most important part.

     And for any endeavor, the most important part is people because it's ‑‑ the technology is here to change the life of people and for me, it's the same way. 

      So here in my first slide, I give you the vision for the global health ecosystem, which is people which have navigation tools for safe and informed care and interoperability assets that fuel creativity, entrepreneurship and innovation, and what this means is that we need the new technology standards. 

     We need technology standards that can help people.  It can help by nurture digital health innovation by strengthening Europe's voice because we are talking about Europe here and impact, of course, and then enable cocreation and enable participation and contribution of the needs because this is what essentially makes services that are meaningful.

     We heard from the previous figures a number of initiatives that would help people working everywhere, from everywhere or on exhausting to the new digital environment but from that you need ‑‑ it's important for people to guess what they have to say and understand and translate into meaningful digital services, yeah?  So this is my first point.

     The second point in eStandards, standards that are serving for innovation you need to essentially fulfill four elements.  The first one is trust and flow and that refers to data.  Create the circumstances that would allow you to share your data safely and entrust in a worthy manner because trust and flow is the basis for well‑functioning healthcare systems, and we do recognize four perspectives and one and probably a very important one for governments today is a well‑functioning health systems.  There are three or four perspectives, of course, the perspective of the citizens, which the previous speakers have explained but also the perspective of the workforce, but there's also the market.  The market is about innovation and how you translate, you know, innovation into mainstream services.

     So these are reflected in the standards form plus we essentially should balance the different perspectives I just mentioned the scale the health systems the citizens workforce and market, and you need to have components, which are technical components that are understood, well understood that fit together, so that you can be able to use them but in order for that to happen, people need to collaborate. 

     If they can collaborate when you set up infrastructures for cocreation, governance and alignment, and so we have done that.  We have done that in the context of the electronic health record exchange format and there we are looking into lab innovations results, discharge reports, passionate summarize and ePrescription and dispensions, and you need to put them in the right context for people to have the digital skills that allows to use them, so we need services that use this component; otherwise, it doesn't make sense.

      Some examples that we are working on and our core element of these ideal is the patient summary, and you see here the components medication summary, allergies and problem list are the main ones but also immunizations.  Think COVID history of procedures, medical devices and diagnostic results.

     We have worked ‑‑ we're actually working on a project called the PanCareSurFup, which is the survivorship passport this is for children who survived the cancer, and they need a passport to be able to convey the information that will allow them to pursue healthy living and meaningful occupation.

      It fits very nicely with the speech of the previous figures of occupational services and regarding health literacy.

     The other thing that Carina mentioned that I will say, and this is actually the one project I'm so fond about is using the patient summary as a lens ‑‑ like a ‑‑ a magnification lens which allows us to look differently into the leaflets that we see in every medication, yeah, so we are kind of ‑‑ you know, we unfold this huge thing like Merie, our ambassador here ‑‑ and we don't know what's relevant for us. 

      The question we are solving here in this IMI project is whether the patient summary with the knowledge of our profile, our health goals, our medication, our allergies, our vaccinations perhaps ‑‑ we can tell what is relevant in this large legal document.  What does it mean for us?

     And I think if you are like an older person who has about 20 of these, you cannot read them.  The letters, the accessibility ‑‑ we mentioned accessibility earlier is next to zero.  Can we do something about technology?  Can we give the digital skills for people to use them?  Can we help them take charge of their lives?  This is a problem we're currently addressing here in this IMI project, and I'm so happy to be part of it. 

      So are we getting there?  We're working on it.  We are working on it and taking my hat as president of the European Federation of Medical informatics, we are not there yet.  We are working.  We are working.  We don't know what the future holds, but we keep working, yeah, we keep working.  And one thing I would like to point out is OneDigital Health where we are trying to collect the data not only from healthcare but also from health environment and bring them together through One Health, and I'll stop here.  Thank you again. 

>> Thank you so much, Catherine, for this very engaging presentation.  It's impossible not to be caught up by your passion presenting this and taking a little bit this final issue that you mentioned, which is connected to OneHealth perhaps this is something we can debate a bit further in the discussion, but I think it would be very interesting for the audience.

     While Catherine was presenting a project that has a lot of impact on other adults ‑‑ and this would lead us to the next speaker, Alexander Peine, you're an expert in this area, and we know for sure there's specific groups even if they're not, of course ‑‑ if they are built by different people but there are specific challenges to address perhaps with other adults and also different ways of identifying how to tackle and overcome them, so can I pass you the floor ‑‑

     Catherine, if I can ask you to stop sharing. 

     And, Alexander, if I could pass you the floor and give you us your thoughts.

>> Yes, thanks, Carina, I hope you can hear me. 

     Let me see if I can share my screen.  So essentially you should be seeing my screen because I presented a conundrum that I would like to present instead of a full‑fleshed project I work on maybe I can say a little bit about myself.  I'm a sociologist. 

     I'm an associate professor at the University of Utrecht.  So in my daily life I study encounters between health and technology and the devices in their life, and I also study encounters of engineers and designers when they are designing for older people and how they meet other people but sometimes they meet only aging and their ideas about aging and ask the target while designing technologies, and that's sort of the realm of working.

     I'm also involved in a EU‑level activities that's specifically designed technologies for all people, so maybe just a little bit of a context of what you can see at the EU level and global national levels too.  There have been multiple millions ‑‑ hundreds of millions literally invested in ‑‑ well, digital technologies and digitization strategies deliberately targeted at the alleged shells of demographic aging, so we keep thinking of robotics technologies, monitoring systems ‑‑ so a whole range of these technologies.

     My main question in this regard ‑‑ and this is what I'll try to elaborate in relation to the questions of inclusivity and accessibility.  My question really here is:  Why haven't these technology projects been successful in the traditional sense?  Why don't ‑‑ why do we see sort of a fairly slow uptake of these technologies?  Why haven't they led to widespread business models and scaling processes? 

      My conundrum here really is, and this is really the question that puzzles me.  We are looking at a field that's extraordinarily inclusive.  So in all of these technology projects that are often publicly funded, we see stakeholders being involved.  We see cocreation being a very significant process.  We see almost an obsession with the needs of all the people.  We need to understand the needs of all the people, so that we can design for all the people.

     And my answer ‑‑ and this is really an answer to this conundrum while we do involve all the people, and we involve the stakeholders and think about the needs of all the people a lot, we also have continued to conceive of other people and later in life and technology as essentially being two separate alien spheres, so all the people in aging and technology don't go well together just yet, and I think this an important element because it is sort of a focal point that maybe representative to other digitalization areas as well because it allows us to take about digitization in relation to later in life as something that's going to happen in the future.

     What we sometimes forget is that, of course, all the people frequently use technologies that digitization is already an ongoing process and is already an ongoing process in the lives of older people, and this separation of aging on the one hand, all the people and digitization technology on the other hand ‑‑ I think, it has consequences for the way we look at inclusivity, and the way we design processes in including older people, and this is where I can put my first sort of examples on the screen.

     This is again something that I call interventionism sometimes.  This idea that if we think about digital technologies older people, aging become targets, and we need to think about the added value that these technologies can have in the lives of older people, and these are just a few examples here on the screen.

     So we talk about cost‑effectiveness in digital health innovations.  We talk about older people need to remain active and value‑contributors to society.  We talk to all the people becoming or being valuable resources and asset in the shrinking labor market, and there's a whole range of these ideas about what kind of value digital technologies can have in relation to aging.  And again, these are just examples.  I think they're very typical for a whole broad range of policy documents here.

     I think that the challenge here is really that ‑‑ what we do here is we talk about values for older people but often these are values that ‑‑ where we say, like, if people would use technologies, then this would be the value.  It's not, per se, the values for older people themselves.  It's rather value that sort of older people can have in relation to society.  It's something that the digital technology in relation to older people can fulfill in relation to health systems in relations to rising healthcare costs and supports.

     So we define values for them, but values only that would become real if people see an everyday object of these technologies.

     The problem with this is we can already see many technologies in the lives of older people, and this is something we can study.  So if we try to understand ‑‑ this is my daily research essentially ‑‑ if we try to understand what technology could mean in the lives of older people, we need to look at what it already means in the lives of older people because this is really the key to understanding what drives an everyday uptake of these devices.

     So we can study how older people use social media.  We can study how they use cell phones to take ‑‑ to take photos.  We can study how they use games, if we do, so we encounter these mundane activities, these every day activities that we perform with our digital devices, but these devices tell us ‑‑ or these usages they tell us a lot about the values that drives technology adoption in everyday life, and these values are not quite the same they are different values that we often digital to digitization if it would happen at some point in the future.

     So I think the main challenge here is the most significant barrier to inclusivity.  We have significant and widespread gaps between often normative, often legal life, often even ‑‑ medical life even ageist later in life in many of the digitization strategies and the realistic experiences; mundane usages of technology that we can find in the lives of older people and digital together is something for me becoming more inclusive in designing for older people.

     And this is something we do in the gatekeeper project where we are involved, let's say, the social science partner, and I'm not going to go into much detail here.  I think we can leave that to the discussion, but I think what we do in gatekeeper, and I think this is really a way forward to reach more inclusivity beyond what we have now is what we call this idea of empirical ethics.

     In gatekeeper what we do we study the lives of older people with all the technologies.  We take key ethical principles like autonomy or beneficence, justice or equality, but we don't ‑‑ we don't explore them as principles but rather we go out in relation to gatekeeper pilots and study how these ideas and principles play out in the lives of older people when they start using particular technologies as those we have piloted in gatekeeper.

     And, again, that's my key message here is trying to understand every‑day use of technologies and trying to understand how these every‑day usages contributes to the articulation of an empirical object, and that's something we need to do and help us understand inclusivity and use of every day technologies by older people.  Thank you. 

>> Thank you very much, Alex, for this very interesting provocation.  I think that you discussed this mainly in connection with older adults perhaps there is a very broader application of what you mentioned to several areas of society and indeed perhaps we also need to have a number of things more embed in our daily lives before we can fully acknowledge how they mess with the tensions that we ‑‑ that we need to address here and there.

     And this will lead me to introduce Claudia. 

     Claudia, I know that you have been working a project that aims to implement a holistic approach for small and inclusive environments so perhaps you have something there that connects and relates to what Alex was talking about and perhaps other ideas.  Thank you.

>> Yes, absolutely.  Thank you, Carina.  Thank you for inviting me here.  I'm very happy to share the forum with these amazing presentations and very interesting projects, so I'm going to share my screen and talk about the project and how this fits into this ‑‑ into this forum.  Let me see here, perfect.

     When we ask in this session if we are shaping the digital market to all citizens well, from our experience from the EU SHAFE perspective we're finding a way to make this happen so first what is EU SHAFE? 

     EU SHAFE is a project that aims to improve policies and practices in six European regions, and we do this by learning by sharing with bottom‑up approach to influence policy at local, national or European level. 

     Yeah, project as the name says it is European‑focused but let me ‑‑ let me tell you what the method or these projects have been so what we do is, so these are real world projects that our regions have identified that they are working ‑‑ they're working well with these aid‑friendly approach so by now ‑‑ this one says 35 out of ‑‑ out of these 35 world practices we have 13 focused on health but now with the evolution of the project we have identified even more, and this is good news; right? 

     It is good that we can ‑‑ we can talk about projects that are working, that studies define the needs of older adults as Alex mentioned there's this on obsession with the needs of older adults but really how we identify this. 

     Are we able to understand really these needs and while these good practices there's a saying where there's a will there's a way. 

      We have ‑‑ we're talking about infrastructure, about technical devices, about access to internet, but the main thing here that this project has shown us is that the people that are involved in solving these problems are important so where there's a will there is a way.

     To do that this project have user‑centered approach, and it focuses on addressing the needs of these older adults but with a bottom‑up approach.

     What does this mean?  It means instead of following ‑‑ following the public policy infrastructure, which is that the government launches their agendas, and then these agendas are followed by the local governments, and then these local governments implements the solutions on the ground, on the real context we do that differently.  We identify these good practices that are solving local‑level problems, and then we're trying to escalate these solutions to the top, so that it can‑‑ so that these submissions that came from real world context can be pulled down and rescaled and implemented in other context.

     So the bottom ‑‑ the key part here is that we are taking ‑‑ well, with this ‑‑ with these good practices we are taking real world problems that are being solved and upscaling them into the public policy, so that they can fit in different context and here the key part is the different context because we're talking about Europe but in these six regions what we learned in this ‑‑ throughout this project is that even if it's Europe, we have different infrastructures, different context, and it is not easy to implement one solution that is successful, for example, in Ireland where I'm based and apply that to Portugal because they have different systems, so what could be the way to real scale these projects and what are we ‑‑ what are we finding is that as long as all the stakeholders are involved for Alex's approach and as long as there is ‑‑ there is an inclusion of real people, of real user in the development of these projects, then we can find a way to create more good practices in different context.

      That is ‑‑ that is a similar of what EU SHAFE is and how can it be ‑‑ how it's perspective can be implemented in ‑‑ in the inclusiveness of the digital market.

     And in summary it is that listening to the users but including them in the design process and really understanding their needs, so that they can be applied to different continents. 

>> Thank you so much, Claudia.  That was very, very interesting, and I think it also makes a very nice flow from starting from broader initiatives like we discussed in the beginning, EU initiatives, national ones, multistakeholder, and now going completely bottom‑up and bringing maybe a complementary perspective to us.

      Perhaps I could ask all the speakers if you can join us in a broader discussion now and perhaps my teasing question ‑‑ and sorry this is ‑‑ well, a little bit out of the blue, but I think it will be the question now after this presentation is:  How do we put all this together?  Because we understand there are on one side multiple approaches to these different challenges and perhaps not all of them are working and how do we put together this tension what comes to the governments and the EU level and what can come from the practices already implemented?  Do any of you have any additions that you'd like to pop in and open the mics and just join in the discussion?  Yes, George, sure.

     Just please open the mics and feel free to debate.

>> I took in so much, and I was taking notes, and I was filling the page, and I was thinking just listen because I'll spend all my time writing.

     What really stood out to me I think ‑‑ we talked well about some of the roles different agencies can take, but really we set out the principles.  I think that whole human centeredness came out very clearly and really the other thing was that there was a huge amount of expertise out there.  A huge amount so, therefore, how do we pick this up?  And I think ‑‑ if I'm speaking just about health management, the role health managers can really take.  There's that pillar between policymakers and putting things into practice so what health managers can do as they set the strategic decisions of the units as they develop their leadership approaches, they need to be prioritizing and embedding this all these values that we talked about and all these opportunities.

     I talked about, as did Alex, that there's a lot of technology already out there, but it's not being picked up, and so health managers can help direct resources towards that.  They can help direct expectations from their staff toward that and feedback to their decision makings how that's going at a practice level into the decision‑making level.

     Now, I don't want to speak for ‑‑ I'm not going to Catherine ‑‑

>> Yeah, yes, you spoke really well, in fact, about some of the approaches that are happening at a management level and at an organizational level, and I feel the like all the presentations ‑‑ and I don't mean to take over facilitations or point fingers I think you had some great ‑‑ Carina is that what you're talking about putting in practice.

>> That's what we would like to take out of the session is that if we can take something home with key action points to be further developed on.  And, of course, that is exactly what you said now so, yes, I think that's the main aim is to see if we can get some new or old agreements out of this. 

     It doesn't matter if we can push them further a little bit and commit to try to strive for more action in if we don't 22. 

      So Catherine, do you want to comment on what George was saying or ‑‑

>> Thank you, I take George's comment as a compliment.  This is what we have been striving.  I must say I am a computer scientist by training, so all my life I have been trying to see some of the really inspiring technologies put into practice, and I would like to call on one of my colleagues who said that interpretabilities in the minds of the people.

     For the first 20 years of my career, we were striving to make technology work and speak to each other, but in the end we understood that the less we make the technology understood to people and the problem interoperability understood by people, this will never happen, but I must say we have a unique opportunity today at hand, and that's the opportunity that data brings.  Data brings an opportunity, a whole new game, you know, of new services that thinks to people entrusting the data, entrusting the services that are based on data is also based on how much interpretability we have on the ground because unless the data is meaningful you cannot put them together. 

     As people say garbage in garbage out.  If the data is not good, then the outcome won't be good and won't be meaningful and that means people do not only need to be digitally literate they also need to be digital literate.

>> Catherine, something you mentioned in the presentation do you think we're already at the stage where people understand enough about digital and data and what it implies even in terms of services in order to trust them, which is something that you also mentioned in your presentation, and that I think is probably overpass all the presentations today is that people need to understand, and then ‑‑

(Talking Simultaneously.)

>> A very important question what you're saying, and I think it's the biggest challenge for Europe because we live in a society where people matter. 

     We take a lot of ‑‑ we pay a lot of attention what people think, and we want to attract to people in the services we provide, and we want to attract the people in the governor services that are there, so how do we make people trust?  That's also linked to the presentation on misinformation, you know, if you try to manipulate people's opinions too much you lose them, so that takes education, that takes the kind of education that people are challenging what they hear, and they are looking for the data high wind decisions.  They look at the data behind services, and then we have a better society because it's a society of people that participate.  Of people that are not ‑‑ are not passive, but they are active, yeah.

>> That is true.  Juan Luis, how did it work for the Greek government when you realized this trust existed?

>> That's a good question, and I've been hearing great opinions on different dimensions during this panel, and there are many lessons for me being learned today to take away.

     I think ‑‑ I mean, taking this point into consideration, I think trust builds also by engaging the people the citizens more into the overall process.  And for that matter, we are trying to have here in our updated strategy more services embedded into the process not just designing but also implementing and providing the services, so we're trying to put the citizens at the center and trying to get more output on professional provide on the deliberate ‑‑ output to ‑‑ and this is one of the critical aspects that we've been trying to look in to try and promote the tech laboratory elements for different parts of the society and different parts of the economy testing technologies for different parts of society and economy and embeds the civic part in it, so I think we heard really interesting points, and it's business from each one of these presentations interlinked together could provide a potential, you know ‑‑ a flow behind the possible approach.  This is my understanding at least, so I take some elements from the different presentations, and I think this would bring up the better design strategy.

>> Yeah, it's very true, and I suppose as soon as we discussed on citizens views Alex raised his hands, and I'm very curious to discuss with Marie and Claudia, and I will pass the floor to you, Alex, so you are able to follow up on this?

>> Yeah, indeed that was ‑‑ the idea of human centeredness obviously is something that stretches across all the different presentations and indeed it's at the heart what we discussed digitization. 

      Probably just also the reminder that human centeredness is ‑‑ it's also a question how we do and how that see the human ‑‑ let's say the human centeredness vis‑a‑vis digitization.

     My take on this sometimes really is ‑‑ and again, this may be a bit ‑‑ may be a bit out of the limb here we often tend to prefigure digitization as the objective here why it may be more moderately being it as a means as something else, and that will probably be a very different perspective, so I can give you an example from one of the projects where we have been looking housing, and we've looked into a broad language of pilot projects.  Some of them are really targeted.  Let's put a lot of technology into homes of people and see how that works out and monitor people very closely and others or weather really social innovations like people trying to find housing opportunities with like‑minded people, being very much embedded in the community, having shopping opportunities nearby.

     But if you look at those social innovations, you also find technology, digital technologies all around.  You find all sorts of different mundane off the shelf technologies, and I think bringing these things together could be a very important way forward, like, trying to from looking at social innovations what actual needs in relation to digitization are and could be ‑‑ could be a way of sort of breaking out of the rut of thinking of digitization as an end of itself.  Something that we should be striving something for because it will ultimately benefit people, which is still a hypothesis.  Digitization will happen, but I think that could be a way forward or could be bringing things together.  It's really trying to think about how we can bring technical innovation and social innovation together.

>> If I can add one thing and step out of my moderation part for one second, just to say that I have a very dear friend I work with like you, Alex, and he says that have been discussing this because human life and technology are built together, and we need to consider this by saying that none is the goal and none is the tool and both are fully interconnected. 

     Perhaps if not already now but in a very near future, I have the feeling it is very much right, and this could also help dilute some of the differences when we discuss because then we will discuss the person as a whole which includes the views of technology in the concept of the person maybe perhaps for another discussion this is also a nice concept and before passing how this resonance outside the EU and Africa and other countries and very much connected to this information issues that you mentioned before, what can you tell us that adds to the discussion?

>> Thank you, Carina.  I mean, I'm really enjoying the discussions and also the presentation of the fellow panelists.  It's very interesting.  I would be very happy to see the notes at the end that you will present to us.

     Yeah.  When you look at EU, and there are big differences as I mentioned in my presentation, 91% has internet when you look across the 62, 63% and also the quality and bandwidth of the internet is also very different when you compare these two, so this is a big difference.

     But when you look at the similarities when you come to the topic of marginalized population when you looks like at the imprint population they are not speaking in the in me languages between them, so the immigrant communities speak in their native languages but when it comes to public health and vaccination, and these kinds of aspects all of them are not safe until everyone among us is safe, so it's important to reach to all of this, and we need to think about these individuals like also when we design public health policies and digital health policies next slide misinformation if you look at information it's in central Europe, for example, if you look at the vaccination Bulgaria, Romania and even Latvia is heavily lacking and as long as we have a free movement in the European area all of us have to be protected to ensure that we are protected.

     We are talking also here ‑‑ we also have the discussion older population, and it's very relative to the population.

     Many times, when you look at the fake information or the misinformation that you see in the social media it's probably started by somebody with, let's say ‑‑


>> When you see the name doctor, some people just assume, okay.  This is valid information, but you need to kind of develop this media to perceive it doesn't mean that it's actually a medical doctor who has ‑‑ who has ‑‑ who's an excerpt?  Immunology and vaccinations.  It might be some doctor who stopped practicing years' ago, so these are kinds of similarities that you can see across the world.  It happens to all of the people

      And when it comes to these life efforts there's also huge differences.  If you look at European commission, they have launched a project for 24 languages in 2020.  There's also European language grid available for developing language tools when its global initiatives is lacking.  There's a global language digital initiative, but when it comes to the language models developed for African continent, it's heavily lacking and also lacking languages in many African countries.  It's heavily European and American‑focused and also Chinese solutions are available.

>> So, Merie.

>> Yeah.

>> I'm going to go around to ask for some messages from Claudia take‑home I could already take the chance because you were telling us about all of this very important factors.  If you had to choose one thing that you would think would need to be prioritized for 2022, either considering your own context of the project or even broader than this, what would you say is the key aspect to focus on?

>> I think if you're talking about infodemic it's a huge problem in EU, so this is an aspect that needs to be taken into consideration by public health officials and digital health policies as well because it's not ‑‑ it's not going to end with COVID‑19 this kind of misinformation is going to spread on many, many other aspects, so this is an aspect that needs to be taken into consideration and strategies to deal with misinformation spreading through social media should be an element and also increasing media literacy to identify misinformation.

>> Thanks, Merie, very nice and Claudia, going to you because you were missing one contribution.  I don't know if you want to ask something discussion while we were going through and/or if I can ask you something specific.

>> You can ask me specific, but I also have a question for Alex.  In my project Alex mentioned not to see the technology for the sake of is this so in our project the end is well‑being ‑‑ health technology can be the means to an end and in this case it is the well‑being but when we are including this for Alex's approach these different sectors to create this influence policy or to create different projects ‑‑ when we're talking in real context do you have, like, a recommendation for ‑‑ for methods that could be implemented in the design phase so everybody involved in the creation of this project or in the creation of this policy ‑‑ in the creation of whatever can really ‑‑ yeah, can really understand the user because ‑‑ I mean, I'm a designer, but I also have this experience with research and if you tell, oh, we have a technology approach okay.  That's grand but if I talk with a designer that doesn't have background in research how can I ‑‑ how can I communicate that and give them the tools, so that it happens in the real context?

>> Thanks, Claudia, I think that's a great question.  My experience ‑‑ first of all, I think my experience with designers is that quite often designers already are very ‑‑ very good at applying qualitative social science methods so to speak, so my ‑‑ I think the best project are often those that involve designers and social scientists alongside with each other.  That would probably be the most tangible idea here would be to involve these two disciplines to understand views from a more qualitative perspective so doing in‑depth inquiries instead of having some randomized control or some measurable stuff but go for ‑‑ go for the everyday life stuff, qualitative inspiration. 

      Monday morning many designers already do that.  I'm not ‑‑ that's also my experience with designers is particularly strong.

     On a more principled level probably the idea of well‑being and what's a conceptual point, not a methodological one?  Not to see it as something that exists independent of technology but try to understand how well‑being already now is something that depends on the technology devices that surround us, and it's already a material idea.  Well, what that means in methodological terms -- I think there's still a lot of room to be explored her but trying to look at the use of devices already now and try to understand how that fits into well‑being, and it's entangled in this idea of well‑being, that's, I think, the minor tweak that can make a big difference. 

>> Thank you, Alex, that's very good.

>> Yeah, and I like this idea of constant dialog, and I think it's helpful between experts and perhaps we can do it on the associate level easily with different stakeholders.

      Claudia to pass on to the rest, do you have any take‑home message very quickly that you would like to highlight before we go?

>> Yes, to contribute a little bit more to what Alex said.  I think my take‑away would be focused on people and take care of people and don't ‑‑ when you're designing projects recognize the value of qualitative research because what I've seen that happens in the real world is that quantitative research it is often overpowering qualitative research because of the time optimization, so that will be another key‑take away maybe a little bit of topic but qualitative research is really ‑‑ has really a contribution for designing projects. 

>> That's very interesting, Claudia, and I think very well taken.

     Alex, do you want to do your take-away to this, and then I will pass to George who has already exclaimed more than once, so we'll be happy to have you back. 

>> I could probably just succumb to Claudia that's my take‑away what's the action for next year thinking about different collaborations and involving qualitative researchers and designers probably alongside with more technical‑oriented researchers and moving towards more in‑depth studies rather than scribing for evidence in the traditional sense.  That's ‑‑ that's the way to go in my view

>> Thanks, Alex.

     George, do you want to comment and follow up on that.

>> Yeah, thanks Carina.  I applaud that request I'm going to seem to betray it and go the other way and say is given that we have such an amount of data ‑‑ some people call it big data.  I don't know the difference between big data and not big data so ‑‑ with all this data we need ‑‑ we need patient confidence.  We need patient engagement, and so we need ‑‑ we need an ongoing commitment to improve the governance of patient data, and I'm thinking of quantitative ‑‑ quantitative data, and I say that in betrayal of ‑‑ I'm just so excited to hear about this generation of more qualitative research, so I want to pick both but if I have to pick just the one I'd say I want better governance of big data.


>> Thanks, George.

     Catherine, you are also smiling, tell us your take‑away.

>> I really think that this is an exciting panel.  That is why I was smiling, and I would like to congratulate you for these different elements together.  It's really refreshing, and I'm so pleased.

     Now, in terms of famous last words I think what was said I could just re‑enforce the message of the previous speakers by saying that it's all about cocreation.  It's all about cocreation and governance and alignment, and one particular issue that we need to understand a little bit more is how can we make and launch meaningful services putting the person in the center? 

     So do you think allow any technical project without having a skills component.  Without having an economic visibility component because right now we are ‑‑ we are forgetting everything about how to make sustainable projects and essentially the people are at the center; otherwise, the projects will die and that and the OneDigital Health initiatives are probably my biggest aspiration for the future so thank you. 

>> Thanks, Catherine. 

     Merie, I take it now to you.  Please tell us not your last words but your final words today.

>> I hope I don't have the last spiteful words, but indeed, I echo what Catherine has said really ‑‑ really important topic.  I mean, really important key to take away, but I'd just like to try to summarize what I've heard in the key elements at the end, and I think that, you know, as a very good friend has said I agree digitization should not be an objective in itself and great technological minds should fight against it so alienation, so I think discovered more or less the aspects of the needs for digital skills for promoting that, and that would, I think, be the way to show many of these issues.

>> I'm very confident after hearing this panel and the discussions that we are in a good way because ‑‑


>> It gives me some hope that we are in a good way because a lot of you have important roles, and I do think that we are very much in tuned even if going for complementary perspectives, so this gives me much hope on the future, and I really hope also that this was interesting for you and for all the participants because some of you also get to know each other and each other's initiatives, and this is also important for us to strive for common challenges and common messages, so I do hope that we can take some advantage of this.

     I would also ask, care Lena, if she come in a second for a minute and perhaps take a full picture of the team and the speakers, so that we can also use it further, and I'm ‑‑ I really hope that we can meet each other soon again and perhaps continue this discussion next year. 

      Thank you so much to all.  And enjoy the rest of your afternoon.

>> Thank you all.