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1. Resource recycling for a New, Connected Telehealth Paradigm Miami Telehealth October 11 th 2022 Dr. Dimitris Kalogeropoulos , Independent Adviser, Global Health Innovation

2. Fundamental principles

3. The Health-Data Value Supply Chain *https://assets.ey.com/content/dam/ey-sites/ey-com/en_gl/topics/life-sciences/life-sciences-pdfs/ey-value-of-health-care-data-v20-final.pdf Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022 value recycling/

4. A Circular Economy Is About the Economy, K Webster, Circular Economy and Sustainability (2021) 1:115–126 Value through recycling: Circular Economy Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022 The retention of the data product as an asset adds new asset classes to the initial use, and coupled with the logic of ‘total product liability’ where the manufacture retains ownership (ideally through grassroots governance) or acts as if they do, links reducing environmental impact to better design, more intelligent use phases and further industry consolidation or collaboration across the value chain This is no place for the peripheral player, thus the need for Platform Economy 2.0 vision to deliver open, equitable, inclusive and sustainable digital development

5. Data Value from Equity The issue of safeguarding the value of data resonates with wider concerns about the equitable and inclusive distribution of profit (value) from public assets “Failing to protect health data as Valuable Public Assets risks making taxpayers pay both to develop and to use novel technologies, further entrenching the costly model of discovery and innovation observed in the pharmaceutical industry’s pricing strategies […], or the lack of equity sharing in uses of published scientific research before these are sold back to the publicly funded institutions which employ the academics” Stephen H Bradley, et al (2022), BMJ Analysis https://www.bmj.com/content/377/bmj-2022-070876 Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

6. Data Quality, Data for AI Erroneous data: The Achilles' heel of AI and personalized medicine, https://www.frontiersin.org/articles/10.3389/fdgth.2022.862095/full Artificial Intelligence Ethics: Asymmetry Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

7. Asymmetry Impact on AI AI vision has reached a plateau Reasoning is still a frontier of AI Investment of the hook Data is a problem Sanford Institute for Human-Centered AI (2022 Index Report) Council of Europe Steering Committee for Human Rights in Biomedicine & Health (2022) AI deployment in care remains nascent Clinical efficacy has been established for few apps compared to reported research activity Performance generalization from trials to clinical practice is largely unproven Scaling is a problem Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

8. Clinical Robustness Digital Health Start-ups Johns Hopkins University School of Medicine FDA and ClinicalTrials.Gov Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

9. Restoring VSC with Resource Recycling & New Telehealth

10. Connecting Data-Driven Innovation Strategy: 70% vaccination coverage prioritising specific groups Policy: mandates Regulation: EUA Innovation Standard: mRNA Effective? Access to RWD/ RWE to evaluate impact Digital Ecosystem AI prediction Telehealth Triage Drug discovery Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

11. SCORE for DAV in the Innovation Ecosystem S haring, CO nnecting and R e cycling D ata A ssets to Accumulate Impact V alue from Innovation Actual temporal reality and impact Disconnected realities and impacts Innovation : Future model of reality and impact scaling which is retrospectively conceived Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

12. Current Telehealth Paradigm Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022 Appointment schedule Test results Disease monitoring Training Measurement Secondary prevention, e.g. readmissions Long Covid Recovery Treatment Compliance Precision Consultation for CD Self-care Post-discharge follow-up Remote Triaging Precision Nutrition & Physical Activity Survivorship Support Grassroots-Social Governance Programmes Pharmacovigilance & Support Patient Support Programmes Patient screenings Disconnected unmet or underserved needs

13. Carbon Sources Reduction in efficiency of health systems Patient care pathway fragments Big Unstructured Data Healthcare Over or Under Use Over or Under Diagnosis Patient-in-wrong-cohort decisions Downstream-focused policies Measurement technology overuse High risk-cost, low benefit treatments Treatments with poor health outcomes & high climate impact Over-medicalisation Antimicrobial Resistance Low or No Value Care Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

14. Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022 Multiple autonomous free-range agents New Connected Innovation Paradigm

15. Connecting Innovation for Carbon Reduction Radiology Screening AI Remote Care Precision Treatment Quaternary Prevention Value-based Care Improved, faster, more relevant clinical trials Upstream & prevention focused policies Digital Designs for high-value care pathways Re-admission prevention virtual care Patient engagement & participation Precision Diagnosis Remote Triaging AI Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

16. Major Green Care Change Initiatives WHO’s Alliance for Transformative Action on Climate and Health (ATACH) NHS Net-Zero Action Plan for a digital low-carbon transformation EU’s Twining Green and Digital Policy Initiative UN Coalition for Digital Environmental Sustainability (CODES) Action Plan for a Sustainable Digital Planet -2022 Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

17. Approach to Resource Recycling

18. Data Asymmetry Solutions Disparity in access to data assets and value production, or inequality in the extent to which different actors can benefit from data, deriving new insights or informing innovation Bridging these asymmetries for scientific research is approached by the FAIR framework for Open Science Secondary uses, such as EU’s Open Science Cloud or Data Governance Initiatives such as EURORDIS or Global Alliance Genomics Project ( GA4GH) Open Science implies Open Data (primary use) - which requires wider reforms in health innovation ecosystems (GDPR->EHDS) Open, Shared Standards will provide equity & inclusion on the way to symmetric data, through equitable value, trust and social benefit derived from insights and informed innovation (Verhulst and Young, 2022) Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

19. Illustrating DAV SCORE D2 D1 D3 D4 D3.1 D3.2 D3.3 connected Ag1 Ag2 Ag3 shared D1 D3 D4 D3.1 D3.2 D3.3 Ag3 recycled t1 D2 Value-Based Care Longitudinal Data Patient-X t2 device-1 device-2 Ag1 Ag2 disease agent Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

20. SCORE for Data Symmetry Data liquidity - Data as a circular economy asset Unlike capital assets, for which the value tends to deteriorate over time, data’s value does not decrease and can, on the contrary, increase, as the data are reused and recombined in different ways. The easier the reuse & recombination of the data, the higher its liquidity Interoperability - ability of agents that create, share and use data to have clear, shared expectations for the contents, context and meaning of that data Portability (GDPR) - ability of users to obtain and transfer copies of their data from one data controller to another terms adapted from Verhulst and Young, 2022 Connect Share Recycle Software Angle Standardisation & Policy Angle Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

21. SCORE Standard for DAV across uses Pre-validated value sources Open Science (e.g. AI) F.A.I.R. Findable, Accessible, Interoperable , Reusable Open Standards/ Global Goods (e.g. Covid-19 phenotypes) Open Data Open, Connected Innovation Translational users user supplier user supplier user supplier Connected Grassroots innovation Suppliers: Research projects, trial databases data spaces, trusts etc. Symmetry Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022 Asymmetry

22. Data Circular Economy the Basics Interpretability, Explainability Reproducibility, Replicability Scaling, Spread Sustainability 2. Connectivity as catalyst & accelerator Equity and Inclusion More and better data 3. Recycling Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

23. Future: Telehealth Driven Symmetry Interaction Outreach Connection Decentralised Networking Federated Disease Phenotyping, AI-ML The full value of data materializes when systems enable the use and reuse of data for different purposes All share equitably in the benefits of data when investments and regulations create a level playing field A trust environment is created when the rights and interests that all stakeholders have in data are safeguarded VTE model is Social Contract for Data – World Bank Flagship Report Data for Better Lives Reliable & Reusable data capture Engagement & Participation Data Recycling Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

24. Circular Economy Policies in HLS aims actions Dr Dimitris Kalogeropoulos Miami Telehealth October 11 th 2022

25. IEEE SA HLS Practice Transforming The Telehealth Paradigm Providing a global platform of excellence Telehealth System Data Asset Recycling for Value-based Care Explores the development of open standards for data capture and recycling through Telehealth systems to enable access to tested & evaluated data sets which can be shared and readily used as validated value sources in R&D, clinical research, and healthcare delivery collaboration IEEE Standards Association Raising the World's Standards Standards incubator & Data Innovation Ecosystem

26. Thank you Reach out to join the incubator [email protected]