“It was an edition that exceeded all our expectations, which transformed the AIIC Conference into an authentic stage for discussion on health technologies and the development of the National Health Service in a truly innovative way”. Thus Umberto Nocco, president of the Italian Association of Clinical Engineers, concluded the 24th appointment of the profession. The numbers – we read in a note – are flattering: over 2,600 present, almost 48 sessions with over 160 speakers, 12 training courses (with 900 registered), over 110 companies present with their technological solutions.
“But beyond the figures – comments Lorenzo Leogrande, president of the Conference – we bring home the awareness of how much our event has become the ‘home of system innovation’, that is, the place where we understand how technologies enter to be part of the daily operational life of clinical engineers, clinicians, operators and professionals throughout the NHS”. And “let’s not forget – confirms Stefano Bergamasco, coordinator of the Scientific Committee – that the call for the need to create a digital eco-system was fully accepted, to prevent investments and projects from being ends in themselves and incapable of giving a real qualitative change of pace to increasingly necessary health responses in a time of wider chronicity and new proximity approaches”. The last act of the AIIC Conference was the announcement of the 2025 appointment, which will be held in Naples and will focus – the title will be finalized in the coming months by the Board of Directors – on the problems-critical issues-opportunities linked to the green transition, sustainability and new organizational culture of the health system.
During the event, the first draft of the Manifesto ‘The Telemedicine I would like’, developed by Aiic and the Italian Society of Telemedicine (Sit), was presented. It is a 10-point document that defines an ethical-professional reference platform for the entire telemedicine system. The proposed values are: vision, ethics, inclusiveness, training, control, interoperability, science, law, architecture, safety. For Emilio Chiarolla, member of the AIIC board and promoter of the Manifesto, “the application of Ministerial Decree 77 and the Pnrr projects are generating an epochal turning point for the care of patients, with telemedicine becoming an indispensable piece in a process of new taken care of in the territory to reach all patients in a widespread manner. The contents of our Manifesto – he continues – start from ethical principles and take into account infrastructural and technological issues, but also professions and the methods of cooperation between different professionals for the obvious benefit of patients. Clinical engineers” are “transversal to all activities for the grounding of telemedicine projects, both from a technological and organizational point of view”.
Antonio Vittorino Gaddi, SIT president, adds: “The Telemedicine Manifesto is fundamental because we live in a universal healthcare system that is unique in the world, which would like to bring the most advanced technology and telemedicine to all citizens, to all patients, and to all hospitals in the coming years. But this can only be done if all the forces of the country contribute: doctors, clinical engineers, and also jurisprudence and experts in ethics, sociology, anthropology, information technology and all the disciplines that must contribute to creating telemedicine in the future”. The Manifesto was shared during the Conference by various professional and scientific entities – Fnopi, Fno, Tsr, Pstrp, Rome Bar Association, Lega Coop Sociali, Confindustria Medical Devices, Sihta, Antev, Card, Antab – and will now be revised and expanded.
The conference also took stock of the implementation of the Pnrr relating to the installation of 3,136 large pieces of equipment throughout the national territory. In a dedicated session, Nocco presented “the Consip data which shows how the first milestone of 2022 on the publication of tender notices has been achieved. The timeliness of the procedures and the framework agreement were winning aspects. Today, the remaining equipment to be acquired is limited to those subject to appeal and therefore this first data is comforting”. However, Nocco continues, “we need to reflect on the fact that, if at a geographical level the percentage of purchase is higher than 90%, the percentage of tested – and therefore working – is only 37%. Thinking of filling the missing 60% between now and the end of the year is a difficult challenge, which we must face up to.” The difficulties faced in the installations are many, said Nocco, “and among these we cannot forget the fact that a fleet of enormously important machines is being replaced while the hospital works: it is necessary to manage a setup without causing inconvenience and limiting delays in disbursement of performance. He certainly observed that there is a need for reflection on the bureaucratic and administrative aspects: the impression is that the reporting system is too complicated. The perception is that there is an obsessive attention to detail, and a lack of attention to operational capacity, to which is added a bureaucratic bulimia that affects delays”.
Concluding the session on the Pnrr, Nino Cartabellotta, Gimbe president, underlined that “Milestones and European targets were achieved in March, while some intermediate targets were then remodeled which concern the signing of contracts for primary care and for corporate interconnections . Our personal perception is that today’s obstacles to the implementation of the Pnrr are above all regional differences, the shortage of healthcare personnel and the shortcomings in the implementation of the national telemedicine system”.
The green transition – also in its impact on HTA culture – will be the central theme of the 2025 Conference, but already in Rome the topic was addressed with some of the recognized experts in the sector. Leogrande, speaking in the specific session, recalled that the Health Technology Assessment “is a multidisciplinary assessment that addresses all dimensions, from the clinical to the technical one, that linked to safety and also that linked to sustainability. Today, when we talk about sustainability we are no longer referring only to economic balance, but other concepts are also activated which refer precisely to the green transition and the circular economy. As AIIC and as a healthcare system we want and must address these issues because we believe that, from an evaluation point of view, they must be new observation points that favor decreasing the impact of healthcare products and waste on the environment”.
An impact that Marco Rossi, Agostino Gemelli Irccs University Polyclinic Foundation, Rome, has expressed in the field of anesthesia, citing for example propofol, a hypnotic agent, and the need for better management of its elimination. “More generally – stated Rossi – in our field sustainability is now considered an essential value. It is no coincidence that a few weeks ago the consensus document of the European Society of Anesthesia was presented which highlights how the use of drugs and devices must retrace the concepts of circularity. We need an overall cultural advancement to which we must all contribute together.”
At the end of the session, Marco Marchetti of Agenas recalled that the Agency is implementing the National HTA Plan presented last November, and has already led to the reformulation of the control room. “In the meantime we need to grow the culture and competence in technology evaluation. In this regard, we have provided a list of collaborative centers which must be updated annually. And to increase the cultural level on HTA assessments, we will very soon come out with a notice for basic and advanced training. In the first we plan to train around 2,000-2,500 operators per year with ECM courses, while for advanced training, aimed at universities, we provide scholarships for qualifying courses”.
Among the important reflections that emerged from the 24th AIIC Conference could not miss the one that professionals, institutions and companies have been discussing for some time: can innovation and sustainability coexist or are they destined for a dialogue between the deaf? While we await the ruling on the Payback topic, Massimo Giuseppe Barberio, Coordinator of the Assobiotech diagnostics working group, declared that “the time is ripe to
accelerate an internal push within organizations operating in the world of health” to make “the shared objectives including those linked to sustainability. It becomes necessary to combine sustainability and appropriateness, using innovative technologies as a glue that contribute to increasing the possibilities of treatment for an ever-increasing number of patients and at the same time significantly reduce the overall cost of managing certain pathologies.”
From her point of view, Fernanda Gellona, general director of Confindustria Medical Devices, highlighted that “on access to technological innovation, we have seen with great favor the entry and definition of the national Hta Plan which, for the evaluation of technological innovations it is, we believe, the right tool. However, alongside this Plan, there must also be the certainty that, for example, an innovation that has received a positive opinion will find space in the LEAs”.
On the topic, President Nocco concluded: “The sustainability of innovation must be rethought. We often stop at the purely economic aspect because it is probably the most understandable to everyone, however there are many drivers that control innovation and therefore it is clear that sustainability is not only to be thought of in an economic key, but is also process-related, because every new technology involves changes to processes which mean changing the way of working, perhaps having more human resources or changing their way of working, and therefore training. It is therefore necessary to enter into a different cultural key in which we finally all agree on the fact that the driver of technological innovation is multidisciplinary and therefore includes the many factors – economic and not only – that give new meaning to the word sustainability”.
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