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21st October 2024
Francine de Stoppelaar is co-founder of Project Asclepius – an excellence platform driving digital transformation and automation of medication management processes – as well as an honorary associate professor at the University of Leicester and an associate at Deloitte for digital transformation of hospital services and medicines optimisation. She speaks to Saša Janković about her trailblazing work in this area and where she sees the biggest potential.
With a background in clinical pharmacology and over 25 years’ experience across the NHS, private healthcare and academia, Francine de Stoppelaar’s career exemplifies the intersection of clinical expertise, innovation and strategic leadership.
As the co-founder of Project Asclepius and former chief pharmacist at Cleveland Clinic London, she has become a leading voice in the digitalisation of hospital processes – particularly in the realm of pharmacy and medication management – and has laid the groundwork for a future where technology and healthcare professionals work in partnership to deliver safer, more efficient patient care.
A long-time champion of the broader potential for multidisciplinary collaboration and the use of digital tools to address unmet patient needs, Francine’s passion for digital transformation in healthcare was ignited during her time at Cleveland Clinic London, which she joined in 2018.
As well as being chief pharmacist, she led the operational activation of the hospital prior to its 2022 opening, in a role that encompassed everything from building, procurement and hiring teams to the integration of equipment and new systems – all of which she spearheaded alongside the added challenges of Brexit and the Covid-19 pandemic.
However, her primary focus remained on pharmacy, where she oversaw the development and implementation of a fully digitalised, closed-loop medicines management system that leveraged digital and automated solutions to enhance patient safety, workforce efficiency and sustainability.
The first of its kind in the UK, this groundbreaking digital pharmacy system included automation at every stage – from prescription verification to bedside administration – allowing for real-time monitoring of medications and dramatically reducing the risk of errors.
‘In fact, after two years the hospital reported only two incorrect administration errors in over one million medication administrations, both of which had no damaging effect to the patient and were easily corrected,’ Francine recalls.
Nonetheless, since most medicines management processes in hospitals across Europe are still based on manual operations to some extent, Francine admits projects like these are ambitious and uncommon.
‘State of the art technologies and innovative solutions are readily available, but their adoption is still limited, partly due to highly fragmented practices and workflows, but also because they are complex and costly,’ she says. ‘That’s why many hospitals in the UK and Europe still rely on outdated analogue systems, but these can lead to inefficiencies and medication errors, which is why it is essential that we bridge the gap between what’s technologically possible and what’s being implemented on the ground.’
This vision has been foundational to Francine’s work with Project Asclepius – an initiative she cofounded with Patrick van Oirschot and Patrick Koch after leaving Cleveland Clinic London at the start of 2024.
‘While some European countries are further ahead than others in managing medication effectively in a hospital setting, there are no consistent cross-European guidelines or effective ways to share best practice,’ says Francine.
‘The aim of Project Asclepius is to contribute to a faster and safe adoption of digital and automated medication management systems in hospitals across Europe, initially by focusing on best medication management practices enabling personalised therapies based on unit doses, with other areas of medication management to follow in future.’
The key to its success, according to Francine, lies in the integration of technology and human expertise. ‘Digitalisation doesn’t remove the human factor,’ she explains. ‘Rather, it enhances our ability to work smarter, not harder, by reducing repetitive tasks and allowing healthcare professionals to focus on patient care.’
One of Francine’s driving motivations has always been improving patient safety.
‘As the healthcare landscape becomes increasingly complex, with workforce shortages and rising costs, the need for more efficient and safe systems becomes critical,’ she says. ‘For example, medication errors in the UK alone are responsible for the loss of approximately 1,700 lives each year.’
For Francine, addressing this through the automation and digitalisation of hospital processes is an ethical imperative. ‘By integrating technologies such as automated dispensing cabinets and real-time scanning at the bedside, we have helped to create systems where every step of the medication process is tracked and checked digitally,’ she says. ‘This approach minimises the possibility of errors, whether from a lack of human oversight or system inefficiencies, because if a medication hasn’t been verified and dispensed by a pharmacist, it simply can’t be administered.’
Through Project Asclepius, she advocates for the wider adoption of such ‘closed-loop’ systems, which not only improve patient outcomes but also have significant impacts on workforce efficiency. For instance, nurses and pharmacists can spend less time on manual tasks and more time focusing on direct patient care. As Francine points out, ‘automation doesn’t eliminate jobs but rather redeploys skilled workers to areas where they are most needed, thereby improving both patient experience and operational flow’.
Another recurrent theme in Francine’s work is the importance of collaboration. ‘Effective healthcare cannot be siloed, and this is especially true when it comes to pharmacy,’ she says, adding that: ‘Pharmacy is the red thread running through a hospital, so that while pharmacy teams handle ‘back office’ tasks such as procurement, logistics and stock management, their work always directly impacts clinical care.’
The challenge, however, is that many hospitals operate in a disjointed way, with different departments using incompatible systems. ‘In my consultancy work with Deloitte I’ve seen numerous inefficiencies resulting from this lack of interoperability, including duplicative processes and wasted staff hours,’ she says.
Her solution is to ensure that all digital systems within a hospital – whether for stock management, prescribing, patient records or anything else – are able to connect and ‘talk’ to each other.
However, she stresses that this requires buy-in not just from pharmacy leaders but from the entire multidisciplinary team. ‘Physicians, nurses, IT specialists and hospital managers must all be aligned in their approach to digital transformation and leaders need to bring everyone on board,’ she insists. ‘Without the support of senior management and the wider clinical team, even the best digital tools won’t succeed.’
Looking ahead, Francine believes that standardisation across hospitals and pharmacies will be key to addressing both workforce and patient safety challenges.
Through Project Asclepius, she is pushing for pan-European standards that would allow hospitals to adopt best practices for digitalisation more easily, which she says ‘includes everything from standardised unit doses and barcoding systems to harmonised procurement processes’.
But she is also realistic about the challenges. A survey by the European Association of Hospital Pharmacists concluded that most hospitals still don’t have plans to implement automation systems, and Francine acknowledges that ‘this is a long game, with huge complexities, particularly in terms of funding and policy’.
But, she says, ‘the potential benefits – fewer errors, better patient outcomes, and a more efficient healthcare workforce – are enormous.’
Ultimately, Francine’s approach to digitalisation within a hospital setting is both visionary and pragmatic. While she is passionate about the potential of technology to transform healthcare, she is also deeply aware of the human factors involved. At the heart of her work is a commitment to ensuring that digital systems serve not just patients, but also the healthcare professionals who care for them.
18th September 2023
Advances in technology mean that moving from microscopes to digital alternatives can now be achieved without sacrificing image quality. Here, Professor Gina Zini reflects on the wide-reaching benefits of digital developments in morphology including time savings for busy morphologists, improved clinical collaboration, enhanced training and sharing expertise with developing countries.
When I started my career as a haematologist, examining a blood smear meant looking through a microscope. This was the standard throughout the world.
Advances in technology have since led to the development and deployment of new approaches in many countries. In particular, digital tools have played increasingly supportive roles, often replacing or reducing the need for many manually intensive tasks in laboratories.
The potential for digital, particularly in areas such as haematology and morphology where I specialise, is now expanding further as more sophisticated technologies continue to be introduced. The aims: to improve efficiency, quality and collaboration in an environment where scarce professionals are in high demand.
Digital morphology analysers have been adopted in many parts of the world as one means to improve efficiency in the laboratory, as well as the quality of reporting in screening programmes. Such devices have helped to automate parts of the screening process, analysing large quantities of blood smears to help to identify abnormalities.
Technology certainly hasn’t replaced the role of haematologists. Human interaction still plays a very substantial role in screening programmes, with haematologists intervening when cases are flagged, and validating significant samples in an ongoing process to help to ensure accuracy and reliability.
Modern digital morphology analysers have allowed professionals in the laboratory to view, validate and report from images on screen, enabling them to more easily find cells and areas of concern than if they were looking through a microscope.
Recalling images on the screen, compared to searching for the cells on a slide under the microscope, also represents a great advantage in terms of both the necessary time and effort for busy laboratory teams.
The on-screen availability of digital cellular images has facilitated intra-laboratory, and sometimes inter-laboratory, consensus and harmonisation, with images easily accessible and searchable for teams who are onsite and those working remotely.
Access to digital images can, for example, allow staff to share images with other colleagues for expert opinion, even if that colleague is working at home.
Additional gains have also been presented by digital technologies. A blood smear can sometimes provide the primary, or the only, evidence of a specific diagnosis, such as myelodysplastic syndrome, leukaemia, lymphoma or haemolytic anaemia. Such blood smears may need to be stored over the long term, which is more easily achievable with digital morphology images.
For some abnormal parameters provided by the automated analysers, such as red blood cell abnormal parameters, accuracy can be higher and less subjective than grading using microscopy. This can help staff to deliver important reports after conducting only a rapid qualitative assessment of the smear.
In short, digital morphology has been delivering significant advantages in laboratories seeking to improve turnaround times, quality and costs, helping to alleviate some of the fatigue and workload challenges associated with optical morphology and improving the opportunity for repeatability and the easier management of cell images.
The need for highly capable digital tools has now intensified. Their role is transforming from supporting the efficient business of the laboratory to one of an urgent necessity for screening services under pressure.
There is now a crisis of human resources in fields like haematology and morphological analysis, fuelled by the availability of fewer experts each year, who continue to manage an ever-increasing workload to support preventative healthcare. The situation now requires even better technologies to augment capacity.
Digital morphology analysers represent an important example of technology that has evolved to support this, and where innovation continues.
Historically, though helpful, older devices have presented some limitations. Many of these devices have worked by rebuilding an image rather than displaying a true image of the smear. This means that images appear differently to those seen on glass slides through optical microscopy.
Consequently, laboratory teams reviewing an image have needed additional training to be taught how to interpret images and recognise areas of concern from images produced by specific devices, in order to be able to report in an effective and consistent manner.
This is now changing. New digital technologies are able to reproduce precisely what is seen under a microscope, allowing clinicians to immediately check and validate the images on the screen.
There is no need for any additional time to locate the slide, position it on the microscope table, search for the observation and counting area, focus with objectives at different magnifications including the addition of oil, as occurs when working with an optical microscope.
Time spent is dedicated to observing the cells and confirming their pre-classification or moving to a different subclass, when necessary. After the movement, the system will automatically regenerate the percentages of the differential, which also significantly reduces the amount of time it would have traditionally taken.
This ability to create images that are indistinguishable from the microscopy view is state of the art. Efficiency gains and support for better quality reporting are benefits that speak for themselves in the context of stretched resources.
But it also opens up new possibilities around training and collaboration. Digital morphology can, in general, reduce the time it takes to train a good morphologist. But it is also worth bearing in mind that despite growing adoption, only around 37% of the world uses digital morphology. Many developing countries, for example, still rely on microscopy as their primary tools.
Having access to technologies that can reproduce an image as seen under a microscope, opens immediate opportunities for laboratories using digital morphology to share recognisable images for training purposes with professionals and trainees in countries where the technology is not yet widely used.
And if we can increase adoption of digital morphology that produces images familiar to those who use microscopy, opportunities to improve screening, reduce false negatives and extend the many other benefits that digital morphology can bring could be realised.
Professor Gina Zini is an associate hematology professor at Università Cattolica del Sacro Cuore, and Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy. She is also a board member and past scientific secretary (2012-22) at the International Council for Standardization in Hematology. Professor Zini has recently contributed to a performance analysis for the MC-80 automated digital cell morphology analyser launched by medical device provider Mindray.
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