“The next major milestone in healthcare will be integrating clinical, biological and contextual data into a single solution,” Shaila Calvo, Head of eHealth & Biotech at Gradiant

Digital health is moving towards more personalised, efficient and secure models, driven by technologies such as artificial intelligence, federated learning, advanced data management and privacy-enhancing solutions. At Gradiant, this vision is reflected in European projects such as ICAREWOUNDS, which seeks to improve chronic wound management through an integrated care model, and FLUTE, which focuses on the secure use of health data to advance the application of AI to prostate cancer diagnosis.

Leading this area is Shaila Calvo Almeida, recently appointed Head of eHealth & Biotech after more than five years as a research engineer in the Intelligent Systems department.

Five years ago, you joined Gradiant as a junior research engineer, and today you are taking the lead of the eHealth & Biotech area. How have you experienced this progression?

Honestly, every time I think about it, I find it hard to believe that five years have already passed. When I joined Gradiant, I was finishing my Master’s degree in Telecommunications Engineering at the University of Vigo and I was still not entirely sure what I wanted to do professionally. Although I had studied engineering, interacting with people had always been very important to me, so an internship focused on applying artificial intelligence to healthcare seemed like a very motivating opportunity.

Shortly after I joined, a vacancy opened for a junior research engineer and I was able to start working on PERSIST, a European project in which I completed my Master’s thesis on the use of AI to detect circulating tumour cells. That was also when I began taking on some small management responsibilities.

Then came the opportunity to lead a technical work package in FLUTE. I remember feeling highly motivated, but also quite afraid that I was not ready, probably because of the impostor syndrome that so often appears. Even so, I accepted, and I believe it was one of the decisions that helped me grow the most. Later came the technical coordination of ICAREWOUNDS and other national projects.

At the same time, Gradiant offered me a two-year training plan to prepare for the position of Head of eHealth & Biotech, including training in management, business and interpersonal skills, as well as support from my manager and other colleagues.

But beyond the projects and responsibilities, I believe that what has truly brought me here is the people. I have been fortunate to learn from those who were part of the team when I arrived, from those who joined later, and from many colleagues in other areas. I have always felt a great deal of support, trust and patience, both professionally and personally, and that has been essential in encouraging me to take on each new challenge.

Gradiant works with technologies such as AI, federated learning, big data and data security. How are these technologies applied in the eHealth & Biotech sector, and what impact can they have?

As in other fields, these tools are designed to “make our lives easier”. Healthcare is, of course, a particularly sensitive field, not only because of the sensitivity of the data and the need to protect it properly, but also because of the very direct impact these tools can have on our health and well-being, which is ultimately what matters most to almost all of us.

That is why the use of all these tools in healthcare and biotechnology requires an additional level of protection and responsibility. However, when they are used consciously and with a proper understanding of how they work, they can provide tremendous support both to healthcare professionals and to us as citizens and patients.

A typical example we often discuss is a primary care consultation. Statistics indicate that a doctor has between seven and ten minutes to see a patient, including the initial conversation, reviewing the medical record, carrying out an assessment, making decisions and explaining the next steps. As we can imagine, it is very difficult within that time to access all the relevant information needed to make decisions, for example, to identify links with previous diagnoses, treatments or consultations. AI technologies are very good at analysing large amounts of data and finding patterns quickly. A model capable of detecting links between new symptoms or situations and past events, and presenting them to the professional in real time during the consultation, can therefore make decision-making much more informed and probably more efficient.

For us as patients, this can translate, for example, into more accurate or faster diagnoses, or more personalised treatments. For professionals, it can provide greater confidence and more information when making decisions. For healthcare systems, it can mean more efficient use of resources, for instance, by reducing waiting lists caused by repeat consultations or the costs associated with inappropriate treatments. This is only one example, but the potential uses of AI and data tools in healthcare are almost limitless: from the rapid detection of tumours in medical images to support for genetic analysis aimed at identifying the risk of developing certain diseases so that preventive measures can be taken.

All of these are extremely powerful support tools, provided that we use them responsibly and that the final decision is made by expert professionals. Another critical aspect, as I mentioned earlier, is that all the data we are discussing are highly sensitive, from a disease diagnosis to genetic information. They must therefore be very strongly protected at all times, not only when used by an AI tool but simply because they are stored on digital devices. For this reason, all technologies related to privacy and information security play a critical role in this sector and must be incorporated into every digital solution from design through implementation.

One of the projects you coordinate is ICAREWOUNDS, which is built around artificial intelligence. What problem are you seeking to solve?

ICAREWOUNDS aims to improve chronic wound care through digital tools and artificial intelligence. These are complex wounds whose healing times can range from four months to a year, and they have a major impact both on patients’ quality of life and on healthcare systems.

One of the main challenges is that every wound is different and there are multiple treatment options. Choosing the most appropriate one requires experience and depends not only on the wound’s characteristics and tissues, but also on other factors such as nutrition and hygiene. However, staff turnover means that patients are not always treated by specialised professionals.

ICAREWOUNDS therefore proposes a comprehensive care model that brings all these aspects together in a support solution for healthcare professionals. The solution consolidates expert knowledge and provides recommendations tailored to each patient and their wound. It also integrates AI models capable of automatically analysing tissue from a photograph and helping to select the most appropriate treatment.

The ultimate goal is to shorten healing times, improve patients’ quality of life and reduce the burden on healthcare systems.

To achieve this, we work within an international and multidisciplinary consortium made up of clinical organisations, technology partners and specialists in socioeconomic, ethical and regulatory matters.

When we talk about healthcare, technology and artificial intelligence, we are dealing with a great deal of highly confidential data. How do you pursue innovation without compromising data privacy?

We mainly address this through two approaches that are considered from the very design of the projects. The first is ethics and European and national regulation, which already place a strong emphasis on data protection and, in fact, classify health data as a special category requiring enhanced protection. The second is the continuous research and development of new security and privacy technologies.

Security is one of Gradiant’s most important research areas. Gradiant’s eHealth team works closely with the centre’s security and privacy teams to ensure that all the solutions developed are secure.

A good example of the collaboration between the eHealth team and the security and privacy area is the FLUTE project. Its objective is to develop a federated learning solution for the secure training of AI models; in this case, to support prostate cancer diagnosis. Federated learning makes it possible to train models without moving the data away from its source, which in this case means the hospitals.

To explain it more clearly, imagine that we want to train an AI model to support the diagnosis of this disease using patient data from three different hospitals. A traditional machine-learning model would require the data from the three hospitals to be brought together in one place. This raises significant ethical and regulatory challenges, which greatly slow down the data-sharing process. Moving the data away from its source also creates security risks. With federated learning, instead of taking the data to the model, the model is taken to the data, so that it is trained directly within the hospitals. This addresses the privacy challenges I mentioned. In addition, the project adds another layer of security through trusted execution environments, or TEEs, which provide hardware-level security beyond the programming techniques that may be applied. 

How do you build technology that genuinely reaches healthcare professionals and patients?

The key is to work directly with them throughout every phase of the project. Historically, end users were brought into projects during the validation stages, meaning that researchers and technology developers created technology for them. As a result, many of the solutions were based on assumed needs that, in most cases, did not reflect reality.

This paradigm is changing, and we are now developing technology with these people. This way of working is known as co-creation. It means that end users, in our case, healthcare professionals, patients and others, as well as all relevant stakeholders, such as healthcare-system decision-makers and experts in regulation and ethics, are involved from the earliest phases of the project: from requirements gathering and design through implementation and final validation. Involving users from the design stage allows them to share their perspective on the real needs they experience and their expectations regarding how the solutions being developed can address them.

The only way to create technology that will genuinely be used is to ensure that it fits properly into the day-to-day work of the person who will use it. Let us return to the example I mentioned earlier of a GP having ten minutes per consultation. We can develop an extremely advanced decision-support tool, but if it is not easy to use and cannot be smoothly integrated into the workflow of a medical consultation, it will not be adopted, no matter how effective it is. The only way to ensure that the tools developed are used is to ask the people who will use them directly.

Of course, to ensure genuine transfer into practice, it is also necessary to include the perspectives of those who determine healthcare workflows and decide which technologies will be introduced, as well as experts in ethics and regulation.

In summary, solutions must be co-created in a multidisciplinary way, taking into account the perspectives of all relevant stakeholders rather than being developed in isolation by technology experts.

A successful example of co-creation is KIUR’s technology, which has recently been launched as a spin-off from Gradiant’s eHealth team. This technology has been co-created at Gradiant with healthcare experts from SERGAS/IISGS since 2016, so their expert knowledge, identified needs and preferences have been incorporated from the outset

What do you think will be the next major technological milestone with a significant impact on the healthcare and pharmaceutical sectors?

The integration of AI into many research, production and care processes, of course.

AI is already here, but implementation in healthcare and biotechnology is still not progressing as quickly as in other sectors, so there is a great deal of work yet to be done.

To highlight a few specific areas that I find particularly interesting, I would first mention the use of AI to understand the complexity of people’s molecular composition and interactions, DNA, proteins and so on, and not only in humans, but also in animals and other organisms. As we know, AI is very good at analysing large amounts of data and identifying patterns. I therefore believe that a key milestone will be using these tools to gain a better understanding of which components are associated, for example, with a higher risk of developing certain diseases or with responding better or worse to particular medicines.

I also believe that the new approach being taken to health, through concepts such as integrated care and One Health, is essential. Most AI models in healthcare have based their predictions on clinical data without considering other cross-cutting factors such as the environment or social context. However, many studies show how relevant these factors are to health. I therefore believe that the challenge and the next major technological milestone will be to integrate all clinical, molecular, social and contextual information into a single solution, allowing us to move towards truly more personalised medicine.

A career inspired by technology’s social impact

In 2022, you told us that what you liked most about your work was its social dimension. Is that still the case?

Absolutely. As I mentioned at the beginning, what motivates me most about my work is designing solutions that can have such a direct and positive impact on people’s lives and well-being. Some people are highly motivated by a particular technology, and its ultimate purpose is not as important to them. For me, it is the other way around: what truly motivates me is the final use, the purpose of the technology and the impact it will have on people.

After working in this field for some time, you become aware of the many needs that healthcare professionals, patients and caregivers may have, needs that we may never stop to consider until we hear about them directly or experience them ourselves. Technology can help address many of these needs, and that is ultimately our role. We cannot cure a patient ourselves, but we can make our own contribution by providing experts with tools that support and facilitate their work and decision-making. For me, that is genuinely motivating.

Speaking of social impact and commitment, we recently saw you discuss gender-sensitive technological development in one of our Tech Talks. Do you think incorporating a gender perspective is a challenge for the technology sector, and specifically for healthcare?

Absolutely. Incorporating a gender perspective into healthcare is already a recognised and increasingly prominent challenge, although there is still a long way to go. Differences related to biological sex and to gender, understood from a social and contextual perspective, directly affect our health and must be taken into account when developing eHealth solutions.

In cardiovascular disease, for example, there are not only biological differences in symptoms, but also differences in help-seeking behaviour. Some studies indicate that women take longer to contact emergency services or seek medical attention when experiencing chest pain, thereby increasing the risk of complications.

This demonstrates the importance of active listening and co-creation. To design technologies that respond to these situations, it is necessary to consult women and understand the social and contextual factors that influence their decisions. It is also essential to consider the impact of hormones at different stages of life. In this regard, we recently discussed the FemTech phenomenon in an interview for the ‘Érase una Red’ initiative promoted by Hi Coruña, and how technology is beginning to recognise women’s specific health needs, for example, during the menopausal transition.

Turning to talent, in Spain only one in three people enrolled in university STEM programmes is a woman, according to figures for the 2023–2024 academic year. The gender gap therefore continues to persist. Why do you think this is?

I believe the gender gap in STEM education is closely linked to deeply internalised social stereotypes. For many years, engineering and technical careers were considered male domains. Although this perception has changed, certain ideas about which professions are more suitable for men or women are still present.

Increasing the number and visibility of female role models in these fields is essential so that new generations can see themselves represented. However, from childhood, women continue to receive messages associating femininity with sensitivity, empathy and caregiving, which may influence our academic and professional choices, even unconsciously.

It does not seem coincidental that women are less represented in STEM programmes while being strongly represented in fields traditionally linked to caring for people, such as nursing, pharmacy and psychology. Rather than a question of ability, I believe we are dealing with social expectations and roles that continue to shape our decisions.

Looking back, from joining as a junior research engineer to your new role as Head of eHealth & Biotech, what lesson would you like to share with people starting out in technology?

At the beginning, I spoke about how important all the people I have worked with over the years have been and continue to be to me, both professionally and personally. This did not begin recently; it goes back to university. I enjoyed studying with friends. We prepared assignments, problem sets and exams together, and spent hours discussing ideas until we reached solutions. Working life is no different.

At first, people may imagine that working in technology means each person sitting at their own computer programming, but the reality is that in every project we spend hours talking and debating. Every solution we design and develop is influenced by the opinions and experience of many different people, both within the centre and beyond it, all working towards the same objective or purpose. So I would say that my greatest lesson, beyond the technical or technological aspects, is the enormous importance of teamwork. 

Finally, what excites you most about this new stage leading eHealth & Biotech at Gradiant?

The opportunity to lead an area and define its strategy within a technology centre such as Gradiant is extremely motivating. Alongside the social dimension, one of the things I enjoy most about my work is designing projects and technological solutions.

I enjoy understanding a problem or need in society and thinking about the technological and non-technological components required to address it. This new role allows me to make decisions in that respect, including decisions about the projects and research lines of greatest interest to the centre. And I will not pretend otherwise: having my own team is incredibly motivating! I have spoken many times about how important people and teamwork are to me, so being able to manage and closely support these people throughout their professional journeys is also something I find very exciting.

ICAREWOUNDS project has received funding from the European Commission, ISCIII, NCBR, HRB, AKA and MUR under the framework of the co-funded partnership Transforming Health and Care Systems (THCS), GA No. 101095654 of the EU Horizon Europe Research and Innovation Programme. 

FLUTE project has received funding from the Horizon Europe Framework Programme (HORIZON) Research and Innovation Actions under grant agreement Nº 101095382.