e-Health: how technology is changing medicine
The Internet and new technologies, including mobile technologies, have irrevocably changed the way we communicate. The rapid and continuous evolution of the knowledge economy influences and affects the activities and behaviour of individuals and businesses, as well as the social, economic and political events of a society.
These transformations also have a strong impact on the healthcare sector, both because of the intrinsic characteristics of the effectiveness and efficiency of innovation itself on the health system in general, and because of the specificity of being able to provide solutions that overcome the traditional geographical boundaries between patient and doctor, a need that has become dramatically evident during these last few years of pandemic emergency.
Electronic and multimedia networks are playing an increasingly significant role in the healthcare system.
As early as 2008, the European Commission highlighted the importance of telemedicine services, defining them as a “cultural revolution” to be implemented in each Member State, even though it was aware of the complexity of their organisation and implementation.
Moreover, the same Commission set in the objectives of the “Digital Agenda 2020” the need to implement key actions in the field of Telemedicine.
The contribution of IT, Information Technology, to the health sector can certainly be a driving force capable of supporting new models, virtuous models, to respond in a different way and with new opportunities to the traditional problems of medicine.
At present, Italy, with the PNRR, the National Revival and Resilience Plan, will invest about 2.5 billion in digital health. In particular, 1.3 billion to create a homogeneous data infrastructure (FSE electronic health record) throughout the country that can collect the entire clinical history of patients and about 1 billion to activate telemedicine, i.e. to provide digital health services based on the data infrastructure.
Important investments to overcome a gap compared to other countries, if we consider that the National Centre for Telemedicine of the Istituto Superiore di Sanità was only founded in June 2017.
In order to examine such a complex subject in depth, we spoke to Professor Angelo Rossi Mori Professional Master in eHealth Management of Rome Business School, who said:
“Telemedicine has been widespread in Italy for about thirty years. Before the pandemic, the Istituto Superiore della Sanità and the Ministry of Health had surveyed about 600 resolutions of local and hospital health authorities, which were unfortunately extremely fragmented throughout the country. From this point of view, there has been a lack of logic in putting them into a system, and even more so of a coherent support policy. If on the one hand the Covid 19 pandemic has placed a very strong emphasis on telemedicine, which is an extremely circumscribed sector of the use of technologies in healthcare, on the other hand it has had the undeniable advantage of clearing Telemedicine through customs as a whole, because it has forced some processes of transformation of the National Health System to be speeded up, so that it can be used in a structured manner. With the PNRR, Italy will have funds dedicated precisely to the construction of digital infrastructures for its development towards practices that are not experimental and isolated, but with a view to real integration in the Public Health System.“
How the doctor-patient relationship is changing
According to a recent study by Frost & Sullivan, the digital health market could reach a turnover of €17 billion by 2026. These investments should focus on the relationship and communication between professionals and patients, bringing collaborative tools such as teleconsultation, TV and messaging into full use, without forgetting the delicate area of data security.
In Italy, according to the Osservatorio dell’Innovazione Digitale in Sanità (Observatory of Digital Innovation in Healthcare), in 2021, 3 out of 4 doctors considered telemedicine to be a fundamental tool for carrying out the healthcare profession. The emergence from Covid-19 has highlighted, in fact, the primary role of e-health, because it has indicated the home as the place of care, thus ensuring the care of patients in their own homes and the application of virtual techniques has introduced important improvements in care. In fact, telemedicine places the patient at the centre of the digital revolution, building a network of services capable of assisting him or her 24 hours a day, making him or her an active and aware participant in the care process.
“Telemedicine should be seen as a new way of managing health. It incorporates several channels of communication between doctor and patient: televisita, telemonitoring of pacemakers for example, or messaging for therapy updates. Of course, telemonitoring is not a replacement for a regular visit but a segment of home care. It is an upgrade of the normal telephone call with the advantage of being more ‘structured’: the doctor receives more information through the video call and the patient is more satisfied with the direct relationship, even if mediated by a smart-phone. However, the patient must have a minimum of computer knowledge and have access to a mobile phone, tablet or computer. In this new “health system”, the family or community nurse is also included. Let’s forget the old figure of the parasanitary nurse, today this profession has evolved thanks to specialist degrees, masters, PhDs: it has become an important resource, a care manager, who follows the patient on a daily basis and who liaises with the general practitioner or specialists as needed, in a bottom-up and top-down logic“.
Interoperability and Co-operability of Information Systems
Rossi says that in Italy too often health IT has been conceived as a mere accumulation of non-integrated hardware and software systems.
On the contrary, the technical infrastructure and the underlying IT apparatus, necessary for the provision of services, must be harmoniously integrated, because they are both tools for the organisational and administrative management of the healthcare system. The networking of the system, if from a merely technical point of view it could be relatively simple, requires an effort in the definition of the general processes and an ability to ensure a correlation between the different sectors.
“I distinguish between interoperability and cooperability. Interoperability is the ability to cooperate between information systems that have to talk to each other. In Italy we have not yet reached an adequate level of interoperability of systems, which are often still independent of each other, but standards are spreading.
Co-operability is the ability and willingness of people to collaborate. Collaboration between different actors is a priority in the new healthcare. Until now, this aspect of the problem has often been neglected. In universities, they teach patient management mainly at the specialist level and the perspective of working together to manage the complexity of the person in an integrated way is usually not explored. In addition, we need to make intelligent use of technology and information for conscious and participatory patient engagement and monitoring. Teaming up is not trivial, and when we succeed in this we will be talking about the health ecosystem and not just e-ealth.”
The pandemic emergency has undoubtedly given a considerable impetus to the implementation of innovative care models and the creation of pathology networks.
In Italy, from the North to the South, initiatives to transform care processes are multiplying, but there is no unified project. A first attempt can be seen in the “Linee di Indirizzo Nazionali in telemedicina sancite in conferenza Stato Regioni” of 2014, acknowledged by the various Regions, but without uniform applications, and the PNRR. It envisages many changes, such as the blanket introduction of Community Homes.
In Italy the best paractises on the use of technology are mainly in the centre-north, but in my experience I have also found excellence in Calabria and Sicily. However, all experiences remain isolated. In some Local Health Authorities diabetes is managed, in others cardiovascular problems.
These experiences are not ‘copied’ and systematised throughout the country. The IT and technology industry in healthcare is under-utilised. We have a budget of 1.5 billion a year when it should be at least 3 billion: this increase in the budget would have a positive impact on the entire country system. New jobs would be created, chronic and frail patients would be better cared for, with less burden on caregivers, for example, and the use of paid leave granted to employees for caring for family members would be limited. Good health would have a significant economic impact not only on the health system but on society as a whole.”
E-commerce in healthcare is heavily regulated in Italy. Medicines are only sold online in pharmacies.
“If the system works it is the doctor who prescribes the medicine, so you buy all and only the medicines you need. If the purchase is left to the individual, who is influenced by advertising, it is clear that he is led to buy unnecessary products.
In addition, long-term drug therapies are very often neglected by the patient over time; intervening on the adherence of therapies with the help of technology would make it possible to obtain all the expected health benefits and avoid wasting resources on therapies that are not very useful because they are incomplete”.
The health file
The confidentiality of personal and sensitive data is a very sensitive issue that has been debated for years, also from a healthcare perspective.
One of the most important aspects is the sharing of information between healthcare teams that draw on patient data through electronic health records, whose privacy is regulated by European legislation under the GDPR, the General Data Protection Regulation.
“Italy is perhaps the only country where the health file was created by the Ministry of Economy. This shows that there is a distortion in the system, because the one who has to govern the health ecosystem is the Ministry in charge together with the Regions, of course with the support of technology, artificial intelligence, the information system. It is absolutely necessary to overcome the dichotomy between the clinical world and the technological world. These two separate areas of knowledge must be able to work together, bearing in mind, however, that it is the health system that has to be the driving force.“
ANGELO ROSSI MORI
Started working in ’73 on medical informatics, then on clinical informatics, health informatics, ICT for health, eHealth, connected health, technology-enhanced integrated care. I has more than 20 years of experience on design principles and technology assessment in national and regional health strategies for meaningful use of digital technologies (eHealth, Telemedicine, Home Automation).With the Consiglio Nazionale delle Ricerche and Federsanità ANCI he has worked in several European projects in the field (including GALEN, KAVAS, IREP, GALEN-IN-USE, TOMELO, C-CARE, PROREC, WIDENET, EHR-Q-TN, eHealth ERA, RIDE, ANCIEN, STOPandGO, RITMOCORE, EURIPHI).On behalf of AGENAS and FORMEZ, he provided technical support to regional health managers in Sicily, Campania, Calabria on a sustainable approach to eHealth and modern telemedicine.In the 1990s he was active on standards for health informatics, in particular on: semantic interoperability, clinical datasets, EHR systems, integrated care pathways, contributing to the creation of the CEN/TC251 and ISO/TC215 committees.Within HL7, he was member of the Technical Steering Committee and co-chair of HL7 Templates SIG and founder of HL7 Italy.