The COVID-19 pandemic has spurred unprecedented progress in the field of digital health. A great example of this is the growth seen in tools such as Catalonia's La Meva Salut, which, in little more than a year, has seen a jump from 600,000 to more than 4,300,000 users. To analyse and debate everything we've learned over the period, the Universitat Oberta de Catalunya's eHealth Center organized the first eHealth What If Forum series, which has just drawn to a close.
Spread across three sessions with different geographical focuses (Spain, Catalonia and Latin America), a range of health system experts and stakeholders took the chance to talk about the event’s theme: "What if the digitalization accelerated by COVID-19 enabled us to transform health systems?"
The pandemic, a catalyst for digital solutions
For Albert Barberà, director of the UOC's eHealth Center, "it has become clear that the pandemic has been a catalyst for the implementation of digital health solutions. Now the consensus is that, after a year and a half, we need to have good look at everything to analyse what's been useful and what hasn't, bearing in mind that, given the complexity of the situation, emergency solutions were often provided." All this without forgetting that, as Marta Aymerich, UOC Vice President for Strategic Planning and Research, noted: "healthcare doesn't begin when we go to the doctor, but is associated with how we live in all the places and at every moment of our lives. Digital health invites us to look after our own health and that of the community at large."
The discussions made it clear that there is consensus around a number of the positive outcomes arising from the mass use of digital health tools during the darkest days of the pandemic. More specifically, online care prevented the system from collapsing at times of greatest pressure, digitalization facilitated and speeded up many processes, and demonstrated the ability for and value of managing a large amount of very complex data.
Areas for improvement
However, the ramping up process stemming from this exceptional situation also showed that some areas had room for improvement. Sometimes, the rushed nature of rollouts resulted in unnecessary duplication, there were problems with changed protocols, and some promising applications, such as those providing 'test and trace' services were not finally implemented or didn't prove to be particularly useful.
Further negative conclusions were taken from how some patients viewed digitalization as an unwanted and lower-quality replacement for in-person care. Nevertheless, there was agreement in affirming that – if properly developed – digital health does not entail the dehumanization of healthcare. In fact, on the contrary, it makes it easier to spend more time on those who really need it. It is a complement to, rather than a replacement for, in-person healthcare.
Although the focus of digital health is often on technology, the sessions made it clear that the main challenges are not technological, but rather organizational in nature. As Barberà said, "technology is just a tool. The digital transformation is a subject impacting professionals and the general public alike that entails a cultural and organizational shift." That's why it's crucial to always bear the public in mind, not only when looking at issues like the digital divide, but also in designing products to meet their needs. They need to feel comfortable with the channels used and they need to form part of the decision-making process from the get-go, not just at the end.
More organization, training and resources
Another important factor is the training provided to professionals to allow them to act as facilitators, because resistance often springs from unfamiliarity. And they should feel comfortable with the tools and the way they are implemented, also bearing in mind the fact that the pandemic has placed the spotlight on digital health and has led to increased investment. One complaint from primary care during the pandemic is that healthcare workers weren't always up to speed on organizational issues. Although we have now seen an increase in the number of them who appreciate the advantages of the model, the lack of a clear organizational plan means a risk of many thinking it's easier to solve everything in the traditional, in-person way. There's also a fear of an excessive workload and a lack of resources. It's not just a question of implementing digital solutions, but also one of providing the resources necessary for doing so properly, as well as ensuring that professionals don't feel that, rather than a solution, they cause more work than before.
International telemedicine to overcome shortcomings
One digital health-related possibility increasingly gaining traction is that of developing international telemedicine to help broaden the scope of services by addressing each individual country's particular shortcomings. In the final session, Francesc Saigí – a member of the UOC's Faculty of Health Sciences and the current series' coordinator – presented the results of a recently published report commissioned by the Inter-American Development Bank, which studied the possibilities of developing international telemedicine in a number of different Latin American countries. The report, containing the results of a survey of 1,443 professionals across 19 countries, as well as interviews with 29 experts in the field, shows that there is evidence of the benefits of developing an international telemedicine model. However, only 17% of professionals use this tool, and barely 20% intend and are ready to do so.
Some of the obstacles for its implementation are technological but, as is the case elsewhere, legal and organizational limitations are also a factor. Additionally, changes in government often lead to policy setbacks, meaning there is a need to start from the ground up again due to a failure to systematize the lessons learned.
Political backing to ensure positive change
For Barberà, there's no doubt as to "the importance of digital health and of the analysis of the data generated by health systems in the implementation of public policies, and this means seeking social consensus on how to use these data. […] It's crucial for there to be political backing for the digital transformation, at both a national and supranational level, [because] the boom witnessed during the pandemic may turn out to be merely a mirage, but it could also mark the start of a necessary change in our health systems."
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