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#EAPM - skaitmeninė sveikatos paslaugų transformacija šiuolaikinėje Europoje

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There is plenty of innovation going on in the health-care sector, although some would argue that there should be even more. But huge a digital transformation is certainly underway and affects health care as much as any other arena, writes Europos aljansas už Pritaikomo Medicina (EAPM) vykdomasis direktorius Denisas Horgan.

The European Commission, for its part, has been working via an Expert Panel to try and identify specific aspects and tangible results necessary to make a noticeable change to health systems and investments at EU level. Other stakeholders are doing the same.

Europe has fundamentally changed from an industrial to an information society. This can be seen everywhere, and in healthcare covers personal and societal aspects (not least with regards to data and data privacy) as well as the technological and scientific ones (genomics et al).

Prevention is more to the fore, now, as is targeted care (the right treatment for the might patient at the right time) and leaps in the use of telemedicine have led to a shift in many cases from hospital-based care to outpatient-based care.

The key focus of the government initiatives is direct to ensure interoperability in healthcare and advance the data sharing process to improve the quality of healthcare services. Seamless data sharing among medical institutions allows healthcare providers to make data-driven decisions and provide faster and high-quality care to patients.

The availability and use of data down the last decades has led to huge swathes of information being stored digitally, but all is still not rosy in the garden. In the healthcare arena, use of data is highly complex - interoperability issues aside, for now - with people needing to switch time-and-again between the real world and the digital/virtual world.

Another big change is that all the knowledge used to sit with healthcare professionals. Now, any patient or citizen who understands the internet can get instant access to huge amounts of information. Healthcare professionals arguably sometimes spend less time explaining the facts these days than they do looking at treatment options, often in consultation with the patient.

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Of course, in this digital world, Europe must strive to have its healthcare digital systems as error-free as possible, as well as totally trustworthy. Not easy with so much information, but utterly essential.

It is a fact that introducing new technologies into healthcare services is complex. Every patient and, thus, every situation is unique and introducing digital situations can be problematic. We are moving way past the one-size-fits-all style of medicine here and now in the 21st century.

Also, some information is difficult to put into a digital format while keeping the context. Furthermore, we now live in an era were self-care management is growing due to technological advances.

But the delivery of goals, as defined by the Institute of Medicine, has not changed. These goals are accessibility, safety, effectiveness, equity, efficiency, affordability, responsiveness and appropriateness. Nowadays we also have to ensure that ‘safe’ covers privacy of data alongside other aspects such as who sees what. And while information can now be shared quickly, so can disinformation.

The Expert Panel mentioned above has recommended that Europe sets up a repository of methods to evaluate digital health services. This, it says, is because it has not found a systematic and collated effort on evaluation options in literature.

Also, it suggests that digital and non-digital approaches should, where possible, be benchmarked to show if and where the introduction of a digital approach has been beneficial.

Meanwhile, evaluation should cover the positive and unintended/unexpected outcomes, and data collected must be used to modify behaviour and optimize the behaviour of the systems.

It has become clear that there is a need to develop a strategy for the digital transformation, as well as a coherent framework for monitoring and evaluating.

And Europe’s policymakers need to find ways to invest in systematic evaluation procedures, as well as in evidence informed policy measures and a robust evaluation methodology.

Support is needed for decentralized/local level decision-making, ensuring, at the same time, interoperability, and policymakers should create an environment that can adopt innovations, be progressive in research and horizon scanning, but also remain cautious when it comes to implementation.

Interestingly enough, there is a move to align literacy with technological development, which means not giving healthcare professionals (HCPs) technology without supporting them in how to use it properly. This basically backs up the long-standing argument that HCPs need continuous education to keep up with advances, otherwise such advances do not achieve optimal value.

Caution also needs to reign to avoid introducing digitization just for the sake of it, while care should be taken in order not to unintentionally create more problems than before the introduction of digital services.

As an over-arching issue, it is generally agreed that interoperability is immensely important (not least in respect of cross-border healthcare), and a failure to address this could potentially be bad for patients.

For example, if different parties do not have information on coding used in a medical health record, confusion will arise. There is obviously a need for agreed and common coding and language.

Due to great leaps in digital technology, for the first time in human history, Transmission Control Protocol/Internet Protocol (TCPIP) is in use as an international code allowing collaboration. Such collaboration and interoperability can be reinforced and improved by the use of a common code and language.

Meanwhile, the concept of ‘digital maturity’ is an underlying one. And in respect of this, it has been suggested that there is no need for any other, newer criteria on healthcare evaluation than already exist. Evaluating digital maturity is difficult without looking at the overall goals of the health system.

As mentioned before, HCPs need to be knowledgable and their experience is also crucial when taking into account their experiences with new products and digital services. This is to ensure that they are fit for practice.

Yet with all our new digital tools, care must be taken not to dehumanize health. Proponents of personalised medicine, of course, agree as this new form of treatment aims to put the patient at the centre of his or her own health care, therefore humanizing the process as much as possible.

Continuity of care is also a fundamental aspect in health generally. And to achieve continuity, there is a need to tackle the problems of interoperability, of information sharing and of potential risks in terms of who sees the information, when and exactly why.

Resilience is critical too, as people begin to rely on services available 24/7, for example in remote areas, it is vital that there is no interference in such services and that a back-up system is in place.

And from an equity point of view, groups such as the visually impaired need to have ways to access the digital services ideally through specific equipment. What must be avoided is a two-tiered system of delivery of care in which digital services work for certain populations while not for underprivileged groups.

After all, a health system should have two simple goals: efficiency, meaning to produce as much health as possible, and equity, meaning that health should be fairly distributed.

Traditionally, inequities between the ‘haves’ and the ‘have nots’ have always been noted. Today, in the context of digitalization there may be a new division in terms of the ‘cans’ and the ‘can nots’. This essentially divides those that can access and work with digital environments and understand information provided to them and those who cannot.

So, it seems that while it is clearly possible to reduce some inequities through digitalization, it is also possible to create new ones. This has to be avoided at all costs, if new opportunities for health-care equity are not to be lost.

Unfortunately, it has been shown that very often best practices are not transferable. With digital services, what applies in one hospital and one country is not always easily transferred to another environment. Hence the need for ongoing evidence-based assessments.

At the end of the day it is clearly important to be progressive, but a little cautious at the same time to reduce the risk of undesirable and unexpected side effects in health care.

And the overall feeling among stakeholders is that the EU needs to play a role where it can in stewarding the digitalization of health services, helping to decide on a joint ‘language’ and encouraging collaboration in this fast-moving arena.

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