e-health and smart healthcare are two fundamental components of the digital transformation process that today involves the health sector at European, national, regional and local level. The purpose of the new measures adopted by the Italian National Health Service is the diffusion of e-health as a common tool for operators, patients and citizens, in order to improve the quality of health care assistance and productivity.
E-HEALTH: ONLINE HEALTHCARE
According to the Ministry of Health, the term e-health refers to “the use of tools based on information and communication technologies to support and promote disease prevention, diagnosis, treatment and monitoring and health and lifestyle management. “
e-health, also known as “online health”, is becoming increasingly important thanks to its initiatives that improve access to care by citizens to increase the efficiency and sustainability of the health sector. But how is it born?
Surely, the socio-demographic evolution of the population and the need to improve the quality of health care are a stimulus to the emergence of systems that give the possibility to clearly trace patient’s care pathway, from the first moment of interaction with the health care network. This happens thanks to a system of integrated services in the network that, in real time, calculates parameters such as clinical risk, diagnostic and therapeutic procedures, the resources and technologies used and the level of satisfaction by the citizen.
In a country with a high rate of seniority and with the need for a kind of assistance focused on local services such as Italy, the application of new technologies represents a valid opportunity to balance the quality of services and better manage the available resources.
This is where the government programme of the National Health System comes into play, the e-health Information Strategy, whose main objective is to ensure a coherent and sustainable development of information systems in the territory to support patient’s care.
THE E-HEALTH DEVELOPMENT IN THE ITALIAN HEALTHCARE SYSTEM
The e-health services are mainly aimed at supporting the monitoring of essential assistance levels, the integration of health and social services and the efficiency of primary care. Furthermore, they are designed to contribute to the integration of active prevention interventions, improve the quality of health services and promote the consolidation and development of excellence, thanks to lifelong medical training. Another important aspect is the possibility to control health spending by monitoring the demand for health services.
At a technological level, the most significant investment in the development of medical software in Italy concerns the electronic medical record, also considering investments in solutions for downloading web reports and internet bookings. Positive signals are coming from the several Italian regions on the development plans of the electronic health dossier and on health reforms, which aim to improve the aggregation of health facilities and the integration between hospital and territory.
The Covid-19 emergency has undoubtedly raised awareness among citizens, healthcare professionals and managers of healthcare facilities about the crucial contribution of digital technology in the process of prevention, treatment and care. However, a full evolution of the Italian health system towards the “Connected Care” model is still far from being achieved, i.e. a connected and personalised health system that makes us of a mature use of digital technologies, the exploitation of data and the empowerment of citizens and professionals.
5 KEY POINTS IN THE DEVELOPMENT OF E-HEALTH
Even if the Italian National Health Service advances slowly, doctors are more and more attentive to technology and four out of ten generally use the existing apps to update their skills, in particular WhatsApp to communicate with patients.
Below the 5 key points in the development of the e-health sector:
The respect of regional and local prerogatives and a harmonious, coherent and sustainable development of the information systems on the territory are crucial, in order to concentrate efforts and investments according to shared implementation paths and priorities.
CITIZEN’S CARE PATHWAYS
The new care pathways provided for the citizen and the solutions to support the provision of health services to track the patient’s journey from the first moment of interaction with the health care network, include:
The care pathway provides the patient’s access to the health services through the primary care physician or paediatrician, who updates the patient’s summary and produces the telematic certificates and the electronic prescriptions for illness.
The patient can access the territorial and hospital services through the healthcare call centres, while the electronic health record, constantly updated by those who care for the patient, will contain all the patient’s clinical information, allowing effective and fast assistance, especially in urgent cases.
Telemedicine is considered a priority area, but the adoption of solutions that envisage its application is still distant.
The most widespread telemedicine solutions in healthcare facilities are those of Teleconsultation between hospitals or departments. More advanced solutions, such as Tele-rehabilitation and Tele-assistance, are being tested, slowed down due to the absence of dedicated tariffs.
Technologies developed in the field of telemedicine have made it possible to innovate care for vulnerable people, and companies such as IPPOCRATE AS are leading the way in this digital transformation.
IPPOCRATE AS is a software house specialising in the development of e-health, m-health and health software for medical research, creating digital technologies to support health and healthcare and developing software for companies and research centres in the medical health sector.
As part of a European project, IPPOCRATE AS has developed Domus Sapiens, a home automation system that enables the monitoring of health status and personal habits. This advanced home automation system is based on innovative AAL (Active and Assisted Living) technologies. It collects and processes data through a network of sensors placed inside the building and worn by the patients, in order to intercept abnormal behaviour and behavioural patterns to be modified for people’s well-being.
That of big data analytics and business intelligence is an area that arouses great interest. In business intelligence applications, the data are mainly used to analyse the information located in the administrative databases, used above all to support the allocation of DRGs (Diagnosis-related Groups), the control of appropriateness and the analysis of dashboards of indicators. Even less widespread are the business intelligence applications that collect social media and wearable data.
One of the main objectives of the health and pharmaceutical sector is to boost digitisation, integrating diagnosis, treatment and patient care processes, not only by implementing new technological tools, but also by adopting a more effective data management approach, made possible by innovative artificial intelligence projects. Artificial intelligence in the health field will growand today there are strong investments in the sector. Thanks to AIit is possible to improve the efficiency of the operators, increase the accuracy of the diagnosis, personalise the care and improve the patient’s experience.
THE MAIN E-HEALTH INITIATIVES AT NATIONAL AND EUROPEAN LEVEL
At the European level, the fastest growing e-health market is the one of the United Kingdom, while Germany is the country where investments grow most rapidly. Below you can find the main e-health initiatives at the European level, mainly attributable to the following areas of intervention:
The spread of information systems for online health allows the dematerialisation of health records. Since the situation on the national territory is still highly differentiated, due to the different ways in which technological innovation is used in the various regions, it is fundamental that the network health initiatives are consistent with the strategy defined by the New Health Information System.
E-HEALTH IN ITALY: LATEST NEWS
The problem of the digital transformation in the healthcare sector is fundamental, especially in Italy. It is thanks to the collection and analysis of big data in healthcare that it will be possible to evaluate the return on investment, to create an economic and social value. There are many challenges facing the Italian National Health System, given innovation represents the right solution, precisely because it has a strong impact on performance and costs, and contributes also to the reduction of the waiting lists, optimising care pathways and bed occupancy.
An important boost on this path could come from 5G, the new standard for mobile telephony characterised by high bandwidth, extremely low latency times and unprecedented transmission speeds. These are all elements that can enable the full and ideal deployment of the potential of digital technology, whether in remote surgery, telemedicine or the remote monitoring of chronic patients. With clear advantages for the quality of care, the quality of life of patients and the economic sustainability of healthcare facilities.With the arrival of 5G, Italy moves from the digital healthcare era to the “connected healthcare” one. The Digital Italy Agency, in fact, illustrated the strategy planned by the institution to help innovate services by exploiting the 5G revolution.
Technology enables the integration of welfare and health, both thanks to the spread of emerging technologies and of 5G, and of the electronic health records. The goal is to succeed in allowing the citizen to access his/her file with a single credential system, through the portal managed by the Agency.
ELECTRONIC HEALTH RECORD
Already fifteen Italian regions are already using their own regional electronic health record, while the others are still completing their development. To encourage its use, a bigger involvement of general practitioners and paediatricians is advisable, to include their patients’ information in the electronic health record, linking it to the performance indicators.
The electronic medical record has a key role for healthcare facilities. The consultation functions of medical reports and images are by now quite widespread, but the characteristic functionalities such as the management of the medical and nursing diary or the management of pharmacotherapy are still lacking. The most widespread digital services in companies are the downloading of reports via the web and the booking of services via the web (61%), while the most advanced features are less widespread, like:
The need, at least in Italy, to update the health information systems that in many regions is still obsolete in terms of hardware and software is evident. In fact, even the connectivity can be a problem, since it is often not sufficient to exchange information contained in very heavy files.
The health and social-health data and documents contained in the electronic health record of current and past patients is managed by each region and varies according to the capacity, resources and needs of the regional health facilities. The file contains a minimum set of documents and there are standards for homogeneous and uniform documents in all the regions. These standards are useful because they make it possible to use the health record both as a container for documents and to extract data useful for the research world and health professionals for analysis. Thus, we pass from the mere logic of the document inserted in the electronic health record, to the fundamental data that can also respond to needs other than health planning, such as the need for scientific and epidemiological research and the evaluation of the administered care.
HEALTH INSURANCE CARD
The Italian Health Insurance Card, therefore, is not just a personal document that replaces the fiscal code, to allow the recognition of the patient when accessing to the National Health Service. The Italian health card is also the European Health Insurance Card, which serves to guarantee citizens, who are on the European territory for a temporary stay, the health care they need. In addition, the health card is a means of accessing the services of national and regional public administrations, and is therefore a national service card.
SOME INNOVATIONS IN THE E-HEALTH
Further news on the Connecting Healthcare are coming from Farmindustria. Digitisation is truly revolutionising the integration of patient data, with benefits in improving performance and processes. In fact, from a simple product, the drug becomes an interconnected product, combined with devices, diagnostics, medtech and caregiving, assuming an increasingly important role in e-health.
The greatest advantages are certainly for the elderly, for the possibility of being monitored with telemedicine, but also for the hospitalized children, who can keep in contact with family and friends.
In the field of telemedicine, the importance of the electronic medical record is increasingly recognised. The electronic medical record is not paper-based, it is created and stored in digital format. It is a modality that foresees the use of digital signatures and computerised procedures, so that the printing of documents – during the process or at the end – would compromise the admissibility of the documentation as evidence, in the event of litigation or judicial investigations. For this reason, a clinic or hospital wishing to digitise its relationship with the patient must totally abandon paper. In order to do this, it is necessary to refer to the electronic medical record and not simply to the computerised one, which can be misleading due to the use of digital information systems.
In the coming years, with the improvement of the availability of clinical data that will also facilitate patients’ care, through telemedicine and telemonitoring of chronic patients, examinations and hospitalisations will be reduced.
Within a few years, the convergence of scientific advances and digital technologies will make it possible to produce innovative medicines and improve the organisation of work. There will be an increasing need for the support of experts in digital technologies who will not replace the old ones, but will interact with them.
To sum up, we can say that, since the launch of the health card system as a substitute for paper prescriptions, a few years have passed and, to date, 93.5% of medical prescriptions have been dematerialised. So, it is just a matter of time and the digital solutions of the future will lead Italy towards a more modern and efficient healthcare system.
To learn more about e-health and smart healthcare, check out the other articles in our JOurnal!