EHEALTH IN THE ITALIAN AND EUROPEAN HEALTHCARE SYSTEMS

eHealth 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 eHealth as a common tool for operators, patients and citizens, in order to improve the quality of health care assistance and productivity.

EHEALTH: ONLINE HEALTHCARE

According to the Ministry of Health, the term eHealth 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. “

eHealth, also known as online health, is becoming increasingly important thanks to its initiatives that improve access to care by citizens and contribute to increasing 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 that is more 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 eHealth 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 EHEALTH DEVELOPMENT IN THE ITALIAN HEALTHCARE SYSTEM

According to an IDC report, eHealth spending in Western Europe is expected to reach $ 14.1 billion in 2021, with a greater growth in software and services, and a decrease in hardware. The largest investments will come from the Public Administration, especially the local one, and will be addressed to digital technologies and ICT for hospitals, while private investments will stop at 1.6%.

The eHealth 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 concerns the electronic medical record, without forgetting the 14 million euros of investments in solutions for downloading web reports and internet bookings. Positive signals are coming from the same 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.

5 KEY POINTS IN THE DEVELOPMENT OF EHEALTH

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 eHealth sector:

  • Definition of priorities in respect of local contexts;
  • Evaluation of stakeholders' constraints and requests;
  • Definition of sustainable development approaches;
  • Optimisation of the project efforts and of the investments;
  • Guarantee of consistency of the paths and results achieved.

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 involvement of the general practitioner, of the outpatient and hospital level, and of those who are involved in the management of the post-acute phase;
  • The start of the care pathway, which takes place through the primary care physician, supported by the electronic health record and the telematic sickness certificates;
  • The outpatient and hospital care, supported by electronic health records and dematerialisation;
  • In the post-acute phase, that regards the taking care of the citizen by the territorial services, the relevant eHealth solutions are the electronic health record and the Telemedicine. The care path can include, at any time, the patient's return to the Territorial Assistance.

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

Telemedicine is considered a priority area, for this reason the investments related to this field are growing, 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.

BIG DATA

That of ​​big data analytics and business intelligence is an area that arouses great interest in strategic directions. 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.

ARTIFICIAL INTELLIGENCE

Even artificial intelligence in the health field will grow, reaching 6.6 billion dollars in 2021 and today there are strong investments in the sector. Thanks to AI, in fact, it 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 EHEALTH INITIATIVES AT NATIONAL AND EUROPEAN LEVEL

At the European level, the fastest growing eHealth market is the one of the United Kingdom, while Germany is the country where investments grow most rapidly. Below you can find the main eHealth initiatives at the European level, mainly attributable to the following areas of intervention:

  • The healthcare call centre, which allows citizens to book health services throughout the whole national territory;
  • The EHR - Electronic health record, for archiving and access to individual health information;
  • The ePrescription, for the digitalization and electronic transmission of prescriptions and sickness certificates;
  • The structural and organisational redesign of the assistance network through telemedicine.

The spread of information systems for online health allows the dematerialization 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 undertaken at the national level are consistent with the strategy defined by the New Health Information System, and that they keep up with the measures implemented in the other EU countries.

EHEALTH 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 that health spending in Italy continues to lose ground and 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.

5G

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

Currently, 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:

  • Support for clinical decisions, with guidelines and best practices;
  • Management of informed consent to health procedures;
  • Digital services for citizens, an important investment area;
  • Services offered by mobile technologies, which is still low but growing as regards the functionality of the electronic medical record.

HEALTHCARE SOFTWARE

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.

2019: EHEALTH IN SHORT

The latest summer news come directly from Emilia Romagna, which further simplifies the relationship between citizens and health. In fact, from July 2019 the paper recipe has been supplanted by the barcode visible on the electronic health record. It is sufficient to show the pharmacist this sort of dematerialized recipe present on a smartphone or a tablet, and with the activation of a simple barcode it will be possible to receive the requested drugs.

To speed up the recovery of the prescription even more, a new item has been introduced on the file in the “deliverable drugs” menu. Here you can view the list of prescribed drugs to be collected at the pharmacy.

In this way, both users and pharmacists get a further simplification without changing the relationship between doctor and patient. Furthermore, within the health dossier it is possible to find the copy of the red recipe issued by the doctor, which cannot be printed or reused, as well as the electronic recipe reminder, which instead can be printed, reprinted and delivered to the patient from the doctor.

Further news on the Connecting Healthcare are coming from Farmindustria. Digitization is truly revolutionizing 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 eHealth.

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. Through the total respect for patients’ privacy, eHealth in the hospital environment will become really strategic. The patient is at the centre of everything, allowing healthy people and patients to increase their active participation in the health system with digital solutions.

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 hospitalizations will be reduced.

Here the problem of the skills needed to recognize the fake news in the medical sector comes into play, so it is necessary to promote the dissemination of safe information sources. Moreover, digital skills will also be useful to recognize, among the many apps available in the stores, those that really improve digital access to health facilities.

By 2025, the convergence between the progress of science and digital technologies, which allows the production of innovative medicines and improves the organization of work, will need professional figures in step with the times, which will not replace the old figures, but will interact with them.

To sum up, today 93.5% of medical prescriptions have been already dematerialized. Certainly, the slowness of the Italian health system will persist for several years, but the digital solutions of the future will lead towards a more modern and efficient health system.

To learn more about eHealth and smart healthcare, take a look at the other articles in our JOurnal!

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