How is digital health in Italy? What progress has been made during these fifteen months of the pandemic? How will it be possible to take full advantage of the experiences on the ground and the opportunities offered by the National Recovery and Resilience Plan? These are some of the questions that the research of the Digital Innovation in Healthcare Observatory of the School of Management of the Politecnico di Milano, presented today during the online conference Digital Health beyond the emergency: more connected to restart. The pandemic has pushed the spread of digital tools in the health sector, also accelerating the knowledge and use of it by citizens, doctors and health facilities in the different phases of the treatment process. Spending on digital health grew by 5% compared to the previous year, reaching a value of 1.5 billion euros, equal to 1.2% of public health expenditure and about 25 euros for each citizen. Digital is a channel increasingly used by citizens to search for health information: 73% searched online for information on correct lifestyles (compared to 60% in 2020) and 43% inquired online about the vaccination campaign. But also for the prevention and monitoring of one’s health, with 33% of patients having use app to monitor their lifestyle and more than one in five use apps to remember to take a drug (22%) or to monitor clinical parameters (21%). Telemedicine has entered the agenda of political decision makers, who have dedicated 1 billion euros of resources to it within the National recovery and resilience plan (Pnnr), and in the daily life of doctors, including the percentage of use increased from just over 10% pre-Covid to over 30% during the health crisis for most applications.
A still fragmented process
But the digitalization process of the health system still fragmented and inhomogeneous. One of the most critical points is the digital skills of healthcare professionals, today insufficient to ride the new trends of the technological revolution. 60% of medical specialists and general practitioners (Mmg) have sufficient basic digital skills (digital literacy), related to the use of digital tools in daily life, but only 4% have a satisfactory level in all areas of professional digital skills (eHealth competences). A more digital and connected National Health Service, then, cannot ignore adequate management and enhancement of data in healthcare, but the main asset for collecting data on patients, Electronic health record (ESF), still little used: only 38% of the population has heard of it and only 12% aware of having used it. The PNRR represents a great opportunity not only for the resources deployed (7 billion for the development of proximity networks, structures and telemedicine for local health care, and 8.63 billion for innovation, research and digitalization of the NHS), but because it outlines the objectives to be pursued to build Healthcare of the future, from the development of digital culture and skills in doctors and citizens to better governance of digital initiatives and more widespread collaboration between the various players in the health system.
A necessary revolution
The pandemic has highlighted the importance of digital to make our health system more sustainable, effective and resilient – he says Mariano Corso, scientific director of the Digital Innovation in Healthcare Observatory -. The PNRR is a great opportunity to overcome the frailties that emerged during the health crisis and start planning post-emergency healthcare right away. To start again “connected” means use digital to promote more effective collaboration between all actors in the health ecosystem and model health services on the needs of citizens / patients to support health professionals. A necessary revolution that can only be implemented by developing the culture and digital skills of health professionals, citizens and patients, improving the governance of digital projects to overcome fragmentation, evaluating the results of investments enabled by the resources of the NRP and making the most of best practices. In 2020 the digitization process of our country’s health ecosystem has accelerated, but it is still proceeding at different speeds on our territory – he adds Cristina Masella, scientific director of the Digital Innovation in Healthcare Observatory -. The resources of the NRP are an opportunity to complete the transition towards “Connected Care”, but it is essential to use them appropriately, investing them for fill the gap still present in many regions and healthcare companies, enable innovation also from an organizational point of view and to promote and share the most virtuous experiences.
The Electronic Health Record
The management and enhancement of data in Healthcare is one of the priorities indicated by the NRP, but the potential of the main asset for collecting patient data, the Electronic Health Record (FSE), is still to be grasped. The files, although activated for almost the entire Italian population, are often incomplete, lacking the most useful information and documents for doctors and patients and, according to a survey carried out in collaboration with Doxapharma, are still little known and used by Italians.: only 38% have heard of it and only 12% are aware of having used the tool at least once. If we consider the point of view of chronic patients or patients with serious health problems, involved in the research carried out in collaboration with Aisc, Apmarr, Fand, Federasma, Onconauti and Ropi, the situation improves: patients know the ESF in 73% of cases and use it in 37%. The most used services are access to online reports (by 52% of citizens and 88% of chronic patients) and to electronic prescriptions (44% and 88%). The implementation of the electronic health record must be an absolute priority for our health system and must be accompanied by an adequate information campaign because the limited awareness of its existence among citizens represents the main barrier to its full dissemination – he explains Paolo Locatelli, scientific director of the Digital Innovation in Healthcare Observatory -. It will also be important for the ESF to spread make it more complete, integrated and interoperable and it must be enriched with innovative digital services of interest to the population, such as care plans.
More connected citizens, patients and doctors
88% of patients learn about their pathology online and 73% of citizens use the Internet to get information on prevention and lifestyles. The most used digital services are the online withdrawal of clinical documents (37%, against 29% pre-emergency), the online booking of visits and exams (26%) and the online payment (17%). 45% of citizens who booked a vaccine did so online (29% of those over 65). With respect to communication between doctors and patients, it was also analyzed the point of view of medical specialists, in collaboration with Ame, Fadoi, Pke and Simfer, e of general practitioners (Mmg), thanks to the collaboration with Fimmg. The most used email tool both by doctors (79% of Mmg and 85% of specialists) and by patients (55%), but with the emergency the use of collaboration platforms by Mmg (54% against 12% before the Covid crisis), specialist doctors (70% against 30% previously) and patients (30% against 11%). Among the digital tools that can be used in the healthcare system, health apps can be a valuable aid in the phases of prevention, treatment and follow up and are particularly appreciated by patients because by using them they are more aware of their pathology and their state of health in general (46%) and because they help them to respect their treatment plan (42%) . An offer of apps certified as medical devices or digital therapies it would favor the spread of these tools and, probably, greater confidence on the part of doctors in recommending them to their patients – he stresses Emanuele Lettieri, scientific director of the Digital Innovation in Healthcare Observatory -. Doctors highlight how the reduced clarity of the clinical validation process of these applications is holding back the development of an Italian market. We also need to work on skills because even today few doctors are quite clear about the difference between health apps and digital therapies (24% of Mmgs and 32% of specialists). Compared to digital therapies, medical specialists are interested in solutions to improve nutrition (71%) and physical activity (66%), as well as adherence to therapy (60%).
Telemedicine finally entered the agenda of political decision makers, who understood how fundamental it is to guarantee continuity of care, even at home, and the integration between hospital and territory – he states Chiara Sgarbossa, director of the Digital Innovation Observatory in Healthcare -. The acceleration imposed by the pandemic and regulatory developments has also increased the interest and use of telemedicine applications by doctors. If before the emergency the level of use was just over 10%, during the emergency it tripled, exceeding 30% for many applications. The most widely used telemedicine service is tele-consultation with specialist doctors (47% of specialists and 39% of Mmg use it), which also attracts the interest of 8 out of 10 doctors. tele-visit (39% of specialists and Mmgs) and the tele-monitoring (28% specialists and 43% Mmg). These services are still little used by patients, not so much for lack of interest but because of a still limited supply. The phone call or video call with the doctor is still the most used modality for remote monitoring of health status (23% of patients). The use of structured telemedicine services is still marginal, such as the tele-visit with the specialist (8%), the tele-rehabilitation (6%), the tele-monitoring of clinical parameters (4%), which, however, are of great interest in perspective, with percentages close to 90% for tele-monitoring and tele-visit with the specialist. According to medical specialists, telemedicine solutions would allow for remote organization about 20% of follow-up visits to chronic patients. This idea is also shared by patients, for whom the percentage of remote visits exceeds 40% for many pathologies. In 2019, only 3% of the visits made by medical specialists with chronic patients took place digitally. Considering the estimates of medical specialists on remote visits (20%) and only patients with chronic diseases (24 million in Italy), the Observatory estimated that thanks to the strengthening of telemedicine services 48 million hours wasted on avoidable journeys could be saved, which rises to 66 million hours considering that 35% of patients are accompanied by a caregiver to their doctor.
May 26, 2021 (change May 26, 2021 | 12:38)
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