The concept of digital healtho digital healthcaresimilarly to what happened for other areas of particular relevance for citizens and businesses, the pandemic quickly transformed from an idea full of good intentions into a series of technologies and operational tools.
In this regard, it would be enough to recall the number of Electronic Health Records (ESF) active at the moment that, according to the AgID, they reached the figure of 57,663,021. Or even i digitized reports which, again on the basis of what the Agency itself reports, totaled 374,356,968. In both cases, the documentary dematerialization process of the citizen’s file that contains all the data referring to his health and the various types of reports that accompany the care pathways does not exhaust the new frontiers of digital health.
Of the 15.63 billion provided for by Mission 6 of National recovery and resilience plan (PNRR) focused on Health, almost half (7.36 billion) relate to technological and digital updating, while 4 billion aim at strengthening home services with the use above all of telemedicine. Telemedicine projects “may concern every clinical area and promote a wide range of functions – reads the PNRR – along the entire path of prevention and treatment: tele-assistance, tele-consultation, tele-monitoring and tele-reporting” .
What is Digital Health (or eHealth) according to WHO
The World Health Organization defines digital health as “a umbrella term which includes theeHealthas well as developing areas such as the use of advanced computer sciences (for example, in the fields of big data, genomics and artificial intelligence) “.
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EHealth, therefore, coincides for the WHO with those ICT technologies in support of health and related sectors. In addition to electronic medical records and telemedicine tools, it includes the use of mobile wireless technologies (mHealth) and wearable devices (wearables).
The role of eHealth today is considered to be fundamental to achieving universal health coverage (Universal health coverage, UHC) which is part of the Sustainable Development Goals that the United Nations aims to achieve by 2030. Of the 17 Goals, the third has the objective of guaranteeing a healthy life and promoting well-being at all ages through 13 target ambitions including reduction of the maternal and infant mortality rate, the disappearance of AIDS epidemics and universal health coverage.
Target whose positive outcome depends on strong investments, on the policies of each country and on the adoption not of a single technology, but of a vast innovative ecosystem capable of integrating platforms, devices and systems in a coherent way within eHealth, which can be considered the “operational technological arm“Of digital health.
The convergence of technologies in Digital Health
Ecosystem means convergence of technologies. To understand the importance that this assumes in Digital Health, one can take a cue from the case of vital function monitoring devices. It is a market whose global size has been estimated for a value equal to 7.59 billion dollars in 2020a value that should reach nearly 11.97 billion dollars by 2026.
The increase in this type of device derives from the growing demand for home healthcare services and from an evolution towards all-in-one products that combine the measurement of blood pressure, heart rate, temperature, etc. At the same time, their use in hospitals and specialized health facilities is contributing to the spread of IoT sensors worn by the patient with which to detect not only the indications on vital parameters, but also phenomena such as “no movement”, which indicate prolonged immobility and poor walking, or “man down”, which signal the fall of a patient.
The intersection of monitoring tools with the Internet of Things is one of the ways through which the collection of those big data mentioned by the WHO that can flow into the same can take place national repository powered by the Electronic Health Record. With the possibility, made practicable by artificial intelligence algorithms, to strengthen predictive models that ensure “uniform planning, management and control in every territory ”, as advocated in the PNRR, without compromising an imperative protection of privacy when handling sensitive data such as those relating to health.
Telemedicine: safety in online consultations
If we move from the world market for vital functions monitoring devices to that of telemedicinethe figures become much higher, with forecasts anticipating the tripling of turnover in the next 5 years. Of the 87.8 billion dollars expected in 2022, it should even reach 285.7 billion dollars by 2027.
This is the reason why the safety of patient data management must be ensured with a cryptography is at-restthat is, when the data is “at rest” in the storage systems, either in-transit. The latter occurrence, in fact, occurs during the consult online typical of telemedicine.
This is why the Ministry of Health, through the document “National guidelines for the provision of telemedicine services” which was adopted with the Agreement in the State Regions Conference of 17 December 2020, established that “all transfers of voice, video, images, files must be encrypted and comply with current regulations on privacy and security”.
The document also listed what the minimum and sufficient elements must be for remote healthcare services. In particular:
- connection network always available between doctors and patients;
- web portal that doctors access with their account to manage assigned patients;
- access to the web page from a computer or tablet or smartphone for healthcare professionals;
- simple login of patients, who must be able to access the service with their account, with identity verification;
- compatibility with the GDPR for the processing of personal data;
- connection to the Internet with the digital tools that the person has available (computer, tablet, smartphone);
- certification of hardware and / or software, as a medical device, suitable for the type of service to be performed in telemedicine.
Digital Health and virtual therapeutic communities
The ministry document details which are the telemedicine services that can be carried out, distinguishing between televisitwhich may include, for example, the support of a caregiver alongside the patient; the teleconsulto doctor, which is used to share the clinical situation of a client between several professionals at a distance; there teleconsulting medical-healththe teleassistance and the remote reporting. In all these cases, the interaction between doctor, or other healthcare professional, and patient can be defined as “functional”. In practice, it limits itself to addressing the single pathology with the only difference that, instead of doing it in the presence, it does so remotely.
But the needs of a sick person often go beyond physical healing and they embrace a range of requests from different points of view: psychological, emotional, sharing one’s status, clarification of health procedures, reassurance and so on. This is why the loneliness imposed for long periods by the pandemic crisis has given rise to some virtual therapeutic communities with the aim of being able to draw on multidisciplinary skills, as well as being able to meet online other individuals who live at any latitude a condition similar to their own.
An interesting experiment of this model, born before Covid-19 upset the life and habits of all of us, is that conducted by the Regina Elena National Cancer Institute (IRE) in Rome in collaboration with Digital Narrative Medicine, a digital platform for the application of narrative medicine in clinical practice. The experiment in question was able to demonstrate the potential of communication understood not as a mere exchange of information limited to the pathology, but as an opportunity to encourage listening and trust dynamics who can find in digital a tool of extreme facilitation.
App, wearable and online self-diagnosis
Virtual therapeutic communities are one of the channels that brings elements of character to Digital Health disruptive, since it undermines the traditional paradigms around which healthcare revolves as we have known it so far. Another phenomenon that goes in the same direction is that ofonline self-diagnosis. Despite the ostracism that, in many cases rightly, surrounds sites and apps that allow you to independently verify your health by entering the symptoms you accuse, not all solutions are the same.
Ranjan SinghCEO and co-founder of HealthHero, one of the largest digital telemedicine platforms in Europe, was able to underline the criteria for disentangling the so-called “symptom checker”. Assuming that they must first be considered “a real benefit to doctors”, Singh outlined the perimeter of these tools: “At the moment they are proliferating, but their overall performance is significantly below what would be accepted in any other field. doctor, despite the fact that there are borderline cases that consistently provide very accurate results. It’s important continue to test them with rigor and transparencybecause they have the potential to drastically increase the efficiency of our healthcare system ”.
In Italiawhere according to Capterra 40% of people use one or more health applications, the discrimination comes from the certification of the source of the data that are intended to be accepted or not in health documents. Among medical devices and wearables that capture some vital functions, the latter are not taken into consideration from a clinical point of view and have the value of do-it-yourself triage. In the future, probably, the accuracy of consumer apps and devices can be compared to that certified in a clinical setting. But until then, digital health and eHealth technologies will continue to nurture doubts about the validity of online self-diagnosis.