Digital health: in Italy doctor-patient-companies still use e-mails and sms - reduce the gap with the EU - monitor chronicity
(by Nicola Simonetti) Demonstrated that digitalization can play, in healthcare, both in the provision of new care models, and in favor of the sustainability of the Health Service. But Italy denounces backwardness: investments in digital health care by the public and private system appear to be insufficient, and the management of the chronic patient, and citizens in general, is not very digital. These are, in a nutshell, the conclusions that can be drawn from the conference held in Rome, Palazzo Giustiniani, on the initiative of the Roche Foundation.
“In chronic diseases, digitization is a major issue when thinking in terms of planning social and health interventions. In recent months - said Mariapia Garavaglia, president of the Roche Foundation and former Minister of Health - on the occasion of the 40 years in our National Health Service, Fondazione Roche has set itself the objective of supporting a debate on the values on which it is based : equity, equality and universalism - he added. In particular, its universalistic character can be severely tested by the gap between available resources and citizens' needs and to respond to these needs, guaranteeing the economic sustainability of the system, digital solutions represent a fundamental lever for finding new balances. "
Digital innovation - said prof. Paolo Locatelli, scientific director of the Digital Innovation in Health Observatory of the Politecnico di Milano - represents the useful element to bridge the gap between needs and resources ... digitization must be expressed in the processes of organizational and technological renewal, but also of patient empowerment / citizen and development of the skills of health professionals.
Medical records, telemedicine, apps, wearable devices, artificial intelligence, big data analysis, etc. can help achieve the goal of long-term economic sustainability of the National Health System, contributing to the provision of an adequate level of quality of care, with obvious benefit for the patient and the country system. A goal, according to the photograph traced by the Observatory of the Politecnico di Milano, based on Istat data and the second GIMBE Report on the sustainability of the NHS, severely tested by the numbers: in the face of an overall health expenditure, between public system and outlay direct of the citizens, stabilized in the last 5 years around the 145-150 billions of euro, the estimated requirement for the 2025 is around 210 billions, given that we must add the fact that the Italian population over 65 is in strong growth, representing it, already today, the 21,8 per cent of the total - one of the highest figures in the western world - and is projected at the 2051 at almost 35 per cent, over 1 on 3 citizens.
"In effect," said Locatelli, "there is a growing awareness that digital solutions can play a fundamental role in supporting the transition to new models of care. The diffusion of these solutions, however, is struggling to be realized today because there is no coherent orchestration of the digital transition and because the charges, risks and benefits expected from the introduction of new tools and working methods are not perceived as shared equally among the actors of the system .
"According to the Observatory's data, in fact, the total expenditure for digital health in Italy, among those invested by the Ministry of Health, the Regions, individual health facilities and the general medicine network, amounts to 1,3 billion (data 2017), equal to approximately 22 euros per citizen. "This is a fact that places Italy in rearguard positions. Consider that, without arriving at the values of Scandinavian countries such as Denmark, which invests 70 euros, countries and systems closer to us such as the French or English "spend" 60 euros per citizen Great Britain and 40 euros France. "
To date, digital in the continuity of care is still little developed. For example, according to the Observatory survey, the solutions that enable the exchange of data and documents on patients through computerized PDTAs are only used by 29 per cent of healthcare companies, with healthcare professionals from different departments, and from the 23 per cent with professionals within one or more pathology networks. The IT support for patient care activities is widespread especially for management and administrative activities, such as the management of patient personal data (in 80 per cent of companies) and the management of reservations (63 per cent). Instead, computerization is struggling to spread as a tool for implementing individualized paths according to the principle of stable patient care: on average, 1, a company on 3, uses digital support in defining, viewing and updating plans for individual assistance, for the analysis of patient data and for connecting all the players in the health system.
Even citizens are "not very digital", according to the Politecnico Observatory. The lack of skills seems to be a strong barrier: three out of ten citizens do not feel able to use these tools, especially among the elderly. To bring citizens closer to digital, therefore, it is necessary to increase the supply of services, train citizens / patients and value reliable and valuable solutions.
As many as seven out of ten citizens prefer the direct encounter with the doctor to the digital deck. Among those who use digital tools, most use email (15 per cent), then text messages (13 per cent) and WhatsApp (12 per cent). Among the doctors who do not use these tools, one out of two fears that there may be misunderstandings with patients and there is a widespread concern that the use of these tools may increase the workload of the doctor and that it may involve risks associated with a failure to comply with privacy regulations.
"Those who use it, use basic tools that often do not require specific training or a profound change at the cultural level. Instead, it is important that doctors are increasingly attentive to their training with respect to the digital skills necessary for the development of new digital innovation projects useful for improving processes and health services ".
Finally, data confirm that, in Italy, 39,9 per cent of residents are affected by at least one chronic disease (24.133.105 people), while those with at least two chronic diseases represent 20,9 per cent of the total (ISTAT 2018) and of these, the 70 percent are non-adherent to the therapy, which corresponds to an outlay by the Italian Health Service of approximately 11 billion a year (AIFA data).
It is therefore evident that the current standardized therapeutic approaches have shown limitations and the personalization of the treatment can represent a winning way to break this clinical-therapeutic inertia and the digital tools provide the necessary opportunities to make it possible.
The teacher. Valeria Tozzi, SDA Bocconi Associate Professor of Practice and Director of the MiMS Master, Bocconi University in Milan, also recalls how the management of chronic diseases absorbs between 70 and 80 per cent of health resources. "To summarize - explained Prof. Tozzi, therefore - there are some trends that are emerging in the management of chronic diseases in our country, which would surely benefit from digitization. These are the approaches of Population Health Management, as an evolution of PDTAs (therapeutic therapeutic and care pathways): integrating information of an administrative nature coming from the big data of the Regions and of the healthcare companies with those of a health nature related to the patient represent an important challenge; the highly complex chronicities for which the role of specialized skills and complex technological resources are central, as well as the need for an important relay between hospital and territory. Also in this area, the technology dedicated to the exchange of information, such as telemedicine, has a fundamental role. "
It is therefore very appropriate, therefore, the hope of the Roche Foundation, so that institutions, health professionals, patient associations, civil society and industry can work together to extend and strengthen digitalisation in healthcare. The whole world is going in this direction, digitization is now in fact a key element of union in all areas. It takes on an even more significant role in the life of a person with a chronic illness, forced to live with its management on a daily basis. All the tools that facilitate and simplify this everyday life, the relationship with the doctor and encourage greater adherence to care cannot but give life to a virtuous system, in favor of the quality of life, health and above all the dignity of the person. Without forgetting that greater adherence to care is equivalent to lower costs for the Health System and, therefore, optimization in the availability of resources.