By Franco Arteaga and Pamela Quispe
Recent technological advances in the area of healthcare digitization have allowed procedures and practices performed in various medical centers to be improved and optimized. In recent years these inventions, which have been developed and implemented mainly in Europe and countries such as the United States, China, India, Mexico and Indonesia (Revista OMPI, 2019), are having a positive impact both on patient care management, as well as on the use of resources to achieve this end.
However, in most Latin American countries and mentioning Peru's public health system explicitly, the lack of equipment and technological systems required to be able to offer an adequate health service is emphasized. In view of all this, through this article, the fields of digitization are presented, along with the technologies used and that are generating a transformation in the area of health. Likewise, the panorama of that change at a global and national level is shown, highlighting the various positive and negative aspects of its implementation, emphasizing the challenges that still remain to be overcome in Latin America and in our country.
Healthcare Managment in modern times
The current era called the "age of digitization" has been characterized by the presence and new role of new information and communication technologies, it being considered as a disruptive element that has transformed the world we used to know. It is questionless to ignore the great impact it has generated on elements of our daily life, such as entertainment, work, even the way how we socialize (Sonnier, 2020). However, the characteristics that define the digital world in which we live go beyond the everyday use of tools such as social networks, web pages and mobile applications. This concept refers to new communication channels that allow better management, control and flow of information in real time (Peña, 2017).
The impact of digital technologies has greatly influenced most sectors that make up society, specifically speaking of the healthcare sector worldwide; combining conventional health practices with current technological developments, resulting in a new terminology that seeks to explain that "complementation", entitled "Digital health" (Sonnier, 2020).
The term Digital Health is defined by the organization "Healthcare Information and Management Systems Society, Inc." as follows:
Digital health connects and empowers people and populations to manage health and wellness, augmented by accessible and supportive provider teams working within flexible, integrated, interoperable and digitally-enabled care environments that strategically leverage digital tools, technologies and services to transform care delivery. (Snowdon, 2020)
It is important to emphasize that not any digital technology related to the health sector can be considered as Digital Health, but specifically all "technology that facilitates the healthcare treatment of a patient, as one more part of the therapeutic approach" (Principio Activa, 2020), in other words, every digital tool that is used in the diagnosis, management, prediction or prevention of a disease of the treated patient (Principio Activa, 2020).
Given the above, it is mentioned that digital health encompasses various technological fields. Its scope mainly involves health information and communication technologies (E-health), mobile health (MHealth), telehealth and telemedicine (FDA, 2020). The field of health information and communication technologies is defined, according to the World Health Organization, as the set of technological tools that, through the use of safe and cost-effective electronic means (IntraMed, 2012), facilitate the transmission of information and communication processes, in order to improve the well-being of individuals (García, Navarro, López y Rodríguez, 2014). Mobile Health (MHealth) is the group of mobile devices, such as tablets and smartphones that support the practice of healthcare, fulfilling a key role in intra-health communication, between health professionals, doctors and patients (SIVSA ,2018).
On the other hand, Telehealth consist of technologies that enable remote health care, which can be considered as such: the internet, satellite and wireless communications, computers, cameras, among other elements; likewise, this field involves the training issues of health professionals, medical care administrative meetings and, in the same way, services provided by pharmacists and social workers (MedlinePlus, 2020). Finally, Telemedicine is defined as a subset of the field of Telehealth, which consists of the remote provision of clinical services, thanks to existing telecommunications infrastructure. It covers remote patient monitoring, warehouse and dispatch technologies, and interactive telemedicine. (Clinic Cloud, 2015).
Digital Health Background
Throughout the last 70 years, technology made great advances that, without a doubt, had an impact on different aspects of our lives such as habits, social relationships or even our behaviour (Ricciardi, 2019). One of his greatest achievements in the field of health was improving the health status of patients, as well as research on signs, symptoms, medicines and food production.
Europe began a tireless effort to improve the quality of life of its citizens for a few years. In 2018, the European Commission designated as priorities: secure access of citizens to health data and its cross-border exchange, better data to promote research, disease prevention and personalized care, digital tools for citizen empowerment and person-centered care (Odone, 2019).
In 2019, during the event called “WHO Symposium on the future of digital health systems in the European Region” it was concluded that the individual must be placed at the center of the health system, and digital health must be driven by needs and people, not technology. In addition to this, an agreement was reached to take into account, mainly, 3 points: a transition to predictive and preventive care models; the individual must be the center of their own health and well-being, the rights and consent of the individual must be respected and acted upon; and digital health must help achieve universal health coverage with equitable and quality access to healthcare for all.
Before the pandemic generated by COVID-19 and, according to PAHO, 70% of countries had a national e-health policy. As well as, 27% of them had a strategy for telehealth, where at least 72% of countries carried out remote monitoring of their patients (Aponte, 2017). With the arrival of the coronavirus, 68% of member countries suffered an interruption of their monitoring systems for diabetes, hypertension and cancer detection. This would cause, according to their projections, an increase of 10% in mortality from breast cancer and 15% from colon cancer (Mann, 2020).
However, Latin America has many more challenges to overcome. From 1999 to 2019 it has presented a slow increase (Curioso, 2019). In recent years, this growth has been directed towards digital health policies or strategies, which were seen as a future tool that would reduce gaps in health care and improve case monitoring as well as promotion and prevention.
According to PAHO, America already presented a mixed picture before the arrival of the coronavirus, as many countries still had very incipient e-health practices. Furthermore, only 36.8% presented an idea or formulation of a strategy for telemedicine. As for big data, they were still in an early part (OPS, 2018). Let's remember that health digitization is not only about data but about finding value in it.
Looking more specifically at Latin America, Jennifer Nelson, a specialist in digital solutions for health at the IDB, stated that there are still gaps with respect to connectivity, software and training of health personnel in these new technologies; since health systems are based on paper administrative processes. Another of the great challenges that he mentioned was the regulatory gap that still persists in Latin America. Only 26.3% have a strategy that supports the use of digital health.
Digital Health Technologies
Various applications of Digital Health have been implemented in several countries. In Estonia, considered as the pioneer country in the area of digital health, operates with electronic prescriptions, electronic files of patients and a national health network with the aim of decreasing the duration of therapies and facilitating diagnoses (Luber, 2020). In Spain, during the Digital Health Congress 2.0, the “Trak Physio” project was presented, which consists in the implementation of a software that allows the development of a tele-rehabilitation treatment for patients through physiotherapeutic exercises, which are monitored by health professionals remotely (Salud Digital, 2020).
The United Kingdom was the first country to innovate with 3D printing since 1986. "3D Systems" became the first company to carry out this activity. Throughout these 34 years, they changed the use of 3D printing in different fields such as health. Anatomical models, is one of the categories in which they work. With the help of a tomography or magnetic resonance previously taken from the patient, they can print 3D models that serve as pre-surgical planning or pre-surgical test for educational purposes (3D Systems, 2020).
Another category in which this company works is medical simulation. Through it, surgeons can practice in simulators that look and feel as real procedures and offer a safe environment. Within the field of dentistry, 3D printing is an innovation that optimizes the time on the patient and the efficiency of prosthetic, orthodontic or even implantology appliances (3D Systems, 2020). It is already a reality in different Latin American countries, however, in our country it is still very rudimentary in the field of health.
In Peru, the telehealth field was boosted even more with the arrival of the coronavirus that caused the cancellation of face-to-face medical appointments that were usually made in hospitals or private clinics. All this caused the search for alternative options that could allow the monitoring of patients with chronic diseases and the tracking of new cases of covid-19. Within the field of telemedicine, we find different platforms and applications that carry out teleconsultations, teletriages, teleorientation and telemonitoring.
On the other hand, we find that there are already prototypes of health technologies, created in our country such as Glucolib, which allows the measurement of glucose through non-invasive methods, avoids pain and prevents contamination. Another project is the telemedicine system for rural areas, winner of Fondecyt, this project proposes to realize a primary diagnosis and clinical follow-up of patients that live in very long distances. It is the first e-health system adapted to our reality which, through cloud technology, means reaching remote areas of our country (Fondecyt, 2019).
One of the latest advances in artificial intelligence (AI) that aims to optimize user times. However, the controversy of the AI's is in the replacement of employees by them and in their margin of error (Cohen, 2020). Health professionals will not be replaced; they will be supervisors of those IA that seek to improve the health administrative system. Those IA's created for diagnosis are an aid to the medical team. Let us remember that all technological responses must be validated by a person who verifies the contribution of this new technology.
Positive and negative impacts of digitization
Health care used to have long and tedious times for both health personnel and users. Thus, ICTs became the best ally to alleviate those frustrations. During this year, we observed the start of a pandemic that shook the hospital environment and permitted us to recognize the lack of it in different countries, including Peru. Likewise, it elucidates the importance of digitization in health to avoid saturation and improve personalized attention in medical attention.
Manu Guedes, a Spanish digital expert, mentions that healthcare has already evolved towards virtual consultations, reducing up to 50% in face-to-face health care. During the last year, thousands of applications have been launched (325,000 health apps in Spain only) whose objective is to improve the administrative process for appointments in hospitals, as well as guarantee the care and monitoring of their patients by health personnel.
According to the INEI 2019 survey, in Peru 92.0% of families have at least one cell phone, 60.6% have the internet and 48% have access to a computer. This represents a strong potential market to activate digitization in healthcare. The same year, the Peruvian Government issued DU 006-2020, which creates the National Digital Transformation System to implement technologies in the public and private sectors. However, its implementation in the health system remains very weak. To this we add the fact that less than 9% of Peruvians use technologies to interact with public services or authorities in order to solve their needs (Aponte, 2017).
The second impact occurs in public health investment. One of the latest studies realized in the United States indicates that the use of health apps in the therapeutic field could produce savings of up to 7,000 million dollars for the Government. This implies a huge saving in public spending that could be invested in the promotion or prevention of diseases (Mann, 2020). That's why technology industries today see the health sector as a huge financing opportunity.
Another impact that comes with the previous topics is Big Data, faced with the digitization of care, therapy and medical history, the data collected means a threat to the country in the wrong hands. Therefore, online platforms, electronic records and others must evolve according to the needs of the patient and ensure the security, privacy and effectiveness of the data provided by each user. All this opens a debate about whether our country is prepared to assume the consequences of the new digital era in health.
According to the above, a very important element to be mentioned is the control of information security. Given the large amount of data handled by the multiple technological elements and high dynamism in which digital health develops, there is a huge risk that these systems suffer a cyberattack, causing a possible loss of data, identity theft, unauthorized modification of data, among other negative consequences (Cano, 2017).
The transformation of the hospital industry has already begun in the world, but what does a transformation in health entail? In the first place, it is to create the policy or legal guidelines that guide the development of the new technological era in health and its consequences. A second step, which countries such as Spain have been implementing, is that of the Electronic Medical Record connected to a National Health Network, which automates and empowers health professionals, as well as helps the timely diagnosis of different diseases and their respective control (Labrique, 2018). This implies reducing the use of paper and increasing the use of computer systems.
Unlike other fields, any implementation, whether technological or not, implies having the patient as the maximum beneficiary. Your needs, threats and opportunities are the fundamental element to innovate, ensure efficiency and customization of processes. In Peru, different regulations have already been launched that seek to provide digital, physical and technical security, confidentiality and ethical management of information, however, there is still a long way to establish these bases as principles to implement an integrated digital health system.
In conclusion, Latin America still has technological and sociocultural challenges to address, this is observed in the small number of professional health personnel trained in technological tools, in the overpopulation of them in urban areas and their lack in rural areas. Therein lie the challenges of healthcare digitization in developing countries. Let's not forget that health professionals must participate within the digital transformation team and not just be spectators of change. That is why we call on the various institutions and groups to join forces to achieve the present purpose: Improve the quality of life of patients.
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