Health Systems Upgrade

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Clayton Hamilton leads the digital health flagship program at WHO Regional Office for Europe. We discuss how digitalization and innovation can support health systems strengthening and reform.

How has digital health helped to address the challenges related to the COVID-19 pandemic?

The COVID-19 pandemic has seen an unprecedented demand for digital health across a range of different health system contexts. In particular, digital health is being actively employed by health authorities to reconfigure health service delivery models, scale up surge capacity in primary and secondary healthcare settings, manage critical equipment supply chains, and battle the COVID-19 infodemic.

As our WHO Regional Director for Europe, Dr Hans Henri P. Kluge said last month, digital technology has the capacity to play a leading role in responding to COVID-19, not least to support contact tracing. At least 27 countries in the WHO European Region have released national solutions for digital contact tracing in Europe, with at least four more having solutions underway.

Digital technology and artificial intelligence (AI) have also proved to be effective in other aspects of pandemic response. In France, an artificial intelligence-based virtual phone assistant is able to respond to more than a thousand people at the same time. Italy is trying the use of an AI-based technology that utilizes a smartphone app and camera to capture vital statistics such as heart rate, heart rate variability, oxygen saturation, and respiration rate in real-time. In Sweden, telemedicine has been used to support traditional care, particularly in rural settings, and is now being used for enhanced COVID-19 response.

Digital technologies have proved to be powerful tools to fight COVID-19. However, these same technologies have exposed us to a tsunami of information and have raised many issues around data protection and privacy.

WHO Regional Director for Europe, Dr. Hans Henri P. Kluge, said that “the full potential of the digital health is yet to be realized.” What vision of digitalized healthcare do you have?

WHO’s vision for the future of digital health and its role in delivering healthcare is anchored in the achievement of the health-related Sustainable Development Goals, WHO’s triple billion targets, and its Thirteenth General Programme of Work, 2019–2023.

Digital health can radically change health outcomes as it improves the efficiency and cost-effectiveness of care.

When applied and governed appropriately, digital health has the ability to support equitable and universal access to quality health services; enhance health systems sustainability and affordability of care; and strengthen and scale up health promotion, disease prevention, diagnosis, management, rehabilitation, and palliative care. Digital health can radically change health outcomes as it improves the efficiency and cost-effectiveness of care, allowing for new business models in the delivery of services.

However, digital health will be valued and adopted only if it is trusted by populations. We are still a long way from having the levels of trust required to leverage the full potential that digital health has to offer.

Digital health promises accessible and affordable health services for all. How to ensure that it won’t create another digital divide?

There is a real risk of digital health marginalizing populations on the basis of their ability to afford the solutions and benefits it offers. We must look to options to mitigate any trend in this direction and encourage the development of a suite of global digital public health goods over time that are freely accessible to all.

In Europe, we do not want to develop digital health services that cater only to people who can afford them or that exacerbate existing social inequalities. That is the underlying premise of universal health coverage, and the equitable distribution of the benefits of digitalization is key in addressing this.

We can’t afford to make assumptions about people’s access to technology, such as having the latest model smartphones, and we need to respect that some individuals may not be willing to share their personal data with governments. Solutions should not preclude these assumptions as part of their design.

We often talk about technology as democratizing healthcare and yet at the same time, prohibitive costs and access barriers to the same technology risk having the opposite effect.

Bridging the digital divide requires a multi-faceted approach that tackles social inequalities head on to address issues such as digital literacy, user interface design, access to computers, and much, much more.

How does WHO plan to support the development of digital health systems in Europe based on shared values represented by WHO?

Member States in Europe are under increasing pressure to ensure that national health systems meet the demand for the delivery of high quality, readily available services in spite of zero-growth or decreasing health budgets. Recent advances in mobile technologies, improvements in broadband coverage and the growing acceptance of telehealth and mobile health (m-health) solutions are providing new and attractive options for health care delivery. As a result, many governments are investing in digital health as a means for reforming health systems and for ensuring equitable and affordable access to health care.

To support this utilization, WHO/Europe is developing a European Roadmap for the Digitalization of Health Systems to bring together the multitude of implementation factors to be addressed in digital health systems and service design.

This roadmap will seek to:

  • Address the implementation scenarios for digital health across different phases of pandemic response;
  • Highlight the importance of applying equity and gender-focused approaches to digital health service design;
  • Pay specific attention to issues surrounding health data and its governance;
  • Address adoption of digital health across the full spectrum of health system environments and modalities of care delivery; and
  • Provide forward-looking perspectives on how health systems can transition from a paradigm of reactive care to preventive health.

If you could formulate your personal definition of digital health, what would it be like?

At its core, digital health is a facilitator for public health and the delivery of timely, high quality, cost-effective, and accessible care. I like to think of it not only as a disrupter of existing healthcare paradigms but also as a conduit to empower individuals in making decisions that are right for them in managing their own health and well-being. The future of digital health lies in its ability to bring together people, data, and health services. I believe this is where the transformative strength of digital health lies to ensure that no one is left behind.

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