The pervasiveness of technology and the exponential increase in data production have contributed to making the digital an integral part of everyone's daily life, affecting many aspects of people's social, professional, and relational lives.
The healthcare dimension is not exempt from this transformation, and indeed has been profoundly affected by it in recent years. years, has been profoundly affected by it. The interrelationship between digital technology and healthcare is also facilitated by the increasing ability to collect and read health data and to provide increasingly effective and personalised services. On paper, data-driven healthcare has great potential, motivating its application and increasing research efforts.
The extension of health services to the digital dimension (and their gradual integration) has two major advantages: on the one hand, reaching populations that have fewer opportunities to interface with the "traditional" interlocutors and spaces of health care; on the other hand, providing services outside the formal health care system, thanks to increased opportunities to monitor and "predict" people's health. Predicting' people's health. With regard to this last aspect, we can think of the great contribution made by 'wearables', all those portable devices that keep track of certain health parameters of the individual.
But the benefits go far beyond these two categories. Among other things, the digitalisation of healthcare is enabling the transition to a system that can make greater use of care at the patient's home rather than in a hospital. At the same time, data-driven healthcare allows for a more efficient and effective allocation of resources, as well as greater control over the quality and effectiveness of the services provided and the technologies and therapies used. In concrete terms, this means that healthcare facilities and hospitals can plan ahead by estimating future hospitalisation rates, which in turn allows them to allocate the appropriate staff to care for patients, for example by redefining schedules and staff rosters, reducing waiting times and optimising resources between departments.
For all these reasons, it can be said that the primary objective of digital health is not the transition from paper to electronics, nor the transformation of activities normally carried out in person to activities carried out at a distance (such as televisit or teleconsultation), but rather the ability to improve the quality and effectiveness of healthcare by improving the decision-making process of doctors through the dissemination of scientific knowledge and the use of support tools whose value lies precisely in the availability of the information they need.
The main opportunities of e-Health can be summarised as follows:
Extending health services to the most disadvantaged populations, who tend to have difficulties in accessing and using them;
Increased control over public health and the services provided;
Putting the patient at the centre of decisions and care;
Supporting and encouraging care at home rather than in hospitals;
Enabling health services to be provided outside the formal health system through Increased ability to monitor and predict people's health status;
Increased ability to allocate, prioritise and plan resources optimally;
Helping healthcare professionals to understand patients' needs and provide more personalised and targeted care.
The increasing production of health data - think of all the databases on the number of infections, deaths and recoveries related to COVID-19 - must be managed through the implementation of flexible, scalable and modulable systems capable of ensuring the proper storage of data in the face of unforeseen events, as well as enabling its efficient processing.
In addition, data collection and management systems must take into account the architecture of healthcare systems, given that healthcare facilities are often made up of several branches distributed across the territory, with the need to process data locally before sharing it. Digital systems
Digital systems must therefore be able to manage all those processes that, by their nature, are mainly processed locally, such as medical records or diagnostic imaging reports.
Today, the healthcare ecosystem is playing a leading role in the data economy through the use of enabling digital technologies (HPC, cloud, IoT, big data analytics & artificial intelligence) in an increasingly connected world.
What is eHealth?
The term e-health has been used a lot in the recent past, but what exactly does it mean? First coined in the late 1990s, it refers to digital health as manifested on the Internet and through the latest technologies. However, there is still no clear definition of this relatively new word.
The noun eHealth, ehealth or e-health was created by some marketing experts around 1999, just like the other more famous "electronic words" (e-commerce, e-business, e-book). This was an attempt to convey the promises, principles and enthusiasm that were developing at the time about the new possibilities that the Internet was opening up for the health sector.
The main difficulty in providing an exhaustive definition of eHealth is that the technology is subject to continuous dynamic change, leading to new applications. For this reason, when talking about eHealth, it should be remembered that it is an emerging field of knowledge, born at the intersection of medical informatics, public health and business, which essentially refers to health services improved through the information provided by the Internet and related technologies.
In a broader sense, the term describes not only a technical development, but also a state of mind, a way of thinking, an attitude and a commitment to global thinking in the online network to improve healthcare locally, regionally and globally through information and communication technologies.
THE 10 BUILDING BLOCKS OF EHEALTH
As we have just seen, the letter 'e' in e-health does not just stand for 'electronic', but implies a number of other 'e's that together better characterise what e-health really is.
EFFICIENCY, EFFICIENCY: One of the promises of e-health is to increase the efficiency of healthcare and thereby reduce costs. To achieve this, it is essential to avoid duplicate or unnecessary diagnostic or therapeutic interventions, through improved communication between healthcare facilities and through patient involvement.
IMPROVING QUALITY, IMPROVING THE QUALITY OF CARE: Improving efficiency through eHealth means not only reducing costs, but also improving the quality of healthcare, for example by enabling comparisons between different providers, involving consumers as an additional resource, and directing patient flows to the best healthcare professionals.
EVIDENCE-BASED: eHealth interventions should be evidence-based, i.e. their effectiveness and efficiency should be demonstrated through rigorous scientific evaluation rather than assumed. Much work remains to be done in this area.
EMPOWERING CONSUMERS AND PATIENTS: By making both medical knowledge and electronic health records available to patients online, e-health opens up new avenues for patient-centred medicine, where patients are freer to make choices for their own well-being based on the evidence of the information they find.
ENCOURAGEMENT: E-health can foster a new relationship between patients and health professionals, towards a true partnership where decisions are made together.
EDUCATION, TRAINING: Through online communication channels, such as webinars, it is possible to improve the training of doctors, but also to provide people with basic health education with preventive information for their health.
ENABLING INFORMATION EXCHANGE: eHealth enables healthcare organisations to communicate with each other in a standardised way and exchange information efficiently.
EXTENDING THE REACH OF HEALTH, EXTENDING THE REACH OF HEALTHCARE: Technology makes it possible to extend the reach of healthcare beyond its traditional boundaries. This is meant both geographically and conceptually. E-health allows patients to easily access healthcare services online from global providers and to purchase all kinds of products and services: counselling (e.g. remote psychological sessions), surgery, medicines and other pharmaceuticals.
EQUALITY: Making healthcare more equitable is one of the promises of e-health, but there is also a risk that e-health can exacerbate inequalities. People who lack money, skills and access to computers and networks will not be able to benefit from digital healthcare unless individual countries intervene with ad hoc policies. The digital divide currently exists between rural and urban, rich and poor, young and old, men and women, and between rare and common diseases.
ETHICS: As e-health involves new forms of doctor-patient interaction, it poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity.
he World Medical Association has published ethical guidelines for physicians using this type of service, emphasising the need to establish an ethical regulatory system that safeguards the interests of patients and reduces the risk of non-compliance and compromised effectiveness. In addition, a recent systematic review (Keenan et al. 2021) analysed the impact of ethical principles in e-health services, giving us a more concrete understanding of the current scenario and future prospects.
Autonomy (facilitating and respecting the decision-making autonomy of those dependent on medical care)
This is the most frequently mentioned theme, and it offers some interesting insights. Indeed, eHealth can either drastically improve the autonomy of some people (e.g. the elderly or vulnerable) or reduce it, as it can lead to a reluctance to leave the home environment, even for a short time. In order not to compromise autonomy, it is necessary to carefully assess and reduce any potential risk.
Non-malevolence and beneficence (preventing or solving another's 'evil' and being willing to act for the benefit of others)
With these principles in mind, ehealth can
Actively promote safety by allowing a patient to be followed at regular intervals.
Prevent potential risks and increase the individual's confidence in health management.
Reduce dependency on professional or family caregivers, improving quality of care and continuity of treatment.
Justice (treating patients equally unless differences are functional for therapeutic management)
When considering justice in the context of eHealth, attention must be paid to equity of access and distribution of services. While it may be easier to access health management services, some people who are not digitally literate or who have particular social, economic and personal circumstances may be excluded. We need to consider these potential barriers and ensure that e-health is accessible to all who need it, minimising any form of discrimination (even if unintentional).
A major concern about the use of e-health is the lack of the 'human touch' and the creation of superficial communication. However, it is important to emphasise that these services can reduce the sense of loneliness for people who do not have many opportunities for face-to-face interaction. Attention should therefore be paid to the context and individual preferences for relationships with health professionals when designing these services.
DEVELOPMENT OF ARTIFICIAL INTELLIGENCE TECHNOLOGIES
One branch of eHealth that deserves special mention is Artificial Intelligence (AI). This refers to the possibility of using data and algorithms to build technologies capable of performing automated tasks. Again, the benefits are many, but the existence of guidelines for proper implementation is crucial. The WHO has identified 6 guidelines, some of which mirror those defined for digital technologies more broadly. These include promoting the well-being and safety of individuals, and promoting transparency and accountability by publishing clear and understandable information. There is also the issue of human autonomy, which must never be compromised, and the empowerment of providers, including through patient and clinician rating systems. Finally, all these practices must always be carried out in a responsible and sustainable manner to preserve the environment, the ecosystem and the climate, and to promote a sustainable future. Specifically, artificial intelligence mimics human cognition in analysing, understanding and presenting complex medical and healthcare data. As a result, when researchers, doctors and scientists feed data into computers, algorithms can analyse, interpret and propose solutions to complex problems.
AI can be used to improve the speed and accuracy of disease diagnosis and screening, enhance health research and drug development, and support a range of public health activities such as disease surveillance, epidemic response and health systems management - all at significant savings to both the public purse and patients. The main tools used are
- Machine learning, a specific branch of AI that aims to develop hardware and software capable of making decisions, which automatically and progressively learn from the data collected and processed to improve decision-making processes over time. It is often used in precision medicine to identify which treatment protocols have the best chance of success for a patient.
- Deep learning and neural networks, which make it possible to improve the accuracy of diagnosis, treatment and monitoring, and to identify the likelihood that a patient will be affected by a disease.
- Natural language processing, a system capable of understanding and interpreting human speech. It can improve clinical documentation, speed up the selection of the most suitable patients for clinical trials, understand and classify clinical documentation and provide decision support.
- Physical robots and robotic processing automation, solutions used primarily to improve operations. For example, robots are used to perform service and routine tasks, repetitive tasks and administrative tasks. Over time, robots capable of interacting with patients during surgery and rehabilitation will become more widespread. An important application of AI is the provision of care in the patient's home, also taking into account the scenario of an ageing population.
AI thus offers great support in clinical decision-making: the doctor is able to make better, more timely decisions based on the analysis of more data. In addition, the results are clear and easy to consult. This use scenario raises important ethical issues, mainly related to a phenomenon known as the "black box problem". This term refers to the inability of machines to motivate the choices made. This lack of motivation leads to uncertainty and a lack of trust in the treatment. Another ethical issue concerns the world of work: there is a risk of job losses, especially if there is a lack of skills in the management and use of new technologies.
The Metaverse: from digital to virtual eHealth
The term metaverse first appeared in Neal Stephenson's 1992 science fiction book. Compared to the 1990s, the concept of the metaverse has changed dramatically. It is no longer simply a digital world, but a virtual world that is closely linked to reality and in which it is possible to interact with other people. A range of technologies such as IoT, blockchain and NFT (non-fungible tokens), augmented and virtual reality hardware and software, 3D graphics technologies, high-performance computing and 5G and 6G converge in the metaverse.
It is therefore a network of collaborative and immersive virtual worlds in which an unlimited number of users can interact, work, shop, produce and participate in various activities using customised avatars that move in purpose-built virtual spaces that reproduce reality. In such virtual ecosystems, which allow reality to be reconstructed into holographic representations, there is artificial intelligence software that can process enormous amounts of data. Therefore, when we talk about the metaverse, we are referring to data ecosystems that recreate reality. The use of visors, digital goggles or sensors allows interaction between the metaverse and the real world, creating an immersive and multi-dimensional experience. Today, the metaverse does not only refer to the world of video games, with which it is generally associated and which is one of the avant-garde sectors, but has numerous fields of application and enables the realisation of various social, economic and educational activities. Among the various sectors that are beginning to be strongly influenced by the metaverse, in addition to gaming, are: fashion, banking, entertainment and even healthcare.
In recent years, the use of virtual reality in healthcare has increased. The first experiences took place in the United States about 10 years ago with the Bravemind project, i.e. the use of augmented reality to treat post-traumatic stress in veterans and war veterans. Consider, for example, the case where specialist facilities or medical staff are not close to the patient's home, and where remote connectivity and all the possibilities of interaction/virtual reality become essential for the patient to have greater interaction with the centre/doctor. Imagining telemedicine in virtual reality means giving patients better access to care even when they are in remote areas. The metaverse also opens up a new frontier in healthcare in terms of the evolution of medicine and healthcare towards the concept of personalisation and proximity; indeed, patients and doctors can be hosted in new virtual/physical spaces that are always available and accessible.
Simulated and immersive ecosystems are part of an integrated care pathway, from diagnosis to follow-up, combining e-care with presence-care (phyigital care) for 360° patient support. The applications of the metaverse in healthcare are manifold, from the training of healthcare professionals to surgery. For some years now, many universities have been using software to simulate clinical cases with virtual patients, providing a truly immersive experience for students. In surgery, the metaverse is also being integrated with robotic technologies to make operations less and less invasive. Developing healthcare services in the metaverse environment certainly offers enormous new potential, but it also raises big questions from a privacy perspective. This is a major challenge for all those operating in the metaverse, and even more so in the healthcare environment, given the nature of the data being processed.
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World Health Organization website. Telehealth. https://www.who.int/gho/goe/telehealth/en/ (ultimo accesso: 08/04/2021).
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