Hospital crises, shortage of doctors, service shutdowns, medical deserts, risk of progressively poorer health in specific population groups – these are just a few of the troubles confronted by the health sector, and more specifically the public authorities. One is tempted to say that the solution commonly includes increasing resources and their remuneration, which is the strategy that has been adopted by Luxembourg over the last few decades. However, this approach has its limitations, as evidenced by the ongoing struggle to recruit, and train, the health professionals despite offering higher remuneration when compared to neighbouring countries.
Yet, in an era in which the upcoming generation is seeking to establish and follow new professional paths with a better work-life balance, a higher remuneration does not appear as being enough when it comes to overcoming such healthcare professional shortages. The healthcare system needs to be remodelled to take into account the challenges of prevention and to thus limit the need to call on medical professionals. Additionally, embracing digital solutions can relieve the work of caregivers and free up their time for direct patient care.
Digitalisation is a long-standing concept on which international (WHO[1], EU) and national players have already published major principles and strategies. In 2019, the WHO published its Global Strategy for Digital Health 2020-2025. The publication recalled that the vision of the digital health strategy is to ‘improve health for everyone […] by accelerating the development and adoption of appropriate, accessible, affordable, scalable, and sustainable person-centric digital health solutions […] to strengthen and scale up health promotion, disease prevention, diagnosis management, rehabilitation and palliative care […] in a system that respects privacy and security of patient health information’ [2].
Digitalising, therefore, means integrating new technologies and artificial intelligence into the core of healthcare provision and the daily routines of healthcare professionals. It means turning practices upside down and reinventing the healthcare model. This prospect can be daunting, and it is often tempting to dismiss it by citing a lack of resources to address present needs.
However, patients, who are better informed and engaged in their personal care, are demanding greater use of these technologies. This is particularly evident in situations such as when individuals need to monitor chronic illnesses like diabetes or cardio-respiratory diseases, or when considering teleconsultations to avoid hospital visits.
Nevertheless, different levels of progress can be observed across countries in the European Union. While countries like Estonia and Norway are rapidly digitalising their healthcare systems, others such as Germany, Luxembourg, or France are lagging behind, with digitalisation projects still lacking concreteness.[3]
When the all-too-recent Covid-19 pandemic necessitated widespread lockdowns, the urgent implementation of telemedicine solutions on a high-seed and large-scale basis, such as teleconsultations, tele-radiology, and tele-expertise, became imperative. This raises questions not only about the maturity of healthcare policies in terms of digitalisation, but also about the potential advantages of these new solutions in tackling the seemingly insurmountable human resource challenges facing the health sector. While the advantages are undeniable and will contribute to an updated healthcare system, it is crucial to acknowledge and address the associated risks and ethical issues. This requires the development of a coherent and relevant practice framework that prioritises the well-being of both patients and professionals.
As we anticipate insights from experts representing the World Health Organisation, the United States, and the United Arab Emirates at the upcoming PwC Luxembourg annual Health Conference, this article aims to offer preliminary insights into these complex issues.
Notes:
[1] World Health Organisation
[2] World Health Organisation. Global strategy on digital health 2020-2025. (2020) p.10. Retrieved from https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf
[3] Sopra Steria, Enquête européenne sur la digitalisation du parcours de santé, Communiqué de presse, Paris, 20 juin 2019, p. 1-2.
Digital solutions for new conditions in patient care
Solutions to limit the arrival of patients in healthcare structures
One of the main difficulties hospitals and regulatory authorities face revolves around effectively managing patient arrivals at emergency departments. To further complicate matters, additional problems arise during holiday periods as a result of the usual bottlenecks or in the event of a shortage of doctors in the establishment.
Digital tools already provide promising solutions by classifying patients’ level of urgency, determining the time required to treat them and ultimately reducing their waiting times. Furthermore, healthcare organisations are increasingly adopting teleconsultation tools and outsourcing tasks, such as the interpretation of medical images, to professionals located remotely. These advancements hold the potential to maintain high-quality care while optimising response times.
Indeed, the focus on acute crises in emergency services, requiring the attention and the availability of human resources often deemed insufficient, calls for a system that limits hospital visits where possible. Consequently, avoiding emergency room visits or hospitalisations, requires, for example, the provision of care in alternative settings such as residences, urban areas, homes, or elderly care facilities.
Building upon a foundation of a locally trained healthcare team proficient in modern communication tools like video conferencing for remote consultations, secure platforms for medical data sharing, and harnessing the diagnostic support offered by artificial intelligence, the integration of digital tools and proactive strategies becomes imperative for any organisation. These benefits are reason enough for us to call for the rapid and responsible mobilisation of the regulatory authorities, the digital solution providers as well as the healthcare professionals to re-imagine hospitals, as systems with responses beyond the hospital walls and in a less medicalised and more care-based form. This new model will put greater emphasis on improving the quality of life in our connected living spaces, rather than residing in healthcare institutions. This shift aims to reduce both direct healthcare consumption and transportation, thereby addressing the need to decrease the healthcare sector's carbon footprint on the environment.
Improving the quality of care through enhanced knowledge of the state of health of the population via digitalisation
In a context where concerns about the quality of healthcare persist and where the deterioration of care is blamed primarily on a lack of human resources, it is easy to overlook the significant improvement brought about by technological advancements. Technology has greatly enabled better understanding of a patient’s state of health for both the physicians as well as the patients themselves. Nowadays, patients enjoy greater access to their health data, or at least the possibility of transmitting their data from one practitioner to another, leading to a certain degree of empowerment of the population. With digital tools, citizens can take greater responsibility for their own health and interact more knowledgeably with caregivers. Health exchange platforms are multiplying, offering access to health without the need for extensive travel to institutions, and are thus preventing an overload of hospitals and specialised structures. For patients, these solutions represent a major convenience: they are granted privileged access to medical advice as well as the possibility of carrying out a health check-up remotely or in person, all whilst allowing continuous monitoring of their health status.
This increased access to patient-specific health information strongly contributes to the expansion of personalised medicine and facilitates scientific research. For instance, patient monitoring through computerised health records and digital health applications, such as those used in the management of chronic diseases, makes it possible to have tailored monitoring of the patient and paves the way for medical research projects providing access to representative samples of data. As a result, patients can benefit from personalised support with procedures and treatments that respond more precisely to their needs, thereby contributing to progress and innovation in medicine.
Digital solutions serving new working conditions for healthcare professionals
The use of less staff-intensive solutions
The health sector is undoubtedly facing a major challenge in terms of staff recruitment, with a vocational crisis, particularly noticeable since the Covid-19 pandemic, but also societal changes emphasise a growing demand for a better work-life balance. Can digital solutions be the answer to the challenges faced by health sectors, in particular, that of recruitment?
Digital health applications, Digital Medical Devices (DMD)… can help free up the time of caregivers, particularly by reducing their administrative burdens[1]. Many manual tasks can be replaced by digital tools to significantly reduce working times. The health sector is confronted with three major challenges, which digital health solutions can help overcome:
- Managing the data collected at different locations, inside and outside the hospital, throughout the patient’s journey, and transferring this bundled data securely via a single pathway (e.g., computerised electronic file).
- Managing diagnostic and monitoring equipment used in hospital wards, outpatient departments or emergency rooms.
- Managing staff by ensuring that every individual is trained and kept up to date with regards to the newest diagnostic technologies for patients.
Digital tools make a compelling case in terms of freeing up healthcare professionals’ time by:
- Facilitating transmission between different health professionals by. Electronic records are one example that can reduce administrative tasks such as filing and transcription.
- Facilitating high-quality patient care. The electronic patient record can facilitate the collection of health data and is likely to make it possible to measure the quality of care provided to the patient and to adopt a personalised medicine approach.
- Facilitating the analysis and exploitation of data. Some computerised patient files have become real clinical decision supports, equipped with diagnostic assistance algorithms, enabling the required patient care to be adapted immediately: “In January 2017, an artificial intelligence system supplied by Google, called Show and Tell and based on image classification, succeeded in detecting 90% of benign skin spots, compared to 76% for the dermatologists surveyed (out of 130,000 images analysed)”.[2]
Nonetheless, to guarantee the effective and secure use of digital solutions, it is vital that they are properly regulated, particularly on a legal basis. In addition to the regulatory aspect, to ensure the proper use of digital solutions, both by healthcare professionals and patients, it is essential to train healthcare staff in these solutions.
Notes:
[1] Hammer et al. (2021). Health and Technology 11, p.525-533
[2] https://lejournal.cnrs.fr/articles/des-logiciels-experts-en-diagnostic-medical
Improved access to health data and therefore enhanced quality of care provided to patients
Press articles and scientific journals are full of testimonies and studies on the decline in the quality of healthcare within our Western societies. They share the idea that a growing shortage of manpower leads to a reduction in the time that the healthcare professionals can devote to the patient. To address this issue, can digitalisation help offer more time to patients by simplifying the administrative life of caregivers?
Although many still point to the omnipresence of paper within healthcare structures, its usage has been considerably reduced in recent years. This starts with computerised patient records, which enable, when effectively implemented, continuous medical monitoring of the patient in both hospital and extra-hospital environments. The digitisation of patient health records can improve the day-to-day lives of carers by:
- Providing real-time access to the patient health statuses, including medical history, test results and medication data. This immediate access empowers caregivers to make informed decisions about patient care, resulting in better outcomes and more personalised treatment plans.
- Allowing for better traceability, as well as protection of health data. The data collected through the computerised patient records allows the patients’ care pathway to be tracked and provides seamless continuity of care across various structures, whether within or outside of the hospital. Beyond medico-legal traceability, the collection of this data also facilitates the financial management and tracking of medical procedures, providing a long-term view of changes in patient’s state of health, and enabling the healthcare system in place to be adapted: justifying an increase in financial resources, prioritising preventive measures, etc.
The launch of the Dataspace 4 Health in Luxembourg, a data space and governance framework for the secure and compliant exchange of health data, is likely to make a significant contribution to improving the quality of care provided to the patient by:
- Offering a better understanding of diseases and effective preventive measures.
- Promoting research and innovation with secured access to healthcare data.
- Building a connected and efficient ecosystem for data sharing between institutions.
The digital tools, provided they are developed and implemented effectively, can considerably reduce the administrative time required by caregivers. This can be achieved by offering flexibility, assistance in decision-making, improved communication, and other features. However, the success of digitalisation is subject to effective development and implementation, which notably involves customised development tailored to the needs of both carers and patients, training medical staff in the use of these tools, and intelligent implementation with strong interoperability. Interoperability is key to the success of digitalisation in the health sector and must be applied across all levels, including medical research, medical care and the reimbursement of care services.
A necessary ethical and supervised use of new digital solutions, for universal promotion
The AI Act and the human guarantee in AI usage
As we harness the potential of digitalisation and artificial intelligence (AI) to revolutionise healthcare, we also face several major ethical risks. The ethical dimension of AI has garnered considerable attention, mainly because these systems heavily rely on the quality and nature of the data they process. Unfortunately, data is rarely perfect and free from bias. This dependency can lead to erroneous conclusions being accepted as fact. For instance, gender and racial biases in health apps pose a notable problem, where data skewed towards a specific group may lead to conclusions that are true for some cases but not for the entire population. A relevant study by researchers at the UCL Institute of Health Informatics involving four AI models – which had previously shown a 70% accuracy rate in detecting liver disease from blood test – illustrated this risk[1]. When these models were re-tested, they failed to identify liver disease in 44% of female cases, compared to only 23% of males[2]. This disparity problem likely stems from the initial data, which was oriented towards more common biomarkers in men used to identify the disease.
These findings raise alarms among health professionals and researchers regarding the potential for AI to adequately serve only certain segments of the population, thereby exacerbating existing disparities. If not rigorously examined for bias, AI applications could reinforce these inequalities by overlooking the needs of those for whom they are less effective.
To address these concerns, legislation such as the AI Act of March 2024 has been introduced, clearly defining the legal responsibilities of both AI developers and users to ensure safe and ethical deployment of the technology[3]. Article 14 of the AI Act, which focuses on human safeguards, mandates human intervention in the AI process to mitigate risks to health, safety, or fundamental rights[4]. This provision requires that potential issues such as gender bias are recognised and addressed during the development and deployment stages of AI systems, ensuring that all populations benefit equitably from technological advances.
This legislative framework not only promotes safer AI practices but also sets a precedent for responsible innovation, protecting the promise of advances in digital health while ensuring all individuals benefit without discrimination.
Notes:
[1] Straw I, Wu H. Investigating for bias in healthcare algorithms: a sex-stratified analysis of supervised machine learning models in liver disease prediction. BMJ Health Care Inform. 2022 Apr;29(1)
[2] Greaves, M. (2022). Gender bias revealed in AI tools screening for liver disease. Retrieved from https://www.ucl.ac.uk/news/2022/jul/gender-bias-revealed-ai-tools-screening-liver-disease
[3] AI Act - Shaping Europe’s digital future. (2024). Retrieved from https://digital-strategy.ec.europa.eu/en/policies/regulatory-framework-ai
[4] AI Act - Shaping Europe’s digital future. (2024). Retrieved from https://digital-strategy.ec.europa.eu/en/policies/regulatory-framework-ai
The need for good governance of health data as part of a plan to promote prevention, based on the example of Singapore
Singapore is a small country located to the South of Malaysia, with a population of just under six million people. Although small in terms of its territory and population, this country is at the forefront of the usage of digital health tools. As stated by Yoann Sapanel in his work, “Medicine without Meds” (2023)[1], maintaining the population in good health involves reduced use of medications, promoting preventive actions, and having a thorough understanding of the general state of health.
To mobilise the population and give them a sense of responsibility in the promotion of prevention, patients are invited to grant access to their health data, in return for certain financial benefits provided or supported by the state (such as social assistance, food discount vouchers…). Access to this valuable data, with the consent of the population, considerably enhances understanding of the population’s state of health and facilitates epidemiological research. This improves the state’s ability to anticipate both current and future health needs.
This example demonstrates the importance of health data as a focal point and a critical issue for the coming years, particularly in the realms of predictive medicine or personalised treatments. The European Union’s commitment to the recent framework for the ethical use of health data (EHDS) supports this development. This regulation recently endorsed by the European Commission, aims to create a true European Health Data Space, in the form of a specific health ecosystem, comprising rules, practices, common standards, infrastructure and a governance framework. Through this common space, ‘people will have immediate, and easy access to the data in electronic form, free of charge. They can easily share these data with other health professionals in and across Member States to improve health care delivery’[2]. Health professionals, in turn, will be able to have real-time information useful for patient care, thereby improving their understanding of patient history, allergies and co-morbidities.
This space constitutes a real asset for the quality of care, but also a real economic and social driver for European countries (in research, medicine, devices, fight against renunciation of care, and so on).
Notes:
[1] Ho D., Sapanel Y., Blasiak A., 2023, Medicine without Meds, John Hopkins, 313p.
[2] European Health Union: A European Health Data Space for people and science (2022, May 3). European Commission. European Commission. Retrieved from https://ec.europa.eu/commission/presscorner/detail/en/ip_22_2711
Ensuring the ongoing training of healthcare professionals
The healthcare sector is progressively moving towards greater integration of technology, requiring continuing training for health professionals, including a digital dimension right from the beginning of their studies. This evolution has led to the emergence of new professions, such as doctor-engineers, specialising in fields such as bioengineering and genomics[1]. These interdisciplinary fields combine expertise in medicine and engineering, enabling the creation and application of technological solutions directly in patient care. For instance, this is exemplified by the roles of clinical technicians in the Netherlands and medical technicians in Germany[2]. Training in advanced areas such as DNA sequencing, artificial intelligence in image analysis, and robotic surgery is essential to prepare healthcare professionals with the skills needed for precision diagnostics and targeted therapies, thereby enabling more effective treatments with reduced recovery times and fewer side effects.
Notes:
[1] Devenir à la fois ingénieur·e et médecin par un double diplôme. (2022). Retrieved from https://www.ec-lyon.fr/actualites/2022/devenir-fois-ingenieure-medecin-double-diplome
[2] MSC Technical Medicine. (2024). Retrieved from https://www.tudelft.nl/onderwijs/opleidingen/masters/tm/msc-technical-medicine ; Pierce, S. (2019). Physician-engineers poised to transform health care. Retrieved from https://www.tmc.edu/news/2019/04/physician-engineers-poised-to-transform-health-care/ ; Furtwangen University. (n.d.). Technical physician MSC - between Medicine and Technology. Retrieved from https://www.hs-furtwangen.de/en/studying-future/programmes/technical-physician-master ; Technical Physician MSc. (2018). Retrieved from https://www.studium.uni-freiburg.de/de/studienangebot/master/info/411?set_language=de
Conclusion
Whether it is a question of financing methods (such as the promotion of prevention and quality, financing of hospital investments), the division of tasks between health professionals (through inter-professional delegations), or even the redefinition of the pathways of patient care (such as the promotion of outpatient care, immunotherapy), the health sector is in constant motion.
While significant progress has been noted over the last 20 years in the field of computerisation or robotisation, the digital challenges ahead of us are poised to profoundly change our knowledge and the way we operate. Fewer human resources but more time allocated to patients, faster diagnosis and definition of therapeutic pathways, revolution in prevention around the use of health data for predictive and preventive medicine, fight against inequalities access to care in the world – these are the challenges posed by digitalisation in health that must be supported, financed, supervised, and promoted among the population and health professionals.
This will be the focus of PwC Luxembourg’s upcoming annual health conference, taking place on the 23rd of May 2024. The conference will provide insight into the aforementioned issues, drawing on the experience of major project leaders from the United States, the Middle East, Luxembourg or, again on behalf of the World Health Organisation.
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