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News & Press: Digital Health Observatory

Digital Health Transformation: The Training Blindspot

06 February 2018   (0 Comments)
Posted by: Matthew Grek
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By Joan Cornet Prat.

Innovation in healthcare is a long story
Healthcare has been in the last 50 years one of the more innovative industries. The driving force of this innovation has been the clinician’s readiness to adopt new solutions, adding value to the clinical process, as well as the pharma and medical devices industry. These two industries have 3 assets in common: 
Big companies with a huge Research and Development and Innovations (R&D+I) budget
Very efficient marketing, 
Personalized education.

The Digital Revolution is a recent phenomenon. The first smartphone only came to market in 2007. Because of the nature of digital technologies, thousands of initiatives have been taking place, in all kinds of sectors, specialties, geographies and professions. At time of writing (February 2018) there are over 250k health apps, countless wearables, and huge development in software and algorithms.

Paradoxically, most companies, start-ups, and university departments that are dealing with digital health are relatively small, with small resources and little capacity.
That means digital health companies have 3 assets in common: 
Small amounts of investment in R&D&I
Limited marketing capability and capacity
Limited ability to educate staff and/or users. 

The digitization of healthcare has long been on the European agenda to modernize and improve healthcare across Member States. The focus recently shifted from developing the technology to implementation of digital healthcare and eHealth. These changes are yet to result in the education of health professionals in order to prepare them for the implementation of digital health. 

The EU therefore risks spending time and resources on implementation strategies that will have little effect because attention to the front-line ability to adopt these changes has been insufficient. (1)

Knowledge is the enemy of disease, the application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade” famously predicted Sir Muir Gray, Director of the UK NHS National Knowledge Service and NHS Chief Knowledge Officer over 10 years ago (2) 

Digital health and training healthcare professionals
Despite considerable investment in digital health companies and a growing digital health ecosystem, there are multiple challenges to testing and implementing innovative solutions. Health systems have recognized the potential of digital health and have formed digital health innovation centres. However, limited information is available on digital health innovation centre processes, best practices, or outcomes.

One of the main characteristics of most healthcare professionals is their commitment to learn and to be updated on new research in their respective academic fields. The problem is the difficulty in finding the right training and education in digital health. There is a lack of knowledge as to digital transformation and its potential in benefiting patients and professionals.

The question is, if clinicians don’t know what is going on in digital health, how is it going to be possible to implement digital technologies in health care organizations?

In the near future, it will be increasingly important to recruit or to promote professionals with these digital health skills. So where can healthcare professionals learn these skills?

In 2015 across Europe there were approximately 2.5million doctors, 4.5million nurses, and 275 thousand practising dentists, pharmacists and physiotherapists (Eurostat: http://bit.ly/2EfdJwy, http://bit.ly/2GlpjqG, http://bit.ly/2njUlXr.) That's a total of 7.275million healthcare professionals, without taking into account other health professionals such as engineers, technicians, or health care assistants.

Organizational context

Most health systems, (public and private), are characterised as being solid, effective, with a silo culture, and rigid organizations. This ensures stability, safety, specialization and strict follow-up of standards and protocols.

Health professionals, especially physicians, have a double responsibility, one with the patient (what is called the "Medical Act") and one to the organization to which they belong. This double assignment is not always easy. The increase in the use of new technologies, especially medical devices, and new digital systems in the last decades in health organizations means that healthcare professionals are more dependent on the organization in which they practice.

Health innovation has been developed within each specialty, with little cross-specialty collaboration or transversal innovation. An exception to this rule is diagnosis by image with digital technologies and Electronic Medical Records; which has had an enormous transversal impact.

The impact of digital transformation on organizations is not a question of adding more technological innovations, as happens in the respective specialties, it is a matter of managing a change in how to deliver healthcare. Other industries such as retail, the audio-visual world, banking, automobiles and the travel industury are an example. 

If it ain’t broke, then why fix it? 
Healthcare, as we have seen, are vertical organizations based on silo working. This structure will have a tough time adapting to the changes that the digital transformation implies. Clinical practitioners, policy makers, public and private insurance companies, as well as managers ask the question "If it ain't broke, why fix it?." Afterall, health services continue to perform their tasks normally, following protocols, and applying clinical evidence in both diagnosis and therapy. Which leader is ready to take a risk and make changes, in a very risk averse organization and sector?

Factors in stability

There are multiple factors that can destabilize health systems:

1.         The increase in costs due to greater number and life expectancy of patients with chronic illnesses, the ageing population, with a notable increase in diseases such as dementia and Alzheimer's, the cost of new drugs and the demands of professionals for increased salaries or service pay.

2.         Evidence that there are significant inefficiencies in the clinical and administrative process, with high costs for both health organizations and patients.

3.         A society increasingly aware of its rights, which increasingly accepts fewer waiting lists, or unexplained delays, which will demand greater efficiency, agility and speed in the delivery of health services.

4.         The increase in citizens who live fully in the digital world and cannot accept that health is an exception. A greater empowerment of people who progressively want to be actors, not spectators (patients) when it comes to something as important as health.

5.         The digital innovation that promotes industry, start-ups, universities and some health organizations, which in different ways will infiltrate the clinical world, as it did the pharmaceutical and medical devices industries.

6.         If local health organizations are not digitized, big tech and large insurers, and others, are likely to take advantage of marketing digital health services at the global level. How long until we see the amazon effect in the healthcare marketplace?

Table 1:  
Enabled by the recent deployment of innovative medical devices, healthcare provision is being increasingly driven outside clinical settings to community and home and even further to care provision on-the-go.While integration of devices to hospital care in dynamic IT “ecosystems” replacing traditional large enterprise databases is lagging behind due to complex regulatory frameworks, major industries have increased their presence in the digital health domain aimed at personal/non-clinical care. In addition to the traditional pharmaceutical and MedTech industries, for example, Coca-Cola and Verizon are adopting health initiatives , IT (Google, Apple) and telecommunications are competing for fast growing wearable/tracking devices markets (Apple ResearchKit, launched in March 2015 presents a new attempt in competing for the developer tool making it easier for medical researchers to use apps to collect data for clinical research, raising the importance of data privacy concerns even higher).

Grand Challenges in Digital Health. Patty Kostkova
 

 

What is Needed to Remove the Blind Spot?

  • Digital is not following the traditional innovation paths. We therefore need a new way to teach and learn how to implement digital solutions in healthcare.
  •  Digital is a moving target with high speed innovations changing very fast, appearing and fading away easily. That means training in Digital Health must be agile, integrated to clinical practice, must bring about real improvement in citizens health, and be kept up-to-date.
  •  Practitioners need flexible ways to be trained with easy access to materials from any location. Short, practical courses, with quick learnng needs to be available. Most of the training must be based on Audio-visual technologies, avoiding long texts and books.( table 2 and 3).
  •  Digital knowledge is local and global. There is a need to identify the best experts worldwide and transfer their knowledge and best practice. The only way to find the right expertise is through powerful and online global training platforms .
  •  Private/ public insurers and healthcare organizations must identify the digital training needs for their health professionals.
  •  There is a need for an international training consortium capable of reaching most countries, that can be agile and adaptable to local language and local health culture, based on organizational and professional needs. They will need to  facilitate knowledge transfer and best practices in digital health transformation. Initiatives like NHS Digital Health Academy in UK, and Digital Health Transformation Academy in Spain (Mobile World Capital and TicSalut Barcelona) both aiming at local and global, are the first steps in the right direction.

Table 2

Adult learners share some characteristics that are different from those of full time
students, which influence the design of on-line learning programmes. In particular, adult learners:

  • Need to know the benefits of learning (why they have to learn something);
  • Like to learn experientially;
  • Approach learning as problem-solving;
  • Learn better where they can see the immediate value and application of content; and
  • Prefer to study at a time, place and pace convenient for them.

Table 3

Raising awareness of the use of digital tools amongst healthcare professionals 
Continuous education of health professionals in the knowledge, use and application of digital health technology should be central to the European agenda to digitize healthcare. Otherwise, ongoing initiatives may prove ineffective, as the successful implementation of digital technology in healthcare is entirely dependent on the ability of the end-users (and notably the health professionals) to adopt the technology. This can be achieved through coordinated initiatives:

  1.  Mandatory tailored training programs on digital skills for health professionals should be established in Europe. These programs should aim to train health professionals according to their occupation, their needs for digital skills, their frequency of using digital technology, their competence in digital skills etc. The training programs should be continuous, starting from an early stage of education, and continue in work place learning and professional development programs. Additionally, the EU should define program content by determining the digital skills every health professional must possess to use eHealth/mHealth solutions to their full potential
  2. The European Commission and Member States should launch a joint action to agree on the key issues related to digital skills for healthcare professionals. This could promote a single approach, centralizing all existing national initiatives, in close collaboration with medical socie-ties and professional organizations. To respect national differences and speed of adoption, an “option-in” with reimbursement benefits could be applied, where Member States adhering to European recommendations would benefit from the support and experience from the EU. As Member States start recognizing the benefits of these recommendations, the penetration of digital skills solutions in the health sector will increase.
  3. Update clinical guidelines to include mHealth and eHealth, so that healthcare professionals are able to deliver mHealth and eHealth solutions to their patients. This would require close partnership with the associations that produce yearly guidelines, which could accelerate adoption of digital skills solutions in Member States.
  4. Make healthcare professionals co-developers of mHealth and eHealth solutions by placing them at the centre of the development process. The role of end-users, the health professionals, is essential in accelerating the adoption of digital solutions. End-users are aware of the challenges facing them, and are well-placed to contribute to solutions tailored to real needs.


DIGITAL SKILLS FOR HEALTH PROFESSIONALS
COMMITTEE ON DIGITAL SKILLS FOR HEALTH PROFESSIONALS EUROPEAN HEALTH PARLIAMENT 2016

 

Conclusions

The digital transformation of health services is progressing slowly. This is due to the complexity of health organizations. Soon, digital health services it become the reality. 


A top priority is the provision of on-line training platforms and on-site training in digital health for health professionals.


Since it is the clinicians who will have to use these solutions, and above all transform they relationships with patients increasingly used to living in the digital world, without this type of training, it will be difficult to implement digital solutions in health services. 


This type of training requires a series of characteristics that are usual; therefore it is necessary to use innovative approaches to understand the needs of the clinicians and their patients.


All this will be possible if collaborative spaces are created, without borders and with the contribution of several professions, professional bodies, user groups and other interested parties. 
 

References:

(1)   The measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358017/

(2)   Available from: http://www.gurteen.com/gurteen/gurteen.nsf/id/knowledge-and-disease


 

By

Joan Cornet Prat,

Non-Executive Director

ECHAlliance