People are the most important factor in advancing digital solutions for health and care

People are the most important factor in advancing digital solutions for health and care

It has been such an intense experience during ICIC24 in Belfast, to try to catch up with all of the amazing presentations linked to the digital integrated care pillar, that I really like! So many ideas, so many initiatives being implemented and evaluated!  I felt digitally enabled integrated care was mostly everywhere in ICIC24. Wonderful to notice how much the implementation side is advancing and how much it has the potential to advance the integration of care.

Over the last decade we have witnessed that digital health has evolved from being ideations, to mostly being research and innovation projects, to finally being implemented and evaluated mostly everywhere. In ICIC24 programme there were so many interesting presentations, that it was really hard to catch up. Let us try to identify some common ideas that I received over those 3 equally exciting and exhausting days of ICIC24.

A good number of digital health research and innovation initiatives were presented in ICIC24. Both innovative and well-known models and frameworks were presented, while some participants shared their “framework” fatigue. More than 20 EU funded projects, most of them linked to digital health, presented their results and lessons learned. Dozens of other initiatives to implement digital health taking place mostly everywhere were also presented during ICIC24. Real world initiatives ranged from innovation micro or meso pilots, local, regional or national initiatives, even system wide digital transformations. There was a great agreement to consider digital health as potentially being a game changer. The complexity of integrating different levels or organisations of healthcare provision was highlighted, including the need to create new coordinated care pathways when digital health is to be implemented. If properly designed, developed and implemented, digital tools can enhance multidisciplinary work, increase coordination and continuity, contribute to patient centred care and empowerment, potentially reducing costs, as advanced by 2CARE4EU cluster, represented by CareMatrix EU funded project.

Why digital health has not been implemented in real life environments more quickly in the last decade? People and IT systems are key to respond to this question. First, people. Many different terms were used in ICIC24: co-creation, co-design, co-production, or others, each with its own subtle differences, but all highlighting a shared principle. People by far are the most important success factor. Real people needs are to be identified and they need to be involved when creating digital health tools, since ideation phase, to its final implementation and validation. Many different presentations addressed concrete conditions or profiles of people being supported by digital health tools, with different successes. Several of the presentations focused on people living with chronic conditions and older people, being particularly challenging to develop digital tools for people living with several diagnosed chronic conditions. When properly involving real people in its development and implementation, digital tools are expected to improve self-care and self-management, bringing care home in a larger proportion and increasing their quality of life and empowerment. Also those caring for them, including their healthcare professionals’ needs, require to be accounted for.

People also are able to decide to use or not the new digital health tools. Indeed, also these words appeared a lot in ICIC24: trust, explainability, health literacy. Health literacy was highlighted by many of the ICIC24 presenters. On the one hand, users’ capability to use the tools needs to be considered when developing the digital devices. On the other hand, their acceptance is based on their capability to understand what the digital tools do, how they manage their data and how their recommendations are being created. Trust and explainability have thus been considered particularly critical for the successful implementation of digital tools. This is even more acute for Artificial Intelligence (AI) based tools, and regarding healthcare professionals whose needs need to be carefully considered and integrated.

From the IT dimension, different presentations in ICIC24 showed that digital tools can support data sharing across and within primary, secondary healthcare, but also with social care and even pharmacies. When connecting different pre-existing systems, it has been highlighted repeatedly by many of the participants in ICIC24 that data anonymisation, interoperability, hardware legacy, ethical and legal compliance, appear as some of the most important challenges faced when advancing digitally enabled integrated care from the IT perspective. Also, that when implementing new digital health tools, the previously existing systems cannot be simply replaced, but need to coexist for some time. Thus, costs might increase in the short and middle term. However, evidence presented in ICIC24 support that the actual implementation of digital tools also involve an increase in the quality of life of the people receiving care and their carers, who feel empowered and with increased support. Value based approach is thus required, not just cost analysis, as suggested by ValueCare project team members.

The best suitable territorial level for digitally enabled integrated care initiatives was also open for discussion. I found it extremely interesting the reflection shared by one of the most important inspirers of integrated care, Dr. Bengoa, on the best means to advance integrated care, during the Opening Plenary session, that can be watched online. While he had defended in the past that the best approach was a system wide strategy to advance integrated care, nowadays he considers that probably it is best to do first structures, then system. I missed more gender analysis, wondering how digital health, particularly home care, is affecting women’s burden and specific care needs.

Evaluation tools also seemed to be evolving at an interesting pace, although still challenging to identify baselines and measure improvements in some areas.

Looking forward to knowing more about digitally enabled integrated care in ICIC25! See you in Lisbon!

Pilar Gangas
Senior Researcher – Digitally Enabled Health and Care
International Foundation for Integrated Care (IFIC)