The role of digital in health services
Mobile and Internet coverage has grown significantly over the past 20 years, with 1 billion more users every 5 years (ITU data: International Telecommunication Union). Digital has the potential to accelerate the transformation of health care systems at all levels, increasing service coverage, simplifying management, lowering costs, streamlining governance, strengthening the skills of health care professionals, and empowering patients.
What is e-health?
According to the World Health Organization (WHO), e-health is defined as “the use of information and communication technologies (ICT) to support health”. The terms digital health, digital health or connected health can also be heard being used.
E-health includes tools and services that use ICT to improve the prevention, diagnosis, treatment, monitoring and management of health-related problems. M-health (mobile health) and telehealth are also included in the concept of digital health.
For example, on-line consultations, digitalization of patient records, telemedicine & specialized tools for healthcare professionals and researchers (digital environments for diagnosis and management for example) are essential elements of e-health.
In France, the “carte vitale” and the Ameli & Doctolib accounts are part of e-health.
E-health in the South
The development of e-health in the world is very variable, even fragmented in places. The public sector has not invested evenly in this topic. By 2020, although 34 member states in the WHO African Region had developed digital health strategies, only 12 had actually implemented them. There are many restrictions: difficulties with finance and sector governance, issues with infrastructure and network access etc. Although the private sector is very dynamic, health aspects are not always a priority, or they are buried in other more general themes (access to water, waste management, etc) and the funds raised remain focused on just a few States.
The Pierre Fabre Foundation created the ODESS to bring coherence, harmonization and visibility to the ecosystem and remove the mystique surrounding it. The Foundation also supports project leaders in effective implementation of their solutions.
E-health to meet many challenges
E-health is a tremendous opportunity for health systems:
Digital health allows more efficient monitoring
The use of information systems at health facility level allows professionals to monitor patients on a daily basis and over time, promoting effective implementation of national protocols and recommendations. The feedback of these data at regional and national level allows health authorities to make decisions based on real and regularly-updated information.
One example is the IeDA project, operated by Terre des Hommes.
Lower costs thanks to connected health
E-health offers the opportunity to move towards more efficient health care systems. Several reviews and analyses published over the past 10 years highlight the cost savings enabled by the adoption of digital health solutions(Elbert NJ et al, 2014 ; Sanyal C et al, 2018 ; Naoum P et al, 2021). Preliminary analysis of a teledermatology project in Mongolia shows a significant reduction in costs, both for patients, notably with savings related to transport, and for the health system with a reduction in hospital referrals.
Recasting patients as playing active parts in their own health
ICTs make it possible to facilitate all administrative tasks related to the care process (making appointments and updating medical records). In addition, their use promotes appropriation by patients of all their health data, increasing their ability to be actors in their care.
Telemedicine: a solution to medical deserts
Telemedicine provides patients living in rural areas with access to medical expertise that may not be available in their area. Coupled with distance learning (e-learning), it also helps to free up health professionals working in peripheral structures and maintain their skills at the highest level to ensure quality care. One example of this approach is the teledermatology programs supported by the Pierre Fabre Foundation.
There are clear advantages, but also many challenges.
Although the use of ICT in the field of health offers new and interesting perspectives, the stakes involved are just as important, including for example:
Avoiding an increase in inequality
Exclusion from digital services can be caused by infrastructure issues (network access and bandwidth quality), financial issues (access to equipment and individual and collective subscriptions) or digital literacy issues (effective ability to use digital services). The development of e-health must not be done without a broader reflection on the reduction of this digital divide, to avoid an increase in current levels of inequality. It is in this sense that digital transformations in the broadest sense must be considered as health determinants.
The Hippocratic principle of “primum non nocere “* is still relevant today. The accelerating potential of digital also presents risks in terms of medical misinformation, leakage or collection of health data, and other areas. Without inclusive systems that effectively protect patients and populations at large, and without rigorous regulatory frameworks, large-scale adoption of ICT in health care risks increasing people’s vulnerability.
* “first, do no harm”