One of the most recurring words in the special vocabulary of the pandemic is undoubtedly ‘digitisation’.
In fact, Italians have begun to understand that the future of their health necessarily depends on this approach and service provision. A future that will need new professionals.
A digital tomorrow that embraces the relatively simple things, such as televisions and the availability of an electronic file, but also the great scenarios of predictive medicine, which could make prevention a concrete reality and not just a slogan. The prospect of e-Health, as the world calls it, will also be guided by the development of the Piano nazionale ripresa e resilienza – PNRR (National Recovery and Resilience Plan), with its objectives and deadlines. A scenario that will inevitably launch some professions, relaunch others or invent new ones altogether.
We discussed this with Fidelia Cascini, researcher and professor of Hygiene and Public Health at the Catholic University of Rome.
Cascini, an expert in digital health, risk management and health responsibility, collaborating with Walter Ricciardi, who has carried out and directed international projects for the European Commission, is digital health expert for the Ministry of Health.
Doctor Cascini, COVID has expedited the process of digitisation, which was proceeding slowly.
The pandemic has certainly caused an acceleration. We think of telemedicine which, at times of quarantine, when access to hospitals was difficult, was the way to respond to the demand for health of many, and we remember the spread of apps for accessing and providing services. Now, with the launch of the National Recovery and Resilience Plan, there are great opportunities but also constraints associated with this action.
Opportunities, because there are huge resources and constraints on spending criteria and timeframes.
In the field of telemedicine alone, a further 1.5 billion is set to be invested in regional projects by 2023 in order to improve healthcare on the ground. We also need to conceive of a major change, not only in the provision of services but also in the availability of theoretically simpler tools, such as the electronic health record, which should contain information on everyone’s health. It can be taken as an example to understand the heart of the matter.
It has been adopted in all regions, albeit at different times, and four of them are supported by central structures in subsidiarity. Unfortunately, however, it is not in fact fully used by operators, who need minimal technological equipment to access it, but above all, as it is still structured, it is just a large reservoir of documents, a large archive: it will need to be transformed using interoperable metadata, to facilitate the exchange and management of information for clinical and healthcare purposes, and also for secondary uses such as research.
What about in the care sector?
All clinical practice will have to be affected: It will be necessary to train operators but also to adapt the digital infrastructure, creating environments that facilitate the daily use of the technological tools available. In short, we cannot imagine digitisation as a large archive of pdf files to be browsed, one by one, but as a place that allows exchange and interaction between health professionals and patients, centres and hospitals. The electronic health record itself, which we mentioned earlier, has general practitioners and paediatricians rather reluctant to update patient data, precisely because it is difficult and time-consuming to use.
And there’s no need to invent because, at European level, there is already talk of open standards, of nationally integrated digital health ecosystems and of interoperable electronic prescriptions between different countries: one must thus be quick on the uptake.
Action is needed on the digital literacy of health workers…
Yes, on several fronts. The National Recovery and Resilience Plan also provides for part of the training needs, precisely to help training in technology. I imagine that every single health authority and hospital will need to have task forces dedicated to this change management process and to devising solutions, but in the background there needs to be a major cultural evolution of the entire country system, so as to accompany the changes and the tools for a new approach. This will require a major communication campaign to get the right messages across. Because every big change, we know, requires facing some resistance.
Communicating a major change. What levers should be used in this regard?
We need to convey the real message that digital brings benefits, that it can impact positively on our lives, making them easier. Patients should also know that their health will benefit. What is needed is a major digital health literacy action. This is because the Italian landscape is made up of low digital skills, for which we are lagging behind in Europe, and although we are all hyper-connected by now, although we are even used to asking for the weather forecast or a piece of music from a voice assistant in the living room, on health there remains a certain resistance because there are established routines.
Together with staff training, which is envisaged in the actions of the National Recovery and Resilience Plan on eHealth, it will be necessary to find these professional figures, whom we could call facilitators.
What about the professions that will have to lead these processes? Do you expect evangelists to operate at various levels in all contexts?
The crux of the problem is this: we’re lacking these professional skills. In November 2021, the Government published the 2022-2024 Artificial Intelligence Strategic Plan. It provides for the recruitment of high-level profiles, such as PhDs and young researchers, precisely because we have encountered a lack of this type of talent, many of whom we train and then employ. This is really an open question, in the sense that, together with staff training, which is envisaged in the actions of the National Recovery and Resilience Plan on eHealth, it will be necessary to find these professional figures, whom we could call facilitators.
What is the role of the university world at this stage?
Above all, to stimulate the institutions and political decision-makers, offering all the expertise possible, in the areas and tables that have to work on these issues. To return to the pandemic, from which we started, the role of academics will be precisely that of preventing, also related to digitisation, the infodemic, i.e. the information chaos, that accompanied this important health experience of COVID-19.
Top photo by Hush Naidoo Jade Photography by Unsplash