The Covid-19 emergency put enormous strain on the Italian health service, bringing to light its shortcomings and delays. But it was also a fast-track for digital transformation, a shift towards a Connected Care model caused by the urgent need for a high-precision, connected system focused on continuity of care.
At the height of the pandemic, more than half of Italy’s hospitals introduced procedures to allow staff to work remotely. Just over half of General Practitioners (GPs) worked remotely and judged the experience to be positive as it enabled them to share information and respond to urgent requests. Obstacles and preconceived ideas about digital solutions were swept aside: whereas before the emergency 56% of GPs and 46% of specialists used WhatsApp to communicate with their patients, in the future 69% of GPs and 60% of specialists would opt for collaboration platforms (such as Skype or Zoom) or specific telehealth platforms. There is now a greater focus on telemedicine, which is essential to be able to manage an emergency according to three out of four specialists. The same is true for Artificial Intelligence, which they believe to be useful in personalising treatment, though it is still not widely used by doctors.
During the emergency, more than half of the Italian population kept themselves up to date on Covid-19 through digital channels: 56% consulted institutional websites, 28% the social media pages of doctors and politicians, 17% used social media networks or blogs by members of the community, and 12% Coronavirus Apps. Given the current phase of uncertainty, however, the population have turned above all to traditional channels to find information: 97% watched television news programmes, 84% followed TV programmes focusing on the pandemic, and 53% read newspapers.
These are just some of the results that emerged from a survey by the Digital Innovation Observatory on Healthcare of the School of Management at Milan Polytechnic into Connected Care during the Covid-19 emergency, which was presented at the online symposium “Connected Care and the healthcare emergency: what have we learnt and what comes next?”
“At such a critical time for the country and with the huge pressure on doctors and hospitals, digital technology has an even greater role to play in increasing the resilience of our healthcare system,” explains Mariano Corso, Scientific Officer at the Digital Innovation Observatory on Healthcare. “Digital technologies can make a difference at every stage of healthcare: prevention, access, patient care and assistance, helping healthcare staff to make clinical decisions and hospitals to provide uninterrupted care. An emergency gives us the opportunity to find the most beneficial solutions: to limit the spread of infection, reduce the number of people admitted to hospital, and manage patients remotely. It is also an opportunity to redesign treatment models and accelerate the transition towards a more connected, sustainable and resilient healthcare model.”
How healthcare services dealt with the crisis
The support of a prompt and efficient IT supply chain (essential to rapidly procure new IT tools and devices) was one of the most problematic aspects for healthcare services to manage during the emergency. Of those surveyed, 47% said this was either a critical or a very critical factor, followed by business continuity plans (44%), organisation procedures to introduce smart working (41%), efficient and timely support from an IT help desk (41%) and the requirement for various clinical departments to be able to collaborate (41%). Just 9% of healthcare services were prepared in terms of business continuity and only 11% had a redundant control system, but just 19% and 14% respectively took action to bridge these gaps, while the majority focused on introducing procedures for smart working (51%) and on the collaboration between various clinical departments (39%).
Digital technologies can make a difference at every stage of healthcare: prevention, access, patient care and assistance
As far as technology is concerned, the most critical factors were the availability of digital tools to ensure staff could work remotely (such as laptops). This was the case for 89% of those surveyed with just 6% stating they were ready. Also critical were cyber security issues (87%), with 53% maintaining they had adequate solutions, which were however exacerbated by the need to work remotely and the fact that staff needed to access unprotected networks through their personal devices. Equally important were platforms for staff to communicate and collaborate (84%), widely available in just 19% of the sample, as well as mobile devices (tablets, smartphones etc) for healthcare staff (79%). To improve their technical equipment, 39% introduced or upgraded their existing communication and collaboration platforms, 31% introduced tools to enable smart working and 30% provided their staff with mobile devices, with just 6% upgrading their cyber security solutions.
The impact of Covi-19 on the work of doctors
The Covid-19 emergency obliged GPs to limit the number of patients visiting their surgeries and increase their availability on the telephone. A survey of 740 GPs by the Observatory in cooperation with the Italian Federation of General Practitioners (the FIMMG), revealed that telephone consultations were the most impacted by the emergency (as stated by 93%), followed by the need to reorganise their surgeries to limit the spread of infection (86%), changing the way they dealt with patients (75%) and made clinical evaluations (73%), and having to use more than one channel to manage the relationship with patients (72%). During the emergency, 51% of the GPs interviewed worked remotely and overall the experience was deemed to be positive, in terms of their ability to share information (63% of GPs) and to respond to urgent requests (63%), while their main issue was balancing work and private life (38% were negative on this point). The experience will also be useful after the emergency according to 40% of family doctors, provided that the tools needed to work remotely and communicate with patients are upgraded.
The digital tools that family doctors felt they needed most were smartphones to communicate with patients and other doctors (mentioned by 72%), laptops (61%) and services to remotely access applications and documents via VPN (60%), followed by tools to share and archive documents (51%), desktop and application virtualisation solutions (48%), tablets (47%) and conference call systems (41%). Most had a smartphone (88%) and a laptop (73%) while just 47% had secure network access (VPN), 27% had conference call equipment and 23% desktop and application virtualisation solutions. What they would most like to invest in for the future is VPN (74%, +27%), applications for sharing and archiving documents (78%, +19%) and for conference calls (62%, +35%) and desktop virtualisation (55%, +32%).
The population (and patients) turn to digital channels
During the emergency, more than half of Italy’s population used digital channels to get updates on Covid-19: 56% consulted institutional websites (Civil Protection Department, Regional government, health services etc), with a spike of 83% among 25-34 year olds and just 30% of the over-65s. The social media pages of doctors and politicians were consulted by 28% (49% in the 25-34 age group and 14% of the over-65s); 17% searched through the social media pages or blogs of other members of the community; 12% used Apps dedicated to coronavrius. These data emerged from the survey by the Observatory in cooperation with DoxaPharma on a cross-section of 1,000 people, but at the same time traditional channels also find favour. The majority of the population got updates from TV news (97%) and TV programmes dedicated to Covid-19 (84%) or by reading newspapers (53%).
“In uncertain times, exacerbated by the rapid spread of fake news, the population continued to place its trust in official channels like TV news programmes (65% of users trust this channel) and dedicated TV programmes (52%) while Coronavirus Apps (74% of respondents don’t trust them) as well as social media posts and blogs by other members of the community (72%) were deemed to be unreliable,” comments Emanuele Lettieri, also a Scientific Officer at the Digital Innovation Observatory on Healthcare. “But the use of digital channels to find information about health is on the rise and we have seen the first examples of chatbots helping users to self-diagnose based on the symptoms they describe, though they are still not widely used by the population (10%).”
Doctor to patient communication
Social distancing rules introduced as a consequence of the coronavirus crisis prompted doctors and their patients to make greater use of digital channels and rediscover tools very rarely used before the emergency. From a survey of 740 GPs and 1,638 specialists carried out in cooperation with AME, FADOI, PKE and SIMFER, it emerges that email, SMS and WhatsApp were already widely used in communications between doctors and their patients. GPs are even more willing to use them than in the past, especially email (91% would use this in the future compared to 82% before the emergency) and WhatsApp (66%, +10% compared to before the emergency), while specialists are less inclined to use email (50%, -16% compared to the past), SMS (29%, -14%) and WhatsApp (43%, -3%). Collaboration platforms such as Skype or Zoom have peaked with 38% of GPs (+34%) and 47% of specialists (+33%) ready to use them in the future, while dedicated communication platforms appeal to 65% of GPs (+54%) and 43% of specialists (+31%).
Less than one Italian in five used digital channels to communicate with a GP before the emergency (19% by email, 9% by SMS, 14% via WhatsApp and very few via dedicated collaboration platforms). In communications with specialist doctors, the numbers are somewhat higher (23% by email, 22% by SMS and 26% via WhatsApp). Around a fifth of the population say they will use digital channels in the future, especially Skype (23% to communicate with GPs and 21% with specialists) and any dedicated platforms proposed by their doctor (24% with GPs and 23% with specialists).
“The health crisis has marked a significant shift in the opinion of doctors on the use of digital tools to communicate with patients, especially toward the more innovative ones like collaboration tools and specific healthcare platforms,” explains Chiara Sgarbossa, Head of the Digital Innovation Observatory on Healthcare. “More than 13% of GPs and 23% of specialists who were already using these tools would continue doing so in the future, whereas 56% and 37% respectively of those doctors who had never used them have been converted and intend to use them in future, though many doctors are still contrary (31% of GPs and 40% of specialists). For them to be used more widely in the future, we will need doctors to propose these kinds of platforms to their patients alongside the traditional physical channels.”
The role of telemedicine
For a long time, telemedicine was not widely used and still seen as experimental. Already on the increase in 2019, with the health crisis there has been a real leap in interest among medical staff. “Covid-19 has fast-tracked telemedicine and this will be difficult to ignore in the future; interest is growing in double figures and many hospitals have taken steps to offer remote services also to patients who have not been infected by Covid-19,” explains Cristina Masella another Scientific Officer at the Digital Innovation Observatory on Healthcare. “Doctors have realised that telemedicine can be a strong partner, allowing them to stay in more constant and closer contact with their patients both during this phase of the crisis and in the future.”
The health crisis has marked a significant shift in the opinion of doctors on the use of digital tools to communicate with patients
General Practitioners are the strongest supporters: one in three used at least one telemedicine solution before the crisis, 62% of those who had never used it will do so in the future and just 5% is contrary. Three out of four specialists maintain that telemedicine was crucial at the height of the crisis, but 30% of them still say they are contrary, compared to 34% who already used them and 36% who are convinced of the benefits and intend to use them in the future. Doctors are most interested in tele-consultations with a specialist (88% of GPs, 64% of specialists), tele-consultations with a GP (76% of GPs and 52% of specialists) and tele-Monitoring (74% of GPs and 47% of specialists) followed by tele-Assistance (72% of GPs, 32% of specialists) and tele-Cooperation (60% of GPs, 47% of specialists). According to GPs, on average 30% of consultations with chronically ill patients could be carried out using digital tools and 29% with other types of patients, while specialists are less in favour, 24% and 18% respectively.
One Italian in three would like to try out a tele-consultation with their GP, 29% with a specialist, a further 29% a tele-monitoring of their clinical parameters and one in four would try a video call with a psychologist. Those who are not interested in this use of these applications stated that they prefer to meet their doctor face to face (59%).
Artificial Intelligence in an emergency
According to 60% of specialists, AI solutions can play a key role in an emergency, 59% believe they can make hospital processes more efficient, 52% that they help to personalise treatment and 51% that it is more efficient, with 50% stating that they reduce the risk of error. However, still very few specialists use these technologies: just 9% used them before the Coronavirus crisis and just 6% worked in a hospital where they had been introduced or upgraded during the crisis. To increase their adoption, it is important to develop the necessary know-how and skills, and to share experiences and the benefits of these solutions: 62% of specialists maintain that it is easier to implement AI projects if other hospitals and doctors have already done so; 58% are more inclined to use them if they know the rationale. On the other hand, just 26% of doctors state that they have the right skills to use them and 22% that the skills exist within their hospitals to implement such projects.
“To speed up the spread of AI systems and take advantage of their potential benefits for the health system, we need to take action on three fronts,” concludes Paolo Locatelli, Scientific Officer at the Digital Innovation Observatory on Healthcare. “Increase the digital availability of data whether they are structured or not, to master AI solutions and make them generate value in personalised treatment; develop the digital skills of doctors and of those who will be managing such systems with a particular focus on Data Scientists; understand the limits of these tools and that their role will not be to replace doctors but to guide their decision-making.”