Xavier Prats Monné, Chair of the Board of Trustees of Hospital de la Santa Creu i Sant Pau and a member of the Advisory Board of the eHealth Center
Teresa Bau
Xavier Prats Monné has spent a large proportion of his career in European institutions, both in the field of education and in public health. From 2015 to 2018 he was Director-General for Health and Food Safety of the European Commission, where he was responsible for the EU's health and food safety programmes. Prats Monné is a member of the Advisory Board of the UOC's (Universitat Oberta de Catalunya) eHealth Center, which includes renowned and prestigious professionals in the field of health. He is also Chair of the Board of Trustees of Hospital de la Santa Creu i Sant Pau. In this interview, he talked about the opportunities and challenges of e-health and how he sees the future of innovation in health.
What opportunities do you see in the development and implementation of digital solutions in the world of health?
It's not about opportunities but about necessity: unless we radically develop digitalization, our health systems will be unable to meet citizens' needs. Perhaps the most relevant area of progress is the personalization of medicine and the improvement in the quality of care based on patient-specific data. As well as improving access to health and decongesting the healthcare system through telemedicine and patient involvement. Tools such as mobile health apps and wearable devices help people manage their own health more effectively, providing real-time data on their fitness and lifestyle.
The aggregation and analysis of large volumes of health data will lead to better medical research, better public health measures and faster identification of disease trends. And, particularly in countries such as ours, with ageing populations and a limitless demand for health services, digital solutions can improve the sustainability of the health system and reduce costs by automating administrative processes.
What are the main challenges that must be faced?
I think there are three particularly important ones. The most obvious one that worries both citizens and policymakers – and rightly so – is privacy and data security, the other side of personalization. Handling sensitive information and ensuring privacy, especially when sharing data across systems, pose real risks and must be a priority for both regulators and industry.
Integration and interoperability are also major challenges, given that most health systems and technologies are not designed for compatibility. And neither are national regulators integrated or coordinated with each other. This is a limitation for companies in the sector and can lead to inefficiencies and errors in patient care.
And finally, the digital divide: disparities in access to technology based on location, socioeconomic status and age can dramatically exacerbate health inequalities. This is a risk not only for the health system but also for social inclusion and democratic legitimacy.
Do you think the public is ready for a more digital world of health and welfare?
In European societies, people are often interested in e-health tools such as wearable devices and health apps, driven by growing awareness of personal health management. A substantial proportion of Europeans are open to using telemedicine services, which reflects a growing acceptance. I also believe that, in some countries, such as ours, awareness of the implications and risks inherent in the use of personal data is lower and less present in the public debate than in others, such as Germany.
But, in my opinion, the most relevant fact for public policy is the digital divide. The degree to which citizens are ready for a more digital health system varies dramatically, because not everyone has the same access to the necessary technology due to differences in socioeconomic status, rural and urban living conditions and, of course, age. Paradoxically, the elderly are both the people who can most benefit from the digitalization of health and the advances of medicine and those at greatest risk of being excluded from it. Preparing the public for e-health must be a priority not only in the field of health but also in education policies.
And are governments and legislators open to it? One of the main complaints of entrepreneurs is that it's hard to get health systems to adopt their innovations.
Yes, technology evolves more easily than administrations, and innovation grows faster than regulation. Bureaucracy is often unjustifiably slow and, above all, there is little coordination between administrations and regulators. But let's not forget that the main function of legislators is safety, which is even more important than innovation, especially in the health sector.
Entrepreneurs complain about the slow adoption of innovations and the low interoperability of systems. But, at the same time, they insist on the exclusivity of their products and services, and they rarely make an effort to develop compatible technologies. Promoting e-health quickly and safely is a shared responsibility, so solutions must come from a strategic partnership between the health system, producers and civil society.
Introducing a new heart implant on the market is more urgent than introducing a new decoration product, but it's also more dangerous if quality standards are not adhered to: we need separate procedures for health that are at the same time faster and safer.
What do you think should be the role of the UOC's eHealth Center in the world of e-health solutions?
As digitalization affects all areas of health, the eHealth Center's potential and mission are also very broad: to generate knowledge for the development, implementation and evaluation of digital solutions for the promotion and improvement of health.
But I believe that the eHealth Center can contribute particularly to citizen empowerment. Digital solutions are a tool for improving people's health, well-being and quality of life. The eHealth Center, which is digital and multidisciplinary in nature, together with the UOC's experience in researching the impact of technology on society, can make the digitalization of health a factor of inclusion rather than a source of social and health inequalities.
You are the Chairman of the Board of Trustees of Hospital de la Santa Creu i Sant Pau's health management foundation. What digital initiatives are being implemented at the hospital, and what impact are they having?
Hospital Sant Pau is updating its information systems and technical infrastructure for the classification and reuse of clinical data. This task will make it easier to apply AI algorithms and support clinical decisions. We've created a centre for the clinical validation of digital solutions to generate evidence that supports the incorporation of digital solutions in clinical practice.
At the same time, we're supporting around 50 e-health projects aimed at incorporating telemedicine programmes for the control of diseases, improving interterritorial coordination and reducing emergencies, hospital admissions and the negative effects of medication. We're working on tele-monitoring, incorporating the patient perspective in areas as broad as heart and bone marrow transplants, women's health, neurological diseases, oncological processes and rheumatic diseases.
Are we making progress in e-health in our country?
The European Union's Digital Economy and Society Index (DESI) shows that countries are adopting digital technologies at different rates and that the Nordic countries tend to lead digitalization efforts, including in the field of healthcare.
In this context, Spain and Catalonia have significantly higher health results than the European average and have achieved in recent years a considerable improvement in digital public services, including in the field of health. We are well positioned in Europe, especially in terms of connectivity and digital public services, which are key to the digitalization of hospitals. This is reflected in the country's strong performance in the deployment of high-capacity networks, which are essential to support modern digital hospitals. The EU aims to comprehensively digitalize all public sectors by 2030, including hospitals, which will also be an incentive for interoperability.
What lessons did you take from your role as EU Director-General for Health and Food Safety from 2015 to 2018? Were there any disappointments?
The list of what I learned would be too long for any reader, but I'd like to mention a paradox. On the one hand, I witnessed the dizzying progress of science and medicine: in the last twenty years, for example, we've transformed virtually all cancers into chronic rather than fatal diseases. On the other, I saw increased scepticism about this very obvious progress: even now, after the pandemic, many people doubt the efficacy of vaccines, or they believe in the therapeutic properties of homeopathy, which is to medicine what astrology is to astronomy. If so many people trust a YouTube video more than health institutions, the scientific world and public authorities must make a greater effort to get closer to the public.
I also learned a lesson that was brutally confirmed by Covid-19: zoonosis is a reality that should make us blur the boundaries between human health, animal welfare and planetary sustainability. Antibiotic resistance is the perfect example of a serious and urgent challenge that can only be addressed with a joint strategy that ignores the boundaries between sectors and disciplines.
My disappointments were those of anyone who believes in public health and the European project: you always think that cooperation between countries and common policies should make faster.
What innovations do you think we'll see in the short to medium term in the field of health and the world of healthcare?
I don't have enough medical knowledge to give you a good answer, but we're already seeing innovations, mainly digital ones, that will transform the field of health. I just mentioned artificial intelligence, machine learning and telemedicine: augmented and virtual reality will transform the training of healthcare professionals through high-fidelity simulations.
Along with digitalization, in the medium term we'll see the impact of advances in gene therapy, for example to cure conditions that aren't currently treated and improve the efficacy and safety of drugs by predicting how different people will respond to them based on their own genetic makeup.
Immunotherapy will provide a transformative approach to healthcare. It's already proven effective in the treatment of several otherwise hard-to-fight cancers and will soon be used to treat autoimmune diseases, allergies and even infectious diseases such as HIV, which suggests a great potential impact on the world of healthcare. Immunotherapy is very likely to become a cornerstone of medical practice, changing the way many diseases are treated.
It's interesting to note that the common element of all these changes is interdisciplinarity, which in my opinion is the driver and origin of most of the scientific innovations that await us.