Francesc Saigí, UOC researcher, member of the Faculty of Health Sciences, and director of the World Health Organization (WHO) collaborating centre for eHealth
The first "eHealth What if Forum" series, an event organized by the Universitat Oberta de Catalunya (UOC) eHealth Center, has just come to a close. The symposia, which are scheduled to take place annually, focused on the question of: "What if the digitalization accelerated by COVID-19 enabled us to transform health systems?"
We sat down with Francesc Saigí to talk about a number of the subjects covered, about the opportunities, obstacles and outstanding challenges, and about his own work. Saigí is an associate professor in the UOC's Faculty of Health Sciences, director of the WHO collaborating centre for eHealth, and coordinator of this year's event.
What was the main aim of this first "What if" event?
The "What if" format means we can ask ourselves that same question, one that, basically, is the starting point for any research question. The lockdown and the social distancing introduced in response to COVID-19 led to a lot of progress in the field of digital health, ensuring that a great amount of healthcare could be provided remotely. However, this shift has not yet been definitively consolidated, and we now run the risk of missing this opportunity to redefine and adopt new digital healthcare models. And it is against this backdrop and with this question in mind that these eHealth Center symposia were held. The event looked to assess what we can take from what has happened to consolidate and improve upon health services that were untenable prior to the pandemic.
What's your overall assessment of the symposia?
Very positive. We've managed to compare and contrast the experiences of experts from Catalonia, Spain and a number of Latin American countries. This has allowed us to see how things are going, acknowledging both the positives and the difficulties we've encountered.
In general, what is the best and what is the worst that's happened, in your opinion, in terms of digital health during the pandemic?
The best: because we've been forced to resort to telemedicine, we've been able to overcome a lot of barriers and fears, even amongst healthcare professionals themselves. The bad news is that a lot of these changes have not been made in the right way, due either to haste because of the pandemic or to the availability of tools. Telemedicine won't be able to consolidate its position if it doesn't go hand in hand with the corresponding organizational changes. And it may just be that we run the risk of returning to the situation prior to the pandemic, because professionals view the current situation as exceptional. What we have to do now is to ensure the optimal bedding in of these changes.
A common observation during the sessions was that it would be a mistake to regard digital health as just carrying out teleconsultations and digitizing documents.
This is because, due to the pandemic's lockdown, teleconsultations and digitizing documents were the only option to provide healthcare. However, digital health entails an entirely new approach to working by leveraging technologies. It also means using other tools such as big data, to work with large amounts of information; artificial intelligence, to predict, detect and connect with other technologies; and "wearables", which help patients to take better care of themselves, and professionals to obtain information and perform better remote monitoring. Digital health is a far broader concept.
What are the main challenges in carrying out this transformation?
At the current time? Unquestionably organizational changes and change management. Professionals will have to get used to this new reality imposed by COVID and, to achieve this, their agenda must be rational. We also need to educate patients in the use of these technologies. This is a good time to do so because, thanks to the pandemic, they've come into contact with them, and seen that they can be of use. It's now time to consolidate the necessary changes to speed services up and to have in-person encounters only when the situation calls for them.
One of the recurring concerns associated with the latter point is that digital health could lead to a dehumanization of medicine.
That's the fear, but the opposite is, in fact, the case: properly used, technology can optimize the system and offer more in-person time for those who really need it. There are also situations in which telemedicine can, in and of itself, work extremely well, as in the case of mental health. The fact that an appointment is just a click away means you can avoid the potentially embarrassing or stigmatizing situations that can occur with in-person sessions.
You are, in addition to being a member of the UOC's Faculty of Health Sciences, director of the WHO collaborating centre for eHealth. What role does the centre play?
We have, for some time now, been partnering with the Pan American Health Organization (PAHO) and, following evaluation of our work, became a WHO collaborating centre in eHealth, with the following goals: training in and raising awareness of telemedicine, promoting the use of eHealth, and studying the adoption of mobile health. Although our goals are closely linked to Latin America, we work on both Latin America, with the PAHO, and on Europe, with the WHO.
What are the distinctive features of Latin American countries?
Well, they are very large countries with a high degree of centralization of services in big cities, which, combined with the rugged nature of the terrain, makes access to healthcare in rural areas enormously difficult. They're also extremely technologically fragmented, which makes data sharing hard. The lack of specialists is another obstacle typical of a large number of these countries. It's for all these reasons that telemedicine helps improve the accessibility and equality of health services in these countries.
You're also a director of the Ibero-American Network of Mobile Health Technologies (RITMOS). What does that involve?
RITMOS is a project headed by the UOC and funded by the Ibero-American Programme on Science and Technology for Development (CYTED). The network brings together 22 research teams across 11 countries, and involves participation of supranational organizations such as the PAHO, the WHO and Médecins Sans Frontières (MSF). Its mission is to work in support of mobile health and to leverage it to enhance health services, together with contact between patients and doctors in Latin America, taking advantage of the wide-spread use of mobiles in the region.
The last of the "What if" sessions saw the presentation of the results of a recent report on the use of telemedicine in these regions. What are its main conclusions?
Yes, it's a project we carried out after winning funding from the Inter-American Development Bank. The goal was to study the possibility of developing international telemedicine between the different countries of Latin America, to overcome local shortcomings and increase available services. The study's results include the fact that the pandemic has proved an important catalyst for telemedicine, at both a national and an international level, and that the viability of international telemedicine is affected by national telemedicine. We also found a positive link between the use of international telemedicine and professionals' productivity and efficiency, as well as with the returns for health systems. And, finally, despite these benefits, only 17% of the doctors in the study's sample used it, and barely 20% were prepared to do so. The conclusions are that it is a viable option, but one that calls for the breaking down of many barriers, both legal and technological. There is also a need for greater governance, with a supranational organization that fosters dialogue between all the countries involved. There's a lot of work to be done.
What's your overall take on the "What if" event and its future in upcoming editions?
I think it's a necessary event, because it lets you take a break to see where you are and where you should be heading. And doing this with other colleagues helps us to learn from one another. In the future, I think it'll go in the direction of our academic and scientific activities. We'll continue to carry out research and add value for the progress of digital health. As we aren't going to be doing this on our own, it'll provide a great opportunity for sharing what we've done and to think, together, about where we want to head.