A highly desirable revolution in digital health

A digital health revolution is taking place. As European health systems are struggling to cope with the most challenging public health threat they have ever experienced, digital health has come in handy in providing effectiveness, safety, and even humanity.

Having to respond to the coronavirus has mobilised the entire global community to ensure the capacity of health services. Restrictions imposed by governments worldwide have kept people locked down so as to contain infections and reduce the burden on hospitals and care homes. In his briefing on 11 March 2020 declaring COVID-19 a pandemic, World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus stated, “This is not just a public health crisis, it is a crisis that will touch every sector.”

The global economy in particular will be affected. There is now a broad consensus that the health crisis will be followed by a deep economic downturn that will represent larger declines in countries’ gross domestic products than ever seen before.

In Europe, the pandemic has radically changed the patient care model overnight. Radical technological and organisational changes are taking place. Since the first COVID-19 cases were detected in Italy, European health systems have responded by making a giant leap toward the virtual delivery of patient care. Led by health professionals, health centres have adapted promptly to this unprecedented situation. They are adopting digital health solutions that enable virtual care to protect both health professionals in facilities for infection control, and patients in hospital and at home.

Virtual care comprises a wide range of applied digital health solutions. It includes electronic and video consultations, telemedicine services, and mobile health applications. When self-isolating at home, patients can communicate easily through these digital platforms with health care professionals.

Examples abound of new uses of digital solutions throughout the European Union. Despite the fact that most of these digital services were available before the COVID-19 crisis, their use was often rather marginal. Even in health systems with an advanced eHealth infrastructure that allowed data-sharing among health providers, care was predominantly delivered face-to-face. Now, 70% of encounters that were previously provided conventionally are conducted virtually in the region of Catalonia, Spain. Germany has experienced a dramatic increase in teleconsultations. Operators of telemedicine platforms report growth rates in use of over 1,000% over the past weeks.

Reimbursement models for care have been modified. Online appointments are now reimbursed in the same way as face-to-face meetings by the German National Association of Statutory Health Insurance Physicians (KBV), but with a technology surcharge. In France, health authorities and health insurers are encouraging expanded telemedicine use, and are offering providers and patients incentives to use this delivery model. The Belgian National Institute for Health and Disability Insurance (INAMI/RIZIV) has fixed the medical teleconsultation fee to €20.

Telemedicine offers myriad benefits. In the context of a public health emergency such as COVID-19, it reduces the risk of infection for the individual patient and for the hospital or practice staff. It also frees up hospital resources for the patients who need them.

These three underlying elements, together with the additional financial incentives being provided in some countries, are decisive for a massive uptake of digital health. The third strategic priority of the European Commission Digital Transformation of Health and Care – empowering patients and health care providers through the use of virtual care – is being fulfilled at an astounding pace.

What will come after the peak of infections is reduced remains uncertain. More remote communication may become more widely used in the future. This crisis is showing that a model of care based exclusively on face-to-face meetings was perhaps not always necessary, and probably seldom desirable for patients. Paradoxically, digital technologies that were criticised as dehumanising care have kept people together in this situation. They are particularly playing an essential role in connecting patients and families.

It seems that the use of virtual care will be consolidated, unless the current benefits reaped alter significantly. Virtual care will provide a more major complement to conventional care than it did before. Consolidation depends on how effectively virtual care will be integrated into healthcare professionals’ diaries, the provision of care pathways, and patients’ electronic health records. Transitioning from physical to virtual care comes with new challenges that will require additional financial and organisational resources. Health system governance arrangements that ensure telemedicine as a more usual way of delivering care will need to be improved.

As has long been said, a crisis also means an opportunity. All in all, the positive side-effects of this undesirable crisis are the massive disruptions catalysed by digital health, and the opportunity to rethink entirely, and in the longer-term, how health services are provided in the digital age.

A digital-first approach can work. The evidence gathered throughout this large-scale natural experiment will likely serve to define a digital-first approach that can deliver value and loosen unjustified expressions of resistance that blocked progress hitherto.