A few days ago, the eight principles for the digital transformation of public health of the Pan American Health Organization (PAHO) were announced and one of the points in particular mentions new information technologies, mainly artificial intelligence. The World Bank also recently proposed that we must move from digitalization to the concept of digital assets in health, that is, stop thinking about adoption – in transactional or healthcare logic – and move on to transformation, with new products and processes to provide health.
During the second day of Roche Press Day, an event held in Miami, United States, where health specialists and journalists from all over Latin America meet, digital health was put at the center. In this space, Daniel Luna, specialist in internal medicine and doctor in computer science, head of the Department of Health Informatics at the Italian Hospital of Buenos Aires, reflected on the matter. “Medicine is a science based on data and information, but although the amount of data is growing exponentially, only 20% of it is structured, 80% is unused.”
Making an analogy with oil, he explains: “There is a well, a process of extraction, refining and then the data is used for the production of products. In health, 20% is in traditional oil wells, but 80% is using new oil extraction techniques, this 20% normally comes from health organizations and structured sources, probably clinical and complementary records on benefits.
But 80% is in the repositories of health organizations, we are talking about free texts, images, audios, videos, genomic data, reports, genetic sequences, “all of that exists, but it is not reachable, it is like the oil that is in “middle of the rocks in the deposits.”
In addition, there is new information such as home capture sensors, smartwatches, translators, data on social networks, data on patients’ physical activity, photos that patients take of their food, menstrual cycle applications, all this information that is outside of health organizations and “they are one of the main sources to try to demonstrate the non-clinical or health determinants of health or disease and that is one of the great challenges for the future.”
Artificial intelligence and health
At the end of 2020, generative intelligence such as ChatGPT appeared, these are new techniques that can navigate unstructured data and this is something very promising for the future. “In this logic between complexity and usefulness, one will find that with reports, dashboards, descriptive, predictive and prescriptive analytics, crossed by artificial intelligence, it gives an opportunity to go to sources that until now were non-traditional.”
The first paradigm shift based on artificial intelligence will be to focus the entire process on members and health professionals, and thus try to bring patient-centered empowerment. This is said to be easy, but it has not been achieved, it is about of so-called value medicine because each monetary unit spent should be the denominator of the most important numerator, that is, the results that patients care about.
During the panel “Data-based health systems”, the specialists agreed: With technology we will avoid unnecessary studies and at the same time be more efficient and precise, but they will not only be useful because of the evidence but also because it will put the patient at the center.
To reach this value model, information systems are a fundamental pillar because you cannot manage what is not measured and you cannot measure what is not clear and classified information, that is the logic of medicine based on value, where the results are what matters to the patient, with all their preferences and differences, not just what the evidence in medicine dictates.
The shadows
“The main consequence of digitalization is the questions that have to be asked when dealing with the data, there are problems that are complicated and others that are complex and there is a difference, the complicated thing is to make a system, place the connection, make an investment and that the health team begins to use it; But the complexity is multifactorial and involves social determinants, in addition to other actors, not only health but civil society, it is difficult to have clean, secure data that really begins to make a difference,” said Henrique Mandetta, former Minister of Brazil Health.
For his part, Anton Zamora, doctor in medical informatics and specialist in digital health, said that it is important to mention that an information system is the shadow of what the health system is, “if you have a fragmented system, like most of the Latin American countries, we will have information in different places and without access, it will be hidden in the custody of each organization and subsystems, it will be a fight for the protection of the data. From that logic there will be different challenges, but always focused on the same goal, quality and patient safety.”
Luna concludes that “technology always has to be a means, we cannot look to technology as an end”, if it is not adapted to healthcare processes it can generate a lot of disruption, negative resistance to change and even bad practices; “There must also be a lot of governance, and it does not just mean having resources, but strategic planning because these projects have to be medium and long term, health professionals do not like to have the way of working changed, so there must be demonstrate quality and safety, as well as efficiency.”
Other challenges to accelerate this paradigm shift are:
- Lack of technological infrastructure or very heterogeneous
- Planning of the infrastructure concept, support of the different government agendas.
- Achieve equity and equality in connectivity.
- Training in new technologies for staff.
- Capacity of the systems for information to flow, for continuity (norms and regulations).
- Outdated regulatory frameworks.
- Financing concepts.