The Covid-19 emergency has tested the stability of the Italian health system, highlighting its gaps and delays, but has also accelerated the digital and organizational transformation towards a model of Connected Care, underlining the urgency of a connected, precision system, oriented towards the territory and the continuity of care.
In the midst of the pandemic, over half of Italian healthcare facilities have introduced organizational procedures to allow employees to work in agile mode. According to research by the Digital Innovation Observatory in Healthcare of the School of Management of the Milan Polytechnic, 51% of general practitioners worked remotely and judges the experience positively, both in terms of sharing information and the ability to respond to urgent requests.
Barriers and prejudices on digital have fallen: if already before the emergency 56% of general practitioners e 46% of specialists used WhatsApp to communicate with the patient, in the future as many as 69% of GPs and 60% of specialists would like to use collaboration platforms (e.g. Skype and Zoom) or dedicated platforms. Attention has grown towards Telemedicine, essential according to three out of four specialist doctors in emergency management, and also towards Artificial Intelligence, considered useful for increasing the personalization of care, even if still little used by doctors.
In this emergency phase, more than half of the citizens got information about Covid19 through digital channels: 56% consulted institutional web pages, 28% social networks of doctors and politicians, 17% social networks or blogs edited by citizens, 12% Apps dedicated to the Coronavirus. However, in this phase of uncertainty, citizens have relied above all on traditional channels: 97% got information by watching the news, 84% TV broadcasts dedicated to the pandemic, 53% by reading the newspapers.
"In such a delicate moment for the country and with such strong pressure on doctors and hospitals, the role of digital becomes even more important to increase the resilience of the health system - he commented Mariano Corso, Scientific director of the Digital Innovation Observatory in Healthcare -. Digital technologies can make a difference in all stages of prevention, access, treatment and patient assistance, to help healthcare personnel in clinical decisions and healthcare facilities in the continuity of care and operations. The emergency is an opportunity to experiment with solutions that make the most of the benefits: contain the contagion, reduce hospitalizations, manage patients on the territory. But also to redesign models of care by accelerating the transition towards a more connected, sustainable and resilient healthcare model".
The emergency response of healthcare companies
The presence of a timely and efficient IT supply chain (essential for quickly purchasing new IT tools and equipment) was one of the most problematic organizational aspects for healthcare facilities in emergency management, with 47% of the sample indicating it as a critical or very critical element, followed by business continuity plans (44%), organizational procedures for the activation and application of Smart Working (41%), the presence of effective and timely support from the IT help desk (41%) and the need for collaboration between different clinical facilities (41%). Only 9% of healthcare organizations were business continuity ready and only 11% had a redundant command structure, but only 19% and 14% respectively took steps to fill these gaps, while the majority it is concentrated on the activation of organizational procedures for the application of Smart Working (51%) and on the collaboration between different clinical structures (39%).
From a technological point of view, the most delicate elements were the need to have digital tools to ensure personnel work in agile mode (for example, the laptop), indicated by 89% of the sample and on which only 6 % thought he was ready, e Cyber Security problems (87%), for which 53% believed they had adequate solutions, but which were accentuated by the use of agile working and therefore access by company personnel to unprotected networks through personal tools and devices. Equally relevant in this communication and collaboration platforms for staff (84%), widely present in only 19% of the sample, and mobile tools (tablets, smartphones, etc.) for healthcare staff (79%) were the phase. To improve their technological equipment, 39% of companies have introduced or enhanced communication and collaboration platforms, 31% have included tools to allow smart working and 30% have provided mobile tools to staff, only 6% has enhanced its Cyber Security solutions.
The impact of Covid-19 on the work of doctors
The Covid-19 emergency has forced General Practitioners (GPs) to reduce patient flows at the practice and increase their telephone availability. A survey conducted on a sample of 740 GPs by the Observatory in collaboration with the Italian Federation of General Practitioners (FIMMG) shows that telephone consultation was the activity most impacted by the emergency (indicated by 93% of the sample), followed by the need to reorganize the activities of the study to limit the contagion (86%), by the modification of the relationship with the patient (75%) and of the methods of clinical evaluation of the problems (73%) and by the need to use more than one channel to manage the relationship with the patient (72%). 51% of the GPs interviewed worked remotely during the emergency and overall the experience was positive both in terms of information sharing (63% of GPs) and the ability to respond to urgent requests (63%) , while the main difficulty was reconciling work and private life (38% rated this aspect negatively). 40% of family doctors believe that this experience will be useful even after the emergency is over, provided that the tools for working remotely and communicating with patients are enhanced.
The digital tools that family doctors felt most needed in this phase were the smartphone to communicate with patients and other doctors (indicated by 72%), the portable PC (61%) and services to access applications and to remote documents via VPN (60%), followed by tools for sharing and archiving documents (51%), desktop and application virtualization solutions (48%), tablets (47%) and call-conferencing tools (41%). Most had smartphones (88%) and laptops (73%), while only 47% had access to a secure network connection (VPN), 27% to call-conferencing tools and 23% to those for desktop and application virtualization. The tools they would like to invest in in the future are VPNs (74%, +27%), applications for sharing and storing documents (78%, +19%) and those for call-conferences (62%, + 35%) and desktop virtualization (55%, +32%).
More digital citizens/patients
During the emergency, over half of the citizens got information about Covid-19 through digital channels: 56% consulted the institutional web pages (Civil Protection, Regions, healthcare companies, etc.), with peaks of 83% among the 25 -34 year olds, while only 30% of the over 65s did it; 28% were informed on the social pages of doctors or politicians (49% in the 25-34 range, 14% of the over 65s); 17% searched on social media pages and blogs maintained by citizens; 12% on apps dedicated to the Coronavirus. This was revealed by the survey conducted by the Observatory in collaboration with DoxaPharma on a sample of 1.000 citizens representative of the Italian population, which however shows a strong link with traditional channels. In fact, most citizens obtained information by watching the news (97%) and TV broadcasts dedicated to Covid19 (84%), or by reading the newspapers (53%).
“In a situation of uncertainty, aggravated by the rapid spread of fake news, citizens remained tied to the official channels in which they placed the most trust, such as the news (which 65% of users trust) and dedicated TV broadcasts ( 52%), while both the apps on the Coronavirus (which 74% of the sample do not trust) and the social pages and blogs managed by citizens (72%) were considered unreliable - he comments Emanuele Lettieri, Scientific director of the Digital Innovation Observatory in Healthcare -. However, the growth in the use of digital channels for health information remains positive and there are the first examples of chatbots that help the user in self-diagnosis based on the symptoms reported, even if they are still little used by citizens (10%)” .
Doctor-patient communication
The social distancing rules adopted following the pandemic have prompted doctors and patients to make greater use of digital channels and to rediscover the usefulness of tools that were used very rarely before the emergency. From a survey conducted on 740 GPs and 1.638 Medical Specialists - the latter carried out in collaboration with AME, FADOI, PKE and SIMFER - it emerges that Email, SMS and WhatsApp were already widely used in doctor-patient communication. Interest in future use has grown compared to the past among GPs, especially for emails (91% would like to use this tool in the future, compared to 82% of use before the emergency) and WhatsApp (66%, + 10% compared to pre-emergency use), while among specialists there is a drop in interest in Emails (50%, -16% compared to the past) and SMS (29%, -14%) and slightly in WhatsApp (43% , -3%). On the other hand, interest in collaboration platforms such as Skype and Zoom has exploded, with 38% of GPs (+34%) and 47% of specialist doctors (+33%) ready to use them in the future, and in communication platforms dedicated, in which 65% of GPs (+54%) and 43% of specialists (+31%) are interested.
Less than one in five citizens used digital channels to communicate with a GP before the emergency (19% Email, 9% SMS, 14% WhatsApp, the use of dedicated platforms and collaboration was marginal), a percentage that grows if we consider the communications with specialist doctors (23% Email, 22% SMS, 26% WhatsApp). About a fifth of citizens think of using digital channels in the future, especially Skype (23% to communicate with GPs and 21% with specialists) and dedicated platforms proposed by the doctor (24% with GPs, 23% with specialists).
"The health emergency has marked an important transition in the opinion of doctors with respect to digital tools for communicating with the patient, especially towards more innovative ones such as collaboration and dedicated platforms - he says Clare Sgarbossa, Director of the Digital Innovation Observatory in Healthcare -. In addition to the 13% of GPs and 23% of specialist doctors who already used these tools and will also want to do so in the future, respectively as many as 56% and 37% of doctors who had never used these tools have converted and intend to do so in future, even if many doctors are still against it (31% of GPs and 40% of specialists). In order for them to spread in the future, it will be very important that the doctor himself proposes this type of platform to his patients, in addition to the physical and traditional channels".
The role of Telemedicine
Long remained uncommon and at the level of simple experimentation, Telemedicine was already growing in 2019, but with the health emergency it has recorded a real boom in interest among operators in the sector. “Covid19 has given Telemedicine an acceleration that will be difficult to ignore in the future, with interest in its various applications growing in double figures and many structures that have taken action to offer remote services even to patients who are not sick with Covid – he claims Christine Massella, Scientific director of the Digital Innovation Observatory in Healthcare -. Doctors have understood how Telemedicine can be an important ally to maintain a more constant and appropriate contact with patients, in this phase of emergency, but also in the future".
General practitioners are the most convinced: one out of three already used at least one Telemedicine solution before the emergency, 62% of those who did not apply it will do so in the future and only 5% are against it. Three out of four specialists believe that Telemedicine was decisive in the emergency phase, but still 30% of them say they are against their use, against 34% who already used them and 36% who are convinced of the benefits and intend apply them in the future. The Telemedicine services that most attract the interest of doctors are Teleconsultation with a specialist (88% of GPs, 64% of specialists), Teleconsultation with a general practitioner (76% GPs, 52% specialists ) and Tele-monitoring (74% GPs, 47% specialists), followed by Tele-Assistance (72% GPs, 32% specialists) and Tele-Cooperation (60% GPs, 47% specialists). On average, according to general practitioners, 30% of visits to chronic patients and 29% of visits to other types of patients could be carried out using digital tools, while for specialist doctors these percentages drop to 24% and 18% respectively. %.
One in three citizens would like to experience a Tele-Visit with their general practitioner, 29% with a specialist, another 29% a Tele-Monitoring of their clinical parameters and one in four would try a video call with a psychologist. For citizens not interested in these applications, the main reason is the preference to meet the doctor in person (59%).
Artificial Intelligence in the emergency
According to 60% of specialist doctors, AI solutions can play a fundamental role in emergency situations, for 59% they make healthcare company processes more efficient, 52% believe they help personalize care, 51% that makes them more effective and 50% that contributes to reducing the probability of clinical errors. However, there are still few specialist doctors who use these technologies: only 9% used them before the Coronavirus and just 6% work in a facility that introduced or enhanced them during the emergency. To increase their use, it is important to develop adequate knowledge and skills and to share experiences and benefits of these solutions: 62% of specialist doctors, in fact, believe that it is easier to implement AI projects if other companies and doctors have already activated them, the 58% are more inclined to use them if they know their logic. On the other hand, only 26% of doctors declare that they have the right skills to use them and 22% that there are suitable skills to carry out these projects in the healthcare facility where they work.
“To accelerate the diffusion of Artificial Intelligence systems and exploit all their potential benefits for the healthcare system, it will be necessary to act on three fronts – he says Paul Locatelli, Scientific Head of the Digital Innovation Observatory in Healthcare -: increase the availability of digitally structured and unstructured data in order to train AI solutions and put them in a position to generate value in supporting personalized care; develop the digital skills of doctors and profiles who manage these solutions, with particular attention to Data Scientists; understand the limits of these tools and that their role will not be as a substitute for the doctor but as a support to his decisions".
