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Posts Tagged ‘e-health’

Remedial care, meaning actions taken after an ailment has been detected, has been the traditional focus of healthcare. Probably that is the reason why, when politicians decide to invest in healthcare, they put the emphasis on hospitals and fancy machinery. Let us not be cynical and think that it is because a picture taken in front of a multimillion-euro hospital looks better than one taken in front of a non-descript primary care building. Most probably, policy makers are the slaves of some defunct theory (to paraphrase Keynes).

They, or probably all of us, do not follow the advice – Keynes again- that “When my information changes, I alter my conclusions.” We see it on the current so-called second Covid-19 wave. There is a lot of talk about building more wards dedicated to Covid-19 – remedial – and little emphasis on reinforcing primary care – prevention – where the pressure for tests and tracing is mounting.

Contrary to reacting to a situation, preventing it is a lot more efficient and effective. Unfortunately, the Covid-19 pandemic has demonstrated how few preventive measures have been taken by all of us. We cannot say the problem lies solely with policy makers; it has been all of us who have decided not to take the most basic measures to fight the spread of the virus. We are all to blame.

Apart from the tracing app, there has been very little development of ICT based instruments to fight Covid-19. The fact is that we, as a society, tend to focus on the immediate, and not to look at the big picture: too many tactics and very little strategy. Confronting the problem as a Covid-19 problem will not solve the imbalance in favor of remedial care against prevention care.  We need to divert our investments, human and material, to primary care, where healthcare becomes much more than treating illnesses, where healthcare is preventing people from becoming ill. Thinking that way, I can see lots of ICT applications that could help primary care do its job: simple, user-friendly applications to be used by normal people, designed to help practitioners do their job and the population to remain fit and healthy.

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e-Health has been around for a long time; we could even say it is an old feature in today’s world. But yet, who is really using e-Health today? Do you know of a friend, a neighbor, a relative using any of the many gadgets that are part of e-Health? Don’t focus only on the internet, that is not e-Health by itself. The internet provides information, albeit a lot more information than what we used to have at home. Certainly a lot more, and up-to-date, than the classic “Our bodies, ourselves” which probably a lot of my readers haven’t even heard about and that, by the way, has moved to the www.

Let´s go through the process that has brought us to this point in the history of e-Health. The first push came from the R&D organizations. More specifically, the European Commission, through its many R&D programs, has been financing research for years into what we know today as e-Health. Millions of euros have been lavished all over Europe to make e-Health a reality. As always, in the USA the private sector has been the driving force behind this endeavor. The result is a myriad, I could safely say even a milliard, of what is known as Personal Health Systems and other types of gadgets and integrated e-health systems.

The second lever for securing a wide permeability of e-Health is the people, i.e. the patient or the primary user. The use of ICT technology by the population is increasing by leaps and bounds. The older population, probably the strata that could most profit from the use of ICT tools to maintain their living standards, is changing radically. There is very little in common between the older population of today, and the future older population coming out of the baby boomers of the post-war. A recent study in Spain by Fundación Telefónica reveals that the population older than 55, is using internet for productive proposes (e.g. banking or filing taxes) at the same level as the rest of the population. And it is in these population strata in which the use of smartphones applications is having the biggest boost.

The secondary end user, the socio-health professional, is obviously an important lever for spreading the use of ICT socio-health applications. Although maybe a little dated, PwC released a study in 2012 on m-Health concluding that “Healthcare’s strong resistance to change will slow adoption of innovative m-Health”. A closer look at the study reveals that it is the skepticism of the professionals that hinders the extensive use of m-Health in particular and e-Health in general. Because I believe that unless professionals prescribe e-Health gadgets with the same confidence that they prescribe today a medicine or a treatment, e-Health will not take off.

But for that to happen, the fourth lever has to act. This is no other than the socio-health care system; in Europe led by the public sector. It is very telling that while one branch of the public sector is pouring money into R&D, the other branch is simply ignoring the fact that ICT tools could save a lot of money in taking care of the socio and health ailments of the population they are covering. Is it so difficult for the politicians responsible for R&D and those in charge of the socio-health system to talk to each other? Apparently so, but I would appreciate your views on the subject so that among all of us we could find a path to a better and more e-Health world.

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A simple look at the press in Europe shows how governments have come to the realization that there is a quick and easy solution to the problem of ageing in our societies:  extend the retirement age.

This solution has distinct advantages.  First of all, it is quick; the government will delay the moment in which one will become dependent on the public purse.  Secondly, citizens will be putting their Euros into the public purse for longer.  Of course, the related problem of the expense necessary to take care of a larger older population is only partially solved by the increase in revenues.

I am not arguing against the simplicity of the scheme.  I only wonder how long it will be before the retirement age is again extended.  Would it not be more sensible to establish an automatic system that makes retirement dependent on, for example, life expectancy?  At least we would avoid the inevitable counter-round of public outcry aimed at blocking the inevitable extension.

But maybe we should focus more on the fact that, as long as Europe’s fertility rate falls short of the replacement rate, the problem will keep cropping up, and this is the real problem.  Of course, populist politicians and the far right will block the obvious and quick solution of letting immigration work and allowing into our markets the much needed and capable hands of people from – in the case of Europe – basically Africa.

But even if the fertility rate reaches the level of the replacement rate, there will be in Europe more older people who live longer.  That means a mounting pressure on the health and social budget.  Have our authorities done anything serious to improve the process by which we take care of that population?  It is apparent to me that we continue to provide socio-health care in the same way as we did a century ago.  True, there are more than enough pilot projects attempting to find alternatives that permit ageing well and in one’s own surroundings.  But has eHealth or, more appropriately, eSocioHealth permeated our daily lives?  No, I am afraid not.

I am convinced that only a real change in the process of taking care of older people, using the technologies that are today in our hands, will permanently dissipate the tension in the budget created by the very welcome increase of our life expectancy.

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