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Posts Tagged ‘ict’

As the demographic pyramid evolves towards a demographic cylinder, we look to ICT as the solution. Even with the push that COVID-19 has meant for the use of ICT, I still doubt that ICT alone is the solution.

If we take ordering goods or services over internet for private use[i] as a proxy of the confidence of users in ICT, we can appreciate that even if between 2015 and 2020 there was an increase of ten points, from 62% to 72%, of internet users in EU27, there are still countries like Italy or Romania and Bulgaria with less than 50% of the population using internet for shopping.

Internet access follows a clear north-south divide[ii]: the population in northern countries who have never used internet is below 10%, while in southern countries, like Portugal or Romania, that percentage is above 20%, or even 30% in countries like Italy or Bulgaria.

Focusing on our target population: old people and informal carers, made up of mostly old carers and immigrants, only 32% of individuals over 64 have shopped online[iii]. Unfortunately, the same divide north-south happens with old people: while in places like Portugal, Greece and Romania less that 10% of old people have shopped online in the past 12 months, in countries like Belgium, Germany or Norway the percentage is above 40 or even 50%.

Going back to the question, is ICT the solution for caring for old people? The answer is a definitive no. Even in countries with a high percentage of old people with ICT literacy, we must assume that the normal evolution of ageing will make most of those people reliant on informal carers who not necessarily have the same ICT skills.

ICT is here to stay and with time will take a bigger and bigger role in the care sector but, as of today and in the near future, we will have to rely on informal carers. People mostly coming from eastern and southern countries in Europe with a lot of heart and passion for their job but little or no ICT skills. The challenge is to develop ICT solutions for these people. These solutions should be similar to WhatsApp, which is so successful because it is easy to use, and the rewards – communication with family and friends – are instant.


[i] Source Eurostat (online data code isoc_ec_ibuy)

[ii] Source Eurostat (online data code isoc_r_cux_i)

[iii] Source Eurostat (online data code isoc _ec_ib20)

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The idea comes from a podcast by The Economist, “The New Old”, in which Andrew Scott from the London Business School discusses the importance of acting rather than reacting.

The point is that there are millions of ideas developed for old people. Few have moved from the drawing board into everyday life. This lack of adoption of new ideas seems to stem from the fact that it is too late for old people to adapt to new inventions and/or methods. And also, it is too late once morbidity has already developed.

As the title clearly expresses, what we should aim for is helping people to develop healthy habits that will make ageing a lot more bearable and enjoyable.

Prevention has traditionally been the black sheep of the socio-health sector. There is a lot of talk about it and very little action. Dare to type “self-help” in Google or in Amazon, and the number of entries is in the range of the thousands. But still, there is no action from the public socio-health system.

It is usually the case in organizations that they tend to put out fires, while forgetting the most vital step:  preventing the fire. Acknowledging that fact, it is no consolation to see that the socio-health sector acts in the same manner: attending those already sick and forgetting about preventing sickness.

So the trend continues, and what the formal public sector does not provide, falls into the hands of the private sector: filling the gap started years ago with the self-help books, and which today has moved from books to apps and ICT tools of all kinds.

Of course, I am not against the private sector coming to the rescue; on the contrary. What I would very much like is for the public socio-health sector to integrate into their system those apps and other prevention tools that would, in the long run, ameliorate pressure on the socio-health system. In short: to integrate the concept of helping people to age better.

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The Riyadh Declaration on Digital Health articulated seven priorities and nine recommendations to be adopted by the health community. Even though Covid-19 has been an accelerator of the adoption of ICT tools applied to the health sector, a deficit in the widespread adoption of digital tools to foster a better healthcare persists.

Of course, out of the 7+9 we could choose many culprits for the situation. But to me there are two recommendations that are the core of the problem:

Number 6: Cultivate a health and care workforce with the knowledge, skills, and training in data and digital technologies required to address current and future public health challenges

Number 8: Develop digital personal tools and services to support comprehensive health programmes (in disease prevention, testing, management, and vaccination) globally

Both recommendations focus on people; one on the healthcare professional, the other on the citizen. Both groups are eHealth users, and both groups are normally forgotten by the developer. The basic problem is the existence of a generation gap. Most ICT developers are millennials, the kind of person who, like somebody I was with yesterday, thinks that a 40-year-old person is “old”. They are not willing to pay attention to the reality of demographics. If they invested some minutes to the study of today’s demographics, they would discover that one third of healthcare workers are over 50, and that one fifth of the EU-27 population is over 65 (see Training for ICTs).

The point is that developers should have users in mind. I know that, at least in EU funded projects, it is a requirement to take end-users into the equation. And I know that efforts are made by the developing consortia to involve them. But the problem exists, and it exists because the process of getting an ICT application into the market starts with the ICT developer dreaming of a solution to a problem that the developer has identified, and then looking for an end user that fits the dream.

The correct process should have been, and very seldom is, for the end user to dream about solving his or her problem, and then identify the ICT developer that fulfils the dream. As you can see, the end user should be the driver of the process, not the back-seat passenger in the development vehicle. Acting this way will make it easier for ICT to reach its true potential.

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Rehabilitation is mostly understood as a side order of a full-blown treatment of an illness. Should it be so? The first casualty of that point of view is rehabilitation itself. Rehabilitation is “a set of interventions needed when a person is experiencing limitations in everyday physical, mental, and social functioning due to ageing or a health condition, including chronic diseases or disorders, injuries, or trauma”[i] The definition does not imply that rehabilitation should be linked to the treatment of an illness. My point is that rehabilitation should be linked to maintaining one’s physical or mental health: a prevention tool more than a cure.

If we take that approach, rehabilitation would become part of primary care as against being a by-product of specialist care. Primary care is the point to which a person will turn when feeling something is wrong with his/her health. That does not mean necessarily that the person is ill; that the person is a “patient”. I resent very much that word. The label “patient” is diminishing any way you look at it. Does it mean you must be tolerant with the health professional who is treating you? Or is it that you must endure your suffering? The use of the word “patient” limits also the scope that rehabilitation should have since it links rehabilitation to illness.

Rehabilitation should take a bigger role in humans’ wellbeing. A recent paper[ii] points out that almost one in three people on the planet needs some kind of rehabilitation. If we narrow the focus, 1.71 billion people have musculoskeletal conditions that could benefit from rehabilitation. Narrowing even more, around 30% of the population in the European Region has musculoskeletal problems.

With an ageing society, that percentage is only going to increase and the health system, or primary care for that matter, is not and will not be able to cope with the problem. A different approach must be taken to devise a system that relies more on prevention and less on after- the fact- cure. The situation represents a unique opportunity for developing easy to use ICT tools that help primary care professionals address the growing demand for preventive and curative rehabilitation therapies.


[i] Cieza A. Rehabilitation the health strategy of the 21st century, really? Arch Phys Med Rehabil 2019; 100: 2212–14. Cited by Cieza A. et al Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. thelancet.com on December 4, 2020

[ii] Cieza A. et al Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. thelancet.com on December 4, 2020. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932340-0 Accessed 08.12.20

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During the pandemic we have taken for granted that all of us are digital natives. Nothing could be further from the truth. Only Millennials (1981-1993) and those younger can be considered digital natives; the rest of us need some kind of introduction or training to the digital world.

Now, bring this to the healthcare world. In the EU27, “One third of workers in health and social care are at least 50 years old,” according to Employment in Health and Long-Term Care Sector in European Countries (NEUJOBS Working Documents 2013).

And what about the population at large? “In 2019, more than one fifth (20.3 %) of the EU-27 population was aged 65 and over,” according to Population structure and ageing (Eurostat).

And yet, we assumed that it was easy to emigrate from an analogic care system to a digital one. No wonder most of us are still running around like chickens without a head trying to make sense of it all.

I have heard a lot of praising of the possibilities that the digital world could bring to our everyday lives. Massive investments in ICT; new apps that will change the way we manage our illnesses; gains in efficiency in the care system, etc. Unfortunately, I have not heard of how those 50-year olds and older healthcare practitioners, and those millions of 65s and older are going to be trained to understand and use those wonderful ICT gadgets.

I hope we are not sleepwalking towards a rude awakening in which those massive investments have been dumped in the garbage, because very few people understand their usefulness and even fewer people are prepared to use them.

Maybe there is still time to pause and think: think about the people who have to use the applications. Or maybe, is it simply to think about people?

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Due to the current situation, Primary Care has been brought to the limits of its endurance. This cannot come as a surprise. Most systems are tailored to the current needs that the system has to attend to, not to emergency situations. The job of Primary Care is to attend the day-to-day business of the population, acting as the front door to the health system, and to monitor the evolution of chronic patients.

Covid-19 has added a new dimension to this job description: doing the triage of the population in view of identifying those infected with the virus. It would not be a big problem if that were a normal procedure: anamnesis, decision, and derivation to the appropriate health resource or, as is the case of the flu, a recurrent winter event that can be pre-programmed. But this is not the case. To start with, SARs-CoV-2 is a very infectious virus that occurs throughout the entire year. The fact that it is highly infectious has changed the way the healthcare professional has to confront his/her prospective patient. The professional has to be equipped with Personal Protective Equipment (PPE), the premises have to be disinfected regularly, incoming people have to be pre-checked to avoid unnecessary contagion of personnel and contamination of the premises. All of these procedures necessarily slow the flow of patients precisely when the flow increases due to the pandemic. The result is a bottleneck in the system, and in an attempt to solve it, monitoring of chronic patients is sent to the back of the Primary Care priorities. The system assumes that a chronic patient will not evolve so quickly as to need urgent intervention: just take your medication and hope for the best.

But there is a solution. There are plenty of simple ICT applications to monitor vital signs and other signs like glucose. Unfortunately, we must admit that the biggest barrier to its introduction has come from healthcare professionals. While it is assumed that if the patient needs a medication, the healthcare professional will administer/prescribe it, it is still exceedingly rare that the same professional will prescribe an app. There is no explanation for this dichotomy. How can you explain that a professional will not recommend/prescribe something that is good for the patient and for himself/herself? It saves work for the professional and empowers the patient, allowing the latter more control of the management of his/her condition. There is for sure a long way to go, but the first step in the journey is to convince health professionals of the usefulness of ICT apps, probably using the same procedure that pharmaceutical companies use to introduce their products.

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“… two-thirds of people aged 16 and over report to be in good health in 2016” (OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris.) Which means that one-third of Europeans think their health is less than optimal.

Taking care of roughly 170 million citizens is not easy. Our health systems are stressed to the limit even without the Covid-19 pandemic. But we have to deal with 170 million people with health problems, 340 million whom we don’t want to get sick, and all of the 510 million exposed to sar-cov-2.

To attend that demand there are approximately 1.7 million licensed physicians and 3.1 million practising nursing professionals. In relative terms, that means 333 physicians and 607 nurses per 100.000 persons (figures for 2018, Eurostat).

It has become quite clear that those numbers have not been able to cope with the pandemic; hence the second wave we are currently going through. I do not know, and what is more, nobody knows, who is to blame and where the fault lies. Only one thing is sure: healthcare professionals are overworked, non-urgent interventions are postponed, and the second wave is here.

We cannot “produce” healthcare professionals. “Importing” them should be ruled out. Depleting other countries of their professionals should be banned. Basically, this is saying: we take your professionals and you keep your pandemic. Furthermore, we will block your country so that no spill over will infect our sancta sanctorum.

Infrastructures are not easy to build and, in the best of scenarios, are just remedial actions for an already sick population.

If healthcare professionals cannot be produced and infrastructures come too late in the process to avoid illnesses, what is left? I can only identify ICT as the solution. Health and fitness Apps should be the solution to make a real difference. They are intended to prevent the user from becoming ill and help him to be fit. The time from inception to the market is relatively short.  And their price is in a range that most people can afford if, as is mostly the case, the healthcare system does not cover them.

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We all are moving fast. The baby-boomers (1946-1964) are coming of age … retirement age. If the silent generation (1920-1945) was the generation that absorbed the car and the telephone as routine communication tools, we would expect the baby-boomers to take information and communication technology (ICT) as their routine communication channel.

That is the case and, when dealing with today’s problems, the expectation becomes a truism. We all jump into using ICT to solve many of the aging problems that baby-boomers encounter. And, as it happens, this is the view that the European Commission holds: ICT is here to solve the ageing problem.

If we take the use of internet as a yardstick, the reality is that only 45% of the +65s use internet once a week or more in Europe. Descending to country level, the differences are striking: in Norway that figure is 82% and 12% in Bulgaria.

So, should we jump from analogic to digital in the blink of an eye or are we going to find the swimming pool empty? Wouldn’t it be more realistic to work on long-term structural change from analogic to digital transition, similar to the energy transition favored by the UN in the current COP25?

A transition of that kind will ensure that nobody will be left behind, a very important factor when we are talking about 55% of the +65s Europeans.

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If you come across anybody who has not heard of Internet of Things (IoT) be careful, the person surely comes from another planet. IoT is at the centre of any ICT research. Everybody is developing devices, claiming that these will interconnect to anything you already have or will have.

And yet, at home we still have several remote controls for our smart TV, for recording devices, and for the all present black box that allows us to enjoy hours of the most degrading TV shows. Of course, the sound system runs under another completely different set of remote controls: for the CD player, the tuner, not to mention the necessary turntable that we have brought to life again after having been convinced that the sound is a lot more natural on an analogic record than in a digitalized CD.

IoT’s promise is that all our gadgets will be interconnected inside our homes and even with the exterior. A different problem is whether I really want my fridge to send messages to my grocery store to replace that uneatable marmalade that my daughter in law gave me and that I have been struggling to finish for the past two months.

Although the promise is great, reality strikes back. As of today, only 6% of American households have a smart-home device, and 72% of Britons have no plans to adopt smart-home technology in the near future (The Economist 11.06.2016). Of course it does not help that some of the smart gadgets like the Samsung´s smart fridge goes for almost $ 6,000.

IoT marketing is probably missing the point, as has been the case in many new ICT developments. Putting the focus on the ICT novelty will not attract people. Unless the smart-home gadget solves a real problem, it is difficult to convince people to adapt it. Technology is available today for doing almost anything that anybody can think of. The problem is the generational divide. Young people full of energy devise new things that are meant for older people maybe two or even three generations apart. Have they asked those people what they really need? Have they participated in every phase of the development?

Just as a marker, go to the pictures of any of the ICT gatherings in the world and try to spot anybody older than 65. Even those gatherings especially dedicated to ageing, like the yearly AAL Forum which I have attended many years, are packed with young people full of ideas that will be tested on older people just because the rules say so, not really because they feel like it.

And then we come to the pure ICT problem of interconnectivity. It is essential to develop a common standard to allow seamless connectivity among gadgets from different makers. From what I know, that is being done more or less for industrial IoT, but something similar for the domestic domain is lacking.

In all, my bet is that IoT as something integrated in everyday life is a long way off. Only a concerted effort to develop an overall global standardisation, coupled with real intergeneration symbiosis, will bring forward the realization of the home IoT.

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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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