Digital-health

I have the feeling that, once again, we are relying on technology to make up for the lost time and make up for the mistakes and inertia of the past.

I am referring to the apps with which you want to solve a long list of problems, including:

• the lack of civic sense of some people who break the rules and who, despite police checks, do not respect social distancing
• the insufficient coordination and lack of clinical collaboration between all those operating in the territory, to whom the USCA have been added
• the fragmentation and predominantly managerial – administrative nature of territorial information systems
• the reduced diffusion of pro-active models in the management of fragile and chronic patients
• the lack of ICT infrastructure to support telemedicine and tele-health
• the inadequacy of epidemiological and prevention systems that are not designed to deal with a crisis such as that of Covid-19.

The list is actually much longer but I don’t want to bore you with a long list of grievances and recriminations.

Technology is a tool with which it is possible to achieve a process of digital innovation that is only possible if it produces benefits, that is, value.

Apps, in the imagination of many, are the solution or rather the perfect shortcut to reach and involve patients. But are we sure this is the case? And that this is enough to improve patient care at home?

Apps require, in order to work, a smartphone, an account at a store (Google or Apple), the ability to select, install and update software, familiarity with this type of application. There are several people who do not meet these requirements (in a medical sense we would say inclusion criteria), especially among the elderly and the frail. Apps are “passive“, i.e. they require someone to use them.

When in the ASL of Lanciano Vasto Chieti we asked ourselves the problem of how to implement a home surveillance system, we chose, also on the basis of the data we had, an automatic (“pro-active”) telephone recall system to avoid excluding part of the patients. The system calls twice a day and formulates simple questions that people answer.

It would certainly have been more modern to think of an app but we would not have had the same effectiveness. The data we collected show a redemption of over 90%. I doubt that with an app it would be possible to achieve the same values.

By this I don’t mean that apps are useless but that it is necessary, even in an emergency, to think about a multi-channel strategy if we really want to reach as many people as possible.

Apps are, however, using technical language, only the front end of the problem. And the backend?  It is, of course, not just a software problem but, first of all, an organizational one: professionals, models, tools for sharing and clinical collaboration, rules of engagement and so on.

In short, even or above all in an emergency, you have to face the problems having a clear and complete vision of all the factors at stake. It is not possible to risk wasting time and resources in operations that are of little use or for ends in themselves.