The hospital-centric model, the organisational form of family medicine, the lack of multidisciplinarity in the CTS, the lack of self-criticism and planning of the NHS after the first lockdown, the emphasis on televisits and not on active remote surveillance: these are the mistakes that are costing us dearly and how to remedy them.
Article published in preview on AgendaDigitale.eu.
After the first phase of the pandemic, the lockdown and what looked like the exit from the health emergency triggered by covid, there was no critical review of what worked and what didn’t, what to develop or improve. It was assumed that the worst was over and that the measures taken in the first phase were sufficient even for a second wave of the virus.
The chronic lack of self-criticism and planning of the Health Service, both at central and regional level, has prevented any attempt to improve and strengthen the measures for Covid-19.
We have lost valuable time and we must, once again, work in an emergency to fight a war that will be particularly difficult.
If we really want to win this war it is therefore essential to use “digital weapons” whose design must include multidisciplinary skills. One cannot face a pandemic of this magnitude without collecting and using big data, artificial intelligence, CRM technologies, multi-channel communication tools.
Let us then try to frame the problems upstream and understand what could be changed, starting from the assumption that the fight against Covid-19 has only made the organisational and cultural limitations of the Health Service and the main health institutions that existed before the pandemic even more evident.
The failure of the hospital-centric model and “analogue” health care
The healthcare model, hospital-centric, that has been built over the years, is neither adequate nor structured to manage a pandemic that develops in the territory where we discount the lack of care networks able to provide help and support to patients.
The organisational form of family medicine, mostly composed of individual professionals, has neither the tools nor the resources to play a role that goes beyond the function of “gate-keeping” to hospitals. Despite the goodwill and commitment that most GPs and PLS are putting into managing the pandemic, the increasing flow of people to emergency rooms is proof that the response that primary care can offer is not sufficient to meet or at least calm the demand for patient care and treatment.
The high number of cases, suspected or acclaimed, makes dramatically evident all the limits of an “analogical” healthcare system based on 20th century organisational models: the doctor’s office, with little equipment; the doctor who visits patients in the office and, much more rarely, at home; an information support that does not have the legal value of a “medical record” and is completely isolated from the information systems of the Local Health Authorities and hospital companies.
The need, in the first phase, to cope with the Covid emergency was addressed by concentrating all resources on the medical management of patients, leaving it to the prevention departments to contain and monitor the course of the pandemic.
Lack of multi-disciplinarity in the Technical Scientific Committee
But who has managed and manages the organisational aspect? With what skills? With what tools and, above all, with what information?
The National Technical Scientific Committee (CTS) has been set up and is made up of university professors, doctors and researchers with a high professional profile in various specialties of medicine. However, there is no process engineering expert in the CTS, let alone digital health, big data and AI.
The lack of multi-disciplinarity and non-medical expertise has meant that a traditional – analogue approach with obvious limitations and problems has been followed in the organisation of the national and regional health system.
Case management has been and still is, in most prevention departments, managed with Excel and email, with errors and problems of various kinds (full mailboxes, copying and pasting of wrong boxes and so on).
The diagnostic process has been and is managed in a hybrid way with email, electronic requests, laboratory systems, communication systems, through a patchwork of very heterogeneous solutions and technological tools.
Home surveillance of suspected and positive cases has been conceived through voice calls, twice a day, from doctors to collect some information on symptoms and monitor patients’ clinical conditions.
The collection and transmission of data from the regions to the Ministry of Health, the Istituto Superiore di Sanità, the Prefectures and the Municipalities takes place through information flows aimed at “counting” cases and differentiating them by territory. There are, for example, no indications as to where the infection occurred (e.g. workplace, transport, etc.) and in what context (home – work, leisure time, etc.).
Decisions are made about what to close or limit without any evidence, but only with assumptions that completely disregard what is really happening in the country.
After lockdown, no self-criticism
Attention was therefore focused above all on the tools that could allow health companies to recover the past, visits and diagnostic tests, maintaining social distancing wherever possible.
This explains the strong push on televisions whose introduction has been greeted by many with emphasis and satisfaction, overestimating in my opinion the real scope of this small medical revolution.
Much less has been done in the field of home care where, apart from a few tenders or projects to activate remote telemonitoring services, the issue of active tele-surveillance has not been fully addressed, starting from the clinical and organisational aspects and the recruitment of human resources.
As far as diagnostics are concerned, new tests have been tried and introduced without, however, taking care of the digitisation of the entire process and its integration with the taking care of suspects and Covid-19 patients.
However, the most important shortcoming concerns epidemiological surveillance systems. To help contact tracing work, an app – Immuni – has been developed to track contacts and possible exposure to the virus. As is often the case when there is a lack of maturity and a clear vision of digital strategies, a technocratic project has been set up as an end in itself, imagining that an app alone could solve all the needs.
Rather than conceiving and developing a national epidemiological surveillance system able to treat cases, define the relationships between them, manage the diagnostic process and the patient’s path, we preferred to tackle a small part of the problem, not even the most important one.
We have lost valuable time and we must, once again, work in an emergency to fight a war that will be particularly difficult.
If we really want to win this war it is essential to use “digital weapons” whose design must include multidisciplinary skills. One cannot face a pandemic of this magnitude without collecting and using big-data, artificial intelligence, CRM technologies, multi-channel communication tools.
Digital-health 