These are the e-health achievements that have come to stay

The pandemic has brought many changes; among them, a new way of looking after our health. Indeed, online appointments imposed by the lockdown, together with the use of apps to test for symptoms and wearables that monitor health-related parameters, have become a part of normal life. Although e-health was not a completely new concept for society when COVID-19 appeared, until then we were not fully aware just how much technology could become an ally for our health.

At least that is what the figures seem to show. In the United States alone, online doctor's appointments will pass the billion mark by the end of the year, according to the analysts at Forrester Research. And in Spain too, there has been a big jump in the same direction: according to the Cigna COVID-19 Global Impact study, 65% of the people in Spain will use telemedicine to consult a general practitioner in the future, which means that from now on it will become a routinely used tool. However, e-health is more than remote appointments. It encompasses many more aspects that have come to stay, as well as certain challenges that need to be addressed in the immediate future.

Apps, big data and artificial intelligence

Some of the applications of e-health include drones to take medicines to areas where there are disease outbreaks or robots that disinfect locations with a high viral load. However, it is possible that this type of technology will disappear when the pandemic is over.

But there are other tools that have emerged or expanded during these months that will stay with us, the experts say. This would be the case of mobile apps that assist in symptom-driven self-diagnosis or gadgets that enable continual monitoring of parameters to control existing diseases. However, if one had to say which technology will receive most attention in the immediate future, the development of algorithms for analysing large quantities of data, making correlations and detecting patterns that would otherwise be missed would have one of the top places in the list. Big data will have a leading role to play in this. Indeed, the pandemic has shown just how important they are, as they can be vital for saving lives if they are shared. This is because they can give us "real information about what is happening and enable us to make evidence-based decisions, which in turn gives added strength to the message that we need open, collaborative, transversal, transdisciplinary science," said Albert Barberà, director of the UOC's eHealth Center and one of the authors of the book Politics in lockdown? New technologies and decision-making during a pandemic (in Spanish; Aranzadi), to be presented at the Spanish Senate on 18 December.

However, there is still a lot of potential to be discovered. As Carme Carrion, professor at the UOC Faculty of Health Sciences and eHealth Center researcher, explained, although the conceptual framework of e-health has started a process of exponential growth with the pandemic, it is still a long way from peaking. One good example is artificial intelligence (AI). According to a report by HiMSS Analytics, the demand for AI tools is growing, especially in Switzerland and Spain, where between 37 and 42% of health professionals plan to use them. However, at present, only 16% of health professionals in Europe actually use them, while this percentage is only 11% in Spain.

Five challenges in e-health

1. Broaden the focus of telemedicine. Although these figures give the impression that e-health is almost a newcomer, the fact is that we did not start from scratch. A study performed by the American Medical Association (AMA) between 2016 and 2019 concluded that during these three years before the pandemic, acceptance of online healthcare by medical professionals doubled from 14 to 28%. And in Europe, the HIMSS e-Health Trendbarometer, which analysed the e-health situation in 27 European countries just before the COVID-19 outbreak, found that telemedicine was also starting to make inroads. At that time, chronic disease management was the most widely used telemedicine service, as 74% of the respondents reported that they used it. However, other areas did not receive the same attention. For example, only the Scandinavian countries were focusing on e-health for prevention and mental health, two fields that have received more attention in most countries since the pandemic.

2. Advance from disease treatment to disease prevention. According to the experts, prevention is precisely one aspect of e-health that we must improve. As Albert Barberà, who was appointed director of southern Europe's first academic e-health centre in the summer of 2019, explained, the pandemic has clearly shown that a lot of work still needs to be done in the field of health promotion. "We still need to do more to put the spotlight on health, not disease. Our health system is still very much focused on treating disease, but not so much on preventing it," he said.

3. Boost e-health training for health practitioners. Given the growth taking place in this area, it is expected that effort will also be devoted to training. Carme Carrion reminded that professionals worked under considerable pressure and stress, especially during the first weeks of the pandemic, and that the primary care network played a key role through the use of telemedicine. However, when the situation returns to a state resembling some normalcy, "implementation of online interventions should continue, as they have been shown to be effective and are a means for optimizing the time devoted to patients. For this to happen, we need research and training".

Albert Barberà shared this opinion. He said that one of the lessons that the pandemic has taught us is that we need to reappraise how health professionals are taught and trained. "Higher education institutions must become change agents in bringing about universal health and well-being," he said. This is one of the reasons why the eHealth Center is already working on improving health professionals' e-skills, "thanks to the knowledge contributed by UOC researchers who have been working on improving the general public's e-skills for some time," he explained.

4. Guaranteeing equal access. E-health has helped turn the health system's focus toward the citizen and make people share responsibility for their health. The challenge now is how to integrate ICTs in this formula without leaving anyone out. "We cannot have a transformation in which people are left behind because they do not have access to the technology or because they have limited skills in this field," warned Barberà. So achieving equity will be another of the challenges we will face in forthcoming years.

5. Protecting patients' data privacy. Sharing health data raises an ethical challenge: it is a necessary step but it must be undertaken with extreme care to continue protecting the privacy to which the patient is entitled. In Barberà's opinion, "we need a new social contract that establishes in what conditions we can process citizens' data, while ensuring observance of the ethical aspects," a field in which, in the judgement of the eHealth Center's director, "European institutions have a lot to say".