The objective of the Policy Implementation Guidelines for Achieving Long-Term Objectives is to outline the main policy directions for achieving the long-term goals set in the project.
The document is a logical continuation of the work of the project partners from Bulgaria and Greece on the project, and in particular the work of EURODRAAR Association for the preparation of a Study, including data collection, identification and mapping (D3.6.1) and the development of Joint Study towards sustainable eHealth management (D3.6.2).
eHEALTH – CHALLENGES AND POSSIBILITIES
• The healthcare sector is the crosssection of the ever-increasing demands and needs of patients with the introduction of high-tech (digital) innovations and scientific achievements in the field of medicine.
• Information technologies provide a number of opportunities in the field of healthcare – starting from improving work and interaction between different actors in the healthcare process, and stretching to developing and delivering of new health services based on innovation, IT technology and cloud services.
• High-tech work approaches can be expected to play a critical role in reducing of the long-term costs, linked to the f provision of healthcare services, while achieving better therapeutic outcomes, and improving the general health status of the population.
• Digitization in medicine allows proactive real-time communication between a patient and the health system (including a physician and / or other medical practitioner) and mediates decision-making on medical treatment based on directly or remotely recorded vital data indicators using intentionally developed algorithms and even artificial intelligence.
TECHNOLOGICAL REQUIREMENTS. TECHNOLOGIES AND SYSTEMS USED.
• The extensive use of digital healthcare, and in particular telemedicine, is interconnected with the technological capabilities of available hardware and software, and by the requirements imposed by the specifics of medical care and the skills of patients and medical staff to handle these advanced technologies.
• It is necessary to achieve and ensure technological interaction and software compatibility between popular and widely used smart devices and specialized medical equipment for measuring vital signs.
• In technical terms, telemedicine systems imply integration between medical diagnostic devices and various information systems (a complex of communication and computer systems).
• Individual devices for measuring of medically important vital indicators (such as heart rate, blood pressure, blood sugar, saturation of blood with oxygen, carbon dioxide, etc.) need to be compact, extremely precise, and not to burden the everyday life for patients.
• The next steps for the IT specialists and the leading researchers in the field of medicine is to cooperate for the development of artificial intellect which will be able to detect pathologies and risky health situations in real time, to elaborate early alarm systems calculating the potential risk factors, to create predicating models (simulations) that could forecast the patient’s medical condition, as well as to create systems for automated support of the decision-making in medical activities.
• Digital transformation will have an impact on the work of doctors and health workers. The main impact will be through the integration of data originating from various sources, including big data, Internet of Things (IoT), Artificial Intelligence (AI), Expanded Reality, Block Technology, Virtual Reality (VR), and Robotics.
• In the context of the implementation of the project “Improving access to health services through a personal health surveillance system” / “eHealth monitoring”, the specific situation in the cross-border region should be taken in cosideration, as the region is characterized by specific demographic structure and geography, socio-economic status and coverage with health care, that require tailored approach and implementation of pilot targeted and state-supported measures.
AREAS OF INTEREST
EHealth and telemedicine can be successfully implemented in different contexts and under various circumstances, expanding their field of application and increasing their added value. In addition to remote medical care, this innovative approach of work could be adapted and applied in emergency situations that require interventions of medical professionals.
The following areas of interest have been identified, where eHealth and telemedicine can be particularly useful:
• Remote monitoring of patients’ status and their medical symptoms allowing filtering and differentiating between emergencies and common health conditions that do not require immediate medical assistance, as well as the provision of remote consultation and guidance for first aid until the arrival of emergency teams that can provide qualified medical assistance.
• Telemedicine is an opportunity for regular, planned servicing of patients living in geographically remote, sparsely populated and/or inaccessible settlements. By assessing incoming data on vital indicators and prioritizing the current health status, one could schedule visits of the attending physician or general practitioner, arrange for medication deliveries, or transport patients to carry out scheduled manipulations such as hemodialysis or blood sampling for laboratory researches.
• Tracking of the development of chronic diseases is a further area of interest. Remote digital medical care allows the tracking of medical indicators, for example, of diabetic patients or patients with cardiac diseases.
• Preventive medicine. The possibility of easy remote consultation with medical specialists in case of early symptoms will allow the detection of possible diseases at their initial stage of development, will ensure more effective treatment and will help to reduce the costs incurred for socially significant diseases – both for the specific ill person and his/her relatives as well as the public health system as a whole.
• Possibility to enhance the general health culture of patients and build knowledge and skills to care for one’s own health. This area of interest is based on improved access to general and specialized medical information and the ability to optimize communication and interaction between healthcare institutions, physicians and other healthcare professionals on one hand, and patients and their relatives on the other.
BENEFITS AND NEED OF eHEALTH PRACTICES
The economic benefits of implementing eHealth are related to the identified capacity to improve the organization, functioning, administration, control and reporting of the used financial funds, human efforts, and material resources in the health sector.
• Reduction and / or optimization of the costs of public health funds that are spent on regular medical care for the population and on the treatment of various diseases;
• More rational planning of the short-, medium- and long-term budgets of health funds, health establishments and individual medical practices;
• Improvement of logistics and organization of work in healthcare facilities, more flexible and rational planning of medical staff location and use of available general and specialized medical equipment;
• To ensure more accurate and long-term planning of the needs for qualified health professionals and healthcare facilities;
• Limitation and / or prevention of unnecessary engagement of Emergency Aid teams, that result from poor judgment of the patient about the severity of his current medical condition and the necessity to receive urgently f specialized treatment provide by healthcare specialists;
• Reduction and / or optimization of the costs paid by patients themselves for unnecessary and / or excessive visits to doctors, unnecessary and / or overuse of medication, and execution of unneeded medical manipulation and tests.
Health benefits are expected to be generated in the following directions:
• Fuller and timely response to the need for medical care for the population;
• Improved healthcare coverage on the territory of the country and the individual regions;
• Facilitated tracking of the course of unanticipated and / or chronic diseases;
• Improved prevention of medical conditions and diseases leading to an overall improvement in the health status of the population and prolonging the duration and quality of life;
• Enhanced health culture and aquired knowledge and skills to care for one’s own health.
The social benefits of wide use of eHealth practices are related to:
• Improvement of doctor-patient relationship due to more direct communication and achieved mutual assistance between patients, doctors and their relatives;
• Building and strengthening of links between health authorities, public authorities, citizens and health professionals;
• Creating and maintaining a community / social network in medical and social situations;
• Improved quality of life and longevity indicators thanks to easier access to medical services.
Educational benefits would come from the use of innovative technology solutions for digital remote medical care during initial and upgrading training for medical students, graduates, practitioners and other health professionals:
• Possibility for (distance) training of medical students, achieved by including those in the process of remote monitoring of patients’ health status, during the analysis of incoming data, when the diagnosis is determined and necessary medical interventions and manipulations are prescribed;
• Possibility to form and use extended medical advisory groups to remotely analyse incoming information, diagnose, and plan the treatment required.
DIFFICULTIES IN THE APPLICATION OF eHEALTH PRACTICES
The difficulties in the implementation of eHealth practices reflect the characteristics of the environment of intervention and the individual peculiarities and capacity of the actors that are part of this environment – doctors and other medical specialists, patients and their relatives, IT specialists, scientists and researchers in the field of medicine, technology and technology.
There are also difficulties caused by legal constraints and / or moral considerations, as well as those that are pre-conditioned by technical possibilities, socio-economic characteristics and cultural and educational status.
The legal constraints are related to the overall regulation of eHealth.
• Currently, the Bulgarian legislator has not created enough normative texts to set the framework for defining and protecting the rights and interests, obligations and responsibilities of legally affected subjects
• It is important to take consideration of the requirements for the protection of patients’ personal data – their identity, current medical status, health history and chronic diseases.
• Issues of liability in the event of a medical mistake and / or professional negligence of a healthcare professional that operates remotely and in a digital environment, while diagnosing and assigning treatment based on data gathered with the help of technological devices should be specified and refined in order to avoid limiting the use of this innovative approach to work due to fear of being subjected to administrative and / or criminal liability.
Difficulties due to technical abilities and skills can be expected, as follows:
• The technical and technological illiteracy of some users, especially the elderly and / or illiterate population (e.g. facing difficulties when handling smart devices and specific medical tools and sensors) may lead to incorrect and inaccurate reporting and transmission of measured vital indicators. This could result in a mistaken assessment of the nature and urgency of the observed medical condition, incomplete analysis of incoming data, and misdiagnosis and treatment.
The economic inaccessibility of the technological equipment and software is a critical limiting factor for the rapid and ubiquitous application of telemedicine and other e-health elements.
• Expensive individual medical devices and sensors, highly specialized medical equipment and modern computer configurations, as well as maintenance of the same, are serious obstacles for healthcare institutions and individual patients.
• The high prices of telecommunication services and Internet connectivity also constitute a serious expense that needs to be planned.
• There is need of specialized training for end users and / or physicians to work with advanced technological (medical) equipment.
Difficulties due to socio-economic circumstances and cultural and educational status:
• Poor health culture, lack of interest in one’s own health and well-being, which is found in part of the population, especially those living in smaller settlements, geographically remote and / or those with difficulty in transport accessibility.
• Difficulties in applying eHealth practices due to differences in educational level and expertise between IT specialists, doctors and patients, problems due to language barriers in communication between doctor and patient when using medical terminology and / or software in a foreign language .
• Possible mistrust towards new technologies work and communication approach based on prejudice, fear and cultural and educational peculiarities.
SUGGESTIONS FOR INFORMATION CAMPAIGNS / ACTIVITIES TO INCREASE THE PUBLIC POSITIVE RESPONSE ON THE SUBJECT-MATTER
In order to promote the benefits and possibilities offered by telemedicine and e-health-based practices, it is necessary to carry out targeted information campaings and awareness raising activities adapted to the needs of and aimed at the general public, scientists and researchers, doctors and health professionals, representatives of the public authorities responsible for public health, health insurance funds, insurers, social partners, business organisations.
Examples of such targeted information activities could be the following:
• Organizing and conducting of on-the-field demonstrations (e.g. measuring of blood pressure, pulse, blood glucose, etc.) with the collaboration of health institutions, Regional health inspectorates, Bulgarian Red Cross, non-governmental organizations active in the field of provision of health and social services and community work, public and local authorities, institutions for provision of medical and social care;
• Voluntary events for blood donation, educational, sports and culinary activities to promote healthy lifestyle;
• Visits to places where the E-Health approach is applied;
• Pilot initiatives for introducing, testing and adapting of the E-Health approach;
• Training of mediators, activists, agents at the local level to further promote, implement and develop the proposed approach;
• Specialized training for end-users and medical staff;
Introducing the concept of sharing of medical and smart devices, in order those to used bymultiple end users.
The presented eHealth model, and in particular the telemedicine, is applicable in the following contexts:
• Geographically specific settlements – mountainous, semi-mountainous, hard-to-access settlements; settlements located away from large settlements and / or located in cross-border (border) territories;
• Settlements and regions, that demonstrate specifics based on demographic and socio-economic characteristics – characterized by an aging population and / or the presence of compact groups of minorities with unsettled or unstable health insurance status, areas with high unemployment, or where large groups of refugees are located, etc .;
• Emergency cases
The possibilities offered by remote digital medical care could also be used in emergency situations that require urgent medical intervention and involve decision-making for medical interventions in the absence of standard fixed medical devices and diagnostic equipment. Emergency medical teams equipped with high-tech measuring devices, sensors and instruments operating in a digital environment could provide timely, qualified life-saving assistance to victims of traffic accidents, victims of industrial accidents or military conflicts, population affected by natural disasters and unfavourable environment phenomena, as well as people situated by chance or living in quarantine areas, formed to limit the spread of communicable diseases in humans and / or animals.
This document is created under the project “Improving healthcare access through a personal monitoring system“/eHealth monitoring/, Subsidy contract B2.9a.11 with the financial support of Cooperation Programme “Interreg V-A Greece-Bulgaria” 2014-2020, Co-funded by the European Regional Development Fund and National funds of Greece and Bulgaria.
The entire responsibility for the contents of the document rests on Euroradar Association and under no circumstances it can be assumed that the materials and information on the document reflects the official view of the European Union and the Managing Authority.