Unraveling Digital Health: Exploring World Health Organisation's European Region recommendations

Speaker 1: 0:13

Hello and welcome everybody to the digital dose. We are super excited to have you all back again and listening, and thank you everybody for so much for the overwhelming feedback that we've received. I'd like to make a shout out to Brian Hill, who supported us through our supporters page. It goes a long way. We really appreciate it. The digital dose will always be free. That's our plan. It's important to get these messages out, but if you want to help, we really appreciate it. It does cost to keep us online, so pop over to our subscription page, which we'll have in the show notes there, and let's get going. So today I'm joined by as normal with Professor Ronda Wilson.

Speaker 2: 0:51

Hi Oliver, great to be back in the digital dose.

Speaker 1: 0:56

We have a very special guest here today. Would you like to introduce yourself?

Speaker 3: 0:59

Yeah, I can introduce myself. I'm Jette, something from Denmark. I'm a PhD candidate and a scholar. What's called yeah, yeah?

Speaker 2: 1:08

well, we're absolutely delighted to have Jette in Australia with us at the moment as a visiting scholar, and so we've been talking a lot about mental health and about nursing, but today we're going to be talking about digital health in particular.

Speaker 3: 1:27

Yeah, it's a great pleasure to be here and be together with you and discuss a couple of things about digital health.

Speaker 2: 1:34

Yeah, so welcome to Australia. Thank you very much.

Speaker 1: 1:37

Fantastic to have you. So today we're going to be looking at the recent document that was put out by the World Health Organisation European Region, which is their digital health guide, and we thought there was a few real key components that we'd actually step through and have a quick chat about the recommendations they came up with. So first up on that, they have some really great stats, just a broad sort of look at what's happening. And first up, they talk about electronic health records. So I know here in Australia a lot of our services have gone over to digital health records over the last 10 years or so. This is evolving. They're looking to make this one to single digital patient records they have there in the European countries, the 45, that 87% of the countries are using some form of electronic health record, with 82% of countries routinely making prescriptions available to pharmacies and 37% of countries report inefficient funding important barrier to the electronic health record system implementation.

Speaker 1: 2:36

Now, personally I can attest to that. I think one of the biggest things we've seen is that it's quite expensive to run an electronic health record and it's very different to the traditional paper model and there's a lot of infrastructure that's required to actually keep things up and running, which is probably much for a further conversation about some of the costs of digital health and supplying the way we do and the non-traditional methods, but I won't harp on that one for too much longer. What else have we got here? We've got digital health literacy. You want to?

Speaker 2: 3:10

Yes, digital health literacy. About 52% of countries in Europe where this report originates from, have countries have developed policies that address digital health literacy. So only about half of the countries in Europe have some policies that actually address digital health literacy. And what would you say? That would have to be about a bedrock, really a foundation, for digital health to be implemented in countries. You've got to have policies that support digital health literacy in the first place, which?

Speaker 1: 3:50

is interesting because within the same report, they have that 91% of countries have at least one government funded mobile health program, but only 52% of countries actually have the digital health literacy program to go along with that, which meant that there's significant portion of people that are likely to be disadvantaged if they don't have the skills, capabilities or even the equipment to actually be accessing these things for their health and that's we know now. This is how it's been communicated by public health systems. Covid showed that social media and all these things were enabled the information to be spread quite quickly where in the past we weren't able to actually access that. So we've seen acceleration, but do we actually have the competency, the literacy, the capabilities in?

Speaker 2: 4:39

And it is quite interesting because this demonstrates that country there is a big commitment towards digital health. There's a financial commitment towards digital health, with that 91% of countries investing in mobile health programs. But it does also demonstrate perhaps the commitment hasn't kept pace in terms of digital literacy, and if that education and information isn't supported by governments in equal measure, then I just wonder whether one of the risks that will need to be managed is that the privileged proportion of the population will benefit more and priority or vulnerable proportions of the population may not benefit as much. And, of course, in health we see vulnerable populations much more affected by poorer health outcomes. So getting that balance right for access to digital health is really, really critical.

Speaker 3: 5:50

Yeah, but what do we actually know? What is what they need to get access to digital health media? Do we include them in our research or in our development of the world in the digital health world?

Speaker 1: 6:10

I think that's a really great point. When we do our research, are we just researching the well-seeked people, the people that are already in?

Speaker 3: 6:16

those brackets, yeah, including users. That's right, not users, because they didn't have access.

Speaker 2: 6:24

Yeah, if users don't have access and the digital literacy to access, then they may well be omitted from important research going forward and won't be included in the evidence pool. So there is a real risk that disadvantage will be perpetuated if we're not mindful of supporting digital health literacy. So this report is really, really interesting. What else is in this report, Oliver?

Speaker 1: 6:53

So the first recommendation they make is about establishing effective governance, and this is looking at national bodies and agencies creating intersectional national policies and strategies. To go quickly over this point, I think it's really key that, as these governance bodies are established and documentations are written, that we have a much shorter life cycle than what we used to have. We have two and three year turnovers, not four years or eight years. Strategies should be long, we should be looking at the longitudinal, but technologies are changing and the needs are changing and access is changing. So I think that we need to be looking at cycles that offer better opportunities to review, so that more people, more clinicians, more researchers have access to the most current thinking around those particular strategies.

Speaker 2: 7:43

Yeah, because we're really moving through very rapid cycles at the moment with digital innovation, and so the governance and the policies need to keep pace with that. So that certainly needs to be a factor when we're thinking about financing resources, that policies need to be able to occur and be reviewed in faster increments. And I think the other point about these recommendation one is the intersectoral nature of them. We have to work and collaborate smarter across organisations, across agencies, at a national level and at an international level, because digital health resources are increasingly available going across traditional geographical bounds and we have a whole cyber geography now, and so we need to be mindful of how to manage that in our public access agencies and how we work with our commercial sector as well.

Speaker 2: 8:57

But the second one here is I think this is a really interesting recommendation and certainly one where I know we're thinking, as researchers, a lot about all the time developing robust evaluation guidelines and increasing digital health literacy, and, as we said a little bit earlier that digital literacy is really a bedrock. If people don't understand how to use the digital health interventions and resources that researchers are able to produce, if they can't access them, or if they're disadvantaged in not being able to access them, then all of the innovation that we come up with has very limited benefit. So increasing digital and health literacy among both health care professionals and the general public is really, really core to national health objectives. We've got to get our head around digital health literacy, jero. What do you think about digital health literacy from a Danish perspective?

Speaker 3: 10:07

I think it's very important, but I also think we need to corroborate about development, the best technology and use, for example, your knowledge about AI in worldwide and in Denmark, because if we use each other in a better way, we can develop in a faster way. As an example, how do we use it in educational level? I work with education and learning, but how do we use it in our educational level and how do the teachers support the students in the best way? Sometimes the students are in a business better mood than the teachers, so how do we actually collaborate about this and how is the strategy to you know, if students can use it, then they better understand and can be innovative in development digital health solutions to you know, the public and the patients who need care in a digital way.

Speaker 2: 11:12

So the experience and the expertise of digital natives, really our students, is really important knowledge to bring forward and to draw forward to perhaps some healthcare professionals who haven't grown up with so much digital technology. Yeah, so that digital literacy our students are often very much more digitally literate, whereas our teachers and our senior health professionals sometimes are less comfortable in that space. And the third one, the third recommendation that the World Health Organization European region have come up with is around ensuring sustainable financing and collaboration, which is paramount, and again, strengthening those collaborations between the public and private sectors. And I think this is really really interesting and I've noted that Denmark has, you know, certainly got some leadership with that innovation space. But working between public and private and how important the small to medium enterprises are in developing some of that early innovation and, you know, those emerging ideas, the imagining of what might be possible, and then how do we work to test and to scale up and actually deliver universal digital health coverage in that context? So it does take a bit of funding to be committed to that.

Speaker 1: 12:51

But the flip side of that also is we don't actually want things being simply for profit, where the profit becomes above the health outcome. And we've had recent discussions with people on those lines, which is, you know I can do this thing and I can do very quickly, and you know it makes good business sense, but does it sit ethically in the right spot that it needs to actually be delivering that particular thing for that person at that instance?

Speaker 2: 13:15

So there's a lot of pull and push as we move forward in this space and financing at both ends of that spectrum, both from the private sector, but also ensuring that universal public access is just really critical. What's the fourth one?

Speaker 1: 13:35

that this is address interoperability.

Speaker 2: 13:38

Oh, I made you say that terrible, tricky word to say.

Speaker 1: 13:42

And standardized health data. The key points that brought up here is about establishing the quality management system for interoperability testing and devising suitable testing tools and certification procedures. We know there's a lot happening in these spaces, so trying to get some consistency that you know, in a marketplace you really can compare apples and apples when we're talking about the particular products or how they work, or even now when we talk about different AI products. It's very easy to get caught up in the hype versus what is that actual tool capable of and is it actually comparable to tool B, et cetera, et cetera. They also highlight the importance of a national health data strategy for the use of big data and advanced analytics, emphasizing that the standardization of data formats and development of data standards to resolve interoperability issues.

Speaker 1: 14:30

Now, I think this will be an ongoing challenge. Even when data is stored in the same way, it doesn't actually mean that the way areas do business is the same. So the lens that the data has to be reviewed through has to be understood, and I think that's where we really need that quality level of input from clinical staff and clinical professionals in understanding how to address the actual data that's been looked at and the blanket assumptions aren't being made because the data was set out in a particular way. Therefore, it must be this. So it's the importance of understanding the complexities of the business itself that generates the data. I could go on for days on that you could.

Speaker 2: 15:17

You could, indeed, and we probably will in plenty of other podcasts that follow. But I think one of the key things in this addressing this interoperability is ensuring that we've got data standards, and so we do need to have some standardization so that we can assess the success or the failure and various strategies that we trial. So, yeah, standardising health data is going to be really, really important as well. And the last recommendation they've got for at least the European region and I hope we've got some other regions in the World Health Organization having a look at this too we'd be very interested to contribute to anything from an Oceana perspective because you know we the last recommendation they have is promoting patient-centred care and digital inclusion, and that digital inclusion we've already alluded to that quite a few times, I think, in this podcast. You know who misses out. We need to have policies and strategies that enable everybody to be able to. You know, nobody misses out. That's going to be absolutely critical.

Speaker 2: 16:43

So, developing capacity building and digital inclusion strategies to ensure universal access to digital technologies and I know I do, you know I do quite a bit of research at the moment with colleagues at the University of Canberra and some of the things that we're looking at specifically is around the digital disadvantages that some really priority populations or vulnerable populations experience, and some of the things that we're seeing in our research at the moment is you know, we're noticing that some priority populations certainly have.

Speaker 2: 17:28

You know, if they have housing insecurity, for example, or larger numbers of people living in a dwelling, then you know there's a lot more people needing to access the internet in that particular dwelling. And with larger families, often there is, you know, more financial constraint in terms of how many people have a digital device and how many devices need to be shared. So if you've got to share your hardware device, whether it's a computer or a smartphone, and you need to discuss your, you know, private health information on that device, then the privacy implications are rather challenging. Or being able to access, you know, the time and the space in some privacy to deal with some often very private matters.

Speaker 1: 18:23

Yeah, I think we've discussed this previous in the past, but you know, take a thought experiment for a moment and unlock your phone and hand it to somebody and the feeling if you get of that intrusiveness or vulnerability that actually comes with that simple act is quite scary. So for someone who's trying to actually deal with their health issues and problems that they may not be willing to disclose, or that level with their families, it's a huge level and as we push towards digital being the way in which to interact and it is a great way to interact this is going to become more and more of an issue.

Speaker 2: 19:02

A critical issue to make sure that we get the digital inclusion right in terms of promoting patient-centered care, but I guess it goes across to education as well, doesn't it?

Speaker 3: 19:14

Yeah, it does, but I just have some thought about what you're talking about, because there's a lot of ethics.

Speaker 3: 19:22

You know we live in a democratic world, most of the country are known of everyone, but there are some ethical issues about how do we support people, how do we communicate, how do we share data, not because we don't have to do it, but we need to discuss how do we do it in the best way to you know exactly where patients centered care, because we need to discuss this issue.

Speaker 3: 19:55

Question about how do we use it in educational. We use it, we have some lessons about innovation and we collaborate together with healthcare system, the private system, to development digital solutions to different people. It could be in mental health sector, it could be in the somatic sector, it could be home care. You know this social system or the healthcare system is very specialized today, so some families maybe live in otherwise. Denmark is a very small country, but if you had to drive three or four hours to get to the hospital to get support to your child, maybe it's a better way and will increase the everyday life and the lives quality if they can talk to the doctor or the nurse or other healthcare professionals in a digital way, so it's very good to discuss these issues.

Speaker 2: 21:02

Yeah, yeah, and that would be very meaningful for in terms of patient centered care. Well, this has been a really, really interesting discussion today on the digital dose podcast. It's been an absolute delight to have Jetta Sernsson from Denmark join us today as well on our very international digital dose, and I guess we'll sign off today. I'm Rhonda Wilson and I hope you'll join us on our next podcast. We're looking forward to seeing you again.