The future of digital technology and health systems

Digital healthcare has had a profound impact on health systems, changing the balance of power between healthcare providers and patients, enabling new healthcare models, and shifting the focus of health systems to customer-centric healthcare in low- and middle-income countries. Health care. Despite many changes due to resistance from organizations and individuals who are unwilling to change the status quo, the explosive growth of global digital technology means that these changes are inevitable. It is foreseeable that telemedicine will be used for remote diagnosis and treatment, and that protocol-driven healthcare will improve the quality of care and better access to goods and services through organizations that change transportation and delivery services, which is to be expected. Data will be at the heart of the health system, whether it's big data and artificial intelligence tools for surveillance, planning and management, or “personalized data” in the form of generic electronic record systems and customized treatment protocols. As with any disruptive innovation, the development of digital health will also present challenges, including who owns, controls, and manages the collected data and how to maintain privacy and confidentiality in this data-rich world.

If there is no major change in the health care practices of low-income countries, universal health coverage will not be achieved. Since the announcement of the Alma Atta Declaration in 1978, what we have been trying to do is that the current doctor-centric, facility-based system cannot be fully expanded to achieve “all-people health”. It may provide the necessary breakthroughs to enable everyone to receive quality care wherever they are. This review looks at how digital technology can change the status of health services in low-income countries and the significance of achieving universal health coverage in the next decade.

The current health care delivery model is based primarily on a top-down medical model promoted by the World Health Organization, with doctors and nurses being providers of knowledge and arbitrators of care. Nursing is primarily obtained through medical institutions in hospitals or communities, and information is primarily provided by medical staff. While verbal services are a need for customer-centric care, the reality remains that services are primarily designed for healthcare organizations and are designed by healthcare organizations with little regard for customer/patient convenience or needs. The problem with this model is that it is difficult to meet the growing needs of people, they need more convenience, better information, and when and where to get better medical services.

Health care in this area is not unique. We have seen the destruction of taxis and hotel systems by companies such as Uber and Airbnb, as well as commercial sales of Amazon and Alibaba. Accessing digital technology through the use of smartphones has fundamentally changed the leaders in these areas and the way we access services. We are seeing a shift in power balance from traditional vendors to new digital models, making services more accessible and flexible based on consumer needs. In the health care arena, we are beginning to see these same changes. Medical information is available online or via telemedicine, and can be delivered to your home through an online pharmacy. Patients can access their medical records and can communicate with providers using email or an online portal without having to visit a medical facility. Access no longer means physical access; for many purposes, this could mean virtual access via telecommunications. In high-income countries, these changes are driven by demand to reduce costs (or at least limit their growth), while in low-income countries, the drivers are poor care and poor quality and explosive growth in medical services. Get digital technology.

New world of health care

Recent work by the World Health Organization describes at least 12 functions that digital technology provides in health5 and is currently developing a set of recommendations for the use of this technology in all countries. 6 In short, these features include providing better, more direct information to everyone. Regarding health and disease; providing support directly to health workers and supervisors in the diagnosis and treatment of patients; providing verifiable and searchable records of birth, death and health encounters; providing relevant health care personnel at all levels Operational and strategic information on supply, finance and human resource management. The impact on these features will fundamentally change the delivery of health care in ways that we may not fully anticipate, but it is very clear that the damage is coming. The following five elements describe how we believe that digital technology will change healthcare and society.

Access to Internet-based information will be common

Although not everyone has a smartphone, everyone or someone close to everyone can access Internet-based information. With groups such as Google and Facebook driving the global Internet even in remote areas of the world, today we are close to popularizing the Internet and will achieve it in the next 10 years. 7 can be accessed through low-cost personal devices, community-based Internet kiosks or some other mechanism.

This global access to the Internet will mean that information can no longer be controlled by a single institution, whether it is a government agency or a professional institution. Increasing use of social networks will provide more peer-to-peer information, and access to web-based publicly available health information will provide a wide range of information. While the quality of information does not always maintain an excellent level, the availability of various types of information will change the role of health workers, from a primary source of health information to a facilitator who helps individuals navigate through a vast array of available information. In most wealthy countries, this is already true, but it will become more common.

The first point of inquiry about health will no longer be a health worker, but the direct consumer-oriented information provided by the Internet or by organizations such as Momconnect4,8 in South Africa or Ananya in India. 9 The role of key health workers will change; these workers are no longer the primary providers of health and disease information, they will be a guide to existing information, helping patients connect to free, useful and accurate sources of information. Just as in the United States, patients no longer ask their doctors what the problem is, they will seek treatment with a preconceived idea of ​​their diagnosis, which may or may not be correct. Healthcare professionals will have a better understanding of the information available to customers to help them navigate virtually unlimited medical information.

Health workers will receive digital support

Today's care models rely on appropriate training for medical staff who are taught to diagnose and treat patients and communicate their illness and health. However, we know that although training is important for providing high quality services, it is not enough to provide high quality care, and more and more people believe that decision support is used in clinical algorithms or pathways. It is an important aid to improve quality and is recommended by the World Health Organization. 6

Each health worker will have a digital tool that will help him or her with diagnosis and treatment as well as communication with the client/patient. This can take the form of a routine care checklist, such as prenatal checkups, decision support for disease diagnosis, and video or graphical consultation information directly from the provider to the client. Numerous studies have shown that using decision support, 10, 11 video consultation, 12 and digital surveillance strategies 13 can improve quality. Although many of these strategies are still in their infancy, countries are increasingly using them as a core component of their health strategies.

Most health care will be available at home

The current health care model is that the client/patient must go to a medical institution to get any form of care or even advice. The new model will bring care to patients rather than providing care to patients. The use of telemedicine and the advancement of universal use of information and communication means that people no longer need to go to the clinic, but can ask questions and get advice and treatment advice by phone or other device. Simply use a smartphone to easily and accurately use low-cost digital diagnostic devices to measure vital signs such as temperature, respiratory rate, oxygen saturation and blood pressure, which means telemedicine and home treatment will replace most of those 15 Except for those who are seriously ill or have complex needs. There are many models for this type of distributed healthcare, where telemedicine is used for first-line, triage, and facility-based medical services when needed.

Transportation and logistics management may revolutionize

Face-to-face care is still needed and can be transported using a shared economy. By accessing the digital network, people will be able to access bicycles, scooters or cars (with drivers) through more and more companies. This model is disruptive and successful in the US, Europe, and China and India, especially for low-income countries where not everyone can afford a car or bicycle, but usually can afford a low-cost single-person rental. . Pay by car. In Tanzania, D-tree International demonstrated the value of this approach to emergency transportation. 20 In India, millions of people using digital technology management systems have received centralized private ambulance services. 21 There is growing evidence that the use of call services associated with ambulance systems has a direct impact on health outcomes in parts of India and can be implemented on a large scale. 22 Even small interventions, such as the use of liquidity to send bus ticket professional services to residents of rural India, can have a major impact on people's lives. twenty three

Data will be critical to health systems

Not surprisingly, one of the areas in which the use of digital technology will have the greatest impact is its impact on data management and usage. Currently, despite the large investments in health information systems, few low-income countries have reliable data. 26,27 Most of the data is still paper-based and is maintained at the national level only at the general level and is used primarily to report the incidence of specific diseases. Reported illness or number of patients seen. This will change. The shift from a point of care to a digital data collection system means that data can be collected more timely and in a more complete manner, improving data quality, and health planners have an incentive to use it for planning and management.

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