Plenary 2: Opportunities and challenges of digitalization for health care and public health
Trends of digitalization in health care
Service Delivery and Safety Department, World Health Organization
Diana has over 14 years of experience in eHealth governance, solutions and service at the national and international level and currently is leading the digital health activities in the Service Delivery and Safety Department at the World Health Organization (WHO).
Prior to joining WHO, Diana worked as a senior design engineer and solution architect at Intel Corp. in the USA.
Diana holds an advanced engineering degree from the University of Pennsylvania.
The value of effective clinical data interchange among Healthcare Organizations. 13 years of experience in Catalonia
CMIO, Hospital Clínic of Barcelona
Prof. Xavier Pastor, MD, PhD
Born in 1957 in Barcelona (Spain). Doctorate in Medicine in 1987, Pediatrician and Professor of Pediatrics at the University of Barcelona since 1988. Attending physician at PICU of the Hospital Clínic of Barcelona. Chief Medical Information Officer at Hospital Clínic since 1996. Project Leader in Electronic Patient Record implementation at Hospital Clínic and clinical interoperability among healthcare organizations in Barcelona. Researcher in several EU funded projects: All-Net PicuBook, Structuring Content for Online Publishing Environments (SCOPE), INBIOMED, and Problem-Oriented EPR in Disease Management. Visiting professor at Erasmus University (Rotterdam) and Bocconi University (Milano). Scientific Director of the eHealth EU-HIMSS 2010 Conference done at Barcelona. Member of Spanish Society of Information and Health (SEIS) and past president of the Catalan Forum of Information and Health.
Patient centered care requires a close collaboration among different healthcare organizations (HCO). In 2006 a task force group was committed by Public Health authorities of Catalonia for a radical redesign of the healthcare in a broad district of Barcelona with a population on 600.000 inhabitants. The focus was the improvement in the relationship between Primary care (PC) and Specialized Care (SC) for a better integrated process of healthcare for the population. Twenty-three centers were involved. They belong to nine different Healthcare organizations: three hospitals, one SC outpatient clinic and six PC organizations. Initial analysis resulted in a high heterogeneity in the degree of technological investment, development and maturity in the use of EPRs by the professionals. An interchange platform was developed using structured xml files with clinical content based on standard HL7 v2.5 messages. After 12 years of real experience in the use of such project several scores demonstrated the benefits in terms of quality of care of the population. The other big achievement has been the standardization of the clinical processes in this area. Such results stimulated and promoted the expansion of the model. Nowadays, the interoperability platform, named IS3, connects nearly all the Catalonian public HCO and allows new relationships like the connection among community and reference hospitals to improve the quality and efficiency of the tertiary care. The Regional Health Information System (RHIS) is complemented with a central repository of clinical documentation. A good governance model of the different ICT departments involved, based upon professionalism, leadership and transparency, are key points for the achievement of the initial goals. However, new challenges are over the horizon. Some of them are related to the integration of more health services like Emergencies, Mental Health, Home care and Social Services. Others, like the online shared management of the Health Problems list of the patient are or care plans are more challenging because they require institutional agreements and interprofessional collaboration among healthcare stakeholders.
Digital solutions for mental health promotion and treatment: examples of good practice and brilliant failures
Dr. Heleen Riper is Professor of eMental-Health at the Vrije Universiteit Amsterdam (Department Clinical, Developmental and Neuro Psychology, section Clinical Psychology, The Netherlands) and works as well at GGZ inGeest a large mental health service organization in the Amsterdam region (Research Department), Amsterdam, the Netherlands. She is honorary professor Telepsychiatry at the University of Southern Denmark (Faculty of Health Sciences, Odense). See www.heleenriper.nl
Over the past 20 years her research focus has been on the development, evaluation and implementation of innovative eMental-Health interventions for common mental disorders from prevention to treatment. The scope of her current research activities includes the use of mobile health, and combined online and face to face ('blended') treatments for depression, anxiety and substance use related disorders. New methodological challenges include the development and evaluation of mobile ecological momentary assessments and interventions (EMA/EMI), patient-centered design and predictive modeling. She has opted for an international perspective and collaboration throughout her academic career and acted as Principal Investigator of over 15 large scale European Union projects and reviewer for Research Funding Organizations globally. She was Principal Investigator/coordinator of the European Comparative Effectiveness study on Internet Interventions for Depression (E-COMPARED, www.e-compared.eu). She has published over 180 (international) peer reviewed papers and book chapters within the eMental-health domain. In 2013 Heleen Riper (co) founded the Journal of Internet Interventions of which she is associated editor (published by Elsevier) and in 2014 she became President of the International Society for Research on Internet Interventions (ISRII) for which she acts now as Past-President. She is chair of the DIFFER EU-Consortium (Digitial Framework For E-health Research) which develops, evaluates and implements the digital MoodBuster 2.0 platform for mental disorders.
Over the last two decades the digital landscape of mental health care research and service innovation has gained momentum. This period is characterized by many success stories but brilliant failures as well. Today, e-mental health is like a two-headed Janus. One side of his face illustrates the birth of innovative technologies that entered mental health services and research practices. In parallel, the evidence-base for the application of these new technologies, such as internet-based treatments for depression, has been established with effect sizes comparable to those of face-to-face treatments. The other side of his face shows, however, that e-mental health has not yet lived up to its full potential as its actual delivery, evaluation and implementation in routine care has proven to be a much longer and bumpier road than expected.
The question addressed in this presentation will be 'what does the future hold'? Acknowledging that futures are difficult to predict Riper nevertheless provides insights on how we may overcome some of these bumps and how we may create a future that serves our needs. Riper will argue that a new paradigm for mental health care is required in which a research by design approach is adopted that integrates scientific methods for the development of innovative health care innovation ('co-creation'), with evaluation ('beyond RCT's only') and implementation ('evidence-based implementation strategies') of these interventions in routine care settings as well. She will illustrate this new paradigm by virtue of the results of a number of innovative research projects that are indicative for this research by design approach such as the H2020 European Comparative Effectiveness Research on Internet-based Depression Treatment.