Digital health implementation: How to overcome the barriers?

Our health systems are facing great opportunities and at the same time great challenges. This is due to demographic changes, progress in medical technology and regional problems in providing healthcare to low density populations. Furthermore, due to an increase of life expectancy and the increasing number of elderly people, there is an increasing need for care and monitoring of elderly people still living at home and of people with chronic diseases. Rapid progress in computer sciences and information technologies already has a great impact on the way healthcare will be delivered in the near future. Digital health encompasses the use of information and communication technologies (ICTs) to treat patients, conduct research, educate healthcare professionals, track diseases and monitor public health. The potential of digital health to provide innovative solutions to health problems is enormous. This has raised high expectations in the public, politicians and healthcare professionals. Many see digital health solutions as the ‘magic bullet’ to solve the many unsolved problems related to healthcare, particularly in times of constrained healthcare funding. Digital health is expected to reduce the burden of diseases, to improve healthcare delivery and the experience of care for those living with chronic diseases, to facilitate more personalized and person-centred care at the right time and in the right place, and all this at reduced or at least not increased costs. The most promising applications of digital health in cardiovascular prevention and rehabilitation include: a) prevention and lifestyle intervention; b) chronic disease management, including hypertension, diabetes and heart failure; c) arrhythmia detection including early detection of atrial fibrillation and telemonitoring of devices such as pacemaker, internal cardioverter defibrillator and implantable monitoring devices; d) telerehabilitation.1–3 In contrast, the European Union e-health action plan for 2012–2020 states that the promise of ICT to increase efficiency, improve quality of life and unlock innovation in health markets remains largely unfulfilled. Main barriers to widespread adoption of e-health have been identified, but the situation has not significantly improved over the last few years. The European Society of Cardiology (ESC) has taken-up the challenge to approach these problems in a more systematic way by starting an action-plan with the mission to play a pro-active role in all aspects of the e-health agenda. In this issue, the ESC e-Cardiology Working Group, in close cooperation with the ESC Digital Health Committee and with the ESC association, is publishing a Position Paper entitled ‘Overcoming the challenges in digital health implementation in cardiovascular medicine’.4 The document provides a brief but very comprehensive overview of the challenges we face with respect to implementation of digital health applications in cardiovascular care. It is also a positive example of how ESC bodies such as Working Groups, Associations, Councils and Committees, each with its own specific competences, could collaborate together by summing up knowledge and interests in the emerging field of digital health for cardiology. Overall, the evidence base for the value of digital health in managing a wide range of cardiovascular disease is increasing but, on the whole, still weak and contradictory. The development of e-health and telemedicine is still primarily technically driven and not by the needs and expectations of clinically active health professionals. Common platforms and connectivity between tools and systems are mostly lacking, there are inherent uncertainties in such systems and there are major issues in the area of privacy and data protection. The use of big data and cloud computing has further accentuated this problem. However, the lack of business cases, cost efficacy calculations and regulation of reimbursement of e-health and telemedicine turned out to be the major obstacle to the introduction of evidence based e-health and telemedicine tools into the healthcare system. Major challenges and barriers for large-scale digital health deployment in cardiology are identified in this Position Paper, including patient related and physician related barriers, legal and ethical issues, interoperability and technical considerations and reimbursement issues. In particular, the authors point out that there is a need for a new user-centric approach to patient education programmes, for a redesign of the digital health workflow to allow better adoption of digital health by healthcare professionals, for a better understanding of the role of uniform European-wide digital health legislation, for a better basis for interoperability assurance, and for a better definition of the role of the digital health industry in describing accuracy and efficacy of their claims and to guarantee privacy and safety of their solutions. Reimbursement issues are closely related to all of these problems and can only be solved if the evidence base for efficiency and cost-effectiveness of digital health applications becomes more solid and business cases are developed based on this evidence. Furthermore, we have to find ways to change health professionals’ perception that digital health strategies are added on top of existing care pathways and, by this, increasing the burden of workload. Blending of both digital health and existing clinical practice will become key for success in overcoming this problem. Finally, health illiteracy and low socioeconomic status have been found to be the most important and persistent barrier for digital health adoption. In view of the fact that healthcare costs are highest in this population, more efforts are necessary to better target this population with digital health implementation efforts. Looking at all of these challenges and barriers, one should not forget the great opportunities for digital health to overcome major health and healthcare problems: – To overcome the problems of demographic changes; – To meet an increased need for the treatment of chronic diseases; – To reverse negative lifestyle changes; – To solve regional problems in providing healthcare to low density populations; – To provide easy access to data/documents for optimization of treatment, avoidance of redundant interventions and improvement of health at reduced, or at least not increased, costs. The opportunities in digital health applications are obvious, whereas the challenges seem to be overwhelming. This dilemma can only be solved if all stakeholders talk together with an open-minded attitude and are committed to contribute to overcoming barriers for implementation. In this regard, contributions such as this ESC Position Paper are highly welcome. Another important challenge for those involved in these new technologies will be to keep the main focus on patients’ individual needs and to carefully evaluate the evidence behind the practice. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article.