Q&A: How Italy is working to digitise healthcare
In a survey carried out by HIMSS Analytics in Europe last year, hospital IT executives reported grappling with many of the same challenges faced by players in other regions around the globe. From the lack of interoperability to ageing populations and issues in attracting and retaining top IT talent, common obstacles to digitisation were identified in most of the European countries polled.
Researchers also found a number of opportunities for providers to improve outcomes for their patients, streamline processes and ease pressures on their staff using digital technology and evidence-based innovations.
Paolo Locatelli, scientific officer at the Politecnico Di Milano’s Digital Innovation in Healthcare Observatory in Italy, has been in charge of research and innovation projects in European healthcare for the past 20 years.
At the beginning of November, he will be part of the committee helping to execute an event organised by the HIMSS Italian community in Rome, looking to support sharing of best practice.
"There is a delay in the digital transformation process, and the healthcare sector needs to speed up the transformation to reach the real impact on digital services for patients and citizens."
Paolo Locatelli, scientific officer at the Politecnico Di Milano’s Digital Innovation in Healthcare Observatory
In this interview for Healthcare IT News (HITN), Locatelli talks about the current state of digital healthcare in Italy and breaking down barriers to bring in innovation.
This interview has been edited for length and clarity.
HITN: You have been working for nearly two decades on process re-engineering and the design of digital solutions for healthcare in Italy and other European countries. How have you seen the space change in this time?
Locatelli: The digital healthcare space in Italy and in Europe has really changed in the last 20 years, if we focus on the digital support of administrative and clinical processes within hospitals and healthcare providers. Twenty years ago, I began working on innovation projects to test the support of digital solutions to the track & trace [sic] of blood transfusions and chemotherapy in research hospitals in Italy, benchmarking these projects with similar initiatives in other EU countries.
In the same years, I have worked to design the information architecture for the EMR [system] in a hospital. Now these hospitals have their CPOE, EMR and RFID track & trace platform fully operating and the challenge, here in Italy, but in my opinion also in other EU countries, is to spread these innovation experiences to more and more hospitals to achieve real "universal access" to healthcare services using digital solutions and services. Then we can work to use the administrative and clinical data collected, using big data analytics or AI solutions, but we really need to have a more widespread use of "process support" [for] digital solutions in the hospital.
The other challenge now is to connect hospitals with healthcare services on the territory, with prevention services and with care services at home, connecting the digital support to the value generated for the patient, for the healthcare provider and for the payer. So, we have work to do for the next 20 years.
HITN: You also worked on defining the regional guidelines for hospital information systems and EMRs in the Lombardy region, one of the largest in Italy. What can you tell us about this?
Locatelli: In the Lombardy region, the level of development of digital healthcare is above the average level of Italy, and the region, with the focused action of ARIA, the in-house company for innovation and procurement in Lombardy, is monitoring the evolution of digital support of inpatient and outpatient management in each of the public healthcare providers in Lombardy.
This monitoring is also used to design shared digital services for public hospitals, such as common data centres, shared HR management digital solutions and now shared solutions to support diagnostic processes, such as enterprise imaging. For EMRs, the region has defined in the first half of 2019 a dedicated budget, and now it is ongoing the evaluation process to define where to use this budget.
HITN: What are you focusing on in your current role at the Politecnico di Milano?
Locatelli: At Politecnico di Milano, with the Digital Innovation in Healthcare Observatory, we monitor the evolution of digital healthcare in Italy year over year. In the last year, we have quantified the economic resources used in Italy to build the digital support to healthcare, and we have found a level aligned to the last 10 years, with €1.39bn and an expense per capita in digital health solutions that is half the level of France and a third of the expenditure levels of Denmark or Sweden.
With these limited resources, healthcare organisations try to introduce new digital solutions in their processes, but, at the national level, healthcare providers do not succeed in answering the need of digital services for citizens and patients. Citizens use smartwatches and other devices to monitor their lives, but they do not know where to use these data, they want to book exams or view their medical reports online, but many of them do not know how to do these activities or they have to access different digital services [that are] not so well integrated. A couple of years ago, we stated: "The healthcare system in Italy is following the digital patient and citizen, lagging behind."
HITN: Did you expect, when you first started working in this field, that we would be further ahead by now, seen as other sectors have arguably digitised faster, while healthcare is still somewhat behind, as you say?
Locatelli: Surely the speed of digital transformation in the healthcare sector in Italy is lower than other EU countries and other sectors in Italy, such as the travel sector or the financial-banking sector. But in the last years, we have seen some push to speed up this transformation at the national level, with the actions of the Agency for Digital Italy – AgID – for the national digital identity for citizens or for the interoperability of regional EMRs, and in some regions, such as Lombardy, Veneto, Emilia Romagna or Puglia.
There is a delay in the digital transformation process, and the healthcare sector needs to speed up the transformation to reach the real impact on digital services for patients and citizens. A strong example, in my opinion, is telemedicine. In Italy, we have had relevant telemedicine projects and trials for the last 10 years, but we have not been able to insert the use of telemedicine in the everyday experience of clinicians and patients. This is an area where the delay is really relevant and we need to work to fill the gap.
HITN: How easy is it for digital healthcare innovators to work with providers of health and care to pilot and deploy their products in Italy?
Locatelli: In the framework of Open Innovation, healthcare providers can leverage the innovation which is born in startups and academic spinoffs. In Italy, we have some relevant startups focused on digital healthcare; at Politecnico we have some of these cases in the incubator or as supporters of the Digital Innovation in Healthcare Observatory. These healthcare innovators had some relevant results in the healthcare environment in Italy, but nowadays their collaboration with public healthcare providers is limited to single projects, and the real disruptive impact of open innovation is not so well leveraged in the healthcare system.
HITN: What are some of the other challenges standing in the way of widespread digitisation, and how are different players in the sector tackling them?
Locatelli: One of the main challenges is the real collaboration for the governance of digital innovation in the healthcare ecosystem, the Ministry of Health, [different] regions, local healthcare authorities, hospitals, general practitioners. A strong governance, with continuity over time, is important to embed digital innovations in the healthcare system as an everyday practice. Without a strong governance, we have the risk to have digital innovations, such as telemedicine or digital services to patients, as local solutions but without widespread diffusion.
The HIMSS Italian community will be meeting in Rome on 8 November at the Università Cattolica del Sacro Cuore. More information [in Italian] about the event can be found here. Healthcare IT News is a HIMSS Media publication.