Assessment of health services based on outcomes rather than on activities done in hospitals or primary care centres is a demand that remains pending. If we were to ask about this in different countries, we would find fairly uniform results: what matters are the results, not the activities.
Let’s ask another question, in this case concerning how health care has been managed during the coronavirus pandemic: Would the results be different if we had a strong and reliable information system that collected every piece of data produced from attending each patient?
Let’s be real. If our health services had suitable data management technology, how many of the 3,347,512 patients infected in Spain, as of the date this was written, would not have been infected? Probably few, given that being infected depends on social, cultural, and work factors. But if the question were, how many of the 76,328 deaths could have been avoided? The answer would probably be different. If we had detailed information on each case, we could have predicted some of the fatal complications and prevented an unspecified number of deaths.
Of the total number of registered cases, only 10% have required admission to a hospital. What do we know about the remaining 90%? What symptomatology do they show? Do they have any residual symptoms? Have they been given any treatment?
Some answers would have been obtained easily by processing certain structured and analysed data. Researchers could certainly have made more progress in seeking treatments or new vaccines.
With the appropriate technological tools, could we have been able to avoid the mortality and morbidity in social-health care residences? Monitoring of the most vulnerable residents would probably have reduced the impact of the pandemic on this group of the population. Having technological tools to support attention for and care of people at higher risk would have given us better results.
Ninety percent of coronavirus cases have been followed out-of-hospital, that is, mainly controlled by primary care professionals, which implies a volume of three million patients in a year. If we compare this with the situation that generally causes the highest peaks in demand, flu season, in the last one in Spain (2019-2020) 619,000 cases were diagnosed in primary care. The difference is overwhelming. What would patient follow-up have been like if the primary care network had some advanced technological tools for patient registration and follow-up?
Although for months now it would have been desirable to have an adequate registration system for real-time monitoring of the pandemic, the priority of dealing with the flood of cases and endless incidents would probably have consumed most of the energy from the management and political structures, in addition to the professional ones. And it would be a bad approach to try to heighten the problems by magnifying the shortcomings, which exist and are not minimal, in how the crisis has been managed.
The important thing is to not look back, unless it is to learn and prepare a list of things that remain to be done. What matters is to make a rigorous analysis of the response from the health services in the different countries and prepare for new crises, which will come, analysing areas for improvement, producing new knowledge, and integrating all the information to be at the service of citizens and health care professionals.
It is urgent for the Digital Transition to reach the world of health care, putting technologies at the service of health policies and health care innovation, thinking about how to bring the necessary services to patients efficiently, and guaranteeing the security of the information. Data can also, indirectly, be a source of health, but to do this it must be used efficiently and, of course, respecting the rights of the patient. This is the revolution that is pending in our health system, which must be addressed without delay as soon as the coronavirus health crisis is definitively under control.
