In December 2021, the Interterritorial Council of the National Health System approved its Digital Health Strategy (In Spanish, ESD-SNS), an ambitious roadmap for the Spanish health sector’s digital transition. The document appeared just weeks after the European Commission’s latest Study on eHealth, Interoperability of Health Data and Artificial Intelligence for Health and Care in the European Union.
In its report, the Commission points out the difficulties the health sector has in moving forward with the implementation of new digital tools, mainly Data Analytics and Artificial Intelligence, highlighting the latter for how it creates a lack of confidence. This lack of confidence is to be expected in a sector that provides services based on the trust between the doctor and nurse with the patient and their closest relatives, in addition to dealing with extremely sensitive matters like someone’s state of health. Other relevant issues noted are the need to adapt the regulatory framework on personal data and the obligation to follow fundamental ethical principles in health care and public health.
Although Spain shares the difficulties expressed by the Commission regarding entry of new digital tools into the health sector, among Member States Spain contributes 11.5% of scientific publications related to Artificial Intelligence, third among the EU27. Spain also has collaborative projects with 18 other countries in the European Union.
The Digital Health Strategy from the National Health System (ESD-SNS) aims to address three broad lines of action:
- Digital health services
- Interoperability of health data
- Analytics of health-related data
The ESD-SNS converges with the Strategic Project for Economic Recovery and Transformation (PERTE), “State-of-the-art Health”, which seeks to promote modernization of the National Health System, guiding it toward innovation through a series of strategic axes. These axes include the development of advanced therapies and emerging drugs, development of an intelligent system for the aggregation, management and exploitation of health data, and to provide momentum for the digital transformation of health care, with a special focus on primary care services.
Artificial Intelligence (AI) is, therefore, one of the digital tools that will transform the National Health System, opening the way to “Four P” medicine: Personalised, Preventive, Predictive, and Participatory. Artificial Intelligence has enormous potential to create knowledge, starting from activity accumulated over decades and with future activity. This new knowledge should be aimed at improving health outcomes in health care systems, facilitating the development of actions in the area of health prevention, and focusing on important advances in all phases of the care process. The pandemic, as we have seen since it began, has made it clear that the information produced has limitations when it comes to being a useful tool for clinical decisions, health planning, research, or innovation.
Addressing the Digital Transition in Health requires building trust among the actors in the health system. This means, firstly, identifying the opportunities it represents for each one of them. Administrations, professionals, users, pharmaceutical and technological industries, service providers, all form a constellation of key actors who must deal with the process in an orderly way and with maximum synchronization. This is because an imbalance between those who advance rapidly and those who move slowly will lead to inefficiencies for some and loss of opportunities for the others.
The citizen, the potential user of health services, must be the first recipient of actions to improve confidence in digital tools and Artificial Intelligence. Personal data related to health is subject to special protection. But this, on a personal level for each citizen, is not enough. The citizen has to feel confident and safe when they go for a visit to a health centre or when they are helped in a video consultation; these new attributes must be accompanied by confidence in professionalism and good practices, in the ability of the doctor or nurse to provide guidance or solve their health problem.
The Digital Transition in Health must reach the level of micro-management, the place in which the health product is produced. Digital tools cannot be a discourse focused on strategic levels. The citizen, as a patient and user of the health service, needs to know at all times that information about their state of health is not used inappropriately. Conversely, they must know that such information can indeed be used positively for health research and innovation.
Therefore, more than at any other time, strategy must come from senior management offices and be anchored in each consultation, in each examination room or in each operating room, permeating the way professionals work and ensuring that this can be seen by patients.
In short, the Digital Transition in Health, within the framework of the Recovery, Transformation and Resilience Plan, must have an intimately united strategy for change that will help to overcome barriers to trust between actors in the health system. As the Commission report points out, this is the only way the digital strategy can succeed.
Enrique González Fernández
Vice President, Health Area, EADT