Introduction

At the basis of each system, whether it is tracking a phenomenon or telemedicine, there is an information system made up of five elements: data, people, procedures, means and principles. The adoption of a new digital healthcare solution by the national health system must therefore consider integration with current information systems as well as the legal framework in data processing.

The current crisis has led to a significant increase in telemedicine tools. If, on the one hand, there is an opportunity for a cultural change and the collapse of the resistance towards such innovations, it is not necessary to consider such solutions in the future as components in their own right and not interoperable with the health system.

Digital healthcare to support Coronavirus management

Reserarch2Guidance identified in a recent research the opportunities deriving from the use of technology in order to address a pandemic.

Source: Research2guidance – How can digital health support the management of the pandemic?

Prevention and Diagnosis

They range from prevention and education (health literacy), such as the information provided by the Ministry of Health (Link), to triage / testing applications which consist of chatbots for the control of symptoms and telemedicine tools. Examples are the #TiVideoVisito campaign and the symptom control chat of PagineMediche also used on the Lombardy Region website and the Provincial Agency for Health Services of the Autonomous Province of Trento (APSS).

Smarthphones thanks to an App and integrated location services, in combination with tracking systems on public transport (where the GPS signal is absent) are a valid tool to contain the infection. It is evident that the use of these solutions raises ethical questions regarding the limitation of freedom.

Source: A schematic of app-based COVID-19 contact tracing, Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing.

Treatment

The management of people with Coronavirus can be supported by technology both in the case of home quarantine, hospitalization and subsequent patient follow-up.

During the quarantine, the person can take advantage of telemedicine tools to stay in touch with the doctor, constantly monitor the vital parameters through the use of wearable devices and manage their emotional state through online support communities, mindufless programs and more ( e.g. via Headspace).

The technology is also a mean to manage patients in the hospital, for example thanks to connected devices (e.g. thermometers) and robots used in tasks that can determine contagion, such as the distribution of meals.

https://www.youtube.com/watch?v=eQVS0R4G05s

Conclusion

The current pandemic is giving a strong boost to the adoption of digital healthcare tools. It is a great opportunity to rethink the touch points to the healthcare system and to include digital in this formula. The ability of digital health startups to participate in this healthcare digital transformation process will depend, without hype, on the speed of implementation of their solutions within the current processes.

Sources

• digitalhealthitalia.com
• research2guidance.com
• science.sciencemag.org

Digital Health is going to make medicine more personalized and efficient. Every area of the hospital will benefit from the use of technology if it adequately implemented into the clinical practice. This is probably the biggest hurdle most startups are struggling with.

Integrated Behavioral Health Care

Value-based healthcare is changing the way we think about healthcare innovation and the debate is not always about technology.

Cost savings community-based interventions can come from new approaches used by Healthcare Delivery Organizations (HDO). One of these is the Integrated Behavioral Health Care (IBHC), that can be described as:

The care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population  – Peak 2013.

The Dimock Center, a community health center based in Boston and serving more than 19,000 people annually, adopted this model.

The Integrated Behavioral Health Care represents a paradigm shift that requires a cultural transformation, with a shared vision, personal relationships across disciplines (e.g. primary care and psychology) and valuing the expertise of the team members. Particulars focus has to be given to the patient experience for what it concerns the location where the services are delivered. For example, the studio of the psychologist should be closed to the GP doctor.

Four pillars of the Behavioral Health Integration

• Improving patient experience (e.g. layout of the hospital)
• Improving population health. For example, prevention and early intervention with the Primary care Physician and Universal Behavioral Health Screening (e.g. Financial Problems)
• Reducing costs, for instance, reduction of Fee for service in the Accountable Care Organizations
• Provider satisfaction, for example, reducing burnout, “this latter is a public health crisis”

Source: TRIPLE (or Quadruple) AIM

There are different types of Behavioral Health Integration. The Standard Framework for Levels of Integrated Care (SAHMSA-HRSA) is based on six levels divided into three main categories:

Source: SAMHSA Standard Framework for levels of integrated healthcare

From Level 1, where collaboration between different specialties is minimal to Level 6, where there is a full collaboration, a unique culture, patients and providers view the service delivered as single health system treating the whole person.

The implementation of the Behavioral Health Model

The integration of services happens at all levels, including the top management, with unified leadership and administrative staff across the whole organization. This makes possible to save costs and avoid budget conflicts.

The implementation of the Behavioral Health Model can take years since it requires a relevant re-organization of the services. It is interesting to point out that it is a cultural change achievable without new technologies and involving the processes of the HDO.

BHM redefines primary care as a biopsychosocial model, considering the person as a whole, reducing stigma for behavioral health services, fostering new collaborations between healthcare professionals and saving costs for the healthcare delivery organizations (e.g. hospital).

The transformation towards the Behavioral Health Model can be leveraged by technology, data interoperability of EMR is key to support this process.