The Future of Health Systems in a Digital Era: a summary of WHO’s Symposium in Portugal

Stop 4: Porto, Portugal

It’s been a busy few weeks with interviews and trying to keep pace with writing up my report and findings, so this reflection is slightly delayed.

After a half-ish day of transit from Copenhagen via Amsterdam, it was touch down in drizzly Porto, Portugal for the WHO Symposium on the Future of Health Systems in a Digital Era in the European Region.

I had been watching this event and its program develop with keen interest over the last 6 months. While it was not on my initial Churchill itinerary (but somewhat in the ‘neighbourhood’) the opportunity was too good to pass up.

Walking inside the Porto Palacio Hotel I spied various attendee’s conference lanyards; it was literally a ‘who’s who’ of the global digital health sector. As silly as this sounds, I was a little star-struck – the room was full of familiar names and faces I had been following closely in recent years and was instantly excited about the collective wealth of knowledge I could tap into over the next few days.

The conference kicked off with welcomes and opening comments from WHO Regional Director for Europe Hans Kluge, Director of the Division of Country Health Polices and Systems Dr Natasha Azzopardi-Muscat, the Mayor of Porto and Portugal’s Health Minister – all reaffirming their commitment to improving health outcomes for the region through harnessing digital technologies. A poignant remark from Dr Kluge stuck with me: “Digital is not the panacea. It is merely the tool”. We would all do well to remember this quote. Digital health needs boots on the ground to activate, innovate and ensure it is applied effectively and equitably.

WHO representatives from the Digital Health Flagship officially launched a new hallmark report: Digital Health in the WHO European Region: the ongoing journey to commitment and transformation. This is a mammoth document with a stack of data and use-cases (potentially a bit of light reading before bedtime if you’re game).

No time to read it in full? The best bits are summed up here in 60 seconds.

I had the opportunity over the last fortnight to digest the report. The aspects I felt resonated well concerning digital mental health include the following:

• Telehealth use for tele-psychiatry (or tele-psychology), as accelerated by the COVID-19 pandemic, is now here to stay. For it to be both useful and equitable, investment is needed in infrastructure, strong governance mechanisms and in some instances, legislative or policy measures to regulate safe use.
• A case study included in the report on Norway’s use of remote / telehealth care mentioned an RCT performed by the Norwegian Directorate of Health between 2018-2021 (NB: you will need to polish up on your Norwegian to decipher this one). The research group concluded that “using telehealth can help provide cost-effective and more sustainable health-care services, if it is provided to those who benefit the most and costs are contained”. Where Australia is concerned, generating more data on the cost-effectiveness and economics of remote care is definitely required, particularly to support more wide-spread use of video-based digital mental health services.
• The use of mHealth apps is on the rise and many Member States have subsequently engaged in formal evaluation programs to test app safety and effectiveness. The report suggested that government-backed mental health and wellness technologies were among the most evaluated of all mHealth apps, however it noted a number of consistent barriers to their use in clinical practice across the European region. It’s no surprise that these included trustworthiness, privacy and security, digital literacy and overall effectiveness.

Two sessions at the Symposium that I found the most interesting focused on Digital for Quality, picking apart how technology can enable individual contributions for quality of care; and another session titled Harnessing the Power of Digital Technologies to Support Better Mental Health.

In this second panel session I was most impressed by Chris Wright who presented on Scotland’s centralised digital mental health model. The Scottish Government funds and coordinates both clinician- and self-referred digital mental health tools. It has reportedly been very effective in scaling evidence-based digital mental health services and achieving good reach where it’s needed most. This centralised model incorporates strong research, consumer and clinician collaboration and it is very advanced. I look forward to hopefully meeting with Chris to dive a little deeper into how Scotland’s model came to be.

Session Chair Ledia Lazeri, Regional Advisor for Mental Health at WHO closed the panel by stating that digital mental health services thrive when they are imbedded, organic and fully interoperable – achieving this requires thoughtful planning, coordination and developing meaningful partnerships.

I mentioned in an earlier LinkedIn post that the team from Cogniss used their novel no-code technology to build a digital health app in 11 hours at the conference. If you consider the use-cases for low resource settings, this type of technology could be truly transformational for the mental health and wellbeing of many people.

To sum up, the Symposium was an extraordinary cross section of some of the brightest minds in digital health and a really inspiring few days in Porto. What stood out for me is despite many countries having mature digital health ecosystems, we’re all largely facing similar challenges to an extent:

• fostering trust in technology
• improving digital literacy of not only consumers, but the healthcare workforce
• enhacing health information exchange and interoperability
• getting governance (both clinical and technical) right
• integrating digital mental health tools into the care pathway or patient journey.

For Australia it will be important to continue working together (or forge new relationships) with our global partners, particularly where we find pockets of success. This will ultimately help us learn from models that are demonstrating good outcomes and help to address our own challenges.

As I flew out over a beautifully lit-up Porto, I reflected on the words of Hal Wolf III, CEO and President of HIMMS from one session on AI regulation. He said “every digital health problem has three dimensions: people, processes and technology“. This statement can easily be reengineered as the recipe for success. Get the right people, working in the right way, with the right technology and we can fully realise the power and impact of digital health.

Next stop(s): Geneva and Paris (a combined update to come shortly).