Velibor Božić

Dear Professor,

Thank you for raising this interesting question.

Digitization of healthcare is like a distant dream in a developing economy like India. That's why, in my case, there has been no transformation in this context.

Best regards,

Anamitra.

that reads like the marketing pitch for the value of digitization. It grossly misses that these are real people with vital health needs. I'm sorry to say this, but before you create new models of care please subject yourself to the reality of needing care, the people who provide it and the needs currently being ignored. And include your after-care needs. Oh, then please explain why your promises make health care harder to access, more expensive to maintain and use and offer little if any improvement in the working environment of the providers.

Joseph A Sprute

Joseph A Sprute

Am in agreement of both points 5 in the list of Velibor Božić However, am skeptical about the term social transformation, with respect to tech-know-logical advances and their respective human consequences.

Karl Polanyi wrote: The Great Transformation (1944), chapter 21 discusses:

Freedom in a Complex Society; this may be a key topic, in terms of future medical applications and human choices in the digital age.

"Digital technologies and the digital environment offer new opportunities for identifying needs and delivering health care (from prevention and health promotion to curative interventions and self-management). As such, they have the potential to transform healthcare services in ways that may contribute to health system goals. The nature and consequences of digital health services can differ substantially from case to case, emphasising the complexity of evaluating their contribution. The results and outcomes of digital transformation of health services (which is further defined later in the Opinion) will importantly depend on the quality of the process and the involved stakeholders. This includes end-users of digital health services (be it professionals, care users or citizens), developers of digital health services, producers of health services and governments. The success of digital transformations requires a sound understanding of the two basic interacting components, i.e. “the health service” and “the digital”, at all these different levels. The full process of their development, production, funding, implementation and evaluation requires careful consideration in this context. The innovative solutions that some digital health services represent can, if designed purposefully and implemented in a cost-effective way, provide better health outcomes and contribute to the sustainability of health systems. However, while digital health services can have this effect, they need not always have it. Evaluations and monitoring should establish whether this is the case for specific digital health services. The scope of such evaluations and monitoring needs to be set appropriately. This is underlined by the fact that, like other technologies, digitalisation in health care normally affects certain goals or certain groups positively, while at the same negatively affecting others. EU policies have consistently emphasised the importance of digital solutions such as eHealth and have accentuated positive aspects of how digital innovations can improve integration of care through up to date information channels and deliver more targeted, person-centred (or personalised), effective and efficient healthcare, reducing errors and length of hospitalisation. However, a balanced view of the effects of digitalisation remains needed and not all forms of digitisation may result in improved care and health system performance. Put differently, a health care service is not good (or bad) just because it is digital. Public expenditure on health and long-term care has been increasing over the last decades in all EU Member States and is expected to rise even further. In 2015, it accounted for 8.5% of GDP in the EU and could reach up to 12.5% of GDP in 2060.1 A substantial part of the increase has been attributed to the introduction and funding of new technologies in health care, including digital ones. In this context, there is a growing need for robust evidence to support arguments that digital health solutions (Car et al., 2008; WHO, 2016) - and the related new organisational models replacing the old - can bring better health outcomes for citizens and contribute to improving the effectiveness, accessibility and resilience of health systems. Given the diverse forms, usages and impacts of digital technologies in health care (ranging from general use of computers to algorithms designed to assist radiologists and radiotherapists in detecting and treating cancers, from robotic surgery to computer aided decision models, and from mobile device apps helping patients to self-manage their disease to electronic health records), this requires evaluations on different levels. Systematic assessment and evaluation of the impact of digital health services is, therefore, needed. To date, such assessments are relatively scarce, especially those addressing the transformative aspects of healthcare delivery on the organisational and operational level. The literature on the impact, for example, of telehealth solutions for chronic conditions suggests that telehealth in some cases may reduce hospital admissions and mortality patients suffering from chronic heart failure, may improve blood pressure control in patients with hypertension, may reduce hospital admissions for chronic obstructive pulmonary disease and may improve glycaemic control in diabetes (e.g. Brettle et al., 2013; Inglis et al., 2015; Flodgren et al., 2015). 2 However, the evidence-base concerning cost-effectiveness can be less clear as is the generalisability of such results. The same holds for equity impacts of introducing digital services, which has the risk of increasing the ‘digital divide’. Models for assessing the value of telemedicine, like MAST, 3 have been developed and used (e.g. Sorknaes et al., 2013), but their use may still be considered limited. The lack of robust evidence on cost-effectiveness is partly due to the absence of available data collected over long periods of time and may also be related to regulations and requirements for funding and reimbursement as well as to difficulties in determining cost-effectiveness in this context. This is especially the case when the introduction of some digital technology changes organisational structures. For some changes, it may not only take several years to see a clear impact at the health system level, but it may also be highly difficult to isolate the costs and effects of such changes in a developing health care environment. There are indeed examples which have demonstrated cost-effectiveness, for instance regarding telehealth, and even cost-savings (e.g. Darkins et al., 2015). 4 Again, the generalisability of such findings, as well as the quality and breadth of the evaluations performed, are important to consider. There are also examples of less favourable or more mixed results for digital health services (e.g. Maddison et al. 2015). A framework for the assessment of the digital transformation of health services and its impact is vital to generate the evidence required for decision-making on stimulating, using and/or funding digital health strategies at various levels in the health care system. In this Opinion, this issue is further addressed based on the terms of reference highlighted next. With it, we hope to support EU member states with decision-making in the domain of health, social and fiscal policies. Moreover, we also aim to help the Commission to shape further activities toward a better uptake of the digital health services at the EU level."

Good idea. Can be implemented....sir

this topic is strongly correlated with the emancipation and education of the society

Digital technologies and the digital environment is used to time saving, if manually estimate water quality paremeters need more time but digital technologies saved that time so it use to develop our nation.