Policy brief first draft
HS Capacity I
Digitalization in Healthcare Workforce System
CONTEXT AND POLICY ISSUE
Healthcare workforce capacity, especially during disease outbreaks or other public health emergencies, can be challenged, or overwhelmed by the sudden increased demand. For example, during the COVID-19 crisis, Swiss hospital resource redirections and decreased hospitalization rate of non-COVID19 patients were observed. Accordingly, a decrease in healthcare quality was noted.
Digital health services could be part of the solution in order to decrease the burden of healthcare systems and the shortage of healthcare workforce, as they provide cost-effective and accessible care, increasing patient’s empowerment and self-management. More specific to public health emergencies, they are necessary for surveillance, early identification, preparedness and response. The use of digital technologies during an outbreak could support prevention of infection, support social distancing through telemedicine, predict future local outbreaks for optimal healthcare resource management, support vaccine development or support data-driven measures and ordinances.
For all of the above, the healthcare digital transformation is a growing demand in OECD countries, so the proportion of primary care practices (PCP) implementing Electronic Medical Records (EMRs) has expanded over time: in 2021, the average of PCP using EMRs was 100% in 15 and 93% in 24 countries. Patient’s interaction with their health data via digital tools (internet portal, apps) was found in 16 countries, while half also offered telehealth such as teleconsultation and remote monitoring. Switzerland healthcare digitalization has progressed slowly in comparison with other European countries, being ranked 14 out of 17 in the 2018 Digital Health Index. However, the country is the host of 900 healthcare start-ups and its population is digitally-literate, so by developing this potential, healthcare delivery could be modernized with significant lower costs and without negative impacts to payers or providers.
The implementation of digital health services still faces challenges, which will shape further policies. For example, future health agendas should focus on digital literacy and “techquity”, which is equal access to digital health capabilities. Other issues such as digital technology performance evaluation, the ethics in the use of digital technology, legal and regulation base for digital health services application or data safety should be considered as well.
FINAL VISION FOR 2040
We consider that digitalization will already be prevalent, mandatory, and adopted in the health arena, in terms of healthcare system capacity-building, workforce, and education in 2040. It will mainly be done by 1) automatization of processes, including the introduction of telemedicines, mobile health, and health information technologies, 2) global digital health hub created in Switzerland, and 3) solid regulations placed on infrastructure used.
1. Automatization of processes leading to the transition of jobs to non-medical stuff
- Mobilizing “non-medical expert human” resources: Social prescribing programs (link workers), supporting community care (community health workers), preventive programs that are continually creating community jobs by the help of atomization and digital technologies to reduce the loneliness and support community resources
- Raising the sector of behavioral change for well-being, wellness, professional health coaching: meeting people in their social context and reducing the risk of NCDs --> partially part of a “new hybrid primary health care model” or “social medicine/healthcare model”
- Minimizing institutional visits via hotlines and applications, automatization of first contacts, regular checkups; e.g. automated booths for routine medical tests, mobile applications, hotlines for public healthcare literacy, telemedicine, wearable devices, personalized & preventative treatments; digital and health literacy as a digital “vaccine” towards public trust in digital health technologies.
- Healthcare equity: gender topics are balanced (in 2023, 70% of the healthcare workforce were women, only 25% in leading positions), UHC will be linked with digital healthcare.
- In 2040, human rights and equity issues are well balanced: we have minimum 50% female leaders in healthcare; research is gender balanced; femtech will be an established, own sector in high-end technological research and publicly funded.
- Gender equality will also be mirrored in digital health (literacy and affordability, accessibility, appropriateness, acceptability, accountability)
- UHC will be covering prevention, and personalized care aside from treatments.
2. Establishment of global digital health hub in Switzerland
Currently, Switzerland obtains two fronts in global digitalization arena - one in Zurich/Basel/Vaud with the concentration of technology giants private sectors (e.g., Google, IBM, META, etc,) and academia working on automation and robotics technologies (e.g. ETHZ, EPFL), and another in Geneva with numerous international organizations, NGOs, civil society organizations, and the recent establishment of the AI for Health initiative focusing on agenda-setting and policy creation. Together with the long-standing function of Switzerland being neutral, we consider a well-coordinated, multisectoral, and global collaborative hub for digital health to be established and functioning in Switzerland.
- Global multilateral collaboration: Building enforcement capacity, minimizing digital health monopolies, digital cooperation (harmonizing global efforts), meeting misinformation with the best science communication
- Switzerland as one of the globally leading healthcare centers is at the forefront with applied digital and data science in Environmental health, Planetary health, and One health sectors
- Secured Human Rights: Empowering others through data literacy, through risk assessments & responsiveness to events, and solving/resisting the “digital divide” by the involvement of IOs, NGOs, CSOs, and other initiatives like AI for health
- Established Data Security and patient safety: Clear and transparent standards and regulations (national & international coordination), Cyber security and defenses to protect data from cyber attacks; well managed regulations for medical devices and innovative technologies by providing timely and appropriate guidance.
- A financial secure health technology hub
- Private-public financing partnerships will be a major part of technological advances, with established centers: Swiss Health Valley Geneva/Vaud, Switzerland Innovation/Future Health Basel/Zurich, Tech giants Google, IBM, META, etc, as international hubs for automation, robotics, digitalization (through academia spinoff / tech ecosystems)
3. Policy making is driven by science:
- Switzerland offers strong science-policy and science-diplomacy organizations, infrastructures and networks. Orchestrated research, strategy, and action-taking with scientific organs. Furthermore, in the situation of a time-sensitive national health care crisis, we need fast, centralized decision-making instead of slow decision-making in all areas of health care. The entrepreneurial sector is less dominated by routine processes and offers more flexibility to change course in the execution and delivery of health care when needed. Therefore, replacing bureaucratic processes with entrepreneurial efficiency could make an important contribution to managing future pandemics. Private-public collaborations will be state of art in future health care. An emergency strategy with a more centralized approach to protect at-risk groups, suppressing viral spread yet applying flexibly stringent measures adaptive to time sensitive developments, which could address the long-term evolution of a crisis for a better public acceptance and outcome.
POLICY STEPS TO BE TAKEN
- Creation of digital health hub by the collaboration of existing Zurich/Basel-based academic and private-sector institutions and Geneva-based IOs, NGOs, and CSOs, which will collectively forecast the demand and supply of health services via data collected from the digital health technologies and applications that emerged prior to 2030;
- Ensuring that digital health services is able to fill in the gaps for healthcare tasks wherein there is a lack of healthcare workforce by introducing health information technologies in local-based health clinics and institutions;
- Continuous financing and technical support allocated to digital literacy and training for healthcare workforce and the public related to the healthcare technologies that have emerged by the Swiss government and Geneva International community; and
- Promotion of these said effective technologies and regulatory policies as part of ODA to LMICs.
FOR 2024 & 2026
Actions for 2026:
- Broaden the use of digital health technologies, guaranteeing extensive adoption and integration across health systems.
- Review and adapt regulatory frameworks in light of lessons learned and evolving technological advancements.
- Reinforce public-private collaborations in supply chain management and ethical digital health practices, stressing the accountability of Swiss tech giants and financial institutions.
- Extend and deepen international partnerships to maintain ongoing support for LMICs, with a focus on capacity building and long-term resilience.
- Evaluate the efficacy of educational programs and training endeavors, implementing necessary changes to secure a proficient and flexible healthcare workforce.
Actions for 2024:
- Invest in and create digital health technologies, such as telemedicine and remote monitoring apps, to lay the foundation for more extensive health system integration.
- Set up regulatory structures for digital health infrastructure, concentrating on data protection, privacy, and fair access.
- Start educational programs and training efforts to cultivate a resilient healthcare workforce, incorporating non-medical personnel like community health workers and well-being coaches.
- Initiate public health initiatives to enhance healthcare literacy and promote the adoption of digital health solutions.
- Commence international collaborations (via international treaty) to offer financial, technical, and technological assistance to LMICs, prioritizing robust health systems and pandemic readiness.
Background on the issue your vision is tackling:
Health systems lacking capacity to respond to pandemic-related public health crises
- Limited health emergency prevention and preparedness systems in place and limited financial, technical and technological support, assistance and cooperation notably to LMICs in this area.
- Lack of capacity which could ensure resilient health systems (notably with regard to available human resources, health system recovery strategies, standard protocols for infection prevention and control).
- Lack of sustainable health and care workforce capacity within national public health systems.
Notes from backcasting exercise:
Collective brainstorming on the following questions:
- Which policy measures should be taken?
- Who should act in CH, internationally? → 3 policy angles (multilateral level, CH policies at the national level + through engagement abroad e.g. development policy)
- Vision: 2040
- Digitalization and data
- Data can help in forecasting [hospital resources, staff resources, health needs (number of people with illnesses), financing necessary to meet health needs given current constraints].
- Telemedicine and AI tools to improve health coverage and reduce healthcare shortage
- Centralized or decentralized
- Decentralized financing is at default, but changed during the pandemic. Financing became centralized. Centralized financing worked during the pandemic. But for the future pandemic, we need to be clear with decision making roles (canton level and federal level).
- In general, funds should be set aside for emergencies at the Federal level
- How should health insurance be structured for pandemics / UHC (economic incentives for prevention? lowering franchises?
- Acute vs preparedness
- Human capacity in health / health workforce
- Workforce is not tackled so much in the pandemic treaty.
- But there should be incentives for health workers in terms of salaries, work environment (resting facilities), continuing education, scholarships.
- Given increasing new technologies, health workforce should be taught and trained so they can adapt easily to these technologies.
- Workload (data, late and night shifts).
- Public health education
- Public (layman, non-health workers) should be literate in public health concepts.
- Health promotion campaigns in educational institutions
- Hotlines and apps