Acceleration of Digital Health in the COVID-19 Pandemic: Rethinking Tools for Global Digital Health
I’m excited to welcome you to our session today on acceleration of digital health and the covid 19 pandemic today's session is a combination of highlighting technical tools for digital health assessment preparedness and evaluation and real on the ground experience with digital health acceleration during the cover 19 pandemic I’m happy and honored to introduce our team today first our special guest this morning from Uruguay's digital health initiative salud punto ue or Uruguay Mr. Pablo or fishy I know he's proud of my Spanish right now Pablo is a computer engineer by training with a master's degree in health services management he has extensive experience in managing large-scale projects and especially in the area of digital health within his work at the digital health initiative he's implemented the design and operation of the health interoperability national platform and as well as the national electronic medical registry of oncology and the integrated network for diagnostic imaging he represents Uruguay in the general assembly before the international organization snomed and the global digital health partnership he also represents Uruguay in the regional steering committee in the American network for cooperation on electronic health and participates in the sbc who working group he is currently senior advisor on the digital health at the idb and was an advisor to the former Chilean minister of health and the sector's digital transformation process finally he participated in the creation of the digital health agendas and the road maps for ministries of health of Paraguay El Salvador Peru and Ecuador a warm welcome to Pablo and from the world bank my very own health nutrition and population digital health team I’d like to introduce our leader in digital innovation and health system analytics marlies gorgins and Gabrielle catan our digital health specialists finally tommy wilkinson our senior health economics economist sorry please feel free throughout the session to drop your questions in the chat and at the end if we still have time we'll open to q a so from there I’ll let Marliese take it away Elise are you muted still I think if we want to discuss digital health and the opportunity of digital health in a covered and post-covered era it's important that we acknowledge and start with the problems that we have we know that even before covered clients of health systems health system providers health care providers health system administrators and at the health system itself there have been significant and persistent problems for which we know that we need new solutions if we want to really transform reimagine healthcare particularly primary healthcare and focus on how to deliver high quality equitable and client centered client centered care next slide thanks Jessica um we know that these problems have only been exacerbated by covert we know that it has brought additional pressure in terms of system capacity we know that it has brought additional pressure in terms of deciding how to prioritize health services it is also brought additional challenges in terms of the perspective of people who want to access health care and they want to improve their their own health so the question is how can we use digital health in this challenging environment how can we use digital health to improve and to expand to use this as an opportunity to not just use digital health solutions for covid 19 in a short term siloed way but to really use it in an integrated way and as we build solutions for covert to simultaneously concomitantly improve the system as well next slide what does a reimagined primary health care system look like the system that I’ve just described that is reimagined primary health care for us the health system itself for health system administrators for the clients for people who want to improve their health and for health care providers I think it's fair to say that what is different about and how primary health care can be different it needs to be responsive coordinated and not siloed in the way that services are currently provided it needs to be efficient and accessible it needs to be equitable and of high quality and then I think some of the things that digital technology particularly enables us to do is these last three and that we can think about using digital health technologies to deliver services that are innovative to deliver differentiated services that is based not just on the needs but on the preferences of clients and that might mean the same service delivered in different ways for different clients in order to get to this reimagined primary health care at the world bank we are about to launch a report that talks about the fact that there are four paradigm shifts in primary health care needed from gatekeeping to quality comprehensive care from fragmentation to client-centered integration from inequities to fairness and accountability and from fragile to resilient health systems and we know that's particularly important in light of covert thanks Jessica so how does all of this link back to digital health well we know that digital health is an essential component of achieving these four paradigm shifts to get to that reimagined primary health care and as I hand over to my colleagues for the rest of the session just to say that I think this is really the crux of the matter that if we want to if we want to do digital health different if we want to not have a thousand flowers bloom not have the current immense fragmentation that we have we have to focus on not digital health as the solution in and of itself but digital health in relation to the health care system and particularly think about how do we provide how do we reimagine primary health care and then what is what is the role of digital health within that and not think of digital health as the solution in and of itself because what we really want to do is change how we provide services and how primary health care works and that is enabled by by digital health as a means to an end thank you very much thank you and thank you everyone for being here so the part of this digital health implementations I think start by understanding the concept of what is a digital disruption and healthcare should go through a digital disruption and this disruption is not about only a transformation or an evolution but it's actually a radical change in the way we do things the way we provide things in the way which tools are we using and how we use the inputs and output and interpret the outputs of these digital health interventions it implies also changing the mindset in the culture of all people and I think in the engine for this digital health interventions is the understanding the potential of data what we can do with data next slide please and so what is digital health and probably you heard about a lot of definitions so basically is the utilization of information and communication technologies what we in the past called e-health but now we include another layer that's the utilization of cognitive computing ai big data machine learning and other advanced technologies for providing health care for health literacy for also digital health skills as well and finally to provide better health care services and when we think about digital health and digital health interventions we can have these four classifications sorry just thank you these four types of classification and as you see it's basically on the end user if they are the patients the health system managers the healthcare provides on that services this is a classifications from who so if you think for example about a digital health intervention such as telemonitoring or reminders or sensors so you may think about for example patients but when you when you talk about health information management systems or automating a process administrative process so you are thinking about digital health interventions for health care providers and health system managers next slide and so as merlin mentioned covid has provided this incredible opportunity that probably without covid may take a couple of years to implement digital health or to think about the value of digital health but covid has exposed this value as how can we use digital health to reduce the caps and increase coverage and increase access and increase access to better service and better quality so but when we think about this opportunity we need to be careful and do it effectively and smarter next slide so one of the things is and why we need to rethink the way we use digital health as well is because there are so many challenges yet especially in low middle income countries there are kind far behind in the development of digital health but also that gap is an opportunity for leapfrogging to understand what others have been done already what have other have been go went through and lessons learned and probably some of the challenges as well is this piloted this phenomenon as we heard in the past from wjo in terms of many initiatives that are not finally operationalized or materialized in the long term so a lot of investment and effort put on something that it is not useful afterwards and probably some of the of the causes of that is the lack of data we need to think about how can we produce new data better data so not to fall on the garbage in garbage out problem and also the lack of frameworks lack of regulation that this the pace when of developing of digital health has been so fast that regulation cannot go in the same in the same pace but we need to have these regulations and frameworks and strategy that should be owned by governments and be managed and be conducted by governments and therefore next slide please and therefore we need to start thinking how can we measure implies a lot of things and one of the things that we need to measure is really different aspects of the ecosystem that will enable the implementation of digital health next slide so one of the things that we observe is that sometimes we are based via to think a lot in the technology but we forgot that technology is only a mean for a final end that is really solving a problem solving a challenge and therefore starting with a problem I think solves at least 80 of any issues but I would say but thinking really about the problem thinking about the end user that should be our motivation when we think about how can we implement digital health and what kind of digital health solutions so once we understand the problem we understand who are the end users thereafter we need to think about the technology but always taking in account the level of maturity and the data and the digital skills that are in the context that we're working with also we need to observe what is going on the regulatory and policy environment the safety security and privacy you don't want to end with applications that for example collect data for one purpose and rafter is sent for another purpose lowering the trust and the utilization by users and also you want to think about and we are going to talk afterwards in this presentation about the evidence of impact and cause effectiveness analysis and all the elements that you see in the slides basically are collected but one instrument we think is like the first step for this digital journey is the digital health assessments next slide so what is a digital health assessment and you probably heard about a lot of of digital health tools most of them they really provide a picture of what is happening in terms of people processes technology and organizational capabilities and the approach that the worldwide world bank we are trying to think is putting all this digital health assessment together pulling all the indicators in in one place instead of creating new assessment because what we are going to see is that some of these assessments are very focused on specific areas and you would like to have a comprehensive perspective of the digital health next slice and so digital health assessment are a very important tool to measure the ability of an organization to really improve to set the bar actually but first to understand what is the current status to have a broader picture of what is happening in the country and that will allow to set new paths set new directions set new strategies these tools also help for benchmarking with their own country or with other countries we need to be careful when selecting to which countries we need to benchmark and by identifying the strength weaknesses opportunities and threats that this tool provides an important input to prioritize digital health tools and rafter implementation to know where to invest how to invest and make the most successful results from it next slide so as I mentioned in the past there were a lot of digital health and you may know some of them but the issue is that because we were so much focused on e-health most of these digital health assessment tools were focused on their architecture and data maturity the infrastructure the databases the interoperability and standards but with the development of big data and the amount of data that we are collecting from many many places we need to think about this analytics maturity area as well to assess how countries are using data what are the digital skills in terms of data science in in terms of interpreting data because most of the countries probably are using a descriptive use of data but we want to start moving towards the more predictive power of data to understand how can we use to make a more personalized service to patients how can we make decision decisions inside driven actually and there is this another area with all development of a iot sensors robotics this is the application so the applications finally is kind of hardware and software that that has this analytic and shine engine and it's based on the architecture but finally is what the end user used and provides the answer and provides the solution to some of the healthcare challenges that the marlins mentioned in the beginning and these all three these three areas should be covered by a governance level and any digital health assessment should cover all the four areas to create a comprehensive digital health system perspective next slide so as I mentioned as assessments are only a a tool but they are an important tool as a first step for a digital health journey once we have this assessment of the situation of a country in terms of maturity or readiness for digital health that should be translated thereafter to a roadmap guidelines with clear steps where we want to go and how we want to go there right that the way we do things is also important and therefore we need to prioritize in terms of what digital health interventions are more relevant based on the context of the country and finally we want to implement we don't want to again do pilots but we want to start doing things and implementing things to create transforming primary care as well next slide please and when we do this roadmap and implementation and prioritization one of the things that we always talk between our team is that we need to start focusing on the low hanging fruit principles so there are a lot of talking about the importance of ai and cognitive computing and for sure these are very interesting topics but sometimes they are a little disconnected or they have a low reductivity to the current context of low middle income countries for sure ai can be a final destiny for a digital journey but we need to think about the actual ability of these technologies also in terms of ethical ai in terms of what are the inputs necessary to run these technologies but also how can we interpret the outputs and that you need a lot of digital health skills and digital has capability to understand really the amp that that's something that we also need to work through and so therefore sorry so therefore we think that countries should start humble and start small that means quick wins thing to start implementing small projects that they are kind of we can see the output very quick and rafter we can scale up and probably the areas to focus are more the administrative tasks the repetitive tasks easy things that can be changed and have a great effect in changing and disrupting the way we do things and just to end so we understand the importance of assessment we understand where we need to focus our efforts in terms of this long-hanging fruit principle so the next step is so when we are designing the digital health interventions what are the kind of features based on this assessment and based on this low hanging fruit principle and what we learned in the in this last month through covid is that any digital health intervention and not only for covid should be easy to use because of the lack of digital health capabilities still that we need to work through collect minimal necessary data and it doesn't mean low level data it just means what you really need and what you are really going to use at the end also when we mention rapid implementation we need more speed and less haste meaning that we need to act fast but smarter thinking not just going in a rush and implementing interventions that are not going to be used at the end and we need to take an account as well privacy and security flexible means that once covid is sent hopefully maybe a new pandemics or nemix or other kind of diseases that needs to be that can be overcome through digital health and therefore these solutions that we are now investing for covid should be capable to be used for other things and most important allow the continuity of her because these solutions will be only useful if they are provided they are accessible they are affordable and they basically provide an answer to the so many healthcare challenges that healthcare system and patients are going on and finally so thinking about all this is very important because our next slide just we don't want to finish with this kind of things like the next slide shows right so it may be funny but this is the truth many times we think about fancy solutions fancy technologies incredible technologies based in an ai they may work fine but it may get a lot of effort to together they may be good but they are not user friendly and sometimes they are really disconnected of the context thank you and now we have Pablo sorry we are still working on some interpretation I have asked the interpreter if he can live translate Daniel are you there yes I am it's going to be challenging because I won't be able to hear him very well but we can do consecutive interpreting meaning he speaks a little bit and then you know we interpret that's going to take time though okay so I must do the slow presentation and I will be sure we'll be show to that what it is so next slide next slide please this is only a few indicators of my country don't worry only to position our country as a 3.5 million post population so next slice please okay I started in Spanish Daniel uh technologically speaking a so we are quite advanced technologically we are a member of the pen American health organization we're also a member of snowmed international and we are also members of the global digital health partnership in the world next slice is yes so we built from public policies and we also have health goals and those health goals are in line with global health goals all of our citizens have access to their medical histories online we have a digital system for medical records for our citizens so 12 years ago we had a change a change in the way we manage health a change in the in the way we finance health and this was a change that had a bet and the bed was to work towards digital health can you press the button please that that's how the digital health strategy so next slide please important so basically the most important thing is that we actually based our system on other countries experiences and we have an initiative that we have started and that initiative is an initiative that has the backing of the president's office of Uruguay the ministry of the economy the ministry of health and also the system of e-governance next slide we also work in this system with the ministry of public health and other public state agencies we also work with public and private health care providers pharmacies laboratories the medical colleges and scientific societies universities and educational institutions and international organizations as well as civil society and ngos next slide is so this is a long-term project that we have although we wanted to have early delivery as well and we also do four kinds of diagnosis and we started doing this in 2014 2016 2018 and 2020 we also conduct the measuring exercises and we have to have thread gives up in line with the system as well initiative so the first thing we do is we started with the initiative in 2012 and we set up standards and the first thing that we did as well is to set up the model and the data exchange system that we needed this is what we did because this is what we thought is what Uruguay wanted provided so we started in 2015 we started working with all the medical providers and we wanted the medical providers to be able to adopt this platform and in 2019 we started putting it into practice implementing it next slide so basically what we do is the government introduced this system and it is a system that is centered on the patients on the patient and it is based on the exchange of information and I work with the community slide so basically what we have here is the adoption adaption adoption plan the plan had five stages we are now on the fifth stage for all providers but all providers had to go through each one of these stages and we have done this gradually with them next slide provides different decrees and regulations by the ministry of health and the percentages and numbers you have them on the screen right here so 82 of the medical records of Uruguay are exactly that are made digitally or digitized and 95 percent of the population has access to those digital documents we have more than 100 million clinical events that we cover that is to say in connection with 3.5 citizens
and this is where we are today we this is our the picture that we can paint on healthcare today okay and next slide about the pandemic on march 13 2020 we have the first confirmed case for covid in Uruguay isolation we had a number of strategies that we took in here why the first strategy had to do with tracing testing and isolation and what we did is we provided a digital strategy to support the health care strategy as well next slide the most important decision that was made at the government level was to stay at home and we did not have quarantine next slide information so basically here the idea part of the strategy was to see how we could reach out to the citizen with information and also with services so to that end we created an app and other channels that throughout the time allowed us to provide better and new services for the citizenship and to provide them during the pandemic next slide what's so here this is what we talked about the virtual environment not everyone is on the digital connected digitally but we have a high number of citizens that do use digital means we have the web page we have Facebook Facebook messenger WhatsApp and clearly called center all of this was put together and this was the way to finally look back to the provider next slide this is possible because in Uruguay we have digital connectivity guaranteed for all providers as part of the private network next slide in Latin America we were the first country in Latin America and the second one or third one worldwide to include contact tracing as part of the app next slide well this is the communication from google ceo to our president next slide press the button please and the other one so no okay um so the last step that we worked on from the digital point of view was the agenda for the vaccination campaign for the immunization campaign the system to register the vaccines and we created through the app the digital certificate for the covid 19 vaccine next slide this certificate can only can also be downloaded from the website and it also includes a digital signature feature next slide next slide uh is so one of the projects that we carried out through a regional approach and this includes all of these countries from Latin America in the Caribbean was to exchange the digital password or the digital certificate for vaccination next slide we're working with who to have this certificate become a health passport so that it becomes valid throughout the world thank you very much thank you so much Pablo thank you everyone and next we'll have tommy just so everyone knows our session got extended an extra 15 minutes so tommy take it away and continue to drop your questions in the chat everyone okay we'll do thanks so much Jessica so what I’m wanting to talk about here is another tool here this tool economic evaluation and how we can apply it to digital health and when I use the term economic evaluation I’m thinking about that basic idea of assessing two or more competing invent interventions in terms of their costs and their consequences and so really what that gets is this is this concept of value or you know what aspects of this intervention matter and what should we what should we assess and so in the covert environment many of these investment decisions out of necessity sort of out of the urgency and the lack of available data and sort of the shifting nature of the evidence base a lot of the investments both digital and non-digital were being made quite rapidly without a lot of economic evaluation to support them but I think we're going to see this this picture change and especially around the opportunities for digital investments to combat covert and to be used within the pandemic so as this evidence becomes available this idea of economic evaluations assessing what the costs are assessing what the impact that is will really help us to make our really smart investments and use our money in the best way possible so we're looking at the right interventions enabling us to sort of catalyze and leverage other sources of investment and also to facilitate the implementation I mean scale up that's so hardly needed excellent but this is an ongoing issue within economics and economic evaluations writ large and it's a bit exacerbated though in in our digital in when we come to digital health interventions but it's also particularly needed because some of our digital health interventions that we've got available some of them represent really good investments the impact the potential impact and the relative to the amount of spend or the investment both in the short term and the long term means that the investment prospect looks like you know really a really good investment however other digital health interventions it's not all one way potentially represent very poor investments it might be because the investment cost is two is too high the potential impact that we're likely to get I might be highly uncertain and there might there might be many dynamics associated with the context and the implementation which means the digital health intervention might be a very poor use of money and so to get at this question of what's poor and what's good obviously there's a there's a sort of financial question but when we think about economic evaluation we're not only talking about financial impact we're saying what's the costs relative to the consequence and so then we get to the heart of the consequences what matters and this is the idea of value and so we have we need to unpack what value means things yes you can go next slide here what value means in the context of dhis but to answer that question as well we don't want to reinvent the wheel so there's a question of asking what's already been done what's already out there and thanks really there's a great conversation I can see here on the evidence available for digital health interventions and Marylanders thank you for usually posting that link so everyone can access that and that was an initiative that we worked on to cast our net wide and so what has been published next slide is yes and without going into too much detail on it we can we can see these were the outcomes that we are looking at and you can see a broad range here so this is this is what's this is what the researchers are publishing all right so this is what they're saying okay this is what so if it's back one slide sorry just this is one this this is what the outcomes in the economic evaluations this is what the researchers think are important as outcomes and what they think the readers think are important and I’ll just highlight the economic outcomes there next slide please just and that when we do look at the economic outcomes they're there some of them are useful for decision making but some of them are a bit insufficient now if you're presenting costs only that's somewhat useful but it only it's just a flat you know a static measure how much did it cost for implementation or cost per you know just to implement the intervention now really what's helpful for decision making is when we get into this field of cost effectiveness analysis plus utility analysis and cost benefit analysis now we actually found zero cost benefit analysis a small pocket of course utility analysis that's when they're doing a cost per you know broad health outcome like a might know a disability just a year or a quality adjusted life year so these sort of measures of general health so we saw a real mixed bag but really there's a potential for improvement in the economic evaluation evidence base for digital health interventions thanks cheers and so how do we break this down and how do we how do we sort of conceptualize it and put it into a bit of a framework well the first step is thinking about our different audiences so we've really got this idea of investors so they can be the governments they can be development partners so who's putting down money to make this digital health intervention implemented at country level and we've got the developers themselves so they could be private and publicly funded and you've got the researchers as well so they're the ones assessing these and doing the publications and saying okay this is how we're going to conduct our analysis this is how we're going to conduct and assess costs and assess consequences now pulling these things together so getting to a common place where we're talking about a different understanding of what value means these different audiences then we can get to then we're talking the same the same language right then we can say well when I talk about the cost for implementation or a cost per certain outcome we all know what we're talking about and we can be on the same page when it comes to identifying good investments and bad investments and really acknowledging the value incorporates especially within digital space a lot of these different things patient experience impact on equity even the data that's being produced as a result of the digital health intervention that's got its own value as well potential for disruption and of course they're all important you're just straight up costs implementation and long term as well next slide please and this is where we're going with this so this is the digital health intervention economic evaluation framework now there's existing frameworks for those in the field we'll be familiar with them for regarding sort of cost effectiveness analysis for those helping benefit cost analysis and every type of economic evaluation you can think of there's not much around guidance for those conducting economic evaluation of digital health and so this this draws on the best practice of economic evaluations methodology but really tailored towards the nuance of digital health interventions and so right at the top there and this comes through you'd see from Gabriel’s presentation and also Pablo mentioned as well the importance of context so who's our decision maker what is the location digital health interventions don't have a value in their own right they don't have sort of an absolute value that's sort of equally generalizable around the globe it's very context specific the next step is around defining exactly what we're what we're talking about the type of intervention looking at the level of complexity applying these basic analytical principles so how do we choose what the comparators what sort of time frame our analysis is going over and then this all important idea of value proposition how are we aggregating this value up are we doing sort of type inventories where we list a lot of the consequences and costs or we're using the tools to combine combined value produce things such as you know return on investment next slide I’ll do a very brief touch on two of those steps here so this level of complexity and this particularly important for digital health interventions and when we're talking about economic evaluation and really understanding this complexity and acknowledging how this how this impacts on the uncertainty of your investment is critical here so when we talk about complexity we're talking about intervention complexity so they're not just a simple tablet that you take and it has a as an effect often there's lots going on and multi attributes of the intervention itself outcomes themselves as well are not are not straightforward as we saw in the evidence base and then particularly in digital health as well this idea of sort of causal pathway so that your digital intervention will have might have this immediate effect on the on the user but it might have this broader sort of health system impact and sort of this this domino effect of either benefit or negative effects as well an economic evaluation you're really trying to capture all of these things next slide please yes and then this is a bit more info on the on the different principles that would apply and as I said this would be common to a lot of economic evaluation sort of methodology writ large but just having a common way of presenting these and talking about them allows us this comparability so we know one economic evaluation would be comparable to another that was done another time and this gets into how do I choose the comparator what sort of time frame for example um and so this is this is an ongoing development we're looking at piloting it in another a number of digital intervention types and decision spaces I mean it's critical to engage with lots of stakeholders this can't be a sort of ivory tower sort of you know academic exercise where we just put out some guidance this needs to have a lot of engagement which we have had with lots of different stakeholders and really applying it in the real world and there's a lot of bit work to go on here as well so there's sort of the applied work to see how it works in practice there's some still things to unpack about things about causal pathway and also how we're representing you know the critical things of digital and such as trust and privacy and the role that that plays in the economic creation space so I’ll stop there and I wanted to give time for us to have queries as well so hand over to Jessica and thank you very much great thank you thank you so much to all of our speakers we will have a few minutes for q a so to start I found actually a great question for Pablo which is from Adriana so Pablo for countries that are potentially less further along in their digital journey what lessons do you think are most important from Uruguay's experience with covid digital health examples well first of all we think that the all the fundamentals of the digital head that we've done in the past years was a strongest for applying a digital strategy for the pandemic the most useful tools that that we think we was the app because it was so friendly to use that any citizen can resistance symptoms or can consult some questions of how is how do you feel about this illness so after that a doctor a medical doctor chat with him or call in a video in a video call and make an evaluation and perhaps he needs a test so in the app will be the result of the test and the other thing we do in the app was you can you can schedule to going to take your vaccines and after that you have your certificate so the we think that the app was a very useful tool that half of the citizens of my country use it every day so we think it was this was our goal in the in the truth on the pandemic great thank you and um I guess kind of to bounce off that question Pablo someone asked earlier in the chat do you feel the human adoption barriers are greater on the health system side or on the patient side and your experience what do you think is larger yeah in the in the system side yeah because um our strategy it was that we don't change any information system for healthcare providers they use what they have so they we don't go with that with a new application so you must you must use this to the clinical top doctors so we what you are doing what you are using it so let's change data between standards and interoperability so this this was good but the use of the technology they have a tele consultation so it can chat with the with the with the patient it was it was a power but they do it so it's part of the acceleration of the of the use of digital channels that all of us use they see today in with the pandemic it's part of the acceleration the great the great challenge now is how we must sustain that how we do that in in a normal process of health of the livery health so that that's our challenge today thank you and I think along that line I’ll open it to everyone of where do you see these the future of digital health and how do you feel with how has covet accelerated digital health in your mind from your experiences and what are still the gaps to overcome this pylotitis versus scalable sustainable models I’ll open it to anyone Gabriel Marley’s tommy or Pablo on your thoughts Jessica let me let me share my thoughts I think if we look back at what we learned from Ebola I think there was a lot of excitement at the opportunity of digital health in a in a post-Ebola environment and I think some of that dissipated quite quickly after the pandemic and the and the crisis was over and so I think the one lesson that we can take from this is how do we prevent this from happening in covert and I think I think we can do that by focusing on re-designing the health system itself right and not in trying to plug in a digital health solution into a system that is currently not operating well so if we start from the perspective of the health system who receives care for what where and understanding our clients much better then I think we can design digital health solutions that are relevant to what we want the system of the future to look like thank you yeah and I also want to wanted to add as well when looking at Pablo's slides the development of previous other initiatives such as the electronical medical records for all the population and the governance and the regulation as well that framework also load for the next series of applications like the covid to be more boost and to be used and to be also decision databases on the other systems that that one aspect the other I think it's the digital skills right so indeed there is really a lack of capabilities on this area in in not only in the healthcare system but also at the national level at the decision maker level and also at the patient level so we really need to think about how can we invest in these digital skills as part of education right so we can take the best of we can really understand the advantages of these digital health interventions once as marilyn mentioned before we need to make another changes not only be thinking on the technology but really thinking on the problems as we as we mentioned and therefore digital skills are a very important thing to invest and also some kind of really ownership uh at the at the central side of the government side on these initiatives so really to own it and feel that it's part of really a strategy medium long-term strategy for the country and just one last element I think that slide that Pablo mentioned in the way that the app was developed in terms of many versions small versions and in every version you add a new thing you're taking kind of an agile approach so you need to really roll out fast so maybe you don't have the most complete application but just you have you know these add-ons that responds to the different challenge that happened during all every day with copy so I think it's that was also an interesting strategy in terms of how can we put something to start working and thinking really on these quick wins that we mentioned in the beginning over I think just I could just come in then and just to agree with my colleagues as well and perhaps just one other sort of indirect impact here is that you know as a result of covert everyone's become an epidemiologist right so everyone's embracing the idea of data and you know you know acknowledging the power of data and sort of interested in you know different elements of data and in the sense that digital goes hand in hand with data that's really opened up a real opportunity for digital health as well both so there's the sort of direct covert ideas but then just acknowledging the role that digital can play in our health systems and the role and role they can play in the generation of evidence and generate a generation of useful data will be I think will be a lasting impact thank you thank you oh yeah I think Pablo's example of Uruguay's experience with this foundation of digital really allowed them to then leapfrog and become agile to the changing pandemic I think one question that goes with the last question in the chat is this idea of the last frontier how do we get low middle-income countries on this digital foundation such as Uruguay and similarly pauline asked did you find whether the use of apps digital is less utilized or difficult for older or less tech savvy populations so kind of on that last frontier meeting grabbing the last people within populations and in different countries what do you guys think about meeting that gap how has Uruguay maybe addressed the issue of less tech-savvy populations or older populations Pablo well I think that that the strategic at the at the political level is one of the of the main issue that that any digital health strategy can condone us as a foundation because what we do it we do it for all the population no matter what kind of population are what if they if they if they the deliveries of the of the health services are public or private we don't care we have the same strategy and we have that works in the in the whole system so we focus in the patient with focus in the citizen but the same strategy to board all the all the needs of the population great thank you so much and I think just to build on that for maybe Gabrielle or Marliese or tommy what are your thoughts on that the last frontier of low-middle-income countries where do you think they should start and how can they get to a foundation of digital health their digital technologies so complementing the answer that merely is putting in the chat I think that the first thing and I it was funny I just heard I was hearing yesterday a session on aging and technology and this person I think it was from google I think but she says do not assume right so the first thing is just not assume what are the different uh skills or capabilities of the different populations right so you just get these assumptions so you start creating things assuming things that prob maybe are not true or maybe yes so the solution is really to build together right build with the population understand the population and that's why I think this in general not only for aging but also in low immediate income context it's really this exercise of a digital health assessment but a really comprehensive one because many have already done in terms of assessment but we need really to build this comprehensive assessment together with the government together with the stakeholders together with the end users and once you have this a perspective of the readiness of maturity then plan you plan if you plan this road map again together with the users being all the stakeholders that you that you think in that way you have an approach that takes in account all the needs and do not assume but really builds together with the final users that's my take I think maybe just to add that that wouldn't call it sort of the final frontier but maybe final frontiers you know there's many different contexts that we must take into account and you know a country that isn't it advanced in its maturity you know comparing that to another country within that basket of lmic's would be would be a mistake you know spending 200 u.s dollars per head is a vastly different health system to one that spends 2 000 u.s dollars so but that highlights this that is as Gabriel said I think the recurring theme through this session has been the importance of context and assessing at a local level and then identifying what are those interventions that are right for that particular context great thank you marlies maybe I’ll have you weigh in on that too if you'd like and then for our final question as we're just about out of time is are you seeing lower income governments more willing to invest versus looking for partners to fund so I you know building on what Pablo Gabriel and tommy have said I will only say that I think I think good solid plans find funding right and what I what I mean by that is that you know we're always going to find in low and low and middle-income countries that funding is a combination of government funding and you know development partner financing and I think those always and other concessional financing means I think those need to need to work together and in in synchronization I think the challenge at the moment I’m not suggesting financing is not a challenge right but I think it is about joining the dots and bringing all the desperate in investments together in a national integrated plan that says this is what partner one is doing this is what the government is doing this is how all these pieces fit together because and I think if we can get that right if we can help support governments that that innovations in digital health are not driven by development partners or technology companies that come with to them with solutions but that the government is saying this is our plan and let's figure out how the support that you can provide fit into that plan I think if we can change that dialogue that is an important step in helping to make sure obviously and when we need the digital health we need regulations we need data privacy consent all those things to be built into that as well but I you know I think that when we to me the biggest challenge in digital health is which solutions are right for this country's particular context and how do we scale and not continue this culture of pilotitis and I think if we can get that right the right financing will follow not suggesting it's an insignificant challenge but I think it's not the number one challenge I think it's this is the case of getting the plan getting the puzzle pieces to line up and then figure out the different financing sources for the for the puzzle pieces so to speak thank you wonderful thank you great answer and just to wrap up I want to give a special thanks to all of our speakers and my participants and the patients today apparently we're still learning how to use zoom and interpreters and our new digital world from covid but to wrap up I’d love to just give it to Pablo one more time and say for everyone listening what what's the biggest lesson learned from Uruguay if you had to give them all one tip one final parting piece in your experience from all your many experiences your final takeaway thank you thank you for the invitation was a pleasure to showing with all of you with cabiel and Thomas and Elise the big lesson is to wait because this is this is a medal long-term project so we must give quick wins but we must wait this is a process this is an adoption you need to be to be to have a good foundation to accelerate process but to going forward and moving forward in continuous way so just wait do it right do it with the with the I with a global strategy political views must showing must accept must be compromised with the with the initiative with the project so take the risk wonderful thank you thank you all I think it might just kick us out in a few seconds so thank you all for coming and have a wonderful rest of your day
2021-09-07 04:33
