By Dr Francesca Properzi, PhD, Research Manager, and Krissie Ferris, Research Analyst, Centre for Health Solutions
This week we launched our report Digital transformation: Shaping the future of European healthcare, our third report in our Shaping the future of health series, focused on the impact of digitalisation on the healthcare sector. While our 2019 report focused on the state of digitalisation in the UK healthcare system, this report extends our research across Europe with the aim of understanding the challenges faced by different countries, as well as the learning opportunities for both the public and private sector to improve ways of working, access to services and deliver a more effective patient and clinician experience.
With this aim in mind, in early 2020 we started a research collaboration with our colleagues from seven European countries (Denmark, Germany, Netherlands, Norway, Italy and Portugal). A key part of our methodology was a survey of 1,800 doctors and nurses and interviews with key stakeholders working in these seven countries. However, just as we were launching the survey, the WHO declared COVID-19 a global pandemic. Although we were concerned about undertaking this survey at such an unpredictable time, our discussions with our colleagues and the survey company, M3 Global, assured us that this was, if anything, an even more important time to understand how digital technologies could help health systems to respond. We therefore continued as planned.
We could not have envisaged then just how much this unprecedented and unanticipated global health threat would accelerate digitalisation across European healthcare. Moreover, with the support of our European colleagues, we were able to complete the primary research, including exploring how COVID-19 has impacted the use of digital technologies in healthcare. We also identified 16 case studies - digital health solutions that are already having an impact in the European digital health ecosystem. The rest of this blog highlights some of the main findings from the report.
Perspectives of our survey of clinicians on digital transformation
Our survey was conducted between late March and early April to assess the use of digital technologies across the seven countries. Its aim was to understand the views of frontline clinicians (nurses and doctors) working across primary and secondary care about the challenges they face and the benefits they are seeing from technology adoption. In addition, we included two specific questions to assess the pandemic’s impact on the adoption of technology.
Survey respondents (1,781) identified the top three challenges they were facing as: bureaucracy in healthcare (57.4 per cent), the cost of technologies (50.3 per cent) and finding the right technologies (49.0 per cent). While the responses were broadly similar across the seven countries, the top three challenges among clinicians in Italy and Portugal included training staff to use technology, and in the Netherlands was sharing patient data. When asked about the current state of digitalisation in their country, the most frequently mentioned negative words were ‘Slow, Complex and Bureaucracy’; the three most frequently mentioned positive words were ‘Fast, Innovative and Efficient’ (see Figure 1). The UK responses regarding the current state of the healthcare system in 2020 were generally more positive that the responses given by the UK clinicians we surveyed in 2019.
Figure 1. The top three words used by European clinicians to describe their countries’ progress towards digital transformation
Our survey also showed there is wide variation between countries in the adoption of the different types of digital technologies (Figure 2). The most frequently used technologies across the EU were electronic health records (EHRs), used by 81 per cent of respondents and e-prescribing, used by 62 per cent. However, there were some notable variations both between and within countries. In the Netherlands, 97 per cent of clinicians reported using EHRs, while in Italy the percentage was only 69 per cent. Germany stands out as having the lowest levels of e-prescribing and Norway with low use of online booking arrangements. Overall, clinicians in the Netherlands, Denmark, Norway and the UK reported higher adoption of digital technologies.
Figure 2. Variations in the percentage of clinicians using the different types of digital technologies used to support care delivery
Our survey results and interviews with stakeholders show that a lack of staff training in using digital technologies is a barrier to progress in digital transformation. A higher percentage of Dutch clinicians felt the most satisfied with the training provided (63.3 per cent) with clinicians in Italy and Portugal the least satisfied (41.4 and 39.4 per cent, respectively). In Portugal, 47.3 per cent of clinicians said they do not receive any formal training in digital technologies.
Key actions to close the digital gap
Despite differences across European countries, the actions needed to close the digital gap are similar and echo our findings in our 2019 UK report. We identified two overarching themes - changing the mind-set and liberating the data - and five actions needed to help deliver digital transformation at scale.
- Create a robust health IT infrastructure, including connectivity (Wi-Fi, fibre optic, broadband, etc), safe data storage, consented access to health data and data sharing.
- Implement accessible and integrated EHR systems and invest in the basic digital technologies that accelerate digitalisation.
- Address the challenge of interoperability through development of shared local or national records with a single patient identifier and transparent consent processes.
- Establish a robust governance framework to support change management and a culture of digital transformation, including clarity over data ownership, cyber security, patient consent and patient education.
- Develop digital leadership skills and improve the digital literacy of staff and patients.
Improving European citizens’ experience of digital health
According to longitudinal research from the European Commission (EC), European citizens are increasingly seeking health information online. In 2019, 54.9 per cent of survey respondents sought health information online compared to 46 per cent in 2015. There are wide inter-country differences, with Dutch respondents most likely to search for health information online (74 per cent in 2019). Respondents from Norway, Denmark, the UK and Germany also reported higher levels of performance, whereas Portugal and Italy were below the EU average. EC research shows that citizens are increasingly using the internet to book healthcare appointments. In 2018, 17.3 per cent of Europeans used the internet to book a healthcare appointment compared to 10.1 per cent in 2014. In 2020, the use of the internet to book appointments is highest in Denmark and lowest in Italy. A number of digital technology companies are helping countries improve access to online appointment bookings.
COVID-19 and the acceleration in adoption of SMART technologies
We asked our survey respondents how far their organisation had increased its adoption of digital technologies (see Figure 3). Overall, nearly 65 per cent of survey respondents said their organisation had increased its adoption of digital technologies to support clinician’s ways of working. A similar number (64.3 per cent) reported that their organisation had increased its adoption of digital technologies to provide virtual support and ways of engaging with patients. The change in adoption to support clinician’s ways of working was highest in Norway (83.6 per cent), and to support patients was highest in Portugal (81.4 per cent). Meanwhile, 45.8 per cent of German respondents said their organisation had made no changes and seven per cent saw a reduction in their adoption of digital technologies to support clinician’s ways of working, and 48.3 per cent reported no change in use to support patients.
Figure 3. COVID-19 is increasing the adoption of digital technologies to transform ways of working
Across the seven countries in our survey primary care doctors reported the greatest adoption of digital technologies in response to the pandemic (74.7 per cent).
The SMART characteristics needed to encourage adoption at scale
Moving forwards, if digital technologies are to help healthcare systems thrive in the post-COVID era, we consider the need to meet the following SMART characteristics (Figure 4). We consider these are crucial in ensuring the sustainability and resilience of healthcare systems, including being better prepared to cope with future infectious disease outbreaks.