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Governance and Global Trends in Digital Health and Social Protection

Clayton Hamilton, Lead, Digitalization of Health Systems, WHO Regional Office for Europe

Sector Network HeSPAEE Regional Conference 2019 | May 27 -29

About myself

• Born in Sydney, Australia.

• Employed at the WHO Regional Office for Europe, Copenhagen, Denmark.

• 22 years of experience in working for the United Nations.

• Responsible for leading the initiative for Digitalization of Health Systems in the WHO European Region.

• Experience in working with countries to develop their national digital health strategies and engagement plans and guiding implementation of national level digital infrastructure development and integration of health information.

• LinkedIn: https://www.linkedin.com/in/claytonhamilton/

• Twitter: @ClaytonHamilton

• 194 Member States

• Headquarters in Geneva, Switzerland

• 6 Regional Offices

• More than 150 country offices

• Over 7,000 staff

Actions for developing digital health in countries are anchored in the UN Sustainable Development goals and Universal Health Coverage

The implementation of digital health must ensure no-one is left behind through ethical and morally responsible policies, good governance frameworks, accessible and affordable solutions and digital public goods - available

to all.

• Extending the scope, transparency and accessibility of health services and health information

• Widening the population base capable of accessing the available health services (including reaching marginalized and underserved populations)

• Improving public health surveillance

• Facilitating training of the health workforce

• Offering innovation and creating efficiency gains in the operation of health systems and the provision of health care

How does digital health contribute to the achievement of universal health coverage?

WHO’s role in the field of digital health

Globally WHO:

• Develops consensus around standards for digital health.

• Monitors and reports on global progress.

• Sets global priorities and establishes international partnerships.

Regionally WHO:

• Supports countries directly in their national digital health implementations.

• Works with international partners in the region in addressing a range of health systems digitalization challenges and priorities.

• Addresses research bodies to help guide priorities for future research on digital health.

• Examines how emerging digital innovations will shape the future of health systems and health service delivery in practice.

WHO’s role in strengthening global governance for digital health

Challenges faced by health decision makers in designing future health systems and service delivery

Increasing cost of

healthcare

Demographic change and

population ageingChanging profiles and

burden of disease

Growing patient

demand

Health workforce

sustainability

Using a health systems strengthening and equity lens, WHO examines the role of digital technologies in addressing these challenges & concerns

Ensuring health

security

World Health Assembly Resolution on Digital Health WHA71.7

May, 2018

• Passed unanimously by Member States globally in the 71st session of the WHA

• Frames the development of Digital Health within the agenda for Health System Strengthening and “as a means of promoting equitable, affordable and universal access to health for all”

• Provides high-level guidance on future priorities and activities of WHO and its partners in the digital health domain

• Draft global strategy on digital health, mandated by WHA Resolution 71.7 made available for public consultation (recently closed).

• As the document develops further, there will be a Member State consultation, after which the strategy will be discussed at the Regional Committees this year, and have the final version presented to the WHA in 2020.

Public consultation on Global Digital Health Strategy

page I

National eHealth Strategy Toolkit

A

FROM I NNOVATI ON TO I MPLEMENTATI ONeHealth in the WHO Eur opean Region

• WHO/HQ released the first WHO guideline on digital health interventions on April 17 this year.

• Provides 10 ways that countries can use digital health via mobile devices to improve people’s health and essential services.

• Demonstrates that health systems need to respond to the increased visibility and availability of health information.

http://bit.ly/WHO-Guideline-Digital-Health-Interventions

WHO guideline on digital health interventions for health system strengthening

Digital health: National challenges, concerns and success factors

Establishing & maintaining trust relationships

Sustainable financing & competing with other

health system expenditures

Tackling data fragmentation and

interoperability

Setup, scale-up & governance of digital health services

Communication - Public & health workforce engagement & training

Privacy, security & consent

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02

0304

05

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Key digital health challenges in Europe

• Do investments in digital health reflect their comparative value to health and health systems?

• Will adopting digital health create an unwanted digital divide?

• Tackling resistance to innovation and technology-based change in health

• Striking an acceptable balance in access vs. protection of health data for different uses

• How can healthcare professionals concerns be reduced (and trust established) when there is no recognized certification mechanism for digital health?

• Poor data quality which limits the ability to drive decision-making

Health decision-maker concerns about digital health

The 11 key factors underpinning national success in digital health

1. National digital identity for citizens, healthcare personnel and providers

2. Strong and visible governance for digital health

3. Strong integration approach for linking health data - both inside and outside of the health sector

4. Clear and unambiguous legislation supporting digital health

5. Political will and leadership for digital health

6. A digitally literate workforce and methods for continued professional development

7. Well-established cultures of trust

8. Intersectoral action and Public-Private Partnerships for digital health (*when well-governed by public leadership)

9. Gender equality in digital health

10. Patient engagement in co-creating and implementing solutions

11. Sustained financing for digital health

Country progress in digital health adoption

01Digitalizing health informationIntegrating clinical systems and disease registers and making health information interoperable and accessible tohealthcare professionals and citizens (EMR/EHR and national data portals).

What are European countries doing in digital health?

02Implementing national digital health services Implementing national ePrescription systems (and supply chain management of pharmaceuticals) together withother key national digital health services (eVaccination, eAppointmentBooking, ePathology, PACS etc.)

03Scaling up mHealth & Telehealth applicationsScaling up mHealth and Telehealth applications (mostly for vertical, disease-specific interventions).

04Implementing health data analytics(Slowly) developing methods for basic data analytics for decision making in policy and health systems efficiency.

05Addressing privacy & securityImplementing mechanisms of data protection & consent, finding an acceptable balance between data privacyand sharing, (EU Countries) implementing the EU GDPR.

01Establishing biobanks and personalized medicineEstablishing biobanks and experimenting with personalized medicine

What are European countries doing in digital health? (advanced)

02Establishing national big data initiatives Thematic Big Data initiatives and national data lakes

03Implementing blockchainImplementing Blockchain-based smart contracts for consent and EHR operation

04Experimenting with clinical applications of AI in healthOncology diagnostics (e.g. Machine Learning based tissue classification and feature evaluation/Understandingdifferential oncogenic wiring across cancers), Image recognition for automated skin anomaly analysis etc..

Global and regional action for digital health

• Identify standardization opportunities for a benchmarking framework that will enable broad use of AI for health.

• Create a technical framework and standardization approach of AI for health algorithm assessment and validation.

• Develop open benchmarks, targeted to become international standards, and serve as guidance for the assessment of new AI for health algorithms.

FG-AI4Health - Goals and Objectives

Developing standardized assessment of AI for health solutions

https://www.itu.int/en/ITU-T/focusgroups/ai4h/Pages/default.aspx

• Project between WHO and ITU under Horizon 2020 funding to select a host for a joint mHealth Knowledge and innovation Hub for Europe.

• The hub will serve as a mechanism to share success in mHealth across the European region and boost uptake of mHealth solutions amongst national governments.

• The Andalusian Agency for Healthcare Quality has been selected as the hub host, backed by a consortium of 19 public and private partners across Europe.

WHO-ITU-EU mHealth Knowledge and Innovation Hub

4. Enabling the transition to integrated, person-centred models of care and facilitating the move from treatment to prevention

5. Technology and innovation facilitating achievement of key public health initiatives

2. Empowering individuals to better manage their own

health and well-beingthrough technology

1. Reforming health service delivery and access

REGIONAL ACTION: The WHO/Europe Digitalization of Health Systems Initiative

3. Improving the operational efficiency and responsiveness of the health system

http://bit.ly/WHO-DOHS-Budapest2018

WHO Symposium on the Future of Digital Health Systems6-8 February 2019

3 key messages from the Symposium

• Digitalization is challenging our understanding of how and where healthcare can be delivered, and is driving a transition to predictive and preventative models of care

• Digitalization of health systems is not simply a notion of “continuing what we’re doing now, faster and more efficiently” but is

• looking at reinventing how health services are delivered • changing the role of healthcare professionals and (empowered)

patients;• harnessing the value of data for health.

• Digital health is centrally important to achieving universal health coverage with more efficient and effective modes of providing quality and equitable access to health for all.

Recommendations for the future development of digital health (implications for countries and development partners)

In an increasingly complex landscape, countries are encouraged to first and foremost take action to:

• Strengthen existing governance for digital health and develop national strategies that are intersectoral and linked to the achievement of public health policy.

• Establish data quality and sharing agreements.

• Establish new modalities of public-private collaboration and co-participatory solution design.

• Tackle privacy and trust concerns through certification and accountability mechanisms.

• Work to establish more sustainable models of funding for digital health.

National implications for the immediate future

• Expand funding and technical support for digital health and in particular national initiatives for digital identity, health data digitalization and integration.

• Coalescing donor and partner activities for digital health - nationally, regionally and globally. There is a lot more we can share!

• Help strengthen the role of national public health institutes in the development of digital health.

• Advocate for the inclusion of patients and special interest groups in strategy development and solution design – and – for gender equality in digital health (both in development and leadership positions).

• Increase communications and advocacy for digital health.

Implications for development partners

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