Chronic Diseases: Challenges and Opportunities in Digital Society

Just recently at the beginning of September at the #MexicoHealthSummit 2022 ECHO, some of the leading ecosystem figures from a very wide range of perspectives discussed the challenges and opportunities in health, in Mexico in particular, but also within the global society of the 21st century. And it is this perspective of social paradigm shift that framed all the thoughts and opinions made over two outstanding, intense and very meaningful days.

In short, we're in the middle of three different revolutions and we're not facing up to them:

1. Demographic revolution

2. Technological revolution

3. Epidemiological revolution

I participated in the panel, "Better Diagnosis for Common Chronic Diseases," and we made an attempt to address these three challenges. The increase in life expectancy, the constant increase in the demand for healthcare, and the growing pressure on financial resources are some of the reasons why it is necessary to renew our healthcare systems.

We have a model based on intervention, not on management of chronicity or prevention. In other words, the healthcare systems that we have inherited address illness but are not health-oriented. They are reactive, not preventive.

Considering that chronic patients represent 80 percent of primary care consultations, 60 percent of hospital admissions and 70 percent of healthcare expenditure, it is obvious where we need to focus.

Chronic patients have special needs, as the care they require often involves multiple centers, multiple specialists, many different drugs provided by multiple providers, etc.

If we do not treat the patient in an integrated way close to home, we are losing effectiveness and multiplying complications and associated costs.

Three barriers that may hinder this 360º view of the chronic patient could be:

- Fragmentation of the system: With a silo-based healthcare model, we lose traceability and therefore intelligence, as we cannot see all the data together.

- Poor primary care: Wherever the patient is, wherever we can provide a local service, we have to reinforce the resources (technical and economic), so that we can care for the patient on a day-to-day basis.

At this level, it is possible and necessary for us to integrate the multidisciplinary approach, ensuring coordination with social care and the empowerment of the patient as an active agent.

- And this active patient is the return key for everything. It's commonplace, we always talk about it, but I'm afraid that we are still far from the cultural, procedural and technological changes that will make it a reality.

This leads to us tackling (actually taking advantage of) the second revolution, the technological one:

• With it we could help the patient to become a consumer and generator of massive digital data that follows their movements, thereby bridging silos, and providing the entire system with useful information on which to base collective and personalized interventions.

• With it we could help provide patients with education and help them achieve self-management, and so decongest the healthcare systems.

• With it we could reorganize the system according to a comprehensive, multidisciplinary vision. In other words, an interconnected health service based on people's healthcare itineraries, not on itineraries of hospital departments or centers.

• With it we can generate, standardize and normalize clinical data for later exploitation, to find coordination between parts of the system with different degrees of technological maturity, to help clinical decision-making, stratify patients based on risk, build public policies around them, and to make them available for research.

It is clinical and pharmacological research and innovation that will enable us to deal with the last of the revolutions mentioned: the epidemiological. We are not going to get sick in the same way. The climate crisis, migratory movements, globalization and its consequences, also pose a challenge for population health.

Technology, innovation and research have already demonstrated their power to combat epidemiological crises such as the recent pandemic, which seems to be coming to an end.

It will be necessary to take the lessons learned and convert the exceptional into structural if we do not want to periodically collapse.

This means, among other things, having flexible systems that manage variable demand, having tools for telematic and ubiquitous health, digitalization of administrative and care processes, and intelligent use of data to anticipate problems and manage them in the most efficient way when they happen.

The problem is very often that regulatory and political decisions have a generational delay that prevents many already available innovations from becoming a reality: We still don't know what to do with artificial intelligence and instead we continue to worry about the supposed volatility of the cloud. We are not talking enough about the application of advances in genetics, but we seem obsessed with bureaucratic control over the patient's medical records ...

The 21st century has brought us new challenges but also tools to manage them. The key is not to use obsolete weapons for new problems, or to assess new opportunities with past fears and biases.