Smart health : a solution relevant to the many challenges of health systems

What is smart healthcare ?The word smart health with its equivalents: ehealth,telehealth, digital health, connected health- refers to all areas where information and communication technologies  are put at the service of health, as defined by the World Health Organization (WHO) in 1945: “The health is a state of complete physical, mental and social well-being, and not merely an absence of disease or infirmity. ” This concerns areas such as telemedicine, prevention, home care, remote chronic disease monitoring (diabetes, hypertension, heart failure …), electronic medical records as well as applications and home automation.

E-health is increasingly emerging as a relevant solution to meet the challenges facing health systems: changes in medical demography, territorial inequalities in access to care, rising prevalence of chronic diseases, and the aging of the population and care of the addiction. On the other hand, uncertainty remains as to its ability to reduce costs, at least initially: if it gives hope for more efficiency, it could also offer new services, entailing additional expenses. The challenge of deploying telehealth is therefore less economic than qualitative.

However, despite the interest generated, e-health has long remained underutilized. This is true for all OECD countries, although some Nordic countries have an electronic prescription system, a national online health information portal and a digitized patient record. Many computer programs were invested in hospitals as part of a modernization of administrative operations, which did not directly contribute to the quality of care.

The context has changed a lot in recent years, and digital health seems to be the solution that combines the efficiency of care with the control of health expenditure, but its generalization means finding answers to questions of all kinds, such as: confidentiality of personal data, management of the deployment of technical solutions to cover the entire population, the switchover to digital health services, accountability, training, autonomy, patient follow-up when e-health will allow them to stay home for their treatment.

The technological tool is certainly not the only answer to the difficulties of taking care of the patient. However, properly deployed in the decompartmentalization of the health and medico-social, hospital and ambulatory, medical and paramedical sectors, e-health can serve as a lever to encourage prevention and primary care, while ensuring a constitutive principle of the health care system.

In addition, smart health will put the user at the heart of the device and respond to his desire for autonomy, now recognized as a right of patients.It should also be noted that the e-health market grows mainly outside the hospital (rather oriented towards the future implementation of the personal medical file), closer to the patients in their place of residence, with two targets. clearly identified who are: patients with chronic diseases (diabetes, heart failure, …), seniors or disabled people living at home and requiring specific assistance.

If the expectations are numerous, so are the challenges. Will ehealth help to better protect medical data, or will they, on the contrary, give the opportunity to increase the mobility of information and services, make this data more vulnerable? Are there methodologies for evaluating e-health? What additional legislative framework for its development? What are the new responsibilities of health professionals? A mobilization of all actors and a new coordination of their actions at regional and national level seem essential for e-health to fulfill its promises, as well as a good integration of these new technologies in the overall health policy.

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