We live in a time of unprecedented technological innovation. From the internet to artificial intelligence (AI) and big data, major advances have transformed our world in just a few decades. We are more connected than ever and rely on tech in many different aspects of our lives – health being no exception. The term ‘digital health’ describes how we can apply digital technologies to healthcare. Professor Antoine Geissbühler, Director of the HUG Innovation Centre and Head of e-Health and Telemedicine at Geneva University Hospitals, spoke to us about where we currently stand with digital health and what the future might hold.

How resistance to change is holding back digital health

Implementing digital health has huge potential to improve healthcare: telemedicine enables us to access healthcare solutions from the comfort of our homes, mobile apps and wearables give us real-time information about our health, and AI and big data open new possibilities for automation and prediction that were unthinkable just five years ago.

Nonetheless, managing this change comes with challenges. One could easily assume that Switzerland – ranked the most innovative country in the world by the Global Innovation Index – would be one step ahead when it comes to digital health, but this is not the case. ‘In Switzerland,’ Antoine said, ‘where the density of care professionals is one of the highest globally, the case for telemedicine is harder to sell than when you’re in Mali and part of the country is at war and travelling to see a specialist is expensive and risky. I’ve deployed large telemedicine networks in hundreds of hospitals in sub-Saharan Africa, but never in Switzerland, except during the COVID-19 pandemic, when we had to shut down hospitals to non-COVID-19 patients.’ In low- and middle- income countries where patients pay for healthcare out of their own pocket, it’s appealing to avoid the cost of travelling – often long distances – to find a doctor. With digital health, they can access a doctor online at a fraction of the cost. This creates instant value to patients.

Sharing data across systems and borders

In Switzerland, by contrast, the value is not immediately clear, and hurdles stand in the way. One of these is that the healthcare system in Switzerland is fragmented. ‘We have a very distributed federalist system with 27 health ministers,’ Antoine explained, ‘which means that there’s no single overarching strategy or even policies to deploy digital health and telemedicine. This is changing now, but we’re lagging behind compared to some other European countries.’

In this vein, one of the key priorities right now for Antoine is to work out how to share data for research more widely – particularly in precision and personalised medicine: ‘We have this big initiative called the Swiss Personalized Health Network where we’ve significantly invested in making data from university hospitals and other stakeholders shareable – as well as FAIR (findable, accessible, interoperable and reusable). We’ve made progress and people are starting to recognise that, as we move to precision medicine, we need to gather data from much wider populations – at a national and European level – rather than being restricted to one million people at a cantonal level. This sample size is too small when you’re dealing with precision medicine.’

When we asked Antoine if the aim is to develop a centralised system, he shook his head. ‘We cannot talk about centralised systems in Switzerland – they have to be federated in some way. Rather, the aim is for different systems to talk to each other in as normalised a way as possible. And that’s what we’re trying to achieve.’

Progressing safely ahead

Of course, sharing data widely is fraught with legislative complications. Antoine advised that we need to balance progress with adequate legislation. ‘To improve the quality, efficiency and safety of care, we need to share information widely – among not only health professionals, but also with patients, their families and carers. However, this information needs to be carefully protected, especially as it has become a coveted target for hackers.’ Indeed, the value of a medical record is steadily increasing on the dark web. It’s no wonder, when we think of the fraudulent ways in which this information could be used if it fell into the wrong hands. In Antoine’s eyes, ‘We must move forward and progress digital health, but with robust systems that do not compromise security.’

When it comes to sharing data, we also need to focus on consent. ‘We’ve been working a lot on getting informed consent from citizens about what could be done with their data,’ Antoine said. ‘When we explain that using their data will improve the quality of care and research, we’ve found that over 80% of them will agree. Of course, this must go hand in hand with societal dialogue around data and intellectual property. We also need to incorporate these topics into training for medical professionals and curricula for students.’

Digital health will change the role of doctors

Another challenge in implementing digital health is legislative. In Switzerland, digital health initiatives are not recognised or encouraged by the reimbursement system. As a consequence, healthcare professionals like doctors, pharmacists and nurses fear digital health might reduce their revenues. Antoine said: ‘It pays five to ten times more for a doctor to have someone in their practice than to have a remote consultation. And so there is absolutely no financial incentive for them to embrace telemedicine. Countries like France, Germany and Sweden have solved this problem by making sure reimbursement is the same, whether a patient attends an appointment in person or remotely. Here, there is change but it’s slow – so we need to build on this.’

Coming back to the shifting role of doctors, Antoine pointed out that this doesn’t mean patients won’t ever see their doctors in person. In fact, AI and digital tools have the potential to improve relationships between doctors and patients. He mentioned Eric Topol’s book Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, in which the author argues: ‘The greatest opportunity offered by AI is not reducing errors or workloads, or even curing cancer: it is the opportunity to restore the precious and time-honored connection and trust – the human touch – between patients and doctors. Not only would we have more time to come together, enabling far deeper communication and compassion, but also we would be able to revamp how we select and train doctors.’

As well as finding solutions to how we get digital health solutions to patients, we must also focus on making these tools accessible to all. As the World Health Organization (WHO) states, ‘Digital solutions are often inaccessible for older people, migrants, persons with disabilities and residents of rural areas, although these people could benefit the most from these tools.’ Antoine told us about the risk of a ‘digital divide’, with those who know how to use a smartphone on one side, and those who don’t on the other. Although digital health tools are particularly beneficial for patients with chronic diseases, the majority of this group are older people who are not digital natives. When we build digital tools and design digital systems, we need to make sure these are accessible even for people with limited digital skills.

Innovation, collaboration, diversity

Complex obstacles in digital health demand innovative solutions. And so it’s important to foster environments where innovation can thrive. Antoine talked about his experience as Director of the HUG Innovation Centre: ‘We’ve created the centre right at the heart of the hospital. This makes a statement: innovation is not the remit of the usual suspects doing biotech or medtech innovation. Rather, it’s everybody’s mission to contribute. In fact, our mantra is “Everyone can make a difference.”’

However, innovation has the power to spread its wings well beyond the walls of institutions. This is why it’s so important to nurture start-ups and spin-offs: they can start out in an innovation centre, then be incubated and grow elsewhere – in life sciences hubs such as Biopôle, for instance.

What’s more, as Antoine asserted, innovation centres lend themselves to collaboration. ‘It’s a way for industry to connect with doctors, who act as sounding boards for different ideas – and can help establish whether an idea can turn into something that’s useful in practice. We can then co-develop solutions together. Fluid collaboration between the industrial, research and clinical environments is important. When we do hackathons, we bring together patients, doctors, researchers, computer engineers and businesspeople. If you want to innovate and develop new solutions, you need different perspectives around the table.’

The future of digital health

Healthcare will most probably become more complex in years to come. People will live longer, but not necessarily in good health. More care will take place in patients’ homes, and citizens will play a much bigger role in managing their health and that of their families. Antoine pointed out that we will need to find answers to complex questions like: ‘How do we rethink how we deliver not only care, but also good health? How do we develop AI tools to have a positive impact, while keeping humans in the loop? Currently, education and training for medical professionals does not equip them to answer these questions.’

Digital health solutions can help us tremendously if we navigate the above obstacles adeptly. Antoine is ready for change: ‘I’m optimistic that we’ll be able to harness the power of technology to create healthcare systems with more humanity. This is our big challenge for the next 20 years.’