Inflexibility of regulatory frameworks can be an obstacle to the deployment of e-health tools. That is precisely the case in France with telehealth, which is struggling to develop under the current conventional amendments. These constraints were lifted in a few days to respond to the Covid-19 health emergency, which will certainly lead to a change of behavior of both doctors and patients. Telehealth has advantages beyond the current crisis. It is therefore crucial to make it a sustainable solution and to make access to it more flexible by building on the framework implemented during the Covid-19 epidemic.
However, the absence of regulations can also turn out to be a stumbling block for digital tools. E-health and artificial intelligence solutions are complicated to assess. These solutions are sometimes halfway between a drug and a medical device, and as such, they do not fit in the traditional assessment channels (and therefore make access to reimbursement all the more difficult). These specificities make the assessment of these technologies more complex and justify the adaptation of traditional clinical assessment methods – based on randomized controlled trials – while ensuring the reliability, validity and quality of the results taken into account for the reimbursement decision.
In line with Institut Montaigne’s previous work, we recommend that patients be more systematically involved in the assessment of digital technologies. To this end, new result-based indicators relevant to our health system must be created.
Building a culture of trust among stakeholders
Lack of trust is currently one of the main obstacles to the use of digital solutions by healthcare stakeholders (primarily professionals and patients). In order to develop trust, we need to develop usage, and this requires a stronger involvement of patients in the monitoring of their own diseases and a more advanced training of health professionals.
The use of digital consultations during the Covid-19 epidemic illustrates how mentalities can change very quickly in response to emergencies. As indicated by the French health insurance authority (CNAM) in a press release on March 31, 2020, remote consultation “has become established among private physicians as a relevant patient management method, whether for the orientation and follow-up of patients concerned by a non-severe form of Covid-19 or for the follow-up of patients suffering from other pathologies". In fact, for the week of March 23, 2020, 44% of general practitioners had given remote consultations thanks to regulatory constraints being lifted.
Beyond highlighting the benefit of remote care practices, the Covid-19 epidemic also exposed the importance of having reliable data to monitor the spread of the virus throughout the country. In an unprecedented decision, health authorities chose transparency by publishing daily reports on the spread of the virus in France, raising citizens’ awareness of the value of this epidemiological data in anticipating and improving public action.
In order to consolidate citizens' trust in the advantages of digitalization, measures are urgently needed to boost public opinion regarding the benefits of sharing health data. We therefore recommend the creation of an observatory on the use of health data managed by members of civil society (patient associations, doctor federations, etc.) to regularly publicize how data is used for research, patient monitoring, the improvement of care, etc.
The issue of trust with regard to digital tools and the use of health data also concerns healthcare professionals and therefore implies the acquisition of the necessary skills to use digital tools, to successfully achieve this digital transformation. In the United Kingdom, the NHS set up an independent interdisciplinary expert consultation group between 2017 and 2019 to determine the new needs in terms of skills, the roles and tasks of healthcare professionals in the context of a swift digitalization, as well as the implications on the training (initial and continued) of healthcare professionals. Such an approach could be implemented in France to identify the training needs of students and professionals.
Mass adoption of digital tools, the creation of a culture of trust, and specific training on the use of AI and data are all equally important, and as such should be included in all healthcare management training courses.