E-health challenge: facing health problem using technology

Read time: 5 mins

The relationship between genetic heritage and environment has considerable effects on health and healthcare. Individual differences have an important outcome in susceptibility to diseases and treatments. Moreover, physiology and health status are influenced by environmental conditions and life-style.

By relying on increasing mobile network options, home broadband, and availability of various information and communication technology (ICT) tools, it may be possible to collect information at various levels, with a continuous screening of patients. Health status monitoring could be translated in early and accurate diagnosis, and  targeted intervention paradigms. In addition, technologies could facilitate dialogues among doctors and patients, and could make citizens aware of their own health and diseases prevention. On the other hand, physicians could take advantage of data collected: they are an incredible wealth to identify trends, to make statistical measurements and to highlight the most effective treatments.

In USA, there are popular programs and tools based on personal engagement to share symptoms, treatment plans, and medications, but also to collect data then employed for research purposes.  For instance, Curetogether covers over 500 medical conditions, while Patientslikeme counts more than 250.000 members, 2000 conditions, and over seven million of treatment and symptom reports.

But there are also tools able to work in the background, as body sensor or non-invasive equipment measuring day-by-day biophysical parameters. Sensors will feed realistic data-driven models and will allow predictive tools to optimize the allocation of resources. This will lead to a greater quality of care and to move towards a more efficient prevention.  An example of integration of multiple devices for healthcare is represented by Continua Alliance, while an open source project to monitor effects of environment and food on our body is Bodytrack.

European and Italian e-health

With a higher life expectancy, Europe is ready to face the rising of health and social care costs at about 9 percent of European GDP in 2050. For this reason, Europe has demonstrated an increase interest in the concept of personalized medicine and procedures, helping people to better manage their health and quality of life, and offering the possibilities to provide cheaper services for health, thus improving healthcare efficiency by 20 percent.

Based on the "European Hospital Survey: Benchmarking deployment of e-Health services (2012–2013)", which involved 1,753 hospitals from 30 European countries, the majority (63 percent) of the them devotes less than 3 percent of their budget to information technology. The two functionalities with the lowest availability levels are those that allow the monitoring of patients remotely (4 percent) and the exchange of medical patient data with any healthcare provider in another country (5 percent). But in any case, the European situation is far from being homogeneous in the introduction of information technologies. In Italy, overall savings from the introduction of ICTs in the Health Sector are estimated to be around 11.7 percent of national health expenditure (i.e. € 12.4 billion). Savings from digital prescriptions alone are estimated to be around € 2 billion.

According to "European Hospital Survey: Benchmarking deployment of e-health services (2012–2013)" Italy closely resembles the European average in e-health: only “Single Electronic Patients Records (EPR) shared by all departments” showed a significant difference with the EU30 average (-27 percent).

All other areas are very close to the European average, with “Picture Archiving and Communication System (PACS) usage” shared by 86 percent of hospitals; e-prescribing by 53 percent; integrated system for e-Referral used by 37 percent; and Tele-monitoring exploited by 18 percent of healthcare institutes. Integration, namely exchange of clinical information, is meanly performed by 56 percent of hospitals.

Nevertheless, Europe has bet on e-health during the 7th Framework Programme with projects like Iterstress, for the management and treatment of stress-related disorders; or Personalized medicine, a project running till January 2015, involving 19 partners from 9 European countries with the aim to develop new tools, infrastructure and models to accelerate personalized medicine for the benefit of the patient.

The proposal of the Virtual Physiology Human Institute, which involves 65 institutions from 15 countries, has the big challenge to reach biomedical data integration at individual level. The project started with Discipulus, planning to generate a digital patient, a virtual living version of an individual, in order to simulate his physiology and possibly response to treatment and medical care. This project is going on with Avicenna, a program creating computer simulations to improve clinical trials of drugs, devices and biotechnology products. Italy joined the majority of these projects with the participations of different research institutes.

Europe and Italy through Horizon 2020

E-health is part of EU2020 Strategy and its Innovation Union flagship initiative – the European Innovation Partnership on Active and Healthy Ageing.  The main objectives of Horizon 2020 programs of e-health will be the introduction of tele-medicine and homecare systems and services; the adoption of integrated regional/national health information networks and distributed electronic health record systems, and associated services; the usage of systems for health education and health promotion of patients/citizens; and finally the implementation of specialised systems for  researchers and public health data collection and analysis.

On April 2014 was launched a consultation on mobile health (mHealth) to put the patient in control, and to reach a more efficient healthcare system. Since 100,000 health apps are already available and, by 2017, 3.4 billion people worldwide will own a smartphone, mHealth could save €99 billion in healthcare costs in the EU. And to get the maximum benefits some questions are still to be addressed.

The Action Plan of Horizon 2020 has already included a budget of €330 million for personalising health and care and the proposal will closed on October 2014. Another call, with the deadline on April 2015,  has been launched with a budget of €162 millions. A program entirely dedicated to old-age support is “Ambient Assisted Living Joint Programme”, with the closure-day for application on the end of June 2014.

But the European's proposed research and innovation funding programme Horizon 2020 includes more than €8 billion in support of research and deployment in the area of health, demographic change and well-being. Over the period 2014-2020, this will mean opportunities for businesses, to get involved in areas as diverse as personalised medicine, advanced analytics, mobile technologies and apps.

altri articoli

Le notizie di scienza della settimana #104

Il biologo molecolare russo Denis Rebrikov ha dichiarato che ha intenzione di impiantare nell'utero di una donna embrioni geneticamente modificati con la tecnica CRIPSR entro la fine dell'anno. L'obiettivo sarebbe quello di prevenire che la madre, colpita da una forma di HIV resistente ai farmaci antiretrovirali, trasmetta il virus ai propri figli. Per farlo, Rebrikov userebbe la tecnica CRISPR-Cas9 per disattivare il gene CCR5, in modo simile a quanto fatto dallo scienziato cinese He Jiankui che lo scorso novembre aveva annunciato di essere stato il primo a far nascere una coppia di gemelle con questo procedimento (He voleva però evitare la trasmissione del virus dell'HIV dal padre alle figlie). La legislazione russa proibisce l'editing del genoma umano in senso generale, ma la legge sulla fertilizzazione in vitro non vi fa esplicito riferimento, e dunque Rebrikov potrebbe trovarsi di fronte un vuoto normativo che conta di colmare chiedendo l'autorizzazione di una serie di agenzie governative, a partire dal Ministero della salute. Scienziati ed esperti di bioetica si dicono preoccupati. La tecnologia non è ancora matura, motivo per cui qualche mese fa un gruppo di importanti ricercatori del campo avevano chiesto di mettere a punto una moratoria sul suo utilizzo in embrioni destinati all'impianto in utero. Non è chiaro poi se i rischi superino i benefici. In primo luogo, la disattivazione del gene CCR5 protegge dalla trasmissione del virus dell'HIV nel 90% dei casi. In secondo luogo, il rischio di mutazioni off-target e on-target indesiderate è ancora molto alto. Rebrikov sostiene che la sua tecnica ne riduca drasticamente la frequenza, ma finora non ha pubblicato alcuno studio scientifico che lo dimostri. Nell'immagine: lo sviluppo di embrioni umani geneticamente modificati con la tecnica CRISPR per correggere una mutazione responsabile della cardiomiopatia ipertrofica (lo studio, condotto nel laboratorio di Shoukhrat Mitalipov presso la Oregon Science and Health University di Portland, risale al 2017 ed è stato pubblicato su Nature). Credit: Oregon Science and Health University. Licenza: OHSU photos usage

Dove finisce la plastica dei ricchi?

Ogni anno gli Stati Uniti producono 34,5 milioni di tonnellate di rifiuti di plastica. 1 milione di tonnellate vengono spedite fuori dal continente. Fino a qualche anno fa la maggior parte veniva spedita in Cina e Hong Kong, ma nel 2017 la Cina ha chiuso le porte a questo tipo di importazioni, autorizzando solo l'arrivo della plastica più pulita e dunque più facile da riciclare.