If you’ve been thinking about the problems that the Spanish healthcare is struggling with and how the telemedicine market looks like in Spain, I invite you to read our interview with Karina Ojanguren Carreira, Medical Director at Humana Digital Health.

You are from Spain, from your point of view what are the biggest challenges in Spanish healthcare?

It will not be easy for Spain to care for one of the highest rates of aging and chronicity in the world, nor the trend that confirms that 74.45% of deaths in my country are due to chronic diseases. We can appreciate a growth in obesity in adults and children, more diabetes, cardiovascular and oncological diseases, senile dementia and Alzheimer’s. This situation makes us face a change in our healthcare paradigm. We are facing more chronic diseases and a profound change in our care model to face population aging, less support relatives, increase of waiting lists in public health systems, etc. If we focus on financing, it is foreseen that the healthcare budget will have to increase by 45% until 2020, which does not seem possible or viable, therefore, the needs of chronic patients will not be met. I must point out that Spain has internalized a change in attention to chronicity, a transformation which is not only clinical, but also political and directive.

The current problem is not only the magnitude of the challenge but also facing the transformation of healthcare, a transformation that has already begun in other businesses, or activity sectors; there are processes of change driven by the evolution of technology and hyper-connectivity. We must respond to our users’ changes in habits and demands.
The needs and demands of our Health consumers also change, they want to have more and more information, and most importantly, choice.

In this Digital Age, we are no longer mere spectators, our role is clearly active, we create content, and with it the ability to influence others. In our sector, scientific and technological advances are incorporated quickly and progressively in the care activity, improving from diagnostic tests to surgeries, making medicine more and more personalized.

The future of Medicine lies in the four P’s: health promotion, prevention, personalization and predictability.
Hospitals must change, we must understand that the largest hospital in the world is in the home of our users, we must work outside the borders that have been common to us until now. At the hospitals of the future, health personnel will work side by side with engineers, bio-computer scientists or new specialities such as genomic medicine, pharmacogenomics and predictive medicine, which, together with AI, will help us differentiate between healthy subjects and subjects with the potential to become ill.

What areas of digital health are you passionate about?

Eight years ago, an insurance company asked me to work and find solutions to care for advanced chronic patients at home. We worked on processes and protocols that enabled us to assist more than 1000 patients at home, giving them a quality, accessible and personalized assistance. Three years later, we created our first technological solution, an interactive clinical history, which allows all healthcare professionals to be interconnected and guarantee real-time answers. This first technological milestone allowed us to improve qualitatively, to be able to control over 200 patients throughout the island of Mallorca with only 15 people. This first solution made it clear to us that technology was not the purpose, it was the means.

This path led us, a year and a half ago, to work and create, Rosa, our virtual nurse. Rosa is a chatbot which is connected to AI, she has the ability to classify or stratify patients and once she does so, she supervises, personalizes and advises about their illness and medication and improves the accessibility to the healthcare professionals. She is also able to guarantee a connection with the responsible doctor if she does not know how to continue or has a demand from a patient or carer.

Currently, we are working under the concept of omnichannel. This is a strategy that integrates all the channels that intervene in the relationship between a citizen and his health system, generating a coherent message, and diluting the boundaries between the digital and the physical. This implies an integral transformation, connecting professionals, citizens, insurers, hospitals, with the purpose of promoting new relationship models based on technology. Today my passion and that of my team is to work on a solution that guarantees the integral treatment of the patient’s entire healthcare process, starting with the provision of devices and including the provision of a highly qualified technical team, a remote monitoring model. We are improving our support centre or Humana Brain, in order to reduce the administrative tasks of the clinical staff, and obtain a fully trained healthcare team. I cannot forget that a lot of our work will be based on AI; our concept is opening. Information will become a shared resource for the entire organization, who will make it available to its professionals and patients, so that the assistance is holistic and personalized.

Telemedicine and virtual care are becoming major topics for insurance companies across the Europe. From my observations, companies stopped carrying about cost-saving innovations. Insurers started to take care of patients and the quality of healthcare they are providing. Healthcare is becoming more patient-centred than ever before. Can you agree with me?

I agree with you, insurance companies are now managing patients, no longer clients. In Spain, although slowly, we started to travel this road some time ago. The main insurers have understood that, in this digital and technological society, citizens are increasingly demanding and informed. Loyalty is a challenge and it is obtained by working on operational efficiency and the quality perception of the service.

You have mentioned your project – ROSA. Rosa is health virtual assistant with the simple mission: to improve people with chronic diseases life’s. Can you tell something more about ROSA?

Our mission is to improve chronic patients’ care quality, change the usual care channels, such as going to the emergency room or being hospitalized at any avoidable aggravation. We want to complement the traditional healthcare structures, with a new virtual care centre, where Rosa, our nurse, is and will be the main tool, helping in prevention processes and health promotion, diagnosis, and monitoring, without requiring physical presence. Currently, we are working on an integrative platform. We know that there will be future Rosas, in triage or in appointments, for example.

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How hospitals and insurance companies in Spain use telemedicine?

Currently, there are some endeavours in Spain, there are communities that, in recent years, have been working very seriously to find solutions associated with telemedicine, like the Basque Andalusian or Catalan Communities. As for private insurance, Digital Doctor DKV or Blua Sanitas. But there is not yet a strong or determined movement to guarantee a profound change. We must change, we must face a change that is already before us, the users must carry the service in their pocket. In the health sector the revolution is to introduce the doctor into your pocket, a doctor who works as a preventivist and as a specialist. And, above all, to build different platforms that allow the improvement of connections and make it possible to sustain the relationship models among all stakeholders.

The world is changing faster than we can predict, but what areas of digital health will be on the top in 5 years time? If you can predict, what it will be? Blockchain, AI or something else will be a game changer in healthcare?

Yes, everything is changing in a fierce way. I opt for AI, which has progressed a lot in recent years. Its development is the logical consequence of the optimal exploitation of data, the digitalization of clinical histories, the inclusion of genomics in the assistance field or the incorporation of real-time data from IoT devices and medical devices. Smart Data, the in-depth exploitation of data will make it possible to customize the demand and supply of health as a long-term business model.

Internet of Medical Things: Our life will soon be invaded by a network of sensors and devices ready to capture, identify and measure data, which will later be analysed through intelligent technologies. They will be used to stratify risks, make real-time decisions: On Body, in Home, Community, Clinic or Hospital. All those advances will lead us to reduce unnecessary actions and provide our patients with information and, especially, Control when making decisions. This will help us achieve interoperability, connect medical devices with the healthcare environment, and at the same time integrate the interaction with the user.
I believe that there is one thing still pending: to be able to incorporate the healthcare environment into the whole package. With this, we will be able to empower the patient through the routine information provided by wellness devices and other more advanced devices, such as Smart Pills or other sensors.

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