Digital Transformation of Healthcare

COVID-19 presented the world with a crisis that went beyond a mere health issue, leading to significant economic, social, political, and societal upheavals, the effects of which will resonate in the coming years.

We lost many lives. It is expected that by the beginning of 2021, the global death toll from COVID-19 will exceed 2 million. Hope for resolving the problem comes with the ongoing mass vaccinations in the United States and Europe. It is time to accept that we have been viewing the problem too narrowly, primarily in terms of the infectious disease itself. It is time to view healthcare and the health sector as a whole and in connection with all other aspects of our lives.

COVID-19 demonstrated to the world that there cannot be a successful economy without good healthcare. The only way to successfully combat such threats is by improving the long-term resilience and effectiveness of our health systems. The need for new health technologies and the development of innovations to ensure the collection and use of data for informed decision-making has become evident. The crisis has accelerated the processes of digital transformation in the health sector, characterized by its over-regulation and conservatism.  

Why did the healthcare sector emerge as key to global economic development?

 When we talk about healthcare and the economy, one of the most frequently used words is “cost,” and some analysts even go as far as to call it a “burden.” The COVID-19 crisis convinced everyone that healthcare is an essential asset for every nation and is key to the national security of every country. The need for healthcare led to the development of an economic sector on a global scale, one that is becoming increasingly clearly defined and significant in the broader economic landscape.

The healthcare sector includes numerous economic activities related to the provision of healthcare services, the development, production, and implementation of health technologies, as well as health insurance and coverage—essentially, economic activities that provide and facilitate the delivery of healthcare to citizens.   The healthcare sector is one of the largest and most complex sectors in the EU economy, engaging nearly 10% of the total workforce. The main drivers of growth, development, and progress in the healthcare sector are:

• Research and scientific activity
• The creation and implementation of effective health technologies
• The higher education system

COVID-19 also highlighted another key component in the healthcare sector: digital healthcare. There has been talk of the digital transformation of healthcare. It became evident that digital health solutions save lives and improve the effectiveness of public health protection measures, not only during a crisis. In recent years, more and more analysts have emphasized the benefits of investments in digital healthcare, particularly in improving access to healthcare and increasing the quality and efficiency of overall healthcare services.  

What are the main directions for the effective digital transformation of healthcare? How do they fit into the overall development of the healthcare sector? Where does Bulgaria stand in the bigger picture?

Pressure on both public and private budgets is increasing due to the growing health needs of the population on one hand and the rapid development of new health technologies on the other. This requires financial resources to be used as efficiently as possible, which in turn drives technological trends such as digitalization and automation. There is a growing demand for integrated solutions that cover all the healthcare needs of citizens and the entire patient journey within the healthcare system: health promotion, disease prevention, precise diagnosis, outpatient care, inpatient care, rehabilitation, and long-term care.

The healthcare paradigm is rapidly changing, with increasing emphasis on effective public health protection and the extension and maintenance of a high quality of life for patients. These natural processes are supported by various digital solutions that add value to medical services, allow for optimization of costs and time, create the conditions for better control and traceability of all healthcare processes and outcomes. In this way, the regional imbalance in healthcare begins to find a solution through remote monitoring and mobile communication solutions, which have rapidly developed during the COVID-19 pandemic. The home has gained greater importance for long-term healthcare, becoming an alternative for effective medical mentoring, diagnosis, and treatment.   According to Radoy Pavlov, Enterprise Technology Architect at one of Switzerland’s largest health institutions, the University Hospital of Zurich, for all this to be possible, “healthcare must become increasingly integrated, preventive, predictive, outpatient, transparent, and managed with the help of digitalized data.” 

In Bulgaria, the digitalization of healthcare lags behind other European countries. Unfortunately, the Ministry of Health’s project for a National Health Information System, which had been prepared and announced as a public tender, did not materialize. Some elements, such as the electronic prescription and electronic referral, were introduced at the end of 2020, and their effects on the system are yet to be seen. Dr. Ivan Madjarov, President of the Bulgarian Medical Association, announced a large-scale project for the digital transformation of the professional organization. The foundation of this project is the digitalization of the register of the BMA and the creation of a working ecosystem for doctors that will improve and optimize their daily work, allow for the inclusion of various digital health solutions they use, including telemedicine solutions.

This register is technologically developed in such a way that it allows for its integration with the future unified national health information system.   The digital transformation of healthcare occurs within a complex legal framework of various interconnected regulations. The experience of other countries shows that the necessary legislative changes may take between 2 and 5 years. A key aspect of these legislative changes, according to lawyer Petya Murgova, is to provide incentives for participants in the digital transformation process so that it can be accelerated as much as possible.

What is the role of medical data in the digital transformation of healthcare?

The new currency in the healthcare sector is data, or clinical information. The main source of medical data in the healthcare system is the electronic health record. In late 2019, interesting data was published from a study among doctors in the U.S., who rated the functionality of the electronic health record compared to other technologies in their daily lives with 45 out of 100 possible points, while giving Google 93, the microwave 87, and Microsoft Excel 57… Another study by Stanford Medical University showed that 59% of surveyed medical professionals believe the electronic health record needs a complete overhaul, and 54% report that using the electronic health record distracts them from their clinical work.

Only 8% of the respondents see a clinical benefit from using the electronic health record.   The findings suggest that in many countries worldwide, the role of medical data is underestimated, and they are not used sufficiently to support the clinical work of healthcare professionals. Another problem that countries face when discussing data is its protection and proper storage. Digital security is one of the most important aspects when working with clinical information.

According to experts in the field, due to the high granularity of the information and its storage in various repositories within healthcare structures, it becomes highly vulnerable to cyberattacks. For this reason, a unified approach to the collection and storage of data in a state central repository is crucial, where all the necessary security tools can be applied more effectively and efficiently.

What is happening in Bulgaria?

Oncology is one of the medical specialties that generates massive amounts of data related to laboratory, genetic, pathological, radiological investigations, and various complex therapeutic procedures on the patient’s journey through cancer treatment. Dr. Radoslav Mangaldzhiev, Head of the Medical Oncology Department at the Specialized Oncology Hospital in Sofia, shares that the vacuum left by the lack of a functioning cancer registry in Bulgaria in recent years is being filled by the National Council on Pricing and Reimbursement, which, with the help of IT companies, collects and analyzes anonymized and aggregated data from all oncology hospitals.

This data is used to track the effects of innovative therapies. This is an important step toward standardizing the work of oncology centers and improving the quality of care for cancer patients.  

Cardiovascular diseases are the leading cause of mortality in Bulgaria. Prevention is key to improving this negative statistic. According to Prof. Ivo Petrov, Medical Director and Head of the Cardiology and Angiology Clinic at the University Hospital Acibadem City Clinic, effective prevention programs in cardiology can only be implemented if they are based on digitalized data, which can be used for informed health decisions for patients. Specific steps in five university hospitals give hope that it is possible to collect, process, and analyze large data sets in cardiology to address significant public health issues.

What is the need for new skills among medical professionals?

The COVID-19 crisis highlighted the need for new skills among healthcare professionals. Skills such as critical thinking, innovation, leadership, problem-solving, and digital skills are proving to be extremely important in the healthcare sector. The demand is evident—73% of students and 47% of doctors are actively seeking additional training and courses to be better prepared for the innovations rapidly entering the healthcare sector. Driven by these needs, for the second consecutive year, the Medical Faculty of Sofia Medical University is organizing an elective course “Innovation and Entrepreneurship in Medicine” with the support of JA Bulgaria, Novartis, and the Bulgarian Cluster for Digital Health Solutions and Innovations.

Dr. Alexander Simidchiev, Head of the Non-Invasive Diagnostics Department at the Ministry of Interior’s Medical Institute, created a web-based course on “Digital Medicine” at Plovdiv Medical University three years ago. An honorary member of the Bulgarian Cluster for Digital Health Solutions and Innovations, he works on several initiatives supporting digital healthcare in Bulgaria, as well as startup companies in the same field.  

JA Bulgaria, with the support of Novartis, has launched the pre-accelerator program Beyond, with a particular focus on healthcare. The aim of the program is to develop ideas from students across various universities, working in teams, into prototypes and potentially even startups. Milena Stoycheva, the manager of JA Bulgaria, shared that “the first semester of Beyond demonstrated that the model works. WHISP Health is the healthcare startup born in our pre-accelerator. The Beyond model has also started its development in Central and Eastern Europe with pilot projects in several other countries.”

Such initiatives support the development of medical education in Bulgaria, as the number of medical students has nearly doubled, from about 6,000 in 2013 to nearly 12,500 in 2020.

In recent decades, we have witnessed tremendous technological progress in all areas of public life. In terms of healthcare, we have also seen a huge leap, especially in recent years. Countries are striving to achieve effective, sustainable healthcare systems based on data and technology that place citizens and their needs at the center. However, healthcare, as a complex socio-economic sector, is characterized by fragmented and disconnected activities and processes within the healthcare structures. It has been shown that this challenge can be overcome by fully utilizing new technologies and innovations, the development tools for which entrepreneurs in the sector have access.

This is why a growing approach to competing in the rapidly developing technological environment is the creation of entrepreneurial ecosystems—structures that support the technological development of sectors in countries. Over the past two years, Bulgaria has successfully established and developed such a digital health ecosystem that encourages collaboration among all stakeholders in the healthcare sector. It creates more awareness of digital solutions and their benefits, supports their development and integration into various healthcare structures, thereby forming a new value chain in healthcare.

The ultimate goal, according to Mira Ganova, Director of the Bulgarian Cluster for Digital Solutions and Innovations in Healthcare, should be the formation of a unified policy to support the digital health and innovation ecosystem in Bulgaria, in order to accelerate the creation of various digital health solutions and innovations along the patient’s journey in Bulgaria. This way, the state will be able to fully benefit from the added value of new technologies and create an effective and sustainable healthcare model that meets the needs of all stakeholders in the field.