Digital Health: Transformation and Innovation in Healthcare with WHO | CxOTalk #364

We’re exploring digital health, the digital
transformation of healthcare with a senior leader of the World Health Organization. Bernardo Mariano is Chief Information Officer
and Director of Digital Health and Innovation at WHO. The World Health Organization, which I will
refer to as WHO, is a 194-member-state organization with over 150 offices around the world. Our main strategic targets for the next 4
years, up until 2023, are centered around what we call the triple billion target. The triple billion target basically is the
aspiration and our strategy to make sure that, by 2023, one billion more people enjoy better
health coverage and health services; one billion more people enjoy better health emergencies
and one billion more people have better health and wellbeing. Around this triple billion target, there are
46 outcomes, result outcomes that drive the work of the organization. What is your role? My role as a chief information officer and
director for digital health and innovation is really to ensure that the digital WHO supports
the digital transformation, the digital healthcare transformation, to ensure that as the world
goes digital and healthcare goes digital, the quality of healthcare deliverables, the
quality of health services, the expansion, the accessibility of health services is enhanced. The achievements of our sustainable development
goals by 2030 are accelerated with the digital transformation, so my role is to cut across
all areas of WHO and within the triple billion targets to make sure that digital health and
digital transformation accelerate the achievement of the triple billion targets but also of
the sustainable development goals. How does digital health achieve these goals
or support the achievement of these goals? The digital healthcare sector is quite behind
compared to other sectors that have gone already to digital transformation. We have some that have gone smoothly, but
also we have some that have gone through that transformation with some unintended consequences. As a normative agency and a scientific organization,
we want to make sure that the global issues such as interoperability, the health data
regulations, how AI is used to offer technologies, how we ensure that, as the world goes and
transforms into this digital ecosystem, all the gains that we achieved on elimination
of diseases, all the gains that we want to achieve to eliminate the existing diseases,
we do it better, we achieve it quicker, and we really meet our targets, the triple billion
target, but also this SDG targets. One of the key issues is this notion of partnership
and ecosystem. When we talk about the digital transformation
of healthcare, there are now many parties that are involved. I know that this is something that you’ve
given quite a bit of thought to. Partnership is key because the ecosystem is
composed of companies, people, government, things that are connected through a platform
to share an outcome. If these different parts of an ecosystem—be
it infrastructure, be it regulation, be it the people—are not connected, then they
are not delivering the best in that particular area of the ecosystem they are responsible
for. Then we will have not so good outcomes. We might have, actually, unintended consequences. I could give you an example of an ecosystem
that somehow was created to bring benefit, but we had a negative, unintended consequence. For instance, the reappearance of measles
in countries that the measles was already eliminated. The antivaccine movement used platforms such
as Facebook, Google, and Amazon, the tech giants, to really campaign against vaccines,
which resulted in the reappearance of measles in countries that had eliminated it. An unintended consequence of the ecosystem,
if the ecosystem’s different entities of the ecosystem do not work together, then we will
have problems. Therefore, in my view, I think if we don’t
look at the digital health through a whole ecosystem and the partnership of the players
of that ecosystem is not addressed correctly, we will not achieve the gains or the promises
of the gains such as AI, blockchain, precision medicine, or even genomics can bring. We really need the best partnership to look
at all angles of the ecosystem. Bernardo, you’ve just raised two distinct
issues. Number one is technology. You mentioned AI, machine learning, and blockchain. At the same time, you’ve just been describing,
could we say, what are really social dimensions, these dimensions of use of social media, sharing
information, and the use of these ecosystem platform companies who are not healthcare
providers but they are playing this crucial role. We see the two sectors, the tech giant or
the technology sector and the life sciences and pharmaceuticals coming together. Those two sectors have different cultures. The tech giants, the technology is a culture
of fast-paced, minimal viable product delivered. The life science and pharmaceuticals are highly
regulated because they do no harm, ensure tests, and tests and trials. By having these two industries coming together,
it’s important that the quality of the healthcare delivered is not affected. It’s important that the positive health outcome
is enhanced. It’s important that the costs of healthcare
are reduced because the global problems right now that we have include half of the world
population that has no access to healthcare. It includes 100 million people per year that
go out of pocket because of health expenses. We want digital health and the transformation
of digital health to ensure that the global issues that we are facing today, the challenges
we have are addressed by the support of the technology. Therefore, organizations such as WHO, we are
there to really strive to make sure that we find that TechQuilibrium between tradition
and technology, digital transformation, to achieve the positive health outcomes, to really
get the best out of technology, to really deliver the best value for healthcare. Health is important for all of us. How do we accomplish this goal and align the
interests? When you have any type of ecosystem such as
you’re describing, there must be some harmony among those ecosystem partners and the incentives. As you said, medical professionals have the
goal of health and wellness, whereas platform companies have the goal of profitmaking. This seems like a tough bridge to overcome,
or am I not correct in that? It is. Today, I donate blood. People donate organs. As we go in the life science and healthcare
sector, contribution to the global health is enshrined in the culture of the health
sector. We have the tech giants that monetize on data:
Google, Amazon, Facebook, and the others. How can we strike the right balance to ensure
that, as data is seen as the new blood and is monetized by some while the academia needs
research data to really bring about evidence of some of the gains that we need to make
in some of the rare diseases? A right balance is important? When I go to a conference where most government
officials are there and they say, “Data should be demonetized,” and everybody raises their
hands and say, “Yes.” If I go to the private sector meeting and
say, “Data should be demonetized,” they look at me as, where am I coming from? We need to strike the balance between demonetization
of data for research and monetization of data to ensure that we have an equitable share
of that monetization. Currently, platform owners own and they basically
take the biggest share. Now, to do that, we need to bring some sort
of international standards on data regulations to ensure that, as we monetize the health
data, we ensure that it also helps reduce health costs or health insurance costs of
the people that will donate or will give data that is monetized. We should not shy away and leave the principle
of free data or free data flows for research to achieve health gains is important. We should not shy away from that. We need to strike the right balance. It’s not an easy balance but, to do that,
the partnership within the sectors is important. What’s the role of WHO, the World Health Organization,
in helping bring these multiple parties together to strike this balance and align the incentives
so that the ultimate benefactor is positive health outcomes? We have a convening power to bring different
stakeholders with different interests to the table to try to achieve that balance, no matter
how difficult the balance is to achieve. To achieve the balance, to ensure that the
interests of the different stakeholders are taken into consideration as we develop tools,
systems, and solutions that improve health, improve health coverage, and improve healthcare
services. The power, the convening power of WHO is something
that we believe all sectors should leverage and we are very much aware of and our member
states actually ask us to ensure some of the key issues such as interoperability, such
as minimum health records or minimum patient health records, as well as other issues around
genomics and the ethical issues. Those are some very difficult issues that
if we just leave them unattended, unintended consequences on health will make us move backward
in time of the diseases that we already tackled. We do have a question from Twitter. Arsalan Khan is asking. He says that digital transformation requires
process optimization first and then technology implementation second. How does WHO look at these two things, the
processes and then the implementation of technology? In addition to processes and technology, we
have people. The tech giants are currently reaching the
consumer base; basically, reaching the people. The processes that the technology, the companies
use is basically minimal viable product and adoption by user. On the other hand, if the World Health Organization
does not operate in that space and we continue to say, “Look, we will just provide our guidelines,
the recommendations, and normative standards for policymakers,” we will miss a large set
of population. In the end, between technology and processes,
we have a person at the end of the line. We have somebody who is worried about their
health and wellbeing. We have somebody that has health issues. We want to make sure that process, technology,
and people strike the right balance to achieve the wellbeing or to achieve a better diagnosis,
to achieve that better outcome, health outcome, and to make sure that we also don’t contribute
to the digital divide because, after all, 49% of the world is still not connected to
broadband. We do have also the responsibility to ensure
that the gains of technology, processes, and people do not just benefit 51% of the world
population. It should benefit 100% of the world population. In that ecosystem of digital health—between
process, technologies, and people—we also have to think about the other side of the
world that is still not connected. We have another question from Twitter, a very
interesting question. Kanupriya Agarwal asks, “What is the role
of academia, do you see, in moving forward with the intersection of public/private partnerships,
especially when real-world evidence is needed, is required?” The role of academia, which is very keen,
the partnership model that is required for digital health should involve the private
sector, academia, and the public sector. These three sectors normally don’t operate
in the same ecosystem. I have to say, WHO and the UN, we always say
the private sector has a conflict of interest. I’m sure the private sector says the UN doesn’t
move at a pace that they move. Academia is an interesting player to really
glue these two sectors, but also to bring this, to pilot some of the concepts, to accelerate
some innovation, to also operate in this space where evidence is not there. If you ask for evidence of AI for health today,
we don’t have scientific evidence to say AI will change the way and will improve, will
largely impact the healthcare ecosystem. We also have to make sure that we navigate
across this hype that AI, for instance, has. The word itself, “artificial intelligence,”
is a hype. Academia, with the scientific knowledge and
the research, has a very, very important role to strike the balance between the public sector
reservation in relation to the interest of the private sector and the private sector
reservation in relation to the public sector slowing down innovation to really bring the
right balance to achieve those positive health outcomes. What about the role of government in terms
of supporting healthcare innovation, as well as the availability, the broader availability
of healthcare? In the innovation space, there are three areas,
at least within the World Health Organization, that we are operating. One is, of course, the innovation internally. These two areas that are very important and
one of them is more important than the other. One is the incubation, right? The private sector and then a number of multinational
and intergovernmental organizations plus NGOs are operating in incubation spaces for innovation. From our perspective, we want to make sure
that if an innovation happens in Timbuktu in Mali, that innovation can actually have
the opportunity to scale up; scaling up innovation for impact, especially health impact, that’s
where we want and we should put a lot of emphasis, at least from the global perspective, to ensure
that if this innovation will address tuberculosis or resistance, antimicrobial resistance – we
have a lot of examples on HIV AIDs. We need to join partnerships with both private
sector academia and public sector governments, as well as UN agencies, to drive the scaling
up of that innovation to make sure that the impact of that innovation that can save lives
is accelerated. The role of WHO in this, as you said earlier,
is in the ability, having the ability to convene multiple groups would not otherwise be so
willing to come together. Exactly. Then ensure that, for instance, governments
and private sector academia, as those innovations take place, are tested, or go into trial and
prototypes, the issues that we need to address, they are addressed at an early stage. We don’t have an afterthought that, oh, these
products or these innovations were supposed to improve health or improve diagnosis or
improve management of aging. Then in the end, actually, it’s harming people. We want to strike the right balance. We can bring regulators, government agencies,
private sector academia to really look at the different angles and bring the best out
of each of these entities to ensure that the end product is one that delivers the good
and positive health outcome. Let’s come back to this topic of data, which
is so complex because, on the one hand, you have data as the source for machine learning
and various techniques to uncover, and patterns that can teach us a variety of different things
that will help improve health outcomes. At the same time, we have these various ethical
considerations such as the ownership of that data. How do we start to navigate this data confusion? That’s where the role of the World Health
Organization is key to ensure that we bring about some sort of international regulation
on health data. The European Union has the GDPR that protects
privacy. Each country has their own national privacy
laws to protect their citizens’ data. More countries are actually bringing laws
that forbid the cloud providers to take, for instance, data to the cloud. There are a number of examples of countries
that health or national data, by regulation, should not leave national borders. As these different interests and different
perspectives come into play, and with the power of machine learning and artificial intelligence
to really lean on big data to address some of the critical diagnoses or treatment of
diseases, we want to strike that balance to ensure that privacy, ethical consideration
is addressed to allow data sharing or sharing of data for global good to deliver those positive
health outcomes, to deliver these gains, the acceleration to address diseases that otherwise
we are challenged to address because of remote areas or to really bring primary healthcare
or take primary healthcare to the next level because of digitalization. The health data regulation is key and this
is enshrined in our global strategy that is going to approval to our member states in
May. We want to ensure that, as we go and get the
approval from our 194 member states on this global digital health strategy, one of the
deliverables of that strategy is international health data regulation to exactly address
the issues we just talked about. We have another question from Twitter. Again, this is from Kanupriya Agarwal. It relates to trust. How do you see the public’s role of trust
in these digital health technologies evolving over time? Trust seems to be a key part of this. Without that, the potential of digital health,
we will not unleash the full potential. Some gains can be made, but the full potential
will not be unleashed. The trust comes not by incidents such as data
leakages or others that we see happening. A people-centric approach and involvement
of people at the earliest stage or at every stage are creating the capacity for dynamic
consent. For instance, I think the European Union is
leading on that, meaning that today I want to share my data for research and tomorrow
I don’t want to share my data. I should have the capacity to have dynamic
consent. Today, the consent is done in a way that I
give consent and the consent is given for almost for life, kind of, in some respects. I think we need to move now from a blank consent
to a dynamic consent. That requires technology and processes to
be aligned. One of the consequences of such a technology
and process being aligned to a dynamic concept, it will start to bring about the trust because
if I can trust that my data is safe and I have the power to give consent and not, to
revoke it, I think that’s where the ecosystem needs to move towards. Similar to today when I decided that I wanted
to go and donate blood because I feel like it is part of my gesture as a global citizen
is to donate blood to a blood bank, and tomorrow I don’t want to do that, I have the power
to decide whether I want to do it or not. That dynamic consent is important and the
platform providers, the technology, and the processes around it have to be enforced to
ensure that that happens. That’s the only way to start building trust
in the system. The trust is key. What I find fascinating about this, if we
think historically, healthcare advancement was about basic research, research into vaccines,
antibiotics, and scientific research in the lab. Today, so much of healthcare research relies
on data and, therefore, the set of issues around data privacy, security, consent, as
you were just describing, is an almost equal partner as research in the lab. Is my point of view a naïve point of view
that consent is almost an equal footing here? You are right with all the trials and the
consent for trials in the lab because the technology, the digital technology is not
just about supporting healthcare providers, but all healthcare practitioners. It’s also supporting, accelerating the research. It will change the way companies, especially
life science, do clinical trials and then assess the impact of those clinical trials
and then report on them. As we think about AI, how can we ensure that
the AI that used data from one country and is sold in a different country or in a different
part of the content, how can we ensure that that correlation or the local context is taken
into consideration in that process? Data is an equal partner. Trust, it’s important. Research, without data, today, will not deliver
the results that we need. Therefore, at the World Health Assembly, we
have established a science division with a research for health and digital health in
part of the science division in addition to normative standards to really address and
be at the forefront of these important topics, both digital health but as well as the research
for health. There must be examples of positive cooperation. The reason I’m asking is because I work with
many different technology companies and, in Silicon Valley, despite what we may say, the
profit motive is king. Harnessing these companies to relinquish data
or protect data in ways that interfere with profit-making seems an almost impossible task. Not really because we are exploring partnership
with some of the tech giants for them to relinquish data for research; depersonalize data to make
sure that we can achieve some of the gains that depersonalized data can provide for research
– some of the insights. It’s true that there are some companies that
are holding their data too close to their chest because they want to monetize it. It’s true that that is happening, but some
of the tech giants, they realize that free data can actually, one, address some of the
key global challenges, but also create even new business avenues. Think about the geo-positioning data. Satellites were launched and we have a GPS
geo-positioning all over the world. It creates new insights. It creates new business. The fact that some of these depersonalized
data for research are not made available to researchers actually might hinder those companies
to actually find new business models. From our discussion with some of the companies
in Silicon Valley—I was there a month ago with a number of my colleagues—they realize
that, yes, we have to partner to ensure that data for research is freely available. Changing business models become a very important
part of this overall digital health landscape as well. Yes, you cannot bring the physical ecosystem
rules and procedures into the digital ecosystem because they don’t work. Just to give you an example, we recently classified
a gaming disorder as a disease. It is now part of the international classification
of diseases, ICD-11. In that classification, a gaming disorder
as a disease happens in the digital ecosystem today. We’re not talking about kids that go and play
in the garden with their friends. We’re talking about kids that spend hours
in the digital ecosystem playing games in that ecosystem. To ensure that we deal with that issue, we
need to operate in the ecosystem itself and not outside. We shouldn’t wait until the gamers get to
the point of classifying that that gaming is a gaming disorder to say, “Look. Now go to the hospital to get treated.” We have to start right inside that gaming
ecosystem, so the digital ecosystem. As part of our strategy, we have one of the
outcomes or one of the products we want to have is guidance on virtual hospitals because
a virtual hospital is about having hospitals in the digital ecosystem. Today, that might sound like science fiction,
but that’s what the world is moving towards in the way that the digital therapeutics or
software apps can manage diseases, but also diseases that need to be managed from the
digital ecosystem before you even reach the hospital. This coming together of partnerships, ecosystems,
data, and new techniques such as machine learning, could we say that’s the foundation, together
with new business models? Is that the foundation of digital health and
digital transformation of the healthcare system, I guess would be the right term? Yes. In addition to that, the academy has to also
change. Medical doctor curriculum has a very small
percentage of the technology inside. Yet, we are moving to a digital ecosystem
where a medical doctor is not just about the interaction between the professional, be it
a nurse or a doctor, with a patient. It’s also the interface with machine learning,
with technology, robotics, and augmented reality. All that needs to be factored into an ecosystem. The literacy is key. You can have the best product, well tested,
but if the literacy is not there, the gains of that will not be realized. The academia has also a role to rethink and
relook at the curriculum of medical doctors at the university, or nurses, or even how
to train midwives to ensure that we really realize the gains and the potential of a digital
health transformation. What about the impact of all of this on healthcare
providers, doctors and nurses maintaining their relevance as we’re going through this
change? If you remember, in the ’80s, there was the
boom of robotics on, I think it was, the transport car industry where there was this perception
that the computers or automation will make people lose jobs. I think, over and over, technology has proved
that, actually, it’s creating jobs. It’s true that the professions have to gain
new skills. Reskilling doctors and repurpose some of the
training of the doctors is key to make sure that we continue to achieve that coverage
that we need, we continue to expand access of healthcare, we continue to actually reduce
the cost. Perhaps, in the future, we’ll have an artificial
intelligence assistant to the doctor, or you will have, perhaps, a triage based on AI in
the hospital that will reduce the queuing. What is important, what we want to see is
that a patient that should go to the secondary, tertiary care does not get stuck into the
primary care. Meaning that if it’s a patient that needs
to see a specialist because he or she has Hepatitis C and live in a very remote village,
she shouldn’t or he shouldn’t be stuck in the primary healthcare to the point where,
when he or she reaches the specialist, the disease has developed beyond the stage that
the person can be saved. Efficiencies in the hospitals, efficiencies
in the healthcare practitioners, efficiencies of doctor/patient interaction have to be looked
into as we move towards that digital transformation of healthcare. Don’t we also run the risk, as we’re attempting
to make healthcare more widely available and more effective with these new digital techniques;
aren’t we running the risk of increasing the digital divide? We will if we don’t bring those low resourced
communities into perspective. I challenge even the concept of low and middle-income
countries because low resource communities exist everywhere, in countries that are high
income, the countries that are middle income, and the countries that are low income. The low resourced communities should not be
forgotten. The issues, the challenges that they have
vis-à-vis access, vis-à-vis cost of healthcare, vis-à-vis health insurance, vis-à-vis aging
should not be underestimated. We need, as we move forward, to ensure that
the inclusion is a key element of the digital health transformation. We need to make sure that accessibility is
a key element of digital health transformation. That’s where we will see gains that will narrow
that digital divide. We will see gains; we will see these low resourced
communities getting great benefits with telehealth, telemedicine, and others. We need also to set regulations that promote
telemedicine to ensure that doctors can be remunerated as they practice telemedicine. We need, perhaps, new certifications on telemedicine
to ensure that a doctor sitting in one country can practice telemedicine to a patient in
another country. Those are some of the rules that we have in
the physical ecosystem where, as a medical professional, I have to be certified by a
national authority in the country where the digital transformation now is challenging
that because a medical professional can be sitting in one country and diagnosing a patient
in another country. What are the rules and regulations and issues? We need to look into that to make sure that
these achieve this universal health coverage, these support the access to health. If a country in Europe has a deficit on nurses,
how can we ensure telemedicine or remote telehealth allows that gap to be narrowed? Yes, there are lots of challenges, but also
there are a lot of opportunities and we just need to strike the right balance to make sure
that we achieve them. Another component of this equation then is
support of these new technologies, new business models, and new innovations by government
policies that make them possible. The role of governments to ensure that the
innovation for health is supported, it’s important. The role of government to ensure that as innovators
and has the private sector accelerates that innovation for health. We need to ensure that the governments and
the public sector are not a part of a roadblock or not part of hampering that innovation. We need to transform within to allow this
transformation to happen. At the World Health Organization, one of our
targets and one of the outcomes is really to promote innovation for health and that’s
what we want to do with a number of partners. We are currently working within and also with
bringing some partnerships. We are preparing also our innovation strategy
to make sure that the innovators that have information for high impact on the healthcare
sector, they have a pathway to scale up. They have a pathway to really realize those
potentials. Yes, it is important. I think it’s important that we also recognize
our own biases, as we talk about innovation and to ensure that innovation is not just
in Silicon Valley, but it’s also in Mozambique. It can be in Mozambique. It can be in Timbuktu in Mali. It can be in Angola. It can be anywhere in this world, and we need
to make sure that, as innovation happens, regardless of the country or location of that
innovator, there’s a pathway to scale up, especially if it’s a good innovation that
really has the high impact. We have another couple of questions from Kanupriya
Agarwal. She’s really on a roll today. Let me ask you these and then I think it’s
going to be time to finish up. Number one, she asks about the funding. What is the evolving role of venture financing
for digital health innovation for the global good? This touches that area of scaling up. Venture capital, development banks have a
key role to scale up or to support innovation scaling up, especially innovation that has
a high impact. At WHO, this is a key element in our strategy
to ensure that health innovation for impact is scaled up; finds a pathway to scale up. Think about the Ebola crisis in West Africa,
DRC, and other countries. There, to achieve or to succeed in managing
that or contain and control the disease, we need innovators. Innovation needed to be very fast to bring
about the vaccine, to bring about the treatment, to enhance care, and to ensure that the patients
and the risks of those diseases are mitigated early enough. That’s a good example of a partnership between
the private sector and public sector academia to really bring about innovation that has
a very good impact on health. The role of venture capital, the role of development
banks, the role of commercial banks to scale up, it’s key. In the role of WHO, within that process is
to contribute or to at least acknowledge those innovations that have a high impact that will
support the achievement or accelerate the achievement of sustainable development goal
number three, health for all, and ensure that health gains are realized through innovation. A very important question and topic. She has another great question. Kanupriya Agarwal, you should be sitting here
in my chair asking these questions. The issues you’re raising are fantastic. She says, “Have we studied and drawn any parallels
from other industries using digital and undergoing digital transformation? What conclusions or lessons could be applied
to healthcare?” We have some good examples of other industries. I think the financial sector is perhaps closely
related to health. One, because it’s highly regulated. Two, privacy and security are key. Three, it impacts everyone in that ecosystem
that uses that. If you roll back 15 years ago, we used to
call it digital banking, digital financing. Today, it’s banks. It’s no longer digital. The digital word disappeared. The digital health that we call it today,
ten years from now I think we’ll just call health because it will be part of the new
normal. We want to do better than the financial sector. We want to do better than any other sector
because it impacts health. At the end of the line, there’s somebody’s
life and somebody’s health at stake. The life or the health, wellbeing of that
person is more important than anything. Therefore, it is key that we do it right. We do it better than the financial sector. We do it better than social media. We do it better than any other sector because
we can’t negotiate health. Health is a human right and we want to make
sure that products, systems, and solutions in digital technology delivers better health
outcomes and not bad ones and do not do harm. We want to make sure that the quality of health
is enhanced, increased, and the coverage is increased as we go through that digital transformation. We have another question from Twitter, again
from Arsalan Khan. You guys are asking great questions. Thank you for that. He is asking, “Are there any examples of countries
that have adopted digital health on a very large, wide-scale? What has the result been?” With the risk of being so undiplomatic, normally
in the U.N., we try not to mention one country because the other countries will think that
they have a better system. Let me perhaps start by saying that the digital
health maturity level needs to be assessed in different countries because the prioritization
of digital health investments should be aligned to the maturity level of the country on digital
health. Some countries are way advanced that perhaps
the challenge is different than the countries that are still quite behind, vis-à-vis electronic
health records, perhaps, and so on and so forth. One country that we all use as an example
is Estonia. If you look at Estonia, digital, how the whole
country moved to e-government and the whole system into a digital ecosystem, including
health, I think it’s an interesting country to look into. We have also countries that are quite advanced
in Europe, in Australia, and other countries that are moving quite, quite, quite, quite
strongly towards that. The one problem that every country has now,
with no exception, is the interoperability of information systems. The interoperability is an issue that no matter
which maturity level the country is on digital health, that issue is a key issue that, at
the World Health Organization, we want to support because it’s a global issue. In this globalized world, without interoperability,
we will not really achieve all the gains that technology or digital health technology could
support. Therefore, yes, while at the national level
and sub-national level we have a number of very good examples in many developed countries,
we still have the issue of interoperability. Kanupriya Agarwal makes the comment. I invited her; she should be the interviewer
today. She says, actually, she’s an elected member
of the WHO digital health roster of experts. Yes, that’s very good. The roster of experts and also the technical
advisory group are a group of experts that we are leaning into as we navigate this journey
of digital transformation to ensure that the expertise that is out there is used for global
good. Thank you for having expressed interest in
the digital health roster, but also the technical advisory group. Bernardo, as we’ve been speaking, we’ve covered
a great many sets of issues. What advice do you have for policymakers to
navigate this very difficult set of challenges and conflicting set of goals among the various
partners and players? I think that policymakers have – I mean
talking to the Minister of Health of Mozambique who is a good childhood friend, one of the
challenges, and a number of them came to ask in a number of meetings that we had, especially
in the last World Health Assembly, is really the prioritization of the investment and sustainability
of that investment. I mentioned to you that the digital health
maturity, I don’t want to call it an index, but the maturity level is important, that
the countries understand what is their maturity level. We can support them on that front. Then create a roadmap on investment priorities
because investment priorities will define how well and how solid is that investment
and how sustainable is that investment. If a country does not have electronic health
records and it goes and implements a system for delivery or even on artificial intelligence,
that investment might actually not yield the benefits that the country is trying to achieve. Depending on the maturity level, the advice
for policymakers is, look at your maturity level. Look at your investment priorities and address
the areas or diseases that are more prevalent in your country where digital health can support. If it’s diabetics, how can digital health
support a reduction and better management of the diabetics? There are one billion people suffering from
uncontrolled hypertension. If hypertension is an issue, how can countries
and how can that particular country look at the digital health technologies to address
that particular disease? Then you start; we also start seeing evidence
of maturity level versus investment priorities and the impact of on the specific diseases
of that country to really have that large impact. Also, we have countries that even have access
issues, so that’s the other. In most countries, primary healthcare is key,
so having digital health to support primary healthcare is another advice that I would
say a country really needs to make sure that is part of their strategy. With a global digital health strategy that
is going to be approved by our member states in May, we want to make sure that we support
countries in that particular journey. But we want to work, and we will work, with
a number of partners that either support these countries or fund these countries to ensure
that the investment priority is aligned to the maturity level and delivers the positive
outcome to ensure that there’s a sustainable model, but also there’s a very high impact
on the health of the population of that country. What advice do you have to healthcare providers,
hospitals, and hospital administrators on managing their own transformation so that
they can keep up? For hospitals and healthcare providers, the
status quo is no longer a possibility, meaning that digitalization or digital transformation
of healthcare providers should be part of a strategy of any hospital. I see, at least in some of the hospitals in
the developed world, that has already taken place. What is even more important is literacy, as
I mentioned before. We want the midwives, nurses, doctors to really
maximize the potential of digital health and, therefore, investment in literacy from hospital
providers or hospitals and healthcare providers is important. The other element that I want to make sure
that the healthcare providers are aware of is, who is going to buy who? Are the tech giants buying healthcare or healthcare
will continue to use technology as they’ve been using before? That has to be very, very close to the mindset
of healthcare providers. If they don’t pay attention, actually, the
tech giants will buy healthcare providers. I think we want to ensure that the delivery
of care and the quality of that delivery does not go down. No matter where that hospital is, be it in
a developing world, in the developed world, the quality has to increase as we digitalize
health, as we go health in the digital ecosystem. At WHO, also we have a drive to digitalize
WHO content, products, and services. That is an internal drive to ensure that the
guidelines, products of WHO, they are available in the digital ecosystem. Hospitals need to ensure that, to look at
the issues such as digital hospitals, issues such as a virtual assistant to medical doctors,
the issues as triage that happens that increases efficiency of queues at hospitals. It is important that the hospitals embrace
the journey and do it ensuring that the quality of healthcare, the real deliverable is not
penalized. Okay. What a very fast and important set of topics
we’ve been discussing. We’ve been speaking with Bernardo Mariano. He is the chief information officer and responsible
for the digital health initiative at the World Health Organization. Bernardo, thank you again for taking your
time to be with us today. My pleasure. Thank you for having me here today. Everybody, thank you for watching. Before you go, please subscribe on YouTube
and hit the subscribe button at the top of our website. We will send you great information about upcoming
shows. Thanks so much. I hope you have a great day and we’ll see
you again. Take care. Bye-bye.

Daniel Yohans

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