Dr. João Breda is the Head of the World Health Organization’s Quality of Care and Patient Safety Office in Athens (Greece).
The theme for World Patient Safety Day 2024, ‘Improving Diagnosis for Patient Safety,’ is a crucial focus area. What challenges and opportunities do you foresee in achieving safer diagnostic processes in a digital health environment?
João Breda: If you look at the WHO Global Patient Safety Action Plan 2021 – 2030, it is obvious what goals and actions member states, nongovernmental organisations, and the WHO itself will have to bring forward.
The action plan explicitly addresses timely diagnosis for patient safety in numerous instances. This is a crucial area of focus for us. The patient safety community worked along with the WHO to identify specific areas in the action plan that require highlighting.
Sometimes, one of the best ways to highlight them is to identify them as the theme for 17th September, which is celebrated yearly as World Patient Safety Day. So, improving diagnosis for patient safety is very important and embedded very clearly in the context of the action plan.
We also look at the data, and we know that diagnostic errors contribute to a significant proportion of patient harm globally. We estimate that this is just below 20%. In fact, diagnostic errors could contribute to a very substantial share of patient harm worldwide that we could prevent. This is often due to challenges in the relationship between the patient and the health professionals and, in many instances, the doctors. It could be related to history taking, examination, test interpretation, and many other things.
This is an area where we can definitely improve patient safety. Diagnostic errors can involve incorrect, delayed, or missed diagnoses or a failure to communicate them to the patient. This topic is central to the WHO action plan, and it’s a great idea to emphasise the issue by making it the focus of the global celebration of patient safety.
Telemedicine, especially in the context of the COVID-19 pandemic, is playing a significant role in addressing safety concerns like diagnostic errors and communication issues. How should we better prepare to ensure telemedicine remains a safe option for patients?
João Breda: WHO countries have agreed on a global action plan. This global action plan talks about the safety of diagnostic processes. This is part of the strategic objectives of zero avoidable harm and safe clinical processes. The plan already anticipates that we need to use all the tools we can to ensure that we reduce unnecessary harm to the minimum. Digital solutions like telemedicine can potentially improve patient safety globally and reduce negative effects linked with inaccurate and improper diagnoses. The theme of World Patient Day 2024 is really well aligned with the aims of this action plan.
Reducing diagnostic errors and the harm associated with inaccurate and improper diagnostics is an important goal. Defining a diagnostic error is more comprehensive than many people realise. At the Athens Quality of Care and Patient Safety Office, which is a centre of excellence for the WHO European region’s work on patient safety and quality of care, we have developed a digital tool for countries and stakeholders to assess the quality of their services.
Just because it’s telehealth doesn’t mean it will be good. We have both risks and opportunities when applying digital solutions, and we must first evaluate their quality. We have the same risks and opportunities, so it is fundamental to understand the real available options to utilise technology to improve the lives of patients, and really to fine-tune the care that we provide, to improve follow-up, etc.
The significant progress in telemedicine is closely linked to the need for innovative solutions during the pandemic. However, it’s crucial that we continue to prioritise this progress and not regress to our initial state. We are concerned about this, and as a result, we have developed a tool to collaborate with countries and stakeholders to ensure that telemedicine services are of high quality, which is not always the case.
The Global Patient Safety Action Plan emphasizes the importance of engaging patients and families in safety initiatives. How can digital tools, such as smartphones, facilitate this engagement?
João Breda: Using health apps to share information is fundamental in educating patients and families. These apps are common nowadays and can provide information about the condition, treatment options, and preventive measures.
However, it goes beyond just giving information; it can be used for other purposes, such as monitoring and self-management through electronic symptom tracking or wearable devices that keep track of vital signs, physical activity, and other health metrics.
Digital safety checklists can also guide you through essential safety steps, such as pre-surgery preparations, post-discharge care, or infection prevention measures. Furthermore, messaging and alerts can further facilitate communication between patients, families and healthcare providers. This was effectively used during the COVID-19 response when smartphones could disseminate real-time safety updates and advice from health authorities to keep patients and families informed and engaged.
Finally, the Global Action Plan calls on learning from the experience of patients and families exposed to unsafe care to improve understanding of the nature of harm and foster the development of more effective solutions. Thus, surveys, feedback and reporting tools through digital platforms would greatly help the health system to identify areas for improvement and tailor safety initiatives to meet patient needs.
So, these digital technologies clearly have a role to play in making things more humane. It seems like a contradiction. However, if used the right way, digital tools can really improve and reduce inequities, which is also very important.
How can new technologies be leveraged to enhance equity in patient safety and improve the quality of care, particularly in reducing disparities across different regions and sectors across Europe?
João Breda: Technologies can be dangerous because they can increase inequalities. Therefore, we need to think about policies that promote the equitable use of technologies and focus on reducing disparities. It’s about being people-centred and responding to individual preferences, needs, and values.
Equity directly influences the fairness, effectiveness, and inclusivity of healthcare systems. New technologies offer significant opportunities to enhance equity in quality of care and patient safety. We need to use them to bridge the gap and reach underserved communities. We can achieve this by improving time response and addressing the needs of people with limited mobility. Making technology simple and accessible for everyone, especially for vulnerable groups, is essential.
Additionally, language accessibility is also fundamental, as technology should be easy to understand and accessible for people speaking languages other than English. In substance, it should also be user-friendly so that everyone can use it.
We should also use data to better understand the impact of technology on gender, income, education, and health status for different groups. It’s important to have disaggregated data for specific groups rather than just averages, and digital tools provide an opportunity to do so.
In some remote areas of the WHO European region, nearly everyone has access to a smartphone, which is amazing but true. This means that people in remote locations can be reached, but we need to be smarter about how we do it. We should tailor and adjust the use of technology to meet the specific needs of these groups.
What are the existing barriers to integrating digital health solutions into European patient safety frameworks and how can countries overcome them?
João Breda: At the moment, only 36% of European countries have a digital health strategy that prioritises patient safety. It is crucial to establish policies and strategic guidance that emphasise this area because technology has the potential to significantly enhance patient safety beyond our current imaginings. This step is absolutely critical.
We need also to consider that only a limited number of countries in Europe have a mechanism for surveillance of the safety of information technology products used for clinical and diagnostic purposes. However, just because something is digital doesn’t necessarily mean it’s good. Therefore, we need surveillance and evaluation mechanisms in place to establish the quality of these services. We need more of these tools. It is a crucial step to overcome these barriers and for countries to have policies that encourage exploring these opportunities.
Given that only 32% of European countries have policies regulating private companies’ use of big data in healthcare research, what actions should be taken to strengthen data privacy and protect patient safety in digital health across Europe?
João Breda: Last year, the WHO European Region published a report on ‘The ongoing journey to commitment and transformation‘, in which several considerations were suggested regarding strengthening data privacy. These could be echoed for protecting patient safety in digital health across Europe. In this case, it’s very clear that we have to follow these guidelines to protect patient safety and privacy.
Member States are recommended to develop and adopt policies or legislation that address, at the very least, the access and ownership of patient data stored in electronic health records (EHRs), specify who is authorised to access the data, provide patients with the ability to restrict access if they choose, outline how amendments and deletions of data can be made, and ensure that patients are informed about the associated risks.
Moreover, fostering public-private partnerships with clear ethical guidelines would be necessary. Such collaborative frameworks would ensure private companies adhere to the same ethical standards as public entities. Shared responsibility for data protection is a key to respecting patient rights, transparency, and commitment to patient safety.
When it comes to digital technology, sometimes regulators step in after an issue arises, even though some companies are already making progress. This isn’t unique to the healthcare industry. It’s almost expected, but it’s crucial for regulators to take a firm stance. Fortunately, they are doing so while also recognising the risks and opportunities involved. Speed is important, and we also believe in collaborating with the government, emphasizing the government’s crucial role in regulation.
What should European countries focus on in the years to come to guarantee better patient safety in digital health?
João Breda: I believe that keep on using digital tools to improve patient safety is crucial. Member States can harness these advantages by developing a national digital health strategy guided by evidence-based resources is critical. National frameworks should highlight the most optimal approaches for the digitalisation of health data, implementing clinical decision-support systems, improving patient engagement, and managing electronic prescriptions. On the other hand, the establishment of national guidelines ensures the safety and reliability of health informatics and technological solutions before their introduction into the health sector.
There’s also a huge opportunity to train health professionals and patients to use digital tools to improve health outcomes. We can and should also use technology to attract young health professionals. The health sector is creative and innovative, but we don’t advertise this aspect enough to attract young, passionate professionals to embrace these professions.