How to preserve humanity in a technological health system with Francesc García Cuyàs

Dr. Francisco García Cuyàs is PhD in General and Digestive Surgery and Associate Medical Director at Hospital Sant Joan de Déu of Barcelona, where he is also in charge of the Digital Transformation program. He is also an expert in digital accompaniment and is associate profesor at the Surgery Department of the Medicine School of the Universidad Autónoma de Barcelona, as well as President of the Digital Health Association of Cataluña.

Could you give us an overview of your work?

I am currently associated medical director and responsible for Digital Transformation at Sant Joan de Dèu Hospital in Esplugues de Llobregat.

My job is to support the medical director with everything related to surgical environments and new technologies associated with daily practice, and on the other hand, to continue with the digital transformation already started years ago in our center. This is very much focused on projects that facilitate the different models of interaction with the patient and their families, all around the basic concept of “digital accompaniment” that consists on sharing all the information with the citizen.

One of my first assignments was the implementation of new operating rooms highly specialized in pediatric procedures. Though technology is one of the key factors we need a balance with the humanization of the environment. In this sense, in order to achieve the best possible patient care, we have incorporated a MRI to the surgical block. This way there’s no need to move the patient and we can do intra-operative checks. Also, we have added an Arco-CT for augmented reality aided surgery, thus improving the safety of interventions, and finally a portable TC to be able to use this technology in any of the operating rooms we have. 

Which are the main technological advances in medicine nowadays?

Currently there are many technological advances evolving at the same time, and the vast majority are closely related to personalization both at diagnosis and pathology treatment level, like, for example, genetic diagnoses and personalized immunological therapies.

Other areas that are advancing are digital image and its processing. We can process images captured from different equipment and merge them to create true 3D maps that allow us develop more effective treatments. One of them is real time surgery with superimposed anatomical images through augmented reality that allow us to identify malformations or access ways for resections.  

And finally, the gadget sector is also experiencing big progress associated with the development of mobile applications. I personally think this is the future in the world of health, voice operated health systems, both as a way to communicate with patients and for collecting clinical data. 

How will technology change the health system?

The main challenge is in the prediction and anticipation. Technology will help us predict situations and, through prevention, avoid treatments with a big impact in the balance sheet of the health systems. 

I think we need health systems to get closer to the citizens so that we anticipate pathologies and can remedy them preventively. 

And how will hospitalization look in the near future?

Technologies in the area of ​​hospitalization can bring improvements in different areas, but above all they should do so in the field of accompanying the patient and his family, and providing tools to professionals to improve decision making. In this sense, I would like to comment on a tool that is being implemented in many hospitals and brings this global vision where knowledge is shared to make decisions that are more consensual and consistent with the needs that appear at all times. The Clinical Command Center is an AI based information visualization system created by an organization that provides a unique vision of the process including intrinsic and extrinsic variables. This allows us to make decisions in a timely manner, apart from being able to run prediction models to make this decision-making more proactive and anticipate foreseeable events 

Which should be the cornerstones of technology based health and care systems?

I think there should be two fundamental basic principles, one of them being ´primun non nocere´ (Main thing is not to harm). By this I mean it is important to introduce new technologies into our system, but these have to be validated with scientific rigor and at the same time generate trust between professionals and citizens.  

The second fundamental principle has to do with humanism and how technologies should not make forget what we, as health professionals, know and have to do, which is talk to and explore patients for accurate diagnosis. 

Are transparency, privacy and interoperability critical in the implementation of technology?

I totally agree. We need agencies to govern privacy and the interoperability of information –without them it will impossible to achieve the necessary transparency to generate trust. And without trust, many of the situations where information sharing is vital to provide the best attention will not be feasible. Cataluña bases its information sharing system on global standards that allow information to be shared between different health providers with full security guarantees. 

The Guardian recently reported how the Department of Health and Social Care has been selling the medical data of millions of NHS patients to American and other international drug companies having misled the public into believing the information would be “anonymous”.

This is one of the sensitive issues in reference to the management of patient information and personal data.

              There are different initiatives at European level that allow the citizen to have control of                     their data at all times and decide who they transfer it to, for what project and for how                         long.

The citizen not only knows what is done with their information, but can cancel its transfer at any time. In this sense, Blockchain will be very helpful. 

Other initiatives are data transfer cooperatives where patients consensually share their information with a trusted organization for common shared objectives.  

  

How important is the human patient-doctor relation?

The relation between health professionals and patients and also their families are the key to the care model. We should not allow technologies to keep us from this concept, because being able to explore, talk, exchange emotions and look into the patient’s eye provides much and very reliable information. This is difficult to obtain by other means, albeit not impossible. 

In Catalonia we implemented a model of professional health-patient relationship called eConsultation, by which the first visits are face-to-face and from thereon a non-face-to-face model can be established. 

  

Do eHealth devices and applications improve our lives?

I believe they can improve life quality if they are used properly and with clear indications. Otherwise we will enter a technology prescription escalation, which on the one hand will make the system unsustainable and on the other will cause citizens to be every time more concerned about their health. 

‘Technological stress’ can detrimentally affect the quality of life of patients but also of professionals.