Technological innovations, whether digital or “analog,” have rapidly changed every area of our society. It is interesting to note one thing: the transformation has been equally radical, whether we are talking about more “ordinary” sectors, perhaps linked to the purchase of goods, or whether we are referring to those relating to more “sensitive” areas, such as health or the management of one’s own financial resources. In this sense, a clear example is the health sector, or, even better, healthcare, which, more than other sectors, is showing rapid and evident changes, as well as facing impressive prospects for growth and transformation.

So, how Italy can benefit from the digital Healthcare?


From healthcare to E-healthcare: the new way of treating health

Traditionally, the medical field has always experienced moments of development, often linked to the growth of knowledge and, therefore, to the improvement of technical skills. However, recent developments have made health services more efficient and effective, and it has changed the very way of understanding the entire healthcare sector, which has begun to exploit new tools and  channels (such as, for example, tablets and smartphones). In essence, even the healthcare sector has become digitalized and we are now talking about eHealth. 

But what exactly does this expression mean?

According to the World Health Organization, eHealth is the use of technology to improve human health and well-being and to strengthen the services of national health systems.  eHealth also underlines the potential of this area in terms of strengthening health systems and improving quality, safety, and access to many types of care. For this reason, in the context of the 58th World Health Assembly, the WHO encouraged all its members to adopt eHealth innovations and technologies.

As a further demonstration of the importance of this sector, the European Union has also defined eHealth (in this case called Digital Health and Care) as the set of tools and services that exploit information and telecommunications technologies to improve the prevention, diagnosis, and treatment of diseases, as well as monitoring and health and lifestyle management. To ensure better dissemination of these services and ensure a consistent level of eHealth in all EU countries, Directive No. 24 of 2011 was also issued, which officially recognizes an eHealth Network, a network of national authorities operating in the digital health and care sector.

In this way, at least in theory, it has become easier for member states to accelerate and cooperate with each other in order to extend the digitization of the health care sector as much as possible.


And in Italy? 

In addition to international organizations and the European Union, Italy has also recognized eHealth. What is important is that the Italian Minister of Health has also acknowledged this international trend by defining eHealth as “the use of tools based on information and communication technologies to support and promote the prevention, diagnosis, treatment, and monitoring of diseases and the management of health and lifestyle”. These official acknowledgements have made it possible for Italy, in recent years, to start working to ensure the spread of some of the digital healthcare services, included in the context of a broader project of digitization for the entire public administration.

Among the main projects that have been carried out is important to remember the:

  1. Establishment of the Single Reservation Center, also known as CUP;
  2. Creation of the Electronic Health File;
  3. Experimentation and implementation of Telematic Disease Certificates;
  4. Activation of the electronic recipe, or the so-called ePrescription;
  5. Application, in some cases, of Telemedicine;

This short list shows how fertile the territory is in terms of prospects for development and possible innovations relevant for patients on the one hand but also for investors.


The number of new sector 

When we talk about eHealth, or digital health and care, we must bear in mind that it is, among many things, also a very attractive sector in terms of financial interest. This is demonstrated by the data, which show impressive growth.

Last year, 2018, was undoubtedly the year of the digital healthcare boom, where as much as $18 billion was invested in eHealth-related start-ups. This figure marks 56% growth of the total sector value compared to the previous year.

In addition, in the last five years, as much as $45 million has been raised by venture capital firms. At this rate, the global market value is expected to reach a formidable $400 billion in 2024. Explaining the reasons for this impressive growth is not easy, so we will focus on three of the main factors that can provide an overview of this phenomenon.


Growth factors 

An important factor is the availability of increasingly efficient and sophisticated technologies, which open the way to innovative solutions applicable in the most varied health care fields.

Secondly, a fundamental role is played by the progressive ageing of the population, which is linked, especially in more developed countries, to ever-increasing health expenditure and to the unsustainable long run.

A third aspect, perhaps the most obvious in terms of economic importance, is the birth and growth of a large number of digital start-ups under the category of eHealth.

This is supported by a report, “The European Healthcare Startup Ecosystem”, produced by the venture capital fund Nina Capital, specialized in in the health tech sector investments. This report provides a snapshot of the European panorama of start-up accelerators, identifying 162 dedicated to the healthcare sector. In particular, the most important countries from this point of view are Great Britain, with 20 accelerators, Germany, with 17, Spain, with 16, and Italy with 15.

This shows us that start-ups dedicated to digital health have now become an economic reality. From this point of view, 2019 has confirmed the funding trends in recent years. About $10 billion in investment funding was raised in the world of innovative startups operating in the healthcare sector. Specifically, the largest investments were raised for:

  1. The provision of user management services;
  2. The development of tools for personalizing individual healthcare;
  3. The collection and management of Big Data and Analytics in the medtech sector;
  4. In the development of medical devices;
  5. In general in the wellness sector;


Digital healthcare in Italy 

The digital healthcare sector is strategic for Italy, which will require increasingly advanced and technologically efficient tools to deal with this “emergency”. For this reason, we would expect significant investments, both public and private, aimed at development and research. Unfortunately, this is not the case, even if there are encouraging conditions for greater growth in the sector in the future.

Let’s start by describing the current context from a single figure: €1.722 billion, which is the total spending on digital health in Italy in 2018. In absolute terms, the figure is positive, as it shows an increase of 4.2% compared to 2017. Despite this, we are far from being able consider it a solid and constant growth, since the expenditure of innovation per capita in the past year was just over €28 out of €2,500 of total expenditure.

This is also due to the fact that digital health investments are still limited, as they come mostly from health facilities, for a total of €890 million in 2018, then from the Regions and, finally, from the Ministry of Health. Also, regarding the start-ups dedicated to e-health, the results are not up to the level of other U.S. or European startups; however, there is still reason to be optimistic.

And while the number of total start-ups in the field is currently unknown, Assobiomedica reports tell us that there are at least 324 in the medical devices sector. Of these, 43% are public research spin-offs, about 20% are corporate spin-offs and, finally, 30% are part of science and technology parks. More specifically, these startups are mainly involved in biotechnology (31%), IT (31%), advanced materials (9%), nanotechnology (6%) and robotics (6%).

Moreover, it is worth remembering that Italy has also been home to major investments such as the €17 million investment by Geneta Science, a biotech start-up founded in collaboration with San Raffaele. Alongside this, there have also been other smaller operations (between €500,000 and €3.3 million by Italian venture capital companies) that are significant enough for developing an adequate digital healthcare sector. 


Italians are ready to become patients 4.0

To complete the picture of the Italian situation, it is necessary to underline an interesting aspect that concerns those who must benefit from these services, that is, all citizens. Italians seem to be in favor of eHealth, especially for the preventive aspects. This is demonstrated by the fact that, in 2017, out of a total of 43 million active users, 32% used digital services to collect information on healthcare facilities, while 22% used them to book check-up services, and 18% used them to check medical reports or to receive reminders of previously booked medical examinations. Also in Italy a new trend has emerged, where more and more doctors are using Whatsapp to communicate with patients. According to a study by the Observatory on Digital Innovation in Health of the School of Management of the Politecnico di Milano, out of 229 doctors working in Internal medicine departments, 42% use Whatsapp to get in touch with patients and answer any questions and concerns.

Digital solutions are also used by doctors when they need to consult images or reports (76%), to manage patient information (47%), or to draw up their own medical diary (27%). This shows that even in Italy the time is ripe for a complete digital turn in the entire healthcare sector, which would also be desirable given the important benefits that this would entail. However, we must not forget: the digitization of health services cannot ignore the development of sophisticated technologies capable of countering hacker attacks. While eHealth provides access to more convenient and efficient services, it also requires a high level of sharing of private data and information.

One of the challenges of the coming years will be not so much to convince users of the potential of the combination of health and technology, but to ensure a protection that is on par with privacy protections, in a careful balance of procedures and responsibilities that protects the personal data of patients without disturbing and agile operation of digital solutions.