Luxembourg must now invest carefully in e-health if it is to reach the top of the digital health index, writes Dr Lilani Abeywickrama
Echoing the message of the newly appointed minister of health, Luxembourg is to focus on investing in the service industry. Having successfully reaped the benefits of fintech, Luxembourg must now invest carefully in e-health if it is to reach the top of the digital health index.
Strategising on solid foundations, Luxembourg ranks second in the world in the Digital Readiness Index 2019. Well-positioned (and -sized) within Europe, the duchy provides a unique platform to develop a high-calibre digital health hub. The country stands out for its positive start-up environment, its sophisticated level of technology adoption and its pro-business outlook.
At the heart of the minister’s policy-planning is a 360-degree vision. Therefore, evaluating some of Luxembourg’s current and future health concerns, both in its population demographic as well as in its healthcare spending, are crucial.
With an increasing life expectancy (82.1 years in 2017), the population requiring long-term care is set to grow as will the risk of future fiscal sustainability. Lifestyle factors within younger age groups--such as rising obesity rates and elevated alcohol consumption, compared to the EU norm--require further public health intervention.
Moreover, despite the cost-containment efforts of 2010, Luxembourg is still in the top quartile of EU Member States in terms of per capita spending on health, at €3,575--it is well above the EU average of around €2,884.
The scope for propelling Luxembourg to the top of digital rankings involves tackling these problems, by investing in the golden triad of e-medicine: preventative, predictive, and precision health.
mHealth: investing smartly in healthcare
The core of the healthcare system revolves around principles of compulsory health insurance and free provider choice for the population. During the Gesondheetsdësch, part of the 2021-2025 health plan focused on developing quality and free choice in healthcare. In order to reduce Luxembourg’s overcrowding phenomenon currently draining emergency services, reforms can be made digitally via local m-health apps or direct online access to nationally approved doctors.
Social security minister Romain Schneider and health minister Paulette Lenert, as seen here during the “Gesondheetsdësch” kick-off on 14 February 2020 Photo: MSAN
By advising patients remotely, such tele-triage can prevent an unnecessary visit to the hospital. This system can substantially reduce costs and streamline Luxembourg’s healthcare under one system, whilst redirecting savings to strengthen the nation’s much needed primary care. Additionally, patients can access healthcare on their time, given the commuting the Luxembourgish population is prone to--smartphone use can be used positively.
As a manageable number of hospitals operate within Luxembourg, a seamless IT system via an application programming interface (API) platform could feasibly promote the streamlining of national healthcare. Along with the recently piloted electronic health records (DSP), a secure exchange of electronic health data between healthcare providers and patients can coexist. The eHealth agency also developed a data sharing tool for medical test results, Regibox. Scope to facilitate channels of direct communication between doctors, healthcare staff and patients alike within one network can be developed, reducing fragmented medical care.
In the long-term, linking healthcare providers with multiple insurance systems using secure blockchain will allow patients to securely exchange financial information with insurance companies, without the need for a third-party authority. An insurance system that minimises touchpoints for beneficiaries will diminish the loading costs for the insurance system while reducing fraud and rapidly disbursing clients. The creation of an electronic health card is projected to replace the current social security card.
A wide scope of healthcare is offered to Luxembourgish citizens which relies on strong infrastructure, but with personnel shortages and population growth, digitalisation could provide a solution to improve doctors’ workload and efficiency. Natural language processing (NLP) could save time for patients and doctors alike when completing medical records. These AI systems exist and are already being trialled in routine medical practice in Europe.
Investing in future health
Investing in preventative care has proven effective for Luxembourg as demonstrated by its comparatively low rate of preventable mortality (140 per 100,000, compared to an EU average of 161).
Further pursuing this avenue is the use of wearable devices promote health-nudging behaviours. Patients are encouraged to reach healthier lifestyle goals through healthy-eating and exercise. Gathering real-time data from blood-pressure monitors (Livemetric), diabetes management (ActImage) or lab testing (Techcyte), feeds into the personalisation of healthcare and remote treatment monitoring. Data analytics can then be used to identify risk factors and predict disease onset.
January marked a year since the Luxembourg Institute of Science and Technology (LIST) and Luxembourg Centre for Systems Biomedicine (LCSB) collaborated with NVIDIA in the field of life sciences fostering Luxembourg’s very own AI lab. The projects can push Luxembourg into a centre of excellence for digital health and personalised medicine.
We are moving away from a one-size-fits-all approach and, with such detailed informationat hand, doctors will consequently be able to focus on prevention therapies and offer early detection advice. Research increasingly demonstrates precision with deep learning in diagnostic imaging (radiological scans, dermatological visits, ophthalmic imaging), while patients will be able to access therapies tailored to their genetic makeup.
Emphasising a streamlined system can promote Luxembourg’s diagnostic expertise to patients in the greater region while attracting skilled healthcare professionals, hence tackling the country’s over-reliance on transitory staff.
Luxembourg holds the keys to complete its current “Gesondheetsdësch” plan. It now needs to ascertain which emerging health technologies are worth investing in. Adaptation will require a risk-taking and flexible mindset. By May 2021 these changes could become tangible--but is Luxembourg ready to step up to Ursula von der Leyen’s “tech sovereignty”?
Dr Lilani Abeywickrama is a Luxembourgish ophthalmologist currently based in Milan. Her main interest is advocating healthy living and precision technology within her specialty and is pursuing her interests in the field of healthcare management.