“The Covid-19 pandemic has been an overall a big accelerator for the adoption and the acceptance of digital technologies in many areas, and in particular, has demonstrated how digital solutions can be an essential part of a better healthcare system,” says, Giuseppe F. Italiano

Italy is a country consisting of a peninsula delimited by the Alps and several islands surrounding it whose territory largely coincides with the homonymous geographical region. Located in southern Europe, Italy is also considered a part of Western Europe. With Rome as its capital and largest city, the country covers an area of 301,230 km2 (116,310 sq mi) and has land borders with France, Switzerland, Austria, Slovenia, as well as the enclaved microstates of Vatican City and San Marino. Italy has a territorial exclave in Switzerland, Campione. It has around 60 million residents. Italy is the third-most populous EU member state.

The Italian healthcare sector is perhaps one of the largest in the world. There are many different companies and organizations that offer clinical services, make drugs and medical equipment, and provide healthcare-related support services like medical insurance. A key function of these companies is to diagnose, treat, nurse and manage illness, disease, and injury. Healthcare is also a very complicated industry: to provide medical services, healthcare providers who may have quite different objectives, such as doctors, nurses, medical administrators, government agencies, pharmaceutical manufacturers, and medical insurance companies, must work together continuously and closely.

Giuseppe F. Italiano, Professor of Computer Science – LUISS University, Rome and spokesperson at the recent Innovation Talk on ‘Arti cial intelligence applied to medicine: Italian excellence in telemedicine and telesurgery’ organized by the Italian Trade Agency at the Italy Pavilion, Expo 2020, explains to Mediworldme how technology plays an important role in the Italian healthcare sector.

Tell us in detail about yourself?

I graduated in Electronic Engineering from Sapienza University in Rome, and then I moved to the United States, where I got a PhD in Computer Science from Columbia University. After completing my PhD, I had a truly inspiring experience as a research staff at the IBM T.J. Watson Research Center in Yorktown Heights, which is perhaps one of the most prestigious research labs around the world. But then I got a bit nostalgic about my country and moved back to Italy as a Professor of Computer Science. I am currently a Professor at Luiss University in Rome, where I am working on many exciting projects in digital technologies. At Luiss, I am also the Director of Masters in Data Science and Management, Masters in Cybersecurity and Masters in Big Data and Management at Luiss Business School. The constant international exposure has had a deep impact on my professional life. Most of my research is centered around algorithms, and I have been designing, analyzing and experimenting with algorithms for more than 35 years. In general, I strive to pursue research questions that are not only academically challenging, but also relate to important practical problems, and I have been actively working on the transfer of my research results into practice. In particular, I have been consulting with several big international companies and co-founded several tech startups.

How has the Italian healthcare sector evolved over the years?

Although the AI revolution is likely to bring deep changes in healthcare systems, I believe that this has to be done carefully, by recognizing not only the AI’s strengths but also its limits and weaknesses. Especially in healthcare we need AI systems which are more transparent and accountable, and can ensure a fairness treatment to all patients, by reducing biases and prejudices that are often buried deeply inside AI tools. To accomplish this, we may need to bring together experts in elds outside healthcare and digital technologies, including ethics and philosophy, sociology, psychology, behavioral economics, and understand better the complex and evolving interaction of humans and machines that are capable of learning and become better at some task as they keep operating.

What is the role of IT in the Italian healthcare system?

I would say that today digital technologies play a crucial role in many aspects of the Italian healthcare system. Indeed the need for an efficient national health service is quite imperative in Italy, and the use of digital technology ts very well in this framework. In recent years Italy has certainly made a great progress in implementing digital healthcare, and the expenditure on digital health has been steadily increasing. Most of the resources invested in this area are addressed to the digitalization of clinical departmental systems and the widespread implementation of electronic health records (EHR).

Although the popularity of EHR among general practitioners and pediatricians is still a bit uneven throughout the country, as very few regions are lagging behind, it is a common practice to use electronic instead of paper-based medical prescriptions everywhere in the country. The use of health apps and medical wearables is also picking up, and there is also a rising interest in communication apps, as their benefits get widely recognized among general practitioners. There is a lot of progress also in remote health monitoring and telemedicine services. Patients seem generally interested in embracing digital health solutions, although the greatest concern remains the lack of human physical contact with doctors, which seems to be of particular importance for Italians. The digitalization process is still ongoing and more will be done in the near future to achieve tangible results in terms of efficiency. Currently, I would say that the main challenges to be tackled are still the lack of digital skills and the skepticism towards digital methods, which is sometimes related to digital illiteracy.

In your opinion would you recommend Italy for medical tourism? Why?

People all over the world have always been attracted by the artistic and natural beauty of Italy. There is no question about that! Perhaps everybody knows that Italy has the highest number of World Heritage sites. What is less known is that the healthcare
system in Italy is considered to be one of the best in the world. We have a life expectancy at birth of more than 84 years (the 6th in the world) and according to Bloomberg, Italy is the 4th country in the world for healthcare efficiency. I guess it is difficult to match those gures. In the last years, Italian hospitals have started promoting their services internationally, by providing interpreters, medical records in the patient’s language, shuttle services to and from the airport, rooms for relatives, and agreements with major hotels. I think all of this is making Italy a unique and attractive destination for medical tourism.

How has covid-19 shaped the Italian healthcare sector?

Before the Covid-19 pandemic, we were convinced to have a great national health systems. Our network of hospitals and physicians were, on the whole, world-class. Unfortunately, for Italy but for many other countries as well, the pandemic was really a shocking stress test for healthcare. Especially after Lombardy, one of Italy’s richest regions, which had invested heavily in centralized state-of-the-art hospitals, became the rst European hot spot in the early days of the crisis. As Covid-19 swept through Northern Italy and even the most well-funded hospitals struggled to tackle the waves of illness and death, it was clear that having excellent hospitals was no longer sufficient to hold up to such a dramatic scenario. I would say that Covid-19 forced us to rethink our public health care system, focusing less on centralized hospitals and more on making care available to patients where they need it, by investing on a network of clinics and small medical centers. This networked structure can have a better coverage of the Italian population, which is spread over many small towns and villages.

Following best practices from some Italian regions, Italy started shifting the focus a little bit away from big hospitals, and investing more in local community care. In those community centers family doctors, who in Italy have an important traditional role towards patients, but provide their services as independent professionals in one-person offices, can work side by side with specialist nurses, psychiatrists, dieticians and social workers. Compared to often far-away city hospitals, community care centers offer the local population the possibility of frequent checkups and more personalized care, and can help keeping people, especially elderly people, healthy and in their homes as long as possible instead of filling up emergency rooms and hospital beds, which was one of the main issues with the covid-19 pandemic.

Over the coming years, the government plans to roll out more of those ‘community homes’ and ‘community hospitals,’ and to invest more in at-home care and tele-medicine, in order to bring the healthcare system closer to patients. The idea is to keep patients near their families and friends who can take care of them. Italy has one of the oldest populations in the world, much of it distributed in small towns and villages that are not easily served by nearby health facilities. Elderly people are not always self-sufficient, making travel to the nearest hospital difficult. General practitioners will work more in teams with nurses and disease specialists to provide care close to patients who don’t need to be hospitalized but do have complicated health needs.

How has Covid-19 demonstrated the need for e-health solutions to improve Italian healthcare system?

The Covid-19 pandemic has been overall a big accelerator for the adoption and the acceptance of digital technologies in many areas, and in particular it has demonstrated how digital solutions can be an essential part of a better healthcare system. Like in many other countries, in Italy many new digital health applications were developed in response to Covid-19 in order to provide citizens with better access to medical information and care. For instance, smartphone-based apps have been adopted to prevent the spread of the virus through contact tracing or by monitoring the location of individuals. In addition, many other apps and websites have been developed to provide citizens with updated information on the virus and the healthcare services locally available. In several cases, this functionality was combined with symptoms checkers that enabled end-users to obtain a preliminary assessment of their health conditions and personal recommendations on their behaviors or medication to take. In other cases, digital health applications have been developed to provide better treatments to those patients who tested positive but were not hospitalized. This was pursued by equipping the patients with wearables to monitor their health conditions or by asking them to regularly record their symptoms on an app or a website that was consulted by health professionals, who could take tailored actions or suggest specific medications. All of this has caused a deep penetration of digital technologies into the Italian healthcare system, has contributed to their wide acceptance by both patients and doctors, and has also demonstrated that we have to leverage on digital technologies as enablers for delivering more effective and efficient healthcare.