1. HOW IS THE USE OF NEW TECHNOLOGIES CRUCIAL IN IMPLEMENTING THE DEEP TRANSFORMATION UNDERWAY IN THE ITALIAN HEALTHCARE SYSTEM? SPECIFICALLY, REGARDING THE NEW TERRITORIAL CARE MODEL...

It is so crucial that it is considered a fundamental component of this model by the very reform decree that introduced it (MD77). We believe that the digital space of the "new" territorial healthcare should take the shape of the most perfect of regular polygons: the square.

The base is the organization; the opposite side - which gives "height" - is the set of digital transformation solutions that support it; on the sides are the operational and directional design capabilities. The organization outlines the operational structure of territorial healthcare, allowing digital solutions to be coherently integrated and put into service.

The set of digital transformation solutions supporting the operational structure of the "new" proximity medicine is a vast field that includes: "composability" of application solutions; a focus on interoperability; integration of telemedicine in every system; proactivity in supporting prevention, care, and treatment pathways; openness toward the citizen-patient; the ability to extract knowledge from data, and more.

Operational design capability lies in conducting digitization initiatives by combining the agility required by the challenging goals imposed by the NRRP with the ability to make them progress over time through strong organizational, healthcare, technological, and application competencies.

Directional design capability consists of driving digitalization initiatives by embedding, from their inception, strategic collaboration between operational and governance application solutions, implanting the former with a view toward decision-making support that the latter must achieve, truly enabling their potential.

Only when digital transformation solutions shape and sustain the organization with robust design initiatives — crafted and implemented to meet both operational and directional stakeholders’ needs — can the digital space of the "new" territorial healthcare aspire to the balance of a square.

This is the way to overcome the irregular shapes still too often observed, where technology does not integrate with the organization but dominates it, and where projects struggle to deliver results and/or show imbalances favoring the operational dimension at the expense of governance.

At Eng, we "square off" to elevate the digital space of the "new" proximity medicine with our established capabilities, enhanced to meet this challenge: modern and constantly evolving solutions; multidisciplinary teams for true digital transformation; the ability to realize and complete complex projects, particularly in the territorial domain; and the ability to guide projects along both operational and governance lines, to "measure" the new territory.

3. TELEMEDICINE: WHAT ARE THE MAIN CHALLENGES AND OPPORTUNITIES IN PROMOTING AND IMPLEMENTING THESE SERVICES?

Telemedicine plays a crucial role in rebalancing the focus on territorial care compared to hospital care, strengthening the former to prevent the onset of diseases and ensure more appropriate chronic care management.

We must consider the starting point of regional healthcare systems, which have "done little" telemedicine so far; also, a first but incomplete milestone, treating 300,000 patients with telemedicine by 2025 as outlined in the NRRP, must be achieved within a few months. Furthermore, regional telemedicine projects, to be implemented through the Regional Telemedicine Infrastructure, are just getting started.

Our national leadership in telemedicine - implementers of the PNT and winners of the IRT procedure - places on us the responsibility to show the way, help chart it, and walk it.  We believe that the telemedicine deployment process should first "rough out" and then "shape" remote care services. The shaping should be a long-term goal, to make these services increasingly effective for a wider variety of patients.

Hence, several golden rules emerge to succeed in deploying telemedicine:  

• Start small (which is actually a lot, as it’s impossible to "do everything all at once"). Regional projects should aim to deploy telemedicine services in a "basic" configuration that can be easily adopted to reach the number of patients expected by the PNRR targets;
• Choose the contexts. It is advisable to identify use cases characterized by greater readiness to "do telemedicine" quickly, which can act as "training grounds" to "train" others over time;
• Proceed with rigor. When deploying the basic configuration in selected use cases, it is essential to address all impacted dimensions because telemedicine is not just a new application solution but a new framework for care, which must be defined and promoted using change management tools;
• Implement continuous innovation. From the basic setup in the most ready use cases, projects can progressively expand to include more patients in telemedicine, fully realizing the goal of making "home the primary place of care," even through increasingly sophisticated and promising technologies.

5. ARTIFICIAL INTELLIGENCE AND DATA ANALYTICS: IN YOUR VIEW, HOW CRUCIAL ARE THEY FOR INCREASINGLY PERSONALIZED AND EFFECTIVE CARE?

Traditional and cutting-edge Healthcare Analytics are central to improving care. At Eng, we are committed to turning this ambition into systematic action, not just isolated efforts.

We work on both data set creation and the design and execution of analytics. On the first front, to exercise any form of intelligence, whether human or artificial, the starting point is the data to reason with - real, not synthetic, historicized, not isolated, but above all, usable for the purpose. This requires "intent" from the very setup of the application solutions that will provide this data, keeping analysis goals in mind from the beginning, so that what is analyzed later is adequate and of sufficient quality to support all different investigation perspectives. On the second front, it’s important to ask how the data will be used to avoid - particularly with AI - a mere technological exercise.

This requires a mix of process, data modeling, algorithm engineering skills, and the right technologies, to create solutions that:  

• Support traditional analyses, but become progressively deeper due to the growing data pools made possible by the extension of basic digitalization across healthcare organizations;
• Are AI-based and address the knowledge challenges that arise in various fields of prevention, care, and treatment, while not losing sight of the broader phenomena characterizing healthcare systems. (For example, in individual clinical and diagnostic specialties, AI increasingly supports diagnosis and decision-making in specialized care processes, but there are currently no solutions that can holistically support the entire patient journey. Similarly, at regional and national levels, AI-powered waitlist analysis or Digital Twin-based service simulations may be less effective if the same intelligence is not applied to understanding the health phenomena driving demand and the organizational factors constraining service supply).  

At Eng, we have access to and familiarity with all necessary technologies, but most importantly, we have many professionals passionate about this journey, starting with the quality of operational solutions and arriving at the introduction of Healthcare Analytics solutions, with the habit of using technology - from data science to management to visualization - alongside domain knowledge, dosing the former to meet the needs of the healthcare system.