Digital Health


Article Author:
Arlen Meyers


Article Editor:
Scott Korvek


Editors In Chief:
Jeffrey Nielson
Scott Rudkin
Scott Korvek


Managing Editors:
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Frank Smeeks
Kristina Soman-Faulkner
Benjamin Eovaldi
Radia Jamil
Sobhan Daneshfar
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Hajira Basit
Phillip Hynes


Updated:
6/11/2019 1:10:35 AM

Introduction

Digital health refers to the use of information and communications technologies in medicine and other health professions. Digital health has a broad scope and includes the use of wearable devices, mobile health, telehealth, health information technology and telemedicine. The key reasons why Digital Health has been gaining momentum is because of the following:

  • Improve access to healthcare
  • Reduce any inefficiencies in the healthcare system
  • Improve the quality of care
  • Lower the cost of healthcare
  • Provide more personalized health care for patients

There is some evidence to show that the use of digital medicine now also permits patients to better track their own health and wellness. For example, the use of digital devices like the smartphone not only helps with communication, but these devices now have a huge number of apps that can help monitor blood pressure, record blood sugars, ensure compliance with medications, and track the amount of physical activity.[1][2][3][4][5][6][7][8][9][10]

Function

Function and Goals of Digital Health

The objectives of using digital health products and services are: 

  • To improve the quality of outcomes of care and service
  • To improve population health
  • To improve the patient experience
  • To improve the physician and other non-physician provider experience. 

Categories of Digital Health Products and Services

Digital health means different things to different people. Here are the main subcategories:

  1. Remote sensing and wearables
  2. Telemedicine
  3. Data analytics and intelligence, predictive modeling
  4. Health and wellness behavior modification tools
  5. Bioinformatics tools (-omics)
  6. Medical social media
  7. Digitized health record platforms
  8. Patient -physician-patient portals
  9. DIY diagnostics, compliance, and treatments
  10. Decision support systems

Issues of Concern

Issues in Digital Health Design, Validation, Testing and Deployment

  1. There is a difference between an industry and a market. Those companies that provide products and services comprise the industry. The customers who use those products and are looking for ways to get a particular job done are the market.
  2. Like all investors, digital health investors are looking for the highest rate of return with the least amount of risk. Given the foggy legal, regulatory and reimbursement atmosphere, it is too early to tell which dogs will eat the food.
  3. Most digital health technologies have not been validated clinically.
  4. The Food and Drug Administration (FDA) continues to offer periodic guidance documents and regulations that contribute to a level of uncertainty. That makes the hair stand up on the back of investor's necks.
  5. Given the multiple stakeholders in healthcare, for example, payers, providers, patients, partners and others, it is hard to target any one customer. Several need to see the value of any given product or service.
  6. The industry is too new, and there is not enough research to know which customers, patients, or stakeholders will adopt a product and why.
  7. Scale trumps innovation. The single most important characteristic of those companies that have received substantial follow-on investments is that they have scaled their customer rate rapidly by at least 70% per year.
  8. Doctors don't have the information they need to know whether to prescribe or use a given digital health technology.
  9. Most doctors don't get paid to use digital health technologies, they disrupt workflow, and there are nagging behavioral and emotional barriers to adoption by both patients and their families and their doctors.
  10. There is significant confidentiality, security and data privacy issues still lurking.

Digital Health Entrepreneurship Competencies

Like other medical school subjects, there are basic science and clinical components and the apprenticeship model is used to develop competent graduates. The same should apply to digital health and learning objectives, curriculum design and assessment should be in three basic and applied areas:

  1. The Embryology, Anatomy, and Physiology of Digital Health. In other words, how are digital health systems, products, and services evolving? How are they built and how do they work?
  2. Clinical Digital Health. How are digital health products and services used? Where are the gaps and opportunities and when are they effective? Like all drugs and technologies, what are the side effects or complications using them and when are they indicated?
  3. Digital Health Innovation and Entrepreneurship. How are digital health products and services designed, developed, tested, validated, deployed, and transferred to human subjects?

The course should be mandatory for every medical student. We should also separate education from training. Here is a summary of the topics typically covered:Section 1: Technologies

  • Social Media
  • Telemedicine
  • Data Analytics and Business Intelligence
  • Personalized and Precision Medicine
  • Wearables
  • Mobile Health Platforms
  • Electronic Medical Records
  • Health Information Exchange and Interoperability

Section 2: Applications

  • Diagnosis
  • Treatment
  • Prevention and Wellness
  • Prognosis
  • Rehabilitation
  • Behavioral Health
  • Disease Management
  • Public Health 

Section 3: Innovation and Entrepreneurship

  • Intellectual Property Protection
  • Regulatory Issues
  • Reimbursement
  • Business Models
  • Financing Digital Health Startup Ventures
  • Leading High-Performance digital Health Teams
  • Product and Customer Development
  • Lean Startup Methodologies
  • Clinical Validation and Translational Research
  • Data Security and Confidentiality

Section 4: Leading Interdisciplinary and Inter-Professional Teams

  • Team Dynamics
  • Leadership
  • Outcomes and Metrics
  • Conflict Resolution

Clinical Significance

Digital health tools have become an integral part of the contemporary practice of medicine and will continue to evolve. 

Other Issues

As technology advances in health care, it also raises challenges and ethical considerations for policymakers. Some of the concerns being raises include transmission of misinformation; the internet is awash with hundreds of medical sites offering all types of advice and treatment options. Many of these websites are not even operated by healthcare workers and the sources used to collect the information include Wikipedia and other non-peer reviewed articles. Patients often subscribe to these sites believing that all the information is true. Often patients make medical decisions without speaking to a healthcare professional and this may endanger the lives of many individuals.

In addition, there is also concern that many of the devices that make connect the patient to the healthcare provider may easily be accessed by third parties and lead to the release of sensitive patient information. Hacking of medical devices has been shown to occur from a distance.

Further, there is great concern that some health care providers who practice digital health may be releasing patient data, which may be in violation of HIPPA. to date, there are no guidelines on the practice of telehealth or telemedicine. As to what information and how much information can be released and under what circumstances is still being debated. 

Finally, a bigger push towards digital health may erode the trust towards healthcare workers and place more reliance on medical websites, leading to quackery. An example of this is the anti-vaccination movement which is quite vociferous and gaining momentum. At the end of the day, the physician must make an effort to physically see the patient on a regular basis. Digital health should only be a complimentary service and not a substitute for the conventional patient-doctor visit.


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Digital Health - Questions

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Digital Health - References

References

Woods L,Cummings E,Duff J,Walker K, Partnering in Digital Health Design: Engaging the Multidisciplinary Team in a Needs Analysis. Studies in health technology and informatics. 2018     [PubMed]
Sun O,Chen J,Magrabi F, Using Voice-Activated Conversational Interfaces for Reporting Patient Safety Incidents: A Technical Feasibility and Pilot Usability Study. Studies in health technology and informatics. 2018     [PubMed]
Tran M,Ginige JA,Boulamatsis C, Evaluation of Visualisation Techniques for Meaningful Representation of Clinical Classification Data Sets. Studies in health technology and informatics. 2018     [PubMed]
Mather C,Cummings E,Gale F, Mobile Learning in Nursing: Tales from the Profession. Studies in health technology and informatics. 2018     [PubMed]
King CE,Sarrafzadeh M, A SURVEY OF SMARTWATCHES IN REMOTE HEALTH MONITORING. Journal of healthcare informatics research. 2018 Jun     [PubMed]
Pianalto J, Hospital wayfinding bridges digital divide: Mobile solutions and personalized apps move signage to the next level. Health facilities management. 2016 Sep     [PubMed]
López CM,Qanungo S,Jenkins C,Acierno R, Technology as a Means to Address Disparities in Mental Health Research: A Guide to     [PubMed]
Havermans BM,Boot CR,Brouwers EP,Houtman IL,Heerkens YF,Zijlstra-Vlasveld MC,Twisk JW,Anema JR,van der Beek AJ, Effectiveness of a digital platform-based implementation strategy to prevent work stress in a healthcare organization: a 12-month follow-up controlled trial. Scandinavian journal of work, environment     [PubMed]
Kujala S,Hörhammer I,Kaipio J,Heponiemi T, Health professionals' expectations of a national patient portal for self-management. International journal of medical informatics. 2018 Sep     [PubMed]
King B,Fishman EK,Horton KM,Rowe SP, The Incipient Digital Revolution in Hospitality and Health Care: Digital Is Hospitable. Journal of the American College of Radiology : JACR. 2018 Jul 18     [PubMed]

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