COMMENTARY

The Goals and Challenges of Digital Health

Mamas A. Mamas, BM, BCh, MA, DPhil, FRCP.

Disclosures

October 04, 2018

My name is Professor Mamas Mamas. And today we're going to talk about digital health and its use in clinical medicine. Digital health is becoming increasingly important and an area of increasing focus. A number of the national and international societies are now really developing working groups around digital health and for example, the European Cardiac Society (ESC). And I think it's a really exciting time in that digital health may completely change how we practise medicine.

So what do we mean by digital health? Well, digital health is the convergence of digital technologies with healthcare to enhance the delivery and the efficiency of healthcare, and it allows us to make treatment options much more personalised and precise for patients.

So digital health involves using information technology to address problems and challenges faced by patients. And these sorts of technologies can be software and hardware technologies. And the types of digital health technology can vary. So we often think of digital health technology as wearable devices but there are other factors such as telemedicine, email, mobile phones, applications, and it can be things like novel ways using technology to communicate information to patients, but also to help healthcare professionals.

Wearables

So one of the most obvious areas for digital health are wearable devices. So wearable devices have been used for a number of different factors. So for example, atrial fibrillation is a very common use of these wearable devices. After all, the Apple Watch has been released and the Apple Watch is used to detect AF, that's one of the big selling points of the Apple Watch. But other wearable devices have had a number of studies focused around them using them in high-risk patients. For example, patients post AF ablation, patients at high risk of developing AF.

I think the challenges for the National Health Service, particularly in other healthcare systems, will be how to action this information because there's no doubt that a lot of these wearable devices will accurately detect atrial fibrillation. But the question is, how then do we use this information? How is this information stored? How is this information stored securely? And how is it accessed? How is it actioned? Because again, we're going to have to change the way that we deliver healthcare within hospitals to be able to use this information to treat patients. And so then there's the whole issue of cost effectiveness.

Whilst these applications and these wearable devices can detect atrial fibrillation, is it cost effective? You know, there's the issues around the cost of the wearable devices. The cost of changing our services and how we deliver these services. And does it result in a benefit over conventional methods for detecting AF?

So these are areas that over the coming years are areas that we really need to think about. Other aspects of digital health include aspects such as mobile phone and text messages. So for example, for a number of conditions such as diabetes, or for patients that struggle to remember adherence of medications, there are a number of digital health studies that have shown improved adherence, improved outcomes through sending patients text messages.

I think other important aspects are telemedicine. So, for example a number of devices can measure congestion in the lungs, so CRT devices, and they send information to the treating clinician.

So for example, the OptiVol device, that can help guide diuretic therapy in patients with heart failure. So again, we're using these sorts of devices to help personalise our treatments and perhaps keep patients out of hospital and allow much more closer monitoring [of] good patients than is currently possible in the healthcare arena.

Big Data and Digital Health

We also have digital health technology using big data. So a lot of what we do in medicine focuses around risk prediction, using risk models to predict outcomes for patients, using risk models to predict the efficacy of treatments, and whether it's the right treatment for the right patient. And so we use big data, machine learning, to capture a wide range of information electronically and develop prognostic models. So this is increasingly taking place.

I think one of the important aspects of digital health that we should really not lose sight of is the patients themselves. Don't forget many of the people that deliver these digital health solutions and interventions are young scientists or middle-aged doctors that are very digitally cognisant, such as myself, but don't forget the end users of these devices are older comorbid patients. And so any technology solution has to be acceptable to them.

I know there have been studies about the use of mobile phones in patients that are elderly and often these patients don't have smartphones. These are patients with conventional phones and who prefer text messages. So I think, you know, one of the key challenges going forwards with digital health is making the application in such a manner that is easily understandable to patients and individuals that perhaps don't have as much exposure or experience to IT.

So I think in summary, digital health represents a very exciting opportunity for us. I think it will represent a big challenge to the NHS because it will certainly change how we deliver services. But I think the most important thing is not to forget who the end user is, and really focus on digital health solutions to the elderly comorbid patients. So what does everybody else think? How does digital health impact on your practice? How do you use it in your practice?

You can follow Mamas Mamas on Twitter

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