DIGITAL HEALTH

Giving birth to new delivery models and fostering innovation

SB Bhattacharyya, Member, National EHR Standardisation Committee, MoHFW, GoI, India Member, Health Informatics Sectional Committee, MHD , BIS.

A 24 x 7 connected healthcare ecosystem where the care receivers and their care providers and receivers are able to be in touch anytime anywhere is changing the way services are being delivered and health is being managed remotely. This article discusses how this is being made possible and the various issues associated with it.

Get connected and stay connected is the new mantra for a new age. As applied to healthcare, digital health is the new paradigm that has the society extremely excited about it and rightfully so. The ubiquitous, relatively-affordable and ever-so-powerful smartphone from a computing perspective has led to a situation where almost every individual is never far from getting the latest information out there literally at his fingertips at any time, the source of which can not only be the Internet but also his own body.

The multitude of mobility apps along with wearable sensors and devices has meant that the person can access instantaneous access to his health status. This has also led to a situation where anyone anywhere with the appropriate access privileges is able to remotely monitor the health status and provide required feedback almost instantaneously to help the individual maintain a healthy state.

By coupling these with right machine learning algorithms, it is possible to run predictive analytics on the available clinical data, some of which are big data, and inform about any impending health issue that can have important consequences.

At the heart of the new ecosystem created by digital health is wellness, i.e. maintaining health. While it has been well-known for quite a while now that prevention is better than cure, it is only recently that there has been any real tools available to that group of stakeholders who really matter — the people — to be able to take charge of their own health. Unless individuals are empowered to take charge of their own health and managing the prevention-methods that would help keep them healthy, the intent of being healthy and staying healthy would remain no more than fantasy at best. Digital health certainly helps address this lacunae in a very effective manner for it has the right components to help the care providers provide the ‘right care’ at the ‘right time’ to the ‘right individual’.

Digital Health – A New Paradigm

‘Digital health’ is essentially an ecosystem where digital technologies such as telecommunications, information technology, information science and informatics converges with health, healthcare, living, and society to enhance the efficiency of healthcare delivery services and help make healthcare individual-specific and precise.1

Simply put, through the use of various electronic healthcare-related devices and telecommunication methods, healthcare is now turning from the hitherto traditional ‘sick care’ approach to the more modern and efficient ‘continuous care’ management by engaging the individual and care provider by connecting them on a 24x7 basis.

Meeting Newer Demand

Gone are the days when a person would visit a consultant for evaluation and alleviation of his problems on an episodic basis. The increasingly prevalent trend that is certain to increase in the future too is to seek advice and be guided from a distance. This helps by having the individual to travel less and spending lesser time away from one’s daily activities leading to higher productivity and lesser loss of time and money. An important offshoot of this approach is lesser number of individuals visiting healthcare facilities for routine work like check-ups and follow ups, many of which can be done from a distance in cases where there are no complications or causes for concern. This in turn leads to the situation where specialists are able to concentrate on those who really require their undivided attention and consequently provide better care to these individuals.

The individual of today demands that he be ‘connected’ to all that he wishes to and expects all his ‘connects’ to respond as fast as possible. These ‘connects’ include service providers and even the government of the day. This has led to profound changes in the way businesses need to run and provide appropriate services to their customers. As online stores replace shops and malls, healthcare services need to be delivered not merely from within the confines of institutions with clinical encounters occurring only face-to-face and in person, but from afar using telehealth that encompasses remote consultation and monitoring. The availability of machines with significant computing power capable of delivering high performance and advanced healthcare IT systems that can leverage mobile technology has made health management of individuals both personal and precise.

Successfully leveraging all this leads to elimination of inefficiencies, improved care access, reduction in costs due to less travel time. Repeated evaluations for the same condition as more and more past results, reports and records are instantly available online. Reduced incomes due to having to take enforced leaves to visit a consultant in person is well-addressed. Service quality and outcomes are significantly improved as the specialists are now able to devote more of their extremely valuable time to managing those who require their attention most.

The easy availability of wearable devices of the affordable kind backed up by patients and consumers can use digital health to better manage and track their health and wellness related activities.

The use of technologies such as smart phones, social networks and internet applications is not only changing the way we communicate, but is also providing innovative ways for us to monitor our health and well-being and giving us greater access to and exchange of information. Taken collectively, these advancements are leading to a convergence of people, information, technology and connectivity to help improve health care and achieve better health outcomes.

Leveraging Current State

Let us look at what all exists today in the real world.

Increased use of health information systems, with ever-increasing adoption and use of womb-to-tomb Electronic Health Records (EHR) coupled with widespread use of affordable mobile connectivity, has led to a situation where all healthcare stakeholders are able to appropriately harness cloud computing. The latter being a type of Internet computing where the Internet is used to deliver different types of computer-related services like server, storage, applications, etc. to connected computers and devices2.

While the craze for wearables by healthy individuals appears to be tapering off mostly due to less-thandependable data they generate, Internet of Medical Things (IoMT) has an important role to play in monitoring of health status for both the healthy and those requiring monitoring on a long-term basis, which may even be life-long and is consequently here to stay. The term is collectively applied to wireless sensors and devices like wearables, apps, monitors, etc. that are connected to other “things” or to a central system that performs storage, analysis and monitoring via aggregation devices located at the patient’s site. The data generated by them is analysed in real-time to help care providers take the necessary care-related decisions irrespective of the physical location of the person.

The handheld devices like the nearubiquitous smartphone are almost close to a personal computer for all effective purposes in terms of computing power, storage and networking capabilities. These devices use GPS for location, accelerometer for motion, flashlight for light, sensors for proximity and temperature, able to capture and reproduce high fidelity sound (through microphone and speakers) and capture and display HD or better quality video (through camera and display screen). All of them additionally support a host of wireless connection protocols (Wi-Fi, Bluetooth®, NFC, etc.) that makes them able to exchange data with external devices having compatible capabilities. These features makes the affordable and commonplace enough for the smartphones to be considered an important health management tool in the hand of the various stakeholders3.

The availability of High Performance Computing (HPC) as it is commonly known, has made processing and analysing huge amounts of all data, including big data, possible. When clinical data is analysed using them, it is possible to flag impending clinical events and take corrective measures to ensure that morbidity and mortality can be minimised to near-zero levels.

Individual genome sequencing of individuals is now relatively affordable in many geographies. Matching them with known health markers can help individuals and their providers to better manage their health. By leveraging HPC, it is possible to help deliver individualised care with high degrees of precision to patients relatively easily and as frequently as required.

The available data can be analysed with relative ease and by appropriately leveraging machine learning they can be used to perform predictive analytics. These would be useful in alerting the various stakeholders of any areas of concern or impending clinical event with fairly reasonable degrees of accuracy.

With the focus of care delivery having long since shifted from ‘sick care’ that only institutions could provide to ‘wellness and preventive care’ that is possible to be delivered remotely to the individual, irrespective of his location. The ecosystem requires appropriate tools that can enable the stakeholders to function optimally. Digital health for sure could not have chosen a more opportune moment to arrive like a gallant knight in shining armour.

Proofing the Future

With increased availability of healthrelated information of varying dependability, increased awareness about one's rights, and desire to be healthy instead of just not-sick has led to individuals to take charge of their overall health and well-being. Better care outcomes has meant people are living longer, many with chronic ailments that require regular monitoring, which means frequent travels and visits to physician's offices for the elderly and the infirm — something that needs to be at a minimum if not avoided. Occasionally, it is either not possible or the decision to move to a healthcare facility taken way too late, leading to consequences that were avoidable.

The demands on healthcare providers has increased with increased population without concomitant increase in their numbers. A modernday care provider is overwhelmed by oversensitive and discerning patients who are sufficiently knowledgeable and very interested in their health. Not only are patients spending more time during every clinical encounter and the providers having to process more information as a result of better investigations being readily available and routinely undergone, their numbers are just way too many to be handled in the 24 hours that any care provider has.

This has led to the need for connecting individuals with their providers 24 x 7, enabling the latter to intervene on-demand. The treatment provided needs to be both individualised and precise to help ensure optimal outcomes. This means that the provider needs to be sufficiently enabled to have the individual's latest health-status at his fingertips to help dispense the bestpossible care advice that will ensure optimal outcomes in terms of quality of life at minimal costs in terms of expenses, time and treatment-related adverse events.

Increasingly, care will need to be provided mostly in the individual's location and minimally at any facility. This will reduce inpatient's stay, an offshoot of which will be lesser exposure to conditions that cause increased morbidity and mortality, while increasing patient's compliance. The overall expenses are reduced too, all of which is very good news for patients and payers. However, this also means that the care provider will have to somehow be available on-demand to the individual.

The humongous amounts of clinical data generated will need to be properly analysed to provide the best-possible solution as quickly as is practical and the care provider of tomorrow will need to separate noise from substance. By leveraging predictive analytics, he will need to be able to pre-empt clinical events and forewarn individuals of any impending events, potential or actual, and appropriately guide them to ensure that all preventive measures are undertaken well in advance, thereby helping to maintain health.

This means that innovative care services delivery models need to be identified and put in place. To this end, telehealth, which essentially means remote monitoring and care appears to provide the best possible solutions.

Need for Circumspection

Cyber safety and security-related issues assume all the more important role within the “Digital Health” paradigm. The underlying issues are serious and potentially life-threatening unless taken care of in a very robust manner.

Electronic devices can be adversely affected by interfering with signals that connect the mobile devices to remote locations. Wrong data or instructions can ruin anything. While manufacturing them, appropriate levels of care needs to be taken to mitigate this.

Dependable and well-proven techniques and processes exist that can help mitigate them, provided they are implemented and followed with due dedication, application and devotion.

The analysis methodology too needs to be well-formulated and repeatedly validated to ensure that the right information is made available to the stakeholders who take healthrelated decisions by basing their clinical assessments on them.

By taking cognisance of these issues and applying due care, it is possible to alleviate them and provide the right confidence to the stakeholders with respect to the safety and security.

Health data has serious privacy issues. These too need to be taken care of and provide sufficient assurances that confidential information shall indeed remain confidential.

Conclusion

Digital health is the future of healthcare, there can be no doubt about it. With every new day comes new challenges and healthcare is not immune to it. The various regulatory pressures, increased competition, increased patient load and need to lower expenses are all causing enormous pressures within the healthcare delivery ecosystem.

The care providers, both institutional and individual, need to be able to face the various challenges while remaining competitive in terms of efficiency, productivity and profitability. The ever-demanding and very discerning customer of their services need to have the necessary assurances that their care providers are sensitive enough to their needs and wants and are able to effectively address them to the satisfaction of all stakeholders.

References:

1. There have been authors who have argued that genomic technology is an integral part of this ecosystem and it definitely augments the precision and individualisation of healthcare, but it is an adjunct and not strictly “digital” in the commonly-understood sense of the term. (https://storyofdigitalhealth.com/definition/)

2. A DIY Guide to Telemedicine, SB Bhattacharyya, Springer Nature

3. A DIY Guide to Telemedicine, SB Bhattacharyya, Springer Nature

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Author Bio

SB Bhattacharyya

SB Bhattacharyya, MBBS, MBA, FCGP is a practising family physician and health informatics professional working as business solution architect for IT in the healthcare and life-sciences domains. He is Honorary State Secretary (2015), IMA Haryana State, Member, National EMR Standards Committee, MoH&FW, Member, Health Informatics Sectional Committee, BIS and Ex-President, IAMI. His main interests include EHR, predictive analysis in medicine and application of machine learning techniques for treatment protocol planning.