20 Years on and Still the Same Problems for Digital Health Technology
Recently, while doing some preliminary research in the digital health space, I came across a publication in the BMJ from Balas and Iakovidis, titled “Distance technologies for patient monitoring.” What gave me pause was that this paper was published 20 years ago, and echoes many of the hope and concerns that still face the medical space around the integration of technology and health services. Their review highlighted the growing role of novel remote technologies that patients could use in the home to collect data, such as glucose monitors, blood pressure cuffs, skin sensors, and electronic stethoscopes, which could be shared over *ahem* a modem to allow providers remotely to see the data and utilize it in patient care.
New Tech but Same Issues
Balas and Iakovidis highlighted that “Future telehealth applications are likely to combine initial screening, measurement devices, patient education, decision support, appropriate telephone and video contacts, home visits, emergency support services, and physician access,” which would not look out of place in any paper published today regarding the same issues. I am sure they did not envision that seven years after this publication, that Apple would push for the mobile revolution, with widespread wireless internet connection, where smartphones and mobile apps would upend how patients go about their daily lives, but some of their summary points are still highly relevant:
Emerging home monitoring technologies can transform episode driven health services into a relationship-based continuum of care
The anticipated information surge from patients’ homes calls for computerised data processing and active decision support
We now see patients increasingly accessing online information, collecting personal data, and have an increased ability to engage in teleservices from their own phone, in contrast to a web camera on a personal computer. But we still are struggling with best practices regarding the use of digital health technologies. The implications of augmented intelligence, chatbots, digital therapeutics, and digital medicines are still being discussed. Training current and future health practitioners on how to utilize and manage this data in the workflow is tantamount. And yet, the authors seemed to have the foresight regarding this issue, with their comment that “Available studies are unspecific about the impact of increased technical sophistication on patient access to quality health care. The role of computer literacy and the need for training clinicians particularly need clarification in future studies. Evidence based healthcare policies could facilitate the development of home care technologies and also accelerate the introduction of these technologies in patient care.” It is incredible that in some ways, the issues two decades ago facing novel technology still ring true to this day.
Going beyond Futurism
We have seen multiple itineration of technology in healthcare discussions over the past twenty years. Whether we call it electronic health (eHealth), mobile health (mHealth), or now digital health, at some point, this will just become a standard of healthcare. But, perhaps, what holds this back is the continuous push to label the use of technology and health aspects as a separate entity. Telehealth is an interesting example, with its essential name still predisposed around telecommunication technologies to facilitate health. Most people now turn to an app, or web page, to look transfer money and maintain their finances, though the term telebanking is not foremost in most discussions, instead it is just accepted as an appropriate means of banking. If we continue to maintain this narrative, whereby it’s tele-x one decade, then digital-x another decade, can we really expect for health professionals and patients to accept it just as health? The futuristic jargon is one limitation, where it may attract early adopters and put others on the threshold of embracing the utilization of new tools, but the educational side also is an issue.
Keeping ahead of the curve and utilizing novel technologies in healthcare has never been an easy process. Costs, logistical integration, and managing patient data are all potential barriers. Nonetheless, introducing current health care students to what is being explored and developed can help alleviate future fears on technology adoption, and possibly help increase the time-to-implementation. We are now facing an era where Gen Z will be entering the medical space, and as digital natives, it can be hypothesized that their generation may be the one who can envision a continually connected health space. But, just as the authors identified, if we lack the ability to adapt and educate, we will keep having these same discussions for the foreseeable future without moving the bar to where healthcare needs to be.