Difference between revisions of "Digital Health"

Revision as of 00:59, 11 February 2022

Digital health is an emerging field that implements technology within healthcare to provide a wide variety of services ranging from mobile health, health information technology, wearable devices, telehealth and telemedicine, and personalized medicine.^[1] Digital health technologies make use of computing platforms, software, and sensors to aid providers and stakeholders in numerous efforts including reducing costs and inefficiencies and improving access and quality of care through a personalized and precise approach to medicine.^[1]

Although digital health technologies enable inexpensive communication and have the potential to prevent disease, the COVID-19 pandemic has made inequities between social and minority groups apparent.^[2] Critics also warn of privacy and security concerns regarding personal health information, along with the possibility of misinterpretation of medical results by patients due to the impersonal element of digital health networks.^[3]

Technologies

Mobile Health

The introduction of the smartphones has revolutionized peoples lives in many ways, including how they seek medical information. Specifically, smartphones have led to a popularity in mobile health, or mHealth, apps. These apps are health related applications that can serve a multitude of functions aimed at improving patients' health. The major app stores house over 165,000 apps that allow individuals to track their own health. These apps can provide “low cost, around-the-clock access” to health information to users, allowing them to stay informed on the best processes and techniques when navigating chronic disease management, mental health, and general health concerns.^[4]

Mobile health apps can be grouped into five categories. ^[4]

• Wellness Management - Two-thirds of the mhealth apps in the app store are consumer-facing that aim to encourage a healthy lifestyle. These apps monitor individuals’s diet and physical activity by collecting data through smartphones or external devices like a heart rate monitor.
• Medication Reminders - For individuals struggling with medication compliance, these apps allow patients to enter in their medications, provide a calendar, and send notifications on when to take their prescriptions.
• Disease Management - individuals with chronic diseases like diabetes benefit from mhealth apps given it allows them to keep a symptom diary, enter food diary entries, and ensure compliance with their medications and physical activity.
• Seld-Diagnosis - Apps of this nature have become popular among consumers during emergencies as they provide a first step for patients to understand their symptoms and generate possible diagnosis.
• Patient Portals - These apps are created primarily by major electronic health companies and enable Patients to access parts of their medical records like laboratory results and serve as a reminder tool for appointments, vaccinations and more.

Wearable Technology

Wearable technology consists of a broad scope of devices including smartwatches. Smartwatches and other fitness tracking devices became prominent starting in 2014 as individuals wanted to track more than just weight loss. ^[5] Popular fitness brands like Apple Watch and Fitbit are equipped with sensors on bands or patches that allow a user’s data to be logged throughout the day. These technologies allow consumers to self-monitor and regulate their own health practices without the need of a healthcare professions ^[6] For instance, these wearable gadgets allow users to track advanced metrics like heart rate, body fat percentage, menstrual cycle, and more.^[5]. Growth within this area is largely contributed to the growth of the internet of things, a move towards connecting devices to the internet ^[6].

In addition to smartwatches, there is ongoing research focusing on associated energy solutions for implantable devices in a healthcare setting. Progress has been made in the study of nanomaterials as research shows that they can allow for seamless interaction with soft tissues and organs. Research also suggests that an advantage of soft, flexible wearable sensors is its capability of tracking physiological parameters such as cardiac activity. These sensors can monitor cardiovascular biomarkers such as hearth rate, blood pressure and more to mitigate incidences and mortality of cardiovascular disease. Monitoring biomarkers through wearable sensors can allow healthcare professionals to deliver personalized medicine to their patients by tailoring medications and therapeutics based on collected data.^[4]

Telemedicine

Telemedicine encompasses a large array of digital health services.

Remote and Digital Clinics

Remote clinics have emerged to provide individuals in remote, typically rural communities, with specialty medical services. In many of these areas, there is also a lack of specialty expertise making it a necessary decision to link health care centers.

Digital clinics include email consultations which can provide rapid communication for non-urgent concerns. Video consultation have emerged as well to save patients time, hospital resources, and to provide care for those who do not have easy access to healthcare. ^[7]

Online Appointment Booking

Online appointment bookings allow for administrative efficiencies where staff sees a minimized number of missed appointments. The industry is Evolving to the technological changes through the use of smartphones to text alerts for appointments and confirmations. Services like ordering prescription refills online and booking clinical appointments have overall benefits like increasing patient outcome, reducing pharmaceutical risk and making the patient’s experience efficient. ^[7]

Digital Doctor

Recently, there has been an information overload due to expansion of knowledge base and biomedical evidence. Doctors are focused on referrals, x-rays, blood test reports, etc during appointments which means staring at computer screens instead of having a conversation with the patient. This hinders the personable component to patient-doctor relationships, but the technology of the time allows for smart access to quality info, allowing for better care and advice from healthcare professionals.^[7]

The “E-Doctor” Era

Nowadays, healthcare professionals google medical information before seeing their patients; they have access to patients monitors that can be viewed on their devices at any time. Even hospitals have adopted a modern digital service where electronic health records are kept for each patient. In this digital age, e-prescriptions ensure speedy drug delivery and also keep doctors aware of a patient’s drug record changes.^[7]

Other

New digital health applications, like artificial intelligence, continue to enter the market as the industry is trying to adapt. Artificial intelligence can be tool used to assist imaging specialists like radiologists that could help minimize errors in interpretation of images leading to more accurate diagnoses. This technology can propel acceleration and automation using AI algorithms to increase productivity and save time for all stakeholders. Tasks that may have been completed manually before could now utilize AI to accelerate the processes. ^[8]

Another technology assisting healthcare professionals is augmented reality. Augmented reality leverages 2D images and other patient data to then create a 3D model that can assist in understanding the anatomy of a patient’s body. These images help professionals like surgeons when planning surgical procedures, decreasing the chances of errors in the operating room. During an operation, surgeons and their teams must sort through a clutter of images and data which diverts their attention from the patient, increasing the chance of a error. Augmented reality technology allows for a higher level of precision when navigating the body to locate organs during an operation.^[8]

Recent Application: COVID-19

Over the course of history, digital health technologies have played an important role during pandemics. The impact on the public infrastructure caused by these health crises has made the need and development for digital technologies apparent. The current Covid-19 pandemic has challenged health systems in several ways making it critical to focus on early detection and treatment, surveillance and outbreak control. Healthcare providers have applied different services such as telemedicine, electronic health records and artificial intelligence to manage care and prevent and control the COVID-19 pandemic. During the pandemic, telemedicine has allowed for an exchange of information, while avoiding close contact to limit disease spread, reducing healthcare exposure, and streamlining decisions made in the first stage care of suspected COVID-19 patients. For instance, the COVID-19 information page has been a resourceful tool updated in real time, while providing readers with symptom information and instructions for quarantine processes. This service has even enabled patients to connect with healthcare providers for remote medical screenings and assessments in efforts to minimize frontline provider exposure. Additionally, with recent travel restrictions imposed, cloud based electronic health records have became critical in documenting recent history of travel to support efforts of contact tracing to control the spread of COVID-19 around the world. ^[9]

The pandemic has also given rise to certain new digital health technologies like artificial intelligence that have assisted in predicting modeling and trends that can help in creating a framework for the epidemic response (article). This technology has been aiding epidemiology and infectious disease professionals develop control strategies along with facilitating an effective COVID-19 vaccine delivery system.^[9]

Criticisms

AI Bias in Healthcare

Lack of Existing Regulations

As new digital health technologies have been introduced, it has become apparent that there is a lack of existing regulation within the industry. The first framework to be passed was in 1996 called The Health Insurance Portability and Accountability Act (HIPAA) to standardize the use of electronic health information and protect the public’s health information (ncbi). Since the implementation of HIPAA, critics have argued for stronger protections than are listed in the framework as it has merely reduced, not eliminated, concerns about privacy and security of personal health information (ncib). To strengthen the HIPAA rules, in 2009, The Health Information Technology for Economic Health and Clinical Health Act (HITECH) was signed to address the privacy and security concerns related to electronic health information (hhs).

In the technological age, the accuracy of health information on mHealth apps is a cause for concern. Given the age of widespread misinformation, a lack of regulations within the digital health space can compromise users’ health and safety (library). Due to the lack of regulations healthcare professionals are hesitant to recommend mHealth apps to patients (library). To help this, the FDA has issued guidance on an approach that focuses on certain apps to transform a mobile platform into a regulated medical device, but critics question whether this can be enforced to make an impact (library).

Privacy and Security Concerns

A big concern sparked by digital health is the privacy of big data. With the application of advanced analytics, protecting privacy has become a challenge. Given this, it is difficult to use standard mechanisms of protection because of how stretched they have become in an environment like this ^[10]

The collection and storage of personal health information have proliferated with the continuing increase in mHealth apps. Due to this, the Federal Trade Commission has recommended that mHealth apps add privacy policies given that consumers value control over their personal data. However, little attention is paid to these policies. A study revealed that only 183 out of 600 of the most commonly used mHealth apps had privacy policies ^[11]. A more recent study by the British Medical Journal analyzed nearly 21,000 mHealth apps available on the Google Play store and found that 88% of the apps could access and possibly share personal data. The analyzed data also suggests that 28.1% of mHealth apps offered no privacy policy text and 256% of data transmissions violated stated privacy policies. ^[12]

Wearable healthcare technologies pose their own privacy issues, however, there is a lower perception of risk towards these technologies as they are seen as low risk vs other devices like smartphones. A study done showed how sensors within smartwatches have been able to collect information on keyboards through keystrokes. This is referred to as keystroke inference attacks and many are unaware of this new type of threat to privacy. ^[13] Additionally, wearable technologies rely heavily on ioS and Android and vulnerabilities within these systems can be attacked by hackers, resulting in private data breaches. Users have a lack of control over their devices when it comes to data permissions given they are not able to shut down a sensor; hence it becomes difficult to authorize and view data. Legislation for wearable healthcare technologies is complicated given there is no uniform industry standard for the data format and content collection, leading to difficulties in storing and managing data. ^[14]

Data security is another concern as cyber-attacks and hacking of databases occur frequently. The Breach Portal of the Health and Human Services states that there have been millions of health care records that have been breached to date, and these incidents continue to rise. Growing public concerns regarding big data along with these incidents have painted a stark picture of the future of privacy, however, these concerns can largely be addressed through enforcement of articulated policies and the adoption of technologies that monitor and evaluate security systems. ^[10]

Misinterpretation of Results

References

1. ↑ ^{1.0 1.1} “What is Digital Health?” U.S Food and Drug Administration, 22 Sept. 2020, https://www.fda.gov/medical-devices/digital-health-center-excellence/what-digital-health.
2. ↑ Özdemir, Vural, OMICS: A Journal of Integrative Biology, Digital Is Political: Why We Need a Feminist Conceptual Lens on Determinants of Digital Health, vol. 25, no. 4, 2021, pp. 249-254., https://doi.org/10.1089/omi.2021.0020.
3. ↑ Özdemir, Vural, OMICS: A Journal of Integrative Biology, Digital Is Political: Why We Need a Feminist Conceptual Lens on Determinants of Digital Health, vol. 25, no. 4, 2021, pp. 249-254., https://doi.org/10.1089/omi.2021.0020.
4. ↑ ^{4.0 4.1 4.2} Kao, Cheng-Kai, and David M. Liebovitz. “Consumer Mobile Health Apps: Current State, Barriers, and Future Directions.” PM&R, vol. 9, 2017, https://doi.org/10.1016/j.pmrj.2017.02.018.
5. ↑ ^{5.0 5.1} Greiwe, Justin, and Sharmilee M. Nyenhuis. “Wearable Technology and How This Can Be Implemented into Clinical Practice.” Current Allergy and Asthma Reports, vol. 20, no. 8, 2020, https://doi.org/10.1007/s11882-020-00927-3.
6. ↑ ^{6.0 6.1} Rich, Emma, and Andy Miah. “Mobile, Wearable and Ingestible Health Technologies: Towards A Critical Research Agenda.” Self-Tracking, Health and Medicine, 2017, pp. 84–97., https://doi.org/10.4324/9781315108285-7.
7. ↑ ^{7.0 7.1 7.2 7.3} El-Miedany, Yasser. “Telehealth and Telemedicine: How the Digital Era Is Changing Standard Health Care.” Smart Homecare Technology and TeleHealth, Volume 4, 2017, pp. 43–51., https://doi.org/10.2147/shtt.s116009.
8. ↑ ^{8.0 8.1} Das, Reenita. “Top Five Digital Health Technologies in 2019.” Forbes, Forbes Magazine, 4 Feb. 2019, https://www.forbes.com/sites/reenitadas/2019/02/04/the-top-five-digital-health-technologies-in-2019/?sh=25112afc6c0f.
9. ↑ ^{9.0 9.1} Tilahun, Binyam, et al. “Mapping the Role of Digital Health Technologies in Prevention and Control of Covid-19 Pandemic: Review of the Literature.” Yearbook of Medical Informatics, vol. 30, no. 01, 2021, pp. 026–037., https://doi.org/10.1055/s-0041-1726505.
10. ↑ ^{10.0 10.1} Vayena, Effy, et al. “Digital Health: Meeting the Ethical and Policy Challenges.” Swiss Medical Weekly, EMH Media, 16 Jan. 2018, https://smw.ch/article/doi/smw.2018.14571.
11. ↑ Kao, Cheng-Kai, and David M. Liebovitz. “Consumer Mobile Health Apps: Current State, Barriers, and Future Directions.” Wiley Online Library, John Wiley & Sons, Ltd, 18 May 2017, https://onlinelibrary.wiley.com/doi/full/10.1016/j.pmrj.2017.02.018 .
12. ↑ Reynolds, Keith A. “Analysis Finds Serious Privacy Problems in Mobile Health Apps.” Medical Economics, Medical Economics, 21 June 2021, https://www.medicaleconomics.com/view/analysis-finds-serious-privacy-problems-in-mobile-health-apps.
13. ↑ Xue, Yukang. “A Review on Intelligent Wearables: Uses and Risks.” Wiley Online Library, John Wiley & Sons, Ltd, 16 Sept. 2019, https://onlinelibrary.wiley.com/doi/full/10.1002/hbe2.173.
14. ↑ Jiang, Dawei, and Guoquan Shi. “Research on Data Security and Privacy Protection of Wearable Equipment in Healthcare.” Journal of Healthcare Engineering, Hindawi, 5 Feb. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884134/.