The Double-Edged Sword of Digital Health and Patient Safety

alt By the 2010s, the digitalisation of healthcare became unavoidable, giving a new status quo and new quotes to patients and caregivers. Now the availability of medical technologies, such as artificial intelligence and telemedicine, and the growing amount of openly accessible medical information facilitate the continuity of care and permit a defined – yet individualised- patient journey.

How digital health betters healthcare

One example of the benefit of digital health for improving healthcare delivery is in critical care medicine. Telemedicine allows patients in distant intensive care units (ICUs) to exchange health information through real-time audio, visual, and electronic means with healthcare providers. The ability of tele-ICU programmes to drive improved clinical outcomes is well-documented. Hospitals that have introduced tele-ICU care managed to reduce their ICU mortality rate and safely decrease the average length of stay in the ICU.[1]

Another asset of digital health is the access to better quality care more efficiently, through solutions and services such as electronic medical records, virtual visits and patient portals.

What does this mean for clinicians?

  • More efficient decision making through access to relevant patient information
  • More convenient e-consult platforms
  • Reduced medication errors with e-prescribing technology
  • Increased diagnostic accuracy, with access to patient’s complete history

And what does this mean for patients?

  • Ability to access their own lab test results and personal health information online
  • More patient engagement and empowerment
  • More time-efficient and affordable way to access health and care services

Digital health: room for improvement

Although there are several examples in which digital health has been associated with improved clinical outcomes, whether these innovations place patients at increased risk remains questionable. Reports about technology-enabled change tend to focus on the large number of exciting future opportunities, but less on how to avoid common pitfalls.[2,3] This is further complicated by the nature of innovation, where there is often a tension between the need for evidence of effectiveness and the drive for fast-paced technological innovation. So, whilst digital innovations offer considerable potential to enhance patient safety, progress remains challenging.

  • Lack of standardisation: In spite of the increased access to clinical data resources, there is still a lack of standardisation of definitions and formats that negatively affect interoperability of health records. This limits the development of comprehensive and universally adopted standards for diagnosis and treatment using evidence-based medicine. It also reduces the accuracy in establishing a patient’s true health condition. For example, many heart failure patients exhibit non-specific symptoms, that are difficult to identify and distinguish from other conditions. Thus, those patients may have undiagnosed or falsely diagnosed heart failure.

  • Questionable software quality: Most e-health applications are produced by developers without medical expertise and lack rigorous evaluation before deployment for general use. Similarly, several digital health programmes have failed miserably despite the investments and commitment of key stakeholders. This is due to inconsistencies generated on the clinical, organisational and institutional level or because open confrontation between health care professionals and policy makers for decision-making power on technological innovation.

  • Patient access to medical data: There is concern that unfiltered medical records or clinician notes may cause confusion to patients who are not necessarily well-versed in healthcare terminology. Decoding these notes might create more issues than it resolves. At the same time, patient data access still harbours a major concern: what if patients are offended by clinician notes or become worried by certain lab findings?

  • Privacy breach: The principal threat to patient safety is the breach of privacy and data security that can occur either as a result of human mistake, or malicious intent. The risk of patient privacy violations is a big concern for patients due to the increasing amount of health information exchanged electronically. There is evidence that people behave differently in online interactions than they do face-to-face which means that they may violate certain norms, such as being more willing to sign something that is false online. Although few electronic data are entirely secure, strict laws and regulations intended to ensure the privacy of clinical information are not yet universally applicable.

What can be done?

What we need is a scalable way to see how safe and effective these innovations are. The vision is to use medical technologies to provide tailored, patient-level recommendations based on a person’s medical history. Fundamental steps are to increase research efforts to evaluate the safety and effectiveness of digital health applications, as well as to address how health-related applications handle safety issues, with adapting the associated regulatory frameworks.

Not only do we need to agree on the most appropriate, scientifically rigorous and ethically sound mechanism for access to these types of data and applications, but we must also become better self-promoters of research while advocating for appropriate access to them.

by Anna Tzanni, Scientific Advisor, medDigital

References:

[1] https://thejournalofmhealth.com/tele-icu-programs-the-benefits-to-critical-care-teams/

[2] Labrique et al. Glob Health Sci Pract. 2018; 6(Suppl 1): S5–S17

[3] Konduri et al. Digit Health. 2018 Jan-Dec; 4: 2055207618771407