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Digital medicine: Hype or hope?

Digital medicine is everywhere, but for most doctors they have a hard time defining it, with most believing it is simply about wrist-worn activity trackers that we all got for Christmas, but are now in a drawer somewhere not really helping anyone stay active.

So what is digital medicine? Is it all hype, or is it something that will change the way we practise medicine, or maybe even replace us as clinicians?

Digital medicine is essentially the management of health related information: How we acquire it, store it, analyse it and use it to make decisions connected to health. 

Much of this information we have been collecting and processing for decades, albeit in a largely analog format. However, with the capabilities afforded by recent medtech innovation, how we organise and utilise this data has dramatically changed.

When Willem Einthoven recorded one of the first ECG traces using a rather bulky recording instrument in 1905 he would have been astounded to witness the contemporary technologies that allow live ECG recording and interpretation using a wristwatch or a credit card-size plate on the back of a phone.

Norman Holter, the inventor of the 24-hour Holter monitor, that originally weighed in at 37kg in 1947, would be amazed that the same function can be achieved using a plaster-sized device, for up to two weeks, that doesn’t require the patient to attend a hospital. 

The stethoscope, an iconic symbol of medicine, is slowly being replaced by handheld echo probes, which attach directly to smartphones.

All of this information we have been acquiring and analysing in healthcare for decades. But two crucial differences now exist. Firstly, we are obtaining this data at point-of-care, with devices on a much smaller and cheaper scale. Secondly, and more importantly, patients and not clinicians are acquiring much of this biometric information directly. 

With the evolving landscape of digital medicine comes an increasingly engaged and health literate patient population. This isn’t about patients taking over all aspects of clinical care, by simply searching Google. This is about patients becoming more active participants in their own care, rather than relying on the clinical community to map every single step of their healthcare needs.

Some clinicians may push back against patients playing an increasingly involved role in their own care. But there is little doubt that the person who has most at stake is the patient. It is not as if we have the scope to answer every clinical question, or provide guidance at any given moment. So while digital medicine facilitates greater patient engagement, it is best delivered in collaboration with clinical supervision.   

However, with patients becoming more involved and often beyond the oversight of clinicians, a strand of digital medicine has been advertised to patients without appropriate scientific validation. It is under this guise that digital medicine has earned, the not so prestigious accolade of holding the potential to be the next generation’s ‘snake oil’ according to the American Medical Association’s CEO Dr James Madara. With claims of weight loss, using electronic headbands, and microbiome analysis, making ‘illness optional’, there is no doubt that the concept of digital medicine may not only be seriously damaged, but, more importantly, patients being deceived or harmed.

The only antidote to such erroneous assertions is the necessity of a scientifically rigorous evidence-base to back up any such claims and not allowing companies that provide medical information to hide behind the guise of ‘for entertainment purposes only’. Rapid innovation is important, but scientifically sound standards must always be maintained.         

If digital medicine is all about the use of biometric data and managed by artificial intelligence systems, thereby excluding the clinician from a large part of the clinical workflow, the question is: Will clinicians become obsolete and will we be replaced by a complex set of algorithms?

The answer is yes, for a large part of what we do. But this should come as no surprise, as many of the tasks we have performed in the past as clinicians are automated today. And healthcare systems still have use for us.

Clinicians will always be required, but how we interface with the digital medicine architecture of the future will no doubt be vastly different.

Digital medicine is about raw data processing and artificial intelligence will always be far better at that than we are as clinicians. What the machines will never do, however, is hold a patients hand when giving a diagnosis of cancer, or stand outside the ICU to tell a family their loved one has died. So maybe, just maybe, digital medicine will take care of the data and allow us to do what we do best and take care of the patients.

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