We've Entered a New Era of Streaming Health Care. Now What?

COVID-19 forced the transition to digital medicine, but there's much still to do

6 min read
A young pregnant woman is having a video call with her female doctor while she's testing her blood sugar .

This is a guest post. The views expressed here are solely those of the authors and do not represent positions of IEEE Spectrum or the IEEE.

It's a rare soul who truly enjoys going to the doctor. Many people feel vulnerable when seated on a chilly exam table in that paper robe, and fear of the unknown or denial can keep people from seeking vital care. This problem has grown in importance as research has shown that preventive care and early detection of disease improve outcomes.

The COVID-19 pandemic changed the equation. It forced a transition to virtual health care delivery and exposed many patients, providers, and health care delivery organizations to the efficiencies and qualities of telemedicine for the first time. The pandemic also pushed venture capital investments in digital health to an all-time high; in 2021, investments had reached $14.7 billion by the end of the second quarter, surpassing the figure for all of 2020.

The change to telemedicine has the potential to transform our entire model of health care, and potentially to vastly improve the health and wellbeing of millions of people. First, consider the traditional model: It's really a "sick care" system that waits for patients to become ill before intervening. This reactive model of care often fails to adequately engage patients in the management of their own health.

Streaming health care can enable a proactive and preventative model of care, using at-home devices and virtual visits to provide a steady flow of information to both people and their doctors. Continuous biometric and symptom data can enable earlier health intervention, preventing the progression and even development of disease, and thus avoiding the costs of emergency treatment and surgery. Personal health devices can not only supply more data over time, they can also provide a more holistic view of the patient that allows for more precisely calibrated treatment.

But to reap the full benefits of the virtual health care model, we must engage users in a continuous health care experience that leverages wearables and other devices. It's our strong belief that digital self-tracking devices and software should be used universally and will serve as powerful generators of valuable data, leading to truly personalized care and profound medical insights.

How Gadgets Can Change Everything

With the help of self-tracking devices that can be used at home, we can provide real-time and individualized feedback so users can gain knowledge of how their behaviors affect their health and become active participants in their health care. Knowledge is power: By seeing in real-time how behaviors such as exercise, diet, and sleep affect health, people can have real insights into their own health preservation.

Digitally connected self-tracking devices come in a variety of forms, such as sensor-embedded wearables, ancillary devices, smartphones, and software. These tools allow users to document and collect, over a long period of time, many measures of human health and behavior. These tools can track such things as heart behavior, sleep duration and quality, metabolism, fertility, neuromotor function, cognition, mental health, nutrition, and physical conditioning.

Illustration of patient information including Sleep, Activity, Labs, Respiratory levels and Cardiac which has a red alert that says "Alert! Atrial Fibrillation Detected" and in the center an alert that says "Elevated Glucose Atrial Fibrillation Detected Sleep Apnea Event"In the patient's view of a hypothetical health app, a patient can access data that is obtained both passively from sensors and actively from patient engagement. USC Center for Body Computing

The line between consumer and medical devices is blurring. Many consumer wearables now have sophisticated health management software that helps people use the collected data to support their health goals. Medically regulated wearable devices, like glucose-measuring patches for people with diabetes, give diabetics continuous glucose information and allow them to take proactive measures in insulin dosing, diet, and activity to optimize their blood sugar. But the same kind of glucose sensor could be repurposed to help non-diabetic people manage their nutrition and enhance their physical or cognitive performance. Similarly, data collected by a consumer wearable that tracks respiratory rate could be augmented with an oxygen sensor to allow individuals to track their clinical status if impacted by a respiratory infection, such as COVID-19.

In addition to providing unprecedented amounts of user information, the new wave of digital health diagnostic devices and software also provide new opportunities to introduce digital therapeutics in patients' homes. For example, a recently approved digital therapeutic called Nightware is helping people with PTSD-associated nightmares sleep better. That system uses the sensors on an Apple Watch (namely the heart sensor, accelerometer, and gyroscope) to detect a nightmare, and then delivers a vibration stimulus to the wrist that terminates the nightmare without waking the user.

Continuously collected data has great potential to fill in existing knowledge gaps related to an individual's risk of developing disease over time. For example, while we know that physical activity declines with illness and that obesity is associated with a significant risk of type II diabetes, what does that transition look like in the data? And can we use what we learn about the data trendlines to create individual risk and susceptibility profiles? With the help of artificial intelligence and predictive analytics, we could notify individuals of their risks.

Yet just giving a person information isn't enough. The user experience that accompanies digital health and self-tracking is critical to helping people interpret, understand, and gain motivation to act on their data. According to the well-established theory of self-determination, people are motivated to grow and change when their needs for autonomy, competence, and relatedness are fulfilled. By providing instantaneous feedback on actions that impact one's health along with education and supportive narratives, these solutions can empower patients to make meaningful changes in behavior.

Don't Forget the Doctors

Providing health care can be a traumatic experience these days. Physician burnout is at record highs, due to a host of time-consuming and career-threatening compliance obligations that place enormous stress on the provider. Digital tools like the electronic medical record (EMR) software provide easier access to patient data but also impose huge burdens on physicians that detract from the doctor-patient relationship.

Streaming health care can offer relief from the routine and repetitive tasks that are largely responsible for provider burnout. This relief can come if physicians know that automated systems are managing the custodial tasks involved in patient care, such as doing symptom checks, monitoring vital signs, collecting other biometric data, checking on medication adherence, and educating patients. Systems that use bots, validated voice recognition, or embedded artificial intelligence can handle typical inquiries, while also standardizing the quality of information delivered to patients.

Illustration of doctor information showing a list of appointments and a red alert about Patient Sarah Johnson that says Elevated Glucose Atrial Fibrillation Detected Sleep Apnea Event" and "Call Sarah Johnson".In the doctor's view of a hypothetical health app, the doctor receives alerts relating to patient data that indicates a possible problem.USC Center for Body Computing

The doctor-patient relationship would also benefit. Increasingly accurate and convenient devices can provide users with a steady stream of information about their own health, helping them better understand their condition and thus seeing their physician as a care partner rather than an authority figure. All of these changes could transform the experience of being a doctor: Physicians could spend more time providing care to people who require their expertise and could reach a greater number of patients, regardless of their geographic location.

The Grand Challenges

There's a lot of work still to do. For streaming health care to achieve its full potential, we need more rigor in collecting data from wearable and self-tracking devices, we need to build a trusted health care streaming service that respects ethics and privacy, and we need to ensure cybersecurity. While there has been substantial research in validating the performance of virtual care, there has been essentially no research on this model's ethical issues, effect on privacy, or role in perpetuating health inequities.

Ethical use of digital health data is one of the most important considerations, and it's essential to earn consumer trust. Ethical governance of data use is still largely an academic discussion; that conversation needs to evolve into globally adopted policies that protect individuals' data and assure their privacy and autonomy.

Cybersecurity is another huge issue that must be addressed promptly. The proliferation of ransomware and other attacks on health care systems threatens the new model of digitally enabled health care, since virtual assessments with the constant collecting of individuals' biometric information will generate vast amounts of valuable data. At the current time, legislation and regulation are evolving to assure these protections. But they must evolve quickly to match the lightning pace at which digital health is advancing, otherwise shoddy practices and data breaches may limit user trust and uptake.

Another barrier to adoption is accessibility. On one hand, remote health monitoring can make health care more widely available, whether it be to rural areas with less resources, to people who have mobility problems, or to people without transportation. However, certain groups may be excluded because they don't own the necessary devices or because they have limited technical skills, thereby perpetuating health inequities. We need additional research on health economics to understand if virtual health care solutions that improve outcomes justify providing devices and data plans to people as covered services.

Medicine is not one-size-fits-all, and a universal standard for the treatment of human doesn't exist. By better understanding our health and behaviors, we can better understand ourselves. Connected smartphones, wearables, software, and services present a historic opportunity to transform patients' role in medicine by appealing to their autonomy and competence, inspiring active engagement in their own care. Continuous health streaming may liberate anxious and idle patients from fear of the unknown, putting them on the path toward self-knowledge and health optimization.

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