Listen to this as a podcast courtesy of the IFMiL or Catalan Institute of Medical Education and Leadership.
Ever since the industrial revolution, there has been a fear of machines taking over our work and medicine is no different. There can be a feeling among digital health enthusiasts that doctors are anti-innovation and that they will have to reinvent themselves or be left behind. Nothing further from the truth in a profession where life-long learning is part of the course and having to think on your feet with every patient is the norm. What is true is that clinicians need to see a validated use for digital health solutions, and that may not be the use that the developers initially had in mind. Another aspect is that there is the mantra “first do no harm” is never far from any clinicians” mind and that reticence to adopt new technology is often coupled to a very real and not theoretical realisation that it is people’s life and health which are at risk if they don’t work. Every medication prescribed has been through a stringent, ongoing safety process and even then, as we sign digitally or with a pen, we do it knowing that is always a risk-benefit balance to our decision. It is not a dinosaur mentality which prevents clinicians unthinkingly adopting every new shiny digital health solution we are presented with. Instead, it is our primary function of being the patient’s advocate and therefore making sure the risk-benefit is in their favour.
Digital health technology, including lifestyle apps, don’t require clinical evidence to be released, and the need for them to be regulated, is discussed in episode 1 of this third series. Digital medicine software or hardware that intervenes and measures human health do need clinical evidence. Furthermore, when it comes to digital therapeutics, in which the technology delivers an intervention, that evidence needs to be not only clinical but also based on real-world outcomes.
Getting the clinicians onboard.
This leads to the question; how can we get valid digital medicine solutions into our daily practice? This is something at which Dr Cesar Morcillo at the Sanitas hospital in Barcelona has been looking. He argues that this is our opportunity to make the change to patient-centred care, and also to expand it to health workers who, as we are seeing in the current pandemic, can quickly become patients in themselves. The power of these digital solutions, whether on the ward in the hospital or at home after they have been discharged, is the ability to relay the information 24h not just the snapshot of time the doctor and nurse are at the bedside. Digital solutions have to be agile and responsive to patient needs. Aim for a good enough attitude to the first version, which is perfected in response to feedback from real patients and clinicians. This feedback needs to be complemented with data and evidence-based. The ability to harvest patient data and work with it in this way directly benefits the patients to whom the data belongs. Medicine is not a solitary practise and working in a transversal manner with other teams leads to better integration of digital health solutions. It also leads to improvement as they too will feedback on what works and what can be done better based on their expertise.
If the mindset is that of “improving a service rather than implementing a technology”, the introduction of new digital solutions is more likely to be successful.
Often successful innovation comes from HCP themselves. Being best placed to see the problem first-hand, they can then suggest solutions which work for their population within the framework of the services they already offer. One example of this is the fracture clinic at the Royal Sussex County Hospital in Brighton, England. A physiotherapist and an orthopaedic surgeon have saved the NHS over half a million pounds by enabling fracture and soft tissue injuries to be followed up virtually. As an EM doctor, I would see patients in the ED, x-ray if necessary, treat and discharge and then the patient would previously have had to come back to a fracture clinic at a hospital with terrible parking and access. Even more complicated for patients with injuries which decrease their mobility. Now, their details would be entered into the virtual fracture clinic referral with all contact details, physical examination and management plan from the ED. All of these patients get reviewed within 24h and receive a video message from the consultant or phone call. Further follow-up can also be virtual. Only patients really needing face to face contact have to come in. An example of innovation from within, this system has been extended to other hospitals. Although this is a model that existed in other parts of the world, the fact that it was introduced by colleagues and not externally, giving a real solution to a real problem meant that the uptake was smoother. All hospitals, whether in Spain or the NHS, have an innovation team. They are tasked with helping clinicians to transform their clinical solutions into reality. They have the experience and team to support clinicians who may otherwise be reticent to take on the non-clinical aspects of digital transformation. If you have an idea, it is worth contacting them even if you don’t want to take on the project yourself. As a practising clinician, you are best placed to see what problems and frustrations affect your day to day practise and offer suggestions for solutions from within.
COVID-19 has accelerated the acceptance of digital health technologies, as has been mentioned in previous episodes. Telemonitoring and video consults are becoming the new norm, and there will be no turning back. As Eric Topol says, “Machines won’t replace physicians, but physicians using AI will soon replace those not using it.”