Digitization is on the rise and doesn't even stop with medicine. A video doctor consultation, a fitness app or a collection of data for a better cancer treatment: eHealth combines the possibilities of the internet with the demands of medicine and opens up entirely new possibilities for the medical industry.
The WHO defines eHealth as the use of information and communication technologies (ICT) for health, for instance in research, education, medical diagnosis or in treatment. There are countless possibilities to use ICT.
The digitization of health care is vitally important, especially due to demographic changes – the number of elderly, multimorbid patients in need of care is growing. Prof. Axel Ekkernkamp, Medical Director and CEO of the BG Clinic Emergency Hospital Berlin sees the future of medicine as a 'digital revolution' and predicts, "Nothing will be like it was. Medical processes will change. Data streams will significantly increase. Knowledge will be obtained in other ways. We will have other types of conventions and trade fairs. A lot of things will change drastically."
Today many patients already get informed in preparation for a physician visit, and the trend is increasing. This shows that more and more patients seek active empowerment. Telemedicine, as well as medical apps, make this possible.
Across borders: diagnosis, therapy, rehabilitation, continuing education
Telemedicine makes up a large portion of the eHealth sector. Teleradiology, telesurgery (remote surgery), telerehabilitation, telecoaching – what all of these terms have in common is that they render a diagnosis, therapy, rehabilitation or continuing education possible with the help of modern means of communication across a spatial distance. "It is a form of medical practice where all fundamental relationships between physician and patient, such as confidentiality or duty to disclose information, for example, apply", explains Prof. Friedrich Köhler, Director of the Center for Cardiovascular Telemedicine at the Charité University Hospital, Berlin. Here you need to distinguish between 'Doc2Doc' communication, meaning between doctors, as well as 'Doc2Patient', that being between physician and patient. The focus here is primarily on information exchange, data transmission, and data documentation as well as empowerment.
Telemedicine offers two key advantages: "One benefit is the information that's being transported and not the patients. If a small hospital has a CT system for example, but not a radiologist who is available around the clock, it is no longer an issue. The system images can be sent directly to the radiology department at a major clinic without the patient needing to travel far", Köhler explains.
Another beneficial aspect is remote patient monitoring (RPM), which provides many advantages, especially when it comes to chronic diseases and conditions. "In the case of a chronic disease, it is possible that the patient's condition worsens without him/her realizing it – until it becomes an emergency situation", says Köhler. One option RPM provides is to read out the vital signs of the patient invasively via an implant. Another option is for the patient to actively measure his parameters using a non-invasive monitoring device, a telescale for example, and then transmit the data to the doctor. If the vital signs are worsening, the attending physician is informed early enough so that he/she is able to immediately respond. This way, emergency situations can be avoided in many instances.
As is the case with heart failure, for instance. This is where telecardiology is able to assist. The vital signs of the affected patients are measured and controlled every day. "One advantage is that patients can be cared for around-the-clock. The other benefit is that the patient doesn't need to unnecessarily go to the hospital." Not only does this give patients the comforting feeling that they can be attended to at any time, but it also eliminates physician visits and hospitalizations. This is a particular advantage for patients in rural areas, where distances to a cardiologist are greater. Telecardiology also offers major potential savings from an economic perspective since most costs pertaining to heart failure are attributed to inpatient hospital care.
That said, telemedicine won't become its own specialty in the future. "Instead, telemedicine will become a work approach within the existing specialties. Besides outpatient and inpatient processes, there are now remote procedures available. This makes telemedicine the third pillar for health care activities," explains Köhler.
A personal health journal, a fitness app or a dermatology app: the use of apps in the health care sector is multifaceted while new developments are being added at a rapid pace. More and more medical apps are being developed and startups founded, so that more than 100,000 health and fitness apps are available in the app stores at this point.
Many apps are aimed at changing the user's behavior, such as eating habits for instance. Others have a more supporting function. There are apps for diabetics for instance that assist in recording blood sugar levels and monitoring diet, which can be helpful during the next doctor's visit. Yet other apps are primarily intended to be information and exchange platforms – to communicate with other affected patients or medical staff.
Apps can also play an important role in telemedicine, like an app that monitors bowel diseases for instance. Here, biomarkers from a stool sample are being analyzed, the results are shown on the patient's smartphone and automatically sent to the attending physician. Not only is it convenient to not having to visit the doctor for every checkup, but it also ensures empowerment. In an interview with MEDICA-tradefair.com, Prof. Martina Müller-Schilling, who was instrumental in developing this app, describes the potential for other applications with this type of app. "I can see an extension of this technology in all areas, functions, and diseases. It might be possible to communicate the general health status, for example, disposition for diseases, prevention information or the next steps that need to be taken."
Quality control is very important, especially in the sensitive area of healthcare, because the potential risks are great if apps are developed without medical expertise or if they do not work properly or are used by patients carelessly. There already exists a number of high-quality apps in the area of medical apps, which are tested beforehand thoroughly. Nevertheless, this does not apply to the majority of the more than 100,000 apps in the medical sector.
Anytime, anywhere – patient data is always available
The future of patient data is also in the hands of digitization. Digital patient biographies aim to make it possible to have access to relevant medical information anytime anywhere in the world. The EU 'MyHealthAvatar' project delivers an idea for implementation. By digitizing health records, it aims to overcome national borders while giving patients the chance to have their medical history always at their fingertips. The project objective is for users to feed an avatar with health-relevant data so that the avatar becomes the digital representative of the user. In an interview with MEDICA-tradefair.com, Professor Nikolaus Forgó, Project Manager at the Leibniz University of Hanover, explains the advantages of this kind of cross-border avatar: "The clear advantages for patients are in being able to control their own data better than before and to always have access to it. The benefit for the health care system is that you are able to prescribe more suitable therapies to better-informed and educated patients. New knowledge benefits science."
Another possibility would be for companies like Google or Apple to take over the task of digitizing patient biographies. "This way, you ultimately might no longer need a national, electronic health card, since companies like Apple and others assume the task of collecting and storing specific data, so that everyone has access to it anytime, anywhere", Ekkernkamp believes. Recently Apple has acquired the medical cloud provider Glimpse, a company that enables its users to collect and manage their medical data and make it available to doctors.
The previous developments in the areas of telemedicine or apps show that digitization in the health care sector is moving at a rapid pace. In doing so, the digital revolution poses major challenges for all involved parties, whether that’s physicians, patients or developers. However, it also provides opportunities – they just need to be taken advantage of.
The interview was conducted by Olga Wart and translated from German by Elena O'Meara. MEDICA-tradefair.com