The ESC Digital congress was a bold and successful initiative of the European Society of Cardiology, and took place in Tallin, a few days ago. The location was not chosen by hazard, as Estonia has 99% of health data digitized and 99% of prescriptions are digital. Prof. Viigimaa exposed the architecture of the Estonian Electronic helth system in a comprehensive presentation at the beginning of the congress.
Current organization of digital healthcare was reviewed by Prof. Martin Cowie in an excellent presentation, where he highlighted that we need to identify barriers and find appropriate solutions on this emerging sector. We will always find at the center of our care the patient and his family, and this aspect should not be overlooked or forgotten, especially in this rapid-digitalized era.
Patient care, patient empowerment and nursing issues were also addressed by Prof. Donna Fitzimons and ACNAP President-Elect Lis Neubeck, with accent on developing the short and longer path to action which have in center the patient and the nurse (as midlevel team member). Digital nursing sessions drawed a lot of constructive comments, with Donna Fitzimons opinioned that if the patient is art ease at using online interaction with a “digital” nurse (avatar talking and guiding the patient by means of AI), then we should use this technology mainly to prevent, and not to treat. Find below the interesting slides from the presentations and their link to full presentations.
A very interesting session addressed the issue of preparing the healthcare force for the digital future chaired by ACCA President Susanna Price. Even though some solutions have been highlighted in a important scientific paper, like as the need for a culture of learning (develop extensive learning environment, encourage innovation and dare to fail), building a strong learning infrastructure and developing a multi-professional and collaborative approach to learning, these approaches are unachievably in the current state of the medical system in Europe, where most of the current medical personnel are disengaged or over-fatigued, doctors and nurses are burned-out.
Does technology make things worse for the medical workers? Can artificial intelligence and automation ease things? See all the debate here.
The same issue was addressed in another session. While trying to find solutions for the future, present issues of healthcare professionals and the digital boom relate to lack of trust and poor experience with new technologies, difficulty to interact with technology, fear of change. This is maybe where artificial intelligence could make the difference, as it can improve healthcare efficiency and delivery and could replace human involvement in some tasks of the medical industry, as suggested Dr. Casado Arroyo. However, for the moment, present algorithms are not completely in their mature stage.
Cybersecurity was a hot topic. Dr. Avi Fischer resumed some of the important cautions to take in reducing cybersecurity risks, such as:
- sharing responsibility between stakeholders-healthcare facilities, patients, providers, and manufacturers of medical devise;
- cybersecurity should be a priority during the design and development phase of the medical device and the issue should be addressed in a “Bolt-On to Integrated” fashion;
- if a vulnerability is found, communication and coordinated actions between stakeholders and healthcare facilities are vital. Development and involvement of government structures to assure security is very important.
The participants also expressed the urgent need for developing secured protocols to transmit data.
A special session to electronic medical record (EMR) can be accessed here. The consensus was that even though EMR are an efficient data base that can help health professionals in decision making, it is also time consuming. A new concept that consists on “less keyboard, more patient contact” should be adopted, because according to one study, for every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day, and outside office hours, physicians spend another one to two hours of personal time each night doing additional computer and other clerical work. Dr. Nico Bruining highlighted an important limitation of EMR used in Europe (vs. US), notably in Europe we use more than 30 languages that makes data collection difficult, and that should probably be aimed by a future Horizon 2020 project.
Augmented, mixed and virtual reality discussions were divided into cardiologist-related and patient-related. The 3 terms are intercorrelated and should not be confused one with another, here is their meaning and a schematic representation:
- Virtual reality (VR) immerses users in a fully artificial digital environment.
- Augmented reality (AR) overlays virtual objects on the real-world environment.
- Mixed reality (MR) not just overlays but anchors virtual objects to the real world.
The 2 main applications in medicine targets the patients and of course the doctors.
- For patients, one of the presenters suggested that VR will do for patient education what Google Maps has done for navigation, thus it “will transform learning experiences by better retention and recall, it will improve patient journey and will determine behavioral change by challenging health beliefs through impactful experiences”.
- For doctors, Dr. Dariusz Dudek explained how a pioneer programe of mixed reality that is currently used in Poland helps cardiologists choose a better punction site for TAVI, with expectancy in the very near future to have VR mask that will allow cardiologists to have echo, CT and eventually other 3D reconstructions in the corner of their eyes, while a cardiac intervention is taking place. Other important applications are stroke recovery and cardiac rehabilitation.
Over-utilization of medical devices.
One of the worries highlighted was that this new technology could cause anxiety in healthy fit subjects, translating into unnecessary consultations either by their general practitioner either by their cardiologist, as presented by Prof. Martin Cowie. 57% of subjects from the “Apple heart” study thought to seek medical attention after having an alarm from a smart device.
Even though wearables and connected devices impact sometimes positively our daily lives (sleep apnea analysis app, selfie to quantify oedema app, accelerometers incorporated into devices that quantify daily effort, smartphone-based blood pressure measurement by transdermal optimal imaging, etc), Dr. Klaus Witte highlighted that there is increased concern that wearables and connected devices impact negatively the society by increased (but unnecessary) cost to the consumer and increases (but unnecessary) cost to the medical system (by over-investigating a healthy person thus launching a battery of tests like holter ECG, echocardiography, stress test). With this in mind, there was a unanimous consensus that medical wearables and connected devices should target special groups of populations if we want to avoid death, strokes or hospitalizations and the clinical benefit of these kind of devices should be carefully thought and evaluated.
Conclusions
Digital technology can help healthcare by providing new tools for diagnosis and therapy delivery, redesigning clinical pathways, individualized risk stratification and individualized care, patient empowerment, support to precision medicine (thus fewer medical errors), and telemonitoring. Digital technology and connected devices (tablets, wearables, apps) will enhance decision making of health professionals only if there is a direct link towards a clinical benefit, and maybe they would have a huge impact if they could be directly linked also to EMR. In real life, adoption of digital technology in healthcare depends on validation, easy integration of workflow & prescription pathways and ability to reduce work.
Consumers could think that by using digital technology and connected devices, they take control over their health; this is partially false because alarms issued by devices could translate into unnecessary consultations and increased cost to overall health system by doing unnecessary tests in otherwise healthy subjects. Narrowing the indications and the target population for the use of this devices should be a priority.
And finally, some punctual issues need rapid and clear solutions: stricter security protocols should be incorporated in data transmission, regulations should be adopted for all digital technology (there are too many devices and few regulations), the huge amount of data (that is collected from all digital technology) needs to be transformed into information.
