Open in app

Sign in

Write

Sign in

Digital Healthcare in everyday life: state of the art examples and criticism

The Healthcare Hub - Bocconi Students
9 min readMar 23, 2021

Authors: Federica Barbara, Massimiliano Mariani, Ahmed Mahomed. Publication date: March 23, 2021.

The demand for new technologies has been growing in this period of Covid-19 pandemic, especially during the lockdown. It is estimated, for example, that the number of daily active users on Zoom has risen in a short time from 20 to 300 million, and at the same time all those tools that allow remote healthcare services to be delivered have grown. In order to provide a picture of this situation and its possible evolution in the near future, the Deloitte Center for Health Solutions, Deloitte’s research center dedicated to healthcare issues, has published the report “Digital transformation: Shaping the future of European healthcare “, which bases its analysis on a survey carried out between March and April 2020 in seven European countries (Belgium, Denmark, Germany, Italy, the Netherlands, Norway and the UK) on approximately 1,800 healthcare professionals. The survey conducted by Deloitte identified the main obstacles to the implementation of digital technologies: in the first position, with 57.4% of citations by respondents, there is the problem of excessive bureaucracy that characterizes healthcare, followed by the cost of technology with 50.3% of citations, and the difficulty in identifying the most suitable technologies with 49% of respondents in Europe. So the doubts that for years have held back the change (strict regulation, ambiguous reimbursement policies, scarce evidence on reliability and cost-effectiveness, privacy problems, difficulty in integrating the new tools into daily clinical practice, distrust on the part of doctors and patients) dissolved in the face of the health emergency.

Let’s take the main videoconferencing and videochat tools (such as Skype, Zoom, Google Hangouts and Apple FaceTime): these systems have been widely used to visit Covid-19 patients and patients with chronic diseases from home. Their use has been supported by scientific societies and healthcare institutions, which have provided guidance on how to properly use these tools and integrate them into clinical practice. For example, the American Medical Association has published guidelines that suggest to American doctors how to integrate these tools with medical records or other systems (digital or paper-based) already in use, so that the data collected during the visit and the communication with patients are properly stored and accessible at all times.

Unfortunately, these systems based on videoconferencing and videochat systems are not sufficiently secure. This is the reason why more advanced systems have been developed by companies specializing in digital health to encourage services that also guarantee the archiving of consultations and documents shared with the patient. Tools that collect and monitor the physiological parameters of patients and allow doctors to view the trends of the parameters detected and receive alerts and automatic messages in the presence of altered or critical values ​​have also made their rapid appearance.

Digital health tools have been used to activate contact tracing systems to identify, on the basis of proximity (measured via bluetooth or via GPS) between two subjects equipped with smartphones and the same app, any contacts of individuals who have tested positive to Covid-19, and epidemiological surveillance systems capable of monitoring the epidemic, identifying new outbreaks and providing useful information to the health policy makers of individual countries for its better management.

So it is not a coincidence that the scientific world begins to take advantage of this period of widespread diffusion of these digital tools to activate clinical studies in order to study their impact on the doctor-patient relationship, on clinical practice and on the quality of treatment and obtain important and useful information to decide whether (and under what circumstances) to continue using these systems even after the pandemic has ended.

Experience in the UK: Babylon Health

The epidemic crisis that has shocked the world this year has certainly increased the demand for digital healthcare services, in particular GPs visits: the requirement for special measures of containment, the need of fast and frequent feedbacks from doctors and the spreading features of SARS-CoV-2 made tools that allowed the GPs to assess general health and symptoms in distance very attractive. Anyway, the supply of specialized tools has begun long before the outbreak of the pandemic: one of the most famous (and criticized) companies engaged in this sector is Babylon Health.

Established in the UK in 2013, Babylon’s core services are included in a smartphone app, that requires paying an annual subscription or a one-off fee for a single appointment, being free if received as a benefit from the employer or insurer. The two most famous and discussed features are the Chatbot and ‘GP at Hand’. The former consists in a program that starts a conversation with the user, who should report symptoms by answering the questions posed by the bot; analysing the answers and posing further inquiries to understand more completely the user’s conditions, the bot reconciles the reported symptoms with own database and then provides suggestions on how the patient should act, going to the hospital, booking an appointment with a GP or simply staying at home for a while. GP at Hand, launched in 2017, is a more complex and advanced system: using AI features, the tool allows the practitioner to visit the patient through a video call, asking directly for symptoms and considering individual characteristics. But the AI program can go further: as the company site claims, it can perceive, linking databases and medical records but also using advanced machine learning techniques that allow it to understand emotional status from facial expressions and choices of words; make decisions, recommending next steps and questions to be posed to better investigate user’s conditions; simulate, making predictions based on data; learn, updating training databases and becoming more precise by every interaction with the patient. ‘GP at Hand’ is offered in collaboration with the NHS in some areas of London and Babylon is planning to expand it in other cities, like Birmingham.

As they are, these instruments can provide great help to users and practitioners: the former ones can assess more frequently their general health situation, without the need to call or visit own GP, avoiding queues and waiting time, from almost every place in the world; the latter are assisted in their visits, that are usually faster than in person, improving productivity and at a lower cost for patients, and the AI ability to detect emotions is fundamental for doctors to understand if the user needs more explanation or is more worried than necessary. Nevertheless, from many sides criticism has raised. Regarding the Chatbot, a critical issue is the appropriateness of the tool and how the users feel about it: even if the company disclaims that the bot only provides suggestions, not proper diagnoses, Financial Times’ journalists have claimed, supported by interviewed doctors, that similar reported symptoms generate dramatic different outcomes and that in some case the Chatbot underestimates symptoms of very serious conditions, like heart attacks. Another problem, reported also in The Lancet, is the lack of independent research on the efficacy and performance of the system: internal evaluation studies, advertised by the company itself, are criticized to be methodologically weak. A report by Iacobucci published in the British Medical Journal has pointed out that Babylon’s users are generally less sick than others but use more services: although, it is widely recognized that users are younger, more technologically advanced and educated, and that the app is not spread among elderly and those more in need of care; given the relatively small selected sample, it is hard to disentangle if the above-average use is due to more preventive care or unnecessary induced demand. Finally, since the company hires GPs to provide its services, the subscription of Babylon requires the user to change own practitioner: this has arisen concerns of equity inside the NHS and the even more poignant problem of funding, because allowing patients from other cities to register to a London GP may create holes in London NHS budget, given the current financing system.

Experience in the US: Teladoc

Within the United States, telemedicine and digital healthcare has been around for several years now, with industry leader Teladoc being founded in 2002. Where the adoption of the technology was previously used to allow isolated and rural communities access to large city-quality care, the onset of Covid-19 has led to a sudden increase in the technology’s feasibility and usage.

Previously, the insurance industry held telehealth back, as insurers were paying doctors less on a per visit basis compared to in-person appointments. In March, this changed as the administration allowed for increased access to telemedicine for Medicare patients. With over 44 million Medicare users, the industry saw a major boon and Teladoc was a major beneficiary. In Q2 of this year, the firm conducted 2.76 million visits, as opposed to the 908,000 the year before. Teladoc focuses primarily on its video chat service. Through this service, patients can book appointments at their convenience, cite their concerns, and talk face to face with a doctor who has reviewed their information. Most patients fall into the everyday care category where they can describe any symptoms, but Teladoc also has mental health, dermatology, nutrition, and more specializations.

Similar to the UK’s Babylon Health, there are a few concerns about the level of care provided through this service. All Teladoc doctors are board-certified and trained on virtual care, but distinguishing between doctors is not always possible. The trust between doctor and patient is highly prized in the American system and there is much scepticism about the platform. About 47% of consumers in the United States research doctors online before making appointments, and not all of these consumers are able to choose their physician on Teladoc. This is because the choice is limited by insurance benefits and also allows physicians to maintain flexible hours. The downside is that patients lose continuity of care. Results can be shared with primary care physicians, but not all primary care physicians can share files on the reverse. Without the confidence and trust of the American consumer, the use of telemedicine as an overall percentage of visits per week has already begun to decline since mid-April. While still higher than previous years, it seems there is still a way to go before the American market can fully embrace this technology.

Final Remarks

As the Covid-19 pandemic has shown us, healthcare can quickly be digitized to provide a competent level of care. The use of AI in diagnosis will only continue to become more and more accurate over time, exciting us about the future of this technology. Bureaucracy affects each country’s implementation differently, and thus no one-size-fits-all system can be implemented globally. In the UK, the NHS has to clearly deal with funding and practitioner change concerns. The US must deal with the Medicare and insurance industry to allow broader and more uniform access. Undoubtedly, digital health tools are a great supplement to the existing in-person consultation services, and will continue to carve a useful niche in the healthcare space.

Photo by National Cancer Institute on Unsplash

References

Digital Health
Covid-19
Telehealth
Equity
Innovation

--

--

The Healthcare Hub - Bocconi Students

Written by The Healthcare Hub - Bocconi Students

7 Followers

The first healthcare focused student association at Bocconi.

Help

Status

About

Careers

Press

Blog

Privacy

Terms

Text to speech

Teams