• The continued emphasis on digital health is overrated but digital health will become an integral part of total patient care.
• To become a vital part of patient care, digital health providers need to provide the medical community with studies that show their value to patient outcomes.
• The rapid advancement in the digital healthcare field brings many advantages and a few problems that shouldn’t be ignored.

What is digital health? The FDA defines digital health this way. “The broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine. From mobile medical apps and software that support the clinical decisions doctors make every day to artificial intelligence and machine learning, digital technology has been driving a revolution in health care. Digital health tools have the vast potential to improve our ability to accurately diagnose and treat disease and enhance the delivery of health care for the individual”.

Of course, with new technology, there is a rush of players trying to get money from venture capitalists and eventually become the next “big thing,” but there are a lot of landmines out there.

According to “The top 10 dangers of digital health – a patient’s perspective“ the dangers are:

1. Regulating adaptive AI algorithms

Where an AI tool quickly adapts to reflect its environment and the context in which it operates, the AI may “reinforce those harmful biases such as discriminating based on one’s ethnicity and gender.” These will further exacerbate existing health inequalities and place certain patients at a disadvantage. It is essential that the ground rules for these AI tools include firm parameters that seek to prioritize patient safety. A bit like Asimov’s Zeroth Law, ”a robot may not harm humanity, or, by inaction, allow society to come to harm.”

2. Hacking medical devices remotely

The idea that hackers might target people’s implantable cardiac devices was popularised in a 2012 episode of the US television drama ‘Homeland,’ in which terrorists hacked a fictional vice president’s pacemaker and killed him. It is not just VIPs (or VPs) who need to worry about this. Anyone with an implanted device could potentially have it hacked and be held to ransom. Medical device manufacturers should take far more care in the security they build into their devices to protect patients from unwarranted attacks. Frankly, when large healthcare organizations are procuring these devices, this is one of the critical areas that they should be interrogating their potential suppliers about.

3. Privacy breaches by and on direct-to-consumer devices and services

This is difficult because if we want digital systems to understand us and provide advice or treatment personalized to us, then those digital tools must have access to our confidential medical data. However, privacy is still very much a high priority for most patients, and they (rightly) want to know what is happening to their data – who is using it, how long is it being held, is it being passed on to third parties without the patient’s explicit consent? People often forget who they have given access to their data and for what purpose. Sometimes, they stop using a digital tool without realizing that all their data is still being held (and possibly collected via an active API) by the digital tool’s supplier. It would be helpful if our mobile phones and PCs could highlight:

a. When we shared sensitive data, who with, and what data was shared.

b. A list of active APIs that are still sharing our data, etc.

Data used for purposes other than those intended by the patient are potentially a safety risk to that patient and should be treated as such.

4. Ransomware attacks on hospitals

Yes, this is awful for the hospital, and yes, it may cost them money; however, let’s not forget whose data has been stolen, the patients! Are they sufficiently alerted to this, told what is happening, and given ways to mitigate any issues personally? In an ideal world, they are, but in reality, the hospital is probably in panic mode, and communicating transparently with patients is low down on its priority list. As the Medical Futurist says: “The average patient should demand more security over their data” – but how do they do this? What can a single patient do to ensure that the hospitals who have stewardship over their data (not ownership, in my opinion) make it as secure as possible.

This brings me back to an idea that my sadly departed friend, Michael Seres, had many years ago. On each hospital exec team (not Board), there should be a Chief Patient Officer, whose job is to push for patient interests in operational matters (which is why they shouldn’t be a non-exec member of the Board). That is the person whose job it should be to hold their organization accountable for the security of their patient’s data.

5. Technologies supporting self-diagnosis

Dr. Google has been an issue for some years. People’s off-the-shelf devices that monitor their vital signs are not necessarily medical-grade, nor do their users generally have the skill to interpret their outputs. However, doctors should embrace patients who are keen to manage their chronic conditions and support them. This ‘shared accountability has to be the model for improved population health, and doctors not willing to work with their patients shouldn’t have any.

6. Bioterrorism through digital health technologies

This one is a bit exotic and certainly not a near-term risk when looking at the sorts of things described in the newsletter. However, in a world that is still dealing with a pandemic and reliant on vaccines to gain some normality back into our everyday lives, the security of (for example) that supply chain is critical.

What if a batch was intentionally sabotaged or, in some way, its efficacy reduced? In precisely the same way that medical products (especially implants) should be made as safe and secure as possible, the same is true for the medicines that we rely on.

7. AI not tested in a real-life clinical setting

The newsletter makes a case for issues related to how staff uses the AI, but PLEASE… test this with patients first! Safety in use is critical, and only feedback involving patients will help developers optimize these digital tools to be as safe as possible.

8. Electronic medical records not being able to accommodate patient-obtained digital health data

This is a very personal issue for me. Why should my doctor send me for tests when I can give them perfectly valid data that I have gathered myself from a device that has been CE marked and approved by the FDA/MHRA etc.? Electronic Medical Record vendors are incredibly reticent to allow anyone other than the authorized doctor to enter anything into a patient’s record. There are some excellent reasons for this. However, I’ve long thought that there could be an annex to the patient-controlled document where they can enter a new address and add data from their blood pressure device and over-the-counter drugs or remedies that they are taking. That way, doctors would have an up-to-date, (hopefully) reliable set of data to have a more informed discussion with their patients. It could accelerate the time between consultation and referral/treatment.

9. Face recognition cameras in hospitals

I’m less worried by this in principle; however, I am interested to know how the data generated will be used and the security around it. If the hospital only uses it to optimize patient flow, or remotely detect symptoms that are then used to help patients directly or indirectly, then OK. If it is shared with others for more sinister purposes, I would be concerned.

10. Health insurance: Dr. Big Brother

This is less relevant to the UK – only 11% of us have private health insurance. Again, this boils down to who collects data on patients, for what purposes is explicit consent gained from the patient to share their data, and how may those third parties use it?

There are both negative and positive connotations to the gathering of a person’s health data by their health insurance company, but given that they already ask for access to all GP and secondary care records, having access to health wearable data (as Vitality Health already does) is not a big step.

Technological advancement makes our lives longer, better, and easier to enjoy – that’s a fact. What sometimes gets overlooked is that it often brings dangers with itself, new problems that weren’t present a few years ago. That rule is correct for every field, but even more so in the case of digital healthcare systems, as they directly affect our well-being. However, it’s important to remember that every problem has a solution.

I’ve sat in a lot of research with HCPs regarding digital health. They see its advantages, but they also believe it has a long way to go before it becomes instrumental in patient care.