Let’s talk… Digital health: a new way to improve respiratory care?

With the advancement of computing, data collection, artificial intelligence, storage and analysis, the potential of digital health is now being realized. Yet how often is it that two professionals discussing digital health are referring to the exact same thing? Is digital health just a buzzword?

In the first of a three-part series, we will discuss what digital health really means with our expert in respiratory care, Dr. John Haughney. We’ll hear Dr. Haughney’s thoughts and concerns surrounding digital health and what we may expect from these technologies in the world of respiratory care.

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Introducing Dr. John Haughney

Dr. John Haughney (UK) is Associate Director at Glasgow Clinical Research Facility and an Independent Medical and Pharmaceutical Consultant. He has academic and clinical interests in the management of asthma and COPD within the community, as well as involvement in the production of national guidelines for asthma and for cough. Dr. Haughney also has a long-established interest in the delivery of care, governance, and service redesign.

Thank you for joining us, Dr. Haughney. How would you describe digital health and what it means within healthcare?

I think we need to step back and see what other people are using the term ‘digital’ to mean. For instance, my bank is encouraging me to use ‘digital banking’ by using an app or a website to manage my accounts. So how do we translate that to digital health? It’s obviously not the same scenario, but it does give a very simplistic picture of the interaction between an organization and its user.

There’s a need to ground in a broader description of what digital health might mean so that people are using the same vocabulary.”

Ten years ago, there was great interest in telecommunication. Using a phone to speak to a patient was quite a novel aspect of healthcare. In the UK, the majority of primary care contact is now initially by telephone, and increasingly, secondary care is using telephone or video for consultations. If we’re going to take the concept of digital health forward in a meaningful way, we’re going to have to be much more precise about what we mean by the term ‘digital health’.

As you say, remote consultations and remote monitoring have picked up massively due to COVID. How do you think attitudes have changed?

If there hadn’t been a pandemic, I suspect the pace of change would be slow and patients and clinicians would have different capacity and preference for change. Even those who would have traditionally shied away from this form of communication, have now been forced to use it.

For some people, the concept of speaking to the GP from a computer in the comfort of their own homes at a time that suits them is preferable. From a clinician’s point of view, you can always tell more from seeing a patient face-to-face because you know as soon as they walk through the door what kind of issues you’re going to be dealing with. You’ve also got the immediate availability of tests and tools which are not available on video.

Because of the pandemic, we are re-writing the whole nature of how we deliver healthcare. It’s partly preference, partly capacity, and partly necessity.

You mentioned one of the downsides of remote consultations is not having the immediate access to tests that would normally be carried out in the clinic. Do you think, as we move forward, we will develop ways to implement those tests outside of the clinic?

There are some specific examples of quite complex interventions already being delivered in patients’ homes. For instance, [in this hospital] we have patients who have COPD and are receiving non-invasive ventilation (NIV) at home overnight. They’re set up with a system that will measure clinical parameters such as pulse, blood pressure, and oxygen saturation, and changes to the oxygen flow can be made remotely by a hospital practitioner in the patient’s home. So, the report of the night in terms of the reading is transmitted to the hospital, and adjustments are made to the NIV remotely. There we have a comprehensive, tested, safe and effective way of managing the patient, with quite a complex condition, entirely remotely.1

It seems that a lot of these changes have been accelerated due to the pandemic and the need to implement a lot more remote consultations amongst other things. Has this changed the level of resistance to implementing these kinds of things, for example, are people becoming more open to these ideas because of this experience?

Yes, absolutely. I think people are more open to it, but it gives us the opportunity to look more comprehensively at the content and style of the consultation because the traditional consulting of “How are you?” may not be a particularly helpful statement in terms of trying to find out what’s going on. If it’s much more focused like “How’s your asthma?” and “Are you using your inhaler?” in a more structured form, it may lend itself more in comparison to a face-to-face consultation.

However, I don’t think that we are ever going to be able to manage patients entirely remotely. There would be better opportunities to do that with devices that give additional information. This also comes down to andragogy (the methods using in adult learning), where most patients would want to learn how to use an inhaler by holding one. In a face-to-face consultation, they could hold and use a placebo inhaler to see if they’re comfortable with using it, which would be much more difficult for them to do if they were just watching a video.

There will still need to be face-to-face consultation, but what would be an efficient way of using that consultation would be to determine those patients who need it regularly and those patients who don’t need it as often.”

One thing that’s mentioned a lot when it comes to new interventions in healthcare systems, particularly within the National Health Service (NHS) is cost, especially during the development of these systems and purchasing licenses from private companies. Do you think that there is space for subsidizing new technologies to come into care, or is it something that needs to be developed more internally?

The first thing we would need to do is some form of health economic analysis, to find out whether the outcomes of the consultation were as high from a video consultation as a face-to-face consultation. Then this would need to be fully assessed.

For example, is it cost-effective to manage somebody receiving non-invasive ventilation at home? Even if the patient needs to have a very expensive piece of kit installed in their home, the general feeling would be that it probably is cost-effective because you either have an expensive piece of kit at home and regular consultations are required, or you have to have an expensive piece of kit at home but don’t need so many specialist contacts. Whether each medical scenario was health economically viable or not would have to be taken on a case-by-case basis. It’s not going to be digital health at all costs, but I think the general feeling is that digital health could work out to be cost-effective.

Where do you think the greatest opportunity is for improving healthcare and healthcare systems with digital interventions?

I think that digital systems will allow for broader reconstruction of the way we manage chronic disease and the digital platforms, that will allow us to reconstruct totally new systems of providing healthcare. For example, we need to formulate new chronic disease management healthcare pathways that encompass aspects of digital health and the use of a triage service to identify respiratory patients who are most in need of a face-to-face consultation which should lead to a more efficient, cost-effective, and agreeable system for HCPs and their patients.

The pandemic has demonstrated the possibilities and as we move forward, we should take the positives from this in terms of the ways we interact and build to develop entirely new systems of delivering healthcare. There is a burning need for us to look at innovative ways of delivering healthcare and building on a digital platform that can help us to deliver them.

Dr Haughney’s key takeaways

  • There is a need to define what the term ‘digital health’ actually means
  • Telecommunications alone are not sufficient in the management and control of chronic respiratory conditions, as there are several ‘face-to-face’ advantages for the clinician (and patient)
  • Determining those patients who need more frequent consultations could be an efficient way to provide a good healthcare service for all
  • In-depth analysis needs to be carried out to prove whether digital solutions are an efficient, cost-effective, and streamlined solution for healthcare services

We hope you enjoyed the first article in our ‘Let’s talk…’ series. A big thank you to Dr. John Haughney for taking the time to be part of this discussion. For more information on the definition and scope of digital health, please check out this article.

*Disclaimer: interview has been edited for clarity and brevity. All the interviews in this series reflect the views and opinions of the interviewees and do not reflect any opinions from any other parties, including Teva Pharmaceuticals.

RESP-42423 September 2021                                                    

References

  1. Duiverman ML, et al. 2020; 75: 244–252.