Let’s talk… Digital health: should we learn to truly embrace it?

Various digital health solutions are already proving to have significant promise, with examples in different fields already improving health outcomes for patients.1 But the potential of digital health does not just rely on individual technologies alone. How can we transform the mindsets of people within healthcare to support these digital shifts?

In the second of a three-part series, we will discuss the adoption of digital technologies with respiratory and eHealth expert, Dr. Vitalii Poberezhets. Delving into his own experiences, we will question whether we can bring these new solutions to respiratory care.

Read more

Read full article

Introducing Dr. Vitalii Poberezhets

Dr. Vitalii Poberezhets (EU) is an Assistant Professor in the Department of Propedeutics of Internal Medicine, at the Vinnitsa National Pirogov Memorial Medical University in Ukraine. Dr. Poberezhets is also the European Respiratory Society (ERS) Chair of Group 01.04 for mHealth/eHealth. His interests include the role and challenges of remote care for COPD, considerations for personalized medicine in respiratory, and digital solutions in pulmonary medicine.

Thank you for joining us today, Dr Poberezhets. In your opinion, what are the most important aspects of digital health?

We’ll start with the definition of how I understand digital health. I believe that it is important to use digital health solutions to provide people worldwide with higher standards of health and promote and protect their health and wellbeing. I believe that the four most important categories of medicine (that a lot of other areas are built on) are:

  • Virtual healthcare (i.e., telemedicine)
    • Definition: Telehealth or telemedicine is telecommunications technology used to diagnose and deliver healthcare services from a distance, outside of traditional healthcare facilities.2
  • Wearables and biosensors (i.e., health informatics)
    • Definition: Digital therapeutics are evidence-based therapeutic interventions driven by software to prevent, manage or treat a medical disease or disorder.3,4
  • Mobile health (mHealth) (i.e., apps and health tools)
    • Definition: Mobile health (or mHealth) describes the use of mobile phones, particularly mobile apps, or other wireless technology for medical use. mHealth refers to the use of mobile phones in providing education or preventive support to patients for a variety of different conditions.5
  • Artificial Intelligence (AI) machine learning
    • Definition: A subset of AI that teaches computers to learn and adapt to new data without human interference.6

I do believe that the other most important issue is the durability of the technology being used.

It’s only when all this information is interoperable (i.e., usable across different systems) that we will receive significant and robust digital systems in healthcare.”

What do you think are some of the key challenges that will need to be overcome to allow for the widespread adoption of digital health?

Data must easily, safely, securely, and effectively be exchanged between one or more devices and systems, and I believe this is key because we find ourselves to be stuck when we have a lot of digital health solutions. Cyber security and data protection is also an important challenge to overcome.

If we are talking about digital medicine, then AI systems are constantly developing, and different networks have started to teach us ways to understand chest x-rays of patients with lung disease, for example.7 When talking about deep neural network and machine learning, we’re now also faced with the problem that we have a lack of databases to teach the algorithm to detect specific changes, and because of a lack of interoperability, the networks are not allowed to use it to learn quickly.

We must not be afraid of digital medicine, but we must think of how to protect it more securely.

There are no specific issues generally for respiratory specific care, but I believe that there are other issues for some features of different patient groups with varying respiratory conditions. For instance, given the age with most patients with COPD, there have been issues with digital literacy where it limits them from receiving any benefits.8 If we’re talking about patients with bronchial asthma who are much younger, we [at the clinic] don’t really see this issue. So, I believe that this personalized approach for each group of patients and each individual patient may have to improve.

You’re currently the chair on the European Respiratory Society (ERS) group for mHealth/eHealth. Can you tell us a bit more about the group and it’s aims, and what progress have you seen so far?

Our group was launched in 2019 to bring together different HCPs with common interests in digital health interventions in respiratory medicine. We try to create discussions between all our members so that it is not only the clinicians who get involved, but also other specialists such as physiologists, physiotherapists, and radiologists.

We have produced three manuscripts in the European Respiratory Journal for Open Research, one of which was a call-to-action by our group.9 The main aim of the [published] manuscript was to increase interest around digital medicine and to involve new specialists in this field, and I would say that the number of positive discussions taking place has proved this. We have a lot of extracts on digital medicine for this ERS congress, and there are a lot of proactive, young, and experienced clinicians and researchers who are willing to be actively involved in our group. The plan is to produce a similar new manuscript but with new aims by the end of this year, and hopefully it will be just as successful.

Overall, how do you believe the implementation of digital solutions will impact pulmonology medicine?

I see how many changes are happening right now, and it shows that we should have created these digital health solutions years ago.

I see this in my clinical practice where I work with patients with COPD, especially those who perform rehabilitation and/or live in remote rural Ukraine, where telemedicine and remote monitoring are now very important in their daily management of COPD. This has changed our clinical practice dramatically, and it will change even more intensely next year.

We are also undertaking research into wearables. With AI machine learning, there are great examples of how we use it, such as making clinical decisions post-assistance and patients understanding their diagnosis, and so we can use info-personalized medicine in their treatment.10 AI may also be used in the pharmaceutical industry for faster and better production of new drugs.11

I believe that all these digital solutions will change everything – how our healthcare systems currently work, as well as how we deal with our patients.

You mentioned the management of COPD in your patients in rural Ukraine, could you please explain more about how you are currently caring for them, remotely?

We are currently using mobile phones to send notifications to patients, helping them with specific problems, for educational purposes to teach patients to better understand their condition as well as the importance of the medications they’re using, and the importance of compliance with treatment.

When we educate patients about how to use their medical devices and sending out information to remind them how they use it, they sometimes forget, or more frequently, they just don’t want to use them. But when we use wearables to help assess their technique, this brings new possibilities to treatment and so we don’t need to just use the information that the patient is telling us. Unfortunately, there have been conversations that show that a lot of patients increase the dosage of inhaled drug use before their visits to their GP or pulmonologist, so that they arrive with empty bottles of drugs.12

What are your thoughts on more personalised medicine in patients, depending on the respiratory conditions that they are struggling with?

We must have knowledge of conditions and needs of each person to make the intervention to change according to the patient. This is important because sometimes we create a solution to be implemented, but then learn later that there is low compliance to particular devices because they are too complicated for patients to use. The main idea is, not to create a digital solution which will be interesting and easily used by the researchers who created it but to hear the voice of the patient who will use it and build the solution according to their will. It could be achieved by using a participatory research approach.13

Dr Poberezhet’s key takeaways

  • We should not be afraid of digital health, as long as we can find solutions to manage cyber security efficiently, create interoperable data across platforms and manage larger databases
  • Wearables are a good way of monitoring patients who may not be able to effectively recall their daily healthcare routine, but some patients may require support in learning to use them
  • Rural communities can benefit from telecommunications and other digital health solutions, meaning greater access to care
  • When creating a digital solution, we should listen to what patients need to manage their condition first, so that the solution is patient-centric

We hope you enjoyed the second article in our ‘Let’s talk…’ series. A special thank you to Dr. Vitalii Poberezhets for being part of this discussion. If you are interested in learning more about the interoperability of data in healthcare systems, then 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-42419 September 2021                                                    

References

  1. Digital Authority Partners. Digital Transformation in Healthcare in 2021: 7 Key Trends. Available at: https://www.digitalauthority.me/resources/state-of-digital-transformation-healthcare/. Last accessed: September 2021.
  2. World Health Organization (WHO). Telemedicine. Available at: https://www.who.int/goe/publications/goe_telemedicine_2010.pdf. Last accessed: September 2021.
  3. Digital Therapeutics Alliance. What are Digital Therapeutics. Available at: https://dtxalliance.org/understanding-dtx/. Last accessed: September 2021.
  4. Makin S. The emerging world of digital therapeutics. 2019. Available at: https://www.nature.com/articles/d41586-019-02873-1. Last accessed: September 2021.
  5. Definition of mHealth (mobile health). Available at: https ://searchhealthit.techtarget.com/definition/mHealth. Last accessed: September 2021.
  6. Jiang F, et al. Stroke Vasc Neurol. 2017; 2: 230-243.
  7. Hosny A, et al. Nat Rev Cancer. 2018; 18: 500-510.
  8. Slevin P, et al. Digital Health. 2019; 5: 1-10.
  9. Poberezhets, Vitalii, et al. “Implementation of digital health interventions in respiratory medicine: a call to action by the European Respiratory Society m-Health/e-Health Group.” ERJ open research 6.1 (2020).
  10. Khemasuwan D, et al. Eur Respir Rev. 2020; 29: 200181.
  11. Freedman DH, Nature. 2020; 576: S49-S53.
  12. Restrepo RD, et al. int J Chron Obstruct Pulmon Dis. 2008; 3: 371-384.
  13. Pekmezaris, Renee et al. “A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach.” JMIR formative research vol. 4,1 e13197. 31 Jan. 2020, doi:10.2196/13197.