Digital health

Driven force ,Goals/Objectives,Digital transformation, Future of Digital health in India
Digital health and COVID-19

1. DIGITAL HEALTH- An understanding for Nursing students Dr.Puvaneswari.K Professor Dept of Fundamentals of Nursing & Research Narayana Hrudayalaya College of Nursing, Bangalore

2. “I think the biggest innovations of the twenty-first century will be the intersection of biology and technology ” Steve Jobs

3. Objectives of the session Definition- Digital health Driven force Goals/Objectives Digital transformation Future of Digital health in India Digital health and COVID-19 Advantages /Disadvantages Challenges

4. INTRODUCTION e- Health- (1990 ) m- Health (2010)- Digital Health (2015)

5. DEFINITION- Digital health “A broad umbrella term encompassing eHealth , as well as emerging areas, such as the use of advanced computing sciences in ‘ big data ’, genomics and artificial intelligence ”. (WHO)

6. Big data Big Data can collect all the data / information on what constitutes a disease - right from DNA, proteins, and metabolites to organs, organisms, cells, tissues, and ecosystems. Big data analytics To detect spreading diseases earlier Generate new insights into disease mechanisms, Monitor the quality of the medical and healthcare institutions Provide better treatment methods

7. Genomics Sequencing and analysis of an organism's genome (entire DNA). Genomics investigates how a person's biological information can be used to improve their clinical care and health outcomes ( through effective diagnosis and personalised treatment). Eg heart disease, asthma, diabetes, and cancer

8. Artificial intelligence Artificial intelligence (AI) refers to the simulation of human intelligence in machines that are programmed to think like humans and mimic their actions .

9. Future of the health industry is a combination of technology and traditional approach which we can call as a hybrid model .

10. DRIVEN FORCE IN INDIA – Digital health L ifestyle diseases Ageing population R ising income levels I ncreasing access to insurance G rowing health awareness .

11. Goals/Objectives of digital health Prevention of disease Lessens the healthcare costs C ustomization of medicines as per patient requirements M onitoring and managing chronic conditions. Enhancing and boosting access Expanding and improving the quality of healthcare Facilitating the individuals at best

12. Digital Transformation in health ELECTRONIC HEALTH RECORD ROBOT ASSISTED SURGERY SELF MONITORING DEVICES IoMT mHEALTH DIGITAL HEALTH TELE MEDICINE ORGANS ON CHIPS

13. 1.TELE MEDICINE The delivery of health care services, where distance is a critical factor, by all health care professionals using ICT for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries , research and evaluation , and continuing education

14. Aspects Tele-Radiology (radiological patient images- x-rays, CTs, and MRIs) Tele-Nursing (Delivery, management, and coordination of care and services) Tele-ICU ( real-time audio, visual and electronic means and health information ) Tele-Consultation Tele-Surgery (Remote surgery )

15. Advantages of telemedicine Saving of cost and effort especially of rural patients Providing timely and faster access. Maintenance of records and documentation Patient’s safety, as well as health workers safety Telemedicine can also enable the availability of vital parameters of the patient available to the physician with the help of medical devices such as blood pressure, blood glucose, etc for the management.

16. 2.Electronic Health Record (EHR) An electronic health record is the systematized collection of patient / population electronically stored health information in a digital format. These records can be shared across different health care settings. EMR - Digital version of a patient's chart EHR contains the patient's records from multiple doctors and provides a more holistic, long-term view of a patient's health

17. Electronic Health Record (EHR)

18. Examples of Software - EHR Vista EHR

19. Advantages of Electronic Health Records Accurate, up-to-date, and complete information about patients  Quick access to patient records for more coordinated, efficient care Diagnose patients, reduce medical errors, and provide safer care, more reliable prescribing  Privacy and security of patient data Reducing costs 

20. 3. Robot-Assisted Surgery

21. Robot-Assisted Surgery Using the assistance of robots, doctors are able to perform surgical procedures more efficiently. With the assistance of robotics, surgeons are able to maneuver more precisely and with smaller incisions. Advantages Reduced loss of blood Better pain management Quicker recovery.

22. Micro robots ( Microbot ) Microbots for diagnosis and treatment of diseases ( Capsule endoscopy, in which the patient swallows a tiny camera so that the healthcare provider can take pictures of the digestive tract) Future focus Removing plaque from arteries. Taking tissue biopsies. Attacking cancerous tumors directly . Delivering targeted medication.

23. 4. Self-Monitoring Healthcare Devices / wearable medical device A wearable medical device can be defined as a device that is autonomous, noninvasive, and that performs a specific medical function such as monitoring or support over a prolonged period of time. 9% in 2014    33% in 2018. (Accenture)

24. Wearable Biosensors It is a combination of wearable objects and biosensors. It can measure the blood glucose level, BP, heartbeat rate, and other biometric data to be constantly measured. The real-time information is then sent to the healthcare providers and there can be two-way communication.

25. Advantages Disadvantages Boost communication Allow multitasking Consistent Develop the communication between an individual and the machine Provide convenience Work from everywhere Expensive Wearable devices can be heavy Some of them consist of a lot of wiring Wearable devices can cause discomfort. Wired network restrictions Easy to loss the data if the item is stolen or lost

26. Bio sensing / Smart Contact Lenses Wireless smart contact lenses could be the answer to detecting diabetes and helping to treat diabetic retinopathy just by wearing them

27. 5.The Internet of Medical Things ( IoMT ) An amalgamation of medical devices and applications that can connect to health care information technology systems using networking technologies.

28. It can be a combination of telemedicine, mobile technology, wearables , including ECG monitors. Many other common medical measurements can also be taken, such as skin temperature, glucose level, and blood pressure readings. The Internet of Medical Things ( IoMT )

29. 6. m-Health mHealth – also known as mobile health - refers to the practice of medicine and public health supported by mobile devices such as mobile phones, tablets, personal digital assistants and the wireless infrastructure.

30. Digital health applications for m-Health include: Education and awareness Diagnostic and treatment support Disease and epidemic outbreak tracking Healthcare supply chain management Remote data collection Remote monitoring Healthcare worker telecommunication and training Telemedicine Chronic disease management

31. Mobile Diagnostics Mobile phones are enabling self diagnostics, enabling patients to identify & manage health Netra -G is a device attaches to a smartphone and enables patients to perform their own eye test by measuring the refractive error of the eye

32. Mobile Diagnostics Heart monitoring - The device snaps onto the iPhone and wirelessly communicates between the app and your phone. Resting your fingers from each hand on the electrodes, the app recognizes skin contact and performs the ECG. While it records, it displays and saves your heartbeat.

33. Mobile Diagnostics Ear view Parents can view their child’s ear canal and eardrum, then share images & symptoms with their physician remotely. Glucose management -The meter will automatically sync data with the Diabetes Manager app tracking glucose, insulin and carbs while also charting glucose patterns over time.

34. Mobile apps: Diet & Nutrition apps Fitness (and/or tracker) apps Wellness apps Patient & Provider care apps Medical Device Accessory apps.

35. 7. Organs on Chips New treatment / medicine at the cellular level can be best studied on the chips instead of humans/animals. Making advancements in DNA sequencing and through in-depth stem cell research.

36. They made chips of other organs like kidney, heart, gut, bone marrow and so on. The organs on the chip device can provide the cells with nutrients and oxygen, just as the cells in the human body are sustained through blood. These cells grow and respond exactly like the real cells in the human organ, and definitely much better than the cells grown in petri dishes.

37. Ongoing initiatives in Digital Health - MoHFW Reproductive Child Healthcare (RCH) Integrated Disease Surveillance Program (IDSP), eHospital , e- Shushrut , Electronic Vaccine Intelligence Network ( eVIN ), National Health Portal (NHP), National Identification Number (NIN), Online Registration System (ORS), Mera Aspatal (Patient Feedback System) and National Medical College Network (NMCN).

38. FUTURE OF DIGITAL HEALTH IN INDIA Telemedicine- 150,000 health and wellness centres along with telemedicine (Digital health india ) Electronic Medical Records (EMRs) can digitalise patient’s information coming from various sources at one place. Artificial Intelligence has the potential to transform everyday health management .

39. Robotics will play a key role through endosuturing , sensing, image guidance, materials, manufacturing and surveillance strategies in surgical procedures. Smart health monitors can collect personalised vital signs and test results in real-time. Human DNA analysis enabled by increased computer processing will enable truly personalised genomic testing and treatment options for certain genetic diseases.

40. Mobile health apps can help in preventing serious diseases by increasing patient engagement, providing health education and expert guidance from healthcare providers. Virtual reality has the potential to transform the way we think about pain management, stress management and rehabilitation.

41. Few evidences on Digital health Cure Fit – (2016) It offers fitness, nutrition and mental well-being solutions through offline and digital channels. It strengthen its technology platform by offering AI-driven health planning, create its own fitness devices. DocsApp - (2015). It is an online medical consultation platform. Investors believe that DocsApp has the platform on-boards only specialist doctors who are then connected with patients in under 30 minutes.

42. Patient’s perspective Increased ability and confidence to self- manage their health conditions . Better understanding Increase their adherence to clinical interventions Improve lifestyle behaviour .

43. Digital health and covid-19 COPAL-19 - Mobile app to track Covid patients at the hospital in real time. They will also be able to track discharged patients who have the potential to become plasma donors 28 days after their recovery. – (AIIMS, IIT- New Delhi) Telemedicine hub – (To provide comfort) contact tracing and providing Covid-19-related help to the residents & counselling , sanitisation in the area, removal of biomedical waste, essential commodities

44. Digital health and covid-19 Karnataka deploys tele -ICU solution to deal with Covid-19 The State Government has partnered with Cloud physician, an indigenously developed tele -ICU solution, to offer its services in Gulbarga Institute of Medical Sciences (GIMS). The firm provides solutions to manage critically ill Covid-19 patients using intensive EMR, audio-visuals, and alert systems

45. Remote monitoring- Care at home for Covid-19 patients - Isolating at home with mild case or pre-symptomatic case of Covid-19 by the treating medical officer provided with a medical kit (with a thermometer and an oxygen saturation metre ), Daily monitoring of the vitals by a trained nurse twice a day, a tele -review / critical alert system with a doctor every third day as well as home delivery of medicines. Digital health and covid-19

46. Advantages of digital health The patient enjoys digital data access Quicker access to test results Easy to pay the bills Sharing of information with your family members Offers clinicians notes feedback P atient can review information for medical errors Instructions and Information is simple and easy to document Patient has a better approach and access to the medical records Tool for health protection

47. Disadvantages of digital health Complicated and complex health information causes concerns for the patients Clinician’s reports elevate patient provider’s relationship concerns Hackers can approach and access patient’s records It needs to be upgraded on a regular basis Digital health records are expensive Complex and composite processes

48. Health System Challenge (HSC) digital health Population denominator Availability Quality Acceptance Cost & Utilization Efficiency

49. Population denominator Delayed reporting of events Lack of quality/ reliable data Communication roadblocks Lack of access to information or data Insufficient utilization of data and information Lack of unique identifier

50. Availability Insufficient supply of commodities Insufficient supply of services Insufficient supply of equipment Insufficient supply of qualified health workers

51. Quality Poor patient experience Insufficient health worker competence Low quality health commodities Low health worker motivation Insufficient continuity of care Inadequate supportive supervision Poor adherence to guidelines

52. Acceptance Lack of alignment with local norms Programs which do not address individual beliefs and practices Low demand for services Geographic inaccessibility Low adherence to treatments Loss to follow up Utilization

53. Efficiency Cost Inadequate workflow management Lack of appropriate referrals Poor planning and coordination Delayed provision of care High cost of manual processes Lack of effective resource allocation Client-side expenses Lack of coordinated

54. Conclusion Technology continues to revolutionize healthcare and we have entered an exciting new frontier of state-of-the-art gadgets and high-tech communication systems. But the core concept of care and compassion can not be disrupted.

55. Reference National Digital health Policy print Digital health in India, Legal, Regulatory and Tax Overview April 2020 Sven Meister*, Wolfgang Deiters and Stefan Becker Digital health and digital biomarkers – enabling value chains on health data Current Directions in Biomedical Engineering 2016; 2(1): 577–581 Technical series of Primary health care Bertalan Meskó1,2, Zsófia Drobni3, Éva Bényei4, Bence Gergely5, Zsuzsanna Győrffy2 Digital health is a cultural transformation of traditional healthcare http://dx.doi.org/10.21037/mhealth.2017.08.07 Classification of Digital Health Interventions v1.0 -WHO