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This monthly series will explore how the digital health revolution is disrupting medical practice.
“DIGITAL health” is an umbrella term for a range of medical technologies. Some examples include wearables that measure real-time physiological outputs, genomics and personalised medicine, online doctor services, telemedicine, artificial intelligence (AI) that reviews medical scans, and electronic health records (EHRs).
Proponents argue that greater connectivity between patients, doctors and digital health technologies will vastly improve the detection and prevention of diseases. However, what truly distinguishes digital health from other advancements in the field of medicine is that digital health promotes a cultural shift to health care delivery that sees patient control as a fundamental and necessary norm of practice. Patients will monitor their own health on their own devices, they will partner with you on decision making, and they will control the data – they will review it, share it and sell it.
Eric Topol, a world-renowned digital health author and cardiologist, suggests that the natural progression is that patients will own their health data, and he contends that this is their civil right. If this is indeed the way that we are headed, perhaps the future will also see that patients require a script in order to purchase digital health applications or devices. This may become a necessary government intervention to curtail the misuse of the technologies that could result from a lack of oversight. The debate on the consumerisation of digital health care will be discussed throughout this series, and we will consider the advantages and disadvantages of different approaches.
Indeed, the major question for our generation is whether these digital health technologies and the new wave of medical practice will achieve a net benefit to patients and the whole of society. It is reasonable to suggest that, in an age of evidence-based medicine, proponents should “prove and explain [the] value” of adopting digital health technologies. This series hopes to shed light on the value of digital health with reference to the evidentiary support outlined in research studies.
An important consideration for technologists and digital health proponents is, according to the Future Health Index 2018 report, that:
“Healthcare professionals are unlikely to adopt new tools when they’re presented as a ‘fait accompli’ by technologists. Creating EHRs and AI solutions in collaboration with both healthcare professionals and the general population will have a significant impact on successful integration.”
In this series, we will discuss a range of topics, such as the technological advancements making their way into various medical specialties, and the evidence base for digital health, with reference to meta-analyses and systematic reviews. The My Health Record system will be discussed, including findings from the Senate inquiry. We will consider whether adopting digital health leads to increased litigation, as well as other legal considerations. International approaches will be explored, and we will discuss the shift to long-standing paradigms of clinical practice that will result from digital health disruption.
It is hoped that the series will promote discussion among peers about the future direction of medicine, and perhaps it will provide some reassurance that despite the technological world’s determination to deliver digital health direct to the consumer, the future of digital medicine is in your hands.
Bianca Phillips is a Victorian lawyer conducting medical law research. She completed her Master of Law at the University of Melbourne with her thesis on telemedicine, and is currently completing a doctoral thesis on the law-making of the digital health revolution. She has authored articles on the digitisation of medicine in both legal and medical publications. She can be found on Twitter @biancarphillips.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.
Thank you for your comments.
Dr. Walker, that is certainly an e-health lesson for all. Thank you for sharing this in the forum.
Stay tuned for article no.2.
Bianca Phillips
I am writing this comment to say that while digital health has a lot to offer, it can also go horribly wrong!
As a result of Health Minister Greg Hunt not accepting the recommendations of the recent Senate Committee of Inquiry into My Health Record (MyHR) the GP run student Health Clinic at Rosny College, Tasmania will close down on November 15, the day all Australians will be lumbered with MyHR unless they have opted out. I am one of the doctors who work there and we will no longer be able to guarantee the essential privacy for mature minors once they have a MyHR.
Rosny is a public Y11-Y12 secondary college and we have conducted free, twice weekly, drop in clinics on site for the last ten years. It has been very popular with students and staff. For the students that have attended our clinics during their time at Rosny we have zeroed the unplanned pregnancy rate, done great work in containing sexually transmitted diseases (STDs) and worked with the staff psychologists to mange complex mental health issues. We are pleased that no student who engaged with our Rosny College doctors in this time has taken their life. We have managed a wide range of trauma and routine adolescent illnesses, reducing ambulance calls and visits to Emergency Departments.
It has been a ‘dream run’ with thousands of consultations and not one complaint lodged with the Health Complaints Unit. We have liaised with staff and parents when appropriate and we have received many compliments.
All this is coming to an end as the extra care and workload needed to protect privacy for a student once they have a MyHR make our clinics totally unworkable. Most mature minors will have a MyHR with the their parents as ‘authorized representatives’ which means a parent can view the MyHR.
Depending on access alerts placed by the parents, when such a MyHR is opened at our clinic (which can happen by accident) the parents will get an SMS within seconds. If we slip up and not place an endorsement on a pathology test (and we do lots of STD screens) the result will be on the student’s MyHR within seven days. (The lab could also slip up!) If a pharmacist sends a dispense record (which they do most of the time) medications will show up on the young persons MyHR. This could be explosive information if an STD is treated or a contraception prescribed.
When I raised my concerns with an official in Minister Hunt’s department, I was advised to set up an extra computer in the waiting area and tell the students to cancel their MyHR before they come in to see the doctor! This is very hard to do as they may not know their Medicare number and they will struggle to follow the process. This is just crazy advice from the Department of Health – just showing how distant they are from the real world of general practice. Sadly students will give up, loose confidence in youth health clinics and not attend – and a great opportunity to help them is missed.
For any young person with a serious or complex illness, there are excellent phone apps and devices that are fast, efficient and very private!
Sadly, MyHR is a health risk rather than a health benefit for mature minors! This should be an e-health lesson for all of us…
Dr Bob Walker
The Lindisfarne Clinic
Tasmania
(name happily supplied!)
It is interesting the number of informed patients (those who know something about health and/or IT) who have opted out of my health.
Many of my older and some younger ones said they had not heard about it and were unsure of how to opt out.
One told me it was very hard to get their children out of my health and said he was going to check if they were actually still in it.
I think there should have more public comment before signing up the entire population. I think a large number would not be in it and there is certainly no real assurance of security.