Aymen Sahal, Med-2 Publication Lead
When thinking of the technological advancements and new innovations in medicine, our minds often shift to robots used for procedures such as the Da Vinci Surgical System (1). But what if humanity’s technological innovations went beyond the OR? What if we could integrate the use of more convenient devices into clinical practice? What if we could rely on a patient’s smartwatch to diagnose, manage, and learn more about complex diseases? The field of digital health aims to provide answers to these questions and refine the way we administer care.
What is digital health?
Digital health is an interdisciplinary field which consists of using information and communication technologies, called digital health technologies (DHTs), to collect and analyze useful clinical data allowing clinicians and scientists to optimize the care they administer and elevate the way they conduct research for the ultimate purpose of improving health outcomes (2). The collection of more longitudinal and quantitative data through DHTs empowers healthcare practitioners to customize and craft the best personalized management plans for their patients by providing them a more holistic and precise view of their patients’ individual factors, all while empowering patients with more control over their care (3).
What are DHTs?
Digital health technologies are digital devices (e.g. smartwatches, smartphones, accelerometers) used in healthcare to measure important health metrics that can yield valuable information on a patient’s condition. The main technologies that often come to mind when referring to DHTs are wearable devices such as smartwatches, which can provide information on variables such as walking patterns, heart rate and rhythm, blood pressure, oxygen saturation, temperature, and even sympathetic nervous system activity, to improve the efficiency of both patient care and clinical research, thus improving patient outcomes, and reducing the burden on the healthcare system. Other types of devices include remote sensing DHTs, which alternatively use radio signals to collect precise information on variables as specific as gait velocity and stride length to decrease the risk of falls and hospitalization, and limit functional decline among seniors (4). The overarching vision is ultimately to monitor patients from the comfort of their own homes, using real world data collected over the course of a few days to many years to aid in diagnosis and clinical research.
What are DHTs used for?
Reducing the risk of falls among the elderly population is a great start, but the uses of digital health technologies do not stop there; their applications are manifold. From heat and pressure sensors used to monitor diabetic foot ulcers (5) to accelerometers and gyroscopes used to evaluate tremor, dyskinesia, and gait in Parkinson’s disease (6), DHTs are showing promise in areas beyond diagnosis and clinical research, such as prognosis and treatment, rehabilitation and behavioral health, as well as screening and prevention. As such, they hold the potential to revolutionize the way we deliver care, empowering clinicians to make decisions based on more longitudinal datasets, as opposed to the time-dependent snapshot picture provided by a more conventional clinical encounter. This paradigm shift can be especially important in managing chronic conditions such as Parkinson’s disease or heart failure, in which novel metrics derived from daily walking patterns using smartwatches could provide key information on functional capacity and help better guide the monitoring of patients before their condition deteriorates, all while optimizing their quality of life (7). Similarly, using smartwatch accelerometers to monitor nocturnal sleep and scratching patterns in atopic dermatitis also allows for better-quality monitoring of patients’ symptoms, which are difficult to objectify and quantify without daily digital measurements (8).
Where are DHTs in the hospital?
Despite DHTs gaining popularity in the commercial space and catching the eyes of more clinician-researchers, there is a lack of validation for their use in the clinical field. In other words, to know whether these digital devices can be used routinely in the general population is one question; whether the same devices are reliable enough to be used in a clinical setting for patient management or clinical research is another. Hence, although DHTs show great potential to revolutionize healthcare, future research is necessary to explore their potential optimizations, assess the safety of their integration in healthcare, and validate how their algorithms change over time.
References:
1. Rivero-Moreno Y, Echevarria S, Vidal-Valderrama C, Pianetti L, Cordova-Guilarte J, Navarro-Gonzalez J, et al. Robotic Surgery: A Comprehensive Review of the Literature and Current Trends. Cureus. 2023 Jul;15(7):e42370.
2. Ronquillo Y, Meyers A, Korvek SJ. Digital Health. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Feb 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470260/
3. Sharma A, Harrington RA, McClellan MB, Turakhia MP, Eapen ZJ, Steinhubl S, et al. Using Digital Health Technology to Better Generate Evidence and Deliver Evidence-Based Care. J Am Coll Cardiol. 2018 Jun 12;71(23):2680–90.
4. Hsu CY, Liu Y, Kabelac Z, Hristov R, Katabi D, Liu C. Extracting Gait Velocity and Stride Length from Surrounding Radio Signals. In: Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems [Internet]. New York, NY, USA: Association for Computing Machinery; 2017 [cited 2024 Feb 19]. p. 2116–26. (CHI ’17). Available from: https://dl.acm.org/doi/10.1145/3025453.3025937
5. Najafi B, Reeves ND, Armstrong DG. Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer-free days in remission. Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3239.
6. Smartwatch inertial sensors continuously monitor real-world motor fluctuations in Parkinson’s disease | Science Translational Medicine [Internet]. [cited 2024 Feb 19]. Available from: https://www.science.org/doi/10.1126/scitranslmed.abd7865?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
7. Kelly JP, Sharma A. Accelerating the Use of Wearable Devices in Heart Failure∗. JACC: Heart Failure. 2021 Nov 1;9(11):836–8. 8. YASUDA K ichi, ISHIUJI Y, EBATA T, KOGURE T, KONDO E, OTA A, et al. Monitoring Sleep and Scratch Improves Quality of Life in Patients with Atopic Dermatitis. Acta Derm Venereol. 2023 Oct 6;103:11922.