Now, more than ever, patients and physicians in both the U.S. and abroad are connected and active in the digital world. While it is more common for younger physicians and trainees to be online for medical purposes, all age groups are now represented. Older patients are becoming increasingly connected — in fact, recent data indicates that the fastest growing demographic on the social media site Twitter is the 55-65 age group. We now have an entire group of patients  who are considered to be electronic patients or e-patients. There is a wide range of new tools that connect and engage each of us in medicine, and in the last decade we have defined a new discipline known as mobile health or m-health. Social media platforms allow healthcare professionals from around the world to connect and learn from one another as we advance care for patients. 

The development of new ideas and collaboration on new research endeavors are facilitated by the “connectedness” now available to us in the digital world. 

Digital medicine is developing at a rapid pace, and as physicians as well as healthcare consumers, we must be ready to adapt to a changing healthcare landscape. In the future, the way in which we seek, deliver, and receive care will be very different. No longer will hospitals and physician offices be the cornerstone of the healthcare system. No longer will simple diagnostic testing be exclusively performed in a healthcare facility. In the future, our healthcare system will increasingly rely on technologies that promote patient engagement. 

In addition to mobile technologies for communication and engagement, wearable devices and technologies continue to be developed at a rapid pace. Many of these wearables are now able to transmit important physiologic data with amazing accuracy. Clothing, monitors, watches, and other tools can measure heart rate, respiratory rate, body temperature, blood oxygen saturation, calories expended, and much more. It has become commonplace for smartphones and items such as the Apple iWatch to be outfitted with increasingly powerful applications. These devices are being integrated into the world of medicine and have the potential to transform the way in which doctors and patients interact. Capabilities for these devices appear limitless — from optimizing the performance of elite athletes to monitoring patients with chronic illness during rehabilitation. 

Patients are becoming increasingly technologically savvy; according to Pew Research Associates, nearly 65% of all Americans now own a smartphone.¹ More impressive is the fact that nearly 95% of Americans (irrespective of age) are connected to the internet in some way — most are interactive by using a cellphone or other mobile device such as a tablet. In addition, polling further demonstrates that 72% of internet users accessed the internet via a mobile device to look up health information in the last year. Medical applications are also becoming more prevalent — nearly 20% of those surveyed have indicated that they have downloaded an app to specifically track or manage a health condition. Nearly two-thirds of Americans track diet and exercise, and another third also track blood pressure, blood sugar, or other health indicator via mobile health applications. It is clear that patients are increasingly connected and ready to embrace mobile health. 

In addition, industry is becoming increasingly interested in the power of digital medial care. EPIC Systems (www.epic.com), one of the leading Electronic Health Record (EMR) companies in the U.S., recently announced a partnership with Apple to integrate date from the Health Kit (https://developer.apple.com/healthkit/) into the permanent EMR record — thus, one day making patient-collected data easily accessible to doctors during routine office visits.² Other medical device companies are working to connect devices such as insulin pumps with smartphones for integration and creating closed-loop systems. By actually allowing the mobile device to perform analytics and interface with the medical device, more control is offered to the patient. Additionally, real-time relevant clinical information can be transmitted directly to the physician for analysis and therapy adjustment.

Virtual office visits are becoming more common all over the U.S. While telemedicine has been around for decades, it has mainly been utilized to provide medical care to those in remote areas with limited access to any type of medical care. Now, telemedicine is gaining traction in the mainstream by utilizing digital technologies to assess and obtain real-time medical data from patients during remote physician visits. For example, by using the AliveCor Heart Monitor, patients are able to transmit real-time electrocardiograms to their physicians simply by holding a smartphone equipped with a specialized case to their fingertips. Patients find telemedicine convenient and reliable, and many are now preferentially seeking care via virtual consultations. Numerous companies have begun to train physicians in virtual medicine, and hospital systems are utilizing virtual consults as a way to leverage their particular institutions in an increasingly competitive environment. 

As you might expect, with the surge in the development of digital medical devices, regulation is imminent. The technology is developing so rapidly that the FDA is drafting guidance of how they may begin to regulate apps and mobile medical devices. While the FDA highly regulates traditional communications regarding medical treatments, there is a significant lack of regulatory guidance by the FDA for internet and social media use. In a draft document, the FDA states that they will apply oversight to mobile applications that are considered medical devices and whose “functionality could pose a risk to a patient’s safety if the mobile app were to not function as intended.”³ Currently, the FDA appears to be focused on applications that transform a mobile device into a medical device by using sensors, attachments, or display screens. In addition, the FDA considers any applications that perform or provide patient-specific analysis, diagnosis, or treatment recommendations to be medical devices that are subject to the same approval and regulatory processes as more traditional devices. 

While the concepts of m-health and the e-patient are not new, they are gaining momentum. Technology has no bigger impact than it does in the medical space. Through innovation and entrepreneurship, we are able to advance treatments, improve time to diagnosis, and impact the doctor-patient relationship like never before. Medicine is changing, and while the art of medicine will continue to be closely tied to in-person contact between the patient and healthcare provider, we must learn to adapt and embrace these new tools and technologies. Patients are able to engage like never before and are able to participate more readily in the management of their own disease process. Physicians are able to connect all around the world on a moment’s notice through social media and other digital platforms. There are limitless new opportunities for research and collaboration between experts from all around the world. We are just now only seeing the beginning stages of the digitization of healthcare — I believe (and sincerely hope) that expansion is imminent. It is important that we all are aware of where we have been in medicine (and carefully preserve the art of the profession) and what the future holds as we continue to digitize healthcare worldwide. 

Kevin R. Campbell, MD, FACC is with North Carolina Heart and Vascular in Raleigh, North Carolina. He is also Assistant Professor at UNC Department of Medicine, Division of Cardiology, and Director of Electrophysiology at Johnston Health. In addition, Dr. Campbell is President of K-Roc Consulting, LLC.

For more information, please visit:

www.DrKevinCampbellMD.com

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References

1. Mobile Technology Fact Sheet. Pew Research Center. Published October 2014. Available online at https://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/. Accessed July 20, 2015. 
2. Apple Partners with Epic, Mayo Clinic for HealthKit. InformationWeek. Published June 3, 2014. Available online at https://www.informationweek.com/healthcare/mobile-and-wireless/apple-partners-with-epic-mayo-clinic-for-healthkit/d/d-id/1269371. Accessed July 20, 2015. 
3. Mobile Medical Applications. Guidance for Industry and Food and Drug Administration Staff. FDA.gov.  Published February 9, 2015. Available online at https://www.fda.gov/downloads/MedicalDevices/.../UCM263366.pdf. Accessed July 20, 2015.