Digital transformation in health care during and beyond covid-19

May 7, 2020
Daniel Shu Wei Ting.

The coronavirus covid-19 that originated in Wuhan city, China, has spread globally causing well over 200,000 deaths and infecting 3 million individuals as of April 23, 2020. Governments have responded with tried-and-tested public health measures such as quarantining high-risk groups, travel bans in more than 180 countries, and draconian lockdowns affecting over 2.6 billion people—a third of the world’s population. However, the virus has continued to spread despite these measures with a new epicenter in the US following the initial closure of cities in China.

Paranoia quickly spread in each new country as initial case numbers picked up, with locals hoarding supplies. This has caused acute shortages in daily necessities as well as essential health-care resources such as surgical masks. This behavior was partly attributed to the unrestricted spread of misinformation in social media. Moreover, global supply chains have been disrupted by the many city lockdowns and cessation of nonessential business operations, further aggravating resource constraints.

The timing of this outbreak could not have been worse, with an already soft global economy seen as a likely casualty tipping into a recession from the current course of this contagion. Experts project staggering rates of unemployment that are already climbing as a result of the pandemic, which has wiped more than $20 trillion from global markets since mid-February. Numerous markets have reported losses of 20% or more, including the S&P 500, the Dow Jones Industrial Average, and London’s FTSE 100, in what has been titled their worst quarter in decades.

Fortunately, digital transformation has enabled the transition to remote work in many industries as this crisis evolves, having already established a track record of tremendous improvements in efficiency and capacity in the past. Experts have projected $280 billion in health technology opportunities by 2021. Yet, large segments of health care have been slow to adopt digital transformation due to a general lack of long-term coordination and facilitation at the national and institutional levels. Although consultants have hinted at the likely forms of digital transformation in health care, a clear roadmap for adoption has yet to be developed due to the heterogeneity in health-care settings and clinical services.

There is now, however, an urgency to understand emerging digital technologies that can hinder or enhance responses to the ongoing pandemic. This impetus has already enabled the development of several targeted solutions that have cushioned the health, social, and economic impact of this outbreak in various settings. In particular, four major technology domains are emerging as valuable tools to fight the pandemic. These are digital platforms for big data (including blockchain technology), digital communication platforms for health care, the internet of things, and artificial intelligence.

Big data and blockchain technology. Digital platforms for big data have been applied in health care to either store, disseminate, or help users visualize trends from data. Cloud-based electronic medical records are a form of these platforms that are increasingly adopted by health-care institutions. They enabled contact-tracing and research in the covid-19 pandemic much faster than in previous outbreaks of SARS and MERS. Progress in the development of cybersecurity in the domain of data sharing has given rise to blockchain technology, which can further enhance the reliability of these platforms as a source of primary data for health-care applications.

Blockchains are mathematical structures for data storage in distributed databases that enable peer-to-peer sharing and collaboration without a need for third-party intermediaries. They are decentralized databases with configurations that allow for secure and transparent data sharing. Medicalchain is one health-care startup that aims to put patients in charge of their own medical data by putting records on a blockchain. In China, blockchains are also being used to manage health insurance, for example by Alipay, and to address issues such as fake vaccines.

Clinical applications of secure medical big data repositories include digesting trends in real-time to highlight actionable insights. This has been demonstrated in the covid-19 outbreak for identifying high risk segments of a population, giving visualizations that front-line clinicians can use to triage patients and inform health policies to minimize exposure of the general population. They can also be used to highlight gaps in the identification of imported infections. The Chinese government launched “close contact detector,” a mobile app that notifies citizens if they may have been in contact with confirmed cases and disseminates necessary recommendations. Other forward-looking countries such as Singapore have launched similar digital contact-tracing measures as well as transparent data dashboards to address false speculation.

Digital communication in health care. Digital communication platforms have played a critical role in the responses of various stakeholders during the covid-19 pandemic. International organizations such as the World Health Organization (WHO) have leveraged these platforms to disseminate critical information from experts and coordinate national responses. In addition, governments have used them to maintain regular communication with citizens about evolving recommendations and regulations.

Health providers have also used these platforms to provide remote care through telemedicine, reducing exposure of the general population to potential infected cases. Their acceptance by various health-care stakeholders in the course of this pandemic hints towards a likely future of greater engagement and communications in health systems facilitated by these platforms.

However, unmoderated sharing of information in digital communication platforms has also crowded out of official communications in what has been termed an “infodemic.” Spread of the virus was followed by surges in mixed information despite the best efforts of organizations like the WHO to counter misinformation. Efforts to directly oppose information are often met by allegations of censorship and may cause perpetrators to hide communication underground in echo chambers where they can continue to propagate while remaining hidden, such as in Facebook groups. These make it difficult to break the chain of misinformation and place the youth at increased risk. They can also be weaponised by perpetrators to drum up support from the ill-informed using half-truths, such as anti-vaccine activists opposing legislation mandating life-saving vaccinations on the basis of autonomy.

Therefore, there is a growing appreciation by experts including WHO that tackling misinformation may require an entirely different approach. Meeting misinformation head-on with regular, transparent updates and well-structured education campaigns may be more effective. “Fighting fire with fire”—this appeals to rational minds and tackles misinformation by appealing to audiences with varied levels of literacy using targeted messages. Fortunately, digital communication platforms for health care are providing experts with digital tools to provide a coherent counter-narrative to misinformation. Examples of these applications in the pandemic include Healthline in the US as well as AskDr, a provider-managed platform launched with volunteer providers in Singapore in response to the pandemic.

Internet of things. The internet of things (IoT) include connected devices that are able to send and receive data. Successful applications in health care include wearables for monitoring markers such as heart rate and even rhythm, with applications like Spyder ECG for remote electrocardiogram monitoring. These solutions can facilitate new models of care through remote monitoring of patients, with an increased relevance in the context of a pandemic. They reduce health-care staff workload and unnecessary exposure to patients with infection through remote vitals monitoring applications such as Visi Mobile, as well as facilitate early discharge of stable patients with remote monitoring at home to prioritise limited tertiary health-care resources.

However, several hurdles for long-term use of these specialized technologies include data security and integration with existing technology infrastructure for clinical care. Another promising application is the conversion of existing commercially available devices such as virtual reality headsets for functional monitoring of eye diseases with VISRE. Furthermore, mobile phones can be integrated with IoT systems for health-care applications such as studying the movement of individuals through transport architecture or within a health-care establishment, and for applications such as contact tracing in an infectious outbreak.

Artificial intelligence. The highly anticipated arrival of clinically validated artificial intelligence (AI) for health care this year saw numerous applications particularly in the field of medical imaging. Touted as the key driver of the fourth industrial revolution, this may exponentially increase the capacity of health-care services. Firstly, at the level of the individual patient, it will help to consolidate findings in medical big data to make recommendations based on data-driven insights for personalized health care and triaging patients to the right health-care setting in order to optimize patient flow within the health system.

Secondly, at the level of individual clinical services, AI promises to achieve this by automating and reducing mundane administrative activities that take up the valuable time of health-care providers. Finally, at the level of the health system, the use of AI for the analysis of big data from multiple open sources may enable early warning systems that help predict patterns of risk and disease spread, and have already been demonstrated successfully in the covid-19 outbreak by teams such as BlueDot AI. Other promising applications of AI in the ongoing pandemic include developing potential designs for vaccinations, identifying drugs that could be repurposed for treatment of covid-19 as demonstrated by Benevolent AI, and forecast likely regions of outbreaks, methods which will likely see new applications in other aspects of health care beyond the pandemic.

Digital technology has advanced by leaps and bounds in the recent decade and is finally being adopted by health-care systems at scale. This has been greatly accelerated by the urgency of the covid-19 pandemic, potentially saving thousands of lives. Future efforts to integrate these solutions with existing clinical technology systems will enable continued long-term viability and adoption of these applications in other aspects of health care following the pandemic.

Daniel Shu Wei Ting is the consultant vitreo-retinal surgeon at the Singapore National Eye Centre, head of artificial intelligence and digital innovation at the Singapore Eye Research Institute, and assistant professor at Duke-NUS Medical School. Dinesh Visva Gunasekeran, co-founder of patient engagement platform provider DoctorBell, contributed to this post.