Advantages and Disadvantages of digital health?

ADVANTAGES

There are a number of possible advantages to increased use of technology in medicine including:

Anytime and anywhere: Digital Health offers the potential to access healthcare at any time and from any place (WHO, 2019). For example, telehealth is the provision of healthcare remotely typically using video conferencing technology. It allows someone living some distance from medical provision to obtain healthcare. It is of obvious benefit to those living in remote, rural areas. Internet and mHealth apps can be used at any time, when it suits the user.

Democratic healthcare: Digital health offers the potential to democratize healthcare, providing people with the potential to be actively involved with the decisions affecting their own health. Traditionally, the physician had professional authority and was considered as the sole source of knowledge, to which patients were expected to defer. Today patients have increased access to the information related to their own health. Thus, the patient-doctor relationship has changed into a more mutual relationship; the physician now needs to understand the patients desires and wishes.

Improved accuracy: Improvements in technology mean that the information used to make decisions could become more accurate. For example, Machine Learning algorithms can categorize images more accurately than trained professionals. This offers the chance for improved medical diagnosis and quicker identification of conditions, which leads to better healthcare. More information, more access to information: The ability to collect, store and access more information means that more informed decisions can be made.

Reducing inequalities: Traditionally, the best healthcare was concentrated and obtainable from only a small number of select locations; these were where the most experienced and well qualified experts were situated, and the best and most modern equipment was. Now wider dissemination of knowledge means expertise is more widely spread and not concentrated among a small group of experts. This means an increasing number of people could receive the best care possible, possibly reducing inequalities of care. Digital Health has global reach. Many of the examples used in this book have the potential to reduce inequalities in healthcare. The classic example might be between the developed and developing world, with even those in the poorest countries now being able to access information about the most up-to-date treatments and methods. However, differences oc-cur at many levels; for example between rural and urban locations in developed nations, and between different socioeconomic groups within a single city. Digital Health helps ensure all can receive the same healthcare.

Towards 'smart' and integrated healthcare: The possibilities raised in the section on Artificial Intelligence and in the chapter on the Internet of Medical Things show the potential that Digital Health has to offer. The use of a combination of technologies opens the possibility of 'smart' and integrated healthcare systems, with technology being used in an integrated manner to improve the entire healthcare journey for patients. More of the healthcare journey will be automated. Increasing personal responsibility: By giving people access to data, and the tools to learn about and manage their own conditions you are empowering them to look after their own health (Lupton, 2013).

Personalized healthcare: Digital Health makes it feasible to provide personalized care, bespoke to the individual involved. The increasing ability to store data and automatically analyse it using Machine Learning and Artificial Intelligence methods, means data from individuals can be collected and analyzed to provide tailored advice on an individual basis. As a result of improvements in healthcare over the last 100 years people are living longer and healthier lives. Once infectious diseases were the major killers, but these have been effectively banished by vaccination and antibiotics. However, this means the 20th century has seen the rise of chronic conditions instead. In the developed world diseases such as diabetes, heart disease, obesity are now major health problems. Instead we now have to learn to live with the problems we have. This requires a different approach and a different mindset. The developments in Digital Health mean personalized medicine is possible, with each of us receiving the support we need for the individual conditions we have. This is likely to be of great help for those with these chronic conditions, where monitoring and control will be important, allowing the personal tailoring of treatment regimes. The ultimate goal must be that we can monitor and assess ourselves and have the tools to make effective decisions about our own health.

​Increased efficiency and accuracy: Digitization offers the chance to improve efficiency and reduce errors. Electronic Health Records can be shared between healthcare providers instantly, meaning no transportation of documents, no replicating taking of records, simply providing more joined up care. This reduces the chance of errors occurring. For example, in the UK from 2018 it was possible for pharmacists using the EMIS 'Web for Pharmacy' system in England to connect with records held at patients local family physicians.

DISADVANTAGES

Increasing inequality: There is a risk that Digital Health further exacerbates the inequalities that already exist in healthcare provision. This is not only due to the cost of Digital Health methods and different abilities to implement them, although this is perhaps the most obvious factor. Another potential reason is the requirement for specialized knowledge in order to utilize the technologies involved in Digital Health. In developing areas of the globe those receiving a medical education may not have the opportunity to train using the most modern techniques or equipment.

Data privacy concerns: Who has access to our data and how can this be controlled? Many aspects of Digital Health rely on the collection and storage of data related to our personal healthcare. The private and personal nature of this data means it is potentially sensitive. In past times personal medical notes might be held in a physical folder, with a limited number of people having access. Today cloud storage means data can be potentially accessed by anyone.

Monetarism of healthcare: Is making money a bad thing? Business has much to contribute to healthcare and the motivation of profit can drive innovation. Business will take the risks that governments and non-profit making health providers can not justify making. Surely it is only correct that those taking such risks profit from them? However, in many countries social healthcare systems exist meaning either that healthcare is free at the point of treatment or run through social insurance schemes. Will digital technologies lead to the private encroachment of such systems?

Does Digital Health work?: Are digitized methods better than conventional ones? Where is the research and evaluation? In many cases these technologies are unproven. Digital Hype?: Is too much being promised? It is now common to see promotional material for new 'Digital Health' products and services, many promising to revolutionize healthcare. New apps are becoming available almost daily. Many of these are extremely useful, for example diet based ones making it easy to track what foods have been eaten, or fitness ones helping plan exercise schedules. However, such activities can be performed easily without apps and were done so before they were developed. Such products make life easier, and might enhance adherence, but they are hardly groundbreaking.

Digital Hijacking?: Digital Health is perceived by many as being the next big thing. For those eager to secure research funding, business support, or sell products, an obvious strategy is to emphasize the 'digital' aspects of the services or products they are offering, or simply to call it a 'Digital Health' method. There exists the risk that the moniker 'digital' just gets appended to anything, whether it really relies on technology or not. In effect, just about everything in healthcare today is now 'digital' in that it relies on computers, digital technology and the Internet. There is a real danger of 'digital washing' or 'digital hijacking'. This would lead to the name 'Digital Health' becoming fairly meaningless.

Digital Bandages?: Another danger is that digital technologies will be implemented where not required, possibly diverting resources away from areas where they are most needed. This could be because those responsible for delivering healthcare genuinely believe promoting digital based methods will make things better. However, unconsciously digital techniques could be used to cover up shortcomings in other areas of health care, or because implementing digital change is an easier step than making more fundamental change.

Digital 'bandages' might appear cheap and feasible, whereas truly effective but necessary reform can be costly and difficult. The classic example from recent years would be the COVID-19 'Track and Trace' system in the UK, which devoured 37 billion pounds (Wise, 2021). The system relied on a combination of testing, digital contact tracing and call centers. But it never worked (UK House of Commons Public Accounts Committee, 2021). 'Feet on the ground' contact tracing performed locally through local family physicians or local health authorities would arguably have been more effective, and cheaper.

Often the most effective methods to improve healthcare are not digital. For example, one of the most effective methods to reduce the burden of malaria in recent years has not been complicated apps, GIS technologies, or telemedicine for healthcare professionals in the areas where malaria is endemic. Far more effective has instead been the greater use of bed netting (Lengeler, 2020). Another example of a non-digital measure which could have great impact is simply the immunization of infants in the developing world. This offers a great potential to save lives cost effectively (Sim et al. 2020), and should be where efforts are concentrated rather than fancy digital methods. Often digitization schemes aim at the wrong target. For example, in 2023 in the UK the NHS spent £240 million increasing the possibility to book appointments online with family physicians (UK Department of Health, 2023). But of more widespread concern was lack of medical professionals providing such appointments.

Rubbish in, Rubbish out: 2023 was the year that generative AI entered the public consciousness with the launch of 'ChatGPT'. On the release of this AI chatbot, the potential of it making diagnoses or answering medical questions was quickly identified, with many medics testing its ability out. Questions began to be raised immediately as to how accurate the answers it provided were (Johnson et al. 2023). Despite the apparent promise of this development, the old adage that 'rubbish in, rubbish out' still seems to apply. Such programs can only use and process the information that is made available to them. This applies to many Machine Learning techniques. Such programs are only as good as the data they have to work with.

There is a risk that inherent bias occurs within such systems (Parikh et al. 2023). The Machine Learning program itself could even be biased, if developed by only a certain subset of programmers. However, more likely is that the data provided to it is biased in some way, meaning that the output produced is likewise biased. Research projects not translating into real benefits: Studies can be promising and show real benefits of Digital Health methods. But once research funding has finished and research has been published are studies taken further? Murray (2012) identified that many promising web based health interventions were developed only as part of a research trial, and were stopped when the research project ended. Research funding is made available when the latest development hits the headlines, but what is needed is consistent long term funding.

The risk of overdiagnosis and overtreatment: Overdiagnosis and overtreatment are the phenomena of making a diagnosis and providing treatment when it is not really required and makes little difference anyway, but simply because you can (Moynihan et al. 2012). All because you can diagnose a condition, should you? The development of an increasing range of easy to access digitally based diagnosis tools risks finding problems where they don't really exist. It must not be forgotten that those developing digital diagnosis and treatment options have an inherent interest in people using them. Whether they are the best option and should be used is another matter. There is a danger that rather than providing a treatment which otherwise would not be provided, Digital Health treatments are used in addition to traditional treatments. This might make the companies developing them more profitable, but would add to healthcare costs.