Medicine is changing, in part because of the increased availability of individual health data, along with analysis techniques known as “big data.” This higher level of information will allow the advancement of precision medicine, with more personalized care and treatments. Increasingly empowered, the patient will require access and control over her information, according to her needs. Another big change will be the decentralization of services encouraged by mobile technologies, telemedicine, artificial intelligence algorithms, 3D printing and biosensors. Despite the fact that digital tools have been used in past health emergencies, the COVID-19 pandemic has been a universal catalyst for the digital transformation of both providers and consumers of health services globally.
The patient as the protagonist of his care
The paradigm in medicine is changing. This change puts the patient at the center, and assumes that he is committed and the protagonist of his care. Telemedicine computer tools contribute to this empowerment of the patient, respond to his need for information and transform him into an active agent of his care. In turn, these tools facilitate feedback, networking and optimization of resources.
The importance of the Electronic Medical Record
One of the main sources of information for these tools is the Electronic Medical Record (EHR). In the region, the Hospital Italiano de Buenos Aires (HIBA) developed a Health Information System (SIS) that has an online, unique, modular, problem-solving, and patient-centered EHR. HIBA has recently been certified by HIMSS (Healthcare Information and Management Systems Society, for its acronym in English) as level 7, the highest level in the Adoption Model of Electronic Medical Records, being the first hospital in Argentina and the second in Latin America. to get to that level.
In addition, this institution has a Personal Health Portal that provides personalized information on the user’s health (exam reports, self-management of shifts, news, among others) and works in direct interface with the Electronic Medical Record; where a secure audio and video channel is established for telemedicine services. The Institution is currently developing community portals that will put users with the same pathologies in contact with each other.
Medicine tailored to the patient
Probably the most significant impact of the new tools will be in the field of precision medicine. This considers individual genetic variability, the environment and lifestyles of each person as well as information obtained from mobile capture devices and biosensors. The precise study of the factors that influence health will allow for more accurate diagnoses, more rational disease prevention strategies, better treatment selection, and the development of new therapies.
Medicine “tailored to the patient” involves a shift from a descriptive model to a predictive model of disease and risk. To implement it, it will be necessary to include information such as family, socioeconomic, environmental, behavioral and lifestyle history.
The patient himself will be the one who generates a large amount of information through the use of mobile technology, biosensors and self-monitoring tools that will allow the monitoring and recording of this data. The use of mobile technologies would also allow the capture of a large amount of data at the patient’s bedside (“bedside”) such as photographs of injuries.
Towards the decentralization of health services
Another change that the new technologies will allow will be the greater decentralization of services. Through the current system, high-cost services are offered centralized and supervised by large and complex institutions. Instead, the shared economy model will bring specialized professionals to their closest environment, overcoming obstacles to access to health care, providing quality care. For example, the ECHO program allows decentralized care for patients with complex pathologies by professionals working in a network with each other and with academic teaching centers, presenting results as good as those achieved in the center of reference. The Italian Hospital of Buenos Aires provides the infrastructure and technical support for these telementoring projects where specialists in Hepatology train professionals from all over the country in Hepatitis and non-alcoholic fatty liver disease (NASH).
How to handle health data?
It is to be expected that the sources of information will multiply, which will require an infrastructure that increases the capacity for data storage and management. It will be vital to identify the information that is really necessary, of good quality, correct and useful for decision-making. To achieve this, there are currently, and in continuous development, various “big data” tools, data mining and artificial intelligence systems capable of synthesizing and prioritizing information. Added to this, usability tools allow both health professionals and patients to have a proper display and management of information.
Maintaining the security of each patient’s information is essential, as well as prioritizing proper use and the balance of accessibility/security and confidentiality. For this, the adoption of informed consent is necessary, which is formulated by multidisciplinary medical teams, and which safeguards the privacy of the individual. In addition, precautions must be taken so that they are not used as an element to discriminate against the individual based on their data.
The challenges posed by technological evolution
There is no doubt that the future is promising and that important advances are coming that will improve the interaction between doctor and patient. But this progress will bring with it several questions and ethical questions to be resolved. Specifically, a balance is required between innovation and consumer demands, on the one hand, and regulatory and quality frameworks, on the other. Efforts should be aimed at overcoming organizational barriers (redesign of clinical processes), economic (forms of payment and recognition of the professionals involved), and legal (determination of responsibility, in accordance with the regulations of each country), since these are aspects that currently limit its implementation and not so much the technological ones, which was evidenced in the recent acceleration in the digital transformation developed in response to the pandemic.