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Opinion

What is digital health and why is it important?

By Cindy Moy Carr, founder and CEO of Vorsdatter Limited

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When people think of digital health, they often think of Apple Watches and smartphone apps. They’re right, but those are only pieces of what digital health encompasses.

Broadly, digital health is any type of healthcare application that is software-based. That can include telemedicine, apps, smartwatches, and remote sensors.

The US Food and Drug Administration notes that “from mobile medical apps and software that support the clinical decisions doctors make every day to artificial intelligence and machine learning, digital technology has been driving a revolution in health care”.

Further, these include “computing platforms, connectivity, software, and sensors for health care and related uses”.

Five potential benefits

Although the potential benefits to patients and healthcare systems of digital health are complicated and far-reaching, they fall roughly into five categories.

  • Access to appropriate healthcare – Access to healthcare is unequal and can be limited by geography, socio-economic status, and cultural issues. In Ireland, Australia and New Zealand, for example, we have customers who live hours from the nearest GP. With digital health applications, people that would otherwise be isolated are now part of health-based communities, able to find information, support and resources.
  • Improved efficiency – The above examples also show how digital health applications can improve healthcare efficiency. It can simplify and streamline communication with healthcare providers and minimise unnecessary site visits. Our digital application focuses on perimenopause and menopause, where symptoms can be broad and generic, often seen with other indications — they can include dry eyes, headaches, and joint pain. In the UK, where patients don’t necessarily see the same physician, multiple visits for different symptoms may never be coordinated into an accurate diagnosis without a broader perspective and cross-communication.
  • Decrease costs – It should be obvious that improved efficiency should reduce costs. Certainly, by decreasing the amount of time a physician and staff spend on in-person patient visits, costs come down. But also, by more accurately and quickly diagnosing conditions, unnecessary procedures can be avoided.
  • Improved quality – Quality can have numerous definitions in terms of healthcare. The World Health Organization (WHO) identified six digital health domains of quality: patient safety, access to healthcare, effective treatment, efficient use of resources, equity of care across subgroups of populations and patient-centred care.

A 2022 review of 54 digital health studies published in Digital Health reported the most common (79.6 per cent) digital health technologies were mobile apps and computer-based programs.

The study found that the “majority of reviews describe improved health behaviour, enhanced assessment, treatment compliance, and better coordination as the main approach of quality improvement via digital health”.

With the wide adoption of electronic health records (EHR), patient and healthcare data already exist. But they aren’t being appropriately accessed, analysed, and linked to alerts to notify providers and patients that action is required.

In the Harvard Business Review, Glaser et al. described a 67-year-old woman who reported to the emergency department with abdominal pain and rectal bleeding.

Diagnosed with colorectal cancer, she died several weeks later after unsuccessful treatment. The woman had received the scheduled colonoscopies at ages 50 and 60.

A radiologist’s note had flagged a few seemingly minor irregularities that would have had her return at age 63, but the note was buried in the “Test Results” section of her EHR. Both she and her primary care physician missed the notification.

This is the sort of thing that digital health initiatives should be able to solve easily.

  • Personalised medicine -Personalised health care (PHC) is generally defined as a framework for patient care that links predictive technologies with an engaged patient to promote health and disease prevention. The Duke Center for Personalized Health Care described the goals of personalized health care (PHC) as focused “on patient-centred health care, personalised health planning (PHP), shared decision-making, and patient engagement”.

In addition to not treating health care as one-size-fits-all, the goal is to improve care effectiveness for people faster with lower costs and improved clinical outcomes.

It is believed — as in the case of the 67-year-old colorectal cancer described above — that new digital tools and programmes have the potential to be more sensitive to change that could complement traditional approaches.

Obstacles

Many of the necessary tools for broader implementation of effective digital health are already in existence: widespread use of EHRs, patient portals, a variety of digital and mobile apps and a patient population already accustomed to the use of digital systems.

These systems range from smartphones and apps, and digital wearables such as Fitbits, Garmin watches, and Apple Watches, to online shopping, banking, and bill-paying. But there is still a lot of infrastructure that needs to be constructed.

A 2021 study by the Pew Research Center found that as of February 2021, about 28 per cent of rural Americans and 23 per cent of urban residents did not have broadband internet.

Interoperability –  the ability of different systems, devices, applications or products to connect and communicate – is also a major challenge.

It’s not of use to have so much digital information in disparate silos if they can’t communicate or be accessed conveniently by a healthcare provider.

Cybersecurity is also a major area of concern. Privacy of health records has always been a priority, and digital health data only increases the risk of misuse.

Governments are making efforts in all those areas. The Biden administration’s American Jobs Plan infrastructure proposal included US$100bn earmarked for broadband expansion. It was part of the US$1.9tn American Rescue Plan Act of 2021 signed into law in March 2021.

The UK has made digital health and social care a top priority in 2022, with the Department of Health and Social Care (DHSC) and NHS England saying the “system’s long-term sustainability depends on it”.

Part of the initiative is to digitise the health and social care records, with a goal of having core digital capabilities, including EHRs, in place by March 2025.

Why define digital health?

Too often, various stakeholders differ on the definition of digital health. When I go into a room with potential investors, they’re usually very excited about digital health.

They’ve heard about it, and want to get involved in it, but they don’t understand what it is. Is it software? Is it hardware? Is it mobile devices like the Apple Watch? Is it software used by a hospital? Is it implantable chips or a ring you wear on your finger? What is it?

Everyone involved in expanding digital health must understand what it is — and what it can be. Because what it can be is transformative, improving the quality of health care, and patient care, while driving efficiencies and reducing costs.

 

Cindy Moy Carr is the founder and CEO of Vorsdatter Limited which developed mySysters, an app for perimenopause and menopause. She’s an attorney and journalist who authored the American Bar Association’s Guide to Health Care Law.

Opinion

The continued struggle for female representation in drug trials  

Dr Janet Choi, chief medical officer at Progyny

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Dr Janet Choi, chief medical officer at Progyny

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

In 2002, the Women’s Health Initiative (WHI) was forced to pause its study on hormone therapy’s effect on menopause symptoms due to results showing it increased the risk for breast cancer, stroke and heart disease, and thrombotic events like pulmonary emboli.

Over 20 years later, in May of this year, JAMA published a review of this study and determined that, given current available hormone therapy formulations as well as risk/benefit analysis, younger menopausal women may actually derive significant benefits from menopausal symptom relief with appropriately prescribed hormone therapies.

The initial study had looked at women who were older and typically years post-menopause – the average age of the study participants was 63.3 years – and the age-related changing of blood vessels, among other things, may be the key to shifting from greater risk to greater benefit with hormone therapy.

I wish this more measured summary of the study’s findings and recommendations had been headlined back in 2002 – and I imagine thousands of my OB/GYN colleagues and billions of menopausal women over the years feel the same.

Yet, due to these 2002 over-generalised published findings, doctors and patients shied away from hormone therapy, which led to unnecessary suffering for many symptomatic menopausal women.

The irony of the WHI study is that after decades of women being excluded from clinical research, Congress finally passed an act in 1993 requiring that the National Institute of Health (NIH) enrol women and persons of colour in clinical trials.

On the heels of this landmark decision, the intentions of the WHI study were excellent – a first of its kind for women – but may have unintentionally set back women’s health innovation.

The reality

If you’re wondering why we are just now reevaluating and reinterpreting findings made in a 2002 women’s health study you may (or may not) be shocked to learn that while there is growing inclusion of women into research trials, they are still underrepresented in key therapeutic research areas, such as cancer and cardiovascular disease.

Excluding women from drug trials can have several harmful consequences. First, it can lead to a lack of understanding about how medications affect women differently than men, as their physiological responses may vary due to hormonal and metabolic differences, among other factors.

This can result in ineffective or potentially harmful treatments for women. It can also hinder progress in medical research by preventing the development of sex-specific treatment approaches.

Additionally, while the amount of research conducted on the behalf of women has grown in the past two decades, research involving pregnant women has been restricted.

This leads to a limited understanding of how best to medically care for pregnant women: for example, less than 10 per cent  of prescription medications have been studied enough to understand the impact in pregnancy on both the woman and her foetus.

While the NIH and American College of Obstetricians and Gynecologists (ACOG) both acknowledge pregnancy as a “medically complex” state that can alter metabolism of medications, and the course of various diseases, increased pregnancy-specific data needs to be collected to optimise the care of women in pregnancy.

Another recent, glaring case study: initial COVID vaccination trials did not include pregnant women, which led to restrictions on the availability of the vaccines as well as restrictions of the use in pregnant women with dire consequences – as unvaccinated pregnant women are more likely to develop severe COVID infections requiring ICU admissions and are more likely to develop other pregnancy-related complications like preeclampsia and preterm birth.

How do we move forward?

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

It’s crucial for the government and pharmaceutical companies to put more resources and funding into women’s health so we can have a deeper understanding of how to treat diseases that impact over half of the population, for more female and diverse talent to enter the medical field – either as doctors, researchers, healthcare executives – and to incorporate how biological sex can affect medical treatment into provider education.

And, for pregnant women, the answer was proposed by ACOG back in 2015: “A more careful examination…points to the need for evidence-based consideration of pregnancy exposure in research rather than broad exclusion of all pregnant women”.

If evidence demonstrates minimal risk to the foetus as well as potential benefit to the pregnant woman, why should she be denied the right to give informed consent to enrol in a clinical trial?

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Opinion

‘Women are left in limbo’: how telemedicine can cut down NHS gynaecology waiting times

By Kat James, director of new projects at Consultant Connect

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Almost 600,000 people in England are waiting for gynaecology treatment. It is clear the current system is not fit for purpose.

The NHS, across the board, is struggling to reduce waiting lists, but gynaecology health, in particular, has been sent to the back of the queue.

Referral numbers are about 60 per cent higher than pre-pandemic, which represents one of the three highest specialties in terms of volume increase since pre-COVID.

Not only are women left feeling neglected, but longer wait times also result in them needing more complex treatment or even emergency admissions to hospital.

Then, there is also the impact on family life, work, and women’s mental health. A survey of the Royal College of Obstetricians and Gynaecologists found that four-fifths (80 per cent) of women said their mental health has worsened due to the wait and that one in four of those whose mental health had deteriorated, pain was given as a reason.

More than three-quarters (77 per cent) of women said their ability to work or participate in social activities had been negatively impacted.

One of the main stumbling blocks impacting patient waiting times is the disconnect between primary and secondary care. Often, patients who have faced long waits for their appointment are discharged after their first hospital appointment and told that their care is best taken care of by their GPs.

The good news is that new ways of working better connect primary and secondary care and ensure patients receive the right treatment first time. If applied at scale, these solutions considerably reduce waiting lists.

For example, giving GPs immediate access to speak to a consultant on the phone for specialist advice and guidance for their patient. In ordinary circumstances, a GP would have to call the hospital switchboard or send a written advice request which might take days to be answered.

Often, these queries would go unanswered or aren’t transferred to the correct department, resulting in patients being referred sometimes unnecessarily or presenting at a busy A&E department.

Technology like Consultant Connect allows GPs to directly “hunt down” a specialist consultant from a pre-defined rota for expert advice via a phone call, ensuring GPs can direct their patients to the right care first time. This service is available for gynaecology in almost 50 NHS areas across the country.

In Coventry, for example, a 54-year-old patient presented with obvious advanced gynaecological cancer. While the two-week wait referral had already been made, the GP couldn’t move the appointment sooner than 14 days later.

Meanwhile, the patient started deteriorating, and the GP considered an urgent admission. The GP used Consultant Connect and, within seconds, was connected to a gynaecologist, who then arranged for the patient to be scanned that day. The patient got the care they needed and avoided an acute admission.

In June 2023, the service expanded to cover a menopause advice and guidance line as referral data in one local area showed increased referrals relating to menopause-specific questions, many of which did not require to be seen in a hospital setting.

This meant that trusts weren’t seeing patients who needed to be seen, and patients with menopause symptoms were on waiting lists for a prolonged duration without management plans.

With the new Consultant Connect Menopause line, GPs can get through to a consultant with special interest in menopause matters within 26 seconds.

Data shows that 87 per cent of calls resulted in the GP receiving “enough” advice for their patient to benefit from an immediate treatment plan via their GP rather than waiting for a hospital appointment with a specialist unnecessarily.

Another way to tackle the wait problem is to leverage remote ways of working, which opens access to a new pool of workforce that otherwise wouldn’t exist.

Consultant Connect runs a network of NHS consultants who review gynaecology referrals remotely, with no need to travel to local hospitals and with consultants choosing their own working hours. This is often attractive to consultants who work part-time in hospital or are on parental leave, for example.

For patients, it means they get access to treatment plans faster: the remote working consultant determines the urgency of a referral and writes up a management plan, which means that treatment can start immediately.

Often, the health problem can be resolved through this plan, and for those still needing to be seen, it means they come to their first appointment on a more informed basis.

At the same time, it ensures patients are on the correct pathway, and any diagnostic test needed for a diagnosis are initiated in a timely manner.

Last year, Consultant Connect’s team triaged over 5,000 gynaecology referrals across the UK, resulting in 43 per cent of referrals being safely removed from the waiting list.

Many of these patients were returned to their GP with a treatment plan devised by the consultant. By fast-tracking urgent cases, women are not put through unnecessary stress and pain while waiting to be referred to a gynaecologist. Among these referrals, one in ten cases were upgraded to the urgent and suspected cancer pathways.

By reviewing current systems to make them more joined up and to allow for efficient ways of working, we can speed up care for women and make sure that clinicians have the right tools to help the NHS deal with the mounting gynaecology backlog.

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‘We are not allowed to talk about our bodies’: why we need to address social media censorship

By Clio Wood, women’s health advocate and founder of &Breathe

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Social media censorship is just another example of women’s issues being sidelined and women being made, yet again, to feel small.

The gender data gap is huge and, if you’ve ever read the great Caroline Criado Perez’s book, Invisible Women, you’ll know what I mean. It touches every day of a female life.

That impact includes social media too. Because while the social media platforms are notoriously secretive about their internal workings, it’s a pretty safe bet that social media algorithms, like most of the rest of life, are built on male data and trained on male behaviours.

This means that as long as women have different behaviours and priorities of what they want to see on these platforms, we’re going to find it a struggle.

Meta and Tiktok are silencing women’s health and sexual wellbeing content. Censorship harms women’s health: it increases women’s pain, and disempowers women, which in turn means the gender health gap cannot close. What annoys you when you’re on your phone scrolling has long-lasting impact for us and our children.

I’ve experienced this censorship first hand on Instagram, with my reach being restricted for simply posting a body confidence reel of me dancing in a bikini.

That in itself – one example of many – is infuriating, but what’s especially galling is that everyday men’s health topics are left uncensored, and hyper sexualised women’s bodies, unsolicited “dick pics” and fake accounts using nearly naked female profile pictures are making their way into social media feeds and inboxes unchecked. The hypocrisy of the situation is clear.

All the while charities are being forced to use male nipples instead of female ones, and female-led period brands are losing hundreds of thousands of pounds when their ad accounts get deleted.

Creators, charities, medical practitioners and brands are being censored constantly through algorithms picking up words like sex, vagina, vulva, or period. Which are all normal human functions or body parts and integral to these creators’ missions. You can’t be a period care brand without talking about periods.

CensHERship aims to alter the trajectory of the current algorithms and end the routine censorship of women’s health content online

Creators end up using written symbols and numbers to disguise these words and bleep them out in speech to try to get around this censorship.

It’s examples like this that finally led me – after many years of finding this situation ridiculous – to do something about it.

Together with Anna O’Sullivan, we’ve created CensHERship, a campaign which aims to alter the trajectory of the current algorithms and hopefully restore some balance to what is allowed on social media. Our ultimate aim is to bring the platforms to the table for discussion by this time next year.

We launched a survey in late January 2024 to try to collect as much information as we can about the incidences of muting and censorship that female creators are experiencing, whether they are educators, charities, brands or medical professionals. The results emphasised that this is a widespread issue taking in all of women’s health and sexual wellbeing.

In tandem we hosted an intimate roundtable to launch the CensHERship campaign and found, to our astonishment, that the problem goes much deeper than social media. Women’s health and sexual wellbeing brands are being refused bank accounts, insurance and being kicked off payment platforms without warning.

Social media censorship is just the tip of the iceberg. It’s just one more example of women’s issues being sidelined and women being made, yet again, to feel small.

We’re not being allowed the freedom to talk about our own bodies and health, because speaking up goes against the male-gaze archetype of the female role and body. Let’s end CensHERship once and for all.

Clio Wood is a women’s health advocate, journalist, author and Founder of &Breathe.

Anna O’Sullivan is a communications and marketing professional and writes FutureFemHealth 

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