Digital healthcare

Digital healthcare (also known as digital health) is an upcoming discipline that involves the use of information and communication technologies to help address the health problems and challenges faced by patients. These technologies include both hardware and software solutions and services.^[1] Generally, digital healthcare is concerned about the development of interconnected health systems so as to improve the use of computational technologies, smart devices, computational analysis techniques and communication media to aid healthcare professionals and patients manage illnesses and health risks, as well as promote health and wellbeing.^[2]

Digital healthcare is a multi-disciplinary domain which involves many stakeholders, including clinicians, researchers and scientists with a wide range of expertise in healthcare, engineering, social sciences, public health, health economics and management.^[2][3]

Innovation cycle

The innovation process for digital healthcare is an iterative cycle for technological solutions that is classified into five main activity processes beginning from the identification of the healthcare problem to implementation and evaluation in working clinical practices.^[2][3]

These five processes are:

• Identifying the healthcare problem: This stage involves defining the healthcare problem, identifying and understanding users and their needs, and the clinical care pathway. User requirements and the context of use of digital technologies will then be formalized through relevant scientific, engineering and psychological theories and principles.

• Doing the research: The research that informs the digital innovation is produced by scanning published literature to identify existing technologies that are appropriate and relevant to clinical practices, as well as potential technologies that can be developed.

• Designing the digital solution: The prototype solution is designed and developed with the aid of various stakeholders according to principles of human-computer interaction,^[4] including user-centered,^[5] experience-centered ^[6][7] and/or activity-centered designs.^[8][9][10]

• Evaluating the digital solution and generating evidence: The technological solution is pilot-tested in patient and user groups to ensure its effectiveness, safety and affordability. Impact evaluations are then carried out in large-scale clinical studies and/or trials, and the evidence is synthesized through published literature. This may also include clinical studies that evaluate the economic impact.

• Supporting the digital innovation: The knowledge generated from the synthesized evidence is then shared among various stakeholders (e.g. patients, clinicians, industry) to promote and spread the digital innovation.

Domains

There are a range of domains that span digital healthcare.^[2][3] These include:

• Assistive technologies and rehabilitation robotics: the use of rehabilitative systems and devices for patients with disabilities so as to aid in their independence to perform daily tasks.

• Clinical decision support: the use of decision support systems to aid clinicians at the point of care. This includes diagnosis, analysis and interpretation of patient-related data.

• Computational simulations, modeling and machine learning approaches: the use of computational and mathematical equations and algorithms to model health-related outcomes.

• E-health:^[11][12] the combined use of electronic means to deliver health information and services so that data can be transmitted, stored and retrieved for clinical, educational and administrative purposes.

• Healthcare technology assessment and monitoring: the use of any technological intervention to prevent, diagnose or treat diseases, monitoring of patients, or for rehabilitation or long-term care. Such technologies include assistive and rehabilitation technologies, unobtrusive monitoring sensors and wearable devices.

• Health systems engineering: the use of engineering applications in health care systems, such as knowledge discovery, decision making, optimization, human factors engineering, quality engineering, and information technology and communication.

• Human-computer-environment interactions: the study of interactions between people, computers and their environment. Human-computer interaction principles tend to be based around user-centered,^[5] experience-centered ^[6][7] or activity-centered designs,^[8][9][10] while user interactions with their environments can be understood by Urie Bronfenbrenner’s Ecological Systems Theory.^[4][13]

• Information management and policy: the continual process of systematically reviewing and providing concise data summaries of high quality evidence on digital healthcare technologies based on principles of information design so as to inform decision and policy making regarding patient care.

• Virtual reality, video gaming rehabilitation, and serious games: the use of 3D virtual worlds and gaming technologies to provide a social and interactive experience for healthcare student and patient education. The popular “Second Life” virtual world is an example.

• Speech and hearing systems: the use of natural language processing, speech recognition techniques, and medical devices to aid in speech and hearing (e.g. cochlear implants).

• Telehealth, telemedicine, telecare, telecoaching and telerehabilitation: the use of telecommunication and information technologies to provide various forms of patient care remotely at a distance.

References

1. Airedale Digital Healthcare Centre. What is digital healthcare? Available at: http://www.airedaledigitalhealthcarecentre.nhs.uk/.
2. Institute of Digital Healthcare. Digital Healthcare Master's Programme for 2013. Available at: http://www2.warwick.ac.uk/fac/sci/wmg/idh/study/mastersprogramme/.
3. University of Sheffield. Centre for Assistive Technology and Digital Healthcare. Available at: http://www.shef.ac.uk/scharr/sections/hsr/rrg/catdh.
4. Yap KY, Chuang X, Lee AJM, et al. Pharmaco-cybernetics as an interactive component of pharma-culture: empowering drug knowledge through user-, experience- and activity-centered designs. Int J Comput Sci Issues. 2009;3:1-13.
5. Norman DA. The psychopathology of everyday things. In: The Design of Everyday Things. Reprint ed. USA: Perseus Publishing; 2002:1-33.
6. Norman DA. Emotion and design: attractive things work better. Interactions. 2002;9(4):36-42. doi:10.1145/543434.543435
7. Norman DA. Three levels of design: visceral, behavioral, and reflective. In: Emotional Design: Why We Love (or Hate) Everyday Things. 2004 ed. New York, NY: Basic Books; 2004:63-98.
8. Kaptelinin V, Kuutti K, Bannon L. Activity theory: basic concepts and applications. A summary of a tutorial given at the east west HCI95 conference. Lect Notes Comput Sci. 1995;1015(189-201):189. doi:10.1007/3-540-60614-9 14
9. Kaptelinin V. Activity theory: implications for human-computer interaction. In: Nardi BA, ed. Context and Consciousness: Activity Theory and Human-Computer Interaction. Cambridge, MA: MIT Press; 1996:103-116.
10. Kaptelinin V, Nardi BA. Activity theory in a nutshell. In: Acting with Technology: Activity Theory and Interaction Design. 1st ed. Cambridge, MA: MIT Press; 2006:29-72.
11. Eysenbach G. What is e-health? J Med Internet Res. 2001;3(2):e20. doi:10.2196/jmir.3.2.e20
12. Della Mea V. What is e-health (2): the death of telemedicine? J Med Internet Res. 2001;3(2):e22. doi:10.2196/jmir.3.2.e22
13. Paquette D, Ryan J. Bronfenbrenner’s Ecological Systems Theory. Available at: http://pt3.nl.edu/paquetteryanwebquest.pdf.