1. With over two decades of experience in medicine, education, and digital health, how have you seen the landscape of digital health evolve? What are some of the most significant changes you've observed in the integration of technology into clinical practice?
In my over two decades of practice, I have seen a shift from the cart to the cloud. By that I mean, when I was in training, I remember it was a person’s job to bring medical records from the records room in a cart to the requesting department. Today, electronic health records (EHRs) are in the cloud. The technological advancements and solutions that have led to modern medical practice are no small feat and they could not have been possible without innovation, policy, and frontline practitioners. The digital health landscape has evolved from a supplementary role to being fundamental to practice. The most powerful impact of digital health tools is that they truly allow for patient-centered care without compromising quality of care. Whether it be the use EHRs for seamless coordination of care, mHealth (mobile health) that empower patients to continue remain connected to their care, or artificial intelligence (AI) and machine learning (ML) that allow for application of predictive analytics and early diagnosis, each have impacted our daily workflows as clinicians. And they will continue to do so. With each iteration, we will see a shift in practice style and consumer demand of the use of technology and we will have to continue to adapt and learn.
2. In the book, you discuss the various tools of digital health like telemedicine, mHealth, and EHRs. Could you elaborate on how these tools have reshaped the patient-physician relationship, particularly in terms of patient outcomes and shared decision-making?
As mentioned above, digital health tools have become fundamental to our practice. Digital health tools have reshaped our relationships with patients in terms of clinical decision-making and patient education. As we continue to see an expansion of this ecosystem, through the use of telemedicine and mHealth, we will see increased adoption from patients. A good example of this adoption was telemedicine during the pandemic. Although telemedicine was not new, the rate of adoption increased due to circumstances and has truly shifted how we look at how, when, and where care is delivered. While rates of telemedicine have decreased in some areas, it continues to be the driving force for increased accessibility to mental health services. More work needs to be done in the policy and regulatory areas to make this tool the norm in other areas. Similarly, mHealth apps have empowered patients to take charge of their health. Everything from tracking fitness metrics to medication adherence is helping patients and providers make real time decisions about care. In my opinion, the next iteration of both these technologies will be AI-augmented clinical decision making based on predictive analytics and further integration of these tools in our daily lives, i.e. TVs, voice assistants, etc.
3. Telemedicine is often lauded for its ability to increase access to care. However, what are some of the practical challenges you’ve observed in its implementation, particularly in rural or underserved areas?
Great question! And this is a topic addressed in the book. As well as telemedicine has been leveraged through the pandemic, we are now starting to see some of the gaps. I think they fall into three broad categories, connectivity, access and trust, and regulations. Although we are as connected as ever, we are seeing gaps in internet coverage in our rural and underserved communities. This has several components; infrastructure, digital literacy, and access. Each of these components has a multi-faceted approach that needs partnership between the private and public sectors. Second, patient trust in the healthcare system and access to care remain a challenge. If there is internet connectivity, it is not accessible when the patient needs it or in rural areas. Lack of clinician trust also remains high due to digital literacy, trust of technology and systems, and malpractice. Last but not least, regulatory red tape and lack of commitment to building for the future. We saw a relaxation of regulatory burdens during the pandemic to allow for care to be delivered virtually. As we are coming out of the pandemic, we are seeing a return to the “old way” of doing things. It seems that the lessons we learned from the pandemic are not being harnessed to improve regulations and policies; we have to do better.
4. The book addresses ethical and social challenges raised by digital health. What do you believe are the most pressing ethical concerns in the use of telemedicine and digital health tools today?
In writing the content and seeking the expertise for this book, I knew this was going to be one of the biggest areas of concern. Ethical and social concerns should always be at the forefront of any tool we utilize in the delivery of patient care but especially ones that we may not have a full understanding of (i.e. AI algorithms). Data security, patient privacy, and equal access to tools are all important aspects of digital health. Protecting patient data is of the utmost importance, especially in this day and age of cybersecurity threats. Building a secure infrastructure and constantly monitoring it for threats should be part of the implementation plan for any organization or clinician. Furthermore, transparency on how decisions are made using AI algorithms should be explainable to patients.
5. How do you suggest clinicians balance the benefits of digital health tools with the potential risks, particularly concerning patient privacy and data security?
The framework of HIPAA and GDPR give us a good start as to how to think about privacy and data security. However, as we think about how data is now collected (by patients, in real time, continuously), we will need to think about more robust security measures to protect not only patient privacy but also the clinician’s ability to access information in a timely manner to provide care. For example, I think that EHRs are headed in the direction of using blockchain technology which will provide a more secure framework. Furthermore, organizations should think start thinking about how to make their IT infrastructure more stable and robust before they start implementing digital health tools. This is an investment in the future of work.
6. The book highlights the importance of understanding state laws and medico legal implications when using digital health tools. What are some common legal pitfalls that clinicians should be aware of when integrating these technologies into their practice?
Yes! We have a couple of chapters focusing on both the regulatory and legal aspects of digital health. Every aspect of the digital health space has a “proceed with caution” sign, the area of law and medicolegal practice is no exception. Old policies, regulations, and laws are being challenged by new uses and application of the technologies.
When integrating digital health tools into their practice, clinicians must navigate several common legal pitfalls that can impact the quality of care and patient safety. First, licensing and jurisdictional issues are critical; clinicians must ensure they are licensed to practice not only in their own state but also in the state where the patient resides. This is especially important in telemedicine, where cross-state care is common. As we approach the end of some pandemic era policies, we need to be mindful of how we navigate the variety of licensing issues that we didn’t have to prior to the pandemic. Additionally, informed patient consent is of utmost importance. Clinicians need to ensure that patients are fully informed about the digital services they will receive, including any potential risks associated with data transmission over the internet.
7. As Vice Chair for Innovation at the University of Pittsburgh’s DPAS program, how do you see digital health tools, including telemedicine, being integrated into healthcare education? What skills should future healthcare professionals prioritize to stay ahead in the field?
Many institutions and programs are already embedding aspects of telemedicine education into their curricula. However, I don’t think it is enough to “add” modules or single lectures. This may help with a transition as you re-envision the curriculum altogether. True digital health teaching requires a strategic approach much like many other aspects of digital transformation. Begin with your mission and goals and align your strategy of implementation with those goals. It’s also important to approach education in a multi-faceted manner and this should include stakeholder engagement. Ask your local organizations what skills they are looking for, what gaps are they seeing in the healthcare workforce, what future initiatives are they planning? Based on this data, crafting a curriculum, educating the educators, and recruiting students and faculty who align with your strategic plan are important.
Technological skills such as understanding the basics of machine learning, algorithm development, and data analysis will be as important as human skills like bedside manner (or “webside” manner), empathy, and compassion.
As a whole, I think the most important skills for the future will be adaptability and flexible thinking paired with curiosity; this applies to the teacher and the learner.
In the book, there are several chapters that speak to the use of AI tools in the classroom and how to best leverage them.
8. What innovations in digital health are you most excited about, and how do you foresee these impacting clinical practice and patient care in the next five to ten years?
I’m genuinely excited about several innovations in digital health that have the potential to impact clinical practice and patient care over the next five to ten years. One of the most promising areas is AI-driven predictive analytics, which can analyze vast amounts of patient data to leading to truly preventive measures that can help mitigate downstream adverse effects. This shift from reactive to proactive care will not only improve patient outcomes but also reduce hospital admissions and healthcare costs. Additionally, innovations in remote patient monitoring are set to revolutionize how we manage chronic conditions. These tools enable continuous, real-time monitoring, giving patients greater control over their health while providing clinicians with the data they need to intervene early when necessary.
Another area that I’m excited about is the integration of AI with genomics. This pairing is already showing results and we are now on the cusp of seeing true practice of precision medicine. Precision medicine individualizes treatments based on each patient’s genetic makeup. This ensures that therapies are not only more effective but also reduce the risk of adverse reactions. Over the next decade, we’ll likely see these technologies become more embedded in routine care, making personalized medicine a standard practice. The impact of these innovations will no doubt change how we practice medicine but also how we teach it.
9. How do you foresee digital health tools impacting the future of primary care?
Although digital health tools will not address every issue in healthcare, they will impact how patient-centered care is delivered. Below I share an excerpt from a chapter that showcases some of the digital health tools that will augment our future practice. There are a number of challenges that we will need to overcome as healthcare professionals, patients, organizations, and regulatory bodies but we will see a shift in care that will be untethered from the walls of a clinic.
This may seem unreachable but with current digital health tools, it is a possibility. As a society we have to decide that this is the kind of care we want to receive and craft policies that make this attainable. To be clear, digital health tools will not solve all problems in healthcare but they can help improve many of them.
10. What are some strategies you recommend for clinicians who are struggling to get patients to adopt and effectively use digital health tools?
Actually, the issue is not getting patients to adopt digital health tools, it’s getting clinicians to accept and adopt them! While I think there is much research needed as the various areas of digital health continue to grow, I do think that clinicians need to think about ways to begin adapting their practice to include digital health tools. For example, having a basic understanding of which health apps are available in the app ecosystem for patient use can help improve understanding of which apps can be helpful for treatment of chronic diseases and lifestyle modification. Not all apps are created equal and not all will apply to all patients. This is a true change in practice style and patient care; this is one example of how personalized medicine is becoming a reality.
11. Given your extensive experience, where do you see the future of digital health heading, particularly in maintaining the balance between technological advancement and the essential human touch in healthcare?
Digital health has become cemented into our work. The choice now is not whether to use or adopt the technology but which of the many tools are best for your practice. The future of digital health is bright. While technology will not solve all the problems in healthcare, it will change how we practice. Just as we saw a shift in practice when the internet became embedded into our practice as an information tool, we will see a similar shift in the use of digital health tools. The difference will be that patient-centered, personalized care will truly become a reality as the areas of AI and genomics will not only improve our knowledge base but also our ability to apply the knowledge. As technology evolves, we will have to shift our approach from singular preventive visits that take place in the four walls of the clinic to a more holistic approach of truly learning from data within the patient’s environment. Our clinical touchpoints will expand beyond the clinic and into places where patients live, work, and play. In this manner, the human touch will continue to be part of healthcare and perhaps even more important than ever before.
12. What are you most proud of with regards to this book?
One of the aspects of the book that I am most proud of are the contributing and collaborating authors. A number of experts in the field contributed chapters but also budding clinicians and patients. For example, there are three chapters written by PA students, both at the doctorate and master’s level. Highlighting their opinions and work is important as they are the future leaders and practitioners in this space. They will be the ones who will deliver care using these tools and technologies and leverage them for better patient outcomes. Another chapter that is notable, is the chapter on patient perspectives. Patients are not only at the center of all we do as clinicians but also the driving force in adoption. Their voice has been important but will be even more important as technology evolves.
I am immensely honored to have been given the opportunity to bring the voices of clinicians, entrepreneurs, technologists, leaders, patients, innovators, and students to the classrooms and board rooms of tomorrow.
