Missing the digital health bus is not an option

by Dr. Jhonatan Bringas Dimitriades, MD

The medical education system of today is still failing to integrate the traditional medical knowledge with the new technological advancements. This only enlarges the gap between the medical community and the technology developers.

When going through medical school, depending on the country of study, one usually gets to learn and understand basic sciences such as physiology, biochemistry, embryology, histology, genetics and so on.

After learning these key topics that prepare you for the complexity of medicine, you must follow pathophysiology and the medical specialties and, subsequently, an internship. This gives you the practical knowledge to be able to be called a medical doctor.

In some countries, these studies last from four years, in the US for example, and up to seven years, like in Spain or some Latin-American countries.

Unfortunately, in none of these countries or these years of studying, do the medical students receive appropriate education regarding applied technology in healthcare.

This gap in medical technology literacy and exposure in the medical student community, makes future doctors unaware of the potential and the meaning of the majority of medical technological principles, or solutions, and why they need to be used in healthcare.

This causes a feeling of defence against the adoption of new technologies, which is amplified the moment they begin to work in the clinic or follow medical specialties and get to experience the inefficiency of the old and current electronic health record systems. These have caused many doctors to fight against adoption in fear of longer hours of administration work or bigger amounts of data without purpose.

Yes, there are many countries that have a very early adopting medical community, such as the US, Israel and Estonia. Even in the US, however, adoption and acceptance is one of the biggest challenges facing digital health startups and entrepreneurs in 2022.

In general, technology continues to experience an adoption barrier from medical communities across the globe.

Photoplethysmography (PPG) provides an example of the adoption limitations health technologies must overcome.

This is a technology that was first explored in the 1930s as an interesting way of seeing how blood vessels absorbed and reflected light and its relationship to blood volume at a specific moment of time.

From this initial principle, many technological adaptations have been made to analyse the information that a PPG raw signal makes.

One of the most commonly used ones is the SpO2 (pulse oximetry) measurement, which analyses the amount of oxygenated haemoglobin transiting peripheral blood vessels at a time. Also, heart rate measurement, which is acquired by quantifying the colour absorption/reflection changes of the vessels per minute.

In 1974, Dr. Takuo Aoyagi invented the pulse oximeter as we know it today and, in the year 2000, Medicare accepted the reading of a pulse oximetry for billable care. This is the crude example of how and in which rate our medical systems accept technology when applied to healthcare.

Now, PPG technology is revolutionising the industry again, from the consumer perspective. In 2007, Fitbit launched its first wrist wearable device with the same technology as the SpO2 devices previously accepted by Medicare, plus other sensors (accelerometer and gyroscope).

It became a great success among consumers in the sports segment and it set a standard for the initial wrist wearables. This new application of the existing technology offers to use PPG sensing technology for the diagnosis, or screening, of atrial fibrillation, to monitor heart rate changes and alert about arrhythmias in the most non-invasive way possible, however, the medical community doesn’t accept it to be used in a clinical setting.

The problem: The medical community doesn’t understand PPG. Medical practitioners do not trust the algorithms and they want to see “the ECG waves instead of PPG graphs”. This comment is one of the most frequently gathered in a series of conversations between myself and medical doctors from several countries.

This answer brings an even more interesting conflict. They accept the algorithm that tells them how much oxygenated haemoglobin a vessel carries, and therefore, add this PPG to their diagnostic criteria of shock, but don’t accept the same technology in warning them about patients having a specific arrhythmia or to be used as a hospital monitoring system, although it is considerably less invasive.

The real origin for this disambiguation is that doctors lack the technological skills to know that these technologies are the same. They have not been taught about what PPG is and how it can enhance medicine and they don’t get courses on the potentials of digital health and health tech at medical school.

The pandemic has catalysed digital health and this needs to be the origin of better education in technology.

In 2019, the world saw how valuable epidemiologic vigilance is for public health, with the arrival of the COVID-19 pandemic. They also realised the need of having actionable medical services at distance, especially in groups such as immunocompromised, disabled or severe chronic patients. This enabled the accelerated implementation and adoption of interactive telemedicine and other associated technologies.

Many defensive doctors had a difficult time in accepting the technologies but, in the long run, telemedicine has been able to be implemented in several countries around the world, including some of the most conservative countries in terms of its medical community and culture.

We need to use this catalytic moment of change to transform and enhance medical education, creating spaces and courses that allow medical students to understand the current evolution of healthcare-related technology and to be able to use these technologies as part of their daily clinical tools.

Another challenge is to show medical students that they can be innovators as well, and that technology can be developed by teams that include doctors, because they better understand the science and the needs of their peers.

CME (Continuing Medical Education) for medical doctors, courses for specialists representing a new route in traditional medical education, plus education on social media and other initiatives, have to happen in parallel.

We see some projects starting to arise in several universities in the US and Europe. Imperial College is offering specialisation courses in digital health, while the Complutense University of Madrid offers a masters programme. The UNMSM (San Marcos) University in Peru is also offering a diplomature in digital health.

And CME organisations are playing their part too. Medscape has an interesting open education panel initiative in innovation, while ‘HealthXL’ and digital therapeutics excellence are two other programmes that are starting to create disruptive educational spaces for healthcare technology. The road is long, but what we can achieve from this is unmeasurable.

Better outcomes, better adoption, lowers costs, better access — and better health.

Jhonatan Bringas Dimitriades, MD, is a medical doctor and executive who works with technologists, developers, medical professionals and patients to deliver digital and technical solutions to enhance the diagnosis, treatment, recovery and quality of life of patients around the globe.