A rapid increase in the amount of digital healthcare delivered during the pandemic has the potential to transform healthcare in the post-pandemic world. From reducing inequality
to continuous at-home monitoring of patient health, digital healthcare changes are leading us into a new reality for both patients and clinicians.
Robert Wachter, MD, author of The Digital Doctor and six other books, is also a researcher who has published more than 250 articles. A frequent contributor to the Wall Street Journal and the New York Times, Wachter is credited with coining the term “hospitalist” in 1996. He is viewed as the academic leader of the hospitalist specialty, which is the fastest-growing specialty in the United States.
During COVID-19, troubling disparities have been revealed about long-standing inequalities in healthcare. Not only do African Americans and Hispanics become infected with COVID-19 at higher rates than Caucasians, they also have poorer health to begin with. Those comorbidities, which include obesity, diabetes, hypertension, and coronary artery disease, lead to poorer outcomes, including higher hospitalization and death rates.1
Wachter noted that increased data collection due to the rise of digital healthcare has substantiated these inequalities, which aren’t limited to comorbidities. Minorities also tend to live in crowded conditions, lack health insurance and have poorer access to healthcare in general.
Now that we, as a society, are aware of these inequalities, pressure to deal with them in a substantive way is rising, he noted. Evidence of these inequalities could be used by the plaintiff ’s bar in medical professional liability cases, he continued. “For example, if a Black or Latino person has a bad outcome and a hospital has failed to address documented worse outcomes for certain patient groups, it wouldn’t shock me if that became one of the points raised by an attorney in a malpractice case,” he noted.
“Inequality in healthcare is a large issue within the public discourse and I think it will play out in a lot of ways,” he continued. “I think digital has the capacity to make inequalities more obvious and more vivid while also acting as part of the solution.”
For example, continuous monitoring of individuals in their home environment could be achieved using a variety of devices that deliver healthcare information seamlessly to clinicians. “It might be information about your pulse oxygen level coming from your digital watch or your blood sugar from a digital glucose monitor. Or it might come from a device in your toilet or a survey you fill out on your iPad that gets sent to your doctor every morning—there are multiple ways to quickly and easily deliver healthcare information,” he said.
While the delivery end of this puzzle is starting to be solved, with more medically oriented devices and apps coming on the market, figuring out how to manage all of that data is a major challenge. “The ability to monitor you and your vital signs, and other parameters, nearly continuously is very exciting but also massively overwhelming for a healthcare system that has no ability to manage that data,” he stated.
The essence of sound data analytics is getting the right data to the right person at the right time. Without the ability to direct data and appropriately categorize it, such data may create a false sense of security for both patients and clinicians. “It also creates liability concerns because while it’s unlikely that I would miss a problem with your blood pressure if I saw you in an office visit, I might miss that same red flag if it came in a message on a Tuesday night into a healthcare system’s data feed,” he said. “There would have to be some kind of air traffic control system to collect, monitor, and alert clinicians as to outliers.”
1. Andis Robeznieks. How COVID-19’s egregious impact on minorities can trigger change. American Medical Association, May 12, 2020