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Wednesday, 7 July 2021

Digital Health sounds like a relatively new research field, conjuring up visions of virtual reality and healthcare apps.

In actual fact, the study of the computerisation of healthcare has been around for decades. It just had a less user-friendly name – Health Informatics.

Dr Chris Paton image
Dr Chris Paton

“Over the last five years, everyone's started to call it Digital Health because it's an easier way of talking about it. Most people understand what you mean when you say Digital Health,” Course Director of Otago's new Digital Health programmes Dr Chris Paton explains.

Digital Health is a broad field, spanning both the administrative (electronic health records) and the innovative (artificial intelligence). As such, some of the research subjects are slow-moving while others are developing at great speed.

“For example, the digitisation of hospital records is fairly similar to how it used to be and change is taking place quite slowly … you have to be quite conservative because if you make a mistake and the records aren't available then people's lives at risk…

“Whereas things like new apps, artificial intelligence systems or virtual reality for medical training are changing a lot – you look back 10 years and the technology has moved on.”

Dr Paton, based in the Department of Information Science, trained as a medical doctor in the UK. After moving into Clinical Informatics, he worked as a Clinical Lecturer at Otago and as a Senior Research Fellow at the National Institute for Health Innovation in New Zealand before moving back to the UK to join the University of Oxford.

He continues to lead a research group at Oxford that works in on Digital Health projects in Kenya and Vietnam alongside his new role at the University of Otago.

In Kenya doctors are being trained to use a smartphone app linked to virtual reality to learn how to resuscitate a newborn baby. And in Vietnam the project team is investigating the use of mobile sensors and smartwatches as an alternative to expensive monitoring equipment used in intensive care units.

“The hospitals in Vietnam want to provide that kind of monitoring, but they are severely constrained financially. So we're trying to see if by using artificial intelligence algorithms and lower cost sensors you can do a similar job and support the healthcare workers to know when something's going wrong.

“It's an exciting field, that's why I like it. You can't really predict what's going to happen in the next few years. Mobile technology like smartphones happened very quickly and suddenly everyone started using smartphones. Artificial intelligence also came up quite quickly – nobody was really talking about that 10 years ago. And it's similar for virtual reality which has not been possible to do at low cost and at scale until now. And who knows what's around the corner?”

The new Otago Digital Health post-graduate programmes (PGDip and PGDCert) have launched with two papers: Principles of Digital Health and Informatics and Digital Health Technologies and Systems.

The course is taught online, which was fortunate as Dr Paton was stuck in the UK, and then in quarantine in Auckland, at the beginning of the year.

“It started when we were locked down in the UK so I was doing that from my garden office. It was nice to hear the birds singing in the background,” he laughs.

The students have been a mixture of healthcare and information sciences graduates – ranging from doctors to non-medical 'user experience' designers.

“What we want is people who've had relevant experience or a degree and that could be on the health side, but it could also be in the information science side. If you work in computers in a different field and want to go to healthcare, then this degree can help you transition.

“Or say you're a junior doctor and you've got an idea for a digital health app. This course gives you the background you need to know about how to get started. Having the idea is one thing, but to get it so it's actually going to work in a hospital environment in the healthcare industry – there's a lot of things you need to know to do that successfully. It has to be safe and it has to actually work for clinicians and patients.

“There are standards and processes for transferring and sharing data. And we teach the students about that and about the ethical and legal issues around healthcare data.”

Next year the two existing papers DIGH 701 and DIGH 703 will be delivered together in the first semester and new papers covering advanced topics will be delivered in the second semester.

“We get more stuck into topics like artificial intelligence, remote monitoring and telemedicine, and patient-centred systems that patients use at home. And we also we teach research methods, so that will be particularly good for people who want to go on to do a master's degree.”

The field is likely to keep evolving, meaning updates and the addition of new papers. But it is not a given that there is an inexorable move to futuristic solutions, particular in resource-constrained settings such as Kenya.

Dr Paton gives the example of 'hybrid' systems in use in hospitals in Kenya which combine pen and paper note-taking with digitisation by ward clerks because it works better for the busy healthcare staff.

The move towards virtual GP appointments using telemedicine platforms – which accelerated dramatically during the pandemic – is another interesting area.

“There are upsides and downsides to the kind of rapid adoption of remote consultations we saw during the lockdowns. In the long-term it allow people to have more convenient access to the health system and potentially GPs could see more patients, because it could be more efficient. But if we are not careful you could lose some of the human contact which is very important in healthcare. People might come to a visit with a GP with one thing when they really want to talk about something else. And you can imagine over the phone or when they are in a zoom call, they might be more reticent to talk about the things that are really worrying them.

“So, it's quite difficult to kind of disentangle. I think quite a lot of things are going to come out in the woodwork because of the dramatic transition we've seen in the last year or so which we'll need to address to make the most of telemedicine in the future.”

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