Digital Health Safety and Effacious Discussion Assignment

11/1/22, 10:08 PM Are Digital Health Tools Efficacious? A Divided Literature Base: XLST Digital and Connected Health (TUESDAY) Fall 2022

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Are Digital Health Tools Efficacious? A Divided Literature Base Are Digital Health Tools Efficacious? A Divided Literature Base

Is a randomized clinical trial required for every mobile health application out there? Is a randomized clinical trial the best method to evaluate a mobile application where the technology might have qualitative aspects which impact use? I can assure you the literature base on many of these areas remains quite mixed. While the following examples are not an extensive list, they are illustrative of a base of evidence which is confused at times, especially when discussing the broader context of digital technologies (all readings can be found on the learning objectives page for the module). You will pick two of the articles to discuss in depth on the module discussion board.

The Good

As discussed in the first module, digital technologies are widely diffused across a number of key populations. For example Latinos and African Americans are more likely to access the internet from a mobile device . The good news in the Giger et al study is that older adults accepted new technologies and often included caregivers or family in the use. While a broad generalization, social influence can be an important driver of overall success in many technology deployments. I would go as far as to say the "technology support structure" should be divulged in many of the articles.

The Seto et al work might be up for reclassification (from good to bad) as there were no overall impacts on the remote patient monitoring groups vs. control groups. However, one key finding was the high number of patients who engaged with the platform. 80% of patients completed a self questionnaire and transmitted digital information regarding digital weight and blood pressure.

In one of the larger studies conducted (n=374), Kim et al provide a number of useful findings. First, a decrease in prescribed medications is reported when using remote patient monitoring techniques. There are of course obvious cost benefits associated with this finding. Another key finding is that monitoring blood pressure in the home can be an important signal for susceptibility to future cardiac events. The final finding is an overall efficacious impact of remote monitoring to better control hypertension.

The Bad

Not every study validates the proffered impact of digital health interventions. In some instances medically complex patients may yield no benefit from longer term or simplistic approaches to monitoring chronic conditions. Why? Acute symptoms might be difficult to detect by monitoring a limited number of vital signs. Furthermore, monitoring periods and studies might be impacted by patient "fall off" or patient "leakage" from a health system. Given a focus on 30 day re admissions penalties associated with Medicare patients, there is a potential benefit to monitoring patients during this important period (both for medical reasons and financial ones).

11/1/22, 10:08 PM Are Digital Health Tools Efficacious? A Divided Literature Base: XLST Digital and Connected Health (TUESDAY) Fall 2022

https://sju.instructure.com/courses/32739/pages/are-digital-health-tools-efficacious-a-divided-literature-base 2/2

In the study published by Ong et al we see the impact of a very complex system, engineered around protocols and sufficiently staffed. Patients in congestive heart failure provide daily information on blood pressure, heart rate, symptoms and weight. The patients also benefit from active coaching by nurses based on collected information. This represents a significant investment in terms of technology, personnel, and process improvement. The findings show no difference in the chance that a patient will return to the hospital. Researchers did find an improvement in quality of life reports by the intervention groups. This could signal a palliative effect where the patient feels better "connected" to care or the caregiver as a result of using technology.

Potentially Harmful?

The last two studies raise important bio-ethical issues related to the use of digital health that are worth considering. Work by Samuel et al raises a very interesting question. What happens if a measurement assigned to the patient is missed? While I don't want to delve to deeply into issues of liability, there is a responsibility by the researcher or service provider to adequately address issues of missed readings or provide prompts or alerts to patients. While software is capable of achieving such a requirement, there are various fine lines as it relates to FDA oversight of medical devices (this is discussed a bit more in the other sectionof this module).

The final reading for this module evaluates the psychological impacts of monitoring patient hypertension in those with diabetes. Work by Tisler et al patients did report anxiety after measuring and perhaps reviewing "poor" readings. Again, certain elements could be better evaluated. Relaxing music might be automatically played during readings or other additional approaches to "mindfulness" could be deployed automatically by a smartphone. There is also the need for feedback or engagement by providers, albeit at the risk of introducing bias into the study.