Connected health: in the right place at the right time

INTRODUCTION

Digital health or electronic health (e-health) involves a broad group of activities that use communication and information technologies to store, retrieve, share, and exchange health-related information for prevention, diagnosis, treatment, monitoring, educational, and administrative purposes^[1]. Due to the technological progress of recent years, the term, originally indicating activities carried out at the local site, has now been extended to the electronic processes involving the Internet and healthcare delivery over a distance, the so-called telemedicine or telehealth^[2]. Indeed, telemedicine services are currently the most popular e-health services among healthcare professionals and consumers. A summary of the most typical e-health services available nowadays is reported in Table 1.

CONNECTED HEALTH

Telemedicine means “healing at a distance”, a composite word of the Greek term “tele”, meaning “distance”, and the Latin term “medicus”, meaning “to heal”. Telemedicine or “connected health” basically refers to the specific use of information communication technology (ICT) to deliver healthcare, clinical and administrative services, and medical education, remotely from one site to another, to offer more prompt and efficient diagnosis and clinical care^[3]. Telemedicine services based on the Internet and, more recently, after the introduction of smartphones and tablets, mobile health services (so-called “m-health”) are now the most popular and widespread applications in the field of e-health^[4]. They are commonly used for remote monitoring (telemonitoring) of specific vital and non-vital parameters. According to current models, a web-based shared platform that favors collaborative care and interactions between patients and healthcare operators and among professionals is the most popular and effective telemedicine intervention. The typical provision model shown in Figure 1 follows a “closed-looped” scheme, also called “Internet-of-Medical-Things” (IoMT), namely a connected infrastructure of health systems and services that are designed to detect issues before they become critical and enable early intervention by caregivers^[2].

Figure 1. Diagram of most common telemedicine services and their workflow. EHR: Electronic health record; NFC: near filed communication; PDA: personal digital assistant; IoMT: Internet of Medical Things. This figure is used with permission from Omboni^[2].

TELEMEDICINE DIFFUSION WORLDWIDE

Telemedicine is a promising tool for improving access to care and empowering patients, influencing their attitudes and behaviors, and improving the quality of delivered care and patient’s health status. The most popular telemedicine applications are in the field of radiology, cardiology, dermatology, and psychiatry. Patients managed with telemedicine are predominantly diagnosed with cardiovascular diseases such as heart failure or hypertension, and metabolic disease, such as diabetes. Recent estimates indicate that seven million patients are managed annually with telemedicine worldwide. Europe and North America are traditional markets for telemedicine^[5,6]. In the US, there are currently some 200 telemedicine networks with 3500 service sites. More than 50% of all US Hospitals have adopted some form of connected health for remote patient monitoring. Approximately 80% of European countries have telemedicine services implemented. Diagnosis is the main reason for resorting to telemedicine applications, followed by emergency care (so-called “telecare”) and vital sign monitoring. Asia, in particular China, and Oceania are emergent markets for telemedicine, especially following COVID-19^[6]. Although televisit and teleconsultation are the most popular telemedicine solutions, home-based telemonitoring is the fastest-growing telemedicine application, particularly in the context of a global pandemic.

A TECHNOLOGICAL CHALLENGE THAT CAN TURN INTO A POTENTIAL GAME CHANGER FOR THE HEALTHCARE SYSTEM

During the recent COVID-19 pandemic caused by SARS-CoV-2, digital health, particularly telemedicine, has thrived and resulted worldwide as an indispensable resource to improve patients’ management, not only of those infected by the new coronavirus but mostly of patients with chronic illnesses, isolated at home^[7-9].

In this sense, a major benefit of e-health is the ability to enable “whole-person” comprehensive care according to a personalized patient-centered model of care. According to this model, health information technologies are used to create multidisciplinary networks involving various healthcare professionals (e.g., physician, nurse, and pharmacist) to make the communication among the care team and the patient more efficient, personalizing the care and favorably impacting on patient’s health.

Many studies published in the last two decades have shown a high acceptance of digital health technologies and services by both patients and physicians. Approaches based on e-health solutions are particularly suitable for preventing cardiovascular diseases and managing chronic conditions. Other applications include the early diagnosis of dermatological or pneumological diseases. As shown in Table 2, evidence exists of high effectiveness for managing patients with hypertension^[10-13], heart failure^[12-15], acute myocardial infarction and coronary artery disease^[16,17], stroke^[18], chronic kidney disease^[19], diabetes^{[12,13,15,20]}, chronic lung disease^[12,13,15], cancer^[15], and mental illness^[21].

Unfortunately, integrating e-health and telemedicine into the clinical practice is not without challenges due to several technical, infrastructural, economical, regulatory, and cultural barriers, as summarized in Table 3.

A NEW JOURNAL: CONNECTED HEALTH

Due to their unequivocal benefit for improving medical care, more and more e-health solutions have been developed and tested in feasibility and clinical studies in recent years. A search of the literature (Medline) for the last three decades based on terms such as “digital health”, “digital medicine”, “digital care”, “eHealth”, “mhealth”, “telemedicine”, “telehealth”, and “telecare” returned 115,169 publications. A progressive marked increment in the number of publications has been observed over the years [Figure 2].

Figure 2. The number of papers related to e-health published in the last 30 years. The line refers to the cumulative number of publications, while the bars correspond to the percent variation in the number of publications from year to year (A). The number of journals related to e-health according to their year of foundation (B).

Current statistics from SJR Scimago Journal & Country Rank indicate 83 ranked journals focusing on digital health or bioinformatics^[22]. The majority of journals have been established in the last two decades [Figure 2]. Only four of these journals have discontinued publications between 2016 and 2018.

Given this picture, do we need another journal publishing articles related to digital health? Surely, we need a virtual place where computer scientists, bioengineers, physicians, and various healthcare professionals, including pharmacists and nurses, can share and discuss their research results in a pragmatic way, focusing on their discoveries’ practical applications. We need a multidisciplinary “agora” where topical experts can exchange ideas and opinions and present innovative digital health solutions that can help boost the integration of e-health services and telemedicine in the armamentarium of healthcare services available to healthcare professionals and patients in the clinical practice.

In this light, the scope of the new journal “Connected Health” is to gather high-quality original research or review papers presenting the available evidence on new digital health technologies, their clinical usefulness, and applications for managing acute and chronic patients. The journal is divided into different sections dedicated to the various aspects of digital health applications for disease management. Notably, the following topics are relevant:

• Innovations in technologies and diagnostics: Technical papers related to m-health, e-health, and telehealth applications, wearable sensors, artificial intelligence, machine learning, blockchain, robotic care (telesurgery), smart home, virtual reality, etc.

• Clinical aspects: Feasibility and usability studies, efficacy studies (including the long-term effect on major health status indices, quality of life, performance status, medication adherence, etc.).

• Economic studies: Cost-effectiveness of digital solutions.

• Policy: Regulatory issues, health policies, ethics, privacy, and legal issues.

• Personalized and precision medicine: How digital health can provide “whole-person” individualized management of patients, moving disease management to a personalized patient-centered model of care.

• Telepharmacy: Medication dispensation, pharmacovigilance, monitoring of medication adherence and patients’ health status, and acting as point-of-care under the supervision of physicians.

CONCLUSION

Digital health and telemedicine are great challenges for any healthcare system worldwide. The current COVID-19 pandemic has finally made stakeholders and politicians aware that remote managing of infected people and patients with chronic conditions may increase access to care and its effectiveness, and it is time- and cost-saving. It also lowers the amount of strain on healthcare workers, who are striving to manage patients in hospitals and emergency rooms. As claimed in the Editorial title, the new journal Connected Health is coming in the right place (the Internet, where digital health is mostly deployed) and at the right time (when the coronavirus outbreak has demanded digital health solutions to improve patients’ management and outcomes).