Editor's Corner | The Digital Revolution and Its Impact in Cardiovascular Care

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We’re experiencing a major revolution in information management that’s creating a significant impact on all aspects of our lives. Among the most important transformations are the rapid and relentless progress in health care technology; communication between patients and health care providers; a growing role for patients to manage their own health and have access to all the information available through electronic records; social media; and large national databases that can provide both physician and patient with a full view of the information needed to maintain health.

The rapid expansion of technology has provided opportunities for clinicians and patients to participate jointly in providing informed and efficient health care. Patients can obtain information on their personal health issues from social media links such as Twitter and Facebook. Physicians can find information needed for their patients within the electronic medical records. Now that all our health information is electronic, patients can access their personal health records.

Many patients are requesting access to their medical records as part of managing their own care. Presently, hospitals claim ownership of a patient medical record. But, in several more years, it’s likely the patient will own the medical record data — and will be able to select their physicians from a database of care givers from around the country. All the data will be available for both patient and physician review. How will we gather the patient data?

We’ll need CT scans and MRI images obtained from imaging centers. Echocardiography, however, may be a patient-generated study. Echo is being done with smaller and smaller instruments. Soon these images will come from smartphone applications. The implications of this shift are profound.

If a patient can perform their own echo with a smartphone whenever and wherever they wish, and intelligent image processing can interpret the image data using artificial intelligence (AI), where will the physician fit in this new model?

If a patient can perform most of these tasks, and interpretation is done by intelligent machines, the world of echo labs would disappear and all echo data would be in the hands of the patient. A similar shift would also occur with the electrocardiogram. Already we can obtain an ECG from a small adapter and send it to a smartphone and then to a physician or to an electronic record. Where would the doctor fit in this scheme?

A similar process is already happening in the world of blood pressure (BP). A significant problem with the new hypertension guideline is the enormous effort required to get millions of people to follow the recommendations. Many asymptomatic people with hypertension will be unaware of their status and won’t be familiar with methods to approach BP measurement and thus understand when and how to seek treatment. We now have a smartwatch that can measure BP, eliminating the need for a clinic visit. Data on BP can be obtained any time or any place the patient desires. The information can be sent to an electronic record, viewed by the patient and physician, and treatment plans developed without ever visiting the physician’s office.

It won’t be long before AI systems will be developed to analyze the BP information, review the patient’s record and make suggestions on changes in lifestyle or medications to achieve optimal BP control. Here again, the entire process can be handled without physician intervention, with a few patients who don’t respond appropriately being seen by a physician for further care.

Several critical issues now confront us as we observe this rapid and relentless technology revolution. How do we educate the next generation of physicians who will obtain much of their information on day-to-day care from social media channels? What do we teach new physicians about the stethoscope and its relation to bedside echocardiography? How do we respond to changes in a patient’s health status when we have a trove of information that’s updated daily?

If we can obtain an ultrasound image of the heart, lungs, liver and other organs at the bedside, is a stethoscope necessary? In a few years, we’ll have data on a metabolic panel obtained noninvasively. We’ll be able to monitor blood glucose throughout the day and program an insulin pump to automatically control blood glucose.

This new health care technology is coming to us and we’ll need to confront these changes as we practice medicine. The world around us won’t tolerate medicine practiced the way we practice now. All of us will need to adapt to the changes. For those of us in current practice, these changes will present a significant challenge, but the patient will demand a modern practice of medicine. The next generation of physicians will adapt quickly. Our tasks will be to move this new education forward and not retard the progress that we can see coming.

We also must address concerns for privacy and security of health information. Currently the massive expansion of clinical information is overwhelming the ability to provide a secure environment for our patient and practice communications. This is now one of our biggest challenges. We hear almost weekly of a health record system that was hacked, some even held hostage, shutting down health systems until a ransom’s paid. But new technologies are emerging that should defeat this important flaw in our communication. A technology called blockchain shows promise for achieving the level of security that we need to secure our digital world.

Whether in three years or six, the relentless growth of technology will expand our world of medicine for the good of all. There is no going back, but adapting to this new digital world is likely to take a decade.

Alfred A. Bove, MD, PhD, MACC, is professor emeritus of medicine at Temple University School of Medicine in Philadelphia, and a former president of the ACC.

Clinical Topics: Noninvasive Imaging, Prevention, Computed Tomography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging, Hypertension

Keywords: ACC Publications, Cardiology Magazine, Blood Glucose, Blood Pressure, Insulin, Caregivers, Stethoscopes, Social Media, Health Records, Personal, Electronic Health Records, Physicians, Physicians' Offices, Electrocardiography, Echocardiography, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Ambulatory Care, Hypertension, Information Management, Artificial Intelligence, Biomedical Technology, Life Style, Health Status, Liver

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