THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
If you’ve ever tried to keep a New Year’s resolution, you’ll understand why managing chronic illness is so difficult. It requires consistency, discipline, and the ability to keep track of a thousand tiny details – all while life throws its usual curveballs. Now, imagine doing this for years or even decades. That’s the daily reality for millions of people living with chronic illnesses like diabetes, hypertension, and heart disease.
Medicine has used the yearly check-up, patient complaint, and intermittent lab test for decades to treat chronic disease. But the system is not flawless. Patients fail to take medications. Symptoms come and go from one visit to another. And let’s admit it; nobody exactly knows the number of times they exercised last week when asked in a doctor’s office.
Thankfully, the age of digital health has set in. And no, not by just having patients download some meditation app and hope for the best. Today, we have sophisticated digital gadgets that can facilitate patients’ and doctors’ observation, treatment, and even prediction of illness states that we could only never dream about getting a glimpse into a generation past.
Thus, how exactly do electronic health tools transform the management of chronic disease, and what are they capable of doing for primary care?
Those days are gone when patients used to wait three months for their next visit to review their blood pressure levels. Wearable technology such as smartwatches, continuous glucose monitors (CGMs), and smart blood pressure cuffs now offer real-time feedback on heart rate, glucose levels, oxygen saturation, and more. For instance, in diabetes management, CGMs monitor glucose levels 24/7. This explains how diet, exercise, and medications function interdependently. This eliminates guesswork, offers a chance for realignment, and removes the risk of complication.
What if we could predict a heart attack before it happens? AI systems scan massive amounts of patient data and seek out patterns that human eyes might miss. These tools allow for earlier intervention and better results by identifying likely complications when they are still not emergencies. A recent study found that AI could predict heart failure flare-ups days ahead by detecting seemingly minor differences in wearable sensor data. That means shorter hospital stays and, ultimately, lives saved.
Think of an individual with hypertension who receives automated reminders to adhere to medication and a virtual coach that guides them through lifestyle changes. Digital therapeutics, as cleared software-based medications, may deliver cognitive behavior therapy, medication reminders, and even interactive coaching sessions. A wonderful example is Omada Health, a digital diabetes prevention program based on data-driven coaching and behavioral nudges to support patients in losing weight and decreasing their risk of developing diabetes. These programs were equal in effectiveness to one-on-one, face-to-face interventions.
Telemedicine is not innovative anymore; it’s necessary. Virtual visits allow patients to see their doctors without the hassle of travel, waiting, or exposure to germs. That means fewer appointment cancellations and easier access to specialist care for patients with chronic disease. Studies show telemedicine improves medication adherence, patient satisfaction, and disease control. Also, let’s be real—it’s a lot more convenient to talk to your doctor on your couch than waiting in line in a waiting room reading dog-eared People magazines.
With such digital technologies revolutionizing chronic disease care, what does this mean for internal medicine? Many opportunities spring to mind.
Instead of instituting interventions based on set treatment protocols, internists can now use patient-specific data to personalize interventions. If a patient with hypertension’s smartwatch detects elevated resting heart rate and disrupted sleep patterns, his doctor can alter his medication or suggest lifestyle changes even before he shows any symptoms.
Physicians are not always available 24/7 with patients, but technology is. Continuous data acquisition results in taking care of the patients even outside of the clinic, leading to increased compliance and decreased emergency department visits. Electronic health technologies bypass geography, which means patients residing in rural areas or underserved populations have equal access to good quality care. A congestive heart failure patient in a small town can now have his vitals recorded and controlled by a specialist who is hundreds of miles away.
True, digital health is no magic wand. It also has its own limitations. The more patient data collected, the greater the possibility of data breaches. Strong cybersecurity measures are necessary. Not everyone is computer-savvy, and some may struggle to use digital resources efficiently. Training and ease of use are required. Digital resources must integrate easily into existing electronic health records (EHRs) and workflows in order to be of the greatest utility.
Despite these challenges, the benefits far outweigh the drawbacks. The digital health revolution is already here. We’re moving towards a future where:
- AI predicts flare-ups before they happen.
- Wearables track health metrics with near-perfect accuracy.
- Patients receive real-time, personalized health recommendations.
- Telemedicine and digital therapeutics have become the standard, not the exception.
For physicians, it’s a heart transplant. Digital health gives us an escape from episodic care and to move to ongoing, data-enabled management that equips patients with ownership of their own health.
Be safe, be aware, and – if you haven’t done so yet – maybe don a smartwatch on your wrist. Your health may well repay you for that.
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist; Board certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ; House Call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7252973/
- https://www.jmir.org/2024/1/e53576/
- https://journals.sagepub.com/doi/10.1177/1357633X221119620
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10101441/
- https://www.sciencedirect.com/science/article/pii/S2667102621000346
