HSS 3110 L6 Epidemiology Lecture Notes PDF

EPIDEMIOLOGY HSS 3110 Lecture 6 WEEK 6 AI/Digital health/Health technology HTA Health technology Ethical issues Telehealth, eHealth, mHealth Lab 6 Technological determinant of health - not individual determinant any factor that affects our health and wellbeing should be incorporated into epidemiology...

EPIDEMIOLOGY HSS 3110 Lecture 6 WEEK 6 AI/Digital health/Health technology HTA Health technology Ethical issues Telehealth, eHealth, mHealth Lab 6 Technological determinant of health - not individual determinant any factor that affects our health and wellbeing should be incorporated into epidemiology Technology is the answer...but what was the question? - Cedric Price, 1966 Infinite challenges infinite possibilities AI technology Digital health health technology medical technology Used to serve a purpose - facilitates human efforts device or any object, or procedure used to improve health outcomes/ well-being ex. Surgeries, vaccines, MRI overlap a lot Objects + procedures used in digital health data - part of medical technology use medical tech to improve health outcomes Digital health refers to the use of information and communications technologies (ICT) in medicine and other health professions to manage illnesses and health risks and to promote health and Digital health/ health technology vs medical technology Health policies —> not classified as technologies wellness e.g. Telemedicine, EHRs, Wearable Devices. “The set of techniques, drugs, equipment, and procedures used by health care professionals in delivering medical care to individuals and the system within which such care is delivered.” - WHO “Application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives" - WHO Health technology refers to the solutions being developed to tackle a given challenge, including everything from websites to vaccines, to the software and hardware we use to deploy them. e.g. drugs, devices, and medical and surgical procedures used in the prevention, diagnosis, treatment, and rehabilitation of disease. These 4 terms represent continuum of care Medical tech Most sig invention in medical sci changed HC delivery www working to improve health systems Technology is complex (wide range of stakeholders), and health is vulnerable. How do we marry the two? Possible some favour certain techs over others ex. Gov wants us to use covid vaccines and masks but some ppl don’t making sense of Digital health Many potential conflicts can arise from continuous digitalization of HC systems have to rely on tech since our capacity is limited as humans Physical issues of using tech: text neck, vision problems Approach thoughtfully and strategically Technology evolves rapidly, but adoption and adaptation take time. Continuum of care (patient journey): Technology can be the catalyst. Understand the medical industry and market Company who is developing the tech vs. Who is using the tech lots of issues w/ pricing, patents, etc. Hc system v/ strictly controlled - gov rly control what’s coming to the market — ppl are consumers — have the choice of adapting certain tech or not — some industries can bypass certain policies/regulations to enter the market without product being test for enough time — links between adverse effects can be discovered way after and we can have technological reversal Enhanced access to care Improved patient engagement why Digital health? Goal is to improve efficiency as healthcare providers Personalized medicine Preventive care and early detection Seamless information exchange Data-driven insights Remote patient monitoring Medication management Efficient healthcare workflow Cost savings (?) Don’t apply to all countries equally in Canada, gov is extremely cynical about accepting new technologies bc gov is always trying to cut or control healthcare expedition also in Canada, digital tech is important for those living in rural areas/ don’t have access to physician, fast aging population, super long waiting times ex. Medicare platform does scheduling by itself automatically Japan + South Korea —> most digitized countries —> have very aged populations Cost reduction: foremost Malpractice avoidance Increased innovation, quantum computing (so much data, we need strong computing powers), more demand (larger pops) drivers of digitization in healthcare need evidence to develop new solutions data revolutionizing HC - key determinant Technostress: spectrum - overuse of technologies (too much info can stress us out), and underuse (we don’t know enough, want to increase our knowledge about our health) capacity/skill to use technology - not simple for some ppl Strong or growing economies Provider competition to offer state-of-the-art technology Changing demographics: aging populations and increased chronic diseases. Most sig in canada, alongside scarcity of physicians Decentralization of healthcare delivery: home-based and community-based care, remote monitoring, telehealth, and virtual consultations Changing disease patterns: infectious disease outbreaks, disease surveillance, early detection, and treatment. advancements in ICT: facilitating clinical decision-making and improving patient outcomes. More informed and demanding patients Well-being factor and patient responsibility: technologies support self-care, health monitoring, and lifestyle interventions. The promises of digital health remain illusory, the landscape is still largely fragmented... challenges in digitization in healthcare Always more cons/reasons to reject tech than pros Inadequate interoperability Reducing error Most needed in HC - means diff systems are integrated — if not then they are fragmented — want systems to become one to give holistic pic of pts — some ppl don’t want this bc of cybercrime humans make more errors than machines - subject to human factors (anxiety/burnout) — AI doesn’t have these factors but can make errors based on data it is fed — how open r we to accepting errors from machines Skepticism: more critics than skilled operators Financing: In the USA, ~ 90% of all health expenses go to disease and injury treatment than to addressing the predisposing factors of these illnesses and injuries. Can we set aside some money to develop preventive technologies? Ethical challenges Healthcare Waste Digital Divide E -waste —> env pollution —> hard to dispose (waste sometimes hazardous) How ready we are in using tech Cybersecurity Data hostage- can blackmail ppl and demand ransom - hospitals do not want to end up in this situation bc it is bad for their transparency/ethics digital divide Digital poverty/inequality sometimes ppl don’t have technical skills to use tech —> impacts health outcomes also, ex. Place where they are trying to reduce wait time , but ppl don’t have access to internet — not fault of tech itself but of users/ ppl deploying the tech The digital divide refers to the gap between individuals, communities, or regions that have access to and can effectively use digital technologies, such as computers, the internet, and mobile devices, and those who do not. ‘The future is already here, it is just not very evenly distributed.” William Gibson digital divide www Fish-bone diagram depicting key barriers to the equity in digital access to healthcare globally Language barriers www Causes and types of digital divide? its not just abt not having access to the tech but also abt how ready we are in adapting the new tech Remote care - zoom, etc. —communication services CADTH defines Telehealth as the delivery of various types of Telehealth eHealth mHealth health care when patient geographically separated conferencing, telephone — and it can calls, provider are involve video electronic data transmission, and other ways of communicating over the Internet. WHO defines eHealth as the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including health-care literature, research. services, and health health surveillance, education, health knowledge and Softwares - self monitoring apps. Provide data to physician WHO defines mHealth is a term used for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, Personal Digital Assistants (PDAs), and other wireless devices. prenatal screening, vital signs - mhealth tech to help pregnant mothers Telehealth eHealth mHealth those who use mhealth report better cognitive health phones give us reminders — we don’t feel that we aren’t rmring things correctly www Barriers to telehealth implementation www HTA is a multidisciplinary process that summarises information about the medical, social, economic and ethical issues related to the use of health technology in a systematic, transparent, unbiased, health technology assessment (HTA) Filtering system/exam tech must pass thru to get accepted make sure they’re safe, cost-effective, examine impact on environment + HC organizations (are they easy to use) in Canada QALY used to compare two techs and robust manner. Health Technology Assessment (HTA) is a multidisciplinary process that uses a number of methods to determine the value of health some HC systems keep examine tech over long periods of time technologies at different stages of their life cycle. HTA aims to provide evidence for health policy decision-making and for establishing an equitable, efficient, and high-quality health system Health technology includes not only equipment, pharmaceuticals, and medical devices but also surgical and medical procedures. Medical devices are not as strictly regulated as pharmaceuticals, although many countries have regulations about safety and efficacy even in this discipline. Most important Canadian Agency for Drugs and Technologies in Health (CADTH) - ON Pharmaceutical Drugs Directorate (PDD) HTA bodies in Canada The Toronto Health Economics and for whole country except QC Technology Assessment Collaborative (THETA)- ON l’Institut national d’excellence en santé et en services sociaux (INESSS) - QC Health Technology Assessment Unit of the McGill University Health Centre (TAU)- QC Calgary Health Technology Implementation Unit (CaHTIU)- AB Drug Evaluation Alliance of Nova Scotia (DEANS)- NS British Columbia Health Technology Assessment Office (BC-HTAO)BC CADTH is an independent, not-for-profit organization responsible for providing health care decision-makers with objective evidence to help make informed decisions about the optimal use of health technologies, including: CADTH drugs diagnostic tests medical, dental, and surgical devices and procedures. CADTH assesses health technologies by appraising the clinical and economic evidence. Assessments may also include reviews of the legal, ethical, social, implementation, and environmental considerations of a health technology, and may incorporate input from experts such as clinicians and patient groups. www Reversal, Replacement, Reassessment.... Medical replacement occurs when a new intervention or treatment is after hta developed and found to be superior to an existing intervention. If tech is not worth it, it won’t be used anymore Medical reversal occurs when an accepted practice—a diagnostic test, medication, or procedure—is overturned. The practice is not replaced by something better, but shown to be inferior to a preexisting, less intensive, or less invasive one. Medical reassessment involves periodically reevaluating existing medical interventions and treatments to ensure their ongoing effectiveness, safety, and relevance. different organizations above that do this Ethical issues with health technologies Privacy Equity and access Loss of human touch/caring relationship Machine consciousness, do intelligent robots merit human rights? cybersecurity Some insurance companies misuse ppls data — more economically viable decisions if they know who is dealing w/ what disease Accountability: Who will bear responsibility if something goes wrong with a 3d printed organ? The physician, the manufacturer, or the patient? Bias and fairness can be due to inputted data statistical value of life - puts monetary value on life