Digital Health Solutions

Incorporating Technology to Improve Patient Care

By Denise Sabac

The role of technology in medicine continues to grow. This integration creates numerous opportunities to improve patient care along every step of the timeline. For example, communication technologies have facilitated interactions between healthcare providers to accelerate the delivery of care. Further, symptom monitoring technologies empower patients to monitor their symptoms outside of the hospital setting and enhance patient autonomy. While these developments may dramatically alter the composition of patient care, it is important to systematically evaluate these changes to understand how they ultimately affect patients. Dr. Robert Wu, Associate Professor with the Department of Medicine at the University of Toronto and General Internist at the University Health Network, is a leading scientist in the creation and implementation of communication systems to coordinate care and internet-based tools for management of chronic diseases.

Dr. Wu currently focuses on the use of wearable devices, such as Fitbit, to monitor physiological data. These wearables are able to continuously monitor patients both inside and outside of the hospital setting to provide large amounts of data for patients and providers. Dr. Wu emphasizes the benefit of in-hospital patient monitoring to identify risk factors for future adverse events. For example, many patients experience post-hospital syndrome, a period after hospital discharge when there is an increased risk of adverse events and rehospitalization. Possible contributors to post-hospital syndrome include factors such as poor sleep and low activity that have occurred during hospitalization, which can better be understood through patient monitoring using Fitbits. Dr. Wu’s findings revealed that the Fitbit heart rate correlated well with the nurse-recorded heart rate and were better able to measure activity and sleep compared to existing assessment methods.1 These results suggest the possibility for wearables to inform management practices through more data availability. In addition, this work provides a foundation for further research on how these devices can be used in addition to regular assessments to optimize patient care.

Furthermore, Dr. Wu explores the benefits of wearables outside the hospital setting. More specifically, he focuses on the use of wearables to monitor chronic obstructive pulmonary disease (COPD), a group of diseases that cause airflow blockage and breathing problems. Applications that monitor oxygen saturation, heart rate, and activity can be useful to this patient population by predicting early exacerbations and improving their awareness and ability to manage their condition. To better understand the role of wearables for COPD management, Dr. Wu employs patient-directed and inclusive practices when developing new technologies. He conducted a qualitative study to identify specific factors that patients liked or disliked about the wearables, and differences between patient preferences. For example, some patients showed a preference for sharing data recorded from wearable devices with their physicians, while others had some reservations. Further, he shares that some patients were reluctant to use the device due to discomfort caused by continuous audio recordings or features related to the device’s aesthetics.2 In using this approach, he could identify areas of improvement to not only enhance the application but also increase uptake by patients. In addition, he identifies a lack of consistent protocol for physician use of the data collected by these devices; therefore, as reliance on technology grows, so should procedures for consideration of available data to inform care.

Dr. Wu further elaborates on additional challenges in the development of wearables for symptom monitoring, particularly for out-of-hospital use. He shares the difficulty in filtering vast amounts of information available through consistent monitoring, and using only relevant information to predict outcomes or ascertain the severity of an event. Furthermore, he explains the importance of understanding how patients interpret the data of their wearable devices. For example, Dr. Wu describes his process of systematically evaluating the perception of dyspnea intensity and dyspnea-related distress and anxiety (DDA) in patients with COPD. In this study, his team found that presenting live physiological data during exercise can reduce DDA and encourage physical activity.3 As such, understanding these perspectives and their impact on behavior may better inform the development of health technologies to optimize benefits for patients.

Dr. Wu describes the activity of developing new health technologies as requiring many different components. First, he describes the process as “a team of people working together,” where it is important to ensure that everyone is on board and open to making changes. Second, he emphasizes the need for a holistic approach during development, and consistent evaluation following implementation. The importance of revisions is demonstrated in one of Dr. Wu’s first projects piloting the transition from pagers to smartphones to enhance communication amongst hospital staff. The project was conducted over two decades ago and demonstrates the evolving nature of communication systems and technologies in general. The initial study findings revealed an overall perceived improvement in the efficiency of communication, while it also increased the amount of communication between staff by reducing barriers to contact.4 Subsequently, the protocol for using smartphones underwent many revisions in past decades, and eventually switched to an entirely different system. This reveals not that the initial system was flawed, but rather that new technologies should be explored and implemented when beneficial.

When asked about the optimal balance between reliance on technology vs clinical judgment in the healthcare setting, Dr.

Wu expressed his belief that technology should support rather than replace existing practices. In particular, he emphasizes the importance of “the actual interactions with the patients and bedside care” provided by hospital staff. He also describes the beneficial role of speech recognition and artificial intelligence in aiding with documentation to increase efficiency in the delivery of care, reflecting his current research trajectory which aims to supplement and enhance the existing patient care models.

Lastly, Dr. Wu emphasizes the importance of collaboration on his projects. He references the involvement of the “researchers, the clinicians, but also technology people” in the successful implementation of new technologies. Furthermore, he directly involves patients in project development through qualitative studies exploring patient preferences. He believes that it is through learning from others and remaining open-minded towards change that health technologies can continue to evolve and benefit patients.

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