Digital healthcare has been called the "inevitable future." However, there are also voices in the field that say it's "doctors' self-satisfaction" or "serving corporate interests."
Critics say that all parties involved have only paid attention to its possibilities while neglecting to evaluate it properly.
The experts pointed out the necessity and limitations of digital healthcare from the perspective of the field and discussed the direction of development at the Boramae Hospital Public Healthcare Symposium under the theme of “Essential Healthcare and Digital Healthcare” on Wednesday. The public sector of SMG-SNU Boramae Medical Center organized the symposium.
"The digital healthcare industry thinks the institution fails to catch up with it, saying older adults have low digital literacy while doctors are conservative even though there is excellent technology,” said Dr. Choi Ho-jin, professor of neurology at Hanyang University Guri Hospital. “That's not true. The industry’s technology level is low, and they don't know the field."
Professor Choi maintained that low digital literacy is “not” the problem.
“I did a study on GPS-tracking of dementia patients. Only 10 percent of the data was usable. Sometimes, the GPS showed dementia patients suddenly move eight kilometers in just 20 minutes," he said. "(The industry) says they make algorithms with AI. It's possible only because (developers) use the data they have. If the conditions change even slightly, it goes wrong."
Professor Choi stressed the need for collaboration of key players.
"The industry should develop the technology further and consider the clinical field. Developers and technologists say they want to work with doctors,” Choi said. “However, they bring products to physicians only after they have finished all processes. Half of the doctors then ask, 'Why do I need this? Doctors should be involved from the conception stage so that digital health can benefit the patient."
Dr. Kim Joo-hyung, director of a family clinic specializing in house calls, admitted that digital healthcare can sometimes be seen as "self-satisfaction for us doctors."
"When I visit patients, some haven't been to the hospital for years or hadn't had blood tests. I've even met people with disabilities who have never been to a doctor in their 50 years of life," Dr. Kim said. "When I get calls asking to give patients nutritional supplements because they won't swallow their food, the house is different. We have to call 119 and send them to the emergency room."
Kim pointed to the wide gulf between the industry and the clinical field.
"Digital healthcare is developing rapidly, but you don't have time to think about digital healthcare in the field. There is no space for IV fluids at the patient's home. There is no one to take it out three hours later. Even if they have a guardian, it's hard to educate them," he said.
Dr. Kim admitted the limitations of digital healthcare in the field. “While thinking about this, I wonder if we doctors are self-satisfied with digital healthcare. Now, we need to deal with the patient's problems in depth. We're looking at something too big. I want the new trend to go in a direction that helps patients."
‘More various valuation and discussion needed’
Others pointed out a lack of effort to identify "high-quality digital healthcare," calling for proper evaluation.
Kim Young-soo, head of the Public Health Office at Gyeongsang National University Changwon Hospital, said he believes that digital health has become "the main stage for venture capitals (VC) and large companies," citing the "ICT-linked artificial intelligence (AI) integrated care project" launched in South Gyeongsang Province in 2020 as an example. The project provided AI speakers to older adults living alone and used them to assist with care services.
"The evaluation reports are fantastic. For instance, the AI speaker satisfaction rate is 95 percent. It's only natural. We gave them a machine worth over 300,000 won ($225) for free. They could even listen to “Top-500 Trop Album.’ Sometimes a consultant gives a call, and a technician comes to the house to make sure the speaker is working properly,” Kim said. “(The problem) is that they use this as research data and turn it into a full-fledged business or include it in health insurance."
On the one hand, the budget of 50 million won has been cut, and the business itself is disappearing, Kim said. “However, on the other hand, a 10 billion won project is underway for 'new growth' and 'AI.' The effectiveness of health promotion is unknown, but (digital health) is constantly called and considered essential for the future. I don't know if it is being properly evaluated."
Dr. Choi Hong-jo, a professor of preventive medicine at Konyang University College of Medicine, also said that digital healthcare "emphasizes only technological achievements and rosy pictures" while failing to address "scientific research methodologies."
Professor Choi pointed out that government regulations and laws hinder new development, but researchers and businesses are busy following the government's guidelines.
"Most of the papers submitted to big data research review are summaries. IRB protocols are very short because they are exempt from review. It is questionable whether they are evaluated according to scientific research methods. The law and the government define the scope of scientific research. The discussion doesn't go beyond what law requires," he said.
In digital health, "technology development should not be an end in itself," he said. It is more important to "discuss how to minimize (anticipated) risks in the evidence production process," Choi added.
"Researchers need to step in to prevent the digital health debate from going in the direction that market and economic forces want it to go," Professor Choi said. "There are many areas that have not yet been discussed. We need a more diverse discussion on digital health than now."