Using digital technology to manage chronic noncommunicable diseases

Abstract

Noncommunicable diseases (NCDs) also called chronic diseases including diabetes, hypertension, CVD, chronic pulmonary, and kidney diseases result largely from an interplay of genetics, personal lifestyle, psychosocial stress, and environmental factors such as air pollution.[1] Chronic diseases have a significant impact on individuals, families, communities, and governments. The most common risk factors contributing to these diseases include tobacco use, alcohol consumption, poor diet, and lack of physical exercise. Given the fact that NCDs affect various sectors and sections of society, the response calls for an inter-sectoral and multi-disciplinary approach. Today, chronic diseases are a cause for great concern globally, placing a heavy burden on society and the healthcare system. They are now the leading cause of mortality worldwide. In India, NCDs such as cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes are estimated to account for around 60% of all deaths, thus making them the leading cause of death.[2] They cause considerable loss in potentially productive years of life. Besides the negative impact on national development, these diseases also are a major source of household expenditure and poverty. The chronic diseases are both preventable and manageable conditions. Nevertheless, new strategies are needed to tackle these diseases. In this regard, digital technology can assist health workers a great deal in NCD prevention, care, and management.[3] Take the example of the COVID-19 pandemic and how the pandemic helped catapult the use of digital health technology helping in providing continuity of care when health facilities were closed, there was supply disruption and the mandate of social distancing was in force. Caused by a virus, most patients who also suffered from one or more NCDs as comorbidity had a relatively severe disease or had higher case fatality rates.[4] Indeed, there was an explosive use of digital technology both during and postpandemic period in the provision of healthcare, in communicating messages, and in disease prevention such as vaccination using the online CoWIN web portal initiated by the Government of India in late 2020.[5] In chronic disease space, digital health intervention can help address clinical outcomes, communicating for behavioral modification, and in-service implementation, particularly at the primary care level. One of the important challenges in NCD management includes underdiagnosis and undertreatment and lack of access to health services, particularly in remote areas. Now portable diagnostic devices such as Mobilab can provide accurate and instant test results in various settings, including clinics, mobile health camps, and remote locations.[6] This mobile-based pocket-sized, blood testing device provides information on multiple parameters related to heart, liver, and kidney profiles as well as to anemia and diabetes. Improved access to telemedicine or teleconsultations postpandemic has made a significant impact on the provision of health care by making it not only accessible but also convenient for chronic disease patients. It helps bridge the gap between healthcare providers and patients, ensuring timely and efficient specialist medical consultations. The Government of India has launched a national telemedicine service called eSanjeevani to bridge the digital health divide and ensure equity in achieving universal health coverage even in the remotest areas of the country.[7] Telemedicine services are being provided through health and wellness centers, now called Ayushman Arogya Mandirs. With the use of mHealth or mobile health technology, chronic disease patients such as those with diabetes are being alerted regarding medicine intake through the use of simple short message services or text messages. There is now extensive evidence that mobile phone-based support for smoking cessation is effective.[8] A recent systematic review demonstrated that such an intervention can increase quitting rates by 71%. Current research suggests that MHealth for smoking cessation, such as smartphone apps are key to delivering wide-ranging treatments more efficiently.[9] Electronic health records (EHR) refer to the systematic collection of patient and population health information stored electrically in a digital format.[10] EHRs are cost-effective compared to paper-based records and can eliminate duplicate and incorrect data. It enables doctors and healthcare workers to access and share patient’s data across different healthcare settings, as and when necessary. Combining multiple clinical data from the electric health records can help clinicians identify and stratify chronically ill patients. These records can thus help improve the quality of care and reduce healthcare costs, particularly in the context of chronic diseases. Information and communication technology has indeed revolutionized the process of information exchange, through social media or by organizing webinars on relevant chronic disease topics, online. Training or capacity building or distance learning is a convenient way to connect without having the participants to travel, thereby saving costs to the organizers. Among the most promising and disruptive advances in digital technology is in the area of artificial intelligence (AI) and machine learning, which is revolutionizing chronic disease prevention and care by transforming traditional approaches, making them more efficient, personalized, and predictive. Defined simply as the simulation of human intelligence through the use of computers, AI in health care typically uses EHR to identify patients at risk for chronic diseases such as heart diseases and diabetes. Recent studies show that AI can be used widely in healthcare settings to optimize the care of patients with chronic medical conditions.[11,12] With remarkable ability for image recognition, AI can help predict individual risks, detect malignancies such as breast cancer occurrence with high diagnostic accuracy, and forecast disease progression and potential complications, allowing clinicians to intervene proactively in the management of chronic diseases. It can also help in developing precise treatment algorithms for the management of cardiovascular diseases and such a personalized treatment improves medical outcomes. AI thus has revolutionized precision medicine by quickly analyzing vast amounts of data on genetic make-up, personal lifestyle, and the surrounding environment of the patient to provide tailored prevention and treatment strategies. AI has the potential to accelerate the process of development of vaccines and therapeutics by transforming key steps of clinical trial design, improving trial success, and thereby reducing research and development costs.[13] In addition, digital technology can help health and hospital management systems by minimizing logistics-related expenses and stockouts. It is useful to point out that AI can only supplement but never replace human intelligence and ingenuity. Nevertheless, the implementation of digital technology in chronic disease management also presents many challenges. These include issues relating to data privacy and security, the cost of emerging technologies, and the need for thorough testing of novel digital technology interventions for effectiveness and applicability at primary care levels. To achieve digital transformation, we urgently need to ensure digital literacy and universal connectivity and address inequities in digital health infrastructure in different districts of the country. In conclusion, digital technology solutions offer enormous benefits for all – to people affected by chronic diseases, to healthcare providers providing care to such patients, and to the government by reducing healthcare costs. The patients benefit by receiving personalized and patient-centric care, the healthcare providers through improved communication and efficiency in diagnosis and treatment, and the governments by reducing healthcare costs and contributing to achieving universal health coverage. Given the explosion in digital technologies today, it is high time that the use of digital technology is expanded rapidly for chronic disease prevention and clinical care and management. Ethical approval statement Not applicable.

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