What is digital?
To a Victorian doctor, the term digital would have referred to the anatomy of our fingers or toes and the nerves and vasculature contained within. This term came from the Latin digitus, which (surprisingly) means finger or toe. A digit has also meant a whole number less than ten for hundreds of years; perhaps they look a bit like fingers. At medical school, we learn that the digitalis genus of flowering plants (better known as foxgloves, with their finger or thimble-like flowers) have a useful medical application in the drug digoxin (and also as a poison if you enjoy crime fiction).
To get to the modern meaning of digital, we need to visit the world of electronic technology. From the early part of the 20th century, mechanical calculating machines like Charles Babbages’ Analytical Engine gave way to the first electronic computers, such as ENIAC. Older analogue machines used a continuous range of voltages to convey information (said to be analogue), but newer machines used discrete values (often binary, which simply means that they used two values; analogous to 1 and 0, on and off, yes and no etc.). These values were digits, so these machines were called digital.
Now that we are firmly in the information age, let’s focus on what we can achieve when those digits on the end of our hands meet a keyboard or other piece of modern hardware. Digital health is the exciting realm where technology meets clinical practice to enhance patient care and transform medical workflows.
Digital Everything
Information technology is a fundamental cornerstone of modern life. It encompasses not only physical hardware such as personal computers, smartphones, wearable technology, household appliances, and smart devices but also software applications, including websites, mobile apps, and cloud services. Every facet of your medical training has likely used digital technologies for organisation, instruction, assessment, and record-keeping.
Similarly, modern healthcare incorporates a plethora of digital technology, touching every part of the patient journey. For example, say you want to measure and record a patient’s blood pressure. Fifty years ago, this meant using a manual sphygmomanometer and (maybe) writing the value down in a paper chart (this is still a common way to do it in the NHS, which is why you’re reading this!).
By contrast, today, we can have a patient with a barcode that we scan to verify their identity. The automatic sphygmomanometer can measure the blood pressure and record it in the patient’s electronic health record (EHR) for us. Behind the scenes, this entry is assigned a clinical code (such as a SNOMED CT code) so it can be recognised as a blood pressure value by any health record software worldwide if the record should ever be exported there. Such interoperability requires a rigorous structure for the data (such as the Fast Healthcare Interoperability Resources (FHIR) standard for exchanging healthcare data).
The EHR system might alert the user that the blood pressure is high. At the same time, built-in clinical decision support suggests an appropriate first-line antihypertensive drug and warns of any interacting medication or allergies. The patient can see trends in their blood pressure on a patient-facing app, and, with patient consent, anonymised blood pressure data can be gathered from thousands of patients in seconds for audit or research. Telemedicine allows the clinician to see readings from a sphygmomanometer in the patient’s home. Analysts can use machine learning models to plan effective community approaches to manage hypertension and identify those most at risk of complications. At each of these stages, the hardware and software were designed and implemented by teams of people to make our healthcare safer, more efficient, and more effective, with more valuable data to guide service development and research.
Demystifying the terms
You will see many different and often interchangeable terms in the digital health space. This is particularly true of the subdiscipline of informatics (where computers and clinicians meet). These terms might include clinical informatics, bioinformatics, biomedical informatics and healthcare informatics. In practice, there is considerable overlap, but healthcare informatics, medical informatics and clinical informatics are somewhat synonymous, whereas bioinformatics relates to the application of computer and data science to the biological sciences, such as in genomics and proteomics.
Digital in the NHS
NHS England Digital oversees digital technology use in the NHS in England. Their multidisciplinary teams “design, develop and operate national information technology and data services that support clinicians at work, help patients get the best care, and use data to improve treatment.” Their responsibilities include the Spine (enabling interoperability between thousands of NHS organisations) and the NHS AI Lab.
A good example of a collaborative approach to technical innovation in the NHS is the Digital Growth Chart API, developed by the Royal College of Paediatrics and Child Health. This project involved interdisciplinary cooperation, technical expertise and the use of international technical and regulatory standards to deliver a product that can be used in isolation or as part of other products in the NHS and private sector. This is an example of open-source software, which means that the code is publicly available for inspection and can (depending on the licence) be made available for modification and redistribution.
Technology has the potential to improve patient engagement and access to care, facilitate remote monitoring and enable collaboration between specialities, disciplines and even across continents to meet significant global health challenges.
What can I do?
At the simplest level, being a clinician knowledgeable about how the systems around you are built can simplify your job and equip you to navigate and utilise digital tools effectively in clinical settings. This can also open up new career opportunities in an evolving field. Some clinicians might have an interest in coding and software development (also known as clinicians who code). Still, you don’t need to be experienced in the technology aspect to be involved.
NHS trusts will usually have their digital health programmes overseen by a Chief Clinical Information Officer (CCIO). Whether in the NHS or the private sector, there are many roles involved in digital health; software engineering, data science, clinical advisors, population health, hardware implementation, product management, design (e.g. product, user interface and user experience design disciplines), mobile application and web development, administration, operations, personnel, legal, marketing, finance and many others. As a clinician, you can bring valuable insights and experience to any of these roles.
Where to start?
Just as there are many roles in the digital health space, there are many places to start, depending on your areas of interest and experience. If you have a product idea, you can find or launch a startup and begin the process of making a product and bringing it into the healthcare market! Some agencies can help advise on business and regulatory aspects of this, not least the medical device regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA). You can also look for jobs on LinkedIn. Other social media services are available too. Unfortunately, there are no formal undergraduate education or speciality training programs in this emerging discipline in the UK, at least yet. There are several courses offered nationally that cover different aspects of Clinical Informatics.
In the NHS, there are forums on various topics (including for clinicians who code) at Digital Health Networks. There are the NHS PyCom and NHS-R communities, focused on applications written in the Python and R programming languages.
If you are interested in digital health, you can contribute in many ways or start developing your knowledge and skills.
The British Computer Society Health and Care Group (formerly the Faculty of Clinical Informatics) has developed a Core Competency Framework to guide clinicians in developing their knowledge and skills in the field of clinical informatics. There is also the Federation for Informatics Professionals in Health and Social Care (FEDIP).
Learning to code can be a great start in clinical informatics. This opens doors to data science, machine learning and application development. There are many resources online. Let’s Do Digital has many resources, including interactive courses and an annual conference. Watch out for the “Essentials of Health Informatics” handbook that Let’s Do Digital will deliver in early 2025, just like your Oxford handbook, but for clinical informatics and online, free and always up to date.
In collaboration with Let’s Do Digital, Mind the Bleep is hosting a webinar on Introduction to Health Informatics on 27th November. Register now at MedAll.
Wrapping Up
As healthcare rapidly evolves, digital health and clinical informatics are becoming essential elements of the medical landscape. By integrating advanced technologies and data-driven insights into everyday clinical work, these fields are enhancing patient care, improving efficiency, and creating new opportunities for healthcare professionals like you.
For medical students, you’ll have a head start if you begin exploring these areas now. Soon, you could be contributing to an exciting new smart device, writing code for electronic health record software, analysing data for the National Diabetes Audit or designing a new portable paediatric ventilator!
Digital health touches every aspect of healthcare planning and provision and offers diverse career paths that complement traditional medical roles. As you continue your journey in medicine, embracing digital health will equip you to deliver better care and position you at the forefront of digital transformation. The future of medicine is digital, and now is the perfect time to be a part of it.
Written by Dr Chris Wilson (GP, Urgent Care Doctor, and Let’s Do Digital Tutor)
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