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Wednesday, September 22, 2021

Digital tools for lung care

The need for a repository that alerts doctor and patients to take prompt medical decisions is one of the important lessons of Covid


August 15, 2021 7:21:52 pm
Platforms such as Aarogya Setu, CoWin, teleconsultation portals, and online clinical platforms have helped provide efficient and affordable healthcare services.

Written by Sushil Kataria

In just a few months’ time, digital technologies in medicine have taken a quantum leap. The pandemic necessitated the use of digital technologies in the healthcare sector at unprecedented levels. Platforms such as Aarogya Setu, CoWin, teleconsultation portals, and online clinical platforms have helped provide efficient and affordable healthcare services. To digitalise healthcare records and avoid crowding at hospitals across the country, India also launched the National Digital Health Mission and permitted e-pharmacy and telemedicine platforms to offer consultations.

While stakeholders at all levels toiled hard to address the healthcare needs of patients, healthcare professionals often found themselves working in an unfamiliar setting, treating an unknown disease. They had to make life-critical decisions every minute. Lack of authoritative data to support these decisions, made it highly challenging for them to match symptoms with treatment recommendations. This raised the need of having updated and reliable information platforms such as Clinical Decision Support system (CDSS) at the point of care.

Doctors are confronted by increasing amounts of clinical data related to every patient they treat along with an exponentially increasing volume of medical research. While databases and electronic health records help doctors to manage the rising tide of paper records, patient-specific recommendations provided by CDSS can ensure improved decision making and enhance patient safety.

Covid is a respiratory disease that reaches into the respiratory tract which includes lungs. It can cause a range of pulmonary problems in an individual from mild to critical. Elderly and people with other health conditions like cancer, cardiovascular diseases and diabetes may experience more severe symptoms. In the last year and a half, CDSS have helped several pulmonologists to consider all drug interactions while treating such patients.

Scanning a patient’s medical history will show traces of several drug interactions. Some interactions may not be clinically significant. However, some can be relevant. For instance, in respiratory care, there are interactions between inhaled substances like lama, laba, and corticosteroids. Then there is drug to drug interactions because a patient may have other health problems as well such as cardiac disease. For patients with heart failure, pulmonary artery disease and hypertension, there would be interaction between their other medicines and beta blockers. And, these patients could also have a history of respiratory ailment. In such cases, we can recommend cardioselective beta blockers instead of non-cardioselective beta blockers. This information is provided to healthcare professionals by CDS systems.

Any discussion of pulmonary care in India cannot be complete without reference to tuberculosis. As per the World Health Organisation, there were 2.64 million TB cases in India in 2019. You cannot treat TB without rifampicin — a drug that affects the body’s sensitivity to other medicines. The efficacy of about 50 percent of drugs will decrease by 25 percent or more due to rifampicin use. Several antibiotics can at times cause QT prolongation — the heart muscles take longer than normal to recharge between beats. Healthcare professionals need to be aware of such information. That is where CDS systems help.

Such systems provide clinicians, staff, patients, or other clinical stakeholders with knowledge and person-specific information which is filtered and is used at the point of care. These systems can encompass a broad array of clinical workflow tools including reminders, alerts, order sets, and documentation templates. Studies show that, when provided to healthcare professionals within their workflows, patient-specific recommendations significantly improve patient outcomes. Moreover, when patients have access to their own health data including test results, prescriptions, scans, among others, it positively impacts patients’ experience.

For instance, we send special alerts for diabetics. Some patients may integrate their glucose monitoring and if their glucose level is high, digital technologies alert them to consult a doctor or a dietician through telecommunication. For hypertension care, I use alerts for my immune deficient patients to remind them of their dosing. As an influx of information may confuse them, we send patients relevant information from time to time.

In fact, large amounts of information could make it difficult to filter medical data. In the post-Covid era, it is critical for hospital information systems to be integrated with CDSS. The move will cut down unnecessary medical jargons and give an insight into the best treatment option which translates into better patient outcomes. Digitalisation of healthcare will bring uniformity in care delivery in India from primary to tertiary level. The need of the hour is to make platforms like CDSS more accessible and training healthcare professionals to use them. More importantly, these systems should be patient or nurse centric as well and not just doctor centric.

The writer is Senior Director Internal Medicine at Medicity

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