Future Doctors

Worldwide, almost everywhere, increased internet access and the growing use of digital devices have fundamentally altered the information available to patients. Patients are becoming more empowered by technology to make healthcare decisions; patients now commonly ask for more information and expect to be involved when making diagnostic and therapeutic choices.

At the same time, the healthcare system is becoming increasingly complex; every country is trying to figure out how to end the pandemic socially and medically.

As a result, many doctors feel unhappy, disempowered, and alienated from their work systems; they are seen as part of the problem rather than the solution.

The solution is undoubtedly directing us back to technology. The future of healthcare is data and work-smart people. Future doctors will probably need these characteristics enhanced:

  1. Healing ability: having knowledge and technical skills to heal people beyond treating disease. Healing and treating are related concepts, Healing, however, can come in many forms other than treating.
  2. Understanding of systems: doctors are no more the dominator but essential players in healthcare systems, from clinical teams to national and international systems. Doctors need to understand those complex systems and, more importantly, know how to improve them.
  3. Enthusiasm for learning and changing: medical students are taught that medical practice is a lifelong learning process. Nowadays, continuing learning is an essential survival skill; love to learn and change is a characteristic of future doctors.
  4. Comfort with technology: it is particularly true with information and digital technology; recognize that doctor plus technology will be much more effective than a doctor alone.
  5. Patient-centered: the concept of patient-centered care emerged in the early 50s; it exploded exponentially in the late 90s. As we strive to improve the quality of care, a patient-centered model can play a pivotal role in this process. More research is needed to explore the various attributes of patient-centered care, its acceptability, digital transformation, and comparative effectiveness in the healthcare arena.
  6. Understanding of evidence: doctors are educated about hierarchies of evidence. Future doctors must be capable of combining different types of shreds of evidence, analyzing and weighting them effectively. Learn to work with and apply algorithms.
  7. Profound ethical understanding: future doctors must recognize the moral issue and have the capacity to think and practice ethically.
  8. Communication skills: listening more than telling. Since Hippocrates’ time, medical school professors have taught their students to listen to their patients. Medical doctors all realize that the patient’s medical history and the patient’s account of his or her illness is the best source of information to make an accurate diagnosis and healing plan.
  9. Love of diversity: enjoying working with people from different backgrounds and of different views and skills.

Social, technological, and science is reforming the role of doctors rapidly. The change of the doctors is driven by patients, knowledge, the workforce, and technological change around us. The SARS-CoV-2 pandemic has thrust many changes upon the doctors in the new ways of thinking and working.

How digital technology help contact tracing of COVID-19 pandemic

How could china quickly control the pandemic in such a practical way? What are the secrets? One secrete is using digital tools for contact tracing.

Contact tracing is a critical step in controlling COVID-19 pandemic. The coronavirus is highly contagious, spreading so fast, it is so overwhelming and impossible to do contact tracing in traditional ways. China has extensively applied digital technology in contact tracing that includes identifying and following-up with patients, identifying, notifying, and following up with the contact.

The digital tools were applied to help contact tracing for accuracy and efficiency. For example, apps were used for electronic surveillance, and people were informed if they took the same train or plane with suspected or confirmed cases, the doctor was informed if their patients had high risk.

The most crucial contact tracing digital tool is the Health Code.

  • Health Code is a unique personal code, generated and saved on a personal phone, shows the pandemic risk.
  • Health Code shows three different colours indicating health status and pandemic risk level: green colour means low risk; yellow colour means medium risk, and red colour means high risk.
  • Health Code colour is generated based on big data collected from different sources, mobile service vendors, social media, online payment platforms, all information about where the individuals have been to
  • It is straightforward to apply.
  • Health Code status is real-time and dynamic.
  • The 1st version of the Health Code was generated on Feb 5th, 2020, over one billion health codes are generated.
  • During the pandemic period, every person must show their health code when entering into a public place, such as residential complex (coming back home), shopping malls, train station, airports, office etc.
  • Health code was not the only measure; temperature check was used together to trace suspected cases.
  • There are limitations, for people who did not have a phone or did not bring their phone, who did not remember their ID number, whose phones did not support 4G or scanning barcode), the manual process was used for tracing.

We have noticed that the Health Code is beyond contact tracing; it is population tracing. It identifies an individual’s footprints, footprint crosses. It makes contact tracing accurate, compressive, more efficient and more effective.

How could China so quickly build and implement such big health code systems nationwide almost within 1 month, the reasons behind include:

  • Mobile phone and internet is popular (i.e. 900 million people have internet access, internet access is over 64.5%)
  • Big Data ecosystems are ready
  • Unique ID for every citizen every individual is available
  • The most important is that people’s acceptance of link ID to register for a phone number, social media access and payment platforms.

To summarize China’s experiences of fighting against the coronavirus:

  • Digital Technology has been applied in identifying individual, tracing individual’s locations, and subsequently empowered contact tracing. It is proved, efficient, and useful.
  • Privacy is considered necessary, but public health is equally or maybe even more important as China has gone through SARS. People are more willing to be disciplined for their safety and society’s protection.
  • Over one billion people have been traced during the pandemic period.
  • Tests are encouraged and available in the major cities.

China’s experiences are of help to the world,  the COVID-19 pandemic will be settled down soon worldwide, and we look forward to going back to everyday life.

How can EHR/EMR Improve Medication Adherence?

Research shows that approximately 50% of patients do not take their medications as prescribed. The treatment of chronic illnesses commonly includes the long-term use of medication; however, the therapeutic benefits are often not achieved or maximized if patients don’t take them or are not adhering to the prescribed regimen.  

The factors contributing to poor medication adherence vary, but in general can be summarised into three categories:

  1. Those related to patients; for example, lack of understanding, inadequate involvement in the treatment decision–making process.
  2. Those related to care providers; such as prescribing complex regimens, insufficient explanation of usage, ineffective communication about adverse effects.
  3. Those related to health care systems; for example, limited access to care, visit time limitation, and lack of health information technology. 

It is recognized that poor medication adherence contributes to suboptimal clinical benefits; increasing adherence may have a more significant effect on health than any improvement in specific medical treatments (Sabate, WHO, 2003). 

How to make patients cooperate? What is a valuable tool to assist patients in forming adherence habits? The solutions need to be multifactorial and sustainable, they need to integrate coordinated efforts between care providers, patients, and health care systems. 

The medications are prescribed by doctors in an EHR/EMR system; therefore, EHR/EMR has a role and responsibility to launch such a medication adherence platform:

Recommended workflow and data scope include: 

  1. Prescription information generated in EHR/EMR. The EHR/EMR has appropriate interaction checks, allergy checks, cumulative dose checks, etc.
  2. Medication collection information in EHR/EMR or in linked pharmacy dispense system. In China, medication collection status is recorded into the EMR / EHR system since the vast majority of pharmacies are inside and operated by the hospital.
  3. Once the patient collects the medication, prescription information includes generic and brand names, usage instruction (before/after a meal, etc.), time of taking medication, side effects will be available to patients on their mobile phone, or online.
  4. The time of taking medication can be automatically added to the schedule.
  5. The patient will be alerted when the time is due.
  6. Patients can easily record the outcome, e.g., when medication is taken, what are the adverse reactions, etc.
  7. The patient’s administration record can be submitted to their care manager or primary care doctor for review, the treatment plan and regimens can be adjusted based on the report outcomes.

Depends on the local health systems, bring payers to such a platform could enforce adherence. Pay for adherence, pay for real treatment, pay for outcomes can be achieved based on seamless data. 

A Digital Model of Doctor-Patient Relationship

The good physician treats the disease; the great physician treats the patient who has the disease (William Osler, 1849-1919).

The doctor-patient relationship impacts the success of treatment and caring much. Currently, the traditional patient-doctor encounter and relationship are challenged by care service demand, the emerging technologies, and the COVID-19 pandemic.

Patients expectations during an encounter with a doctor (Delbanco, 1992) are:

  • Patients want to understand the competence and efficacy of their doctors.
  • Patients want to understand how their illness or treatment will affect their lives,
  • Patients often worry that their doctors are not telling them everything they want to know.
  • Patients want doctors to focus on their pain, physical discomfort, and functional disabilities.
  • Patients want to discuss if their illness will affect their family, friends, and finances.
  • Patients worry about their future.
  • Patients worry and want to learn how to care for themselves away from the clinical setting.
  • Patients want to be able to check the health care system effectively and to be treated with dignity and respect.

When the doctor-patient relationship includes competence and caring communication, there will be better adherence to treatment; patients will be more likely to be satisfied with the care received and can achieve better outcomes and quality of life.

How can information technology help build a doctor’s competence? IoT has proved its capability of improving the accessibility of healthcare services. How can IoT help caring communication between doctors and patients?

There are 3 Patient-Doctor Relationship Models:

  1. Activity-Passivity Model:  it is most appropriate and often seen in emergencies. The patient seeks help and information, and the doctor provides care decisions, actively treats the patient, the patient passively accepts, and has little control.
  2. Guidance-Cooperation Model: this is based on the theory ‘doctor knows best’, it is the most common in current medical practice. In this model, the doctor recommends a treatment plan and the patient accepts in a cooperating way.
  3. Mutual Participation Model: the doctor and patient share information and responsibility for making decisions and planning treatment and recovery. Some have recommended that this is the most appropriate model for chronic disease management.

The implementation and adoption of The Mutual Participation Model heavily rely on clinical data interoperability, interpretation, and sharing in a meaningful and sensible way between the doctor and the patient and their families.