© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
EDITORIAL
Advances and opportunities in the new digital era of telemedicine, e-health, artificial intelligence, and beyond
Harry HX Wang, PhD1,2,3 #; Yu-ting Li, MPH4 #; Junjie Huang, PhD5; Wenyong Huang, MD4; Martin CS Wong, MD, MPH5,6,7,8,9
1 School of Public Health, Sun Yat-Sen University, Guangzhou, China
2 Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, China
3 Usher Institute, Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Scotland, United Kingdom
4 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
5 Centre for Health Education and Health Promotion, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
6 Editor-in-Chief, Hong Kong Medical Journal
7 School of Public Health, Fudan University, Shanghai, China
8 The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
9 School of Public Health, Peking University, Beijing, China
# Equal contribution
Corresponding author: Prof Martin CS Wong (wong_martin@cuhk.edu.hk)
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Over the past decade, there has been an explosion
in the development and use of digital technologies
in health and health-related areas. In 2018, the
71st World Health Assembly Resolution on Digital
Health demonstrated collective recognition of the
contributions of digital technologies to improving
health, reducing health inequalities, and enhancing
healthcare services in the context of achieving the
Sustainable Development Goals laid down by the
United Nations.1 The increasing popularity of digital
tools, wearable devices, information systems, and
electronic resources in clinical practices and health
services has resulted in unique opportunities to
reshape healthcare in response to diverse existing and
emerging health system challenges. Furthermore,
technological innovations have been evolving at
an unprecedented scale, transforming the ways in
which medicine is practised. This transformation
has created a range of opportunities for telemedicine
and mobile health to transform service delivery, and
for advanced ‘big data’ and artificial intelligence
approaches to enhance evidence-based decision
support. At the global level, the World Health
Organization established an e-health vision in its
Global Strategy on Digital Health 2020-2025, with
strategic objectives and an action framework to
support countries in various development contexts
when expanding the implementation of digital
health technologies.2
In this issue of the Hong Kong Medical Journal,
two original articles report survey findings regarding
the perception and acceptance of telemedicine, a
service which is rapidly expanding to overcome
distance barriers in healthcare delivery.3 4 Hung et al3 analysed the experiences of individuals who used
telemedicine during the coronavirus disease 2019
(COVID-19) pandemic in Hong Kong. They found
a high level of satisfaction with telemedicine
consultations; users felt that such consultations
were useful in disease diagnosis and management.
Choi et al4 explored the values, concerns, and
expectations associated with telemedicine among
Hong Kong adults aged ≥60 years in two hypothetical
scenarios: during a severe outbreak while under
government-imposed lockdown, and after the
COVID-19 pandemic. The results of both studies
supported the use of high-quality telemedicine as a
novel approach to enhance clinical consultations and
patient education, while emphasising the need for
government- and provider-level support to promote
and expand services.
There has been global recognition of the power
that digital health technologies (eg, telemedicine)
have to exchange information for disease diagnosis,
treatment, and prevention. For example, the use
of telemedicine technologies to educate patients
and train community care providers is included in
an innovative stepwise approach recommended
by the World Kidney Day Steering Committee to
improve service affordability and access for patients
with kidney disease and their care partners in low-resource
settings.5 The increasing access to digital
resources and growing popularity of electronic
health records have substantially supported patient
self-education and public advocacy regarding kidney
disease awareness and learning, thereby bridging
gaps in kidney health education and literacy.6 Mobile
messaging applications and social media platforms, characterised by multi-channel information
dissemination and knowledge sharing, also play
key roles in meeting the need for community
empowerment and public engagement through
digital health communications.7
In addition to the collaborative efforts of
healthcare professionals and scientists to navigate
challenges arising during the COVID-19 pandemic,
digital health technologies have significantly
contributed to the widespread adoption of the
quick-response code–based contact tracing system
in many countries. In particular, the LeaveHomeSafe
mobile application in Hong Kong has enabled
the public to more accurately record the date and
time of entering and exiting various locations.8
There has been a remarkable increase in the use of
artificial intelligence—a cutting-edge computing
science innovation—to inform diagnosis, prognosis,
treatment, and triage decisions across clinical
settings. As summarised in a recent scoping review,
66 artificial intelligence products and tools have
been used in the healthcare response to COVID-19,
including pulmonary evaluations, assessments of
infection risk, personalised care recommendations,
triage decisions, patient deterioration monitoring,
and predictions of disease severity.9 Another
scoping review specifically examined the cost
savings, performance in improving health outcomes,
workflow efficiency in treatment and diagnosis,
local feasibility, user friendliness, and reliability and
trust associated with the implementation of artificial
intelligence in low- and middle-income countries.10
Innovations such as clinical decision support
systems, treatment planning and triage assistants,
and health chatbots have demonstrated the potential
to strengthen healthcare systems.10
Regarding the management of arterial
hypertension, which is the most important
contributor to the global burden of disease, the
2023 European Society of Hypertension Guidelines
recommend the use of internet-based, interactive
digital interventions in home blood pressure
monitoring to enhance the digital storage and
transfer of home blood pressure data, and to facilitate
evaluation of those data by healthcare professionals.11
Remote clinical management programmes based
on standardised home blood pressure monitoring
supported by automatic transmission via mobile
applications, along with collaborations involving
multiple healthcare providers in the context of
team-based care, could help reduce nonadherence
to antihypertensive treatment. Meta-analyses have
shown that virtual care for hypertension, mediated
by telemonitoring and smartphone applications,
provides benefits such as better patient education,
greater blood pressure reduction, and improved
cardiovascular outcomes.11 A scientific statement
from the American Heart Association has affirmed the utility of telehealth in risk factor modification,
medication adherence, and symptom monitoring
during the management of various cardiovascular
diseases.12
Ophthalmology is another branch of
medicine that has closely embraced new models
of care to improve patient-physician interactions
through digital health innovations, such as multipurpose
mobile applications, community-based
teleconsultation units, and medical chatbots for
improved case triage.13 Additionally, the screening
and management of diabetic retinopathy—a major
complication of diabetes mellitus and leading cause
of preventable blindness worldwide—has been
augmented by advances in healthcare digitisation
and increasing emphasis on telehealth initiatives.
In primary care and community settings, deep
learning–based artificial intelligence for automated
image-recognition, combined with telemedicine
programmes based on low-cost devices and remote
interpretation, would enable greater population
coverage and facilitate timely referral to ophthalmic
specialists for the management of vision-threatening
conditions.14
Digital infrastructure can also play a central
role in efforts to support and expand research
capacity. As accurate and reliable sources of research
data, electronic patient record systems have been
extensively used in epidemiological investigations of
clinical manifestations, radiological characteristics,
laboratory results, and biomarkers.15 16 17 18 The use of
electronic clinical management systems for patient
screening and data collection to identify socio-economic
factors, as well as health-protective and
health-damaging behaviours associated with quality
of life and health outcomes, was demonstrated in a
study of childhood cancer survivors in Hong Kong.19
Despite potential risks and challenges related to
oversight, regulations, data protection, and privacy—the focus of stepwise capacity-building efforts and
mitigation strategies—digital health innovations
have been implemented worldwide. Considering
the rapid growth and development of digital health
technologies, the use of telemedicine, e-health,
and artificial intelligence as integral components
of routine health service delivery is revolutionising
medicine and health; the greatest impacts involve
management of the increasingly complex conditions
and circumstances encountered in primary
care.20 These innovations and advancements will
benefit medical education, clinical practice, and
healthcare delivery, thereby ensuring service
quality, accessibility, and affordability. In terms of
effectiveness, acceptability, and feasibility, studies
with rigorously designed methodologies in various
contexts are needed to formulate evidence-based
recommendations regarding the use of digital health
technologies.
Author contributions
All authors contributed to the editorial, approved the final version for publication, and take responsibility for its accuracy and integrity.
Conflicts of interest
The authors have declared no conflicts of interest.
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