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The-future-of-primary-care-practices

Modern technology has thoroughly transformed many aspects of our lives in unprecedented ways. This extends not only to trivial matters, i.e. finding the best restaurant in an arbitrary location or browsing through this season’s clothes collection without visiting a brick and mortar store, but to far more important fields of human endeavour like medicine.

Thanks to advancements in the field of medical devices, physicians can allocate more time to formulating a proper treatment plan on the basis of comprehensive and unambiguous diagnostic results than judging the severity and extent of the disease when browsing through mountains of (paper) data and results (a common situation before the advent of modern personal computers and their use in medicine).

Gone are the days when certain medical conditions could be reliably diagnosed only through vague symptomatology-based speculation or invasive surgery with considerable risk for the patient, or diagnostic devices which could be harmful even for physicians (the first x-ray machines). Despite leaps in diagnostic technology, however, human input is still needed when interpreting results and deciding on the next course of action.

Where technology can be of great help to physicians and other healthcare professionals today and has already proven its worth is medical record keeping and management. Electronic medical records (EMR) or electronic health records (EHR), as some refer to them, are slowly but surely displacing paper-based records, bringing healthcare into the digital era. They have numerous benefits starting with the simple fact that the use of EHRs is associated with a better quality of care [1, 2]. Next is uniformity of information, eliminating (costly) errors due to poor penmanship (illegible handwriting) [3, 4, 5].

Users of EHRs also have the benefit of traceability (who, when and why were alterations made to the records) and the consequent reduction in malpractice claims [6]. One study found that while 6.1% of users of EHRs had a history of paid malpractice, that number was far higher (10.8%, i.e. nearly 80% more than in EHR users) in users of conventional, paper-based records [7]. Last but not least is the option of seamless sharing of EHRs between various users, whether they are sitting behind a PC or holding a tablet or a mobile phone, though only a few selected EHR management systems enable such cross-platform sharing of data. It should be noted that even fewer are integrated directly with diagnostic devices for easy and automated test result storage and sharing. They greatly improve workflow efficiency in healthcare settings where they are used and enable physicians to allocate more time to their patients instead of to trivial administrative work.

What is the future of primary care preventive practices?

Average life expectancy is on the rise in most developed countries and is even projected to surpass the 90-year mark (for females) in some countries for those individuals born in the year 2030 [8]. This is a testament to advancements in medicine in both preventive and curative care, ranging from implementation of effective awareness/preventive programmes on the dangers of e.g. smoking or lack of regular physical activity to the advent of effective treatment methods for diseases that were, until recently, incurable. However, rising life expectancy is also associated with a host of challenges that will become more apparent with the rise in the number of patients and growing complexity of their medical needs.

Based on current historical data on health trends, it is reasonable to expect that as individuals get increasingly older, they will be afflicted with more diseases and spend more years living with a disease (or diseases) or a disability [9]. Despite the advances in preventive care, the likelihood of being affected by many conditions, e.g. peripheral artery disease (PAD), simply increases with age [10]. An additional aggravating factor is comorbidity, like (again) in the case of PAD, which is associated with many serious cardiovascular diseases (CVDs) (coronary artery disease, stroke) and other diseases [11]. The most notable other comorbid disease is diabetes which is a complex and difficult condition to treat in its own right, let alone in combination with PAD [12]. Formulating and managing an effective treatment plan in just a single patient is a difficult task, but it becomes nearly unmanageable for a single general practitioner to do so for a large number of patients, at least if old methodologies and workflow protocols are used.

The digitalisation of medicine aims to mitigate such problems through integration of EHRs and data management and sharing systems in diagnostic devices, and proliferation of their use in preventive and curative healthcare. Despite sounding futuristic, it is actually already in use, though for now only in a limited extent, the notable exception being EHRs, which are fairly rapidly coming in use. One segment of digitalisation is the use of commercial mobile technology enhanced with diagnostic sensors, wearable and implantable diagnostic devices for data acquisition and sharing [13]. Implementation of such a system, however, particularly on a larger scale, is fraught with difficulties associated with big data and effective cybersecurity [14].

Due to obvious benefits, digitalisation is also poised to transform the private healthcare sector, which is not usually subject to budgetary constraints and internal politics that may hinder the adoption of new technologies. This need not take the aforementioned route that includes a myriad of interconnected diagnostic devices and systems, but may start slowly and gradually with the introduction of a singular diagnostic device. A good example would be the MESI mTABLET, which is a fully customisable, portable diagnostic solution encompassing the tablet, wireless diagnostic modules and mRECORD EHRs management system and the mSTORE, an online repository of diagnostic apps.

The mTABLET and additional hardware and software components comprise a complete ecosystem that enables diagnosis and sharing of diagnostic results amongst selected healthcare professional (even those who are not users of the mTABLET device). The direct integration of an EHR system in a (physical) diagnostic device is a unique solution and offers an affordable entry in the nascent world of digital healthcare.

Digitalisation of workflows is the future of primary preventive care practice in both the public and private spheres with the latter having the edge when it comes to adoption of new time- and cost-saving technologies.