Join CardioNerds Co-Founder Dr. Dan Ambinder, Dr. Nino Isakadze (EP Fellow at Johns Hopkins Hospital), Dr. Karan Desai (Cardiology Faculty at Johns Hopkins Hospital and Johns Hopkins Bayview) and student Dr. Shivani Reddy (Medical Student at Western Michigan University Homer Stryker SOM), as they discuss how digital health in changing the landscape of CV Disease Management with Dr. Dipti Itchhaporia (Past President of the ACC). The overall goal of this episode is to broadly describe the current landscape of digital health for cardiovascular disease, define “digital health tools” and describe their role in cardiovascular disease management. Episode audio was edited by student Dr. Shivani Reddy and show notes were developed by Dr. Nino Isakadze.

In this series, supported by an ACC Chapter Grant and in collaboration with Corrie Health, we hope to provide all CardioNerds out there a primer on the role of digital heath in cardiovascular medicine. Use of versatile hardware and software devices is skyrocketing in everyday life. This provides unique platforms to support healthcare management outside the walls of the hospital for patients with or at risk for cardiovascular disease. In addition, evolution of artificial intelligence, machine learning, and telemedicine is augmenting clinical decision making at a new level fueling a revolution in cardiovascular disease care delivery. Digital health has the potential to bridge the gap in healthcare access, lower costs of healthcare and promote equitable delivery of evidence-based care to patients.

This CardioNerds Digital Health series is made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Nino Isakadze and Dr. Karan Desai.  

Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values.

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1. COVID 19 pandemic accelerated the digital transformation of healthcare.
   
2. Digital health tools exist for disease prediction, diagnosis and management.
   
3. Digital health can increase access to care and lower overall cost expenditure.
   
4. Clinicians, policy makers, and insurance providers should be involved to facilitate rapid and effective adoption of digital health interventions to better patient and population health.
   

1. How did the COVID-19 pandemic accelerate the process of adopting digital health tools in healthcare including cardiovascular disease management?

• Although technological advances and technological transformation have been implemented in many aspects of our lives, their adoption in healthcare, including cardiovascular disease management has lagged behind.
  
• The COVID-19 pandemic was a force that led to the Tech-celeration as we adopted telemedicine and remote patient monitoring platforms in a short time to preserve access to healthcare.
  
• Technology became essential not to replace but to support face to face interactions.
  
• Reimbursement models were rapidly created that fit digital healthcare delivery; however it remains unclear whether these models will continue to be in effect in the post pandemic era.
  

2.  Can you discuss broadly the current landscape of evidence-based digital health tools available for cardiovascular disease management?

• Three components of digital health landscape can be broken down as follows:
  
  • Virtual care/telehealth platforms
    
  • Remote patient monitoring systems including implanted devices, patches, wearables, smartphone applications and more
    
  • Artificial intelligence to allow meaningful use of the big data obtained from remote patient monitoring systems in therapeutic and disease management pathways
    
  
  

   3. How can we balance benefits and burden of digital health tools? 

• The pure definition of digital transformation is using digital tools to make lives of patients and clinicians better.
  
• The data we derive from digital health technologies is only useful insofar that it can be used to affect change. We need analytical tools like AI to create actionable information and summary sheets to summarize data in meaningful ways.
  
• While developing digital health tools, companies should engage in co-designing processes with end users. In the case, clinicians should receive iterative feedback so that tools that are developed meet user needs.
  

   4. What are the ways to ensure inclusiveness in design and delivery of digital health tools for disease management to every patient, including those from underrepresented racial and ethnic groups?

• We need to improve access to infrastructure needed to operate digital health tools. This requires engagement with institutions, organizations and legislators.
  
• Digital health tools need to be co-designed with a diverse set of users including those with low tech literacy as well as multiple stakeholders.
  
• We need to communicate with community members when translating science to make sure that the process is transparent to address any trust issues or skepticism.
  

5. How do we ensure data privacy, especially when health data is stored on different servers? 

• There are gaps in federal legislation that need to be addressed.
  
• IT health standards for handling data collected outside hospital settings with digital health tools should be developed in an iterative manner. When health IT standards are developed, we need to enforce them and ensure that they are working well with feedback systems.
  
• Individuals need to control how their data is health systems and other entities use and store their data.
  
• Clinicians need to trust that data is stored in a secure manner when appropriate channels are utilized.
  
• Data management should be a transparent process.
  
• Confidentiality is going to be fundamental and all entities involved should be subject to HIPPA rules.
  

6. How can big organizations help advocate for updated reimbursement models and policy changes to allow for greater adoption of digital health tools?

• Big professional organizations have pivotal roles in promoting the digital transformation, and implementing digital re-design.
  
• Big professional organizations can act as conduits between different stakeholders, promote digital literacy in public as well as among professionals.
  
• They can create standards and guidelines on proper use of digital health technology, facilitate robust studies to test clinical impact, and advocate for reimbursement and policy changes.
  

 7. What are the near future and long-term opportunities of digital health tools in cardiovascular disease management?

• Digital transformation is in progress, and we need clinicians to be at the center of innovation to drive development of care pathways and care delivery models.
  
• Digital solutions should promote health equity, add value to healthcare systems, and promote wellbeing of clinicians
  

1. Bayoumy K, Gaber M, Elshafeey A, et al. Smart wearable devices in cardiovascular care: where we are and how to move forward. Nat Rev Cardiol. 2021 Aug;18(8):581-599. doi: 10.1038/s41569-021-00522-7. Epub 2021 Mar 4. PMID: 33664502.
   
2. Cowie MR, Lam CSP. Remote monitoring and digital health tools in CVD management. Nat Rev Cardiol. 2021 Jul;18(7):457-458. doi: 10.1038/s41569-021-00548-x. PMID: 33824486; PMCID: PMC8023506.
   
3. Itchhaporia D. Navigating the Path to Digital Transformation. J Am Coll Cardiol. 2021 Jul 27;78(4):412-414. doi: 10.1016/j.jacc.2021.06.018. PMID: 34294274.