By Dr. Sherry-Ann Brown, MD, PhD, FACC, FAHA
The COVID-19 pandemic has changed the medical playing field and provided some noticeable benefits. Telemedicine is one.1 Digital health and remote patient monitoring have also gained more stable footing in the pandemic. As we look toward the future, telemedicine, digital and connected health, mobile health, artificial intelligence (AI), ECG software, electronic health records (EHRs)—including EHR software systems—and remote patient monitoring can all improve the lives of patients.
Wearables and ambulatory ECG have implications and utility for cardiologists, as well. Over the past two decades, and especially during the pandemic, several technologies have been developed that can work well with telemedicine.
Ambient AI is described as giving "superpowers" to clinical providers. AI listens to what we say, summarizes the conversation, and records it independently. This allows physicians to focus on patients while capturing the necessary information and making it available for review.
These innovative technologies hold the power to curb burnout, change the patient experience, and find their place among cardiologists.
Defining the Cloud
A common theme and requirement for many techniques in the new era of clinical medicine is cloud-based computing. Essentially, "the cloud" is shorthand for services run on the internet and hosted externally via secure servers. The benefits include the ability to access files or services anywhere through an internet connection, but there are also downsides, such as privacy concerns and reliance on that internet connection. Cloud-based healthcare services fill similar needs in clinical and hospital care, offering the same central benefit of removing the need for the user to provide computing power or storage space.
Exploring the Cloud
For cardiologists, the cloud has already revolutionized imaging, but its full impact goes beyond images. Cloud-based services store patient data in secure locations that allow for integration with other enriching data sources. For example, a heart–failure patient recently discharged from the hospital will have clinical data about her recent hospitalization. She can also wear a device to monitor how day-to-day activities affect her condition.
Based on the integrated clinical and device data, the medical team can flag a patient's increased risk and put in place more aggressive monitoring and follow-up. These devices can provide a wealth of information to cardiologists about the real-time health of patients and monitor the effects of treatment. By storing data in the cloud, doctors can access this information to deliver timely care based on the patient's evolving needs. These profound clinical advantages must be balanced against the risk of security breaches and device malfunction. Robust security specifications as well as device vetting (e.g., only capturing data from FDA–cleared devices for ECG software) can help cardiologists mitigate risks.
Practical Solutions in the Cloud
When patients pull up a mobile application and show their doctor their blood pressure trends and heart rate patterns, this is informative. Through EHRs, the remote monitoring information from patients fills in gaps that may otherwise be invisible to the practitioner.
Various initiatives in clinical practice—including those that give patients more autonomy and self-management options—create an opportunity to study patient outcomes and tweak initiatives. Such iterative cycles in the system are built largely on cloud-based computing that allows us to:
- Employ machine learning techniques and EHRs to predict which individuals might be at a higher risk for developing cardiovascular diseases.
- Use the results of a screening algorithm to identify occult diagnoses.
- Leverage natural language processing to search through unstructured notes to make predictions that inform screening efforts.
When we use patient similarity and network-based algorithms to search through EHRs and determine which patients are most similar to each other and use the information to predict poor outcomes in some of our patients, we are using cloud-based computing.
When we give patients AI chatbots and education materials that help them learn asynchronously, we can use cloud-based computing to enhance the quality of life of those we serve. While much of clinical practice is conducted outside of the cloud, pursuing all of these options in the cloud gives us more power and helps to elevate our work.
Without cloud-based computing, our efforts and progress in telemedicine, AI, digital health, connected health, remote patient monitoring, and various other tools would be limited. In the cloud, various servers, algorithms, rules, and standardized languages allow us to communicate across distances within and between clinical practices, regions, and countries. Such capabilities are crucial to the success of digital transformation for cardiologists.
Cloud and Edge Computing
Among the cloud, a related set of technology becomes additionally important: edge computing. Both cloud storage and edge computing can be broadly characterized as distributed computing—computing that does not take place in a single physically centralized location. Edge computing, however, specifies a style of distributed computing where, in contrast to traditional cloud computing, as much data storage and manipulation as possible occurs at the site of the user, rather than at the central host.
In healthcare, this means that raw patient data is stored at the hospital, clinic, or lab where the data is initially gathered and processed on computers located on-site. Yet, the results of this processing are sent to central hosting for review, further processing, and storage.
One obvious advantage of edge computing for cardiology is the reduction in latency in processing caused by the time spent sending data to and from a central host. This is especially true with extensive data files. Cardiologists often need to make decisions quickly and edge computing is advantageous for this reason. Many of the benefits of software as a service (SaaS) for healthcare providers lie in the ability to fundamentally elevate the administrative functions of healthcare organizations by streamlining communications, improving data security, and expanding access to critical information resources.
There are disadvantages to both edge and cloud computing. Edge computing requires some local storage and organization, which utilizes power and space on-site. It requires an investment that can be balanced by the distinct advantages cardiologists and their patients have in the ability to process high volumes of data quickly and make clinical decisions without delay.
To learn more about the power of the ECG in today's clinical landscape, browse our Diagnostic ECG Clinical Insights Center.
EHRs vs. Electronic Medical Records
Another nuance for clinicians to consider is the difference between EHR software systems and electronic medical records (EMRs).2,3 EHRs are far more comprehensive than EMRs. Although EMRs are essentially electronic versions of paper charts, EHR software systems comprise entire networks of data across lab results, imaging, and more. EHRs often use EMRs as data sources.
EHRs can also be used to store and process information for individual patients and populations of patients, typically stored remotely in the cloud. EHRs typically include particular workflows and can seamlessly integrate with external systems from other clinicians caring for patients. These characteristics help to improve coordination, availability, cost-effectiveness, efficiency, and quality of care.
Both EMRs and EHRs empower healthcare providers to access, share, and manage patient data much more efficiently and securely than traditional paper records do. Notably, EHRs offer distinct advantages, allowing sharing between providers and adding enriching context to clinical decision–making.
Cloud-Based EHR for Cardiologists
EHRs provide a broader suite of information that can be used to optimize patient care and delivery among various clinicians across platforms and populations. Such EHRs typically adhere to "Meaningful Use" regulations and facilitate health information exchange securely and confidentially. Approximately 80% of clinicians use an EHR system, as noted by the Centers for Disease Control and Prevention.4
In EHR software systems, the ability to visualize physiological data from remote patient monitoring and other sources in the learning health system can help cardiologists generate new operational and clinical insights. Coupling such data with clinical acumen and experience can power even more informed decision-making. A useful cloud-based EHR system also facilitates interaction with the data to enhance completeness and allow for the organization and interpretation of that data, especially in response to input from stakeholders.
EHR Software as a Service
The use of cloud-based or edge computing solutions for EHRs as SaaS in cardiology clinical practice varies for each group, depending on size, available resources, overheads, and location. SaaS, by definition, refers to software that resides with a cloud-based service provider and can be continuously purchased and used to provide solutions. One can subscribe to a centrally hosted service and receive its benefits as long as you keep paying.
SaaS hosts applications, storage space on servers, firewalls, and much more. In the context of healthcare, providers can benefit from services that expedite the secure transmission of patient data and lab results between facilities. Therefore, whatever the solution, these technologies create an opportunity for cardiologists and administrators to better tackle the complex problem of healthcare in a cloud-centered world.
Resources:
- Greiwe J. Telemedicine lessons learned during the COVID-19 pandemic. Current Allergy and Asthma Reports. January 2022;22(1):1-5. doi:10.1007/s11882-022-01026-1.
- Practice Fusion. EHR (electronic health record) vs. EMR (electronic medical record). Practice Fusion Blog. https://www.practicefusion.com/blog/ehr-vs-emr/. Accessed December 20, 2022.
- Landers M. EHR vs. EMR: Which is better for your practice? Software Advice. https://www.softwareadvice.com/resources/ehr-vs-emr-whats-difference/. Softwareadvice.com. Accessed December 21, 2022.
- National Center for Health Statistics. Electronic medical records/electronic health records. Centers for Disease Control and Prevention. CDC.com. https://www.cdc.gov/nchs/fastats/electronic-medical-records.htm. Accessed December 20, 2022.
Dr. Sherry-Ann Brown, MD, PhD, FACC, FAHA is an Assistant Professor and Director of Cardio-Oncology. Board-certified in Internal Medicine and Cardiovascular Diseases, she specializes in Cardio-Oncology and Preventive Cardiology.
The opinions, beliefs, and viewpoints expressed in this article are solely those of the author and do not necessarily reflect the opinions, beliefs, and viewpoints of GE HealthCare. The author is a paid consultant for GE HealthCare and was compensated for creation of this article.
