Read Full Text: Integration of Artificial Intelligence, Blockchain, and Wearable Technology for Chronic Disease Management: A New Paradigm in Smart Healthcare
Journal: Current Medical Science
Year Published: 2021
CEU Podcast: #58: OT and AI with Sarah Brzeszkiewicz
Will artificial intelligence (AI) replace occupational therapy?
There’s no doubt that this technology will transform healthcare. It will surely accelerate the existing move toward healthcare taking place at home.
To help us wrap our minds around this transformation, we are reviewing an article that explores three technologies:
- Artificial intelligence
- Blockchain
- Wearables
The article explores how such technologies are used in chronic disease management. The authors also introduce a patient-centered management framework based on AI. They close out the article by discussing the potential shortcomings of this new paradigm.
Next week on the podcast, we’ll host a guest whose career shows how OT is involved in this transformation of healthcare. Sarah Brzeszkiewicz, OTR/L is the clinical advisor at Sensi.ai, where she’s helping to pioneer AI’s role in home care. She and I will discuss the implications of this research, including how AI is best seen as a tool and an opportunity…rather than a threat.
Let’s dive in.
The current challenges of chronic disease management
Chronic disease is the dominant cause of morbidity and mortality worldwide. For the sake of this article, these conditions are grouped into:
- Cardiovascular disease
- Pulmonary disease
- Diabetes mellitus
- Chronic conditions requiring gross motor rehab
The traditional model of managing these conditions is based on the model of:
Diagnosis > treatment > rehab > follow-up
But, there are multiple problems related to traditional chronic disease treatment strategies:
- Short management radius
- High manual dependence
- Blurred responsibility
- Privacy concerns
Many patients still do not have a sense of access to their information, making it difficult for them to truly engage in self-management. And, since care providers do not have access to long-term monitoring data, they often fail to follow up with patients in a timely manner. This, in turn, leads to diagnostic failure and unsynchronized treatment.
The potential of AI, blockchain, and wearables for chronic disease management
In our current reality, healthcare takes place primarily at hospitals and in clinics. Healthcare itself also tends to be reactive to major health events, rather than focused on preventative care.
When patients do see their providers, much of the time is spent by clinicians assessing the status of their patients’ health. Thus, patients often wind up passive participants in their own treatments.
AI, wearables, and blockchain now presents the opportunity for patients’ health status information to be accessed continuously and in real time.
This paradigm truly centers care around the patient. Much of the data can now be collected in the home setting. This increased efficiency opens the possibility for our treatments to be much more preventative and proactive in nature, focusing on early warning signs of health deterioration.
Let’s look quickly at these 3 technologies:
Wearables:
Wearables allow for the continuous monitoring of key health metrics like blood glucose, blood pressure, heart rate, blood oxygen, temperature, respiration, and posture.
AI:
Artificial intelligence can analyze large volumes of health data. Deep learning of data from wearables can help alert people to their individual risk factors, and the data can help guide treatments. On the population level, sophisticated diagnostic and treatment models become possible.
Large data sets, along with AI, also create possibilities for creating digital twins. (I had to do a lot of extra reading about this term! But, it essentially involves creating digital models to test changes, before implementing such changes in real life.)
Blockchain:
How do we share and analyze large amounts of data, while protecting privacy? Blockchain presents an option. It acts as a shared ledger, as it protects privacy while providing the ability to audit health data.
Illustrating the connection between the three technologies
The authors put forth a hypothetical process (pictured below) of how wearables, AI, and blockchain could be used together to create individualized treatment plans—while continuously improving the relevant algorithm models.
Practical applications in the monitoring and management of chronic diseases
In this section, the authors present current applications of digital health, as well as potential future directions digital health could take.
For the sake of this review, I am staying very high-level. That said, I will share wearables related to each category, as we are currently most likely to encounter this type of technology at work.
When applicable, I link to examples of the technologies the authors discuss. These links are from my own research, and were not shared in the article.
1. Cardiovascular diseases
The use of AI in the diagnosis and treatment of cardiovascular disease has been on the rise. Its use has already been improving the quality and cost-effectiveness of care. It has also improved mortality rates among patients with cardiovascular diseases. Here are examples of the technologies being employed:
Wearables:
- ECG monitors
- Cardioverter defibrillators
- Handheld echocardiograms (looks like a wearable one is on the horizon…)
2. Pulmonary diseases
Wearable devices that allow uninterrupted assessments of lung conditions in the home are now available. AI algorithms can already give an accurate assessment of conditions like COPD, pneumonia, and chronic asthma. Machine learning also has the potential to help children with asthma, as well as improve management of sleep apnea.
Wearables:
- Breath sounds
- Oxygen saturation
- Detectors for airborne aerosols associated with lung disease (like pollution or COVID-19)
3. Diabetes mellitus
Wearables already help patients monitor their blood glucose levels. And, we’re seeing developing use of AI to control insulin pumps (based on ongoing readings).
Wearables:
At the time of this writing, the authors were rightly excited about a smart contact lens, which Google was developing for glucose monitoring. That particular venture failed, but many continuous glucose monitoring options have come to market. And, rumor has it that Apple is working on a non-invasive monitor for its Apple Watch. Here are some of the currently available continuous glucose monitors.
4. Chronic conditions requiring gross motor rehab
The most readily available wearables at this time seem to be ones geared toward improving posture and preventing falls. But, the article mentions multiple applications for upper and lower extremity rehab, which are currently being explored.
Wearables:
Ethical risks
Although these technologies have already improved global health and have great potential to continue to do so, they are also prone to ethical risks, including:
- Security and accuracy of data
- Interpretability of data may be complex and potentially beyond patients’ understanding
- Cost may limit equitable access
- Interoperability limitations between different systems may limit efficiency and security
At the end of the day, patients’ data is collected according to algorithm designs, the rules of which are created by humans. As a consequence, ethical and moral constraints of AI are still based upon human constraints. AI is still a tool—and, thus, the creators of AI remain ethically accountable.
Takeaways for OT practitioners
(Please note: These are my personal takeaways. They are not mentioned specifically in the article.)
1. The future of healthcare is in the home—and these are the technologies that are going to get us there.
So much of the research we have covered in the Club highlights this big-picture shift of healthcare from the hospital into the home. This article fleshes out the categories of technologies that are going to make this transition possible. And, not only is the location of care going to shift, the care itself will also shift from being reactive to proactive in nature.
There are so many advances happening with these technologies! I encourage you to explore the developments in YOUR particular practice area. Please share what you find in the comments!
2. As OTs, we need to start visualizing our work in this new model of care.
Healthcare is changing because new technologies are becoming available. But, it is also changing because the care we’ve historically delivered has had significant limitations.
AI is not an ominous threat for us to avoid—it is a tool for us to start using appropriately to improve our care.
This shift may be as simple as asking our clients which health trackers they are already using, and seeing if the information can be leveraged in your sessions. For many of us, though, AI will fundamentally shift our careers. Next week, I am so excited to talk with Sarah regarding what the embrace of these new technologies can look like.
Here’s the full APA citation for this article:
Xie, Y., Lu, L., Gao, F., He, S., Zhao, H., Fang, Y., Yang, J., An, Y., Ye, Z., &; Dong, Z. (2021). Integration of artificial intelligence, Blockchain, and wearable technology for Chronic Disease Management: A new paradigm in smart healthcare. Current Medical Science, 41(6), 1123–1133.
Earn one hour of continuing education by listening to the podcast on this article!!
Listen: Apple Podcasts | Spotify | Google
In this podcast episode, we dive even deeper into this topic, with OT (and Club member!), Sarah Brezeszkiewicz. You may be eligible for continuing education credit for listening to this podcast. Please read our course page for more details!