Can digital technology and medical care can go hand in hand?

"In the chaos, we needed to administer an epinephrine drip to stabilize [the baby's] blood pressure. However, the rare dosage required for such a small child was unavailable in the 'smart' infusion pump, leaving us stranded."

"Desperate to save the baby's life, we turned to a massive pharmaceutical book, searching for the correct dosage. With trembling hands and racing hearts, we attempted manual calculations — a task that should have been straightforward but felt impossibly difficult under the weight of the situation."

"Finally, after what seemed like an eternity, we managed to start the drip at the right dose, and the baby's condition improved over time. Still, the experience left me determined to ensure that no medical professional would ever face a similar challenge again."

Technologies like EZResus exemplify how advancements in medical technology are becoming increasingly instrumental in aiding doctors and medical teams. With this in mind, it begs the question: Could technology reduce the burden on doctors to such an extent that patient care is entirely reliant on technology alone?

Split-second decisions

The EZResus app has been developed to help healthcare professionals, especially those who may have limited experience, navigate the resuscitation process. 

Resuscitation, commonly known as CPR (cardiopulmonary resuscitation), is a life-saving technique used to restore heartbeat and breathing in those experiencing cardiac arrest or respiratory failure.

During resuscitation, medical professionals may administer medications, perform chest compressions, and use advanced medical equipment to restore breathing and heartbeat. Depending on the situation, the process can be highly complex and time-sensitive.

The app can advise on various factors, such as drug dosages, selection of proper equipment, and procedures checklists, removing the need to consult manuals and perform complicated dosage calculations. 

As Dr. Lemaire put it, "The dream is to remove all logistics of the resuscitation and alleviate the cognitive overload of the team so they can focus on what really matters — the patient."

This type of technology could help not only doctors but also nurses, emergency first responders and others who might need to perform CPR.

Information overload

The impact of digital technology on the medical world cannot be overstated. As Nik Tehrani, from Argosy University, writes, "Improved digital technology is providing the health care field with upgrades that are necessary, [such as] electronic files and health records, mobile apps, and remote monitoring devices."

Medical technology has already reduced the burden on doctors with advances such as electronic health records (EHRs) that facilitate the organization, storage, and retrieval of patient information or the use of AI for analysis and decision-making when there is a large amount of data involved.

However, medical technology needs to be regularly updated to ensure that the information reflects the current state of medical knowledge and best practices. The team behind EZResus achieved this by having a team of 30 healthcare professionals who volunteer to maintain the content on the app. 

Dr. Lemaire explained, "Our scientific team is divided into three groups: adult, pediatric, and neonatal. All app content undergoes revision on a three-year cycle. When a new study is relevant, a member of our collaboration platform proposes it, and there is a discussion on whether to include it in the app."

Healthcare in space

One potential use of the EZResus app is to aid with the provision of healthcare in space.

The isolation, limited resources, and unpredictable circumstances pose unique obstacles for providing healthcare on space missions. These same challenges are also experienced by many remote communities on Earth.

In fact, EZResus was recently chosen as one of five finalists in the Canadian Space Agency's Deep Space Healthcare Challenge, a competition to develop new diagnostic and detection technologies that can be used both for remote communities in Canada and crews on deep-space missions.

Dr. Lemaire explained that, "This situation [of practicing medicine in space] parallels challenges in remote Earth communities, where healthcare professionals work alone with immense pressure to stabilize patients using limited resources. The more remote the location, the more relevant our app becomes."

Other technologies developed to provide medical care for astronauts may also find uses in remote communities on Earth. For example, in 2018, the Canadian Space Agency launched Bio-Monitor, a system developed by Carré Technologies that continuously monitors the heart rate, breathing, physical activity, blood pressure, temperature, electrocardiogram, and blood oxygen levels.

Robot doctors?

The big question is, if an app can provide guidance that will allow almost anyone to perform complex medical procedures, could we eventually develop apps or robots that can take the place of human doctors? Dr. Lemaire, at least thinks not. 

"Here's my prediction for the future: I don't think I will see, in my lifetime, a software to diagnose illnesses on its own. I'm obviously deeply biased by the fact that it would mean my profession would become irrelevant," he said playfully. 

Dr. Lemaire continued, "Medicine is a bit messier than people think, as it is difficult to put a doctor-patient interaction in a text prompt. It's a complex interaction where you get subtle visual, audio, and gut feeling cues that make you elaborate a differential diagnosis," he explained. 

In fact, this gut feeling seems to be important. A 2018 study by scientists from MIT found that doctors' intuition, honed by years of experience and training, played a significant role in their decision-making.

They further noted that doctors' sentiments were influenced by factors beyond the medical data available in the patient's records.

While Dr. Lemaire might not see software replacing human doctors anytime soon, advances in artificial intelligence (AI) could deliver just that - intuition or not.

Innovations such as smart contact lenses that can diagnose glaucoma and AI that scans radiographic images for signs of disease are growing rapidly and finding new uses every day.

Dr. Lemaire explained how he thinks AI tools could also work for diagnosis, "Imagine being able to remove the physical app interface limitation. You could navigate all the app content by speaking to the AI and making some gestures in the air!"

"If you go a bit crazier, the headset could record your patient and your look at the patient's chest X-ray and electrocardiogram in real-time. You then gather more data and feed it to the AI to elaborate a more robust differential diagnosis. The AI could even, in real-time, give you comments and corrections on critical procedures you are performing," he concluded.  

So, which one is it?

Evidence has shown that relying too heavily on digital technologies can negatively impact doctor-patient communications, physical examination skills, and the development clinical knowledge. But is eliminating technology the answer? Jingyan Lu, from the University of Hong Kong, suggests a different approach.

In a paper titled, "Will Medical Technology Deskill Doctors?" Lu highlights the importance of promoting training in medical technology, as well as emphasizing clinical evidence, and fostering autonomy in medical professionals to reduce the negative impacts of technology.

The use of AI in diagnosis and treatment also raises a number of ethical issues, including data privacy. A study led by Andreia Martinho, from the Delft University of Technology, found that while most areas of healthcare can benefit from AI, it is vital that AI use is aligned with core bioethical principles and that medical professionals participate in the AI design process.

A review study led by Maksut Senbekov, from the S.D. Asfendiyarov Kazakh National Medical University, supports this by highlighting the need for consideration of reliability, safety, testing, and ethical aspects of any new medical technology that involves AI and big data.

The future of medicine

While there is much to consider, the reality, as Dr. Lemaire points out, is that even today, "there are still a lot of places where all the drug dosing calculations are made by hand on a piece of paper. This is especially true in remote communities and when a rare case presents an emergency."

In these situations, apps like EZResus could prove a vital resource.

But, as Dr. Lemaire also emphasizes, AI or other types of technology will likely never completely replace doctors. This is a point of view that also seems to be shared by most doctors.

In fact, it is likely that the human element will always be a vital part of medicine. That does not mean, however, that apps like EZResus do not have an important role to play, including in outer space, remote regions, and the local ER.