Prior to 2016, the study of digital health was still an emerging area in academia. Today, digital health studies apply technologies from electronic health (e-health) to mobile apps generating insightful findings and developing new healthcare uses.
In the 1990s, the computer was used mainly for patient administration. Patients provided the doctor with their health information and any follow up related to an illness would not be timely planned. In every clinic consultation, physicians would keep the treatment records in a paper-and-pencil form and this would usually be filed in a yellow folder. These patient records would then be stored at a corner shelf of the clinic and was already a time saver for family physicians (Figure 1). As the population ages, patients would visit the physicians more often for different types of illnesses beyond seasonal influenza. Diabetes mellitus is a typical case of illness which requires a long-term disease management plan to sustain one’s quality of life. The increasing volume of patient visits can be troublesome for physicians who have the mundane task of daily recording the number of visits so instead, the patient records were suggested to be stored in a computer. This is the early form of digitalization on health records, which is now known as electronic health records (eHR).
During this time, historical patient records could also be scanned into the computer and some laboratory readings could be extracted as health indicators for future disease management. Physicians soon found it much more convenient to read the clinical information from the computer. This eventually led to the beginning of a new kind of clinical system which served as an all-in-one solution for patient management. Physicians were able to write clinical notes on the system and select the symptoms of illness in the toolboxes. In general, physicians greatly benefitted with this new way of working as it not only saved consultation time but improved the overall efficiency of work. The experience enhanced the acceptance of eHR among physicians and more and more healthcare data started to be digitalized.
The way most patient data was stored in the early days was through something called the Intranet. This was essentially one shared connected network of computers in one central location. It made it possible for physicians and nurses to access the same patient file on different work stations at the same time. Although the Intranet also improved the efficiency and accuracy of patient management, there was a growing concern of data privacy especially after the introduction of the first computer virus in the late 1990s. Patient privacy is still today the top concern among physicians and patients, hence why many eHR systems is still located within the Intranet.
A better eHR system can contribute to a more efficient healthcare delivery model for the general population. Many countries caught on to this new eHR system. In the United States, eHR has not been a new idea and there’s been many positive reviews about EHR improving patient care, promoting safe practice, and enhancing communication between patients and multiple providers. In the United Kingdom, NHS has committed to making patient records ‘largely paperless’ by 2020. The intention is to have a comprehensive profile of each patient electronically and the records would then be accessible to all health and social care providers with real-time updates. In Hong Kong, an EHR sharing system was developed called the Electronic Health Record Sharing System (eHRSS). eHRSS is a territory-wide, patient-oriented electronic sharing platform which enables authorised healthcare providing organisations in the public and private sectors to access and share participating patients’ eHR for healthcare purposes. Although internationally, eHR has been adopted by many there are still many hurdles for full adoption. Cases are mainly due to slow adoption of a fully integrated eHR system , data privacy, and the capacity of existing systems to handle such large volumes of data.