Digital Health Digest: Curated Weekly by Dr. Jennifer Joe - Digital Screening Tests & Digital Diagnostic Tests

JMIR Publications?publishes 30 leading journals in digital health. The main journal,?Journal of Medical Internet Research, has been a lead in Open Access for over 20 years.

I'm delighted to be serving as the Chief Ambassador for JMIR Publications, and hope that these weekly postings highlight interesting evidence-based medicine for my digital health readers.

Next week, I'm giving a keynote to the Tuft's Masters in Health Informatics & Analytics students during their Immersion Program Fall 2021, where I'll discuss how informatics and data are transforming healthcare today. COVID has pushed through a digital revolution in healthcare, and one of the areas I'm most fascinated with is digital screening tests and digital diagnostics.

It takes a long time and is expensive to develop new conventional molecular diagnostic tests. The area of greatest growth that medicine has seen is the ability to take existing data sets with data sources that are available, but not commonly used in a structured diagnostic, and create new screening tests, or even new diagnostic tests -- essentially big data plus artificial intelligence.

In this article, I highlight some recent digital diagnostic screening tests and digital diagnostic tests to give you a sense of the breadth and depth of the exploding field.

1) A Combined Digital and Biomarker Diagnostic Aid for Mood Disorders (the Delta Trial): Protocol for an Observational Study from corresponding author, Sabine Bahn, PhD, MD (University of Cambridge, Cambridge, Great Britain) - Existing diagnostic methods for mood disorders often result in a delay until accurate diagnosis, exacerbating the challenges of these disorders. Advances in digital tools for psychiatry and understanding the biological basis of mood disorders offer the potential for novel diagnostic methods that facilitate early and accurate diagnosis of patients. The Delta Trial was launched to develop an algorithm-based diagnostic aid combining symptom data and proteomic biomarkers to reduce the misdiagnosis of bipolar disorder (BD) as a major depressive disorder (MDD) and achieve more accurate and earlier MDD diagnosis. The Delta Trial is now complete. More than 3200 participants completed the digital questionnaire, 924 of whom also submitted dried blood spot (DBS) samples and a World Health Organization World Mental Health Composite International Diagnostic Interview (CIDI), whereas a total of 1780 participants completed a 6-month follow-up questionnaire and 1542 completed a 12-month follow-up questionnaire. The analysis of the trial data is now underway. The authors conclude that "If a diagnostic aid is able to improve the diagnosis of BD and MDD, it may enable earlier treatment for patients with mood disorders." JMIR Res Protoc 2020;9(8):e18453

2) Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study from corresponding author, Tahmina Begum, MD, MPH (University of Queensland, Brisbane, Australia) - Diabetic retinopathy can cause blindness even in the absence of symptoms. Although routine eye screening remains the mainstay of diabetic retinopathy treatment and it can prevent 95% of blindness, this screening is not available in many low- and middle-income countries even though these countries contribute to 75% of the global diabetic retinopathy burden. The aim of this study was to assess the diagnostic accuracy of diabetic retinopathy screening done by non-ophthalmologists using 2 different digital fundus cameras and to assess the risk factors for the occurrence of diabetic retinopathy. In 1455 patients with diabetes, the overall sensitivity to detect any form of diabetic retinopathy by non-ophthalmologists was 86.6% (483/558, 95% CI 83.5%-89.3%) and the specificity was 78.6% (705/897, 95% CI 75.8%-81.2%). The authors concluded that "Digital fundus photography is an effective screening tool with acceptable diagnostic accuracy. Our findings suggest that diabetic retinopathy screening can be accurately performed by health care personnel other than eye consultants." JMIR Public Health Surveill 2021;7(3):e23538

3) Patient Perspectives on the Usefulness of an Artificial Intelligence–Assisted Symptom Checker: Cross-Sectional Survey Study from corresponding author, Ashley N D Meyer, PhD (Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA) - Patients are increasingly seeking Web-based symptom checkers to obtain diagnoses. However, little is known about the characteristics of the patients who use these resources, their rationale for use, and whether they find them accurate and useful. The study aimed to examine patients’ experiences using an artificial intelligence (AI)–assisted online symptom checker. A total of 329 usable responses was obtained. The mean respondent age was 48.0 (SD 16.7) years; most were women (230/304, 75.7%) and white (271/304, 89.1%). Patients most commonly used the symptom checker to better understand the causes of their symptoms (232/304, 76.3%), followed by for deciding whether to seek care (101/304, 33.2%) or where (eg, primary or urgent care: 63/304, 20.7%), obtaining medical advice without going to a doctor (48/304, 15.8%), and understanding their diagnoses better (39/304, 12.8%). Most patients perceived it to be useful as a diagnostic tool (253/301, 84.1%), as a tool providing insights leading them closer to correct diagnoses (231/303, 76.2%), and reported they would use it again (278/304, 91.4%). The authors concluded that, "Despite ongoing concerns about symptom checker accuracy, a large patient-user group perceived an AI-assisted symptom checker as useful for diagnosis."?J Med Internet Res 2020;22(1):e14679

These peer-reviewed articles from around the world highlight the benefits of using new data sources to create new meaningful symptom-checker screening tests, diagnostics for diabetic retinopathy using digital fundus photographs, and improved major depressive disorder diagnostic tests. No doubt, these digital tools will increase access to healthcare while decreasing costs for world health.

Driven by a commitment to democratizing access to important scientific and healthcare-related information,?JMIR Publications?was one of the pioneers in open-access. That means that all articles are free and available for anyone in the world to read the entire research article along with supporting images, graphics, and data.

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