The digital era is the result of decades of technology development underpinned in part by three key concepts: digitization, data, and computation. As the importance of digital technologies increases in medicine, it is informative to explore not only the definition of these concepts but their implication for medical physiology and clinical decision-making. In a classical sense, digitization refers to the conversion of an analog quantity (often a voltage) into a discrete quantity that is subsequently expressed in binary format. The analog quantity itself is either the parameter of interest or has a defined functional relationship to the parameter of interest. Over the past 10-20 years, digitization connotes not only analog-to-digital conversion but also the real-time availability of the digital data through the internet, often on cloud services. As suggested here, data is generated by analog-to-digital conversation. Slightly relaxing the technical definition, data can be viewed in the context of the “data-information-knowledge-wisdom” hierarchy, with wisdom directly driving decision-making. In an even more relaxed sense, data refers to the “unreasonable effectiveness of data,” the realization that large corpuses of data can be leveraged to solve complex problems in ways that have frustrated more classical explanatory or mathematical approaches. Computation refers to using computing machines and algorithms to process data. Machine learning in conjunction with large corpuses of data have opened up new ways of defining input-output relationships when underlying explanatory models are inadequate. Lastly, it is important to note that, at the moment, most of medicine is not digitized. On the other hand, the concepts of digitization, data, and computing can help understand the potential clinical impact of digital medicine. The history of and ongoing evolution of glucose measurement in diabetes care offers keen insights into the impact and future of digitization, data, and computation in clinical decision-making.
Michael A. Choma, MD, PhD (Yale University)