Digital Health Literacy (22 June 2026)

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Dr Emma Spencer (ES): My name is Doctor Emma Spencer, and I am a member of the Trainees and Members Committee at the Royal College of Physicians of Edinburgh. And today joining us is Prof. Mahmood Adil. He's worked as a medical director and worked for Public Health Scotland and clinically as a paediatric diabetologist. He's a clinical informatician appointed by the college as the first ever clinical data and digital health lead. Today, we'll be talking a little bit about what that role might entail, his career to date and how he feels these areas might be relevant to the general medical trainee. So welcome, Prof. Adil.

Professor Mahmood Adil (MA)Thank you, Emma, and I'm grateful for having me on, on this podcast.

ES: With your role with the RCPE College lead for clinical data and digital health and your roles you've done in other organisations. Can you tell us a little bit about what those roles might entail?

MA: Well, I think it depends on the role. For example, when I was medical director for Public Health Scotland, Public Health Scotland is the organisation which collects all the health and care data in Scotland. So, it means that it has got a huge advantage of having a data five point four million people. And it means anyone who is working in Public Health Scotland, in particular in professional leadership role, you are keen to use that data and change into health intelligence to give insight, and that was my role while I was at Public Health Scotland, that how best we can change this data for our clinicians, for our policymakers, for our managers and for our patients so that they can use it and make their health better, or we can deliver better services. But then I remember I had a good conversation then with the president of the Royal College, Derek and I said to him, look, so many people are coming to Public Health Scotland. My colleagues, the clinicians, that they're saying how best we can use this data for clinical purposes and more effective manner. Why don't we create a role within the college which could be much closer to our fellows and members? And that's the reason this role was created. But what does this role entail from college perspective? The first thing I was very keen and still very keen to do is to raise the awareness of data and digital, because our clinicians need to be very clear what is meant by health data and what is meant by digital health. And just to recap, and I'm sure if you go on the website of the college, we have done two wonderful videos which explain what is health data and what is digital health. And I would encourage that anyone who's listening, they should go. It is only seven minutes a bite sized video. But let me recap that. What we are very keen to do in the college, to be very clear that when we say health data, it is not the clinical data you collect through your patient interaction in the hospital. So, health data fall into four groups. First is clinical data, of course, the lab data and everything else. Second is the lifestyle data, which now we started collecting so many countries, in particular the Nordic countries, they're very, very good. And the third one is the omics data, the genomics, proteomics and so many omics data. And this omics data is becoming almost routine. And the fourth one, which is in my view, is the most important is the social determinants of health data, because seventy percent of the outcome of the disease or outcome of the health of the person or health of a nation is dependent on the social determinants of health. And in Scotland we divided the country into almost ten thousand data zones, and we collect data in each and every data zone. And this is the same state of play in England as well. So, I think this is the data side for digital health side. I want to be very honest that people use the digital health terms in a very, very different way. For the question comes what is digital health? If someone asks and what would be my answer or your answer? It is the use of information and communication technology in support of health and health related fields. And of course, as time went by, artificial intelligence came on board big data, blockchain, so many other new technologies, they all come under the remit of information and communication technology. And with that clarity, I would say that digital health is the field of knowledge and practice associated with the development and use of digital technologies to improve health and health care delivery. So, it is a field of knowledge and practice. And this is the way my colleagues from USS Hornet, because they wanted to make it a separate speciality. And there is a number of reasons that before we start thinking, can we make it a separate speciality in UK? But the point is that this is a very important field. And now raising awareness is first the most important thing. What we did in the last few years within the college, as you might have seen, as I said, those videos were created conferences, the evening updates, wherever I got the opportunities, I did my best to raise the awareness. And the second thing about the data and digital literacy, because this is again key thing that yes, you can raise the awareness, but what is the purpose? So that brings me to the question that when we say the digital literacy, what does it mean? It means your ability to access, understand and use the digital tools. Let me repeat it. Your ability to access, understand and use. So, we are very lucky in the NHS. A lot of things have been done, for example by nice. They say these are the digital tools which have been could be used safely and effectively. FDA in the past in America they have approved a number of digital tools. But the question is have you got the ability to access them? Second, to understand them and the third to use them. And I think this is something the college and we within the college are very, very keen to do. And the third thing which is important in this role is to show the example of best practice, because to make things tangible that how it is going to make a difference for my patient. It is very important. The clinician needs to know. I should show them the example. College and other organizations should show them the example how the things can be done in reality.

ES: That was yeah, that was a perfect answer and lead so nicely on to our next questions, because I was going to ask you exactly what you'd want that term digital health literacy to mean to a resident doctor. And it sounds like, you know, you've already summarized that and there's some amazing videos online that people could go to if they wanted to watch an explanation. Again, maybe you could also give us a bit of an idea of how a clinician could enhance their digital health literacy or get better at using understanding and accessing those tools.

MA: Yeah, excellent. You know, if I go back to my clinical days and I'm sitting in outpatient or I'm doing a hospital ward round, what are the things expected from me as a physician, both from my colleagues as well as from my patients. I think it is expected I should be delivering effective care, safe care, patient friendly care and efficient care. So, if these are the four purposes of my day, I've been trained over the years, then the question comes what knowledge and experience I need to gain for digital health to make myself an effective doctor is safe doctor, a patient friendly doctor, and an efficient doctor. So, I always say that there are two ways to deal with this challenge. First, you need to be motivated, right? You need to be very clear that, yes, really, I want to do it. And the reason you need to be motivated, whether we like it or not, digital health is the future. You can see that in your trust. They're using epic and many other organizations. They're bringing very, very potent EMR, but they're only potent as long as you can use them effectively. Coming back that how you could be effective with me. You can deliver care which can improve the patient outcomes. Let me start. There are many different tools available. First are the clinical decision support tools. Have you heard of open evidence?

ES: Yes. I actually downloaded the app this week because someone told me about it at work. Yeah.

MA: Oh, wonderful. Okay, so let me use that example. So, there is another app which is called medwise dot ai. Exactly. Work on the similar premises. You get a question or you have a patient and it's complex. You cannot go back to so many nice guidelines or you cannot go back to many things you need to look at. You put the information in, and it can give you the answer. If you have tried open evidence in such a way so that it is going to make your life and the interaction with the patient very easy and very effective. So this is what I learned, that if my clinical colleagues started using those tools in their day in and day out, it means they can save time and their health outcomes would be better if I had the opportunity to present, which I think I presented a couple of years back at the Royal College Conference. Then I usually showcase it that here is a patient with these sort of comorbidities. These are the medications the person is on and all the social parameters, and then see what results you can get. And then you will see it will give you the answers much easier. You can digest it and its evidence based. Then the second thing, thinking about how you can learn, either you can go by knowledge-based approach or experience-based approach. It depends which organization you are working in. Let me give you one example. My understanding is Great Ormond Street in London. They have started ambient speech in the whole trust. It means when you're having interaction with your patient, everything is getting recorded and it goes into the patient record directly. It will save you a lot of time. So, it means if these tools are available, you need to have the courage to start using them. So, this is one way of how you can learn with experience. Other is the knowledge base. Now if you go on Moodle, if you go other platforms, there are very fifteen to twenty minutes programs which you can go, not the AI programs. It's just there is a program which has been created so that you can learn the A, B, C of the digital health tools. So, I would say first you need to have the motivation. Second, you need to think where you are based. Then you can ask your hospital and trust that you are very, very keen. And then third thing is that do it by experience. And the fourth one, if you have time, is better to have the basics sorted and go on those Moodle course.

ES: Absolutely. I'm sure there's lots of our listeners that know that this will be a part of our future in healthcare and want to get more knowledge, so that's some great signposting to where they can. And my homework is to start using open evidence now, which will be exciting. I wanted to maybe ask you to give one example of how you can see improved digital health literacy impact directly on patient care. I know you've talked about a few throughout your chat there, but just maybe a specific one you'd want to raise to people.

MA: Okay. If you're happy, I can use diabetes as an example.

ES: Always, yeah.

MA: Right. Because we have about five-point four percent prevalence of patients with diabetes in Scotland. So, what you need for a patient who has got diabetes, you warned that the patients. Nowadays, diabetes is not a disease. It means that if you have a disciplined patient, you can treat the patient in the right way. Patients live as healthy life as any other individual, and the complications of diabetes can get delayed or even chances are they may not get those complications. But the question comes that what are the tools we have in hand? That digital health tools, which can help us to achieve that goal. So, in Scotland, we have got the data called diabetes. It's all the data with patients with diabetes at one place. Then they have developed the tool called my diabetes my way. This is the app which any patient with diabetes can download and can see that what control he or she has on diabetes. Plus, it can guide the patient that how best you can improve your own outcomes. So, there are a number of tools being approved by FDA. And these apps are available because we need to remember that with chronic diseases we try to co-create health. It is not like surgery that being a surgeon, I can do the appendicectomy, and ninety percent onus is on me because I and my team need to do the right surgery to take the acute appendicitis out. In chronic disease management. It is a multifactorial and we need to make patient our partner, and we need to empower patient and digital health does empower patients. The role for our clinical colleagues is. When you do your consultation, you need to ask the patient, do you use any digital health tools? Are you wearing any Apple Watch or any other thing, which is collecting a lot of parameters by asking that question? Do you remember when I was trained, I was told that in history you need to take these, these pieces of information from the patient, including social history. Now the time has come that we need to tell our current and future graduates that they need to ask what their digital health history, that what tools you are using, or you are keen to use because you can check the aptitude of the patient. So, coming back to diabetes. So, in this way, this is one way. Now on the other side, if you go by the type one diabetes where your patient is on insulin, and I doubt many of those in my career over the years is that we need to use the monitors because we are giving them insulin through monitors. And now the algorithm of using the giving them the right combination of insulin at the right time is becoming much easier because the computer and those algorithms can be calculated in the background, and you do not need to be doing it as a physician spending a lot of time. And the third thing is that which I feel, which is the public health and prevention side. We need to be thinking in terms of diabetes. What are the things we can do, and we can help the patient or the people who are going to be the patient, how best we can improve the health outcome of the nation. And this is what we have done. Many countries have done. For example, in England they developed the Atlas of variation. So, when I was in Scotland, we learned a lot. I mean, I'm still using Scotland, England, but it means our difference in health care system is wonderful because we learn from each other. So, in England, they develop Atlas of variation on the complication of the diabetes. And we learned that how best we can do these things in Scotland. So, it means we can think at the population level why, when we have got standardised data, some part of the country is not getting a standardised care, and they are having more amputation because the diabetes is not well controlled. And then, of course, you need to work with the diabetologist and the clinicians that what are the things they are not doing in order to improve patient outcome. So again, I use the diabetes as an example where you can use the data and digital health in order to improve the patient outcomes and make your services more effective.

ES: Yeah, I think that's really interesting. I think those tools on an individual level are amazing to empower patients in chronic diseases, as you talked about. But maybe I don't think as much about how from a bigger picture, public health perspective, you could look at what's different in different areas and how you can intervene there. I wanted to ask you a bit about maybe what's the thing you're most excited about in the future of the NHS with digital health literacy? And maybe what you see is the biggest challenge for the NHS, because there are undoubtedly challenges in using these kind of tools.

MA: I think, first of all, we all should be proud of the National Health Service. It was, of course, established in nineteen forty-eight and fifth of July. Every year we celebrate the birthday of the NHS. But the system is wonderful on many fronts. First, it is clinical based, so you are treated on the basis of your clinical need. It is a free at the point of delivery and it is outcome driven. It is keen to improve the patient outcomes. And now we do collect a lot of data in the NHS. So, NHS does collect a lot of data. At one point there was a cliche we use. It is a data rich intelligence pool that we collect a lot of data, but we don't use it effectively. So, the opportunity NHS has created is that it is collecting a lot of data on individual patients and on populations, but now we need to find the ways to change it into health intelligence, which we can provide to our front-line clinicians. We can provide to policymakers, and we can provide to patients and populations so that we can improve the health of the nation. And I think this is what I see the biggest opportunity now, having data itself is not good enough. Now AI is coming. There was a time when we say, okay, I can collect a lot of data, and then my data analysts could change and help me to change into intelligence. Now, with the availability of most of the AI tools, which you and I have got access to from ChatGPT and a number of others, we can ourselves change that data into very much applied intelligence relevant to my patient and to your patient. Then the challenge comes patient confidentiality. What data I can use in order to improve my patient outcomes into those AI tools. And this means we need to raise the awareness of the information governance, patient confidentiality. You know, there are two main big concepts in information governance. First one is primary use of data and second is secondary use of data. Primary use of data means that your data is used for providing you direct care. It means no one need to have your permission to use that data. Otherwise, you and I and any other doctor who is providing services wouldn't be able to provide any services. So, by law, it means for secondary use of data means that the data is going to be used for research, for innovation, for policy, other things. And this is where we need to be very, very clear. So, I feel that my clinical colleagues and the new graduates, they need to have a good understanding about the information governance, so that we can use patient data in the right way to achieve the right outcome. And the challenge, I mean, this is the opportunity. We have a lot of data, and we can use it to improve our patient outcome and population health outcome. The challenge comes that, first of all, you need to have the understanding going back to the data and digital literacy. If we don't include in our curriculums in the medical schools and the postgraduate curriculums, the competencies, if I use the word, then the chances are that we will have a lot of data and we, our clinicians, won't be using them effectively because they are not data and digital literate. And we can only make them, and we can improve their competencies if we can include it in the undergraduate and postgraduate curriculum. So, this is you are a part of education and training within the Royal College. This is very important. We need to be looking from that perspective. Second, people are very concerned AI. So, AI is being used everywhere, and there are two school of thoughts that I can use the AI and I can trust it. And the second school of thought is, no, I do not want to use AI because I don't trust this. And I think I personally feel that we as clinicians need to work together to identify the reasons why we don't trust the AI used in healthcare. And we need to overcome those challenges because at this point in time, Academy of Medical Royal College is now making an effort that how best we can have a unanimous voice and to understand, to explore the trust issue and all other issues, because data leads to AI, and AI will lead to improve health outcomes. And I think we need to be making sure that as professionals, we understand it and then we do our best to contribute it accordingly.

ES: Yeah, I think the development of AI in healthcare will be fascinating and is just undoubtedly already in our, you know, already existing in our day to day lives and will be more so. So, it'd be really interesting to think more about how we incorporate it and yeah, how we get trusting and use it. Well, when I was preparing for this, I was having a read about you online and I just noticed one of the really interesting thing you've done with your career, which was from a public health point of view, be involved in Olympic Games and Commonwealth Games. I wondered if you'd talk very briefly about what you did there. I just thought that might be of interest to some of our listeners.

MA: Well, it says that sometime opportunity knocks on your door and you need to grab it. And this is what happened in two thousand and two Commonwealth Games in Manchester. I was head of health protection and clinical services for North west of England, working within Department of Health, and when Manchester won the bid to have the Manchester two thousand and two Commonwealth Games, I was given the responsibility to look at the emergency planning and look at are we clinically prepared because we're having one hundred thousand visitors and we are having fifty six countries. Commonwealth teams were coming and they were coming with their own doctors, with their own rules and regulations, and that was my job, that to work in collaboration with those fifty six countries and to make sure that our emergency planning services are up to scratch, and sitting on the Gold Command, working with the all blue light services to ensure that we are ready to deal with any incidents. And thank God there was no big incidents happen.

ES: Yeah, that's so interesting. It sounds like a massive job to me. I wouldn't know where to start with that, but so interesting to prepare for an event like that.

MA: But interestingly, then we competed against many other countries for twenty twelve London Olympics. And I vividly remember that two countries went into the final. International Olympic Committee have got rigid criteria against which they can judge the city, which is going to host the Olympics. And one of the chapters within those criteria is held. So we were against France, right? Paris against Paris. Of course, Paris subsequently won it for 2024. And at that point, the Department of Health and my colleagues in London, they were very keen to use our experience from Commonwealth Games. So, I was very lucky in a way that I was able to offer my knowledge and experience from Commonwealth Games, and that went into our bid, and I can't claim that because of that effort we won it. But at least I can proudly say that me and many other colleagues played a part and we delivered an excellence 2012 and I think, on concluding remark on this question, crowd medicine has become a now a big speciality or big discipline now, because I remember we were dealing working very closely with police on the Manchester United Games with eighty thousand people were coming to the stadium. And as you know that this. Manchester City and the same in London football. But then with Commonwealth Games, we started in. Before that we had the European football in ninety-six, then Commonwealth Games and then globally the big, huge event happening in Mecca. We learned a lot that they are doing a big crowd medicine because they're having millions of people within five square miles, and they deal with all the health needs of those millions of four to five million people. And this is now a speciality in many countries. The crowd medicine. So, I had already got a glimpse of it while doing the Commonwealth Games. Because you're dealing with the crowd medicine, you're dealing with many other things, but crowd medicine is something we need to be considering now, in the future.

ES: Yeah, I think actually this discussion with you has been a really good example of public health medicine being an incredibly broad speciality, from crowd medicine to the digital health side of things. You're really interesting. Thank you so much for taking the time to talk to us. That was fascinating and has given me, you know, lots of food for thought. So, I really appreciate it. Thanks so much, Prof. Adele.

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