Is Digital Health Helping or Failing Patients? A Conversation Between a Futurist and ePatient

Over the past few years, we’ve seen an explosion of interest in digital health technologies, which are loosely defined as tools such as mobile apps, genetic testing and data analytics that are influencing how people receive, think about and deliver care.  It’s clear that these technologies hold a great deal of promise, and it’s digital health’s potential that has driven the hype surrounding it.  

Over the past few years, we’ve seen an explosion of interest in digital health technologies, which are loosely defined as tools such as mobile apps, genetic testing and data analytics that are influencing how people receive, think about and deliver care.  It’s clear that these technologies hold a great deal of promise, and it’s digital health’s potential that has driven the hype surrounding it.  

In May, I’ll be participating in a unique event produced by the innovation consultancy Enspektos, digihealth pulse Virtual 2014 (DHPV 2014), which is the world’s first all-Web digital health conference. During DHPV 2014, I’ll be delivering a talk (and leading a Q&A) about the ways health technology can be used to truly help patients.  I’ll also participate in a discussion with Fard Johnmar, digital health futurist and founder of Enspektos, about this topic during the event.

During our conversations about DHPV 2014, Fard and I came up with an interesting idea: why not hold a public conversation focused around the following, provocative question: Is digital health helping or failing patients? It would be interesting to see the differences and similarities between how an ePatient (me) and health futurist (Fard) respond to this question.

Also, Fard would love to hear what you think. He has launched a Twitter contest where he’ll be giving 3 randomly selected people free tickets to DHPV 2014 who tweet the following between April 15 and 19: “Is #digitalhealth helping or failing patients? [Insert your answer: yes/no] [Tell us why] #DHPV2014. Please be sure to use the hashtag #DHPV2014 in your response so that Fard will be able to track your tweets and select the winners.

Fard: Let’s start out with the question of the day: overall, is digital health helping or failing patients?  Marie, I’m going to put you on the spot by asking you to answer first.

Digital health certainly has the potential to improve the quality, safety, and efficiency of health care, but in order for patients to tap the full benefits healthcare systems need to adapt so they are truly patient-centric and promote greater self-care. If patients/consumers have increasing personal responsibility for their own health, there is the potential to move towards a society focused on overall wellness and preventive measures.  Beyond improving individual care, digital health also has the potential to address the problems presented by a fragmented delivery system. Technology is providing the opportunity for individuals to be at the heart of their own healthcare; we’re not quite there yet, but I am hopeful that we are moving in the right direction.

Marie: Well, Fard you think deeply about digital health every day, what’s your take?

First, I want to say that we’re still living in the very early days of the digital health revolution.  So, it’s hard to give a verdict, overall, about whether digital health is helping or harming patients.  Despite this, there are some areas where digital health is clearly succeeding and others where current trends don’t look so good.

One area of clear success has been in the data analytics, or Big Data arena.  Let me start off by saying that I’m not talking about Google Flu Trends, which was famously outed recently because flu incidence predictions it made (based on Big Data analytics) were not accurate.  No, I’m talking about how a range of health organizations, such as hospitals in the United States, are using Big Data analytics to  predict whether patients will require immediate care post-discharge.  This is important because hospitals (due to the Affordable Care Act, or Obamacare) are being required to reduce the number of patients who return to the hospital shortly after they are discharged or pay fines to the U.S. government.  This financial incentive has forced hospitals to re-think how they operate and ushered in a range of data analytics solutions that can help them identify which patients are most likely to be re-admitted and proactively manage them in the short and long-term.  So, I view the rise of Big Data in hospital settings as a clear win for digital health.

Where things haven’t gone so well is in the area of personal genetic testing.  I think most people reading this will be aware of how the U.S. Food and Drug Administration requested that 23andMe stop selling its genetic testing kits to the public under the umbrella of health.  Part of the reason the FDA made this request was because patients were using the risk-related information provided via the company to make health decisions that may have been ill-advised.  Moreover, the data set used to develop disease risk profile assessments is incomplete — especially for people of non-European heritage. 

But, I’m a glass half-full type of person.  While personal genomics has not yet lived up to its promise, there is a lot of exciting work being done in the area of parental genetic testing (screening parents and newborns for genetic defects and diseases) and refining screens for common and deadly illnesses like breast cancer.   Also, we’re going to see genetics play an increasingly important role in helping doctors select and use medications based on individuals’ unique genetic profile. 

So, Marie, I backed out of the question a bit by talking about the benefits of personal genomics, but I’m optimistic overall about the promise of digital health.

Marie: Okay, let’s open up the conversation a bit more. What do you think it will take for digital health technologies to be adopted and successful in the long run?

Well, I believe that while adoption will continue to be important in digital health for the short-term, the long–term picture will look a bit different.  Currently, the way we’re used to thinking about digital health is that a new technology like the Scanadu or wearable device, or even the rumored iWatch, is introduced and then a lot (or a few) people adopt the technology.  What’s going to happen in the future is that a range of digital health tools, everything from sensors to genetic testing, will get a lot cheaper and then be integrated into a range of devices people use anyway, or become a part of how doctors practice medicine.  I describe this shift in focus as moving from engagement (active adoption of digital health tools) to embedment (the integration of digital health technology into the framework of our lives). 

What will really make embedment powerful is the collection and application of a range of data that will inform health providers, patients, caregivers and more.  One great example of embedment at work is Lively.  This firm has developed a simple sensing device that can be placed in seniors’ homes to monitor their physical activity, whether they are eating and taking their medications.  Seniors don’t have to adopt anything.  Their caregivers have embedded these sensors into their homes so that seniors can remain independent and their families can monitor their well-being. 

If we stay in the adoption, or engagement mindset, it will take longer for digital health tools to be successful.  If we focus on embedment, or integrating these tools — in invisible ways — into people’s daily lives via devices they already use, or inexpensive technologies that fade into the background, the future is brighter. 

Fard: Marie, what do you think?

I agree with you Fard – integration is key. If we take healthcare apps as one example; despite rapid development the current level of functionality is limited. From a provider point of view, there is a lack of incentive to recommend them to patients; so patients have to navigate a maze of healthcare apps with little guidance. From a payer perspective, there is unwillingness to consider providing reimbursement for apps without evidence that they bring clinical or cost benefit – and to date there are minimal studies demonstrating efficacy. So to move the needle on adoption, digital health will need to provide solutions that are seamlessly integrated with other health information technology systems and develop credible evidence of effectiveness.  

Fard: Marie, you will be going into much more detail around how digital technologies can be used to help patients during the conference. Can you give us a brief sneak peek of your talk?

The title of my presentation is “Understandable, Useful and Actionable. What it Takes to Ensure Health Tech Truly Works for Patients and Their Families”. So I will be addressing how we can develop digital health solutions which provide real meaning and value to the patient/consumer.

Fard: Fantastic. I’m looking forward to continuing this conversation with you during DHPV 2014 and excited to hear what other people think on Twitter.  Thanks for this conversation!

Marie: I’m happy to participate.  See you next month!

(Digital health / shutterstock)