So what exactly is Digital Health?
The majority of people that I speak to still don’t really understand what Digital Health is, nor its potential implications. Many people, particularly Government health departments are still using the term synonymously with eHealth, which shows a great misunderstanding of the potential power of Digital Health. As I’ve said previously…
Digital Health gives us an opportunity that we’ve never had before – the chance to reach into the lives of almost every health consumer in the world, regardless of socio-economic status. Through mobile devices we have the opportunity to create a digital channel to the health consumer.
This digital channel can be used to gather data – large quantities of high-quality, real-time data regarding medication adherence, symptoms, Patient Reported Outcomes, care plan adherence and much more. Further, mobile devices can be used to drive health literacy, patient engagement and the empowerment of patients and carers, supporting behavioural modification (through techniques such as gamification) and ultimately lowering the long term risk of disease amongst key cohorts.
The combination of the digital channel to the health consumer and the patient data (appropriately filtered to separate the signal from the noise) sourced through it are allowing us to innovate in new and exciting ways. This is supporting the creation of digitally-based models of care, making use of new and emerging technologies and social dynamics to drive disruptive change in healthcare delivery.
I see new (higher quality, safer, more efficient, more accessible and more sustainable) models of care as being the objective of Digital Health, with improved outcomes for all health stakeholders (but particularly patients and their carers) as the end goal.
With all that said, and in the absence of other definitions that I think are any good, I wanted to attempt my own definition of Digital Health…
Digital Health is a disruptive and transformational approach to the delivery of healthcare, with a focus on engaging and empowering patients, activating caregiver networks and understanding that patients are increasingly behaving as consumers of healthcare. Digital Health provides us with a toolbox of technologies and techniques that support the development of new, innovative patient and caregiver-centred models of care, driving improved engagement, accessibility, quality, safety, efficiency and sustainability into all corners of the health system.
In that context, what follows is a (non-exhaustive) list of what I perceive to be the fundamental technologies and techniques that make up Digital Health:
- Mobile Devices and Apps – Mobile devices and apps create the digital channel to the health consumer, as well as improving access and user experience for health providers. Consequently, mobile devices and apps underpin almost every element of Digital Health. However, as I’ve discussed previously, these mobile apps need to be the face of new, integrated models of care, not standalone solutions that further fragment health information.
- Consumer Health Devices – Whilst most Consumer Health Devices are yet to be of significant clinical interest, consumerised medical technology shows great potential in early intervention for deteriorating patients and even in diagnosis. The challenge, however, will be to separate the signal from the noise when it comes to identifying clinically significant events amongst the large amounts of data generated, making sure that we make clinicians lives easier, not harder.
- Patient Engagement – The idea of patient engagement is fundamental to Digital Health. The understanding that patients are one of the most under-utilised resources in the health system, and that engaged patients generally get better health outcomes should sit behind the design of all new approaches and models of care. Only by including patients in clinical decisions, sharing medical records with patients, and acting to reduce medical paternalism will healthcare delivery improve.
- Activated Caregivers – In addition to engaged patients, the intrinsically motivated network of friends and family that surround a patient can be harnessed to great effect. This ‘circle of care’ can be used as a first line of defence to improve adherence to care plans and medications, and to intervene early as patients begin to deteriorate. Some of the greatest advances in healthcare in the next few years will be in this space.
- Patient Reported Outcomes – Although subjective in nature, Patient Reported Outcome data (e.g. how bad is my pain today?) shows great potential as a foundational component for the development of new models of care. By capturing regular, real-time PRO data via a mobile device, we have the potential to detect patient deterioration and intervene early.
- Gamification – We are quickly learning from many different industries that consumer engagement with digital solutions seems to have a limited lifespan. Gamification shows great potential in extending the depth and duration of patient engagement through digital channels, as well as driving behavioural modification, although this is yet to be explored in any rigorous way. In addition, gamification (in its most general sense of harnessing intrinsic motivators) offers the potential to modify clinical behaviours (e.g. with regard to clinical data quality) where extrinsic / financial motivations have largely failed.
- Digital Health Communities – Digital Health Communities provide us with something that regular, 6-10 minute appointments with GPs / Primary Care Physicians don’t. Sympathy. Empathy. A listening ear. Psychological support. Tips on living with a diagnosis. The chance to tell our story and be heard. At their worst, Digital Health Communities are full of nut-jobs trying to offer ill-qualified diagnosis and ill-informed medication advice. At their best, Digital Health Communities offer a vital support community for those with an existing diagnosis, providing a service completely neglected by traditional health systems.
- Consumer Genomics – The consumerisation of the technology (and price) behind genetic testing threatens to significantly disrupt much existing clinical practice. Pharmacogenomics offers the opportunity to begin to reduce inappropriate and inefficient prescription of medications to those whose genomes won’t respond well to those drugs. Nutrigenomics will one day be the foundation of medicine. Granted, of course, we’re still in the dark ages of this technology, so we must treat it with very great care (and not believe everything we read), but much transformation of the health system will come from this.
- Precision Medicine – Building on genomics technologies, the idea of precision medicine is both an aspiration and a growing reality. Rather than applying clinical protocols and medications to patients because they are statistically likely to work, we will further develop our understanding of the root cause of disease such that we can apply precise and targeted treatments. Unfortunately, today this feels a long way off, as medicine is rarely the science that it purports to be.
- Artificial Intelligence – Although I still believe that the potential of this new generation of Artificial Intelligence solutions has been somewhat exaggerated, AI will prove incredibly useful in certain areas. I believe that the greatest potential lies in diagnosis (including image analysis and structured questioning without cognitive bias) and the large-scale replacement of much of the current GP workforce, and in real-time detection of patient deterioration.
By assembling these foundational components of Digital Health in various combinations, I believe that we can deliver more precise and intentional models of care, designed to support the challenges of 21st Century health systems.