Imagine you have been diagnosed for clinical depression and have undergone therapy or treatment. Then your doctor asks you to download a smartphone app that will run in the background and passively monitor your phone usage activities. Through machine learning algorithms, it can recognize behaviors that are associated with a depression episode, such as changes to the number and length of phone calls you make or texts you send. A notice then gets sent to your healthcare provider’s IT systems and lets your doctor’s office know, perhaps resulting in a proactive phone call or some other action. Is this the future? No, it is now, and startups like Ginger.io are starting to offer this.
“It is getting to the point where digital health is just health”
This is an example of mHealth. e-health. Digital health. Health 2.0. These all refer to a major trend impacting the healthcare field through digital technologies. “It is getting to the point where digital health is just health,” says Professor Kirsten Ostherr, a media scholar who specializes in health and medical visualizations at Rice University. Prof. Ostherr and Dr. Bryan Vartabedian, a pediatrician at Baylor College of Medicine who directs programs in digital literacy. Both are founders of the Medical Futures Lab at Rice University, which explores the intersection of medicine and technology. They are offering a MOOC, Medicine in the Digital Age, on the edX platform that starts May 5.
In an interview with Class Central, Prof. Ostherr and Dr. Vartabedian described some of the major trends in digital health. Four in particular stand out:
1. Greater access to information and medical records. Until the very recent past, most of our medical records were stored on papers filed away in offices, full of handwritten scribbles from physicians. But there has been a push for electronic medical records (EMR), and the percentage of hospitals that have EMRs rose from 16% in 2010 to an astounding 76% in 2014. That is a lot of change, and opens up lots of new opportunities to access and leverage this information, though there is still a long way to go before EMRs fulfill their full promise.
2. The advent of wearable technologies. This has been dabbled with in the past, but wearables will finally hit the mainstream, with platforms from Microsoft, Apple, Google, Samsung, and the like. They will allow us to generate a large amount of data about ourselves—the ‘quantified self’. Prof. Ostherr describes the potential of wearables:
“Capturing data through wearables can intervene with behavior change in a way that wasn’t possible before such as: real-time sensing of potential relapse behaviors, reminders for prenatal care, adherence to HIV regimens, etc.”
3. A transition from episodic to continuous healthcare. The first two trends enable a paradigm shift in how healthcare is practiced. Traditionally, it is delivered through trips to the doctor, triggered by symptoms or some periodic check-up. But data from wearables or apps can be made available to your healthcare provider, and there is the potential for ongoing monitoring of health.
4. The integration of healthcare systems and personal apps. However, the scenario described in #3 is too simple. Dr. Vartabedian points out that simply sending output data from wearables or apps to your healthcare provider will not automatically result in usable information. What physician will want to comb through reams of quantified data on his or her patients? This is where the development of algorithms (typically via machine-learning) that can look for patterns in the data, and then signal the attention of human experts, will play a vital role in moving digital health from potential to real impact.
Changes for Physicians
Physicians will need to become more tech-savvy, something that they probably have not been trained for
In this new world, physicians will need to become more tech-savvy, something that they probably have not been trained for. They need to deal with new systems, and also with patients who are able to access a lot of information on their own, ready to whip out Google to challenge what they say. “Online health literacy is a big issue,” Dr. Vartabedian says, and though many physicians may have initially reacted with irritation with mis-informed or partially-informed patients back in the days of Web 1.0, physicians have matured and are starting to engage in more in-depth educational discussions with their patients.
Prof. Ostherr and Dr. Vartabedian are trying to promote more technology training in medical schools—thankfully younger physicians in training are much more comfortable with technology. But the current group of practicing physicians will need to learn and adapt as well. One contribution to this educational effort is the MOOC—a number of doctors have signed up for the course.
Innovating in Digital Health
Who will bring innovation into these areas of health that we have been discussing? Because of the strong technology component, startups and smaller companies will likely play a big role. Dr. Vartabedian says:
If you look at healthcare innovation in 20th century, much of it came through medical schools. Looking at the 21st century, it appears that a lot of the greatest innovation to date has come from the private sector.
There has been a lot of attention focused on digital health startups, but they have an especially tricky road to navigate. There are three major challenges that are especially pertinent:
• There are significant regulatory constraints in operating in the healthcare setting. Most established companies have a regulatory or compliance department, something that few startups can afford. This is an area where entrepreneurs may need to seek additional guidance or advice.
• Personal privacy concerns are going to be paramount. If you are using a device and a service to capture your heart rate, who owns that data? What happens if a database gets hacked? These are big questions that need to be discussed. In the U.S. there are HIPAA regulations for patient privacy, but Dr. Vartabedian notes that these were developed a before the age of modern technology, and are out-of-date. Thus there are uncertainties that innovators will need to navigate.
• The difficulty in demonstrating outcomes efficacy data. Much of modern medicine runs on randomized double-blind, placebo-controlled clinical trials. This trickles down into high standards across the board for judging efficacy and safety. Even with wearable tech, despite its exciting potential, Dr. Vartabedian says “I don’t think we’ve reached the point where wearables have been proven to change outcomes.” Conducting these trials and establishing this data is a complex effort, usually requiring years. But the flip side is that if a particular invention is demonstrated to be effective, similar products may not be able to make inroads until they are proven.
But there is help available to help navigate these issues these issues. There are digital health-specific venture funds and accelerators such as Rock Health in San Francisco. In addition, there is a trend toward large hospital systems and schools creating their own innovation centers to nurture startups. These will also provide expertise and guidance in the innovation and development process. “It’s going to be interesting to see the marriage of traditional academics with startups,” Dr. Vartabedian says.
There is a trend toward large hospital systems and schools creating their own innovation centers to nurture startups.
Get Conversant in Digital Health
Prof. Ostherr and Dr. Vartabedian hope to start conversations about these topics in their course, which already has several thousand people signed up. The course will provide an understanding of the basic trends at a 50,000-ft. level, in order to help participants be better consumers, doctors (some are signed up), and informed citizens. But it will also provide a forum to discuss some of these trends, participants’ hopes and fears and ideas and concerns. As the instructors explain:
“We’re hoping to start a conversation about the coming age of digital health, and some of the issues surrounding it. We want to get people excited about the potential that lies ahead.”
If you are interested in being part of the conversation, you can enroll in Medicine in the Digital Age, on the edX platform and starts May 5.