What is digital health and why is it important?

When people think of digital health, they often think of Apple Watches and smartphone apps. They’re right, but those are only pieces of what digital health encompasses.

Broadly, digital health is any type of healthcare application that is software-based. That can include telemedicine, apps, smartwatches, and remote sensors.

The US Food and Drug Administration notes that “from mobile medical apps and software that support the clinical decisions doctors make every day to artificial intelligence and machine learning, digital technology has been driving a revolution in health care”.

Further, these include “computing platforms, connectivity, software, and sensors for health care and related uses”.

Five potential benefits

Although the potential benefits to patients and healthcare systems of digital health are complicated and far-reaching, they fall roughly into five categories.

• Access to appropriate healthcare – Access to healthcare is unequal and can be limited by geography, socio-economic status, and cultural issues. In Ireland, Australia and New Zealand, for example, we have customers who live hours from the nearest GP. With digital health applications, people that would otherwise be isolated are now part of health-based communities, able to find information, support and resources.
• Improved efficiency – The above examples also show how digital health applications can improve healthcare efficiency. It can simplify and streamline communication with healthcare providers and minimise unnecessary site visits. Our digital application focuses on perimenopause and menopause, where symptoms can be broad and generic, often seen with other indications — they can include dry eyes, headaches, and joint pain. In the UK, where patients don’t necessarily see the same physician, multiple visits for different symptoms may never be coordinated into an accurate diagnosis without a broader perspective and cross-communication.
• Decrease costs – It should be obvious that improved efficiency should reduce costs. Certainly, by decreasing the amount of time a physician and staff spend on in-person patient visits, costs come down. But also, by more accurately and quickly diagnosing conditions, unnecessary procedures can be avoided.
• Improved quality – Quality can have numerous definitions in terms of healthcare. The World Health Organization (WHO) identified six digital health domains of quality: patient safety, access to healthcare, effective treatment, efficient use of resources, equity of care across subgroups of populations and patient-centred care.

A 2022 review of 54 digital health studies published in Digital Health reported the most common (79.6 per cent) digital health technologies were mobile apps and computer-based programs.

The study found that the “majority of reviews describe improved health behaviour, enhanced assessment, treatment compliance, and better coordination as the main approach of quality improvement via digital health”.

With the wide adoption of electronic health records (EHR), patient and healthcare data already exist. But they aren’t being appropriately accessed, analysed, and linked to alerts to notify providers and patients that action is required.

In the Harvard Business Review, Glaser et al. described a 67-year-old woman who reported to the emergency department with abdominal pain and rectal bleeding.

Diagnosed with colorectal cancer, she died several weeks later after unsuccessful treatment. The woman had received the scheduled colonoscopies at ages 50 and 60.

A radiologist’s note had flagged a few seemingly minor irregularities that would have had her return at age 63, but the note was buried in the “Test Results” section of her EHR. Both she and her primary care physician missed the notification.

This is the sort of thing that digital health initiatives should be able to solve easily.

• Personalised medicine -Personalised health care (PHC) is generally defined as a framework for patient care that links predictive technologies with an engaged patient to promote health and disease prevention. The Duke Center for Personalized Health Care described the goals of personalized health care (PHC) as focused “on patient-centred health care, personalised health planning (PHP), shared decision-making, and patient engagement”.

In addition to not treating health care as one-size-fits-all, the goal is to improve care effectiveness for people faster with lower costs and improved clinical outcomes.

It is believed — as in the case of the 67-year-old colorectal cancer described above — that new digital tools and programmes have the potential to be more sensitive to change that could complement traditional approaches.

Obstacles

Many of the necessary tools for broader implementation of effective digital health are already in existence: widespread use of EHRs, patient portals, a variety of digital and mobile apps and a patient population already accustomed to the use of digital systems.

These systems range from smartphones and apps, and digital wearables such as Fitbits, Garmin watches, and Apple Watches, to online shopping, banking, and bill-paying. But there is still a lot of infrastructure that needs to be constructed.

A 2021 study by the Pew Research Center found that as of February 2021, about 28 per cent of rural Americans and 23 per cent of urban residents did not have broadband internet.

Interoperability –  the ability of different systems, devices, applications or products to connect and communicate – is also a major challenge.

It’s not of use to have so much digital information in disparate silos if they can’t communicate or be accessed conveniently by a healthcare provider.

Cybersecurity is also a major area of concern. Privacy of health records has always been a priority, and digital health data only increases the risk of misuse.

Governments are making efforts in all those areas. The Biden administration’s American Jobs Plan infrastructure proposal included US$100bn earmarked for broadband expansion. It was part of the US$1.9tn American Rescue Plan Act of 2021 signed into law in March 2021.

The UK has made digital health and social care a top priority in 2022, with the Department of Health and Social Care (DHSC) and NHS England saying the “system’s long-term sustainability depends on it”.

Part of the initiative is to digitise the health and social care records, with a goal of having core digital capabilities, including EHRs, in place by March 2025.

Why define digital health?

Too often, various stakeholders differ on the definition of digital health. When I go into a room with potential investors, they’re usually very excited about digital health.

They’ve heard about it, and want to get involved in it, but they don’t understand what it is. Is it software? Is it hardware? Is it mobile devices like the Apple Watch? Is it software used by a hospital? Is it implantable chips or a ring you wear on your finger? What is it?

Everyone involved in expanding digital health must understand what it is — and what it can be. Because what it can be is transformative, improving the quality of health care, and patient care, while driving efficiencies and reducing costs.

Cindy Moy Carr is the founder and CEO of Vorsdatter Limited which developed mySysters, an app for perimenopause and menopause. She’s an attorney and journalist who authored the American Bar Association’s Guide to Health Care Law.