Why digital health needs a definitive definition

Digital health is loosely defined as any type of healthcare application that is software-based. Or is it?

A 2020 overview of 1,527 papers by Fatehi et al. found 95 unique definitions of digital health. The authors noted “digital health, as has been used in the literature, is more concerned about the provision of healthcare rather than the use of technology”.

They added: “Well-being of people, both at population and individual levels, have been more emphasised than the care of patients suffering from disease.”

They also suggested the dominant concept in digital health is mobile health or mHealth, which is associated with concepts such as telehealth, eHealth, and artificial intelligence in healthcare – none of which particularly helps an investor that wants to become part of what is a revolution in healthcare.

From 2011 to 2021, digital health funding and deals climbed from 94 deals and a total of US$1.2bn to 729 deals for a total of US$29.1bn. The average deal size in 2021 was US$39.9m, according to Rock Health.

In my experience in talking to potential investors, they’re excited about digital health. They’ve heard about it and want to get involved in it.

But they’re not sure what it is. Is it software? Is it hardware? Is it a device like the Apple Watch? Hospital software? Implantable chips or a ring to wear on your finger?

Most importantly to potential investors, how can they make money from it in a relatively short time frame?

Digital health has the potential to transform healthcare and improve quality of patient care. It can drive efficiencies and decrease costs. But it’s important that everyone involved understands what it is.

A few thoughts on definitions

Often, the definition of “digital health” is built on tools. For example, the U.S. Food and Drug Administration (FDA)’s definition includes, “Categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine.”

Another definition, from Mesko et al., is based on societal impact or vision: “…the cultural transformation of how disruptive technologies that provide digital and objective data accessible to both caregivers and patients leads to an equal level doctor-patient relationship with shared decision-making and the democratization of care.”

The Healthcare Information and Management Systems Society (HIMSS) proposes: “Digital health connects and empowers people and populations to manage health and wellness, augmented by accessible and supportive provider teams working within flexible, integrated, interoperable, and digitally-enabled care environments that strategically leverage digital tools, technologies and services to transform care delivery.”

These are complicated definitions, for sure, and as someone running a digital health company, I prefer the broader and looser definition of a software-based health application.

It covers a range of modalities, including wearable devices, telehealth, online portals, and apps. Another definition could be “where healthcare and the internet meet.”

Why should we care?

One reason to care is that digital connectivity changed everything. Although there are still obstacles with interoperability — how data from one device or system communicates with another system or device — the current impact and future impact are considerable.

Consider five possible benefits:

1. As is well understood, appropriate healthcare is unequal, often limited by socio-economic status, geography, and cultural issues. Women use our apps, mySysters (iOS) and Hot Flash Sisters (Android), to manage perimenopause and menopause symptoms. They were developed during my own experience of caring for small children, a spouse who survived a heart attack at the age of forty-eight, a mother with dementia, and an elderly father, all while experiencing severe perimenopause symptoms including migraines, dry eyes and repeated UTIs. At the time I was living in Minnesota–home to the biggest concentration of medical device companies in the US, as well as the Mayo Clinic–and married to a biomedical engineer. Despite health insurance, geography, and other resources, it was ten years–TEN YEARS–before I was able to access medical care for perimenopause. Seven years later, the healthcare situation has not improved for most women. Half of US counties do not have a single ob/gyn. Of those that do, many understandably prioritise pregnant patients, leaving perimenopausal and menopausal women with nowhere to turn. Use of a digital health application enables a person to actively learn about and manage her symptoms through lifestyle changes before making a doctor appointment.
2. Efficiency. Digital health can streamline communication with healthcare providers and potentially decrease unnecessary site visits. Women who track their symptoms are more engaged and informed patients. Physicians may have fewer than ten minutes to spend with each patient. Imagine the level of care received by one of our customers who walked in and presented twelve weeks of data on every migraine, hot flash and night sweat she experienced compared to my initial doctor visits in 2007 when I’d never even heard the term ‘night sweat,’ much less whether I’d had one or when.
3. Lower costs. Improved efficiency can decrease costs. Reduce the time physicians and staff spend on in-person patient visits and decrease costs. More importantly, more accurate and faster diagnoses can avoid unnecessary procedures. The data is still undeveloped, however. A 2022 study published in Front Public Health by Gentili et al. reported, “Findings on cost-effectiveness of digital interventions showed a growing body of evidence and suggested a generally favorable effect in terms of costs and health outcomes.” But due to the heterogeneity of reports, it was difficult to compare effectiveness between approaches.
4. Better quality. A 2022 review of 54 digital health studies published in Digital Health found that the “majority of reviews describe improved health behavior, enhanced assessment, treatment compliance, and better coordination as the main approach of quality improvement via digital health.” Although electronic health records (EHR) are common now, patient and healthcare data⁸ aren’t being appropriately accessed, analyzed, and linked to alerts to notify providers and patients that action is required.
5. Personalised medicine. Sometimes dubbed personalised health care (PHC), personalised medicine is a scaffolding for patient care linking predictive technologies with an engaged patient to promote health and disease prevention. The goal, simply, is to treat individuals, and not treat healthcare as one-size-fits-all. Further, but more effectively treating patients, digital health should decrease costs while improving outcomes.

Where is the money going?

Investor interest is a good reason to settle on a reasonable definition of digital health. GSR Ventures conducted a survey of 50 digital health venture capital investors at the end of 2022 and expected there to be investments from about US$15bn to US$25bn in 2023.

In 2021, digital health investment hit US$29.1bn, per Rock Health, a jump from US$15bn in 2020.

Last year was actually down, around US$12.6bn, but 2023 is projected to be similar to 2020.

Not unusual, investors are interested in a high return on investment (ROI). Another factor investors appear interested in is clinical validation of a technology’s platform. That makes sense and is only likely to become more important as the sector matures.

In addition, any digital health solution that reduces ongoing labor shortages in healthcare or can help with administrative burdens is likely to be of interest to investors.

Approximately 40 per cent to 50 per cent of health-tech investing since 2019, worth about US$30bn, has been toward alternative care, according to Chris Moniz, market manager in Silicon Valley Bank’s HealthTech & Devices segment. This has included telehealth, home dialysis machines, and a variety of remote trackers.

Moniz believes two subsectors of alternative care will be the hot new areas of growth: mental health and women’s health.

One thing is certain. There’s still quite a bit of interest in digital health. And its impact has the potential to be huge.

 

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.