Not wanting to be a pedantic Don Quixote tilting at in-apt windmills, I have nonetheless succumbed to addressing an issue that has bothered me from the very first time I heard the term “digital health.”
This term is deeply branded into the forehead of health care, it's at the forefront of the conversation about reform and it's part of the shift to value-based care.
A quick Google search reveals more than 7 million hits in 0.44 seconds.
It’s clearly out there, but it’s not right.
To get everyone on the same page, I refer here to the word “digital” in its literal definition, i.e., based on binary elements.
Please see this Oxford English Dictionary entry for a broader, more illuminating discussion of the term’s meaning and evolution.
Many things are digital: digital clocks, computers, communication technologies, the internet, advanced imaging devices like CTs and MRIs, just to name a few.
Even the human genome can be viewed as digital, as the sequence of base-pairs that make us who we are can be easily characterized as a finite chain of discrete elements, each being either G, C, A or T. But health and disease aren’t digital -- not even close.
Disease processes rely on underlying complex biological, biochemical and neurological constituents that vary with time, temperature and myriad other continuous variables.
Even genetic diseases that are closely linked to specific mutations of our genetic material are often wildly modulated by a broad array of post-translational factors that provide various disease manifestations.
Health and disease are natural, qualitative states made up of convolutions and integrations of the few things we know with countless protean processes and influences, many of which even today defy objective measurement.
The only part of health that resembles the nature of digital processes is the binary outcome of life and death … and even then there can be some haziness to the distinction.
Health isn’t digital. Not. At. All.
But digital health care makes perfect sense.
Health care is a human construction made up of a series of decisions, interventions and outcomes based on insights, values and options.
The options are finite, the choices are discrete and the outcomes are often binary.
And the emerging tools of modern health care are increasingly rooted in digital technologies -- sensors, imagers, sophisticated algorithms for analysis, prediction, prevention, decision support and so on.
And it is these technologies that are combining to dramatically transform health care delivery, moving health care from its hyper-variable, uber-expensive, frustratingly confusing, geographically maldistributed and error-prone present to a democratized, decentralized and learning-oriented future.
If that sounds like hyperbole, consider these five key ways that digital health care is uniquely qualified to solve some of the most pressing issues revolving around care delivery:
1. Defeating the tyranny of geography: Health care expertise is not uniformly distributed, and the conventional wisdom that “all health care is local” illustrates the implications for the availability of quality health care in rural or impoverished environments. Technologically-enabled remote delivery of expertise and care can bring both to the patient independent of locale, removing geographical restrictions and/or the burden of travel. Organizations like Specialists on Call (SOC Telemed) are excellent examples of this theme.
2. Helping clinicians function at the top their license: Worsening the impact of the maldistribution of clinical expertise is the relative shortage of specialists -- a problem likely to worsen given our nation’s aging demographic. By automating those redundant or low-impact but time-consuming tasks, technology can help health care providers focus on those aspects of patient care most likely to benefit from their unique skills, improving the overall efficiency and efficacy of the health care enterprise.
3. Objectively capturing the subjective: Health care is no exception to Peter Druker’s axiom that “If you can't measure it, you can't manage it.” Without objective metrics of the details of health care delivery, we will all continue to struggle to know what is working and what isn’t. From making objective assessments of patients’ functional limitations to documenting procedural details and subsequent course, technology can measure every aspect of care and outcome, objectively and quantitatively tracking the relationship between treatment and effect. Reflexion Health is one example of this approach applied to post-acute care physical therapy.
4. Learning from every encounter: A key component of a smart health care system is that it gets better with every experience, wherein every patient experience is measured and documented in a way that allows for some incremental understanding of what’s working and what isn’t, with relentless analysis of opportunities for improvement. Objective measurement, careful linkage of condition, treatment and outcome, and machine learning approaches are essential here, and it is only possible with the advent of digital tools like those popularized by IBM’s Watson.
5. Use engagement to drive behavior change, treatment and recovery: Patients get no benefit from pills they don’t take, therapy they don’t perform and changes they don’t make. The presence of consumer-friendly technology can be a potent reminder, as well as an easy and smart way to maintain engagement, with some of the best of these devices leveraging artificial intelligence and the anthropomorphization of animated avatars to provide interactive personalized instruction, driving engagement and compliance to prescribed therapies.
Digital health care isn’t something new or alien. It’s a tech-enabled transformation that makes delivery simpler, more streamlined, more patient-centered, more data-driven and more value-based. It represents an innovative use of established and emerging tools with the goal of fulfilling key elements of care -- meeting patients where they are, defeating the tyranny of geography, bringing the best care to the most remote settings and providing easier access to better outcomes at lower costs.
Digital health may be a nonsensical term, but digital health care is an imperative if we are going to fulfill the potential to create a smart, democratized, decentralized, efficient, effective and relentlessly learning health care system.