In a world where digital and genomic revolutions meet to transform the healthcare sector, digital health is developing at unprecedented speed. Every day, we hear about new solutions holding promises to empower patients, reduce healthcare costs, increase physicians' efficiency, and improve accessibility, safety, and personalisation.
The use of health apps doubled between 2014 and 2016, jumping from 16% to 33%, with more than 165,000 mobile health apps available to consumers. The use of health wearables doubled as well, growing from 9% in 2014 to 21% in 2016, with consumers and doctors confirming that wearables help patient engagement. Moreover, the use of social media for healthcare has increased from 14% to 21%. Meanwhile, 65% of patients knew more about the data they could access through their electronic health records (EHR) in 2016 compared to 39% in 2014. These are just a few examples from one report; there is much more, and the digital health market keeps growing.
Despite the buzz around the possibilities that digital health presents, the clinical proof supporting its effectiveness is still rather scarce. For example, a report from IMS Institute for Healthcare Informatics finds that even though the number and adoption of mHealth apps are increasing, over 50% of those apps still have limited functionality. Also, while healthcare providers are interested in using such apps to improve patient engagement and care delivery, adoption is limited due to barriers like a shortage of scientific evidence, limited integration in the healthcare system, and a lack of clarity around regulatory and privacy issues.
Hype or hope?
The barriers slowing the adoption of digital health show it has a long way to go both in technology and how it fits into the healthcare ecosystem. This caused some wide-ranging criticism, such as when the American Medical Association CEO, Dr. James Madara, called digital health "the digital snake oil of the early 21st century".
Published research indicated that seniors are less likely to use digital health tools, despite being one group that needs it the most. The researchers suggested that the reason isn't a lack of willingness to use it from the seniors' side, but rather a lack of user-friendliness of the tools themselves.
Another study implied that low-income households are less likely to benefit from digital health. Considering 70% of the participants had low health literacy, they had difficulties with manual data entry and could not easily retrieve data from the apps. Based on those findings, the researchers' recommendation was to design apps with larger buttons, simpler interfaces, and add function explanations to help users understand the purpose of each task, for example, explaining to diabetic patients why it is beneficial to keep a diary of their meals. Simple and intuitive recommendations that are still overlooked in some health apps, leading in many cases to poor adoption rates.
These studies are rightfully raising concerns about Digital Health and its ability to improve healthcare, while there are many other studies that show the value of digital health solutions and how they can positively affect healthcare. Could it be that the real question to ask is not whether digital health is effective, but what are the factors that make a specific digital health solution effective?
A promising potential
Considering more digital health solutions, we can find examples of inspiring success stories. A remarkable case of medication adherence app involved coronary heart disease patients with a mean age of 73.8, an age group that, according to other studies, is less likely to benefit from digital health. The study concluded that nearly all patients favoured the app over the pen and paper journal, and wanted to continue using it. The key to success, per the researchers, is that they focused not only on developing a winning app, but rather went beyond technology and made sure that an investigator personally coached each patient on how to use the tablet and the app. As they explained, "Although this requires initial offline training, it can reduce complications and clinical overload because of non-adherence."
A study evaluating the efficacy of using digital health for diabetes management in India - known as a lower-middle income economy - revealed that it significantly improved patients' quality of life and their knowledge about Diabetes. The study recognised a great potential in using digital health for reaching people in remote areas.
A Mayo clinic meta-analysis found that digital health solutions reduced relative risk of cardiovascular disease by 40%, which is a better result than what one could get with statins, aspirin, or anti-hypertension drugs alone.
Going beyond technology
Evidently, not all digital health solutions perform the same, but the failure of some cannot deny the valuable impact of others.
The real value of digital health goes beyond technology and embraces the user engagement processes, without which even the most brilliant solution would not deliver its promises. It's important to develop workflows that ensure a seamless integration of such solutions into patients and practitioners' daily routines, while fitting in the healthcare ecosystem as a whole.
One thing is clear: digital health presents a real opportunity to improve healthcare if done properly, balancing technological and sociological aspects to reach effectiveness.