Beyond Mobile Health Apps

In a recent Next Avenue story, we examined the ubiquity of mobile health apps. Now, our focus shifts to a more expansive view about digital health technologies and on how these technologies are not only playing out today, but what their impact will be in the future.

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“Under the term ‘digital health,’ advanced medical technologies, disruptive innovations and digital communications have gradually become inseparable from providing best practice health care,” writes the director of The Medical Futurist Institute, Dr. Bertalan Meskó, in a paper on digital health.

A slew of physician-authored books helps explain an overwhelmingly complex picture of digital health. They include such expressive titles as The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan by Joseph C. Kvedar; The Patient Will See You Now: The Future of Medicine is in Your Hands by Eric J. Topol; and The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age by Robert Watcher.

“The medical practice of the future will involve both face-to-face and digital components,” Kvedar writes. “It will have to because of the looming shortage of healthcare providers and the growing demand for services” [due to longer life expectancies].

“We are embarking on a time when each individual will have all their own medical data and the computing power to process it in the context of their own world. There will be comprehensive medical information about a person that is eminently accessible, analyzable, and transferable,” Topol explains in his book.

A March 2019 report, “Technology for Aging in Place 2019 Market Overview,” by Laurie M. Orlov, principal analyst for Aging in Place Technology Watch, provides a comprehensive overview on the world of digital health. Orlov chronicles everything from tech-enabled software offerings for home care; to electronic health record systems; to virtual assistants and telehealth; to sensors, health-smart wearables, virtual reality, better smartphones for older adults, and much more.

“Sorting out all these issues will take deep thought and hard work on the part of clinicians, healthcare leaders, policy makers, technology vendors, and patients,” Watcher adds in his book. “Sure, we should have thought of this sooner. But it’s not too late to get it right.”

The use of virtual reality (VR) in hospital patient post-operative care is one example of a digital health technology that’s getting things right.

Virtualmedicine.health is a large documented clinical VR program, having reviewed the experiences of 3,000 volunteer hospital patients over the past four years who have watched 3D videos created by AppliedVR on Samsung Oculus headsets as part of pain-therapy research. Referred to as “therapeutic VR” or “immersive therapeutics,” the VR program is run by the digital health research team at Cedars-Sinai Medical Center for Outcomes Research and Education (CS-CORE) in Los Angeles.

Center director Dr. Brennan Spiegel says CS-CORE’s therapeutic VR work is “teaching us about consciousness and mind/body medicine. We have been using it for managing pain, anxiety, stress, depression. It is being used for autism, hypertension, for stroke rehabilitation. There are probably 50 different applications now for virtual reality therapy.”

AppliedVR CEO Matthew Stoudt claims that more than 200 hospitals in eight countries are using his company’s virtual reality experiences to help patients better manage their post-operation pain. Siegel wrote a “lessons learned” article where he envisioned a future with a “VR pharmacy of evidence-based, well-characterized visualizations that clinicians can pull off the shelf and ‘prescribe’ to individual patients.”

Therapeutic VR is a small part of the massive, complex, and rapidly changing world of digital health. While it  sits on the cutting edge of today’s digital health movement, other technologies have dramatically changed health care going back to the 1990s.

Kvedar, a dermatologist, mentions the common use of smartphone photo apps, for example, as a game changer in dermatology. He explains how patients now share smartphone-taken images of their skin conditions with their doctors.

“When we get someone in the office, we are seeing a biopsy in time, if you will,” Kvedar says. “People bring their phones and say this is what it looked like two weeks ago, and this is what it looked like last week. It is incredibly helpful to have those chronologies. So, digital imaging has really changed our field.”

Patient-accessible electronic health records, along with secure email communications, are also well-established digital health technologies that have enhanced patient-doctor communications since the late 1990s and early 2000s, bringing about more efficient and effective care, as explained by Health Affairs.

But electronic health records are still not ubiquitous. A 2018 Consumer Survey on Digital Health by Accenture surveyed 2,300 U.S. adult consumers with a mean age of roughly 47 “to assess their attitudes toward healthcare technology, modernization and service innovation.”

When asked if they have accessed an electronic health record, 44% said yes, 32% said they did not have one available, 6% opted out of having one, and 18% had one but never accessed it. More than 67% of the users said that obtaining lab work and blood-test results was its most helpful feature.

The Accenture report also surveyed consumers about their use of virtual care services, also known as telemedicine or telehealth (meaning healthcare services provided remotely via telecommunications technology), showing a slight surge in usage, with 21% saying they have received virtual health care in 2017, rising to 25% in 2018.

The 2018 Rock Health fourth annual national consumer survey on digital health adoption, with 4,000 respondents, showed that “more Americans use digital health to manage diagnoses, connect with providers, and make critical healthcare decisions than ever before.” The survey also noted that unfortunately “these tools often do not reach the populations who stand to benefit the most,” such as poor, rural and digitally illiterate segments of the population.

The survey also touched on the use of digital health sensors, such as Apple smartwatches, FitBit fitness trackers, and various other wearable gadgets that track things like sleep, blood pressure and EKG, showing a shift “from fitness toward managing health conditions. Wearables are morphing from their original fitness and wellness label into a tracker that can be clinically meaningful to patients—and perhaps even providers.”

The Medical Futurist Institute has a helpful Body Map of Digital Health Sensors on its website with an infographic created through their continuous tracking of “the best gadgets to measure vital signs and health parameters.” An extensive database of digital health sensors is included with the map.

Orlov’s market overview offers numerous predictions about the state of digital health, including a prediction that older adults will increasingly experiment with artificially intelligent-enabled voice technologies such as Siri, Google Home and Assistant, and Amazon Alexa. Such “mini service provider interfaces” bring a “transformation from typing, pinching, zooming and glass screen frustration into a services world in which what you say should get you what you need.”

Regardless of the digital health trends that lean toward artificial intelligence, automation, and easy-to-use voice-enabled technologies, having strong digital literacy skills is still vitally important.

According to the Pew Research Center, technology usage among older adults keeps climbing upwards. But older boomers, in their late 60s and early 70s, as well as people age 74 and older are not always as digitally savvy as the younger digital native generations.

“We do find that older patients are sometimes more hesitant, have more questions and concerns about the role of technology,” Spiegel says. “It’s understandable. But give it a shot. Think about the benefits. Just like any other medical intervention, you have to understand why you are using it and how it is helping.”