COMMENTARY

Have We Been Good or Bad? A Health Tech Holiday Wish List

Aaron Neinstein, MD; Carolyn Bradner Jasik, MD

Disclosures

December 24, 2015

Here it is, the end of 2015, and the digital health industry has yet to reach mainstream adoption. According to Rock Health, 75% of the $4.3 billion of digital health funding in 2015 went to early-stage companies,[1] an indication that the industry is not maturing very rapidly.

Heavy investments have been made in new wearables, apps, and analytics platforms, and even more in electronic health record (EHR) adoption. Despite these investments, digital health products may remain mostly novelties unless further changes are made to the healthcare system infrastructure, culture, and care delivery processes. Technology cannot fully deliver on the promise of better—and more efficient—patient care without all of us closely examining how we do business.

Therefore, we have put together a "wish list" for what would enable digital health to begin to reach scale in 2016:

  1. Accept that the EHR is not enough. The healthcare system is large and equally complicated: No single vendor can develop a software solution that is a panacea. The deep financial investment in EHR implementation makes it hard for institutions to consider funding additional software. But in several key areas—such as mobile health and telemedicine—institutions could benefit by making room for more innovation beyond EHR offerings.

  2. Streamline healthcare data access. Imagine the possibilities if EHR platforms were more open systems with app stores enabling an ecosystem of innovators to build compelling applications. To get there, we need truly open application program interfaces (APIs) from EHR vendors (learn more about APIs robust protections for privacy, and ways to prevent inaccurate data from being written to people's health records. SMART on FHIR and the Argonaut Project are a great start.

  3. Raise the bar on design. For both patients and providers, the EHR user experience falls short of its potential. Physician satisfaction with the EHR declined from 61% to 34% between 2011 and 2014.[2] For consumers, the current patient portal offerings are not meeting expectations.[3] We need to fine-tune or replace current solutions with others that are intuitive and fun to use. In order to be adopted more widely, digital health interventions will need to look and feel like all the other technology products and services we use every day.

  4. Empower enterprise innovation centers. Innovation centers are popping up at hospitals across the country to support digital health integration into healthcare.[4] They do this by accelerating internal development into the market, securing industry funding for research, and advising the enterprise on digital health solutions for their technology stack. However, they often do not have purchasing authority or clinical operations oversight, leaving the technologies they have uncovered stuck in perpetual pilot. To get to scale, we need to redefine and strengthen the innovation center's role.

  5. Rethink pilots. Often perceived as "nice to have," digital health innovations can be susceptible to "death by pilot," according to Halle Tecco of Rock Health.[5] On the enterprise side, this can occur when pilots are initiated by groups that do not have operational decision-making power to scale them afterward.[4] Pilots should be considered initial implementations, with clearly defined parameters to scale and with proper support from executive leadership.

  6. Pay for validation. Digital health products and strategies need peer-reviewed evidence that they work. Recent controversy over the lack of validated data to support marketing claims has exposed a huge gap for the field.[6] New groups like Evidation Health are offering these services to startups, but it is not clear who should pay: the National Institutes of Health, the enterprise, or the startup?[7] For the time being, venture capital firms and digital health companies should incorporate research validation into the cost of doing business.

  7. Take implementation as seriously as the technology itself. John Kim, former CEO of DocBase, recently wrote that what's "killing" startups is not the technology but the failure to integrate into clinical workflows.[8] Beyond the buzzworthiness of a technology, much less attention is paid to consider how the end user will navigate multiple systems during a busy day and whether the technology adds value in terms of efficiency or outcomes. If busy clinicians and patients don't find a system useful, they won't use it.

  8. Adopt a unique patient identifier. This has long been a political battle in the United States, leaving us with no current method for easy identification of one person's records across institutions. Having a single way to connect patient records would dramatically reduce barriers to health information exchange. While this may seem like more of a holiday "fantasy" than a goal, it should not be, as almost every other modernized country has it!

Getting serious about digital health adoption will require addressing these key areas before we can move forward as an industry. We hope that in the year ahead, we'll see continued advances in mobile health solutions that are easy to use and integrated into care, wearables that are validated and produce actionable data, and health information that can be seamlessly exchanged across platforms.

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