2015 American Journal of Gastroenterology Lecture

How Digital Health Will Transform Gastroenterology

Brennan Spiegel, MD, MSHS


Am J Gastroenterol. 2016;111(5):624-630. 

In This Article

A "2 × 2" Framework for Digital Health

Digital health is ultimately about our patients; it is about monitoring and improving their physical, social, and emotional health. With that mindset, we can imagine a "2 × 2" table of opportunities to evaluate patients using digital technologies (Figure 2): patient outcomes can be subjective or objective; they can be measured actively or passively. This framework yields four opportunities for digital monitoring.

Figure 2.

"2×2" Framework for digital health. Patient outcomes can be subjective or objective; they can be measured actively or passively. This framework yields four opportunities for digital monitoring. See text for details.

The top row of the 2 × 2 framework includes subjective outcomes of health. In the left upper corner, defined by subjective outcomes that are actively assessed, is the world of patient-reported outcomes (PROs). PROs are subjective experiences of health that are reported by our patients using formal questionnaires; they include symptoms, health-related quality of life, functional status, and satisfaction.[5] PROs are used like vital signs to assess the quality of health-care delivery. Previously relegated to traditional "paper-and-pencil" assessments, PROs are now measured efficiently with smartphone apps and EHR portals.[5] In order for health-care providers to collect PROs, they must actively prompt patients by offering apps and portals and then by sending timely reminders.

The right upper quadrant, defined by subjective outcomes that are passively assessed, contains the world of social media. With applications such as Facebook, Twitter, Google +, and YouTube, among many others, patients are dynamically sharing information about virtually every aspect of their lives. There is no intervention required by health-care providers, no outside prompting, and no provision of PRO questionnaires. Instead, analysts can just listen passively as global forums self-assemble to collectively share knowledge, attitudes, beliefs, and experiences about their health and wellness.

Beyond subjective data, objective biomarkers remain central to the everyday management of digestive and liver health. Until recently, it has been difficult to monitor physiological biomarkers remotely. However, advances in microcomputing enabled development of wearable biosensors that measure a range of parameters. Off-the-shelf devices such as Fitbit, Jawbone Up, Withings, and the Apple Watch, among many others, allow convenient acquisition of free-range data. This "connected health" revolution is rapidly changing how we can measure patients unobtrusively and in real time. Patients can actively trigger a biosensor when experiencing a health event or symptom (bottom left corner) or just wear a biosensor to passively monitor background activity (bottom right corner). Data from biosensors may lend context to other clinical data, such as laboratory tests, imaging studies, or endoscopic findings. For purposes of this article, data captured from wearable biosensors will be called patient-reported informatics, or PRIs, to contrast with PROs.