The Future of Digital Health Add to reading list

Advancing Patient Treatments and Outcomes

Clearly the most important goal for all the players in the digital health field is to improve and advance treatment methods and patient outcomes. No matter how gee-whiz impressive a piece of health technology is, if it doesn’t help patients live better, longer lives, it’s useless.

One of the most promising technologies for advancing treatments and outcomes is artificial intelligence.

One of the most promising technologies for advancing treatments and outcomes is artificial intelligence (AI). The complex algorithms that make AI so smart can be applied to virtually any health care scenario, turning AI into a sort of universal tool that enables researchers and clinicians to make earlier, more accurate diagnoses, choose treatments that are more effective and obtain better outcomes for patients, regardless of the condition or disease at hand.

That’s the idea behind IBM’s Watson Health and its associated subproducts, including Watson for Genomics and Watson for Oncology. More than 230 hospitals are using IBM’s oncology tools, and they say their patients are seeing the benefits—but others say the product isn’t quite living up to the hype. In 2012, MD Anderson Cancer Center initiated a pilot of the Watson-supported Oncology Expert Advisor, but in 2015 the health system decided to terminate the project.

One of the obstacles IBM ran into with MD Anderson was that Watson couldn’t integrate with the center’s electronic medical record system. It’s a problem that other information systems have encountered, and it’s a conundrum that AI will need to solve once and for all before it can fully deliver on its promise of improving health care in ways that no human can.

Another place where AI needs to improve is actually one of its greatest strengths: natural language processing. Watson’s uncanny ability to respond correctly to natural-language questions is part of what made its performance as a Jeopardy! contestant in 2011 so compelling, but it turns out that listening to Alex Trebek read from a card is one thing; reading and understanding medical text that’s part of a patient’s medical record is another.

In some of Watson Health’s early projects, the AI had a hard time understanding the medical text documents it was shown—another problem that other AIs have encountered. For now the workaround is to have “robotic clinical documentation scribes” go behind the AI to check that its transcription of medical text is correct. Until AI can process natural language as well as humans can, these scribes will constitute a new and growing segment of the digital health workforce.

Advancing Our Health Care Systems

In addition to advancing patient treatments and outcomes, digital health innovations have great potential to improve the systems that structure and provide care. One striking example of this is Mercy Virtual Care Center, a health care facility with four floors, 125,000 square feet, 330 staffers—and no beds. It’s a virtual hospital that uses a wide array of sophisticated telemedicine systems to provide care to patients in facilities throughout the Mercy health system in Arkansas, Kansas, Missouri and Oklahoma, and to patients in other facilities across the country. The doctors and nurses in Mercy’s Virtual Care Center use sensor technology to monitor hospitalized patients and can alert on-site staff if a patient’s clinical signs indicate a problem. This allows overstretched nursing staff to congregate at the bed of a patient in cardiac arrest, for instance, without worrying about missing an important change in the vital signs of every other patient on the ward.

An even more fundamental innovation in Mercy Virtual’s care model is their Engagement@Home program, in which patients at home use laptop video chats and wearable sensors to receive “visits” and clinical evaluations from nursing staff. This type of intervention actually allows nurse and patient to develop a closer relationship than if they saw each other in person; it’s far faster, easier and less costly for an elderly, homebound patient to have frequent video calls than to be driven 40 miles one way to a weekly office appointment. In this way, Mercy’s virtual care keeps patients out of the hospital for longer, keeps the patient healthier and saves the patient, the insurer and the health system money.

Perhaps Mercy Virtual’s most striking innovation, and the one that is likely to make the biggest difference in the future of digital health, is new systems of payment. The facility’s administrators expect that soon insurers and the government will start paying them to keep patients well, rather than paying a fee for each service the facility provides. That one change would flip the health care reimbursement paradigm on its head, landing us in a future where the entire health care system is more focused on promoting health than on treating illness.

Leveraging Personal Accountability

Digital health innovations have put more control and agency in the hands of consumers than ever before. Now anyone with a smartphone or fitness tracker can take charge of their own health and wellness to an unprecedented degree.

Digital health innovations have put more control and agency in the hands of consumers than ever before.

And yet, not enough people are doing it. As two cardiologists noted in a recent journal article, 75% of early cardiovascular disease is preventable through modification of lifestyle factors, such as maintaining a healthy body mass index, eating a health-promoting diet and engaging in sufficient physical activity. They say the digital health era holds great promise for reducing the incidence of cardiovascular disease because of mobile tools that can collect data, warn patients in real time of potential cardiovascular problems and encourage personal accountability for choices that affect the risk of disease. The clinical literature shows a strong correlation between health behaviors and resultant health outcomes, so the ability of mobile tools to boost accountability for one’s behavior could have a significant effect on health.

The ability of mobile tools to boost accountability for one’s behavior could have a significant effect on health.

Personal accountability is one of the linchpins of the RevUp digital care management platform, which uses a team of live health coaches to communicate directly with patients via the RevUp app or a web interface. The coaches use the patient’s health, activity and nutrition data to provide real-time feedback that fosters personal accountability, based on the latest research on behavioral change.

In a less formal fashion, personal accountability is also at work in the social functions of the FitBit and the Apple Watch, which allow you to share your exercise activity and compete with your friends as a way of keeping yourself—and each other—on track to achieve your fitness goals. Perhaps the personal accountability promoted by the social function of digital health tools will make the crucial difference in helping people take full charge of their health.

Much Yet to Do, and Much to Gain

Digital health hasn’t solved all our problems yet.

The technologies, tools and innovations of digital health are already remarkable, and they’re only becoming more so with each passing year. However, digital health hasn’t solved all our problems yet. AI’s natural-language skills could still use some improvement before it reaches its full potential, and mobile tools have just begun to encourage us in making healthier choices for ourselves. If the digital health revolution overtakes payment systems and causes them to shift their focus from illness to health, that’s when we might see other systemic factors fall into place to transform our society into one that values—and embodies—health.