Recent comments linking digital health tools to so-called “snake oil” has the channels of social media atwitter. (Add this post to the noise!) While some may decry the comparison, there is a lot we can learn from that perspective.
One of the challenges of broad digital health adoption is the simple fact that digital health encompasses such a broad array of technologies, usages and purposes. There is no one tonic that will cure a list of ailments; rather we are presented with shelves of solutions to even more shelves of challenges waiting to be addressed. Digital health includes, by my definition, the application of social media tools to preventative health and chronic disease management measures, as well as highly sophisticated data analytics applied to massive amounts of population health data to identify important health trends. It also includes home monitoring devices that keep health care providers informed of their patient’s at-home health condition, as well as telestroke programs that allow physicians to access needed expertise. The list is potentially endless, as new technologies created to address health issues and existing technologies are being put to use in the health care context.
The multitude of factors that could impact efficacy is enormous. Obviously, the technology itself must be able to perform the function it was designed to perform. While this is a simple concept to grasp, in application it becomes much more complicated as technologies are constantly improving, and consumer technologies, in particular, are constantly evolving to add new functionality. Relatedly, to appropriately assess efficacy, the technology must be utilized in the right way; and should be easily usable in the right way. In clinical settings this may be easier to achieve than for consumer products, which may be used by an individual in any number of distracted contexts.
Intended usage is, of course, another critical factor when contemplating efficacy. A digital health tool that is intended to lower the cost associated with a particular treatment regime should not be evaluated the same as one designed to improve a particular health outcome. Further, some intentions may run counter to others, a dichotomy that needs to be considered when evaluating efficacy. For example, a digital health tool designed to increase access may result in higher health care expenditures within a particular community. Determining how to evaluate digital health tools from multiple or competing perspectives is not necessarily an easy task.
More broadly, digital health tools should be assessed in conjunction with a broader treatment program, and not in isolation of its particular usage. For example, a digital health tool may be utilized in conjunction with a broader effort to reduce preventable readmissions for a hospital – to protect Medicare rates from reductions. The tool itself may drive up hospital costs initially; but it may ultimately reduce readmissions and create real value. Similarly, a social media tool used to ensure appropriate follow-up care and improve outcomes by connecting patients to health care providers may require the active and effective involvement of health care providers. If the providers fail in their function, this does not mean the digital health tool is itself faulty.
The number of possible factors that can impact the efficacy of digital health tools is both enormous and particular to the technology, its use and its intended effect. In such a circumstance, evaluating efficacy is no simple task; and the process must be undertaken deliberately and fairly. Right now, massive experimentation is underway – and when conducted and evaluated appropriately this experimentation will likely show that there are multiple pathways for the successful utilization of digital health tools. In addition, both trade groups and traditional credentialing organizations have begun to focus on digital health tools recognizing that independent evaluation of the tools can help motivate adoption and efficacy. Finally, the American Medical Association recently advocated telehealth education as a part of physician training.
All of these developments bode well for the development of digital health tools that will meet the challenges they hope to take on.