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Digital Health Solutions: What Companies Need to Know
Elaine B. Goodman, MD, MBA, medical director of the Medical Walk-In Unit at Massachusetts General Hospital and associate chief medical officer at Wellframe, discusses sustained engagement and impact for digital health solutions.
Digital health solutions such as mobile apps, patient portals and care team dashboards are proliferating rapidly. By one estimate, U.S. investment in such electronic products will reach $410 billion by 2022. Ideally, digital health solutions improve patient care, make clinical teams more efficient and reduce costs. But so many products are now on the market that patients, physicians and organizations are suffering from digital fatigue.
Elaine B. Goodman, MD, MBA, medical director of the Medical Walk-In Unit at Massachusetts General Hospital and associate chief medical officer at Wellframe, is an expert in the field of digital health. She answers three questions about what a digital health solution should provide and what organizations should consider before implementing one.
Interview condensed and edited for clarity.
What evidence do purchasers seem to want before implementing a digital health solution — is a randomized control trial looking at outcomes an unrealistic bar or logistically unfeasible?
Most corporate purchasers are looking for real-world, actionable, timely data. They want evidence of return on investment (ROI). It's important for purchasers and vendors to come up with a mutually agreeable approach for measuring drivers of ROI, such as increasing the patient panel clinicians can support, improving staff efficiency or reducing the number of missed medical appointments. Vendors need to be able to provide these metrics quickly, so that they can be nimble and make adjustments to make sure the purchaser is on track to meet an ROI goal.
Research suggests that randomized clinical trials (RCTs) may not be the best measure for digital health interventions. Not only are RCTs costly in terms of time and money, they involve a select population that may not represent a larger, real-world population. There are also practical issues that come up when you try to operationalize a digital health tool that aren't captured by RCTs.
What are you learning about the keys to sustained user engagement?
Human connection is essential. Patients want to have a personal relationship with a nurse, social worker, physician or other members of the clinical team. You can facilitate that relationship with technology, but you can't replace it. Chatbots and other automated computer programs have their uses, but they can't take the place of human interaction when it comes to driving engagement.
Digital health tools should also involve a two-way conversation. All too often, tools collect information from patients by asking a lot of questions. But if patients are not getting anything of value back, they will disengage. For example, if you ask a patient to use a tool to log vital signs such as blood pressure, you need to be able to provide timely feedback on whether their blood pressure is high and what options they have to lower it. It's also important to ask patients about their priorities and concerns, and then address them so that they remain engaged.
What have you learned in the process of getting your product to market and doing deals, and what key things do digital health startups need to understand about how health care works?
About half of health plans and hospitals are managing four to nine different digital point solutions. Organizations are now looking for a comprehensive, integrated solution on one platform. They want an approach for both the patient and the care team that is streamlined and dynamically adjustable for different needs, rather than switching in and out of different programs.
There is a lot of hype surrounding a digital solution for one health problem, such as heart disease or diabetes. But the patients who need the most support, and who are driving costs in the system, have multiple comorbidities. They have other challenges, such as transportation difficulties or language barriers. That's why the ideal digital health solution supports a patient in a comprehensive way while generating insights for the care team that enable early intervention.
But you also have to think about the impact a digital tool has on clinical staff, who are suffering burnout from the demands of technology. One study found that primary care physicians spent twice as much time typing electronic notes as they did seeing patients. It's very important to figure out how a digital tool will help clinicians be more efficient and work at the top of their license. A digital product also has to fit into the broader ecosystem of tools in an organization, to avoid double documentation or increased overhead.
Continue the conversation on Twitter by connecting with us @HMS_ExecEd or with Dr. Goodman @wellframe.
— Ann MacDonald
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