The Long-Term Impact of Digital Health

Published - Written by Don Casey, MD, MPH, MBA, Clinical Advisor to Medecision and President of the American College of Medical Quality (ACMQ)

It’s safe to say that digital health technologies are transforming the healthcare industry. Fitness trackers are used by everyone from stay-at-home parents to marathon runners to help them record the number of steps taken each day, as well as monitor their sleep patterns and heart rate. Glucose monitors are going digital, and many now include Bluetooth capabilities, allowing people with diabetes to sync blood sugar readings and insulin doses to their smartphone and send to their physician. Smartphone apps can help users achieve fitness goals, connect them to a doctor or keep a food diary, and smart pill bottles can even keep track of when a medication is removed. Telemedicine also is making it easier for patients—especially those in rural communities—to communicate with their physicians through email, text or video messaging.

Digital health is a ubiquitous, yet nebulous term—it encompasses a broad range of categories, including mobile health (mHealth) apps, health information technology (HIT), wearable devices, telehealth and telemedicine, population health management tools, artificial intelligence, and personalized medicine.

Digital health technologies may one day potentially solve some of healthcare’s biggest problems. But big problems require big solutions in order to demonstrate significant Impact on Quality (IoQ).

Measuring Long-Term Impact

In 2018, venture capital funding for digital health saw a record-breaking year, with $9.5 billion raised—a 32% increase from 2017, according to a report from Mercom Capital Group. There are hundreds of digital health startup companies vying to enter the healthcare marketplace, but nontraditional players—such as Amazon, Apple, Microsoft and Google—are dominating the game with significant investments.

Last year, Amazon announced its collaboration with Nimblr, a healthcare artificial intelligence (AI) company, and Microsoft announced a partnership with St. Jude’s Children’s Research Hospital to study genomics and AI. Apple offers mHealth apps on its iPad, iPhone and Apple Watch devices to help healthcare providers deliver personalized care, and the Apple Watch Series 4 is considered a Class II medical device by the Food and Drug Administration (FDA). In early 2019, Google joined forces with the Mayo Clinic to develop and deploy AI-enabled technologies to improve clinical outcomes, too.

Despite the influx of digital health innovations in recent years, it’s difficult to determine whether these solutions have actually made a measurable impact on healthcare’s Triple Aim, an industry-wide initiative focused on enhancing the patient experience, improving the health of populations, and lowering the costs of care. It’s important to note the lack of peer-reviewed, clinical evidence for many of these digital technologies. At the beginning of 2019, Health Affairs released a report that analyzed the clinical impact of 20 of the top-funded digital health companies in the United States. The researchers discovered that few companies actually study the clinical effectiveness of their products in terms of healthcare metrics, such as patient outcomes, cost and access to care.

“Only 28% of the studies targeted patients with high-burden, high-cost conditions or risk factors,” according to a follow-up Health Affairs blog post about the study. “Healthy volunteers were the most commonly studied population. There were no clinical effectiveness studies in heart disease, COPD, mental health conditions, hyperglycemia or low back pain.”

In addition, a recent report from advisory firm Damo Consulting found that many health systems still lack a long-term digital strategy. It’s not because health systems undermine the importance of digital technology—there’s just no clear consensus on what digital transformation looks like, according to Damo Consulting CEO Paddy Padmanabhan.

A digital health system seems like an obvious solution for a patient, who may be delighted that she can send health data from her smartwatch directly to her physician. Her physician, on the other hand, may not feel the same way when he’s connected to daily Apple Watch data for his thousands of patients. That’s why healthcare providers and other stakeholders must “weigh the costs and benefits of these technologies, decide how to make use of them, and determine how they should be paid for,” according to a recent article from STAT News.

Beyond the Hype

Despite health systems’ slow adoption of digital health technology and the paucity of high-quality clinical evidence thus far, digital health tools still hold a lot of promise for the healthcare industry. Used alone, digital interventions can’t solve every problem, but they can help consumers make lifestyle changes and take control of their health.

Digital health can improve the IoQ. For instance, systematic reviews of digital health interventions for high blood pressure show that, in some studies, significant decreases in systolic blood pressure can be facilitated by certain digital technologies. But in these studies, the technology is the enabler, not the cause of the improvements in blood pressure. Such studies also involve using five or more traditional, non-digital care interventions that have been proven in randomized clinical trials to work together to achieve these improvements via ‘high touch’ of highly trained clinicians.

Another example is the activity tracker, such as the FitBit or Apple Watch. There’s little high-quality clinical evidence that using an activity tracker can prevent obesity or lower blood pressure or cholesterol levels, and, as a result, lower the risk of diseases such as heart disease or diabetes, according to an analysis published earlier this year in the American Journal of Medicine. The activity tracker alone can’t prevent obesity or other comorbidities—but it can motivate users to take charge of their health and get active, as long as people continue using the trackers long term.

“Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable,” said Tedros Adhanom Ghebreyesus, MD, director-general of the World Health Organization (WHO), in an April 2019 press release about WHO’s recent guidelines for digital technology.

Healthcare of the Future

Customer-focused companies such as Zappos, Southwest Airlines and Starbucks are offering engaging digital experiences—and, increasingly, consumers are expecting the same level of service from the healthcare industry. The ongoing shift from fee-for-service to a value-based reimbursement model—coupled with the rise of consumerism—is driving the need for digital transformation in healthcare, as health systems strive to drive patient engagement and prevent patient leakage. While the verdict is still out on the long-term impact of various digital technologies on reducing adverse health outcomes, an evidence-based digital tide will no doubt help to move us toward a new era of care.


About the Author

Don Casey, MD, MPH, MBA
A board-certified primary care internist, Dr. Don Casey has practiced primary care, emergency medicine, and hospital/critical care medicine in a variety of clinical settings for 19 years, including an inner city Federally Qualified Health Center (FQHC), a 2 physician private office practice, a large internal medicine teaching program group practice and a multispecialty group in a rural community providing full risk/capitated care to Medicaid patients. He is the current President of the American College of Medical Quality (ACMQ). He has also served as a medical director for long term care, palliative care, geriatric services and home care organizations. A highly sought after speaker, Dr. Casey lectures and teaches nationwide on health policy issues, physician leadership and on new strategies to improve patient care through population health, clinical integration, effective care coordination, evidence-based clinical practice guidelines, patient-centered outcomes, new models of undergraduate and graduate medical education and quality performance measurements.


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