Digital Health Before and After A Crisis

This blog post is our 'Behind the Paper' on A Digital Health Industry Cohort Across the Health Continuum, which was published on May 12, 2020.
Digital Health Before and After A Crisis

This pandemic has forced a great medical experiment. It shows the vulnerabilities of traditional healthcare, the limits of our resilience, and the durability of each care delivery tool. The pandemic is a test for digital health, too. Necessary and ready digital health technologies will be used while others will not.

In our manuscript, we reported on the digital health industry cohort as it existed before Covid-19. A world traumatized by sweeping contagion, which physically separated patients and clinicians, will change the way it uses digital approaches to healthcare. Thus, the digital health industry will look different on the other side.

We had looked across the key domains of the health continuum including prevention, detection, and management, the latter of which includes treatment, monitoring, and care coordination. Before Covid-19, most companies focused on management of disease over prevention or detection. This mirrored traditional healthcare where care and research dollars spent on management dwarfed those spent elsewhere. Yet, a newfound pandemic-inspired interest in prevention and detection may shift healthcare, including digital health, more to the left.

A mass of new government- and industry-sponsored monitoring technologies, for example, now track both infected and uninfected people to encourage or enforce social distancing. They provide alerts to high-risk encounters to prevent infectious disease. A host of other new digital health technologies from symptom survey apps to vital sign wearables aim to detect early signs of infection, too. Beyond addressing the immediate needs, these novel types of prevention and detection technologies will persist, however, only if proven to be useful now. Companies and patients will benefit most if these products, or lessons learned from them, are applied to conditions beyond Covid-19.

In our pre-Covid-19 assessment, telemedicine was already a leading digital health technology type for management-focused companies. During Covid-19, telemedicine came to life. Google searches of “telemedicine” increased by 800% in a month.

At Johns Hopkins Hospital, where I work, ambulatory care went virtual overnight. Telemedicine visits increased from <1% to 80% of total ambulatory clinical volume. Since telemedicine (and video conferencing) companies were well-established prior to Covid-19, they were able to absorb the demand. A rapid regulatory relaxation enabled the dramatic uptake – this came from across the federal government, including U.S. Department of Health and Human Services leadership, Center for Medicare & Medicaid Services, and private payers. Enough clinicians and patients have now experienced telemedicine that backtracking across the Rubicon seems implausible.

Before Covid-19, digital health companies in our cohort generally did not target a specific clinical indication, such as cardiac or neurologic diseases. Instead, their products, from activity trackers to remote monitoring to telemedicine offerings, were marketed for general use. They were not developed for any one disease in particular.

Consider these technologies again, but for Covid-19. To be impactful, they must be specifically designed to address the pertinent infection-related symptoms, complications, and co-morbidities. We hope to see a similar trend across digital health whereby technologies are developed for and then studied, verified, and validated for specific clinical indications.

Finally, in our pre-Covid-19 assessment, patients were a common purchaser of digital health products. If this crisis has provoked a digital health revolution, it won’t be for patients alone. As with telemedicine, providers and their systems are likely to increasingly embrace digital health. Our great healthcare vulnerabilities, further exposed during Covid-19, should drive this change.

Patients on our non-Covid-19 inpatient wards, for example, are eerily absent and flying under the radar. Because inpatient clinicians only become aware of patients upon arrival, we have few means to effectively manage patient panels outside our walls. For both ambulatory and inpatient-level care, the pandemic has exposed what we don’t know between encounters. Digital health solutions could enrich the encounter (telemedicine), but also provide insights and allow early intervention between encounters (wearables & biosensors, remote monitoring, internet of things).

As for all of industry, including the start-up and tech world, the pandemic is a test for what healthcare needs. For digital health, too, we can ask: What are the essential services?

This great medical experiment will provide an answer.

Acknowledgements: I thank Dr. Kyan Safavi and our co-authors of A Digital Health Industry Cohort Across the Healthcare Continuum. I also thank Dr. Christine Krueger from Johns Hopkins Medicine and Sean Day, Megan Zweig and the research team at Rock Health.


Go to the profile of Liming Voo
about 2 years ago

Dr. Cohen,

Great article!

I agree with you that "Digital health solutions could enrich the encounter (telemedicine), but also provide insights and allow early intervention between encounters." Effective intervention require personalized knowledge of the patient's symptoms and medical history which are often hard to do when he/she arrives at the clinic. Digital health solutions should enable patients to record their symptoms and their progress to transmit such information before they get to see their health caretakers. Personalize or precision medicine should also work beyond the genetic and biochemical levels.

Liming Voo