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article imageEssential Science: New perspectives needed for digital health

By Tim Sandle     Aug 21, 2017 in Science
This week's Essential Science takes a different approach. We cast an eye over developments in digital health, focusing on patient centered technology and the need for what are, at times, neglected areas of science.
Digital health brings together general science, medicine and engineering with digital technologies and specialist scientific fields like genomic technologies. The aims of digital health platforms and devices are equally as varied, from technologies to be used in remote locations, to devices aimed at improving the patient experience; add to this the desire for rapid results to the gathering of patient-centric data for big data analysis and a drive for economic efficiencies, digital health is a deep technological well. It is also a rapidly growing area in both healthcare and technology.
Why the interest in digital health?
Digital health is growing fast because healthcare overall remains a key growth area. Take the U.S. economy, for instance, a projection from the U.S. Bureau of Labor Statistics indicates that more than 2 million people will work in home health care services by 2024 compared to the 1.2 million employed recently in 2014. This covers the spectrum from outpatient care to nursing facilities. This trend is supported by Forbes magazine which assesses healthcare related professions as among the fastest growing jobs in the U.S.
Within this growth in jobs and service reach is the digital transformation of the healthcare sector, with a myriad of technology firms seeking to get e-services and new products and medical devices into the health marketplace. Research by business analysts Accenture reveals that in 2016 some $8 billion was invested in 500 start-up digital health companies. Such investments do not always lead to success; the same report suggests around 50 percent fail to get their products onto market in time before their capital dries up.
This infographic describes the elements of Digital Health.
This infographic describes the elements of Digital Health.
Paul Sonnier (CC BY 1.0)
There are many successful companies, however. To tally up the most promising medical futurist Bertalan Meskó has drawn up a list of 100 of the most promising digital health start-ups. Many of these fledgling companies will no doubt succeed, but some won't make it. As with any industry, digital health is a competitive marketplace and some products either simply do not appeal or they do not receive the necessary level of health marketing.
A woman receives an injection during H1N1 flu innoculations in Rockville  Maryland  October 21  2009
A woman receives an injection during H1N1 flu innoculations in Rockville, Maryland, October 21, 2009
Saul Loeb, AFP/File
Why does digital health go wrong?
Although digital health is interdisciplinary, there are other aspects of science that need to be considered in order for digital health to work. Take medical devices, for example. While medical science delivers evidence-based results and technology enables the ideas to become translated into functional devices, without understanding the target demographic, the psychology of the patient, or physical aspects of design, many devices fail. Each of these other 'sciences' - social science, psychology and ergonomics - need to be factored in when developing patient-centric digital health solutions.
Patient-centric technology
One of the many subdivision of digital health and a hot-bed of interdisciplinary research is with patient-centric developments. This includes the use of information and communication technologies to help address the health problems and challenges faced by patients. These technologies include both hardware and software solutions and services, including telemedicine, web-based analysis, email, mobile phones and applications, text messages, and clinic or remote monitoring sensors.
Two seniors relaxing on a bench
A man listens to his iPod while the woman fills out a crossword puzzle
By Ed Yourdon
While this may seem self-evident too many digital health technologies have stumbled because the developers have forgotten to put the patient at the heart of the development. Sometimes this is down to poor design (an inhaler designed by computer aided design, for instance, may not turn out to be all that easy for an elderly patient to manipulate). The design importance has also been picked up by the U.S. Food and Drug Administration (FDA), concerned about risks to patients from poorly designed medical technologies. In light of this one recent FDA report reads: "Designers benefit both by enhanced understanding of the degree of conformance of a design to user and patient needs, and by improved communications and coordination among all participants in the process."
Other reasons for failure include a lack of clarity as to the point of the digital health imitative. In one case study, digital health innovator Steph Habif describes how an idea of hers fell flat. This was for a software app called "The 100 m.i.l.e. Club” (Minutes I Logged Exercising). The aim was to allow users to plan, track and see their exercise progress. Initially thousands of people signed up, and then left after a few months. The reason was due to a disconnect with user psychology, as Habif explains: "I realized one of the biggest reasons “The 100 m.i.l.e. Club” (100MC) failed was because we developed for an outcome. Our goal was to “enable people to exercise more.” That’s a great goal. But we did not do any strategy to specify exactly how that would happen."
Microsoft PowerApps lets businesses create native iOS  Android and Windows apps without learning cod...
Microsoft PowerApps lets businesses create native iOS, Android and Windows apps without learning code
Aside from some of the failures, there are successful companies that have taken on the message that the patient needs to be at the forefront of digital health. One example is Smart Patients, which is an online community for patients and families affected by a variety of illnesses. This community shows how strong patient digital communities can be and how much patients can help each other when technology, in this case an on-line facility, is a facilitator.
For medical apps, a survey by Accenture revealed five important features that app developers need to keep in mind when constructing software for digital health. These features are:
Give people more control over their condition, or keep them healthy,
Be easy to use,
Be capable of being used regularly,
Allow networking with other people like them,
Be trustworthy.
This philosophy is revealed by the developer of one successful medical app . Here Amy Tenderich, founder of Diabetes Mine told the organization Powerful Patients: “we will use tools that answer our questions and solve our problems. We will avoid tools that help us do what you think we should do and we won’t use tools that add to the work of caring for ourselves.”
With the development of patient-centric technology, a key driver is with changing expectations of patients themselves. This leads some medical sociologists to discuss the idea of the "e-patient", as an establishing group within society. An e-patient is a health consumer who participates fully in his/her medical care. E-patients see themselves as equal partners with their doctors in the healthcare process. E-patients are those who seek to gather information about medical conditions that impact them. This can be by using the Internet or digital software. The extent to which the e-patient becomes an informed consumer depends on the quality of the material accessed and the degree of understanding that the patient possesses; this aside the trend can lead to greater expectations from patients and sometimes medical professionals being challenged about their decisions.
The different examples drawn together in this article indicate that other areas of 'science' need to be considered when developing digital health products, aside from the technology itself and the verifiable medical expertise. Attention needs to be paid to sociology (what are the changing patient expectations?); ergonomics (can anyone actually use the product?); and psychology (will the user keep engaging with the product for a reasonable time period?) Digital health is multi-disciplinary indeed.
Essential Science
Metastatic breast cancer in pleural fluid
Metastatic breast cancer in pleural fluid
This article is part of Digital Journal's regular Essential Science columns. Each week Tim Sandle explores a topical and important scientific issue. Last week an interesting new map was presented. The map shows over 760 genetic dependencies across multiple cancers. The map suggests new opportunities for developing innovative cancer treatments for scientists and start-up biotech. The week before we looked a new map of the dark matter of the universe taken using one of the most advanced telescopes in the world.
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