Digital health typically refers to software used to directly intervene in patient healthcare or the administration of care. For example, although a fitness tracker would not fit into that description, an application used to take pictures for a dermatologist would. The software that manages a hospital's billing would not be considered digital health, but software that nudges doctors into using the most cost-effective drug would.
Dr. Nick Genes, an assistant professor of emergency medicine at Mount Sinai in New York, wrestles with the evidence issue. He's found that it's hard to get hospitals to consider the evidence when purchasing or implementing software solutions that impact clinical care, and that the rapid pace of development in technology makes it hard to study and quantify effectiveness.
“We're rarely doing that, because the hospital has to move quickly to respond to federal incentives, to respond to quality initiatives, to capture more money, to improve billing. It's usually an afterthought, making these decisions on evidence. It's often the last consideration,“ he laments.
He sees a conundrum in the marketplace. “If (academics) research it properly, dispassionately and disinterestedly, they'll be left behind,” he said. Technology is developed and deployed too quickly for traditional academic-based research. So if academics want to “meaningfully participate” in the field, they have to work with the tech companies themselves. But “then they're branded as conflicted,” he noted.
A possible response would be to embed academics into such companies, or to foster closer collaborations between academia and commercial developers to help verify claims. A few schools already have moved in that direction, he noted.
For example, the University of California, San Francisco, has partnered with Samsung for a new organization called the Center for Digital Health and Innovation. It's intended, in part, to help validate that digital health tools do what they're supposed to.
“When we say validate, it can be a variety of things,” Dr. Michael Blum, an associate vice chancellor of the school, told industry publication MobiHealth News in February. “If it's a brand new sensor we would be doing clinical validation of 'Does it measure and sense what it was intended to?', and 'Does it do it with sufficient accuracy and reliability?' at a very basic level.”
Another thought, said Julia Adler-Milstein, a professor at the University of Michigan's School of Information, would be to improve the information that's gathered in the periodic surveys of hospitals.
“We should be thinking much less about the technology itself and much more about the context in which it's implemented,” she said.
“I'm tired of studies that say, 'do you or don't you have an EHR?'” The trouble is that health IT is too complex, and it depends on how it's used and who it's used by to determine its ultimate success or failure.
“But there's this appeal and draw of looking at technology as if it's a deterministic thing. You put in the technology and this happens. Every industry has gone through this phase of thinking about technology too simplistically,” she said.
To combat that, she would prefer that, to take one example, surveys include more nuanced and detailed questions regarding use of health IT.
“I think we should be collecting a lot more … on organizational processes: do you have a performance dashboard? Having an EHR plus a performance dashboard, so you know they're actually looking at data to improve performance or not. It's that combination of factors that's likely to improve performance,” she said.
Some believe that digital health tools can actually improve the process of gathering evidence. Wendy Nilsen, health scientist administrator in NIH's Office of Behavioral and Social Sciences Research, believes that digital health tools can improve clinical trials and make it easier to study various phenomenon, including digital health.
Nilsen thinks that digital tools can speed up trials by speeding up recruitment. The source of the solution, then, may ultimately be the same as the source of the problem.
Follow Darius Tahir on Twitter: @dariustahir
