America is searching for a transformative healthcare application. This app will be easy to use, readily adopted and make a measurable difference in people's health. But so far, it's been elusive.
While there are thousands of apps and devices designed to help people lose weight and eat better, these technologies are doing little to improve individual or population health. Raw information about calories, steps, heart rates and overall activity is generating more confusion than clarity. As a result, more than 30% of people stop using their digital devices within six months.
The problem is, apps are a simplistic answer to a complex problem—a hit-and-run solution. Simply making these technologies available does not create a platform to help people make extensive and difficult lifestyle changes. Apps provide valuable information, often in real time, but do nothing to make the data actionable.
Our inability to make this information useful is digital health's Achilles heel and an issue that must be addressed. The World Health Organization estimates that eliminating obesity and other major risk factors could reduce heart disease and Type II diabetes by 80% and cancer by 40%.
Today, 90% of Americans have a smartphone. We have an historic opportunity to extend life and improve quality of life for millions of people by making the smartphone our digital health companion.
The human element: In addition to digital tracking software and hardware, the transformative healthcare app will require two additional elements to become a real digital-health companion: machine learning and human support.
Decades of behavioral science research has shown that human contact is critical to any successful lifestyle intervention. People need help translating step counts, heart-rate data and weight trends into next steps and better outcomes.
Who will provide this support? We like to think it will come from physicians, but that simply does not make sense. In 2012, there were 90 primary-care physicians for every 100,000 patients. Doctors don't have time to regularly contact high-risk patients.
To scale up and prevent chronic disease, we must add physician extenders. Healthcare professionals who understand human behavior, such as nutritionists, registered dieticians, fitness professionals, nurse practitioners and physician assistants can engage patients and provide personalized action plans. Consistent human contact will transform Fitbit steps, blood-pressure readings and other data from background noise to actionable information.
Combining devices with physician extenders is a proven model. In its 2011 SMART Trial, the University of Pittsburgh showed that people who received regular coaching had more success meeting their weight-loss goals. A 2012 study by Harvard physicians at the Center for Connected Health at Partners HealthCare showed similar benefits with activity. Patients who received pedometers and coaching increased their activity more than those who received pedometers alone. In addition, an analysis of 11studies published in the Journal of Medical Internet Research found that text messaging from health coaches increased physical activity.
Dozens of other studies, including the landmark Diabetes Prevention Program conducted in 2002, have continued to demonstrate the power of personalized interactions over traditional medicine to support widespread behavior change and prevention.
A helpful companion: To make the digital-health companion a reality, these human interactions must be scalable. We can only accomplish this by embracing machine learning.
Much like Google, which learns from each search, sophisticated algorithms can aggregate activity and calorie counts with blood work and genomic information. The software then interprets the data, providing physician extenders with personalized information for each patient.
The digital-health companion tracks activities and provides useful information directly to our smartphones. This companion also grows smarter with time. As it sees more and more data, it learns our patterns and fine-tunes its messages.
This is a crucial piece of the prevention puzzle. We must recognize that people deviate from their health programs in different ways. Some don't eat right; others avoid interval training; still others neglect to monitor their blood pressure. Machine learning helps us not only accumulate the data but learn from it. Patients who are doing well receive less coaching. Those who are doing poorly receive personalized interventions based on where they need the most help. This precise interpretation and application of data allows us to scale up these interventions and help more people.
So the transformative app is not an application or device on its own, but rather a digital tool combined with data aggregation, machine learning and high-touch care to create a digital-health companion. The system applies the technology in a meaningful way, determining which patients are benefiting and which ones need support. The end result is real clinical outcomes.
Do we need any more reasons to create a sustainable system that produces real preventive care? With rampant obesity leading to heart disease, diabetes and cancer, a comprehensive digital platform could save millions of lives. For every five high-risk patients we move from low to high fitness, we can prevent a single death. Research has shown us these approaches work, and with digital technology, we can scale up these lifestyle interventions. This is no longer an option—it is something we must do.
Dr. Samir Damani is CEO of MD Revolution and a cardiologist on the medical staff of the Scripps Clinic in La Mesa, Calif.
