When I first turned my attention from clinical practice to the management of healthcare IT the first buzzword (or perhaps phrase?) I encountered was Digital Health. Whether it was on Twitter or otherwise, I couldn't escape it and I immersed myself in it instead.
Over the last five years I’ve grown distant from this world and my work today focuses on working with enterprise scale healthcare IT infrastructure vendors.
I want to explain why.
1. Consumer Health vs Hospital Systems
There are plenty of individuals and groups terming themselves as ‘futurists’ or ‘evangelists’ for the digital health movement. In reality, these protagonists primarily have little clinical experience and prefer to champion gadgets and gizmos (i.e. Wearables). For me this is problematic as many of these solutions have absolutely no significant impact on the practice of medicine or the management of patients. As a clinician, the challenges that I see facing clinicians day in and day out centre around the reliability of information and data systems and how they impact workflow, clinical documentation and communication instead. Digital health has an identity crisis about its core meaning and what it wants to achieve.
2. Supporting the Right Startups
With the birth of digital health came a renewed focus on startups as a source of innovation. Accelerators started to spring up left, right and centre. In many cases, the startups that were being selected once again seemed to focus on easy-to-market solutions without significant business cases or value propositions. These were also skewed to app-only solutions in many cases rather than robust systems which can be scaled. Ultimately, I felt this led to support being neglected for enterprise-grade healthcare platforms which focus on difficult healthcare IT issues.
3. No Evidence
This one is rather simple. I advise large healthcare IT infrastructure vendors and my number one priority is developing tangible business cases based on clinical, operational and financial outcomes. Digital health (in terms of solutions commonly promoted) as a sector can’t fulfil these. Healthcare IT and infrastructure solutions can. Wearables, apps, tracking and gamification simply remain significantly unproven in terms of any sustainable impacts.
4. No Interoperability
Many of the commonly touted digital health solutions claim to impact healthcare practice. One big problem. Most of them are standalone solutions and are not integrated into larger hospital IT systems. Data sharing is cumbersome and many solutions cannot be scaled for use by the clinical population. Intrinsically, these solutions are doomed because they cannot realise their claimed benefits without interoperability. This applies to any device or application.
The final problem I have with the digital health sector in its current incarnation is that there’s too much rhetoric that places doctors as obstacles rather than partners. Many of us have had negative interactions with healthcare IT systems so forgive our scepticism. However, we want to see solutions that will make our lives easier and we are the crucial champions you need on your side. Healthcare infrastructure vendors have recognised this and that’s why solutions focused on clinical documentation, information management and communication are securing far more traction and at far more lucrative levels.
So that’s my personal opinion and my work bears it out in many cases. I hope that this schism within the sector, as I see it, leads to a greater debate about what we are aiming to achieve with technology in healthcare. We need to focus on evidence and targeting the low hanging fruit in terms of supporting our clinicians to provide the best possible care for our patients first. Futuristic technologies and ideas, in my opinion, can wait until we have fixed today’s challenging problems.