What is digital health?
While digital health is a simple concept — using technology to help improve individuals' health and wellness — it's a broad and growing sector. It can cover everything from wearable gadgets to ingestible sensors, from mobile health apps to artificial intelligence, from robotic carers to electronic records. Really it's about applying digital transformation, through disruptive technologies and cultural change, to the healthcare sector.
Why is digital health so important?
The industry's aims are diverse and complicated: preventing disease, helping patients monitor and manage chronic conditions, lowering the cost of healthcare provision, and making medicine more tailored to individual needs.
What makes the healthcare industry interesting is that those aims could potentially stand to benefit both patients, as well as their healthcare providers. By gathering more data on markers of health, from activity level to blood pressure, it's hoped that digital health will allow individuals to improve their lifestyles and maintain good health for longer, and so need fewer visits to their physician.
Digital health tools could also help identify new illnesses or the worsening of existing ones. By enabling doctors to step in earlier during the course of a disease, digital health tools could help shorten the length of a disease, or help ease symptoms before they really take hold. Not only could digital health help improve quality of life, it could also reduce the total cost of a person's healthcare over their lifetime, trimming bills for providers and patients alike.
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Which companies are driving the digital health revolution?
All of the major tech companies with a consumer presence are looking to get more deeply involved with digital health, but they're all taking interestingly different paths.
Take Google, for example. The company has the most comprehensive, and arguably most far-sighted, strategy. Like many of its rivals, it has a stake in the health-tracking wearables market, through Google Wear, and Fit, a health platform that launched in 2014 and has been largely overlooked since then.
However, it's putting a serious amount of effort into artificial intelligence for healthcare (for example, using it to identify signs of eye disease from scans normally read by doctors), through its DeepMind unit. Elsewhere, Alphabet — Google's parent company — also oversees Verily, its health sciences unit. Verily has a number of interesting health projects ongoing, including Project Baseline, a longitudinal study of human health, and joining the Aurora study, a research project attempting to identify physical biomarkers of mental trauma (it's designed its own wearable for use in both projects). Alphabet's other health unit, Calico, has the somewhat mind-blowing task of "combating ageing" (or to put it another way, defeating death). In an effort to bring together all these disparate strands, Google recently created a unit called Health, and appointed a new CEO.
While Google has its sights set on the future, Apple's strategy is far more grounded in the present, looking to create an ecosystem reaching from the provider to the consumer. It's expanded the functionality of the Apple Watch to make it more health-focused (with the ECG and falls detection features, for example). It's also looking to build up its offering on the provider side with the likes of Health Records and ResarchKit. All of these moves are laying the foundation for health companies to subsidise the Apple Watch for its customers, and expand Apple's share of the wearables market.
Amazon too has dramatically ramped up its efforts, has bought a medication delivery company and is part of a joint venture that plans to remake how healthcare is delivered in the US, by building its own health benefits platform.
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What are the key technology trends that will shape the digital health market?
The consumer side of digital health has been driven to a substantial degree by the growth of wearables and mobile health apps.
The boom in digital health arguably started with the launch of wearables such as FitBit's bands and the Apple Watch. The hardware let users easily gather data on their activity levels, usually their number of steps and minutes of exercise, while the mobile app ecosystem that grew up around them extended the ways that data could be analysed and viewed.
For the first time, individuals could store, compare, and share certain metrics associated with their health and wellness. Before long, app makers and hardware companies started expanding the range of what users could monitor, from sleep to reproductive health. So far, most apps and hardware have been focused on 'lifestyle' measures of health; in future, those are likely to become more medical as hardware capability expands as new sensors and functionalities are added: think blood glucose or pressure, heart health, and drug levels and side effects.
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What problems are digital health companies solving?
Once apps and peripherals started to gather all that data, it was only a matter of time until companies decided to see how they could extract value from it.
There's a number of reasons why tech companies are targeting health in particular: it's a huge industry and recession proof; it's also an expensive one, where growing demand means providers are looking for new ways to save costs. One way to do that is to shift from treating diseases to preventing them.
Many conditions whose prevalence continues to grow — type II diabetes, high blood pressure, and raised cholesterol, for example — can, to a large extent, be prevented or controlled by lifestyle measures, such as maintaining a healthy diet and active lifestyle. That's where digital health wearables come in: by providing a means for people to track their weight, exercise, and so on, digital health hardware could potentially help people get a better handle on their health.
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What are the trends and opportunities in the digital health market?
But it's not just 'lifestyle medicine' that digital health can help with: an ecosystem is developing that will increasingly offer ways for people with chronic conditions to better monitor and manage them. While digital health can give users the tools to practice lifestyle medicine with just a smartphone and an app, adding in a peripheral or two could improve the medical management of their disease as well.
Take those with high blood pressure: an off-the-shelf connected blood pressure cuff can show whether a user's blood pressure is on the way up or on the way down, and so help identify not only what lifestyle changes are successful, and which medications can help control the condition (or even if someone has 'white coat syndrome', where the stress of being in a doctor's office causes a spike in a patient's blood pressure). Similarly, connected glucose monitors can help diabetics get a handle on their diet and how effective their medication is by tracking their blood sugar control over time. Digital health tools mean more and better data on such metrics can be collected, and shared with physicians to allow them to analyse the results, and adjust their management accordingly.
While it would be reassuring to imagine such systems were designed for the altruistic purpose of keeping people healthier for longer, the ultimate aim of using digital health to manage chronic conditions is to cut providers cost by reducing the amount of doctor's appointments, emergency room visits and even hospital admissions that people with such illnesses need.
The digital health market is also likely to see the blending of what might typically have been considered 'consumer' and 'medical-grade' digital health tech, driven by companies from both sides of the divide. Take Apple's recent addition of an ECG-like function into the latest Apple Watch, for example: with the new feature, a consumer device could potentially identify previously undiagnosed heart conditions like atrial fibrillation in a way that could be highly beneficial to not only the wearer, but their doctor too. Similarly, medical hardware is increasingly gaining digital functionality: for example, medical device company Medtronic has created an app that lets people with internet-enabled pacemakers share data (via their smartphone) with their doctor.
With this blurring of the lines between consumer and medical-grade digital health hardware and apps, it's perhaps no surprise that 'consumer' tech companies are making more of an effort to go after the enterprise healthcare space. Amazon, for example, looks to be building a version of Prime for healthcare, while Apple has rolled out a health records service to let patients see information from their health providers, such as clinic visits, test results, and immunisation records on their iPhone.
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How big is the digital health market?
Putting a definitive number on the size of market is difficult, given researchers often have different views on which technologies can be brought under the digital health umbrella, though most researchers agree it's in the region of hundreds of billions of dollars worldwide. Research and Markets, for example, says $223.7bn by 2023, while Global Market Insights predicts $379bn by 2024 and Transparency Market Research foresees a 2025 market of $536.6bn. However, such reports typically focus purely on the technology used by the healthcare industry, such as digital prescribing, electronic patient health records, and telemedicine.
Reports that take into account consumer digital health are harder to come by, and often focus on the industry's constituent parts. Research and Markets' report into mobile health, for example, predicts a market of $189bn by 2025, driven by the healthcare industry's interest in cutting costs by moving to "patient-centric healthcare", while CCS Insight says the wearables market will reach $27bn in 2022, due to consumers' interest in tracking their health.
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Are there any other benefits to digital health?
One of the less talked about benefits of greater use of digital health tools around the world is the potential insights that building up a vast repository of data on health markers of people around the world could create. In future, with the help of big data systems and artificial intelligence, researchers may be able to tease out connections between conditions and people's lifestyles, determining how doing or not doing a certain thing (be it where you live, what you eat, where you work, what medications you take, and so on) will increase or reduce your chances of having a certain medical condition.
While there are obvious and sensible privacy concerns over how sensitive health data is used, if handled appropriately, data gathered by digital health apps could potentially prove a treasure trove for scientists trying to improve public health. Take the case of Apple's recent data gathering on the ECG feature of the Apple Watch: it managed to get 400,000 people to join in its research, a figure far beyond what most research institutions could manage and a number big enough to potentially provide results of significance. That said, unlike most universities and research institutions, Apple is not a public body and doesn't open up its findings to peer review, meaning that the research is sadly not as valid or useful as it could be.
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What are the concerns over digital health?
For digital health to be as useful as it possibly can, it needs to be used by the widest range of people possible: any age, any gender, any ethnic or genetic background, with any income, with medication condition or without. However, at the moment, those that use digital health tools, particularly wearables, tend to be fitter, wealthier, and more likely to be in their 20s to 40s (though manufacturers are increasingly targeting older consumers, so that's likely to change with time). At the moment, the data that's been gathered by digital health tools is focusing on a small section of the population.
Similarly, it's thought at the moment that those who are interested in digital health tend to be 'the worried well', people without long-term problems who are interested in preserving good health.
As digital health products become more and more medicalised, there are likely to be slip ups: people who may be 'diagnosed' with a disease by an inaccurate system, who go on to undergo an unnecessary doctor's visit and lab tests; similarly, there are likely to be those that are told they're fine by their smartwatch or fitness band, and don't go to their doctor when they really should.
There are also questions around how insurers should be involved in using digital health. Several companies are encouraging their customers to adopt healthy habits by giving them discounted or free wearables if they hit certain exercise targets. However, it's not a huge stretch of the imagination to see that data from such devices could one day affect pricing and eligibility, potentially requiring customers to share more than they would be comfortable with.
It's also worth remembering that for all the excitement about new technologies there are still many parts of healthcare that are still struggling to get up to date and stop using fax machines without having time to start thinking about a future filled with wearables and more.
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How is the regulation of digital health changing?
While regulation often proves a stumbling block for new technology, the FDA appears to be making steps towards speeding up the process digital health companies undertake to get their products certified. In 2017, the FDA launched its Digital Health Action Plan, which brought new guidance on implementing legislation touching on digital health, and to clarify which products fell under its jurisdiction, as well as debuting a pre-certification program for certain developers. That program went live earlier this year, aimed at low-risk products made by companies "who demonstrate a culture of quality and organizational excellence based on objective criteria". Apple, Samsung, and Verily have all joined.
In Europe, there's more legislation on the horizon. The Medical Devices Regulation (MDR) is due to come into force in 2020 and will revamp the legislation digital health products are governed by. In particular, it clarifies and broadens the definition of a medical devices, software, and apps, and strengthens the traceability of medical devices.
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