Accelerating Adoption of Digital Health
CNBC journalist Christina Farr ignited a discussion on Twitter earlier this year about the definition of "digital health" stating that, "Maybe we should sit down and define digital health. There’s too much variability and it’s confusing. e.g. wellness apps are being bucketed in the same category as an FDA-cleared medical wearable prescribed by doctors."
When first introduced in 2000 by Seth Frank, digital health largely encompassed internet-focused applications and media to improve medical content, commerce, and connectivity. Over time, the term was expanded to include wearables, mobile applications, analytics, telemedicine, genomics, and, more recently, artificial intelligence algorithms. In 2018, the World Health Organization issued a detailed taxonomy of Digital Health**, and the Digital Medicine Society (DiMe), Digital Therapeutics Alliance (DTA), HealthXL, and NODE.Health have developed a useful framework for categorizing digital health. They also narrowed the framework for digital medicine and digital therapeutics based on requirements for clinical evidence, outcomes, and regulatory oversight.
At the Center for Digital Health Innovation (CDHI) at the University of California, San Francisco (UCSF), we believe that digital tools and data will enhance most, if not all, aspects of health and healthcare delivery. The recent Coronavirus (COVID-19) pandemic is accelerating the rate of adoption of digital health solutions including:
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Telemedicine (defined as “healing from a distance” by the World Health Organization) has been around since providers could consult with patients utilizing a telephone. Telemedicine includes physician and patient communication in real time via phone, video, or text as well as remote patient monitoring (including device data) to collect key health measures, and the sharing of a patient’s health information with other healthcare specialists.
Since COVID-19, telemedicine is being utilized to connect physicians and patients in ways that optimize safety, outcomes, and reduce the demands on the healthcare delivery system. In response to COVID-19, federal and state regulations that previously restricted the use of telemedicine are now enabling this potentially paradigm-changing method of delivering care.
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Following a March 13, 2020 San Francisco public health order to screen employees working in healthcare settings on a daily basis, UCSF’s Digital Patient Experience (DPE) team, working with Conversa Health, were able to rapidly deploy an online COVID-19 symptom screener and tracker resulting in a “Clear to Work” designation. The team employed user-centered design and agile product development to launch the digital screener within five days of the order. Ten days after launch, 3,600 employees had enrolled and were using the screener to fast track their entry into UCSF hospitals, reduce any risks of physical proximity while waiting in line to be manually screened, and saving 36 combined hours per day compared to the in-person screening checks. Enrollment as of April 10, 2020 is 4,200 employees and the total time savings is projected to exceed 1,000 hours during the first four weeks of use.
CDHI has been developing, validating, and working with commercial collaborators to commercialize digital solutions since 2012 to improve care. Some important milestones include:
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In 2013, CDHI supported Tidepool’s development of an interoperability platform that integrated data from blood glucose monitors and insulin pumps for people with Type 1 diabetes to access their own data, and then share it with doctors, family, and caregivers for more meaningful and actionable discussions about treatment.
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In 2014, CDHI developed CareWeb – a team-based collaborative communications solution that is integrated with the EHR. CareWeb allows a patient’s entire care team to view and participate in important care conversations in a real-time social, collaboration environment. The CareWeb technology was licensed to Voalte (acquired by Hillrom) for commercialization and scaling to global user community as Voalte Story.
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CDHI also led the creation of UCSF’s Accreditation Council for Graduate Medical Education approved Clinical Informatics Fellowship to train the next generation of physician informatics and digital health leaders.
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In 2016, CDHI partnered with Cisco to explore the development of an interoperability platform to power a third-party app ecosystem. CDHI has influenced the national dialog and regulatory framework around health data interoperability and continues exploring methods for overcoming the challenges of interoperability in healthcare.
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In 2016, CDHI established a partnership with GE Healthcare to develop, validate, and gain regulatory clearance for artificial intelligence algorithms that improve clinical workflows and patient outcomes. In 2019, the effort achieved a major milestone for AI embedded algorithms in patient facing devices with the FDA clearance of the first generation of the “Critical Care Suite.” This was an industry first in both the focus on life-threatening conditions and in the development with an academic medical center partner.
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In 2017, CDHI established UCSF’s DPE program to create new digital solutions and bring commercially available technologies to our patients in order to improve the quality, efficiency, and experience of their care. The DPE addresses the digital transformation and “consumerization” of healthcare to provide contemporary clinical and service excellence to our patients and their families.
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In 2018, CDHI established a public policy advocacy effort to ensure the academic health perspective was heard within the setting of relevant digital health policy debates. Historically, consumers, patients, industry advocates, and lobbyists have shaped the narrative of appropriate use, value, and importance of these new technologies. This has resulted in the tendency to obfuscate high quality evidence and clinical rigor. The goal of public policy advocacy is to ensure that discussions pertaining to new technologies facilitates balanced perspectives, including care providers.
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In 2019, CDHI implemented the Fax-to-Referrals automation solution within UCSF. The application, integrated with our electronic health record (EHR) via SMART-on-FHIR, improves staff efficiency in managing the referrals process by over 30%. When implemented along with Luma Health’s self-scheduling platform, patients newly referred to UCSF are able to schedule their appointments on their smartphone the same day the referral is received.
Moving forward, CDHI recognizes that digital health must be delivered across the spectrum of health (wellness to illness) and in multiple environments (home to hospital). We are currently working on digital health projects to:
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Ensure a contemporary, unified digital experience to access and interact with care delivery in a way that is empathic, reassuring, personalized, and modern.
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Apply machine learning to uncover insights that improve clinical outcomes, enhance clinical decision making, and reduce inefficiency and waste.
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Make it easier to access UCSF and affiliated specialists through referrals automation and patient self-scheduling.
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Automate patient generated data capture into the EHR and support its use in clinical workflows that do not add to provider burn-out.
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Deliver virtual care with chatbots and video visits.
Healthcare is undergoing a profound transformation from the analog world to the digital. Our work at CDHI drives this transformation by engaging with administrators, clinicians, and patients at UCSF as well as global commercial collaborators and national policy experts. Our North Star is deceptively simple: creating effective digital solutions that transform health and enable compassionate care delivery for all.
Digital health is not an app or a device. It is not AI or blockchain. Digital health is all of these and none of these. As in every other industry, healthcare must leverage technology to transform the way we make decisions, decrease the burden of administrative work for care, enable the delivery of personalized, patient centered care, and improve outcomes for our patients and healthcare institutions. We will need payers, regulators, technologists, care delivery organizations, providers, and patients all working toward these shared goals. CDHI believes that we have embarked on a journey toward a digitally powered health system that be more effective, efficient, and compassionate, while delivering convenience and satisfaction to our patients and their families.
Michael Blum, MD
Executive Director of the Center for Digital Health Innovation at UCSF
Assoc. Vice Chancellor for Informatics and Chief Digital Transformation Officer, UCSF
Prior to Dr. Blum’s medical career in cardiology, he trained as an engineer and has a special interest in the application of digital technologies and clinical decision support to improve clinical care. At CDHI, he leads UCSF’s early stage development and validation of digital health technologies for use at UCSF and for co-development and distribution by industry collaborators. Dr. Blum was recognized by Becker’s Hospital Review in February 2020 as one of the 20 chief digital officers to know.
Additional Resources
*Frank, S. R. Digital health care—the convergence of health care and the Internet. J. Ambul. care Manag. 23, 8–17 (2000).