This week marked another digital health conference – the Rock Health Summit. I confess that when I signed up for this one, I didn’t realize that I would be going to 2 other conferences so close in time. I experienced a bit of “conference fatigue” of sitting in dark rooms, being offered too many sweet and starchy foods, and seeing a number of the same speakers sitting on a similar white couch on the stage. This raised several amusing but irrelevant questions in my mind: How can healthcare conferences offer such unhealthy food? Why are the couches always white, is it a filming thing or does it make everyone look skinnier?
Aside from that silliness, having invested my time and a reasonable amount of $$ for the registration fee, I did some searching on whether I could extract a few personal and new “take homes” from the conference. And yes, they appeared. I will also say that I met quite a number of people for the first time, some working in larger pharma and providers, and others pursuing their own endeavors with some exciting new concepts.
What learnings did I extract? They clustered around hurdles and barriers.
Bakul Patel, the FDA’s Associate Director for Digital Health, discussed the new FDA schema for reviewing software with the CEO of Evidation Health, Deborah Kilpatrick. Notably, the word was “review” and not “submission” when it came to the planned FDA process. It was difficult to get a sense of what the review would entail, not surprising because it’s a work in progress. The direction appears to be a review of quality and risk management to arrive at trusted companies, rather than a focus on the individual products. In this manner, once a company fell into the “trusted” category, addressing minor software iterations and improvements along the product lifecycle could be accommodated without demanding a continual series of FDA regulatory submissions.
On the panel addressing trends in future technology, Dr. Michael Hodgkins, Chief Medical Information Officer (CMIO) for the American Medical Association, advocated for evidence-based evaluations. A number of digital health apps (and other health-related companies) have found themselves front and center with the FTC. Making medical claims and advising consumers on treatment can’t be treated like any other game in the app stores. A number of companies have invested or are investing in clinical trials and objective research evaluations of their platforms. What this leads to is trust – a key factor in all of healthcare.
Healthcare of all types, technology or not, brings heaps of challenges. Some of these can act as barriers to certain segments of the population seeking treatment, as well as barriers to access. These barriers can be low-tech, for example a lack of transportation to a dialysis center when the buses aren’t running on time. Others get more complicated and delve into human behaviors. Several examples caught my attention during the panel discussions.
The first one is a super tough nut to crack, the current opioid crisis. It’s not going to be solely solved with technology, many other factors including prescribing habits and addressing socio-economic issues rise to the top of the list, but technology can lend a hand. Potential offerings included a smart and personalized dosing device based on one designed originally for smoking cessation, and case management software to facilitate team approaches to care.
The digital/human balance also comes into the realm of barriers. The use and acceptance of technology is generational, cultural and also varies by individual. Some folks need a bit more hand-holding to take them through the new app or device. While mentioned, not very many companies and organizations spoke about outreach to get adoption for their platforms. Another related problem is motivation. This a trait at which retail companies like Nike excel and companies in the healthcare space have generally not mastered. If we want consumers or even sub-populations of consumers to adopt healthy habits or keep up with regimes for their chronic conditions using technology to monitor and aid them, what will keep them engaged and motivated? On a related subject (not part of the conference), this podcast interview with Andrew Sykes raises some interesting points on what it takes to get to healthy habits.
On the flip side, it seems that in some areas, a tip of the scale to the virtual rather than human interactions can be a benefit. One of these areas is mental health. The use of digital based models such as chat bots apparently gains more acceptance where individuals feel ashamed or uncomfortable discussing the same subjects with a live person. Additionally, folks have no qualms about reaching out to a chat bot at 2 am when they feel stressed, where they might hold off calling a therapist in the middle of the night. In this area, technology reduces a barrier that has stood with traditional methods.
The sum total for me on the hurdles and barriers is this: Digital health applications depend on how the proposed technologies fit into the problems we are trying to solve. And like its traditional counterparts, it still demands a hard look on a case-by-case basis whether the fit is appropriate and if it yields worthwhile benefits that can be shown with solid evidence.