Physicians complain bitterly about electronic health records and attribute major burnout due to overwork and fatigue. The completion of data entry for EHR alone amounts to one to three hours/day, which causes a decrease in patient volume, or an extension of a doctors work hours.
Digital health technologies hold great promise to solve some of the biggest problems in our healthcare system, including achieving higher quality, lower cost, and greater access to care. In the January 2019 issue of Health Affairs, we reported that scant evidence exists demonstrating the clinical impact of twenty top-funded digital health companies.
We found 104 peer-reviewed published studies on the products or services of these companies. The majority of the studies were from three companies. Nine companies had no peer-reviewed publications. Only 28% of the studies targeted patients with high-burden, high-cost conditions or risk factors. Healthy volunteers were the most commonly studied population. Further, 15% of all studies assessed the product’s “clinical effectiveness” and only eight studies assessed clinical effectiveness in a high-cost, high-burden population. The eight clinical effectiveness studies measured impact in terms of patient outcomes, while no studies measured impact in terms of cost or access to care. There were no clinical effectiveness studies in heart disease, COPD, mental health conditions, hyperglycemia, or low back pain. Studies that did not assess clinical effectiveness may have intended to validate the product against a gold standard measurement or report feasibility of use.
This is of particular interest given the incredible amount of funding, interest, and hype in digital health. Although these companies were only a small portion of total digital health companies, they were a large portion of total private funding and had the most resources to demonstrate impact. Further, since “digital health” currently encompasses myriad technology types and approaches, these findings have broad implications.
Does this mean digital health is doomed? Should investors, consumers, patients, and developers stop spending their money on digital health? Do our results describe all digital health sectors and companies?
No. No. No.
The idea of a telemedicine visit between doctor and patient to foster more effective care is not new. The concept was first reported in the April 1924 edition of Radio News (Exhibit 2), making the cover of that issue. Although many centers practice telemedicine today, that vision developed in the 1920s is still not yet a fully deployed reality.
Today, telemedicine visits are hyped as one of the healthcare approaches that could revolutionize vast areas of patient-provider encounters. Yet, even at the most prolific centers that perform telemedicine, it represents less than one percent of total care volume. The major leaps in how healthcare is delivered won’t occur with a great new idea or a remarkable advance in technological capabilities. Instead, the transformation will occur when an innovation is effectively integrated into complex environments with complex people.
To truly make a transformative impact on health care, we encourage digital health companies to begin with the standard of evidence of impact that physicians, hospitals, insurance plans, and patients seek: high quality studies of highly-burdened populations using rigorous study design in real clinical environments with meaningful metrics of impact - outcomes, cost, and access to care.
Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis.
The Oversell And Undersell Of Digital Health | Health Affairs
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