Much of the digital health technologies on the market today are wellness products utilized by the relatively younger segment of the population. Technologies which are focused on chronic diseases have found it much harder to reach their intended target audience for a variety of reasons. The market is right with regards to need, and the demand would be great were it not for significant barriers to adoption, namely lack of awareness by providers and the public, lack of adequate business models, and lack of proper patient portals with connectivity to EHRs. Some may say that this is a chicken or egg situation. “Build it and they will come” has been a mantra for much of the digital health technology sector. While this might be best applicable to consumer-focused wellness smart phone apps, it is not a good strategy for more involved technologies targeted towards chronic disease management.
It is well-known that only a minority of the 45+age group in the USA own smart phones (http://blog.nielsen.com/nielsenwire/online_mobile/who-is-winning-the-u-s-smartphone-battle/). People age 65 and older search the Internet for health information less than younger persons. http://pewinternet.org/~/media//Files/Reports/2011/PIP_HealthTopics.pdf. Since these relatively easy access tools of communicating medical information are less utilized by older people, how can we best engage them in healthcare?
So how do we get digital health to the people who impact the system most; older patients with chronic diseases? The easiest scenario will be at the point of contact in the healthcare system. That is, at the healthcare provider’s office or the hospital. In the office, a patient presents with a chief complaint, which may or may not be related to chronic underlying conditions. It would be intriguing to have recommended digital health technology diagnostic or disease management tool suggestions prompted by electronic review of preexisting diagnoses or the input of a new one, as part of a clinical decision support. In the hospital, this would be in the pre-discharge period. An informatics program would determine, based on the patient’s diagnoses, medications, ancillary services required in the hospital, vital signs, procedures performed, and types of consultations, an appropriate set of digital health monitoring assistance, medication adherence tools, telehealth applications, and follow-up appointments.
Digital health technologies delivered in this manner will be easy to disseminate, connect to EHRs and patient portals, and appropriately targeted. Older patients can therefore be connected to digital health on the back-end, without the industry fighting consumer-type barriers on the front end.
