Digital health technology has seen an incredible growth in the last few years, fueled by a combination of consumerization of wearable technologies, ubiquity of mobile devices, proliferation of technology incubators, attention by government health and regulatory agencies and involvement of large companies heretofore not focused on healthcare. The fastest path to widespread adoption of these technologies is the application to the most pressing public health needs. The mission of public health is to improve the public health and achieve equity in health status. A review of studies of text messaging for health demonstrates a general positive effect on health-related behavior. These findings, as well as growing demand for more economical, convenient, and outcome-oriented data-focused care are driving interest in digital health tools.
A recent report on public health state by state by the Trust for America’s Health describes the dilemma of increased general healthcare spending and increased public health needs with their associated decreased funding allocations. I would like to highlight what I see as public health issues ripe for digital health technologies, some of which have already spurred initiatives.
- Mental Health. The disappointingly slow recognition of mental illness as a medical problem is compounded by the paucity of human and digital educational, and monitoring resources in the field. While there are currently some technologies focused on mental health, their scope lies more in the consumer than medical realm. An interesting recent review of mental health mobile apps in the journal Nature discusses positive feasibility studies but a lack of robust outcomes data. In addition, some unintended consequences of at least one app were found. Tools providing support for medication adherence, urgent virtual visits with clinicians and self-management will have maximal effects in this sector.
- Opioid addiction. The National Institute on Drug Abuse has long recognized the potential of mobile health technologies for its mission. The Agency for Healthcare Research and Quality is launching a three-year $19M initiative focusing on mobile apps and telehealth aids for rural physicians in efforts to treat opioid addiction. The Substance Abuse and Mental Health Services Administration recently released a free mobile app for clinicians called MATx. It provides information and guidance to medication assisted treatment of opioid addiction. An interesting company to watch in the sector is Pear Therapeutics which offers a patient-facing mobile app combining digital tools to be used in association with medication-associated treatment for opioid dependence (other tools in their portfolio address other disorders such as PTSD and schizophrenia).
- Childhood nutrition. Nutrition is an important aspect of a child’s health regardless of age. CDC statistics on childhood obesity are sobering. Supporting education about the problem are reports such as the WHO Guidelines for Sugars Intake and the Global Nutrition Targets which includes its Childhood Overweight Policy Brief. Digital health technology is going to be critical to providing educational and self-management tools to young people and their parents. Digital natives are experiencing the obesity epidemic and expect digital resources to help them. One company in the forefront of this effort is My Shapers which targets children ages 6-11 years old.
- Adult physical inactivity. Physical inactivity is a known significant risk factor for cardiovascular diseases. I have discussed threads between consumer and traditional healthcare digital strategies in previous pieces. Front and center in these discussions are wearable sensor devices intended to promote physical activity. Though use of activity trackers has failed in one study to result in weight loss they resulted in improved fitness, body composition, diet, and increased physical activity. They are used by millions of people to at least remind them to be more active which itself might promote better health. Trackers are being ‘tweaked’ to improve the user experience.
- Asthma has been well-studied from an epidemiologic standpoint. It is the most common chronic illness in children, found in 1/10 of them in the USA with increasing numbers. It impacts society from morbidity, mortality, and financial perspectives. Allergens causing asthma are ubiquitous and have documented to be common in schools according to a study by Boston Children’s Hospital and Harvard Medical School published in JAMA Pediatrics. Interestingly mice allergens were found in 99.5% of school samples. Digital technology in the form of an allergen sensor is commercially available from Alersense (disclosure: the author is an advisor to Alersense). It allows for custom programming of allergen sensor thresholds to alert the user before symptoms may occur.
Digital health tools are by no means meant to replace clinicians but the potential scale, convenience, support of self-management, potential effects on cost savings and patient reported outcomes are all very significant. Public health consumes a lot of healthcare resources which as noted above are decreasing. With an epidemic rise in chronic diseases, the need becomes magnified. Strives must be made to demonstrate improved outcomes and provide the privacy and safety that patients demand and deserve.