Academics embrace digital health: Bringing measurement and participation to medicine

I was thrilled this morning to read about UCSF's newly-created Center for Digital Health Innovation (CDHI), an effort to organize and catalyze the university's efforts and activities in this vital, emerging space.

This initiative seems to be driven by much the same spirit that led a group of us to establish the Center for Assessment Technology and Continuous Health(CATCH) at MGH and MIT: the recognition that healthcare faces unprecedented challenges - challenges that emerging technologies and approaches to information can, must, and will help address.

If I had to distill the opportunities of digital health in medicine down to two themes, I'd nominate "Measurement" and "Participation."

Measurement refers to our increased ability to measure both people and process.  Technologies permit us to understand both health and disease with far greater granularity, and in a continuous rather than episodic fashion, affording comprehensive understanding, and ideally enabling the sort of precision medicine for which UCSF Chancellor Susan Desmond-Hellmann has so passionately advocated.  CATCH Director Dennis Ausiello and I have argued that phenotype is the new genotype, and that integrating the two may be especially powerful (and very challenging).  Such integration has also beeneffectively championed by Eric Topol, Director of the Scripps Translational Research Institute and author of digital health's defining bookThe Creative Destruction of Medicine.

Technology also provides us the means to study the delivery of care, to critically evaluate quality and cost, and to identify opportunities for improvement.  While medical research has not always paid adequate attention to these sorts of systems issues, healthcare's apparent movement away from fee-for-service to some sort of value-based approach has highlighted the need to figure these questions out.

Participation is the second great theme of digital health, and emphasizes technology's tremendous democratizing potential.  While I don't see doctors becoming obsolete, they will need to recalibrate themselves to a world of informed, involved patient and patient communities - and see this evolution for the enormous opportunity it unquestionably is.

Participation also involves the important subject of behavior, which is critically linked to health.  Technology can provide new opportunities to better understand behavior patterns, and ideally, novel approaches to motivate and sustain behaviors that are more healthful.  Many nascent digital health companies focus on these challenges.

None of this will be easy.  Arguably our most significant learning thus far from keeping score has been how incredibly difficult it is to durably improve health(much less to do so in a way that reduces total costs - my "Milstein Metric," and, the goal to which many aspire).  Elegant gadgets and inexpensive appswon't offer a magic answer, and engagement, as my favorite digital health provocateur Al Lewis points out, is not a panacea (though, like David Chase, I'd argue it's more important than Lewis lets on).

In the end, we are likely to be propelled less by all the goodies a technology-enabled future might offer, and more by the growing, technology-enabled concern about the level of care we now receive.  Digital health approaches, including sophisticated analytics, will not only capture practice variation, but can help guide us to more effective solutions.

A striking feature of both CATCH and the CDHI is the explicit recognition of the translational value of public-private partnerships, and of the need to capture and nurture the development of promising but preliminary ideas from providers in the trenches.

As the newly-designated director of the CDHI puts it,

"UCSF faculty and students are among the most creative and accomplished that you can find.  Add to that the proximity to Silicon Valley, and you have the ideal environment for digital health innovation. Previously, faculty struggled to bring promising concepts to fruition due to lack of resources or technical or business expertise. Now, the CDHI will provide the administrative, financial, and technical resources, as well as the guidance and connections to create the public-private collaborations and partnerships needed to bring these exciting projects to market. Great ideas will no longer die on the vine."

Although perhaps less obvious, organizations such as CATCH and the CDHI are also likely to provide technologists with more opportunities to connect with physicians, and to develop a more nuanced appreciation of the challenges they face.  I've unsparingly pointed out that many brilliant and bold tech innovators don't seem to known what they don't know about medicine and health.  At the same time, many are passionately interested in using their resources and know-how to improve health.  Thus,  CATCH and the CDHI may offer ideal settings in which important knowledge and cultural differences could be bridged, new understanding forged, and original ideas hatched and productively evolved.

The future of medicine and healthcare - as well as the future of medical products companies (whether or not they fully realize it) - is likely to increasingly depend upon the extent on our success in improving measurement and fostering broader participation.

Hopefully, initiatives such as CATCH and the CDHI will provide the nidus for digital health innovation within the trusted confines of premier academic medical institutions - and achieve results that extend far beyond.


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