The U.S. health care system is not unique in having deficiencies along with strengths. Examples of strengths and deficiencies of the system – relevant to digital health’s potential to make an impact – are presented in Table 1. Digital health solutions can address the most pressing deficiencies, i.e., cost of care and reach/coverage of the under served. Care coordination and continuity of care are also areas which digital health solutions can improve. Another deficiency of the care system is that it mostly activates when a person falls ill, i.e., it is reactive, not preventative. Digital health solutions can provide effective and affordable pathways for preventative care. The health care system also has a number of inefficiencies and waste – areas where digital health solutions can be effective. Finally, it goes without saying that digital health solutions can also enhance the strengths of the system.
Table 1: Example strengths and deficiencies of the U.S. health care system where digital health can have an impact
|Education and training|
|Best practices emphasis|
|Research and research translation|
|Geographic reach and timely availability|
|Sophistication of specialized care|
|Physical plant quality|
|Reach (not so much geographic, rather covering the underserved)|
|Care coordination and continuity|
|Reactive, rather than preventative, features|
Table 2 outlines some of the opportunities and challenges for adoption of digital health. In general, enhancing quality, improving convenience, extending reach and reducing cost of health care are the anticipated benefits from digital health solutions. Enhancing quality would result from: (i) timely, targeted care based on collection and/or communication of relevant health data and information; and (ii) new care possibilities that are enabled through continuous monitoring, wireless communication and/or rich new databases of disease conditions. Improving convenience would result from the resulting mobility afforded the patients and the care providers. Extending reach would result from possibilities in diagnosis, therapy and monitoring at a distance and/or in places otherwise difficult to reach. Reducing cost would result from keeping patients out of care facilities through preventative care solutions and timely diagnosis, as well as by reducing errors and amplifying the productivity of the health care providers. Regarding cost, technology integration into medicine has often been responsible for increasing the cost of care, a point to keep in mind.
Table 2: Opportunities and challenges in adoption of digital health
|Acquisition and ownership cost|
|Clinical and health education|
The rate of adoption or digital health will however depend on overcoming the challenges, including technology availability, acquisition and ownership cost, regulatory efficiency, reimbursement policy, clinical and health education, demonstrated outcomes and patient awareness. Technology availability refers to the extent and richness of solutions possible to a wide range of health problems. Acquisition and ownership cost refer to costs associated with purchasing the solutions and operating/maintaining them, respectively. Regulatory efficiency refers to the time and cost associated with obtaining approval for specific solutions to particular problems. Reimbursement policy refers to covering the cost of utilizing digital health solutions, including when used for prevention, which is a great application opportunity but not reimbursable in the current system, for the most part. Clinical and health education refers to the need for the health providers to adopt digital health solutions and know when/how to deploy them; it also includes teaching patients about preventative and self-management practices. Demonstrated outcomes refers to clinical or field studies that show the efficacy of digital health solutions. Finally, patient awareness refers to the visibility of patients into digital health solutions to promote their self-interests and to gain their willingness to use such solutions.
Fortunately, there has been tremendous progress in overcoming these challenges over the last five years as the potential of digital health has been recognized. The current pandemic has been a catalyst of visibility for digital health and has significantly accelerated its acceptance into the health care system.