Adoption has all too often been a source of consternation for the digital health ecosystem. The traditional healthcare stakeholders and indeed a large segment of consumers have found ample reason to hesitate before implementing, using or paying for the myriad new technologies promising to streamline healthcare access, delivery and management. There are various reasons for this which we’ll get into, but first of all it’s worth taking a moment to understand the current state of play. What’s rising, what’s sinking, and where?
A great place to start would be Rock Health’s Digital Health Consumer Adoption survey, last year’s rendition of which painted an interesting picture of a shifting market. For example, while it’s still more common for consumers to use wearables in pursuit of fitness goals than for any other reason, the number of users citing that motivation dropped a full ten percent in 2018, the decline being offset by an inverse ten percent rise in those using wearables to manage a health condition, indicating an increasingly complex use case. Discontinuation, of course, remains a significant challenge for this particular genre of product: a wearable that’s served its purpose, failed to serve its purpose, or simply offended its owner’s aesthetic taste, is easily discarded. But the thrust of the report is nonetheless positive, with 89% of respondents reporting use of at least one digital health tool.
Bearing in mind that the survey focuses exclusively on North America, I’d also point out that the APAC region—and specifically China, nowadays the world’s largest wearables market—is making comparatively enormous strides. Philips’s Future Health Index 2019 names China as a “positive outlier in terms of healthcare professionals encouraging their patients to track healthcare data”, a trend which has deepened patient engagement and led a higher percentage of users to seek professional medical advice regarding the data they’ve gained access to—digital health working exactly as it should. That the US lags behind in adoption of many digital health product areas is not lost on the nation’s providers. A 2017 report from SERMO, the global social network for doctors, found that only 15 percent of US respondents rated their state’s use of telehealth services ‘well’ or ‘very well’; 44 percent, a plurality, chose either ‘poor’, or ‘very poor’. In the United Kingdom the story was worse still, with 62 percent, an outright majority, responding negatively.
In such a complex network of interlocking stakeholders, technologies and interests, totalising statements are best avoided, since any discussion around adoption of digital health interventions and products is fated to be complex. What delights a consumer might leave a provider cold, and what thrives in a particular market might flop in another.
Take digital health apps, for example. These are deeply consumer-centric products, yet the consumer market is proving tough to crack. Paddy Padmanabhan points out that the payment mechanism behind apps is a core problem—if the best way to make money is to sell to a provider (whose requirements are very particular) user satisfaction is bound to pay the price. Essentially, the apps with the highest adoption rates are those with a consumer-centric and, crucially, interoperable designs which slot neatly into everyday life. With telehealth, it seems the problem may be a lack of confidence in the idea itself, namely in the efficacy of remote clinician visits, especially among patients who are uncertain as to their condition or the action required. Telehealth is more widely used when it serves as a shortcut, uniting a patient with an already-determined treatment; both convenience and trustworthiness are proving to be critical success factors.
Hospitals and Health Systems on the other hand, are more likely to cite technical and administrative challenges as their key limitations. Of the 220 health IT executives surveyed by HIMSS, 64 percent regarded their own uptake of mobile and digital technologies to be wanting, the most common explanations being cultural resistance from clinicians, legacy systems, a dearth of skilled IT staff, and cybersecurity concerns.
I certainly don’t have the answers to such a diverse set of problems, but it’s important that the ecosystem does begin to remedy this issue—after all, high adoption rates define success stories which in turn demonstrate return on investment, without which investment is at risk of drying up. This is just this question Chandana Fitzgerald, CMO of HealthXL, asked back in May: after so much investment, where is the return and how exactly do we calculate it? An objective measurement of ROI in digital health is hard to come across, since the nebulous terms that we tend to rely upon to describe positive outcomes aren’t necessarily easy to translate to concrete metrics.
To summarise, adoption of digital health crosses a lot of boundaries and is ultimately too complex to do justice to here; but we can certainly identify some core success factors. At the level of individual products and interventions, interoperability, convenience, and sustainable, scalable payment mechanisms are crucial. For the ecosystem as a whole, it’s about understanding where value is created, for whom, and how to make sure one stakeholder’s interests don’t run up against those of another. Here’s hoping that as the digital revolution continues to blossom, we’ll see closer ecosystem collaboration to achieve make healthcare the best it can be for all that need it.