Investments in the digital health sector dipped substantially last year compared to the prior year, from $15.3 billion in 2022 to $10.7 billion in 2023. While funding in the industry has decreased, so has the need to rethink how digital therapeutics are created to ensure clinical effectiveness and company longevity.

Dr. Guido Giunti, leader of the digital therapeutics research group at the University of Oulu in Finland and adjunct professor at Trinity College Dublin in Ireland, sat down with MobiHealthNews to discuss the potential impacts of digital therapeutics and his advice to developers creating the tools. 

MobiHealthNews: You highlighted your work with MS patients at the HIMSS Global Conference in Florida in March, but you also work on many other projects with heavy patient involvement. Can you tell our readers about those projects?

Dr. Guido Giunti: I am involved in different projects here in Finland and also in Ireland.  

A lot of the work I've been doing right now has been focused on how to involve patients in the design and development of digital health.

The whole point of public and patient involvement is to be inclusive, and we always say that we want to place patients in the center and all of those things, but when you take it into practice, we tend to just think of them as participants in studies and not as actual coequals to you and your team. 

So, for example, one of the things that we're working on has to do with exploring how the dynamic changes when all of the sudden you have a patient representative as part of your design and development team. What happens when it's now another employee?

Because we're used to considering these as beneficial relationships, but the second that you change things and add reimbursements, you create a transactional relationship, how does that really affect you as a professional? Or as a patient? 

Are you still a typical patient even though now you have become professionalized and get paid to give your insights? From another perspective, how much should we train them on the expert or technical level? Does that take away from being now an average patient? 

That's really interesting, and there's a lot of tension with that. A lot of the work we do has to do with using participatory design and participatory development of digital health solutions.  

MHN: What is it about digital therapeutics that convinces you the technology will have a positive impact?

Giunti: Well, that's a really interesting and important question. To be honest, I think that we are still narrowing down how they are going to have an impact and where. I strongly believe that we still need to work more on the research side to avoid committing the mistake of translating drug-type thinking into digital thinking. It may be that we're using the wrong tools for that. 

We are carrying on with the thinking of reaching the largest population possible when creating digital health solutions. If you're thinking about producing a drug, that makes sense, because of the billions of dollars' worth of investment to reach that point. But I think that there's a problem, because technology allows for a very targeted approach.

The approach we’ve been taking with More Stamina, the MS self-management fatigue solution we are working on in Finland, is to see how we can create evidence, not only at the very end of the process, when you just want to test whether it works or is effective, but for all aspects of the design and development process. Otherwise, solutions are just black boxes that we measure the outcome of.

MHN: As someone who creates these solutions, what advice would you give developers devising digital therapeutics?

Giunti: I would really say know your audience, and I think that has several layers. 

So, on the one hand, you really need to know who is your target population to really cater to them. But at the same time, know who your customer is. One of the main challenges that we are having all the time with these digital therapeutics is, what is your path to reimbursement? 

At times I get this feeling that we're kind of in this bubble right now. The money goes in, because well, you're showing traction, you're showing people are using it or are interested in your product, but ... it's like this episode of South Park where gnomes make a business plan to steal underpants: phase one, collect underpants, phase two, question mark, phase three, profit.

In the digital health space, sometimes it seems like it’s: phase one, collect data, phase two, question mark, phase three, profit. It’s not really clear what the right approach is.

At the same time, we are digital people now, and the demand for our attention is huge. If I go through your phone, you are probably going to have just the messaging and social media as the permanent residents there, some work apps, and then there are ones that you just haven't deleted because why bother? We don't use the same apps forever, so why would that be true for digital health?  

So, I think that the challenge that we have for digital therapeutics is that we need to understand the level of ultra-segmentation that we can achieve.

Companies need to take that into consideration when thinking about their digital therapeutics, because it may be that the solution will only be effective for a year or two, and that should not be cause for despair.

MHN: So then, the patient experience needs to change too.

Giunti: Absolutely, I think we need to be able to cater to them with, like, an array of solutions for their condition, considering the different moments and problems, and understand that they're going to have different engagement levels instead of thinking that we are going to have a "cure all app."