About the author: John Crawford is the founder and managing director of Crawford Works, and an independent consultant with experience in digital health. Until 2018, he was the Healthcare Industry Leader for Europe at IBM, and, from 2016 to 2018, a director of the Global Board of HIMSS, owner of MobiHealthNews. He is now an advisory consultant for HIMSS in Europe. The opinions in this piece are those of the author and do not necessarily reflect the opinions of MobiHealthNews or HIMSS.
Since the introduction of the first smartphones, we have seen enormous growth in the availability of applications connected with managing our health. According to ORCHA, a UK-based organisation which reviews and evaluates health apps, there are currently over 327,000 such platforms available to download.
On their website, ORCHA assert that just 43 apps are responsible for more than 83% of all health app downloads, and that over 80% of health apps don’t get more than 5,000 downloads. These numbers confirm that we are still far from market maturity, with much experimentation going on, and a surprisingly small proportion of apps achieving significant scale. Even patients managing long-term conditions such as diabetes and COPD, which one might think would benefit from the use of a health app, are slow to adopt these tools, with ORCHA suggesting adoption rates of just 7% for diabetes, and 2% for COPD.
There are of course many reasons for this lack of take-up, including limited awareness among both patients and doctors, insufficient evidence of effectiveness based on clinical studies, sometimes questionable quality and usability, and concerns about data ownership. Nevertheless, it is likely that some of these apps will begin to establish themselves as essential support services in our pockets, in the same way that others such as email, instant messaging, navigational aids, transport, newsfeed and social media have already done.
Much of the activity so far has centred around the B2C or consumer market, often for apps that are aimed at supporting or coaching for physical fitness, diet, weight management, mindfulness and others, in addition to managing the more common long-term conditions. More recently, we have seen an increasing number of apps that are designed to encourage healthy lifestyles, to reduce the risk of disease, by ‘nudging’ us at the right moments to make healthier choices. These all have their place, but are unlikely to be prescribed as part of a consultation with a medical professional, and will typically be located, downloaded and tried by motivated individuals with a specific goal in mind.
Accelerating the feedback loop
However, in the past few years the new category of apps and services known as digital therapeutics has entered the lexicon. These apps are designed to be used on their own, or in combination with devices such as wearables or with medications, to provide evidence-based interventions to prevent, manage or treat various conditions. The standard of evidence expected of digital therapeutics is much higher, ideally based on blinded trial results published in scientific journals. The potential impact of these innovations, if truly effective and if made accessible to large portions of the population, could be profound.
In the case of mental or behavioural health, for example, where there is limited access in many healthcare systems, the treatment of stress, anxiety, depression and other mood disorders could be transformed by prescribing digital therapeutics in place of more conventional face-to-face services. Similarly, when dealing with alcohol or drug abuse, or many other forms of addiction, there are promising signs that these innovations may be helpful in achieving lasting behaviour change. Even improving those human activities that we need to optimise for a healthy existence, such as sleep, can be aided by a better understanding of our real sleep quality combined with personalised education and coaching. The ability of these apps, combined with sensors, to accelerate the feedback loop could make a significant difference to outcomes, and at a low cost compared to alternatives.
Recognition of the potential for such interventions is growing quickly. In addition to digital innovators, who are often new and agile entrants into the healthcare market, the pharmaceutical sector is now taking a strong interest this field, with several software-only solutions being granted FDA approval over the past two years.
On 21 November, an entire day will be dedicated to the consideration of digital therapeutics at the Week of Health and Innovation (WHINN) 2019 conference in Odense, Denmark, where there will be presentations from researchers and companies working in medical domains including pain management, IBD, psoriasis, brain health, and physical & mental rehabilitation. This will provide an opportunity to assess the value of the solutions available today, and how to make them available at scale. It will also feature a glimpse into the near future, with the possibility of AI and machine learning supporting greater personalisation and deeper insight.
HIMSS will be organising as part of the WHINN event in Denmark a CXO Dialogue taking place on 19 November and a session in the Digital Health Track on 21 November. More information can be found here. MobiHealthNews is a HIMSS Media publication.
