We are in a new communication age in which change has happened so fast that the technology we use every day was unimaginable to most of us 20 years ago. Data show that 77% of Americans now own a smartphone and that ownership is ubiquitous in the 18- to 29-year-old age group. Older citizens are catching up, with 74% of 50- to 65-year-olds connecting in this way; however, this rate decreases to 42% among those over the age of 65.
Digital technology and much of the “disruptive innovation” that is needed in health care delivery is likely to be driven by start-ups, which are often run by educated 20- to 30-year-olds. However, these people are not the same as those who may be the greatest users of health care, such as the oldest old, lower-income patients, and individuals with chronic health care problems. To ensure that we engage the patient groups who have much to gain from the more flexible health care interactions that digital innovation can provide, we must consider issues of computer literacy, access, and trust.
The USC Center for Body Computing
At the USC Center for Body Computing, University of Southern California’s digital health and innovation center, we have been working on innovative digital health programs that are safe, effective, and accessible to all patients. Our team works along with a diverse group of non-medical experts, including representatives from the design and creative communities, to gain an understanding of how to use asynchronous communication (e.g., text messaging) and to harness the power of social networks to support care and facilitate communication in an ongoing and continuous digital platform.
The health care solutions of the future will be patient-facing and directed toward patient education, self-management, and on-demand diagnostics and service; therefore, medical care should become more of a continuous experience that patients can access when and where they need it. Adding on-demand services such as the ability to obtain medical information specific to the individual, real-time diagnostics, and communication with health experts has huge potential in that it creates a unique opportunity to design digital disease management solutions for patients that address as many of their health care needs as possible.
One of the unique aspects of digital technologies is that they allow for the integration of information from across a patient’s entire care network. For example, we designed a mobile app for drug adherence for hypertension that also provides dietary information, activity tracking, a supportive social network, and texting ability to facilitate communication between patients, patient-designated caregivers, and physicians. In addition to creating digital health products, the Center for Body Computing works with digital designers to research the ability of patients to use digital hardware and software tools for health purposes. Digital health access also means that patients have uninterrupted and stable data plans and networks, regardless of their economic or educational status.
The Virtual Care Clinic
Digital communication and cloud-based data storage allow for a completely different model of health care that does not depend on patient visits to a brick-and-mortar health care facility and, therefore, can provide the greatest advantage for patients for whom such visits are physically or financially challenging. This model, known as the Virtual Care Clinic, has been an important unifying construct for us because it represents a health care model in which the patient drives the health care interaction and digital technologies are used to continuously provide information and integration of services.
We understand that these solutions must reach individuals who are not currently well served by traditional health care, such as patients without insurance or access. The Virtual Care Clinic model has no borders and is a digital system of care with the potential to reach any patient who has a smartphone anywhere in the world. As more people in the world have mobile phones than have toilets or potable water, virtual care is a very tenable model. Close attention to user interfaces that will positively engage patients who are illiterate, elderly, or disabled is an essential element of our work. Cyber security, novel clinical trial design, and governmental regulatory and payer policies regarding digital health delivery are all-important elements of our work.
Our goal is to create durable experiences for patients, caregivers, and medical professionals who provide on-demand services not only to patients within our network, but also to patients with an Internet connection anywhere in the world. We have developed and are testing several mobile apps for patients with heart failure across the heart disease spectrum, such as a heart failure–specific rehabilitation app for use after hospital discharge and an app designed to manage patients after the implantation of a left ventricular assist device.
Chronic conditions such as heart failure are often difficult for patients to manage because of the gaps and delays in communication between their caregivers and clinicians. Constant tracking of medication adherence, activity, and diet, and the ability to change a management plan on the basis of a change in patient status, are better suited to a digital model of care. In all instances, these applications leverage activity sensors already present in smartphones, social networks, and asynchronous communication, and they provide medical education specific to the patient’s condition.
Virtual Human Caregivers
Working with the USC Institute for Creative Technologies, we have created Virtual Human caregivers that use voice-recognition artificial intelligence and can provide disease-specific health information to patients on demand. Early data, including those collected from veterans suffering from post-traumatic stress disorder, indicate that some subjects are more comfortable disclosing information and communicating with virtual human agents rather than actual humans.
Modeled after our own expert providers, the virtual human physician is a deep subject matter expert that can be accessed on demand to provide the most up-to-date information about any condition, such as atrial fibrillation, and updated digitally to meet the unique needs of every individual.
Digital Technology for Behavioral Health
Digital health technology also appears to offer new solutions for the management of behavioral health. Behavioral health issues such as social isolation and depression are risk factors for health as much as smoking and obesity are. Globally, individuals over 60 represent the fastest-growing age group, and, in the developed world, individuals over 80 represent the fastest-growing sector of the older population, according to the United Nations. Patients in the latter age group not only may have multiple comorbidities, but they may also suffer from social isolation and loneliness. Assisting these patients with the use of digital technology could help them to become more active participants in their health care and also could increase their connectivity and social engagement.
Ensuring that we design digital technology to maximize engagement by considering the challenges posed by age, sensory impairment and cognitive decline, and access is central to minimizing the “digital divide” and may help to realize potential benefits to improve patient engagement and outcomes.
This article originally appeared in NEJM Catalyst on June 15, 2017.