Driving Digital Health adoption – it’s all and only about value

Technology is advancing at a rapid pace, leaving the world obsessed with innovation. But before we wonder ‘What’s next’, we must first ask ‘What’s in it for me?’, especially in healthcare. After all, how can anything take off long-term if it doesn’t actually work?

Cue Value-Based Digital Health (VBDH), an emerging discipline that focuses on defining, delivering and measuring the value of digital health (DH) products throughout their lifecycle.

It’s a strong reminder that honing in on the benefits to real-world users from the get-go, and not as an afterthought, is key to the sustained adoption of DH solutions.

DH categories and areas of impact

The world of DH is broad and varied, encompassing many different tools and products. But there are two specific areas where VBDH can be the most transformative.?

The Digital Therapeutics Alliance provides a three-level model to categorise everything within DH:

1. Digital Health: All digital tools and services aimed at improving health outcomes and healthcare processes.
2. Digital Medicine: A subset of Digital Health products spanning evidence-based software and digital tools that deliver clinical interventions for diagnosing, treating or managing diseases and conditions.
3. Digital Therapeutics (DxT): A subset of Digital Medicine products comprising evidence-based therapeutic interventions to prevent, manage or treat medical disorders or diseases.

Digital Medicine and DxT – areas generally expected to be subsidised – are where VBDH can have the greatest impact in revolutionising healthcare.?

Products more central at the DxT level like Propeller Health, a platform for tracking, managing and using medications, and dNAV, a technology making insulin therapy more safe, accurate and effective, are specialist, clinically-validated tools that often require a prescription.?

On the outer rim are applications that are more accessible by end users and generally used for improving wellbeing aspects such as exercise, stress and weight loss.?

Uptake of DH in Australia – who foots the bill?

Over the past two decades, we’ve seen a surge in the use of DH tools and interventions in Australia alone. A change only accelerated by COVID-19.?

Yet there’s still much more scope for uptake.?

For a long time the government has covered 75% of healthcare in the country, and many expect it to stay this way instead of shifting to a more privatised model where only 55% is subsidised. A case the US is notoriously known for.?

So you wouldn’t be alone in assuming that the government would pay for most digitally-enabled healthcare. But what’s the process?

Traditionally, the government has used Health Technology Assessments (HTAs) to determine whether new ‘technology’ – a term encapsulating new drugs, surgeries and equipment – will provide real value and subsequently, its eligibility for funding.

It’s therefore only natural to believe that DH solutions, particularly specialist ones in digital medicine and DxT, would be assessed on the same grounds.?

HTAs ?? VBDH (??Information Systems)?

A globally-agreed definition for HTA is that it’s a multidisciplinary process using explicit methods to determine the value of a health technology at different points in its lifecycle. It exists to inform decision-making and promote an equitable, efficient and high-quality health system.

Sounds a lot like the aim of VBDH doesn’t it?

But HTAs can often be black and white. And the impact of DH tools and products can be far more complex, having a ripple effect on multiple people in a multitude of ways.

That’s why we must incorporate another perspective for a more sophisticated assessment – that of information systems (IS).

The mission of IS research is defined as ‘advancing knowledge about the effective and efficient use of information technology by individuals, groups, organisations, society and nations for the improvement of economic and social welfare’.?

The IS’ focus on using technology in a way that improves wellbeing lends itself to the concept of achieving value not only within healthcare but also across the broader realm of business environments – aligning with the goals of HTAs and VBDH while providing a more comprehensive lens.

Where to from here?

It’s increasingly acknowledged by the HTA community in Australia and globally that DH is an area ripe for investigation and support.?

Combined with the challenges to driving greater uptake of safe and effective DH solutions, a key opportunity for impact has emerged for specialist work in VBDH.?

An example starting point would be applying the PICOTS-ComTeC framework to ensure that Complexity, Technology and Context (ComTeC) are considered alongside the traditional factors of? Population, Intervention, Comparator, Outcomes, Timing and Setting (PICOTS). This helps deliver a holistic assessment that captures the multifaceted nature of DH solutions.?

What are your thoughts on how we can advance VBDH to drive the sustained adoption of DH products and tools?