The evolution was not televised

The rise and fall (and A.I. fueled rise?) of digital health?

Its been a longtime coming...

The digitization of healthcare is into its 3rd decade. I've been researching the 'phenomenon' for nearly 20 years, boldly predicting [ahem, correctly] in 2009 that 'online consultations were along way off'. They were. The technology widely available and used commercially long before the advent of telemedicine.

Ben Gibbons, who carried out the study , said some aspects of internet activity, such as online consultations, may seem a long way off, "but the speed with which technology and trends are developing means pharmaceutical companies should start to examine what this, and the other findings from the insight, might mean for them."

Most healthcare companies did not seriously start to understand the digital needs and behaviors of its customers and patients until 2020 when they had no choice. Until then the industry carried on its model until forced to change. gaining very little benefit in digital health.

Understanding digital needs and behaviors

Prior to the necessity brought by the pandemic, digital health technologies largely failed to excite consumers or providers. In part this was due to a combination of functional annoyances (interoperability, reliability and accuracy) for health systems and providers and a lack of appeal for the vast majority of the general population (except those already engaged in tracking performance or reaching a health goal.) Simply put, digital health tools failed to connect to user needs and provide a solution for a recognized problem.

So, what of the revolution seemingly nobody cared about?

RéVOLUTION! РЕВОЛЮЦИЯ! REVOLUTION!

Revolution is big, societally chaotic, often violent. They've been quiet, silent . . . even velvet. Technologically, discoveries have led to rapid industrial change to a country, a region with global implications for the centuries following.

However they happen, what comes after is not what came before and it never is again. A total transformation.

The term 'digital health,' coined so long ago by Seth Frank in 2000, referenced the Worldwide Web as the catalyst to change. Talk of REVOLUTION was not until the 2010s.

The hyperbole, and hysteria really got going in the middle of that decade. Exciting new terms such as personalized health ecosystems, new digitized health models, and digital paradigms of patient-centered care to name a few were often cited as essential in the new service delivery approach in healthcare.

Following the seismic launch of the iPhone 7 years earlier, Apple Health (it's always Apple) launched in 2014 fueling the belief this [change] must be real. Everything will change.

Lots of noise (to those listening). But to most of us. Nothing. Wait for it...the 4th industrial revolution is happening. More nothing. Billions and billions of dollars pouring in. Still healthcare largely did what healthcare always has. Moved slowly. And everyone was OK with that. Then...

COVID!! Suddenly, there was an immediate need. A massive one. THE facilitator to adoption. Additionally, the tech had moved on. No longer just the Worldwide Web. Near universal smartphone adoption, superfast always connected pocket computers with sensors/trackers, and high quality digital cameras. 10+ years of data (BIG DATA), machine-learning, artificial intelligence (but not really) and so on.

This was healthcare in the 'New Normal', this was it. No.

The new 'new normal' became the old 'new normal'.

No total digital transformation in healthcare. In the U.S., telehealth a cornerstone in digital health service delivery, use?totaled 5.5% of medical claim lines in February 2023, a drop of 6.8% from January 2023, according to Fair Health’s monthly telehealth tracker.

Investor hype (which it always was) has died down or went bust. To some extent, we've entered an era with talk of the 'death of digital health'.

The sprawling digital health category remaining disjointed and confusing.

No revolution after all.

Evolution: Total transformation

There was never going to be. Those in health delivery, and drug development probably always knew.

It was the 'disruptors', 'change-makers', those who saw the margins in healthcare and pharma, and that the pace of development as too slow. True, there are many genuine inefficiencies in need of improvement. But an industry ripe for the taking by Silicon Valley? Where vast amounts of fast money was to be made (or missed out on).

In reality, healthcare of the past 20 years has been through huge change and massive 'digital' transformation and is still evolving and quickly.

Evolution. To investors' ears is not exciting. It sounds like an excuse when growth has stalled.

But what now?

We're through a once in a century no-going-back global event, and in many countries, in an era of total connectivity. Healthcare delivery still feels largely as it was in 2020.

There will be a necessary period of consolidation. Digital health startups are feeling the pressure. Money has dried up and business models are being questioned. Pioneering companies like Pear Therapeutics have gone bust. But still nearly daily announcements of the latest 'revolutionary' innovations for healthcare keep coming (in spite of the naysayers).

In the words of Colombo...,

If you're reading this then your feed is jam-packed with news that ChatGPT changes EVERYTHING.

How, and how quickly in healthcare remains to be seen?

The regulatory and reimbursement barriers that have stifled digital health still exist. They will/are being removed. Driven in part by the cost of keeping aging populations healthy or at least out of hospital.

The benefit(s) in the application of A.I could be the driving force in the rapid, albeit delayed technological revolution in healthcare.

Still, digital health as a category is confusing. To now, it has not translated industry excitement into end users who are willing to pay for its products.

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