Digital Health: A Primer for the Practicing Clinician

Hello, my name is Ben Schwartz, and this presentation is on Digital Health, a primer for the practicing clinician.

By way of introduction, I'm a fellowship trained Tiff and Knee Replacement orthopedic surgeon. I serve as Chief Innovation Officer of Healent, a Digital Health company working on remote patient monitoring for musculoskeletal conditions. I was named a LinkedIn top voice for Frontline Healthcare in the year 2020, and I'm also a Healthcare Technology enthusiast. The objectives of this talk are to discuss the what, why, and how of Digital Health. What is Digital Health? Why should I care, and how do I get involved?

So what is Digital Health? From the FDA website, Digital Health is defined as technologies that use computing platforms, connectivity, software, and sensors for healthcare and related uses.

This definition of Digital Health comes from a white paper written by David Rowlands from Australia. He defines Digital Health as in fact something quite new, an evolutionary step in the use of information and communications Technology in the health sector, but a step that transcends Technology.

In essence, Digital Health can be broadly defined as the convergence of Technology and Medicine.

The goal is to leverage Technology to improve outcomes, enhance Efficiency, and increase value by lowering costs and providing better quality, and most importantly, to support the patient and the healthcare provider.

Digital Health encompasses a broad array of companies, products, and services including Lavongo, a Digital Health startup, the Stryker Mako Robot for computer assisted surgeries, the Apple Watch, a consumer wearable device, a large electronic medical record company such as Epic, and even a Peloton bike which combines wellness and Technology.

So if you're a practicing clinician, why should you care about Healthcare Technology? For us, our exposure to Digital Health often has come in the form of the electronic medical record, which increases our frustration and decreases our Productivity. It's not clear what Digital Health even means. It's a very broad category that's poorly defined.

Healthcare Technology may represent just another intrusion by outsiders looking to get their slice of the nearly $4 trillion healthcare pie, and the idea in Technology often is to move fast and break things, which goes against our tendency in healthcare to practice evidence-based Medicine and to carefully adopt new approaches to care.

This chart represents digital advancement by sector. Any blue areas on the chart represent high digitization, and any gray areas represent low digitization. On the left hand side, the different sectors are listed in order of decreasing digital advancement. If you look, healthcare falls 4th from the bottom, and there are only gray boxes, no blue boxes. This means that healthcare lags behind Other industries in the adoption of Technology, and this could be to the detriment of our patients.

It's important to have a balancing act between moving fast and breaking things and adopting evidence-based approaches.

But we must be open to the use of Technology in healthcare.

This chart put out by Rock Health shows Digital Health funding between the years 2011 and 2019, and as you can see over the course of those years, the amount of venture funding for Digital Health has increased significantly, with $8.2 billion invested in 2018 and $7.4 billion in 2019.

Every indication is that 2020 is going to be another record setting year for Digital Health funding, which is amazing when you consider we were in the midst of a generational Pandemic. Despite this, there is still a lot of venture capital money flowing into Digital Health.

In addition to the venture funding of Healthcare Technology startups, Big Tech has also taken an interest in healthcare. Google has formed partnerships with Highmark Health, the Mayo Clinic, and HCA, among others. They've released their Google Health Research app and they've made multi-million dollar investments in companies such as Amwell, Clare, and others.

Verily, Google's Life Sciences arm is also getting in the insurance game with a company called Coefficient. They completed a $700 million investment round at the end of 2020, and they've rolled out Project Baseline, which is an attempt to bring healthcare Research to the public.

Not to be outdone, Apple has also shown an interest in healthcare.

Their CEO Tim Cook said that health will be Apple's greatest contribution to mankind. Apple also continues to push its consumer wearable watch device as a health-focused device, releasing the ability to monitor blood oxygen saturation with the most recent version of the watch. Apple is also supporting health records, which is a secure way for patients to take their medical records with them on their iPhones, and Apple is also supporting Research through their Research kit.

Not to be outdone, Amazon is also making a strong push into healthcare. They continually add health functions to their Alexa devices. They bought Tillpack. They've started Amazon Pharmacy. Amazon also has numerous partnerships with hospitals like Beth Israel Deaconess Medical Center and Boston Children's Hospital. They formed partnerships with companies like Lavongo, Express Scripts, and Cigna, and they even have partnerships with the National Health Service in Great Britain. Last year, Amazon started Amazon Care.

To deliver Primary care to its own employees, and Amazon Web Services is a cloud-based data collection and analysis service which has broad applications in healthcare.

This is Vinod Khosla. He's a well-known Silicon Valley entrepreneur and venture capitalist, and he's had some pretty interesting things to say about healthcare and Technology. He has said that healthcare is like witchcraft and just based on tradition. He said that eventually computers will replace 80% of what doctors do.

Expecting the medical establishment to do anything different is expecting them to reduce their own profits, and Innovation seldom happens from the inside. This is a fairly cynical take on healthcare's ability to fix itself, and KOSA seems to believe that true Innovation in healthcare will come from the outside and not from within.

All of this raises the question of whether or not clinicians are becoming obsolete. There are studies showing that Artificial intelligence can be better than radiologists at detecting lung masses on CT scans or breast masses on mammography. We've seen the rise of chatbot and algorithms meant to replace some of the decision making process that clinicians go through, and currently we have Robotic-assisted Surgery, but you can imagine a future where the assistant is eliminated and the robot is doing the Surgery.

On the right hand side is a quote from David Shawitz.

From an article that he wrote in The Atlantic in October of 2011, so almost 10 years ago now, and he said the idea that physicians are going to be far less important in the Medicine of the future seems to be a central assumption of many next generation health companies.

While all this would seem to indicate that clinicians will be less and less important in Medicine in the future, I believe it's a call to action. We know the marriage of healthcare and Technology is the future of Medicine, but I believe success depends on collaboration between those with real world clinical experience and innovators and technologists looking to improve healthcare. In order for these efforts to be successful, I believe clinicians must be intimately involved.

So how do you get involved in Digital Health? Well, there's really no one right way. I think it's important to define your goals, figure out what you're trying to accomplish. Are you looking to advise a startup company? Are you looking to join a more established company, or are you looking to start a company of your own? Decide what you can contribute. For many of us that are practicing clinicians, one of the most important things that we can contribute is our experience in real world Medicine.

You can leverage Social Media to make connections and grow your network, and you can invest in Healthcare Technology startup companies as a way to gain some experience in the realm of Digital Health. So one way to get involved is to become a mentor or an adviser. There's different organizations, accelerators, and incubators that offer opportunities for clinicians to get involved. These include Better Health out of Chicago, Mass Challenge, Tech Stars, Plug and play Tech Center from Silicon Valley.

And MIT hacking Medicine from Cambridge. This is not an exhaustive list, but it's a good place to start if you're looking to get some experience in Digital Health and become a mentor or an adviser. Joining an organization is another great way to get involved, and there are several organizations that are focused on Healthcare innovation and Digital Health. This includes the Health Care Information and Management Systems Society, or HIEIMMS, the Digital Medicine Society, or DIME, the Society of Physician Entrepreneurs, or SOAPE.

The Physician Innovation Network, or PIN, which is part of the American Medical Association, although you do not need to be an AMA member to join, and Innovator MD, which is an organization that brings together

Entrepreneurial and innovative physicians and clinicians.

Subscribing to a newsletter can help you stay informed in terms of what's going on in the Digital Health world. This includes Rock Weekly put out by Rock Health, the Digital and Innovation Report put out by Beckers Healthcare, Rama on Healthcare, which culls different stories from across the web focused on Digital Health, and Stanford Medicine's Center for Digital Health also puts out a weekly newsletter. These newsletters come to your email inbox and are a great way to stay on top of current happenings in the world of Healthcare Technology.

There are many books focused on Healthcare Technology and Digital Health. This is not meant to be an exhaustive list, but it's a good place to start to gain some knowledge about Healthcare Technology. Deep Medicine was written by Eric Topo, a well-known Digital Health physician.

AI and Health was written by Tom Lowry of Microsoft, and these are two Other books on healthcare digital transformation.

And Digital Health Revolution written by Edward Marks and Kevin Perot, which are a great place to start to learn more about this topic.

Finally, reaching out and networking is another way to gain some more experience and exposure in Digital Health. I'm more than happy to talk to anyone who has an interest in this topic. You can connect with me on LinkedIn. This is my email address, and we've also started a Digital Health discussion group on doc.social, which is open to anybody that has an interest in Healthcare innovation and Entrepreneurship.

Thank you for your time and attention and good luck on your journey into the world of digital healthcare.