Digital Health for the Practicing Clinician

Hi, I'm Ben Schwartz, and this is my updated version of Digital Health, a primer for the practicing clinician.

These are my disclosures. I'm an investor in several Healthcare Technology startups. I'm an advisor for Heelent, Osteoap.AI, and PrecisionOS. I serve on the Medical advisory board of Buoy Health, and I serve several clinical Leadership roles in the field of Orthopedics.

By way of a brief introduction, I'm a fellowship trained Hip and Knee replacement orthopedic surgeon. I completed an MBA at the Quantic School of Business and Technology in 2020. I was named a LinkedIn top voice for Frontline Healthcare, and I consider myself to be a Healthcare Technology and Innovation enthusiast like many of you, and I hope you all find this talk helpful in your own journeys.

So the objectives of this talk are to first define what is Digital Health, to outline why as a clinician you should care about Digital Health.

And to go through some steps that you can take to get involved in this burgeoning field.

So in defining Digital Health, the FDA website says that Digital Health includes technologies that use computing platforms, connectivity, software, and sensors for healthcare and related uses.

In a white paper, David Rowlands defined Digital Health as something that's in fact quite new. It's an evolutionary step in the use of information and communications Technology in the health sector, but he felt that using Technology in this way to apply to healthcare really transcends Technology itself.

So in reality, Digital Health can be thought of as the convergence of Technology and Medicine, and the ideal behind Digital Health is that it allows us to leverage Technology to improve outcomes, to enhance Efficiency in the way that we deliver care, to increase the value of healthcare by delivering lower costs and providing better quality, and also to support both the patient and the clinician.

In fact, Digital Health is really a very broad term. It can apply to a large electronic health record like Epic. It might be a chronic care platform like Lavongo. The Peloton bicycle can be considered part of Digital Health, as can a consumer wearable like the Apple Watch, or even a Robotic-assisted Surgery like the Stryker Mako Robot. All of these things technically qualify as Digital Health, so it's a very large, broad catch-all term.

So I would argue that Digital Health is no longer in its infancy, but it's still in its early stages, and it's really a constantly evolving concept. In reality, Digital Health encompasses more than just Technology and healthcare. I think it's really a part of a broader idea of Healthcare innovation, and that is really changing the way that we deliver healthcare and trying to improve the processes that currently exist.

At the same time, I think it's important to define and clearly delineate what Digital Health is not. Digital Health should not be seen as a replacement for evidence-based, high quality, high value care. It's not a substitute for the clinician-patient relationship, which remains at the core of healthcare, and it's not a magic cure-all for all of healthcare's ills.

So if you're a clinician, you might be asking yourself, why should I care about Digital Health. For many of us, our interaction with Technology and healthcare has been through the electronic medical record, and that hasn't been a great interaction. We consider EMR to be a four-letter word.

As we saw in previous slides, Digital Health is really a broad catch-all term. So what does Digital Health really even mean? Is this just another intrusion by outsiders looking to get their slice of the large healthcare money pie? And in healthcare, traditionally we don't like the idea of moving fast and breaking things, which is what a lot of Digital Health or Technology in healthcare may seem to be.

So we know that healthcare lags behind Other industries in the adoption of Technology, and this could be to the detriment of our patients if we're not taking full advantage of Technology to improve the way that we deliver care. It's really a balancing act between moving fast and breaking things and taking a more evidence-based Approach to care delivery. So if you look at this chart to the right, it shows digital advancement by sector.

And gray areas are areas of low digitization and blue areas are areas of high digitization.

At the top is IT, media, professional services. These are areas that have embraced Technology and really leveraged Technology in their individual sector. But if we look a little bit further down, 4th from the bottom is healthcare. It's all gray boxes. There's no blue boxes, and so there's really low digitization of healthcare, and we really have not taken advantage of Technology in healthcare.

So there's really been a tremendous amount of interest and investment in Healthcare Technology and Digital Health. This is a chart from Rock Health that starts in 2012 and goes through the first half of 2022, and it looks at Digital Health funding and deal size.

And as you can see, the trend over time has been an increase in the amount of money invested in Digital Health companies over time, as well as an increase in the number of deals being done. 2021 was a tremendous record breaking year, both in terms of the number of deals and the amount of money invested in Digital Health.

If we look to 2022, there are some headwinds. 2022 is not going to be 2021's numbers, but there's still a lot of interest in Healthcare Technology and Digital Health despite macroeconomic headwinds. I think this shows that we're beginning to enter into the next phase of Digital Health, but there is still a lot of interest and investment, and there's still a lot of companies being formed in the Digital Health space.

We're also seeing a lot of interest in healthcare on the part of big tech companies. Google has partnerships with Highmark Health, Mayo Clinic, HCA, and others. They recently acquired Fitbit as a personal wearable, and they're working on a product called Care Studio which interfaces with traditional EMRs. Google's

Venture arm Google Ventures has invested in many different Healthcare Technology companies including Clover Health, 23andMe, and Allidate amongst many others. Google's sister company Verily has a product called Verily Value Suite which is aimed at healthcare. They purchased Onuo, which is a diabetes management company, and Verily also runs Project Baseline, which collects healthcare data and tries to gain insights from this data.

So not to be outdone, Apple has also shown a tremendous amount of interest in healthcare.

Their CEO Tim Cook famously said a few years ago that health would be Apple's greatest contribution to mankind, pretty bold statement. We're all familiar with the Apple Watch, which is increasingly being positioned as a healthcare device with every version of the watch and every version of the software adding more healthcare-focused features. Apple also has produced health records which allows patients to put their medical records on their iPhone and take them with them.

They also have developed a Research kit to make Research easier and more accessible. And just recently in July of 2022, Apple released a 59 page report that really outlined its present and future plans in healthcare, and this report was entitled Empowering People to Live a Healthier Day. So Apple seems to be pretty serious about its healthcare intentions.

Amazon also has been in the news quite a bit recently regarding their healthcare efforts. Amazon has Alexa, and they're increasingly adding healthcare functions and skills to Alexa. They bought PillPack. They have Amazon Pharmacy. Amazon also has numerous partnerships with different hospitals, health systems, and companies, including Beth Israel Deagus Medical Center, Boston Children's Hospital, Livongo, Express Scripts, Cigna, and even Britain's National Health Service.

Now, up until recently, Amazon had Amazon Care, which was its direct care delivery platform.

They have shut it down, but they also are in the process of buying one Medical, which is a healthcare delivery company delivering concierge Primary care. Amazon also has Amazon Web Services, which is their cloud-based product, and that's not to be overlooked because a lot of Digital Health companies run on Amazon Web Services.

There are several Other big retailers that have shown increasing interest in getting involved in healthcare and healthcare delivery. Walmart has their health effort, and there's been some ups and downs there, but they purchased a Telehealth company called Me MD. CVS Aetna has a partnership with Amwell to deliver some virtual care. Walgreens has partnered with Village MD to provide medical services in their stores, and Mark Cuban started Mark Cuban Cost Plus Drug Company.

To try to disrupt the pharmaceutical industry and bring affordable pharmaceuticals to the mass market.

So what does it mean when these outsiders or big retail or big tech companies or venture capital firms take an interest in healthcare? How do they view traditional healthcare?

This is Vina Khosla. He's a very famous Silicon Valley entrepreneur. He has a very famous venture capital firm, and he said some pretty provocative things about traditional healthcare. He said healthcare is like witchcraft and it's just based on tradition. He said eventually computers will replace 80% of what doctors do. He thinks that expecting the medical establishment to do anything different is expecting them to reduce their own profits.

And he also said Innovation seldom happens from the inside. So this is a pretty cynical and pretty pointed view of traditional healthcare and traditional healthcare's inability to fix its own problems coming from somebody who's not within traditional healthcare.

And this point of view really begs the question, are clinicians becoming obsolete? There's been a lot of buzz in recent years about Artificial intelligence being better than radiologists at reading X-rays and CT scans and maybe one day even replacing radiologists. We have the rise of chatbots, algorithms, and health coaches that really may replace what doctors can do, or at least may be viewed in that way.

And we increasingly hear about this concept of, well, we're supporting doctors and clinicians to practice at the top of their license. What does that really mean? Are we using Technology to replace clinicians, to replace doctors? Is this a good thing? Is it possible? And is it in the best interest of patients and the healthcare system in general?

There's another telling quote from David Shawitz in The Atlantic all the way back in October of 2011, so just about 11 years old 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, and I think that's a pretty bold statement, and I think that's a fairly eye opening statement if you're somebody that is practicing Medicine in the traditional system.

So what does all this mean? Is it right to assume that Technology is going to replace physicians? Are physicians obsolete? Is Vinod Khosla correct in that healthcare can't fix its own problems?

Well, I don't agree with that. As a practicing physician, I do agree that the marriage of healthcare and Technology is the future, but I believe that success really depends on collaboration between physicians, clinicians, technologists, innovators, disruptors. We all have to come together and work together to be successful, and I think clinicians must be intimately involved in leveraging Technology and bringing Innovation to healthcare in order for these efforts to be successful.

In order to protect the way that Medicine is practiced and in order to do things in a safe, productive, and effective manner.

So if you're watching this video, chances are you're a clinician or somebody else with experience in healthcare that's interested in getting involved in Healthcare Technology and Digital Health, and you might be asking the question, how do I go about doing this? Well, I don't think there's any one right way. There's no guaranteed blueprint or roadmap that you can take to get involved.

But I do think it's important to define your goals. What are you trying to achieve? Are you trying to start your own company? Are you trying to advise a company? Are you trying to do some Healthcare Technology investments? Maybe you're trying to join a company as a chief medical officer. Figure out what you're trying to achieve.

I think it's also important to decide what you can contribute. What do you bring to the table? Maybe it's your clinical experience. Maybe it's companies that you've been involved with in the past. Maybe it's things that you've experienced on a day to day basis within healthcare and ideas that you have to make things better that you can contribute to a Healthcare Technology company or a Digital Health idea.

So there's several ways to go about getting involved in Healthcare Technology and Digital Health. I think leveraging Social Media is a great way to connect and collaborate with like-minded individuals, share what's interesting to you, share what you're working on, share what's important to you, share interesting thoughts, and also learn from others. There are a lot of great individuals out there who share content, who post things about Digital Health on Social Media channels.

And from whom you can learn a lot about this area.

Joining a community is a great way to get involved as well. If you don't feel comfortable sharing in public on Social Media, there are a lot of different communities that I'll talk about in a minute that you can join that allow you to connect and collaborate with people in a little bit more intimate setting and also, again, know your value, know what you bring to the table, know what you can contribute. That's going to allow you to be more helpful. It's going to present better opportunities for you.

To get involved if you know what you can bring to the table and what you can contribute.

So one great way that I have found to get involved in Healthcare Technology and Digital Health and to start to dip your toes in the water, particularly if you're a clinician and you primarily have clinical experience, is to become a mentor or an adviser. There's a lot of accelerators, incubators, hackathons that need clinicians to share their clinical experience with startup companies. So there's Matter Health out of Chicago. There's Mass Challenge and Techstars, which are two well known.

Accelerator programs, plug and play Tech Center, and MIT Hacking Medicine all have programs that are looking for people with clinical experience to serve as mentors and advisors.

So there's a lot of different organizations that you can join as well. HIMMS is one of the most well known, that's the Healthcare Information and Management Systems Society. There's the Digital Medicine Society. There's the Society of Physician Entrepreneurs. The AMA maintains the Physician Innovation Network, and there's a great community called Innovator MD which really supports physician innovators and entrepreneurs. They hold events that you can

Present at

Or connect with Other physicians who have an interest in Healthcare Technology and Digital Health.

So as I was mentioning before, there are a lot of great communities that you can become a part of. Health Tech Nerds is a fast growing community that includes people from across the Healthcare Technology spectrum, not just clinicians, but Business people, founders, people on the software and Technology side. So it's a great community to connect with a broad array of individuals who are like-minded.

M Disrupt is a community that is focused on clinicians and allowing clinicians to leverage their clinical expertise to help Digital Health startup companies out of pocket health, maintains an excellent newsletter, and also a Slack community.

To connect with like-minded individuals. Beyond Medicine Group is another group that's focused primarily on clinicians and physicians, but has a lot of great individuals who have experience in Healthcare Technology and can support one another, and Docsocial is a Social Media platform that connects people from across the healthcare spectrum, not just clinicians, but others who are involved in healthcare and Healthcare Technology.

Things move quickly in the Healthcare Technology world, and it's important to stay on top of what's in the news, what's exciting, what's interesting about what's going on in the world of Digital Health and Healthcare innovation. So subscribing to a newsletter is a great way to stay on top of what's happening. Rock Health puts out a weekly newsletter called The Rock Weekly. It comes out on Mondays and it's always a source of great original content and information.

Becker's Healthcare puts out a digital and Innovation report that is delivered directly to your email inbox.

There's an organization called Rama on Healthcare which really curates interesting information about healthcare and Healthcare Technology from across the web and delivers it to your inbox on a daily basis. I found setting up Google alerts for ideas, companies, concepts that are interesting to me, and this allows that content to be delivered to my email inbox every day so I can keep on top of what's going on.

Stat News is an organization that writes a lot of great articles about healthcare and Healthcare Technology. They're another one to follow and to subscribe to.

I'm always a fan of reading a book to gain more in-depth knowledge about a particular topic. There's a lot of good Healthcare Technology books to start with. Eric Toal, who's very active on Twitter and posts a lot about healthcare and Healthcare Technology topics, wrote a book called Deep Medicine How Artificial intelligence Can Make Healthcare Human Again.

Tom Lowry, who is affiliated with Microsoft, wrote a book called AI and Health, A Leader's Guide to Winning in the New Age of Intelligent Health Systems. Edward Marks wrote a book called Healthcare Digital Transformation How Consumerism, Technology, and Pandemic Are Accelerating the Future. And finally, Kevin Perot wrote a book entitled The Digital Health Revolution. These are all great places to start to gain a deeper understanding of Healthcare Technology.

So in my own journey there have been a number of individuals that I have come across that have really helped to stimulate my own thoughts. They've really taught me a lot about healthcare and Healthcare Technology. A lot of the people on this list maintain newsletters that you can subscribe to that are a wealth of information. They're all active on Social Media, whether it be Twitter or LinkedIn.

Some of them are journalists that write regularly for their respective organizations. This is by no means an exhaustive list, but it's a great starting list.

Of people to follow on Social Media to learn more about healthcare and Healthcare Technology.

So I thank you for taking the time to review this presentation. I'm always happy to connect, whether it's through LinkedIn or Twitter with others who have an interest in this field and in this topic. So feel free to reach out to me anytime and thanks again for your attention.