The First Word in Digital Health - Sonnier and Nosta take a closer look at Digital Health

In our inaugural article together, we take a 30,000ft view on the pulse of digital health today, with a keen eye on the future... and this is only the beginning...

Digital Health. Two simple words. Apart, they define the essential realities of many aspects of our lives.  From the magic of the computer and smart phone to the tribulations of health, a day doesn’t pass without some aspect of these ideas and concepts touching our lives.  Then, there’s the convergence of these two words—digital and health.  It’s an expression that conjures a host of emotions, from excitement to confusion.  For many years, we have both been active participants in this important evolution and shared—and perhaps even created—many of these emotions.

Our task, with the help of our team at nuviun, is to advance the story of digital health.  We don’t expect to end the debate but, to the contrary, we look to catalyze and invigorate the discussion. Our goal is to be the “First Word in Digital Health.”

Let’s focus where necessary.  Let’s stir the pot as appropriate.  And let’s ask the tough questions and seek out the even tougher answers.

So, with that backdrop in place, let’s take a view from 30,000 feet—from our two perspectives.  For this, our inaugural post, we’d like to take the pulse of digital health as we see it today and with a keen eye on the future.

Digital Health: Delineated and Defined

Paul Sonnier

First off, let me start by saying that I’m delighted to be working with nuviun, collaborating with John Nosta, and sharing our unique perspectives to help determine where digital health is now in its evolution, adoption, and provision of benefits to our health and our economies. I work with many companies and initiatives, both within specific markets and on a global scale because I believe that by working together we can accelerate the development and application of digital health. One thing I’ve noticed over the past few years of curating the Digital Health group on LinkedIn, facilitating dialogue on the many issues, and constantly surveying the global, evolving ecosystem, is that we all have unique perspectives which have been molded by years of experience and the development of expertise in diverse settings. And when we leverage this expertise in a collaborative fashion, we can do much more together than we can ever do alone.

That being said, I am often taken aback when I hear that “digital health” hasn’t arrived yet. Certainly, there are many challenges and hurdles still being overcome, but who of us hasn’t utilized a digital tool or solution for health-related purposes; be it Googling a condition, talking with a family member on a mobile phone, sharing a personal health issue or news article on Facebook? There’s also been a massive influx of information technology into healthcare systems around the world. Sure, there are challenges there (e.g. interoperability, user experience and workflow, status quo resistance), but over time, we’ll see many improvements that resolve issues or sometimes totally disrupt the current way of doing things.

Digital health is already here and in widespread use. But, as novelist William Gibson famously stated, “The future is already here — it's just not very evenly distributed.” The same holds true for digital health. Manufacturing systems, for example, were not digitized overnight, but over decades—an analogy that’s apropos for many segments of digital health as well.

While the term “digital health” has actually been around for many years prior to my founding the Digital Health group, it was lacking one fundamental component: genetics and genomics.  When I founded my group in 2009, I called it “Wireless Health.” It rapidly became a respected forum and source of news for this important area of technology convergence. Shortly thereafter, I renamed the group and put forth the modern definition for “digital health” on Wikipedia. I also set about inculcating others as to precisely what digital health is and the significance it holds for revolutionizing human health and the delivery of healthcare. With diligent effort and input from stakeholders and other key influencers, the digital health meme has permeated the global dialogue on health innovation and even crossed over into coverage by the mainstream media. I consider this a major measure of success.

My inspiration for this modern definition of digital health came from Dr. Eric Topol’s book, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. It was there that I noted a succinct enumeration of all of the digital innovations I had been seeing converge with health and healthcare: wireless devices and networks, microprocessors, information technology, social networking, the internet, and biometric sensors; plus genetics and genomics—the latter being associated with J. Craig Venter’s comments on the digital nature of the molecule.  All of these enabling digital technologies are presented in a beautiful graphical format by nuviun, in the Venn diagram they created to describe the digital health landscape. These can also be seen in my video, “The Story of Digital Health – Part 1.”

While all of this progress is great, and the definition is foundational to our understanding of what digital health is, there’s still much to be done.  Confusion, conflation, and misuse of sub-terms is ongoing. Moreover, I often see headlines proclaiming that digital health is this or that, and still needs much development. But these headlines are almost always inaccurate, simply because digital health is not a monolithic industry or segment. As outlined above, it’s more of an amorphous conglomeration of powerful digital technologies which are converging with health and healthcare. This simple and broad definition is not intended to facilitate sweeping or hyperbolic statements about what’s happening, but to be straightforward and accurate. Consequently, it’s also easily understood. It’s from this foundation that the details, measures, and benefits of digital health can be parsed to convey precisely what’s happening throughout a variety of segments.

To find evidence of the depth and breadth of digital health, just visit my crowdsourced Digital Health solutions list, currently over 500 and ever-growing. The 130+ descriptive tags I created there have come to represent a digital health taxonomy, albeit unintentionally. I’m excited about this, because I feel it helps to further inculcate stakeholders regarding what digital health is, thereby increasing the awareness of its potential applications and overall impact.

Digital health is seeing a Cambrian explosion of solutions, with diversity and overlap in the functionalities they enable, the markets they serve, and the varied benefits they provide.  A useful gauge of this evolutionary progression—at least for some areas of digital health—can be gleaned from Gartner’s Hype Cycle for emerging technologies, published  August 9, 2013. Their most recent version includes digital health elements such as Biochips, Big Data, Gamification, Mobile User Interfaces, and Mobile Health Monitoring.  In their chart, we can see the “when” of some aspects of digital health, and an obvious visual representation that digital health is not monolithic, but a set of pieces with endless combinations and possibilities all driving (at varying speed) towards technological maturity and market adoption.    

An oft-featured aspect of digital health relates to measuring investments in startups, exits (IPOs, M&A), and market share. But again, digital health does not ideally lend itself to this generalized form of analysis. For one, it’s difficult and confusing to include genetics and genomics without skewing the data. Hence, what we often see are analyses that exclude the biggest news in those segments, which typically are captured in business analyses of life sciences. Moreover, as Nobel Laureate Joseph Stiglitz recently stated, "The profitability of an innovation may not be a good measure of its net contribution to our standard of living." In the “Innovation Enigma”, Stiglitz proposed that the traditional measure of GDP can’t be relied upon to capture the improved standards of living that technology provides. This translates well to digital health, since the inability to directly or easily measure health benefits or economic profitability (of some aspects of digital health) doesn’t mean that it’s not already providing great value to society. When it comes to digital health, it’s not always about building a multi-million or billion dollar business, but realizing that small, diverse solutions and the benefits they provide are, in aggregate, beneficial at a population level, even if we can’t track them as we’d like to.

In the final analysis, digital health is already empowering us in innumerable ways to manage and improve our own health. It’s also transforming and disrupting our healthcare systems and how we receive health care. New market entrants are helping to improve access, reduce costs, increase quality, and make medicine more personalized and precise. Digital health is pervasive and doing enormous good already.  And the greatest thing of all is that we’re just getting started!

Digital Health: Capturing Innovation in a Simple and Memorable Way

John Nosta

When I think of digital health, I almost immediately sense a duality between the vast complexities of science and innovation with the utter simplicity of a simple device that can potentially save someone’s life.  These are two poles of tremendous accomplishment. Yet my intellectual journey doesn’t reside on either side.  I, like many, tend to shift around defining digital health in the context of a discussion and driven more by the audience than a fixed perspective.  Could there be an “uncertainty principle” to digital health similar to Heisenberg’s?  Can we fix on a position; yet fail to accurately measure momentum and direction?

The comprehensive list that Paul has created captures everything in digital health—from genomics to disease prevention and is very powerful.  One glance and you can see the vast range of potential applications and real-life solutions for health issues.  For the educated and informed, this glance is a quick reminder and a great touch-point for discussion.  But for many—from clinicians to consumers—the definition may pose both a solution and a problem.  Simply stated, does the attempt to try to be “all things to all people end up being nothing to anyone”?

Now, let’s take step back from the informed clinician and the empowered patient and take a look at the rank and file population.  You know the type very well—the overweight, hypertensive couch potato.  It’s this person that will help establish the proverbial “democratization” of health that pundits (like me) banter about as a central driving force behind digital health.  But to get that individual’s attention, I’m not sure the rich diversity and complexity of digital health will get him up and off that couch.  In fact, it may just add to the confusion of health and wellness and drive him away.

What this audience needs is a Volvo.

Yes, a Volvo.  But it’s less about the car and more about the single-minded definition that Volvo owns.  And it can be reduced to one word—safety.  The challenge is finding a way to focus digital health in a similar way that will make it memorable yet doesn’t reduce it to irrelevance. Volvo knows that its customers are less interested in logistics than outcomes, which is why it has drilled into this cornerstone of marketing strategy: focus on benefits, not attributes. It has wrapped all of the diverse details into a neat, yet powerful package that the consumer not only understands, but remembers and wants. If we’re ever going to roust the Potatoes from their nests, it’s what digital health must do as well.

So, let’s take a step back and consider some of the core issues for digital health.  Technology will empower all to take steps up the clinical continuum from disease detection to diagnosis to management to prediction and ultimately to prevention.  That’s a powerful ladder of benefits. And the top rung of prevention takes us to a highly desired place. My friend Paul has teamed up with MISFIT Wearables to create a wonderful infographic that portrays this continuum, based on the work of Dr. Eric Topol.

But can we push harder and up to one final rung in our health quest? Can we move past the “What” of digital health and move to the more emotionally resonant question of “Why”?

The “what” is factual.  From genomics to disease detection and prevention, these concepts are all part of the essential laundry list of facts and figures.  But let’s go back to our friend sitting on the couch and see what might be driving his behavior. Exactly what would make him pry himself from his comfort and participate in some form of digital health? Or, more clearly, “What’s his Why?”

I believe that the sum total of health initiatives offered up by digital health push beyond prevention (the What) and move towards the simple idea of adding years to your life (the Why).   Some of our best democratizing agents in this effort will be the baby boomers—prime subscribers of digital health because they place such a high priority on living well and living longer.  Here, we’re seeing a simple and focused Volvo beginning to emerge:

L o n g e v i t y.

It’s a powerful word that excites our rational “thinking man’s” neocortex with practical solutions around health and wellness. But it also strikes a chord in our primitive brain—a brain that is more visceral and reacts in a way that is unencumbered by cognition.  It moves us beyond the simplistic “longevity” into the context of survival as related to our “fight or flight” response that defines our limbic system.  At our very core, I believe we want to move to the next rung on the ladder, living not only better—but longer. And I’m not alone, since it’s a concept that corporate ventures have already tapped into—like Google Calico and Human Longevity, Inc., which is comprised of a team of leading experts, such as Robert Hariri, MD, PhD, J. Craig Venter, PhD, Peter H. Diamandis, MD. Whilst writing this article, I asked Dr. Hariri to give me his perspective on the role of digital health to enhance longevity. This is what he had to say:

"The digital health movement represents a unique and powerful dynamic in human history.  The convergence of science, technology and human needs provides the basis for redefining some of the very basic expectations of humanity and the way we live.  The vital mission of Human Longevity, Inc. is to leverage this new and expanding capacity to extend and enhance a high-performance life-style.  Our goal is to solve the disease of aging and change the way medicine is practiced. In a word—that's longevity."

Robert Hariri, MD, PhD

Human Longevity, Inc.

Vice Chairman and Co-Founder

To carry this thought even farther along this continuum, longevity and survival may even have the potential to become moot.  As the promise of digital health pushes us into unchartered territories, life extension and Ray Kurzweil’s Singularity may evolve into a practical discussion of immortality.  It’s a concept that’s graced the pages of Time magazine and actually has a predicted date—2045. However, as interesting as it may be, immortality in the human sense still lies on a distant horizon.  But it’s these ideas that move us forward, sometimes effortlessly and sometimes dragging and screaming.

Distilling digital health down to a single word can certainly be a dangerous exercise.  The compromises necessary may exclude key points and make for an abstract promise.  But if we truly strive to democratize healthcare and empower the patient, we need to do this type of exercise—to define, refine, focus and even dream.  And while we many not capture the totality of digital health for some, we may do something much more important.  We may avoid the pitfalls and complexities that can obscure the magic and innovation of digital health.  And in the process, define an idea that single-mindedly captures our hearts and our minds and our lives forever. 

Conclusion

So there you have it. The view from 30,000 feet as we see it. Our attempt to describe the “What” and the “Why” of this exciting, fascinating and ever-evolving story—the lists, the ladder, and the Volvo. The story that we’re all writing together.

It’s why we need each other in the global community, and why we’re both excited to be part of the nuviun team. Here, we seek to attract thought leaders to engage, to challenge, to dream and to create in a manner beyond anything we could accomplish in isolation. And in so doing, we’ll all be able to come together respectfully, without the need to agree, but with the ability to learn from each other—sharing knowledge and perspectives and passion. The outcome will be that digital health will be catalyzed globally in a manner that moves beyond vision to implementation in a perpetual and fluid cycle of progress.

It’s up to all of us to take a hard look at digital health together. To ask the difficult questions. To dream its dreams and yet challenge each other to better and more clear solutions. To create a world in which digital health is both understood and optimized—while simultaneously supporting the exponential expansion of its future into realms that lack boundaries, are little understood, and sometimes even scary. 

In so doing, we’ll be able to offer our individual passions and expertise to something so big that it requires our collaborative efforts in order to capture the innovation within to write the Story of Digital Health that belongs to us all.

We hope you’ll join us.