- What is digital health? Digital health is the application of digital technology using mobile applications or wearable sensors for the betterment of health.1 This offers a distinct pathway for advancing healthcare as compared to medical devices and drugs. Digital health is uniquely positioned to tackle multiple unmet needs in healthcare such as improving medication adherence, enhancing patient experience, increasing access to care and reducing healthcare costs. The digital health sector is on track to raise over $8.4 billion in 2019.2 Riding on the winds of optimism from multiple stakeholders, digital health startups have an incredible opportunity and an equally important responsibility to deliver results. The Health Tech and Innovation Summit at the AHA Scientific Sessions 2019 in Philadelphia was the hub for thought leaders from academia and industry to build relationships and share insights on shaping the future of medicine. It offered a chance for early career members to make connections and learn about the current landscape of digital health.
- The need for more evidence. During his AHA presidential address, Robert Harrington, MD emphasized, ‘evidence matters’. As the number of digital health startups claiming to disrupt healthcare continues to rise rapidly, it is becoming increasingly important to ascertain the credibility of these claims. Traditionally, drugs and devices are subject to strict regulatory oversight for the assessment of clinical efficacy and safety prior to widespread use. On the contrary, digital health startups are not directly incentivized for generating evidence for the validation of their technology. Mohamed Elshazly, MD who is a cardiac electrophysiologist and health tech entrepreneur shared his experience as the founder of Ember Medical, ‘Startups have to move fast with product development to keep up with the need for raising capital.’ Clinical trials need significant time and capital expenditure which many early startups cannot afford. For instance, conducting a NIH funded randomized trial from grant application to publication takes about seven years.3
- Challenges faced by startups. Startups constantly cope with the pressures arising from limited resources and considerable uncertainty about the validity of their business model. That’s why many startups embrace a hypothesis-driven approach to conduct rapid testing for pressure testing assumptions regarding their business model.4 Unfortunately, many healthcare startups end up focusing heavily on product development and underestimate the value of understanding patient preferences and physician workflows.5 Elshazly shared an important statistic to give perspective, ‘Only 5% of startups ever succeed’. Although digital health presents a challenge, there is also an extra-ordinary opportunity for early career members and startups to come together for developing groundbreaking innovations that could revolutionize the practice of medicine. ‘This is where physicians can leverage the skills acquired in an academic environment and make a broader impact’, said Bimal Shah, MD, MBA, Chief Medical Officer at Livongo.
- How to build a career in digital health? An important question for early career members is figuring out funding mechanisms to support themselves. Analysis of NIH funding shows that the age of obtaining the first independent grant funding is rising, while the overall funding capacity of the NIH is declining.6 Therefore, early career investigators stand to benefit from working with startups, doing clinical research and generating high quality evidence. For startups, these partnerships provide the opportunity to introduce scientific rigor in product development and conducting validation studies. It is important for early career members to be supported by senior mentors who share their vision. Maulik Majmudar, MD, medical officer at Amazon cautions, ‘It is crucial to find alignment between your personal goals and those of your organization. It is also important to show your value to the leadership by demonstrating success’. Shah shares another tip, ‘Health systems across the country are investing in creating centers for innovation. This can be another way to get support for working in this space’. In conclusion, with the changing healthcare landscape and the need for innovation in medicine, there is a need for clinician innovators. Early career investigators are uniquely positioned to lead the way in digital health. Gathering high quality evidence will be crucial to achieving the full potential of what digital health has to offer.
- Turakhia MP, Desai S, Harrington RA. The outlook of digital health for cardiovascular medicine challenges but also extraordinary opportunities. JAMA Cardiol. 2016 Oct 1;1(7):743-744. doi: 10.1001/jamacardio.2016.2661.
- Digital health investments in 2019 poised to surpass 2018. Fierce Healthcare. 2019 https://www.fiercehealthcare.com/tech/4-2b-invested-digital-health-first-half-2019-as-sector-poised-to-surpass-2018
- W. Riley, R. Glasgow et. al. Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise. Clin Transl Med. 2013 May 10;2(1):10. doi: 10.1186/2001-1326-2-10.
- Eisenmann T RE, Dillard S. Hypothesis-driven entrepreneurship: The lean startup. Harvard Business School Background Note.812-095
- Why do digital health startups keep failing? Fast Company. 2019. https://www.fastcompany.com/90251795/why-do-digital-health-startups-keep-failing
- Rockey S. Age distribution of NIH principal investigators and medical school faculty. 2012. National Institutes of Health Extramural Nexus. https://nexus.od.nih.gov/all/2012/02/13/age-distribution-of-nih-principal-investigators-and-medical-school-faculty/
The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.
Sumeet Pawar, MD is a cardiology fellow at Yale University and interested in healthcare innovation, digital health and leadership. He is currently working on piloting a digital platform for streamlining hospital operations by democratizing access to inpatient clinical data for patients and their families. Follow on Twitter: @sumeetpawar