In Defence of Digital Health
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Frank Boermeester Frank Boermeester - November 20 2014

In a recent post Dr Saif Abed explains why he turned his back on the digital health sector and instead aligned himself with “enterprise scale healthcare IT infrastructure vendors”.  A sampling of the argument: digital health products are “gizmos”, they have “no impact on the practice of medicine or the management of patients”, they lack “evidence” in the sense of proven business models, they’re not interoperable, they’re “anti-doctor”, and they’re “skewed to app-only solutions.”
 
Some of the criticism is valid. But in my mind he’s confusing the issues and overstating the so-called schism between digital health and healthcare IT. There are at least three distinct issues here that need untangling:
 
Digital health as anti-doctor: Many digital health proponents (but not all) are concerned with patient rights and see open/cheaper/consumer technologies as an opportunity to improve those rights. The point for such folks is not to improve the ‘management of patients’ by people with ‘clinical experience’ but to develop tools that give ordinary people more power and control over their health and healthcare. Yes, that’s anti-doctor, but that’s fine and legitimate. 
 
Digital health as unproven consumer technologies: Consumer technologies in the health sphere have lacked validation, scale and impact, true enough, but that’s changing as 1. major scientific institutes get in the game (e.g. Imec’s wearable health division), and 2. such institutes start partnering with major consumer technology companies (e.g. Imec-Samsung partnership), to 3. bring more robust, scalable, and open tech ‘platforms’ on the market (e.g. samsung Simband), giving startups/app developers (and healthcare providers) better tools to work with. Also, this platform trend should help solve the interoperability issues Dr Abed refers to. Robust consumer technologies (wearable sensors in particular) will HAVE to be connected to “enterprise” (hospital/doctor) systems. Interoperability is a challenge to be solved, not a reason to dismiss digital health. Furthermore, it takes two to tango. Enterprise-grade platforms may be big but that doesn’t make them interoperable. 
 
Digital health versus Enterprise IT: Dr Abed argues that the digital health inspired focus on ’startups’ and ‘accelerators’ (the latter of which tend to select ‘easy-to-market’ and ‘app-only solutions’), have led to the neglect of ‘robust enterprise-grade platforms’ that tackle the ‘difficult healthcare IT issues’. Yes, a lot of flunky startups are receiving unwarranted attention, but there are many others who are tackling the difficult issues, in partnership with ‘enterprise’ customers (e.g. New York Digital Health Accelerator as a case in point http://digitalhealthaccelerator.com/portfolio/). 
 
New innovative startups warrant attention because  a few ultimately do manage to expose the limitations and weaknesses of the incumbents, and thereby put in motion a process of creative destruction. The enterprise ICT sector has seen tremendous progress thanks to companies that used to be dismissed as ‘startups’ not fit for enterprise-grade needs (e.g. salesforce.com, amazon, Red Hat, Skype, etc). Incumbent  ICT companies have suffered (e.g. SAP) or have been prodded into action (e.g. Microsoft) because new competitors with cloud/saas/opensource/mobile/internet-based business models emerged, proving to customers that they could deliver equally robust & scalable solutions, solutions that moreover were cheaper, more flexible and more user friendly.  
 
Furthermore, that old distinction between “startup” and “incumbent” is in decline. Most incumbents are trying to behave more like startups and cannot but embrace the underlying technological drivers of the startup movement. Also, they’re working more closely with startups, supporting and funding them, and even bringing them into their HQs.  Most large technology and pharmaceutical companies have initiatives in place to work with and learn from startups (e.g. Bayer’s Grants4Apps initiative  https://www.grants4apps.com). 
 
The “us versus them” narrative isn’t helpful anymore. Digital health, eHealth, health ICT, call it what you want, ultimately we’re all just trying to figure out how technology can make a difference to people’s health and healthcare. 

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