The last decade saw the start of the smartphone revolution. Ten years ago, the iPhone was just three years old, around a quarter of us owned a smartphone, and the term Digital Health was first coined. 2020 sees the start of a new decade where 79% of us own a smartphone, and almost 100% of those aged 16 to 24 have access to the internet via a smartphone. Digital Health is anything that is digital which can support health; whereby health is a continuum from staying healthy and fit through to managing health conditions and supporting healthcare professionals. Digital Health is the opportunity to extend care beyond being there face-to-face, and the opportunity is massive. There are about half a million Digital Health solutions on the marketplace available globally! Most major healthcare systems now accept Digital Health offers a huge opportunity to revolutionize healthcare delivery. The evidence is growing that good Digital Health solutions can deliver significant benefits for patients and healthcare systems that support them. The COVID-19 pandemic has also accelerated the adoption of Digital Health.

However, the reality of the opportunity is recalcitrant. Despite five million health apps being downloaded every day, with more than 350,000 to choose from, it’s hard for the best apps to be spotted by consumers, health professionals or national health bodies. Only 15% of the digital health solutions meet minimum standards, as assessed by the Organisation for the Review of Care and Health Applications (ORCHA). Whilst the uptake of Digital Health solutions is growing, evidence shows that those in the most need, are much less likely to engage.

The question raises: “How can we unlock the full potential of Digital Health for the population?” To answer this question, we need to solve several barriers that will counter the uptake of Digital Health apps, namely:

1. Trust: The lack of suitable quality indicators inhibits the embracing of Apps by end users and professionals in health and care space
2. Awareness: Apps are not yet part of the day-to-day management of health and care related conditions
3. Accessibility: Finding and matching Apps to support your needs or those of your service users is very difficult
4. Digital pathway integration: The lack of interoperability creates data silos, limiting the potential of the data being gathered
5. Procurement: The lack of clarity about the appropriate financial incentives won’t stimulate individual product owners to share data. The evaluation of impact ((S)ROI) remains a challenge and so inhibits adoption

These barriers will each be overcome over this next decade.

Trust as one of the biggest barriers for adoption of Digital Health

The COVID-19 pandemic has been a magnifying glass for trust as one of the biggest barriers to the adoption of Digital Health. For example, think of the Covid contact tracing app. Questions were raised regarding the number of people that would be using a contact tracing app, and what would happen with this data? To accelerate the adoption of Digital Health, it is important that users understand the app they are using – its strengths, but also its weaknesses – so that they know when and how to use it best; similar to a information leaflet contained within a medicine packet.  A large part of mitigating the risks of misinformation and hesitancy to adopt digital health lies in offering full transparency to the public about how an app works, what it is intended to do, and whether it succeeds in doing so. We should not make the mistake of claiming that an app is a perfect solution or ‘silver bullet’. Rather, being open about the rewards and corresponding risks means that people will be empowered to make an informed choice as to whether to use an app, how they will manage it and when they will stop using an app, while not expecting unrealistic outcomes. In addition, peer-to-peer recommendation has recently been shown to strongly drive the adoption of digital health[1].

Transparent and independent libraries for digital health solutions are just as necessary as there are recognized formularies for prescribing drugs. And help the population to go to a safe place with high quality products. It also enlarges the awareness and accessibility. ORCHA creates such places and independently reviews health and care apps and has reviewed over 4.300 apps to date. Eighty-five percent of these apps do not meet the requirements of ORCHA’s Baseline Review.

Creating an ecosystem of data

Towards an affordable, accessible and of high-quality health and care system, the role of data will be massive. Self-collected data by patients is getting more and more appreciated and used in daily practice. The data, on itself, is not necessarily more valuable than it has been in the past ten years, but we are finally starting to use it to its full potential. Due to COVID-19, more patients and healthcare professionals have experienced the value of data. However, we see that personal health data is held within fragmented data silos. We foresee a movement towards an ecosystem of data. An aggregation of data from different Digital Health applications. This will enable patient and healthcare professionals to access one picture, pulling information such as blood glucose, exercise and diet, from a variety of apps into one dashboard. It extends the personalised, integrated, whole life proposition that apps will offer and will allow us to prevent and predict personal and population health.

Though people have been talking about interoperability for years now, the question raises whether the health and care system is mature enough to incentivize individual product owners to share data. As long as we pay for Digital Health transactional, product owners will never make their systems interoperable. It is necessary to develop new reimbursement models for data driven and digital products. In addition, the more apps are collecting the same type of data, the more they can work together to monetize the data. We need to think carefully on the business models of the innovators, as someone needs to pay. For example, the National Institute for Health and Care Excellence (NICE) is developing an approach to assess value-based pricing.

Getting the ecosystem to move

Digital Health is still too fragmented right now to unlock its full potential. One the one hand we need to create independent libraries to stimulate trust, access and awareness. In this, also unified research is key. More attention should go to funding councils, a unified approach to fund digitalization and research into it. To generate evidence for Digital Health. On the other hand, we need to work on digital pathway integration and appropriate procurement of Digital Health. ORCHA acts as a middleman in the ecosystem of patients, healthcare professionals and Digital Health developers & researchers. But it is now time for the ecosystem to move. And to acknowledge it’s a journey, a process in which we are still learning. The journey requires collaboration, both nationally and internationally. And Covid-19 has given us the burning platform to do that.