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By Jeffrey L. Sturchio for Biogen
When you visit your doctor, there is a high probability that they will be sitting in front of a computer – reviewing blood work and other physical tests on a screen as part of your electronic health record. If your doctor is a member of a larger health system, as most are these days, your information will be combined with data from your other clinics, practitioners, and hospital visits to form a more complete picture of your health condition.
This is one of many examples of digital health at work. Over the past few years, advances in interoperability, mobile and wearable technologies, and more have ushered in a new era of innovation in how illnesses are diagnosed and managed, equipping the best and brightest medical minds with a fuller picture of the disease landscape and burden before embarking on prescribing treatment.
A new era in everyday digital monitoring
Imagine, for a moment, the sheer amount of health care data that exists in the world. The answer may surprise you. Today, as much as 30 percent of the world’s data volume is generated by health care, with a compound growth rate that’s estimated to be faster than manufacturing, financial services, media, and entertainment. All of this information — including personal data, insurance claims data, behavioral health data, treatment history, and more — is maintained in databases that are linked in a complex, interconnected data ecosystem. This information may also link to your own electronic devices, whether it’s a tablet, smartphone, or smartwatch. These systems are now part of the fabric of everyday life and the applications of these new digital tools are seemingly endless.
For example, people living with sleep apnea used to go to sleep clinics for periodic evaluations of their condition and adjustments to their treatments. Now, with the development of remote monitoring tools such as wearables, physicians can view a continuous record of sleep and breathing patterns online, making those visits to the sleep clinic unnecessary, saving time and money. In fact, taken together with other applications using artificial intelligence (AI) and the automation of care processes, the McKinsey Global Institute estimates that, in addition to positive impacts on patient health and outcomes, the cost savings from digital applications in health care will be as much as three trillion dollars by 2030.
Furthermore, when coupled with advances in AI, machine learning (ML), and sophisticated data analytics, health care data can open the door to new ways to research disease dynamics with a special focus on early detection. In particular, digital biomarkers, which are objective, quantifiable, physiological, and behavioral measures collected by digital devices, have become a particularly active area of research, allowing scientists to gain real-time insights into a patient’s well-being in a seamless and unobtrusive way. Just consider a recent Stanford Medicine cardiovascular study, which sent irregular pulse notifications to participating patients using an Apple Watch, enabling 57 percent of patients to get in contact with a health care provider outside of the study.
Studies like these hold tremendous potential in the world of medicine today, particularly because certain diseases, including Alzheimer’s disease and other forms of dementia, develop slowly years before overt symptoms appear. By leveraging digital biomarkers to identify cognitive, sensory, and motor changes in individuals in real-world settings, scientists can revolutionize the future of preventive medicine and bring holistic care to millions of individuals who suffer from these debilitating diseases.
Digital applications for the world’s most elusive diseases
Dr. James R. Williams, PhD, Head of External Innovation & Alliances, Biogen Digital Health, studies how digital health data and, in particular, digital biomarkers, can potentially be used to address significant unmet needs in neuroscience. Williams, an epidemiologist by training, has been involved in digital health innovation at Biogen for the past eight years, developing health research networks and external collaborations to explore new approaches, products and services that improve patient outcomes and access.
“We’re living in a universe of connected things,” says Williams. This provides a unique opportunity to use background information from everyday devices in a way that’s informative, actionable, and accessible. “Imagine a world, where [digital] tools bring to your attention signals that suggest it’s worth contacting your health care practitioner,” he says. Developing this kind of actionable information would be tremendously useful for both health researchers and individual consumers alike, who each seek to benefit from these unique insights through new care pathways and improved health outcomes respectively.
To test these ideas in the context of a specific condition, Biogen has begun a virtual research study (Intuition) to investigate the role that iPhones and Apple Watches can play in measuring changes in brain health, including mild cognitive impairment (MCI), one of the early signs of Alzheimer’s disease. The Intuition study plans to enroll a broad, diverse population of 23,000 adults in the U.S. (aged 21 to 86) who will use these everyday devices to generate longitudinal data on their brain health for two years.
In recent years, data scientists have catalyzed a tremendous amount of progress by identifying digital biomarkers to help monitor cognitive function. For example, a Washington University study showed how monitoring the driving performance of older adults, such as braking and speeding behaviors, could predict preclinical signs of Alzheimer’s disease 88 percent of the time. In Japan, a team of researchers have used ML tools to track the pitch, intensity, and silences in phone conversations and compare them to healthy patients’ vocal signatures to predict cognitive impairment.
Now, companies like Biogen have an opportunity to continue this important work with potentially significant implications for generations to come.
Bringing trust to the center of digital processes
Of course, as the new world of digital health evolves, it will be equally important for health care leaders and patients alike to ask how data are generated, stored, interpreted, and deployed. Who owns it? Who decides how it should be shared and, perhaps most importantly, how will it be used? These will all be top-of-mind concerns for those wary about combining emerging technologies with potentially sensitive health information.
As Williams notes, developing new digital health tools won’t work without trust. “If we’re not transparent or if we abuse that trust, people won’t share their data,” he says. Conversely, however, if people can choose who they share their health data with, and have autonomy in selecting the appropriate controls, they are generally willing to provide researchers and health care practitioners with access. In many ways, these controls have been, and continue to be, a necessary foundation upon which some of the world’s most incredible digital health advances have been built.
“How we implement digital health is as important as who controls the data,” adds Williams. As the power of new computing platforms increases, and the precision of digital health tools improves, the importance of preserving personal choices through appropriate standards of data privacy and data security will be critical. Frameworks like the Health Insurance Portability and Accountability Act of 1996 in the United States and the General Data Protection Regulation in the European Union are examples of legal rules designed to protect patient privacy and ensure trust in systems that collect and use personal data.
Simply put, without trust, digital health solutions can’t succeed.
As evidenced above, however, it’s become clear over the past few years that digital technologies will be increasingly integrated into the fabric of our health care system. Gone are the days of siloed ways of thinking and working. On the contrary, with the rise of digital health solutions, health practitioners, health care companies, community leaders, patients and caregivers alike can now contribute more directly, and more collaboratively, in the pursuit of breakthrough therapeutics and improved health outcomes.
Moreover, as the promise of a narrowing “digital divide” increasingly comes to fruition, digital health offers a powerful mechanism for improving health equity. Equipped with the transformative innovations that will likely emerge in coming years – and with trust and transparency at the center – digital health solutions hold tremendous promise to help us achieve the goal of better health for all.
Jeffrey L. Sturchio is past chairman of Rabin Martin, a global health strategy consulting firm.