The Digital Difference

Digital therapeutics and wellness apps are shifting the way we view medical care, says Kerry Dimmer, making us all healthier in the process.

Wearable computers, and particularly smartwatches, haven’t necessarily lived up to their initial hype, but after a rocky start to sales since Apple launched its watch in 2015, their popularity is on the increase.

According to the NPD Group, the overall value of the smartwatch market grew by 61 per cent in the US during 2018, and the reason is clear: health apps. By 2024, says a 2019 Juniper Research report, more than 870 million consumer wellness apps will be installed and regularly used on smartphones around the world. In line with industry norms, Juniper makes the distinction between wellness apps — which tend to be smartphone- or smartwatch-based — and “digital therapeutics”, physician-prescribed clinical-grade applications, which do a similar job of monitoring and reporting patient data.

In total, Juniper reckons, the use and value of the market for digital health apps will grow by 1 000 per cent over the next five years. This brings with it obvious challenges — who is liable for medical advice given via a chatbot, for example?

Over the next few years, the claims of wellness apps will be put under increasing legal scrutiny. “A number of health applications are capable of drawing associations between symptoms and disease,” write Michael Lang and Ma’n H Zawati of McGill University in Quebec, Canada. “This places mobile health applications in a poorly understood legal space”.

The merging of consumer apps and medical diagnosis will remain controversial. But the true value of wearables is in motivating for lifestyle changes, says Dr Craig Nossel, Head of Vitality Wellness at Discovery.

Because the fitness data is verifiable and easy to collect, it creates a cascade effect on personal health attitudes and behaviours.

“Increasing physical activity is often a catalyst for improving other lifestyle factors such as healthier eating, improved health metrics, tracking sleep patterns, stopping smoking, measuring stress levels and mental health benefits,” he says.

While data collected from wearables doesn’t generally get recorded into a patient’s health record, as is the case with digital therapeutics, the distinguishing features between them are narrowing.

In a country such as South Africa, where access to specialists and services varies dramatically by region and income, such connected technologies could represent a paradigm shift in the way medical diagnoses are made and the ability of patients to self-diagnose and self-monitor a percentage of their health status. Digital therapy apps are already being used to obviate the need to travel distances, for example, to obtain professional healthcare advice.

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Companies such as pharmaceutical giant Cipla Medpro are embracing and pioneering connected healthcare.

Cipla recently acquired a 30 per cent shareholding of South African firm BrandMed, which in turns owns KardioGroup.

KardioGroup specialises in developing medical devices that send data over the network to a software platform.

The devices range from professional equipment designed for use in surgeries to glucose monitors and blood pressure cuffs that patients can take home, sync to their smartphone, and then share their data with a doctor without having to leave their lounge.

BrandMed founder and CEO Dr Riaz Motara believes that drugs are no longer enough to manage a disease. KardioGroup’s networked devices and applications are designed to help with chronic lifestyle and noncommunicable diseases (NCDs) such as hypertension, diabetes, high cholesterol, asthma and chronic obstructive pulmonary disease.

“The disease burden will become unmanageable unless innovative solutions are implemented,” he says, “which is why we integrate medical expertise with next-generation technology, specifically in the world’s first end-to-end cardiovascular risk reduction and treatment approach.”

The data collected by KardioGroup’s products, and the way it is transmitted and analysed, transforms the healthcare landscape, argues Motara, giving doctors a more complete set of insights into patient health. While not the first company to develop homecare hardware, the difference is that data is kept in one place. Typically, digital therapeutics has a siloed approach to data analytics, looking at specific measures or outcomes.

“Another silo that has been of concern exists between doctors, patients, pharmacists, funders and specialists. Connected digital health breaks these down when all stakeholders understand the benefit across the board,” Motara says. “When you capture data in such an objective and validated process, in context and showing real-world value-based health communications, cost-efficiency and better patient health manifests.”

Driving down costs, along with improved patient engagement is going to be a large part of the digital transformation of the health industry in the forthcoming year, Motara advises.

One thing that will be critical to the success of connected health, however, will be the security of patient data. In a paper published in the British Medical Journal earlier this year, researchers found that 19 of the top 24 smartphone apps for health routinely shared data outside the app. This might have been with developers, advertisers, operating system owners (Google or Apple, for example) or a clinical database.

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