A New Health Care Paradigm: The Power of Digital Health and E-Patients

Success factors and measures for scaling patient-facing digital health technologies from leaders' insights

BACKGROUND

Europe's healthcare systems face a triple burden: the rise of non-communicable diseases (NCDs), an aging population, and a shortage of healthcare professionals. NCDs, the leading causes of death, disproportionately affect older adults, placing significant pressure on healthcare services. By 2050, nearly 30% of Europe's population will be aged 65 or older, up from 20% in 2023. These challenges demand urgent solutions to sustain healthcare systems. Patient-facing digital health technologies (DHTs), such as Digital Diagnostics and Digital Therapeutics, offer promising tools to address this burden by empowering patient self-management, reducing strain on healthcare professionals, and enhancing system efficiency. Despite their potential, the scaling and adoption of DHTs remain limited. This study investigates: (RQ1) What key factors drive success across different patient-facing DHT categories? and (RQ2) How can companies implement these factors?

METHODS

Following COREQ guidelines, we conducted semi-structured interviews with 29 executives and founders of European DHT companies targeting NCDs. Participants were identified using PitchBook, focusing on revenue-generating companies with over 20 employees. Virtual interviews were conducted in English between May and September 2024, lasting an average of 28 min (range: 21-40). Data saturation determined the sample size. Thematic analysis was performed, with two researchers independently coding the data to ensure reliability. Success factors were categorized as internal (e.g., employees) or external (e.g., partnerships). Ethical approval was obtained, and data was anonymized. A follow-up survey (n = 27) was conducted to confirm our findings.

RESULTS

We identified 18 success factors for scaling patient-facing DHTs. Health & Wellness companies prioritized business model flexibility, while Digital Therapeutics relied on regulatory compliance. Validation of health impact was critical across categories, emphasized by all respondents in Digital Diagnostics and Digital Therapeutics. Other key factors included customer awareness, strategic partnerships, and investor alignment, highlighting the importance of tailored growth strategies.

CONCLUSION

This study provides structured guidance for scaling patient-facing DHTs, emphasizing category-specific strategies aligned with operational, regulatory, and consumer demands. It offers actionable recommendations for founders and executives to allocate resources effectively and adapt to diverse market contexts. By addressing the unique challenges of scaling DHTs, this work contributes to advancing digital health research and improving healthcare system resilience.

A study on information perception and engagement, emphasizing the essential role of E-clinics among Palestinian adolescents

Adolescents increasingly rely on electronic platforms for health information, highlighting their rapid technological adoption among significant developmental changes. Utilizing E-clinics presents a promising approach to enhance their health outcomes. This study aimed to identify adolescents' preferred health information sources, the challenges guiding their choices, and assess their willingness to use E-clinics. A cross-sectional survey was conducted among adolescents in grades 8-12 in governmental schools across the West Bank, Palestine. 646 questionnaires were distributed (69.5% females, 30.5% males; median age 16). Results highlighted family/friends (34.4%), HCPs (32.5%), and the Internet (23.7%) as primary sources of health information, with 91.2% of Internet users seeking health advice. Internet convenience (56.2%), abundant information (31.9%), and anonymity (7.6%) were valued by participants. Place of residence significantly (p < 0.001) influenced health information sources, with 94.4% in the center preferring the Internet. Three key factors emerged: trust in HCPs (p < 0.001) influenced reliance on them (76.7%), and willingness to use E-clinics for privacy (63.5%); distrust in healthcare services led to Internet reliance (32.7%) and E-clinic interest for privacy (30.4%); privacy concerns (p = 0.00) led unconcerned participants (52.9%) to rely on the Internet, and 51.6% believed E-clinics were private. Trust in HCPs and healthcare services influenced E-clinic anonymity perception, while location and privacy concerns affected E-clinic benefits perception. Findings suggest that E-clinics can improve accessibility to healthcare by filling the gaps left by traditional healthcare models while also addressing privacy issues. Incorporating them in healthcare systems that serve adolescents can improve trust, accessibility, and improve well-being.

A System Model and Requirements for Transformation to Human-Centric Digital Health

Digital transformation is widely understood as a process where technology is used to modify an organization's products and services and to create new ones. It is rapidly advancing in all sectors of society. Researchers have shown that it is a multidimensional process determined by human decisions based on ideologies, ideas, beliefs, goals, and the ways in which technology is used. In health care and health, the end result of digital transformation is digital health. In this study, a detailed literature review covering 560 research articles published in major journals was performed, followed by an analysis of ideas, beliefs, and goals guiding digital transformation and their possible consequences for privacy, human rights, dignity, and autonomy in health care and health. Results of literature analyses demonstrated that from the point of view of privacy, dignity, and human rights, the current laws, regulations, and system architectures have major weaknesses. One possible model of digital health is based on the dominant ideas and goals of the business world related to the digital economy and neoliberalism, including privatization of health care services, monetization and commodification of health data, and personal responsibility for health. These ideas represent meaningful risks to human rights, privacy, dignity, and autonomy. In this paper, we present an alternative solution for digital health called human-centric digital health (HCDH). Using system thinking and system modeling methods, we developed a system model for HCDH. It uses 5 views (ideas, health data, principles, regulation, and organizational and technical innovations) to align with human rights and values and support dignity, privacy, and autonomy. To make HCDH future proof, extensions to human rights, the adoption of the principle of restricted informational ownership of health data, and the development of new duties, responsibilities, and laws are needed. Finally, we developed a system-oriented, architecture-centric, ontology-based, and policy-driven approach to represent and manage HCDH ecosystems.

DiScO: novel rapid systems mapping to inform digital transformation of health systems

Background

Global health systems are confronting challenges that intersect climate change with evolving communicable and non-communicable public health risks. Addressing these challenges requires systems integration via citizen big data that exist outside health systems. However, systems integration across jurisdictions is a complex challenge that requires stakeholder input. This study's purpose was to conduct rapid systems mapping with international health system stakeholders to inform the development and implementation of a global digital citizen science observatory (DiScO), which aims to catalyze digital transformation of health systems across jurisdictions.

Methods

A rapid qualitative systems mapping study was conducted during the International Society for Behavioral Nutrition and Physical Activity Annual Global Summit in Uppsala, Sweden, in June 2023. The choice of the venue and approach was informed by three key criteria: (1) Established evidence linking physical activity and nutrition with non-communicable diseases; (2) Concrete existing methods of obtaining citizen big data by physical activity and nutrition researchers; (3) Precedence of physical activity and nutrition researchers conducting citizen science as well behavioral/clinical big data collection. The design of this study was an innovative pre-post systems map development, which consisted of (1) real-time rapid systems mapping (pre/initial map) by engaging with international stakeholders and (2) adjustment of the real-time systems map (post/final map) after analyzing stakeholder discussion data.

Results

Rapid systems mapping resulted in a complex network that included key themes to successfully develop and implement DiScO: priorities, opportunities, risks, challenges, partnerships, and resources. Additionally, a new theme emerged organically through stakeholder group discussions - mitigation strategies. The adapted rapid systems map (i.e., after data analyses) depicts 23 key nodes of intervention across the seven key themes.

Conclusion

Rapid systems mapping at international symposia is a novel methodological approach to capture stakeholder input, particularly to understand complexity across international jurisdictions - an approach that can be replicated across disciplines and sectors to inform digital transformation of health systems. The development and implementation of DiScO, a platform for decentralization and democratization of technology, will take into consideration all the key nodes of intervention identified in the rapid systems map to promote digital health for equity across global jurisdictions.

Transitioning Perspectives in Digital Health Through Phenomenology Integration

The evolution of digital health, from its early days as eHealth to its current expansive scope, reflects a significant transformation in health care delivery and management. This transition underscores the integration of digital technologies across the health continuum from prevention and diagnosis to treatment and rehabilitation. The emergence of digital health has introduced innovative solutions but also posed challenges, particularly in aligning technological advancements with health needs, human experiences, and ethical considerations. This position paper aims to explore the integration of phenomenology in digital health, advocating for a paradigm that emphasizes the centrality of human experience in the design and implementation of digital health solutions. It specifically seeks to address challenges related to relevance for individuals who "speak" different languages, ensuring long-term use, addressing digital and health literacy, coordinating various sources, and navigating ethical issues in the rapidly evolving digital health landscape. Drawing upon years of research and practical experience in communication technologies and health, this paper uses a reflective approach to examine the intersection of digital health and phenomenology. It reviews the historical development of digital health, identifies the challenges faced during its evolution, and discusses the potential of phenomenological methods to enhance user-centered design and ethical practices in digital health. The integration of phenomenology into digital health facilitates a deeper understanding of user experiences, enabling the development of more responsive and ethical digital health solutions. Participatory design models, informed by phenomenological perspectives, offer a pathway to bridge the gap between technological innovation and human-centric health care. The paper highlights successful practices in digital health development, including mobile apps for vaccination decision-making and platforms for managing chronic conditions, illustrating the benefits of a phenomenological approach. Transitioning perspectives in digital health through phenomenology integration represents a critical step toward realizing the full potential of digital technologies in health care.