To prevent the next Theranos, industry-wide collaboration on evidence-based therapeutics is mandatory

By Dave Muoio
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Dr. Ashish Atreja is an unabashed proponent of digital health. As chief innovation and officer and associate professor at the Icahn School of Medicine at Mount Sinai, he has contributed to a number of the organization’s digitally-focused initiatives and often speaks of the benefits these technologies can bring to care.

However, for digital health and medicines to avoid major pitfalls during its rapid sprint toward wider adoption, he stressed the need for healthcare players to collectively demand more stringent evidence of efficacy from these interventions.

“If we look at [the year] 2020, you’re going to see more virtual touch points, and we already have a theme of digital medicine,” Atreja said this week during a session at the Digital Health Care Innovations Congress in Boston. “But there are major barriers that we have to solve. None of the startup companies, none of the hospitals can solve this — we have to solve it together as an ecosystem. And that barrier is evidence.”

The market for digital health products is expanding with each passing year, thanks in no small part to the growing interest of investors in this space, Atreja said. While this has led to a greater awareness of digital health’s potential, it also has placed many healthcare providers in a difficult position when selecting interventions for their patients that are both cost effective and impactful.

“All of this funding for digital health has created a problem. If you really have to get a telemedicine solution, a device, or something, you cannot make a decision … because all of the competing companies out there providing similar solutions,” he said. “What we do not want is something like Theranos happening, and this is happening in the dark every single day. They may not go to the level of Theranos, but they’re out there, and we don’t have [the time] to find all of these. So we have to see all the innovation that’s happening really combine with the rigor of evidence-based medicine, which we all have been taught, … and really establish a new science of evidence-based digital health.”

To drive this goal, Atreja urged the audience to embrace clinical data sharing collaborations that span systems. Much like how medical practitioners will gather with their peers at academic conferences to share their expertise, he pointed to collaboration-focused digital health organizations like NODEHealth — which he founded in 2016 and currently chairs — as an alternative to individual innovation groups working with “their blinders on.”

“We have to work together to create a community and learn the best practices together, and then we can be successful, because no one can distinguish from 5,000 new apps,” he said.

Delivering digital interventions will require simple, collaborative platforms

If inconsistent clinical evidence is Atreja’s primary concern for the future of digital health, the lack of easy-to-use platforms for digital medicine delivery is a close second for the innovation evangelist. Without a smartly-designed means to easily navigate various offerings, the burden of sifting through countless overlapping (or worse, incompatible) interventions will hamper adoption among providers and patients alike, he warned.

“There are not many platforms to deliver digital medicine,” Atreja said. “Think of them from an EHR perspective — when EHRs came, we had thousands of labs — blood through genomics, all those labs. The labs are different, the drugs have different kinds of reaction, but the workflow is exactly the same, right? We need to do exactly the same thing. The interventions can be different, digital therapeutics can be different, [but] what we need is platforms so that health systems can have the same workflow, and patients can have the same workflow.”

The ideal implementation of such a platform would be integration friendly so that a number of different offerings could be included within a single portal, he explained. Further, such a tool should be designed without a specific healthcare organization in mind so that it can be employed across systems.

As an example, Atreja described the early success his team has seen after building one such digital platform in collaboration with a handful of other organizations.

“We’re going beyond our health system with the American College of Cardiology [ACC] to create a network of health systems, starting with 10 hospitals in the US, and we’re creating a cardiology toolkit to take all of the guidelines and [translate] them into care plans and make them available then to 10 hospitals together,” he said. “So, we [do] not do innovation alone, but with 10 hospitals together, and do everything from cardiometabolic to heart failure to [mitral regurgitation].”

The collaborations on these and other projects don’t have to be limited to provider organizations alone. To this point, Atreja highlighted Apple’s launch of smartphone-based EHRs, describing it as a substantial accomplishment that couldn’t have come from the provider space. By leveraging its space in the consumer market and conducting pilots with a number of health systems, the company became the health industry’s largest user of FHIR in just six months.

“Now we have two main channels of engagement — not only EHR, but the personal health record that Apple has unleashed,” he said. “And the same rules that we have been creating with the ACC, we can shift to patients through Apple records, or we could shift to health systems, and suddenly we can have bidirectional information that can feed into each other.”

Partnerships like these between providers, device makers, payers, and other stakeholders will be vital if digital health various hurdles are to be solved, Atreja concluded.

“Digital medicine is true medicine. You’re going to see more touch points, more care being delivered by digital medicine, but what we have to do is find ways of working together,” he said. “Innovation is not a solo thing. Innovation is a collaborative thing, and we all need to work together.”