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Defining Digital Health: What Makes an ‘Effective’ mHealth Program?

The Connected Health Initiative, which tackled the murky concept of asynchronous telehealth last year, is now setting its sights on a comprehensive definition for telemedicine's effectiveness. Others may see it as a question of value.

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- How does the healthcare system measure the effectiveness of a digital health program?

The Connected Health Initiative, which last year sought a consensus definition for asynchronous telemedicine, is ready to tackle more confusing mHealth concepts. At the top of the list is a better understanding of how healthcare defines digital health success.

“We want to dig down to how the process of medicine is done,” says Morgan Reed, executive director of the Washington, D.C.-based coalition, a two-year-old offshoot of ACT | The App Association that’s been tasked with exploring the intersection of healthcare and technology. “A lot of that work is going to be definitional.”

Reed says the healthcare ecosystem is rife with words and phrases that mean different things to different stakeholders – mHealth, mobile health, digital health, connected care, eHealth, telehealth and telemedicine, just for starters. This makes it difficult for the various parties involved in healthcare to work together, and in turn hinders the industry’s adoption of new technology and concepts.

For example, in a simplistic sense, a consumer may consider an mHealth or telehealth program to be effective if it proves more convenient than in-person care, while a doctor might measure its value in whether clinical outcomes are improved and a health plan might prefer a program that reduces cost and waste. In another case, a consumer might embrace a program that makes him or her feel better, while a provider values that platform’s ability to protect patient data.

In addition, each party has a different idea of a program’s monetary value. Patients want to save money, doctors want to be reimbursed for their services, and payers want to reduce future health expenses by paying for the most effective treatments.

Because different parties have different ideas of how a program is or isn’t effective, that can affect whether it’s accepted by everyone. A program that appeals to consumers might not be embraced by doctors, and something favored by doctors may not pass muster with payers, who would ultimately reimburse doctors for that service. Conversely, if consumers don’t like a program, they won’t use it, and it’ll fall by the wayside no matter whether it’s reimbursable.

“So how do we define effectiveness?” Reed asks. “That’s why we need to get everybody to the table” to come up with acceptable standards.

Reed doesn’t like to use the word ‘value’ because “it’s wrapped up in a monetary concept.” But others see value as something that will define the telehealth industry in the future.

Ralph Derrickson, CEO of Carena, a Seattle-based telehealth provider, says the industry will evolve as healthcare providers and consumers go back and forth over its value. A doctor who understands that a telehealth service is attractive to patients because of convenience will negotiate with patients to set a monetary value on that service.

“Providers know that those first dollars are going to come out of the patient’s pocket, so they’re going to be able to negotiate” for up-front services, Derrickson says. And as treatment and payer data become more accessible and transparent, patient and provider will have more leeway to determine the true value of a telehealth or mHealth service.

As consumers and providers look for common ground on how to value telehealth services, Reed and the CHI want to make sure they’re speaking the same language.

Last year’s project to define asynchronous, or store-and-forward, telehealth “fostered quite a bit of discussion,” he says, on how different people can have different ideas about the same concept. That might be best seen in how some states see asynchronous telehealth as an acceptable platform for the delivery of care, while others limit or even ban its use.

“We realized that we had to define, at least initially, the term,” Brian Scarpelli, a CHI member and the ACT’s senior policy counsel, told mHealthIntelligence.com in an interview last November. “What we’re looking to do is work from the ground up, creating [definitions] that shape the way [healthcare providers and payers] recognize and use these tools.”

“It can get very confusing,” added Alexandra Cooke, a tech policy professional with ACT and fellow CHI member. “In some cases it’s not the word itself [that is confusing], but how it applies to healthcare or how it’s used.”

Reed says the CHI will “absolutely” tackle more vague words and concepts this year. It’s part of an ambitious 2017 agenda that includes Congressional staff briefings, technology demonstrations, support for resubmitting legislation like the CONNECT for Health Act and CHRONIC Care Act, and research on how connected health technology can become a standard of care.

“Healthcare, like many other industries, has its own language and style,” he says. The problem right now is that telemedicine – or mHealth, digital health or whatever else it’s called – adopts technology and concepts from so many different industries.

The language has to be worked out, he says, for the industry to move forward. And that begins with identifying what it means to be ‘effective.’

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