**Abstract**

Digital Health promises to transform healthcare in this decade. We have gone from "low tech" telephones, fax machines, dictation lines, desk-top electronic medical records, and data storage centers to video visits, texting, emails, smart phones and other mobile devices, and to higher forms including artificial intelligence, cloud data storage, and blockchain. However, letting go of legacy applications and then implementing the best available technology for clinical use has been challenging. This chapter will review the factors that contribute to the difficulty of moving from old to new tools. Specific examples will be video, electronic medical records and remote patient monitoring. The process of evaluating a new technological application will be described and a standardized framework proposed. We will finish with a discussion around local and scaled steps that can facilitate, support and sustain a patient-centered application of the best technology in healthcare. A call to action for the reader will be presented.

**Keywords:** digital tools, accessibility criteria, evaluation, implementation, strategic goals

## **1. Introduction**

The experience of Healthcare is not pleasant. Accessing and navigating the system to receive timely care of high quality and affordable is not easy for patients. Cumbersome operational processes and inefficient legacy tools cause clinicians to waste time and promote burnout. Stakeholders- including payers and members, clinicians and their patients, industry, government agencies, and non-profit organizations- crave for a new paradigm that is smooth, seamless, and individualized. In 2020, technology was heralded as the means to make this happen by an end-to-end and fully integrated approach—all in a timely fashion under a viable business model that is cost-effective.

Despite the diversity of priorities amongst stakeholders, they can share a singular vision around technology. Digital Health, synonymous with Technology in Healthcare, is commonly defined as a convergence of digital technologies with Health, Healthcare, living, and society [1]. Furthermore, the author's vision of Digital Health- a patient-centered application of the best available technology to further the Quadruple Aim of better patient experience, clinician engagement, affordability, and quality [2]- can undoubtedly be adopted by all users of Healthcare. The technology we are talking about are just tools to make Healthcare easier for everyone but always starting and finishing with the patient.

What is facilitating this drive for the digitalization of Healthcare? As a practicing family physician for over 35 years, this author believes that the phenomenon is mostly due to our inability to meet demand requirements. The general practitioner had it right by providing in-person care in the office or emergency department or hospital or home, wherever the patient needed it. This clinician knew the patient well due to 1:1 clinical encounters and continuity through follow-up, so it was very personalized. Care was relatively affordable as testing and treatment, and referrals and appointments were decided based more on the clinical necessity and less on profit and liability. However, the shortage of primary care physicians, even with nurse practitioners and physician's assistants, has resulted in the erosion of this relationship and the gold standard of care. Virtual ways of communicating and "seeing" patients, although not ideal, are practical and can help.

Even with the coronavirus pandemic, the healthcare system has kept consumer engagement a top priority though some would argue for the wrong reasons such as sustaining and growing membership. Many capabilities have been strained and changed, but on a positive note, Digital Health has been pushed to the forefront with its promise of being able to have a positive impact on Healthcare, care delivery, and, ultimately, health. At the beginning of 2020, we were doing national presentations on audiovisual visits to promote the value of this type of care, especially for those with poor access. In 2019, only 11% of US consumers had used telehealth, but this has skyrocketed to 46% in 2020 [3]. We all experienced the rapid adoption and growth of telemedicine out of necessity due to ambulatory care and hospital facilities limiting access, and reduced utilization from fear of exposure while at brick and mortar settings. Those with an established video care component had modest increases from 2019 to 2020. In our urgent care telemedicine clinic, which has been in existence since 2013, volume tripled, or increased year to year by 200%. Nevertheless, clinical groups who had done limited video care pre-pandemic saw unprecedented exponential growth. In our multispecialty practice, both primary and specialty care divisions had nearly a 20,000% increase year to year.

An audiovisual connection was unquestionably the most prominent example of a Digital Health tool used during this crisis. There are many others. Texting applications, especially around symptom-checkers, were introduced. Some focused on mental health for those that could do self-care. Surgical centers found excellent use to reduce physical contact with patients during pre-operative management and post-operative follow-up. In direct response to the pandemic, Covid-19 symptom checkers were distributed by CDC, individual payers, and provider groups. Employers have also been using customized versions for employee wellness and surveillance.

These are some of the countless technological tools that the health care system is deploying to improve the patient experience end-to-end. This effort preceded the pandemic, but it has become even more critical as direct, in-person contact is of clinical concern. The historical exponential growth of Digital Heath in the technology industry accelerated in 2020 to unprecedented levels. It is much like the dot com era. Start-ups and established companies are professing to have the "solution" to a health care problem or case use through their software or "system" or "model." Worldwide in 2018, there were 318,000 mobile apps and 200 new ones per day [4]. These numbers have grown exponentially ever since.

A huge challenge for leaders in dealing with Digital Health is to figure out which technological tools to select. They have to decide if a device or application can perform as advertised. It is essential to determine if it will have an impact on the quality of care and outcomes. Affordability is always a concern too. Also, consideration must be given to legacy applications – are they worth keeping and integrating with the new? Or should they just be retired? While the first step is to find a reliable

#### *Emerging from Smoke and Mirrors DOI: http://dx.doi.org/10.5772/intechopen.96212*

and reproducible way to identify Digital Health solutions of high quality and value, a framework for implementation is essential.

The myriad of stakeholders may share a high sense of urgency about Digital Health, but each has distinctive priorities that make all of this difficult to put into practice. We need to try to move Digital Health hopes systematically from "smoke and mirrors" to impactful reality if we are to create a truly better healthcare experience and system for all. In this chapter, let us look at the challenges of the initial selection of technological solutions. Then we will introduce a scorecard as a good starting point for evaluating the technology's quality. Next, a methodology is presented to measure outcomes. Finally, we will offer barriers to implementation, then some suggestions for a strategic framework.
