The current status of digital health education: Where are we and what's missing?
Digital Health. Digital Medicine. Digital Therapeutics. Are they buzz words or the future of care? I don't know, and honestly, I don't care. They are terms that are recognized in the industry, adopted by regulators, and will likely stick around until the 2030s. So for the interim time, these terms are needed as we undergo a level of digitalization of health care that has been needed for the past decade, and the pandemic has finally forced upon us.
That sounds great. New treatments, new business options, hopefully, improved patient outcomes, and some level of cost reduction. But as I've been critical of before, we just aren't ready for some of these items on a professional level. I've published some thoughts on how to get digital health education across medical programs with my friend Ravi Patel, PharmD over at Pitt, but recently I have seen some interesting new programs I really want to dive into here, as I think they will be a guiding mechanism going forward.
Digital Health Syllabi Breakdowns
What got me started with this was an interesting post by Lisa Gualtieri, Ph.D. over at Tufts, who mentioned an upcoming course they were teaching in, along then Brennan Speigel, MD, chiming in on his course; I had to give these a look into. In addition, recently, Berci Mesko, MD of The Medical Futurist and DiME, also announced their own certificates, and I can't help but feel things are advancing along. So let's take a look at these offerings.
Tufts Univesity School of Medicine: HIA203 - Digital Health
A required course for the online MS in Health Informatics & Analytics. The course description is:
We all generate data through smartphones, sensors, trackers, and other devices, and our physicians generate data about us. In this course, we look at how medical practitioners, technology professionals, data analysts, and public health professionals use technology and data to bring value to the lives of patients. This course focuses on the variety of technologies available, how they are used, and how they can be used ethically to assist in behavior change, diagnosis, and treatment for individuals and populations. The course provides an overview of digital health through lectures, readings and expert guest interviews. Students engage with real technologies and examine the experience of using these, and their potential applications, through assignments and class discussion. The course culminates in a group design project, where students create a viable digital solution to a health problem.
Overall course is 14 weeks, and at 3 credit hours, I am assuming 3hrs/wk, with each week's layout being:
Physician's perspective on digital and connected health (Jeffrey Phillips, MD)
EHRs
EHRs from the patient perspective (Ali Loveys, MD)
Patient-generated data through digital health devices (John Shambroom)
Digital mental health and digital phenotyping (John Torous, MD)
Patient perspectives on digital health (Dave DeBronkart and Dom Gualtieri)
Behavior change and messaging
Uses of data in public health (Raed Mansour)
Telehealth (Joe Kvedar, MD)
IoT and voice assistants
Aging in place
Global perspectives on digital health
The future of digital health (Berci Mesko, MD)
Design thinking group project presentations
Cedars Sinai: Principles and Practice of Digital Health Science (HDS 201A)
This course is part of the Masters's degree in health delivery science and is part of the core curriculum. The educational objectives are quite interesting:
Recognize the role of digital health and the quantified self-movement in driving healthcare delivery and value of care
Learn the principles of developing, validating and testing wearable biosensors
Recognize the pros and cons of different electronic health record (EHR) architectures, including cloud-based versus fixed EHRs
Understand basic principles of data transfer and security protocols for digital health data; study limits and opportunities of EHR interoperability
Evaluate the role of patient-provider portals for clinical and research applications
Understand the benefits and challenges of implementing OpenNotes in clinical practice
Review models for using telehealth to deliver remote care
Explore the role of social media for healthcare analytics
Study how text processing techniques can be used to gain insights from EHRs and other open-text formats
Evaluate the role for computerized clinical decision support (CDS) systems for improving healthcare delivery
The course description is:
Explore how digital interventions are being employed to drive clinical decisions and offer value to healthcare organizations, their patients and their staffs. Digital health is a broad term that encompasses use of digital devices and platforms, including electronic health records (EHRs), patient-provider portals, mobile health (mHealth) applications and wearable biosensors to improve process and outcomes.
The course begins by focusing on the revolution in remote patient monitoring made possible by ubiquitous broadband networks and wide penetration of smartphones. (Over 80% of the U.S. population now owns a smartphone.)
In addition, it is now possible to supplement patient reported outcomes (PROs) with additional data from remote monitoring, such as from wearable biosensors. Specialized, medical-grade sensors are increasingly approved by the Food and Drug Administration and are useful to monitor physiologic data, from glucose levels to brain function to medication adherence.
The class will also cover the burgeoning ecosystem of mobile health apps, including patient-facing, provider-facing and patient-provider smartphone apps. We will review best practices for mHealth app development and review example of apps that worked—and didn't.
Students will learn how to develop, test and scale apps for patients and providers. We will also review issues surround data security, data storage and data sharing using mHealth applications, and discuss their role within the domain of consumer health informatics.
The class will next explore electronic health records (EHRs), including patient-provider portals. The class will review the different EHR architectures, benefits of cloud-based vs. fixed EHR systems, and ways to leverage the EHR to improve the value of care.
We will then examine technologies gaining traction in digital health, including telemedicine, virtual-reality interventions, and social media, among others. We consider these examples within a framework for making smarter decisions in the age of digital health—a model that brings together what the clinician knows, what the patient wants and what the technologies predict.
In all cases we will explore real-life case studies at Cedars-Sinai and beyond, learning from practitioners in the field using digital health in the clinical trenches.
Per Dr. Spiegels Twitter post, it looks like the class runs for 15-weeks with a final project. Unsure how many credit hours the course runs or how many hours a week. The classes are as follows per session:
Introduction to the course (B.Speigel)
Introduction to design thinking and its application to digital health (C.Khalil)
Mobile health (mHealth) part 1: wearable biosensors (B.Spiegel)
Wearable case studies (B.Spiegel & T.Daskvich) [lecture looks at mechanisms of developing, validating, testing, and FDA involvement for different mHealth devices]
mHealth part 2: smartphone apps and patient portals
App case studies (C.Almario) [similar to before, looks at development and validation of mhealth apps]
The essential nature of clinical validation to the success of digital health (D.Albert & D.Kraft)
AI in healthcare: how can we ensure the benefits outweigh the risks? (M.Juneja)
AI Case Study (M.Wong)
Virtually better: the science and practice of medical extended reality (B.Spiegel)
EHRs Part 1: overview of EHR structure and functions (I.Masson)
EHR Part 2: application programming interfaces, data storage, and data security (S.Soohoo)
EHR Part 3: improving quality and value of care through EHR-based clinical decision support (R.Riggs & P.Roberts)
Discovering hidden themes in unstructured biomedical data: introduction to NLP in healthcare (M.Thompson)
Social media analytics in healthcare (B.Spiegel)
Leading and managing change in the era of digital health - perspective from a CMO (C.Goldzweig)
Group final project oral presentations and written report due
I wonder how much of the class here is synchronous and asynchronous. In addition, how long the sessions are and the opportunity for discussions.
Digital Health for Practicing Clinicians: A Certificate Program
Run out of the Rocky Vista University College of Osteopathic Medicine Digital Health Track and with the Digital Medicine Society, this online certificate program looks geared toward current and future healthcare professionals. No listing on the faculty involved or exact program details. The learning objectives are:
Obtain an overview of digital health and understand the differences between digital health, digital medicine, and digital therapeutics.
See how new, patient-centered approaches to evaluating digital health products can lead to safe, effective, equitable, and ethical patient care.
Understand the changing roles of clinicians with technology and how digital medicine tools can support the evolving future of healthcare.
Realize new opportunities for efficiently acquiring new skills and incorporating "digital" into patient care.
Learn best practices for how to integrate digital medicine and digital therapeutic products into real-life clinical settings.
There are eight modules, with each lasting 30-40 minutes for a total of 5 hours of content. This will cost you $250, though it does have CE. Looks like you have a final exam for credit, which is 24 questions with 3 retakes. Each module also looks to have about 2 assessments. The modules include:
Introduction to Digital Health
Evaluative Frameworks for Selecting Technology for Patients and Clinics
Best Practices for Telemedicine
Artificial Intelligence in Healthcare
Integrating Digital Health Technologies into Clinical Care
Patient Advocacy in Digital Health
Consumer Health Informatics
Health Equity and Ethics in the Digital Age
Overall, looks interesting. I think for a CE-based course on digital health, this one stands out for being a longer-track offering compared to others that I've seen (or given myself, heh).
The Medical Futurist: The Digital Health Course
Berci Mesko, MD group, put together this new online course, costing $225. It seems targeted more towards those who want a better understanding of digital health (e.g., pharma, biotech, policy, generalists) and not necessarily at clinicians. It does not look to offer CE at this time. It has 55 lessons of varying lengths over 7 chapters, and 2.5 hours of video content. Per TMF, the course summary is:
Welcome to the Digital Health course – Introduction and basics
What Is Digital Health – A general overview of the field and the current landscape
How Does Digital Health Reshape Healthcare? – The timeline, the technologies, and patient empowerment
Digital Health Technological Trends – What is a trend? How to identify them? The methods you can use
The Business side of Digital Health – Hype vs Facts, Good vs bad features, Tech Giants and regulatory challenges
Forecasting the Future of Digital Health – How to do foresight, The power of the crowd
Depicting the Future of Digital Health – What is going to happen? The importance of playing with the 'What if' question
What Do I Make of All These Courses?
Overall, I think there is a definitive corner being turned in digital health education. As Ravi and myself published three years ago when we looked at the digital health education market, it was primarily offered on digital health entrepreneurship with very little clinically focused. Most were certificate models. However, Lisa and Brennan's courses in their master programs demonstrate a movement, especially for programs in health information and related, that digital health has a role to play. The track that Ravi and myself saw coming out of Rocky Mountain morphing into a CE program is nice, and I think rather smart of the school and faculty there to team up with DiME. I may take some time to look into it and actually take the course myself.
In terms of other items, some of the content being offered in these syllabi stood out:
A focus on EHRs even for those not in clinical programs. The faculty are banking on the EHRs being a primary role in digital health delivery. This is interesting given all the headaches digital health companies have been having getting their products into EHRs.
mHealth is still here! I think wearables, sensors, etc still need this term, despite some people's wish for it to be just digital health.
My biggest critique is -- So much of this content being delivered is from the position of a physician. And I'll call out the inherent bias this creates in the health care space. If digital health is supposed to be an area that is massively transformative to the delivery of health care in the next decade, by physicians by and large are driving the content, we are set up for failure, as I feel the lesson that is being sought is that not only is digital health equitable and scalable for health care delivery for all patients, but that all of us in healthcare are also able to deliver. Also, it buys into the bias that physicians are the key decisions makers for digital health products and services when its more downstream, and hurts digital health innovators outside of healthcare who make go after KOLs or related and fail to capitalize on a viable business strategy... as I have been critical of before.
Segwaying from my last point, I suspect we will see individual health organizations and schools make their own content. That may be good or bad. The only bad thing I think would be if terms or definitions vary too much. For instance, I struggle with many in the pharmacy profession that want to put digital health under the auspices of pharmacy informatics... which is frustrating, to say the least.
I wonder how long telehealth stays as content before being subsumed by being a standard of care
Suprised, not more focus on health data and privacy. This is an area I always get asked about no matter what.
Building upon design thinking is interesting. Gonna just shout out to Bon Ku and Ellen Lupton here if you want more read on the topic.
Now why I wanted to write this piece isn't just because I have been thinking about how to teach digital health in pharmacy programs, it's also because it's a reflection on what I want to update on my own material. You see, I also offered a 'digital health' elective at one time.
My Own Experience
Ok, so I offered a Pharmacy & Technology Elective from 2014-2018. It ran for 10 weeks during the summer, with a 3-hour long lecture each week. I designed the class for 30 students, broken into pairs to do projects together. The students had assigned readings, and since Eric Topol, MD "The Patient Will See You Now" had just come out that was one thing we read through the whole semester. Sessions included:
Introduction to Course & How Technology has invaded our lives and healthcare. Students were assigned longitudinal projects for the course.
Social media and me: being an e-professional and navigating online health information. A talk about online patient interaction and online health consumerism. Now it's webside manners I realize... and Dr. Glaucomflecken videos.
The internet and the fallacy of medical information. Students shared an online post or meme related to healthcare for the class to discuss (I wonder how this would have looked had I run this class for the last few years of the pandemic)
Moving towards mHealth & the quantified self.
How has mHealth impacted me?
Using technology to access the medical literature - Becoming an information ninja
What is informatics, and what does it impact pharmacy?
How genomics and data can impact personalized medicine
mHealth apps for patients, pharmacists, and providers
Pharmacy Shark Tank
Over the course, students were responsible for several projects to present during these sessions. Usually, I would give a 30-minute chat about the reading, and then a 30-60 minute presentation, and then the rest of the class was discussion or students presented their work, including:
Downloading a health app of their choosing and sharing their experience and what they think
Jellybean experiment. A 30-day supply of 'medication (tic-tacs)' that they spent 2 weeks trying to remember to take and then performing a pill count, followed by a 2-week digital health intervention (smart pill bottle/tray or app) and then sharing their experience. For many students, this was a first-time experience and probably one of my favorite assignments.
Evaluating mHealth applications and medical apps for different people. Now with the advances of different groups like John's, this would be so much easier I feel. Plus so many new apps on the market.
Pharmacy Shark Tank. Students pitch their health apps or service ideas. This was hit or miss at times, but was really fun, especially if I got industry people to help judge.
So what would I change now?
Add AI/ML topic
Tackle data privacy
Health consumerism
Payers and market considerations
More case studies (since we have a lot of success and failures now)
Focus on clinical scenarios and conditions (that aligned with their curriculum)
Digital medicine and the medical literature with a focus on digital biomarkers and disease management and clinical research
DTx/PDTs and alignment with pharmaceutical care
Pharmacy of the future
RPM strategies
Digital Health P&T Hands-on activity
So how should we integrate digital health into the pharmacy curriculum?
You know what? I'll just make that another post.
Closing Thoughts
If I was to offer an elective on digital health again, so much I would need to change and I think seeing what others are teaching we are now running towards common themes I can adopt. If anything, if you want to broach this topic you need to really define who the audience is and the value of the content for them. So is it topical knowledge, in-depth practical knowledge, business-focused, or clinical? I do not think you can do all of this in one course, or just be very superficial and topical. Maybe each could be its own, but you'll never get it into a curriculum currently. So I think being very strategic for your learners, especially if you have a dedicated course, is going to be important.