Partners' Kvedar on how digital health can break into the mainstream

By Jonah Comstock
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Connected health has arrived, almost. In a talk this week at the Digital and Personal Connected Health conference at HIMSS17 in Orlando, Partners HealthCare VP of Connected Health Dr. Joseph Kvedar talked about how far advances like telemedicine and remote patient monitoring have come, how far they still have to go, and how the industry can clear the final hurdles between today’s early adopters and widespread, mainstream adoption.

“I have to look at it and say, maybe this thing is just happening, is it like a snowball rolling down a hill at this point?” Kvedar said “Is innovation required? Because if it is, leadership needs to step in, but if it isn’t, we should get out the way and let it happen. One sobering thing you can see is, if you look at the totality of all healthcare that’s delivered, and stop to say ‘How much is delivered by virtual means of any sort?’ It’s got to be zero point some number of zeroes one percent.”

As a guest on two different radio programs, Kvedar recently had the opportunity to see firsthand the way digital health is still perceived by most people. He said that people who called in either didn’t trust digital health because their personal physician had never mentioned it, or they were concerned about privacy and security.

“Well on some level I’m sure you’re not surprised to hear that, right?” he said. “But on another level, think about what we give up every day to Google and are happy with it because of what we get back. And in healthcare I’d say we’ve under-imagined how to get people to share their data and how to get people to give their data back, because what we give them back is admonishment that they’re going to have a heart attack if they don’t shape up. Who wants to give up their data in exchange for getting scolded?”

If the key to getting widespread patient adoption is to get doctors to recommend health tools, then the question is how to get doctors to buy in. Kvedar said doctors are burnt out and are concerned with things like liability, reimbursement and data overload. Kvedar says the concern about data overload is understandable, but misguided.

“On the one hand, let’s just acknowledge that that’s a little bit arrogant,” he said. “Because what it suggests is that the only thing that matters is that little slice of life when you’re in my office. Can’t we get beyond the idea that the doctor’s visit is a magical time when your vitals mean something and they don’t mean something the rest of your life?”

On the liability front, Kvedar says that the best encouragement he can offer is that no one’s been sued yet for having access to more patient data. But legal clarity would still be helpful, since it’s often the fear of liability that keeps doctors from accepting the data.

Kvedar also re-iterated a point he made in a recent NEJM editorial: That there’s a disconnect between digital interventions’ performance in clinical trials and in the real world because clinical trials artificially increase engagement, and engagement is so important to a digital health intervention’s success.

“We really need to validate this stuff,” Kvedar said. “But don’t conflate a positive outcome from a clinical perspective with a market success from a patient perspective. And that’s where I think we need to do more. Build more engaging tools into your software, and the mobile industry has taught us what those things are: They’re things like games, they’re things like contests, things like that. We’ve got to build those in and then you have a better chance of success, even if it works in a clinical trial environment.”