IPO fever is hitting a bit of a frenzy amidst a slew of recent listings, and with it has come a renewed focus on the exact boundaries of digital health — or, alternately, of health-tech, connected health, eHealth, or any of the other myriad monikers for the intersections of healthcare, technology and innovation.
As observers from various mainstream and niche industries have flocked to discuss Health Catalyst, Phreesia and Livongo’s entries into the public markets, it’s becoming clear that those inside and out of the healthcare technology world hold a different idea of which companies are in the space, and how best to describe them.
Today’s coverage from Business Insider and Inc., for instance, included each of these firms as well as Change Healthcare’s revenue cycle management business as recent examples of digital health IPOs, while also counting Ancestry’s genetic testing business and SmileDirectClub’s online assessments for mail-order teeth aligners in the same camp. Even connected fitness company Peloton has been evoked as a part of the trend.
What's in a name?
In reaction to the increased media attention, those further embedded within the sector are using the opportunity to discuss the industry’s adoption of these terms — and often, to debate which names most accurately describe which companies.
“I wish media would stop calling Phreesia ‘digital health,’” Andrew Matzkin, a partner focused on digital health and health IT at healthcare industry consultancy Health Advances, wrote on Twitter a few days ago. “Using tablets doesn't make you a [digital health company]. They're health IT, much more like Epic than Livongo. Their IPO says almost nothing about the potential for @Livongo, @PropellerHealth, @Pear_Tx, etc.”
“If it's not digital health, is it health-tech?” CNBC’s Christina Farr replied. “And what's the difference between the two terms? Now we're getting philosophical…”
The semantics of a budding industry can influence public perception of the market and, subsequently, its growth, Farr continued, highlighting the differences between “drug company” and “pharma company,” or the always controversial “payor” and “insurer.” At the same time, inconsistent categorization of certain companies under the digital health or health IT umbrellas can lead to industry analyses that aren’t quite one-to-one, as is the case when comparing the tallies of VC funding roundups from market observers like Rock Health, Mercom Capital Group and even MobiHealthNews.
Categories within categories
Further complicating the discussion are the technology and service subsets that exist within the healthcare technology umbrella. The FCC is among many who have sought to delineate “telehealth,” “telemedicine” and “telecare,” all of which have been used to describe the provision of health service over telecommunications technologies. But even these phrases become fuzzy when the debate begins to dip into the remote monitoring space, not to mention the fact that some leading providers of these services often gravitate toward phrases “virtual care” or “virtual visit.”
Interestingly, standardized nomenclature has lately been a driving focus for another subset of digital health: digital therapeutics.
Looking to differentiate their products from those unable to provide evidence of delivering a therapeutic intervention, the Digital Therapeutics Alliance, a consortium of industry stakeholders, published a whitepaper late last year with an official definition of what is or is not a digital therapeutic, as well as guidance and best practices for how the products fit into the larger digital health landscape.
In this instance, explained Digital Therapeutics Alliance Executive Director Megan Coder, having consistent guidelines is not only necessary to to build recognition among the average consumer, but to provide stakeholders across various pharmas, payers and regulators a shared lexicon when evaluating these products for the first time.
“Even in larger journals, there’s been this misconception of assuming all of digital is the same,” she told MobiHealthNews. “So therefor, when they say ‘all digital products don’t have regulatory oversight’ or ‘all digital products don’t have clinical evaluations.’ That’s completely inaccurate. But unless you start to have a differentiation, you don’t know how to actually describe the subsets and understand what needs to have what. … No matter who you are, those things are going to become important, and will start to emerge more in the coming months and year — hopefully.”
A tale as old as.... MobiHealthNews
So with all of that being said, where does MobiHealthNews land on health technology semantics? Cofounder and former Editor Brian Dolan reminisced on Twitter today about the rise and fall of “mHealth,” “wireless health” and other terminology that has since fallen by the wayside. Noting that “digital health” took roots in the mid- to late 2000s and become more established around 2011, he recalled a 2010 interview with health analyst Jody Ranck, who argued that overly specific definitions were likely to cause more harm than good.
“A very narrow definition can blind us. In global health you can feel the impact of a lot of linear thinkers and it can be a constraint on innovation. I like to avoid that,” Ranck said at the time. “Sometimes people need a precise definition to do their market research study — I understand. I think there are costs involved in putting too great a limitation on it, though. As a result, creative responses to certain problem sets might get overlooked or not even thought about.”
Different language and categorizations have a role to play for those who establish them. Speaking broadly, MobiHealthNews seeks to align its coverage within the purviews of digital health and healthcare technology innovation, but those definitions are unlikely to align from observer to observer, and stakeholder to stakeholder.
For the purposes of this month’s class of IPOs, all are employing novel digital technologies to reinvent or streamline the healthcare experience. It's hard to deny that enough companies in that space are going public at the same time to constitute a trend, and one worth examining. But Matzkin's original point stands — it's incumbent on all of us to make sure that those examinations aren't comparing apples to oranges.
For better or for worse, digital health is a big tent, and as the space grows, maybe the best the industry can do is strive for clarity in these specific cases — to make sure that new and growing subcategories like digital therapeutics stick to a defined, but still broadly useful, name.