It’s still early days for integrating digital therapeutics into clinical care, said panelists at the 2023 HIMSS Global Health Conference & Exhibition. But they have a role to play when developers consider the different needs of all healthcare stakeholders, including patients, hospitals, clinicians and payers.
Santosh Mohan, vice president of digital at Moffitt Cancer Center, said there are plenty of opportunities for digital therapies in cancer care, where patients are frequently managing additional concerns like anxiety and fatigue.
“A lot of patients live with this disease for a long period of time, and so the ability to engage these patients over a long period of time and help drive positive outcomes is really important. And that’s where digital therapeutics play a role,” he said. “Think about coaching for symptom management, directions for dosing associated with supportive therapies, tailored recommendations as to the treatment plan.”
But it can be a challenge for digital therapeutics to cater to all the groups within the health system that are involved with their successful deployment.
For example, clinicians need to balance the time they spend helping patients use digital therapies with all their other responsibilities. Meanwhile, hospital and infrastructure teams are concerned about the cost to onboard and the effort to maintain therapeutics, while patients need easy-to-use and clinically relevant tools.
“It is a big ask. But we need to satisfy everyone all at the same time to make this work,” Mohan said.
Dr. Kamal Jethwani, CEO and managing partner of Decimal.health, said physicians have a lot of demands on their time, and they may already know about other tools that work well for them. Plus, there’s another elephant in the room when it comes to adoption of digital therapeutics: the recent bankruptcy filing of pioneer Pear Therapeutics.
The company, which made prescription digital therapeutics for substance use disorder, opioid use disorder and chronic insomnia, made a lot of headway with providers and payers, he said.
But Pear didn’t create the volume it needed to. According to the company’s annual report, it noted about 45,000 prescriptions last year, though only about half were actually filled.
“Our challenge is getting more providers to get used to this infrastructure,” Jethwani said. “But once they start, they keep doing it.”
Dr. William Jin, a resident physician at the University of Miami, said health systems need to be aware of the real-world challenges that arise when using digital therapeutics in a clinical setting. He conducted the HIDRATE PRO trial, which aimed to use a digital therapeutic to help prostate cancer patients prepare for treatment.
When they come in for radiation, patients need a comfortably full bladder to limit damage to surrounding tissue. But Jin said patients sometimes struggle to achieve that, leaving them anxious and waiting around before they can begin treatment.
The digital therapeutic used a connected water bottle and a companion app that told patients when to drink water until they reached a volume goal. Jin said about half the patients used it before every treatment, while two-thirds used it about 85% of the time. Those who used the tool spent less time accessing treatment, which saved money.
But there were some unexpected problems that need to be fixed before implementing these tools at scale. For example, Jin said one of the study staff that was supposed to train patients on using the app didn’t have a smartphone. Provider burnout is also a concern.
“Before COVID, I had a lot of interest in participation and engagement for the trial from the clinicians that were part of our cancer center,” he said. “After COVID, the general consensus was, ‘We’re overworked, we’re understaffed and we’re just trying to get to our status quo and just do our clinical job.'”
But patients definitely showed interest, Jin said. Still, developers need to keep in mind that many patients are older and may not be tech savvy.
“Make it very seamless, make it so my grandparents can use it,” he said. “If I have to sit down with a patient to be able to work through it for them, that’s going to defeat the purpose. It has to be so seamless that it has to be like magic.”