COVID is accelerating innovations in digital health and driving growth in patient-centric tech

The COVID-19 pandemic has accelerated the development of patient-centric technologies and health care models that provide much quicker diagnoses and information via digital applications, which has the potential to improve access to care, especially in communities far from health facilities.

This shift is due in part to needs that have arisen during the pandemic, including the need of patients for up-to-date information about COVID risks and the ability to diagnosis themselves during lockdowns, as well as the needs of governments for real-time data and information on the spread of the virus. A growing range of digital applications satisfy both needs and are helping patients self-diagnose and interact with health systems simply by logging on.

“Health systems have traditionally put the health care provider at the center of their health system model and patients at the mercy of the system. Typically, patients trek to a provider, then endure long wait times at facilities that are understaffed, understocked, and under managed," said Chuck Slaughter, founder of Living Goods.

"These new, digital models put patients at the center and are accessible to those patients anytime, anywhere. The driving force and appeal of these models is convenience and timeliness – making it easy and frictionless to get what you want whenever and wherever you want it,” Slaughter added.

The pandemic-driven boom in digital tools is also helping demonstrate the potential benefits of more patient-centered health systems. The shift is notably providing opportunities to improve health outcomes in LMICs, especially in sub-Saharan Africa, which The Lancet described last year as “the new breeding ground for global digital health.”

“Sub-Saharan Africa has become an emerging arena for digital health innovations directed at strengthening health care, in terms of both patient management and disease surveillance and prevention,” wrote the authors of The Lancet article. “Across the region with the world's largest burden of disease and the most severe shortage of health care workers, we see increased use of digital health solutions and interventions for clients, health care providers, health-system managers, and data services. As the traditional health care systems are typically ill-equipped, understaffed, or not accessible at all, subSaharan Africa is booming with digital health.”

One example of these new digital health tools is South Africa's Health Connect. The platform uses WhatsApp and a chatbot to help users check if they are showing COVID symptoms, assess their own risk, and register for vaccines. Another example is Vietnam’s NCOVI, an which allows people to share their health status to create a digital "neighborhood watch" for COVID.

What all of these tools have in common, said Nicholas Gordon, the Director of Digital Health at Last Mile Health, is that they create health systems in which, “patients are the first to signal a need, whether that be for information, or for reminders, or for health services” while at the same time generating powerful, actionable data for health leaders and providers.

Many of these tools can trace their roots back two pre-pandemic pioneers in patient-centric digital health in LMICs: South Africa’s MomConnect and Cameroon’s GiftedMom.

MomConnect is a communications system launched in 2014 by the South African Department of Health and the Praekelt Foundation. It connects mothers to health information and services and sends personalized, stage-based information and reminders to its two million registered users. GiftedMom, developed in 2013, offers pregnant women and nursing mothers access to health information tailored to their pregnancy term or newborn’s age, such as reminders about immunization schedules. It also and includes an “Ask A Doctor” SMS text service and an in-app chat and currently serves more than 200,000 women.

The pandemic is also demonstrating how these apps can be adapted and adopted in LMIC settings to help improve access to health care after the pandemic ends.

Rwanda is perhaps furthest along in exploring the potential of this approach. The country has contracted with Babyl, which allows patients to “visit” with a doctor or nurse over their mobile phone. Babyl uses text messages and voice calls so that it is accessible even on phones with limited multimedia and internet capabilities. More than 30 percent of Rwandan adults are registered with Babyl, and the app has already supported more than one million consultations with health care providers – typically more than 5,000 calls a day.

Overall, these digital patient-centric tools have the potential to deliver important benefits. When apps reach scale, they can achieve lower costs per consultation than in-person models. They can help frontline health workers triage and expedite referrals to health centers. This, in turn, can help to free up health system to manage more serious conditions since only patients who need more complex care can be directed to health facilities for treatment.

In geographies where cell phone access is widespread, these apps can also help ensure community health workers (CHWs) visit the households where they are needed most – reducing the number of long walks CHWs need to make to get to patients. The apps can also be designed to generate automatic reminders for follow-up care and help patients stay on track during their recoveries. This is in addition to the significant benefits that can be achieved through analysis of the health data they generate.

What remains to be measured is how much these benefits translate into better health outcomes or cost savings for health systems overall. The willingness of countries to pay for these digital health tools will likely be linked to outcomes and cost-savings.

The recent Lancet and Financial Times Commission on Governing Health Futures 2030 wrote, for instance, that "digital health technologies are an essential part of transforming UHC, but they must be aligned with the actual needs of health systems, the health workforce, and users to do so. The analogue and digital components of future health systems need to be integrated in a strategic and coherent way."

The Commission's report includes an overview of the growing number of tools to help health leaders assess digital health readiness. The WHO's Classification of Digital Health Interventions also includes a list of these apps and how they are being used around the world.