Digital health & low-value care
Introduction
Digital health is growing at a fast pace, rapidly transforming the way health care is delivered and how patients and clinicians interact. The recent steady growth of telehealth visits,1 was markedly accelerated by the COVID-19 pandemic leading to multifold increases in video visits in the span of just a few weeks.2 The rapid development of digital health products offers timely opportunities to improve health and health care, but also may create low-value care. This commentary, developed by members of an AcademyHealth thematic working group, offers a conceptual framework to consider the potential for digital health to generate low-value care and to offer policy solutions. We assert that digital health may potentiate three types of low-value care; 1) ineffective care because it is underdeveloped, 2) inefficient care because it adds unnecessary care rather than replaces it, or 3) unwanted care because it does not align with patient and clinician preferences. With all the excitement around digital health advances and the hope it garners in reducing the spread of COVID-19,3, 4, 5 thoughtful consideration about the potential for harms to exceed benefits – the traditional definition of a low value service - has never been more urgently needed.6
Section snippets
The promise of digital health: substituting, augmenting, and creating new health care
The term “digital health” covers a wide array of hardware and software technologies including, but not limited to, mobile health (mHealth), wearable biosensors and garments, telemedicine, artificial intelligence, web-based analysis, virtual reality, robots, and emerging technologies intended to improve health care services, public health and patient well being, reduce inefficiencies, and personalize health care.
Our conceptual framework is presented in Table 1. The first three rows categorize
Illustration of digital Health's potential to exacerbate low value care
The columns of the framework use Verkerk's typology16 to organize digital health by the potential to generate low-value care because it is either ineffective, inefficient, or unwanted.
Digital health risks produce ineffective low-value care when the technology is undertested and potentiates harm. The vast majority of mHealth applications do not meet the Federal Drug Administration's (FDA) definition of a medical device and are available to consumers without validation.17 However, only 1% of
Policy solutions to mitigate low-value care generated by digital health
While the elimination of low-value care has become a recent policy priority,33 little attention has been paid to the prevention and reduction of low-value care generated by digital health. Verkerk's framework16 offers guidance about which strategies may be most effective for managing low-value care potentiated by digital health. The bottom row of our framework illustrates Verkerk's three policy mechanisms adapted specifically for digital health with the goals to limit ineffective care, lean out
Disclosures
The views presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or its Methodology Committee.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
The authors sincerely acknowledge the thoughtful contributions of Paul Armstrong, Jose Benuzillo, Brock O'Neil, Emma Woo, and Lisa Simpson in developing this framework as well as AcademyHealth, the ABIM Foundation and the Donaghue Foundation for supporting this work.
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