Digital Medicine: How It's Shaping the Future of Healthcare

UC Davis Health digital medicine leader Ashish Atreja, MD, shares the growing impact of digital therapeutics, the value of unifying platforms to prescribe digital solutions to patients and share research, and why he's an 'intrapreneur.'

How does a gastroenterologist become one of the nation's leading voices in digital medicine? In 2000, on the first day of a Cleveland Clinic gastroenterology residency, Ashish Atreja, MD, MPH, was asked to see a patient with a lung transplant. He had never managed a patient with that condition, no one was available to guide him, and standard textbooks didn't address the topic.

Someone directed him to UpToDate, an online clinical decision support resource, which had the latest information about treatment.

"I was able to manage the patient, the patient survived, and I said, 'Wow, what if technology can empower all of us?' "

For Atreja, this wasn't a hypothetical question. When he completed his residency, he launched into a two-year post-graduate fellowship to study medical informatics.

In 2012, he established one of the nation's first digital innovation labs, the Sinai AppLab at Mount Sinai Health System. He served as chief innovation officer for the health system and associate professor at the Icahn School of Medicine at Mount Sinai until this month when he started a new position as chief information and digital health officer, UC Davis Health, an academic medical center in Sacramento, California, which includes UC Davis Medical Center and the UC Davis School of Medicine.

HealthLeaders caught up with Atreja as he was transitioning to his new role. "I consider myself an 'intrapreneur,' " he says, "working within a health system, finding all the gaps in the health system, and then finding solutions and creating platforms so we can transform health from the inside out rather than the outside in."

His experiences related to the phenomenal growth of digital medicine and lessons he's learned while at Mount Sinai provide strategic insights to health leaders as they formulate their own's organization's path forward through innovation. 

Ashish Atreja, MD, chief information and digital health officer, UC Davis Health

The Impact of COVID-19 on Digital Medicine

The pandemic gave rise to explosive growth in the digital health sector. Venture funding shot up 66% over 2019, with a record $14.8 billion raised globally in 637 deals, according to Mercom Capital Group.  

One advance that occurred as a result of the COVID-19 pandemic, is that the crisis "demystified" telemedicine and digital medicine, Atreja says. Many physicians got a taste of the technology for the first time, and, unlike electronic medical records (EMR), it did not multiply their administrative burdens.

Yet the way most physicians are engaging with telehealth is not an ideal path forward, he says. With synchronous care, the physician still spends the same amount of one-to-one time with the patient. "The real growth you're going to see in value," says Atreja, "is the ability to deliver one-to-many care."

To support this dynamic, Atreja says the next technology wave will be digital care monitoring that supports hospital-at-home programs, population health initiatives, and chronic disease management. "This will allow us to transition from one-to-one care in-person or virtually to one-to-many care, and lead to efficiency like we've never seen," he says.

Meanwhile, the urgency created by the pandemic led some hospitals and health systems to "choose any [telehealth] solution just to get going." As the crisis abates, these organizations will seek more mature, highly secure solutions that not only provide the ability to offer video visits, but also seamlessly onboard patients and enable follow-up so that these processes become part of the workflow.

When the public health emergency ends, progress may stagnate a bit, he cautions, until permanent changes are made to federal and state regulations that were temporarily lifted to accelerate access to virtual care.

"We're definitely going to see slowing down … and maturation of the space for video visits over the next year, but we're also going to see an increase in [chat]bots, digital front doors, and digital monitoring," says Atreja. "That's going to slowly keep on picking up as the incentives line up." Further down the road—in three to five years—he expects digital therapeutics and monitoring will be an essential component of care delivery. "That's where the maximum value will be for health systems, health plans, and for the patients as well," he says.

Discovering a Common Thread: The Need for a Unifying Platform

Although Atreja has been the driving force behind numerous digital medicine endeavors, there is a unifying thread that weaves through many of his ventures: The creation of a platform that brings disparate elements together. Understanding that dynamic was one of the greatest lessons learned during his tenure at Mount Sinai, he says.

As the number of digital health technologies proliferated in recent years, Atreja says that it became difficult for physicians to keep abreast of which solutions might best serve their patients. As a result, he became the founding CEO of Rx.Health, which was later spun out of Mount Sinai as an independent company. Atreja still serves on the board. The EHR-connected digital health prescription platform enables physicians to prescribe evidence-based mobile health applications, digital therapeutics, multi-media education, wearables, and remote monitoring programs to patients at the point of care.

"We were able to create a unified platform where all the best tools can be linked together in the EMR, and physicians can prescribe to one or thousands of patients at once," he says. Think of it as a digital health formulary." To illustrate how it works, he cites a couple of examples:

• Mount Sinai used the platform to prescribe digital therapeutics for patients experiencing congestive heart failure. Before discharge, they downloaded an app, which connected to remote monitoring devices that tracked blood pressure and weight. The technology helped Mount Sinai reduce 30-day readmission rates by 40%. The program is now available to other health systems through the American College of Cardiology.
   
• A different initiative with the American Gastroenterological Association created a digital front door and digital navigation tool for GI procedures, such as colonoscopies. Traditionally, patients receive a written handout of colonoscopy prep instructions sometimes several months before their procedure. As a result, seven out of eight patients do not prepare properly for their procedure, Atreja says.

By using the digital tool, patients receive instructions and reminders throughout the preparation process, which lasts several days. The resource reduced the number of aborted procedures by 58%, increased bowel prep quality by 20% in multiple locations using the app, and patient experience rose by 92%. "Patients said that they loved getting a colonoscopy done," says Atreja, "and the best part was the digital experience."

Another venture he launched is NODE.Health (Network of Digital Evidence in Health), which serves as a platform to bring together people and organizations focused on evidence-based digital medicine—a term Atreja is credited with coining—to transform healthcare and support the move toward value-based care. Memberships are available to health systems, corporations, and individuals. Atreja serves as an executive board member.

Bridging the Digital Divide and What's Next

As usage of digital therapeutics rises, Atreja is aware of the digital divide and the potential to leave behind populations that don't have access to technology or the ability to use it.

As with most of his endeavors, he's approaching the issue with research. Phase one of the study, funded by a grant from the National Institutes of Health, is designed to measure the divide and determine which patients are underserved because they don't use smartphones, lack broadband access, or lack skills. Phase two will create a program to teach people the skills they need to become digitally engaged and gain access to better technology.

As Atreja closes the chapter on one era of his life at Mount Sinai, and begins his new position at UC Davis Health, he shares two lessons from his experiences that he wants to pass along to others:

• "Ultimately, for digital transformation to be mainstream, you have to involve people at grassroots level," Atreja says.
   
• Also, he says, "One of my central messages is that we need to share and learn from each other; we don't need to duplicate the work or start from scratch."

As Atreja assumes his new role at UC Davis Health, he is excited about the potential to serve both as chief digital health officer and chief information officer. "That will allow me to do innovation that is not separate, but to do innovation as part of the core IT culture and bring them together."