A new report from the Consumer Technology Association finds that both consumers and providers are bullish on the value of consumer-facing digital health technology, but there are still barriers to widespread adoption.

Consumer-facing digital health technology has the potential to improve healthcare delivery and outcomes, according to healthcare providers eyeing the market. Yet those providers also say the technology isn't living up to that promise.

That's the main takeaway from a new report from the Consumer Technology Association (CTA), Driving Consumer Adoption of Digital Health Solutions. The report, prepared with IPSOS and culled from interviews with 1,000 consumers, 300 providers, and a dozen digital health companies, finds that consumers and providers are both ready to embrace digital health, but they often find issues with the technology that sour their interest.

“Economic, social, and geographic divides make the adoption of health technology at scale challenging," René Quashie, CTA's vice president of digital health, said in a press release accompanying the report. "Digital health technologies need to be adaptable, portable, and meet the needs of consumers. Healthcare providers can drive adoption by building and sharing awareness of the tools available, while lowering barriers to entry.”

The consumer-facing digital health market is large and growing, and includes mobile health devices like blood pressure monitors, insulin pumps and pulse oximeters, mHealth apps , smart devices like scales, wearables (like smartwatches and fitness bands) and smart patches, AR/VR devices, hearing aids, even pacemakers, defibrillators, and portable ECG kits.

The research touches on a long-standing gap between consumer-facing technology and the healthcare industry, which often casts a skeptical eye on the validity and reliability of those products. Many companies are seeking to bridge that gap by developing products that meet clinical standards, while healthcare organizations are exploring innovative ways to use consumer products in health and wellness programs.

[See also, CES Recap: Does Consumer Tech Have Value in Healthcare?]

According to the CTA, whose annual CES event in Las Vegas is attracting more healthcare organizations each year, digital health companies need to focus more on building consumer awareness around the healthcare benefits of their products, while also talking to providers about their products and rallying behind policies that drive access to digital health.

According to the report, 58% of healthcare providers agree that these digital health solutions can lessen the burden on the healthcare industry, yet 44% say the products aren't living up to their potential. Among consumers, the top reason for using these devices is to take control of one's own health, followed by accessibility, reliability and the support of an insurer.

The cost of these products is the main barrier to widespread adoption or continued use. Providers say adoption could be increased through more clinical evidence proving the value of the technology and more support from payers.

Virtua Health is using AI technology to fine-tune its messages to patients, giving them access to the right information at the right time.

One of the more popular current uses of AI in healthcare is to improve marketing and messaging campaigns. This includes getting the word out to the right population that they’re good candidates for a specific healthcare service.

Virtua Health, for example, has been using AI for several years to refine engagement campaigns. One such campaign targeted people with or at a risk of developing cardiovascular disease. Working with digital health company Actium Health, the 400-site New Jersey health system created a messaging campaign that increased patient engagement and scheduled check-ups and generated roughly $800,000 in revenues.

The health system is also using the technology to target teens and young adults in need of bariatric surgery, a tricky and often underserved population that would just as easily steer clear of healthcare if the message wasn't right. And while one recent study finds that more teens are getting the surgery, experts say this service could save many more lives.

"There's an art and a science to marketing," says Ryan Younger, Virtua Health's vice president of marketing. "You want to connect the right people to the right information that they would find most helpful, so that they can choose their own path. It's not easy."

Whereas healthcare organizations traditionally send out mailers to targeted demographic groups, the advent of AI technology has made the process much more efficient. Using algorithms that comb through claims and EHR data (and, more recently, social determinants of health), health systems, health plans, and CRM companies can drill down to specific people and offer personalized messages.

For Virtua, this platform led to the scheduling of more than 470 bariatric surgeries and 8,500 scheduled appointments to related services, which in turn boosted revenues. More important, it helped the health system get in front of patients who needed access to care, and who otherwise wouldn’t have gotten that care.

"There are a lot of challenges to accessing healthcare, especially in underserved groups," Younger points out. "This helps us to [address] health equity as well."

While emphasizing that the platform gives patients the resources they need to make their own healthcare decisions, Younger notes that the information is more personal than a generic mailer or message. And where those traditional campaigns were lucky to get a 20% open rate, newer outreach efforts are pushing that number even higher. Simply put, the more personal the message, the greater chance that it will engage the reader and make an impact.

"We want to get in front of people [and see that] they're interested in the message," he says. "I know it's still a pleasant surprise when that works … but we're getting better at this."

Younger says the value of these programs goes beyond extra services and revenues. Better engagement means that patients are getting the care they need or the resources they need to improve their health and wellness. That translates to improved clinical outcomes, as well as fewer acute care needs and hospitalizations later on.

Aside from cardiovascular health and bariatric surgeries, Virtua has used the platform to reach out to patients at high risk for breast cancer, a campaign that can save lives through early detection and diagnosis. Younger says the opportunities are plenty, ranging from bone and joint care to kidney care to cancer and behavioral health services.

"Bariatrics is such an important issue because it's a long patient journey," Younger says. "It can take more than a year, with a lot of requirements and choices to make. It's so important that we get the right information in front of them as soon as possible [so that they] can make those decisions."

"It's all about empowering people," he adds.

The US Drug Enforcement Agency has proposed expanding the rules to allow providers to use telemedicine to prescribe controlled medications. Telehealth advocates say the new rules aren't that helpful.

Federal regulators are taking steps to expand the use of telemedicine in prescribing controlled substances, a key pandemic waiver that has helped behavioral health and substance abuse providers but which is scheduled to end soon.

The US Drug Enforcement Agency (DEA) unveiled proposed permanent rules on Friday, aiming to put them in place before the COVID-19 Public Health Emergency ends on May 11. They would allow providers to use telemedicine to prescribe 30-day supplies of Schedule III-V non-narcotic controlled medications and buprenorphine, the latter specifically for the treatment of opioid abuse disorder, for new patients and without the need for an in-person evaluation.

“DEA is committed to ensuring that all Americans can access needed medications,” DEA Administrator Anne Milgram said in a press release. “The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

“Medication for opioid use disorder helps those who are fighting to overcome substance use disorder by helping people achieve and sustain recovery, and also prevent drug poisonings,” Milgram added. “The telemedicine regulations would continue to expand access to buprenorphine for patients with opioid use disorder.”

While the proposed new rule would be an improvement for some providers, there are limitations. According to the DEA, the proposed rules do not affect telemedicine consults that don’t involve the prescribing of controlled substances or consults with established patients. They would also not affect consults by a care provider to whom a patient has been referred, as long as the referring provider has previously conducted an in-person exam with the patient.

Reaction to the new rules has been mixed. Nathanial Lacktman, a partner in the Foley & Lardner law firm and chair of the firm's national Telemedicine & Digital Health Industry Team, said they were "not what most industry stakeholders were anticipating" in a blog posted today.

"The proposed rules are intended to bridge between the DEA’s current PHE waivers and a post-PHE environment," he wrote. "In so doing, DEA proposed creating two new limited options for telemedicine prescribing of controlled substances without a prior in-person exam. The options [are] both complex and more restrictive than what has been allowed for the past three years under the PHE waivers. The DEA’s proposal will discontinue the ability for telemedicine prescribing of controlled substances where the patient never has any in-person exam (with the exception of an initial prescription period of no more than 30 days’ supply).  Moreover, if the patient requires a Schedule II medication or a Schedule III-V narcotic medication (with the sole exception of buprenorphine for opioid use disorder (OUD) treatment), an initial in-person exam is required before any prescription can be issued."

The proposed rules, which now go through a 30-day public comment period, were drafted with the help of the Health and Human Services Department and US Department of Veterans Affairs.

“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” HHS Secretary Xavier Becerra said in the press release. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in-person. At HHS, we are committed to working with our federal partners and stakeholders to advance proven technologies and lifesaving care for the benefit of all Americans.”

When the PHE was enacted in January 2020 to help the nation deal with the growing pandemic, a number of waivers and exemptions were put in place by federal and state regulators to help healthcare organizations expand and be reimbursed for digital health and telehealth services. The idea behind this was to allow providers to use virtual and connected health tools and platforms to reduce the spread of the virus and make sure consumers were able to access needed healthcare services.

Many of those waivers were extended until the end of 2024 in the Consolidated Appropriations Act of 2023.  But the waiver on the use of telemedicine to prescribe controlled substances wasn't included in that bill.

Passed into law in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the DEA.

Writing in their Health Care Law Today blog earlier this year, Thomas Ferrante and Rachel Goodman, partners with the Foley & Lardner Law Firm and members of the firm's Telemedicine & Digital Health Industry Team, say the waiver of the in-person exam during the PHE ensured that "millions of both established and new patients were able to receive medically necessary prescriptions via telemedicine."

"There have been efforts to amend the Ryan Haight Act and encourage the DEA to activate the telemedicine special registration rule before the PHE expires, including pending federal legislation," they wrote. "However, to date, the Ryan Haight Act has not been changed and the DEA has not activated the telemedicine special registration rule." 

Telehealth advocates say the new rules don't go far enough, and that the DEA still needs to set up a special registration process so that more providers can use telemedicine for behavioral health and substance abuse treatment.

"The DEA’s proposed rules are not the special registration process that Congress mandated and could gravely disrupt millions of patients’ treatments and care regimens," Robert Krayn, co-founder and CEO of telepsychiatry company Talkiatry, said in an e-mail to HealthLeaders. "Instead of taking inspiration from more modern state-level prescribing policy already introduced in Connecticut and Florida, the rules reinstate obsolete and counterproductive in-person requirements under the guise of novelty. There is nothing novel about sending vulnerable patients back into the dark ages of care delivery."

"Rather than restrict bad actors, this over-corrective proposal disadvantages and disproportionately affects mental health care, preventing responsible physicians and clinical leaders from expanding care access," he added. "The mental health care community must unite and fight for patient access to quality care, regardless of a patients’ location and socio-economic status or the societal stigma attached to their condition." 

The New York-based health system is closing care gaps and improving clinical outcomes through a platform that offers multiple opportunities to connect with patients in between medical visits.

A lot happens to patients in between medical appointments, and healthcare organizations are starting to take that into account. From automated messaging programs all the way up to remote patient monitoring and home health visits, they're developing an understanding that healthcare is a continuous journey, rather than a series of isolated incidents.

At Northwell Health, those interactions are handled in an automated care program. Zenobia Brown, MD, senior vice president and associate chief medical officer at the New York-based health system, recently sat down—virtually—with HealthLeaders to talk about how health systems can identify the best opportunities for in-between visit care within larger health strategies, and how they ensure those opportunities drive impact.

Q. Can you give us an overview of Northwell Health's automated care program strategy?

Brown: Northwell’s approach to in-between visit technologies has been ‘What can help us as we try to achieve something that aligns with our organizational need?’ An example of that is that for the past six years we have worked very successfully on our readmission rates. If someone leaves the hospital and then comes back, especially within 30 days, in some cases that represents a clinical failure. We don’t want that for patients. We want patients to be well when they leave our buildings and not need to come back, especially for things that are preventable. So we took a look at how are we interfacing with patients before and after they are in our care. Then we took a look at how we could do that at scale across our 21 hospitals. 

Zenobia Brown, MD, senior vice president and associate chief medical officer at Northwell Health. Photo courtesy Northwell Health.

One phrase I love is ‘You can fix any problem with enough money.’ If you have a nurse physically follow every discharged patient home for 30 days, that will work. That will probably keep people out of the hospital. Of course, that is not feasible, and that’s where the technology comes in. That is the disciplined approach that Northwell has taken. We ask ourselves, ‘What are we trying to do clinically? Where is the gap? Can technology help us with this gap?’

Q. How do you measure success with these programs?

Brown: Ultimately what you need is for providers to behave differently, and for patients to behave differently. You need an infrastructure that can respond to the needs of those two parties. If I can’t engage with the patient when and how it is convenient to them, then I have no hope of changing their behavior or what happens to them. But when you are mindful of the patient’s needs and they feel that you will be there for them any time they need it, then the trust is built and then behavior changes.

We want our patients to call us at the first sign that they are having trouble, but we must be asking the questions. We need to be engaged and asking the questions and asking them often.  And that’s where the technology comes in. Asking questions multiple times in different ways and at different times when it’s convenient to the patient is what sticks. This creates an infrastructure and provides really good information coming right from the patient. This patient-generated data then comes back to the providers, who can then adjudicate that information. 

Q, How many of these programs has Northwell deployed, and how have they helped to reshape in-person care?

Brown: It really spans the gamut of everything from pre-operative, postoperative pain, test results, cancer treatment, COVID-19, etc. It was huge, the ability to do some of this automation during the pandemic. So when you’re looking at big populations and straightforward things that patients don’t want to get tied up on the phone for, it can just be a chat. It lends itself to a lot of use cases.

We talked about patient-generated data and how that extra information is helping us build, reframe, and retool our different programs. For example, a really important issue is the maternal mortality crisis. How do we end that cycle of maternal mortality, particularly amongst Black and Brown women. So we’ve established the Center for Maternal Health and are using automated care programs to stay connected to these women. How are we hearing them? How are we asking them the right questions at the right times when it’s convenient to them? I can now tell you the top reason that moms are escalating back to us through these chats is due to high blood pressure. Based on that information, we can build additional programming to address that specific issue. Post-visit chats that are creating escalations also help us change our behavior during the visit to proactively address some of issues. It’s about enhancing how we deploy our clinical programs as a whole.

Q. Can you provide an example of how an automated care program is improving patient care?

Brown:  I’ll give you an example from that high-risk moms program. We talk about patients needing to be approached with the questions in multiple different ways, in ways that are convenient to them. We had a patient who, in her in-person encounter, did not reveal that she was having behavioral health symptoms consistent with severe depression, with suicidal ideation. She revealed that in the chat. When the stakes got lower and she was home and she could just put it in her phone, she revealed that. She already had the appointment, so standard care would’ve meant no further intervention for this mom until her next appointment. But we were able to have another interaction with her that then surfaced this issue, and then we were able to respond to that. That builds trust.

Q. How do your care providers feel about these programs?

Brown: I think it’s been invigorating for the team. In cases where the patient needs it, the team has actually interacted more with the patient. There is always a concern with automation that it is replacing a person, but we don’t see it that way. It helps with scaling, it helps with efficiency, and we actually see additional interactions, but they’re happening when the patients need it. So, let’s say a single nurse can do 10 patient interactions—one interaction per patient, 10 interactions for 10 patients. Well, with automated care, now a nurse can do one interaction for all 10 patients, and then that one patient that might have an issue, they might need 10 interactions themselves. And then there’s everything in between. 

Q. What is one piece of advice in terms of identifying opportunities for automated care programs that you might give to another health system considering this strategy?

Brown: This can help with every aspect of patient care, from something very simple to something very complicated. There are many use cases and because you are trying to do something for so many people, this can surface a lot of very helpful information to make people well. Basically, you’re talking about a new way of delivering care and communicating with patients.