Chronic diseases, caused by poor lifestyle choices, is a growing concern in countries world over. In the US alone, one in four adults struggles with a chronic disease, and a major load on the healthcare system’s expenditure is the cost of managing these conditions.  

With the onset of the pandemic, it has become even more abundantly clear that managing chronic disease is the need of the hour – over 90% of COVID mortalities are linked to pre-existing medical conditions, many of which are chronic. During the peak of the pandemic last year, the US Centers for Disease Control (CDC) estimated that people with underlying health conditions were six times more likely to require hospitalization and 12 times more likely to die from Covid-19. 

With lockdowns forcing people into isolation, management of chronic disease has become more difficult than ever, as people lose access to screenings and prescriptions, and their lifestyle choices take a turn for the worse due to anxiety and depression. Faced with the possibility of a future in which virulent and contagious diseases might become the norm, containing and controlling chronic diseases becomes a pertinent societal obligation. And when controlling medical, behavioral, and socioeconomic factors becomes difficult for traditional models of healthcare delivery, it is important to examine ways in which we can boldly rethink Chronic Disease Management (CDM) using digital technology.  

 Digital Technology Enabling Healthcare  

Can anything replace a clinicians trained judgement of a patient’s condition? Probably not.  But emerging technology in healthcare is making it increasingly possible to deliver the right care at the right time – to a degree of accuracy impossible for human fallibility. Sensor Technology, Artificial Intelligence and Machine Learning have begun to unlock the vast potential of patient data, providing actionable insights that can guide clinical decisions.  

Some of the popular digital technologies that have already made their mark in healthcare, as listed by the Agency for Healthcare Research & Quality (a department of Health & Human Services, Govt of the USA), are enumerated here: 

  • Clinical decision support (CDS) systems  
  • Health information exchanges (HIE)  
  • Disease registries 
  • Patient portals, personal health records (PHRs), and integrated voice response (IVR) systems  
  • Electronic health records (EHRs)  
  • Telehealth applications, wearables and related applications 

The benefits of using digital healthcare technologies to enrich CDM functions are many – it improves the accuracy and precision of care, it significantly reduces administrative work for healthcare staff and empowers patients by giving them day-to-day control of their disease-control measures through the data generated by wearables.  

There are certain key innovations that help tackle chronic illnesses more than others – for instance, Predictive Analytics can help identify patient care gaps, including identifying patients who at high-risk for developing a chronic disease but haven’t sought medical assistance yet. Technology can bridge the communication gap between patients, care providers and other third-party stakeholders, enabling them to better coordinate the care of the patient and provide more empathetic care. Digital therapeutics can address the problem of insufficient personalization in healthcare by using evidence-based behavioral interventions, delivered mainly through software.  

And perhaps the most applauded digital-enabled addition to healthcare today – telemedicine acts as a literal savior in these times when people don’t have the option to safely step out of their homes. Audio and video consultations ensure that patients receive timely and quality care, from the convenience of their homes. 

Implementation of Digital Healthcare Solutions: Customize or COTS?  

When healthcare providers make the decision to invest in digital health systems, one of the first questions that arise is the debate between building a custom solution or buying a commercial off-the-shelf solution. Considering the nuances and complexities of controlling a chronic disease, and considering the sizeable investment that goes into implementing either of these decisions, it is often a wiser choice to opt for a custom solution. 

There are very few COTS solutions in the market that cater specifically to CDM functions – this in itself makes building a custom solution a better, more long-term choice.  Even if you find a COTS software that seems like it might fit the bill, you will inevitably end up modifying the system to support your CDM requirements.  

In a study by AHRQ, it was found that of all digital healthcare solutions used by CDM projects they funded, Clinical Decision Support Systems required the highest level of customization. When making the decision between custom and COTS is being evaluated, carefully consider the expertise and resources needed to implement a CDS system, so human resource time is most effectively utilized.  

COTS system vendors need not stick to delivery schedules or stick by the promises made in terms of system functionality. When you choose a COTS solution, a significant amount of time is lost testing and revising the system before it is implemented, because it wasn’t perfectly suited to your organization’s specific needs. If you intended to pick a COTS vendor, balance the vendor’s claims with the experiences of other customers, and build penalty clauses into vendor contracts. 

While working in healthcare, every second counts. When technology becomes a part of this life and death scenario, technical support needs to be available 24/7, and this is often not afforded to those who choose the COTS route. It is imperative to research the availability and cost of technical support, no matter what the organization decides to invest in. It might even be wise to invest in training their own staff rather than relying solely on vendor support.  

In short, custom solutions are built to suit specific requirements, gives the organization complete control of their IP rights, requires less or no dependency on the vendor once the solution is rolled out and any software changes required can be made relatively easily.  

A detailed look at the pros and cons of this decision can be found here. 

Change management while adopting Digital Technology in Healthcare  

While shifting to digital health systems, it is important to earn the trust of the stakeholders involved and make the transition to these new processes as smooth and efficient as possible – the systems need to be implemented and adopted enthusiastically to derive maximum value.  

In order for successful change management to occur, it is important to engage clinicians directly involved in patient care in the development of the digital solution. Their on-the-ground knowledge, the empathy they have cultivated over years of practice and their expertise are irreplaceable when it comes to understanding the needs of the patient, and the needs of the practitioners – both of whom can end up being end-users. Standardized templates and UIs tend to be inadequate to secure buy-in and adoption of healthcare practitioners.  

Including an inordinate number of features to a solution does not always result in better care. In fact, applications such as patient portals and Integrated Voice Response can get very complex and discourage adoption, if not thought through thoroughly from a user standpoint.  It is important to keep user interfaces as simple as possible to get the best outcome and adoption rate.  

In Conclusion 

Without embracing innovation and improved forms of intervention, the burden of chronic diseases on human lives and society will continue to grow. As of today, in the US alone, batting chronic diseases accounts for 86% of the healthcare system’s annual expenditure.  

As technology opens new avenues for improved infrastructure and more data-driven care, healthcare now has the power to improve both the quality and quantity of people’s lives. The pandemic has pointed out the flaws in every country’s healthcare system – it has exposed the weak links and pointed straight at the various inefficiencies – Digital Technologies could be the answer to many of these problems. It would be in the best interest of governments and people alike, if healthcare organizations around the world accelerate the adoption of digital health systems.