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ver the past decade, an entire industry has emerged to support the use of mobile health technology. New digital trackers and connected sensors are released every month. A quarter of a million health-related smartphone apps are available for download today. This technology was supposed to disrupt and transform health care. So why hasn’t it, and is there a comprehensive solution on the horizon?

The fundamental fault is that the industry as a whole hasn’t actually focused on meaningful problems. The question “What health care or patient challenges need to be solved?” has surreptitiously become “How can technology solve a health care problem?” It’s a subtle distinction, but the result is a glut of mobile technologies searching for medical purpose.

Take, for example, the use of smartphones and wearables to deliver mindfulness therapies. There’s something ironic about your phone beeping to tell you to relax and then incessantly buzzing until you tell it you took a deep breath. Perhaps it is not surprising that only a small percentage of mindfulness apps, 4 percent to be exact, provide actual mindfulness education and training.

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There are hundreds of cases of digital technologies searching for health care purposes, like square pegs trying to fit into round holes. This may be disruptive, like that buzzing mindfulness app in your pocket, but it isn’t innovative. Perhaps it is time to move beyond the smartphone and bring digital health technology off the screen and into the real world.

We believe that one way in which mobile health technology can be improved is by including the physical environment as part of the intervention, creating feedback loops via therapeutic environments instead of smartphone screens. We predict that the next wave of digital health approaches will focus on actual health challenges and help solve them by actively sensing and influencing the real world outside of pockets or purses.

For this to happen we need a new mindset of how to solve health problems in connected ways and employ creative uses of home-sensing or internet-of-things devices.

This new wave of digital health technologies is already beginning to emerge. Instead of telling a sleep app how many hours you think you slept last night, sensors can automatically infer your sleep patterns. And instead of the app buzzing at you that it’s time to go to sleep, it can dim the lights in the room as a behavioral nudge to head to bed. Smart windows made with novel materials will be able to automatically adjust the amount of light coming into a room based on the day’s sun exposure and further tuned to an individual’s preferences, and soon to his or her health.

The home environment is a natural place in which to start this new wave of digital health technologies. That’s where many healthy — and unhealthy — behaviors are displayed and choices are made. Sound, temperature, smell, and light are some of the many environmental variables that can be customized in the home to promote wellbeing or finely tuned for people with chronic conditions, such as human-centric lighting for Alzheimer’s patients being developed at Rensselaer Polytechnic Institute. The home is a natural start, but the environment outside the home, ranging from office spaces to outdoors spaces, also beckons with boundless potential.

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Digital health is still a nascent field, and apps have provided it with a good start. But as the field matures, it may be time to move beyond the smartphone. As this evolution continues, so does our understanding of what constitutes a health intervention and which people and skill sets are best equipped to spur health promotion. Future iterations will continue to include those with or at risk of illness, those who are aiming to stay healthy, researchers, and technologists, but will likely also involve architects, biodynamic lighting specialists, urban designers, public health professionals, microbiologists, and others all working together to map the human environment while pushing the boundaries of what is traditionally defined as digital health.

John Torous, MD, is a psychiatrist and co-director of the Digital Psychiatry Program at Beth Israel Deaconess Medical Center, a Harvard Medical School teaching hospital. Carlos Rodarte is founder and managing director of Volar Health LLC, a digital health consultancy focused on digital biomarkers, patient engagement, and commercialization of novel sensor technology.

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  • The main problems of smartphones for eHealth are:

    a) The small size of screens makes it impossible to use the smartphones to
    communicate complex information. And most health related information
    is complex. There is no problem to use the smartphone to visualize the
    date and time of an appointment with your physician, but it is very lttle
    useful to visualize your PHR.

    b) Most smartphone apps are based of the use of hyperlinks to navigate
    complex information. Since the 1990’s it is well known that hyperlinks
    produce disorientation and lostness. It is the “lost in hyperspace” effect.
    Being lost and using a mini-screen is not a good combination…

    c) When accessing PHR’s using the internet we find the problem of cost when
    traveling abroad or connectivity problems when on cruises.

    If we want physicians and patients to benefit from eHealth apps, we have to start thinking in the use of tablets (with big screens) and moving out of the
    hyperlink paradigm. To this effect, mind mapping is probably the only solution.

  • Great post. I completely agree with the authors. It would be so helpful if my refrigerator said to me every time I lift up a bottle of fruit juice, “You know there are 500 calories in each glass of that stuff, drink water instead.” My new book, Connected Health: ImprovingCare, Safety and Efficiency with Wearables and IoT Solution explores this topic as well.

    • Bravo Pat! Long time no see!? What’s new? Yes, the “step away from the juice” refrigerator…

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