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Digital Health Care and the Fourth Industrial Revolution

Jung, Minsoo PhD, MPH

doi: 10.1097/HCM.0000000000000273
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We live in a world where big medical data are being compiled. Many people make use of biometric information gathered by a variety of health care devices linked to smartphones, such as Fitbit devices. In addition, the development of medical information management schemes and the introduction of health information systems have greatly increased the possibility of using medical records stored in medical institutions. With the development of sensor technology and analytical capabilities, we have gained new knowledge through big data, stemming from the collection of data that was not important in the current medical area. Digital health care is moving toward creating value while creating utility as well based on data collected beyond the level of those collected by sensors. Only organizations that have quickly entered the market and accumulated data and have already developed advanced algorithms based on the data can be competitive. However, digital health care companies that survive in the market will lead the change and will reorganize the health care sector. In addition, a big data–based health care platform can help increase the number of e-patients through patient participation.

Author Affiliation: Department of Health Science, College of Natural Science, Dongduk Women's University, Seoul, South Korea.

This study was supported by Dongduk Women's University grant (2018-04363).

The author has no conflicts of interest to disclose.

Correspondence: Minsoo Jung, PhD, MPH, Department of Health Science, College of Natural Science, Dongduk Women's University, 23-1 Wolgok-dong, Seongbuk-gu, Seoul 136-714, South Korea (mins.jung@gmail.com; mj748@dongduk.ac.kr).

Online date: June 26, 2019

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VALUE AND UTILITY OF DIGITAL HEALTH CARE

Digital health care helps consumers lead and use products to manage their health personally. However, the quality of digital health care products tends to be relatively low and the cost relatively high because they are close to credence goods, for which the quality is difficult to evaluate by consumers.1 As the quality of credence goods can be difficult for consumers to judge, it takes a long time for such products to gain trust in the minds of consumers.

There are 3 main benefits that digital health care products can offer consumers: medical utility, consumer awareness of problems, and whether to use a product to solve a problem. One related issue is that consumers are often obsessed with medical utility. For example, Eight Cubs (www.8cups.me) is a product that helps consumers drink 1.5 to 2 L of water a day for their health. However, it is questionable as to whether consumers will drink more water after being reminded that they need to do so by means of sensors and apps. Welt (www.weltcorp.com), a type of smart belt that functions as an activity tracker with an accelerometer on the belt, measures the length of the belt in order to indicate changes in the waist circumference and the frequency of overeating. However, at times this product can be confining to the consumer. Although consumer perceptions can change, understanding how changes in perception lead directly to the purchase of health care products remains unclear. Moreover, the number of products that fail to gain market acceptance is significant. However, several products have long been recognized and trusted by consumers. For example, InBody (InBody Inc, Cerritos, California) and Fitbit (Fitbit Inc, San Francisco, California), which measure body fat and activity levels, appeared in 1996 and 2008, respectively, and after a long period, they changed consumer perceptions.2

However, this change appears to explain the success of these products only partially. The largest wearable device and activity tracker companies help users change their behavior habits in healthy ways.3 Dedicated apps allow a user to compose a community that includes friends and family and compare the number of footsteps while showing intuitive data such as walking distances and calories burned along with step data. Thus, the individual's lack of will is overcome through a type of peer pressure. Nevertheless, one-third of users of activity trackers do not use the product after 6 months.4 Additionally, the number of paid active users, a key indicator released by Fitbit after their listing, falls short of expectations.

In fact, health care products are not a complete medical device and thus do not fundamentally address consumer health problems. Zeo (Zeo Inc, Boston, Massachusetts), a sleep analyzer, was noted for analyzing sleep patterns at home rather than in a hospital. Zeo failed because it did not define the value and utility of the product for consumers. Users could be satisfied with the product only to the extent that they appeared to have slept well overnight, but in fact they were not achieving good-quality sleep from a sleep medicine perspective. Controlling light and sound does not help to improve sleep quality, causing consumers to conclude that the product failed to create real value for them.

Nonetheless, the market for digital health care is steadily growing. A typical example is telemedicine. In the United States, various telemedicine companies, including Teladoc, provide medical services through voice, video calls, or chat.5 Apps such as Pager and Heal in certain larger cities in the United States provide a means by which to connect patients to doctors who will visit. ZocDoc is also helping to improve medical accessibility to patients with a medical institution reservation service. From a hospital's standpoint, it can easily obtain additional reservations when reservation scheduling is not ideal. In addition, some products are more focused on maximizing medical value. For example, KardiaBand, a product made by Alivecor (www.alivecor.com), is an electrocardiograph in the form of a smart watch.6 In order to obtain electrocardiogram measurements, at least 2 electrodes must be placed on the body, but it is difficult to measure the electrocardiogram because the smart watch is in one hand. Therefore, KardiaBand achieves electrocardiogram measurements by having the user, when desiring such measurements, touch his/her wrist with his/her inside finger and touch the outside electrode with his/her opposite finger while attaching the electrodes to the inside and outside of the line. In addition, efforts are being made to compensate for the lack of willingness of users to receive health care products, such as activity trackers. Noom, a health care app, provides coaching consultation services that help people directly manage their weight, making it easier for consumers to do this. If the coach system is changed to a health care provider here, telemedicine can be extended to more flexible types of care.

Products made with health care technology can have their value extended beyond the health care landscape. Looxid Labs can analyze the perception of an individual with a wearable headset that measures eye movements and brain wave information (www.looxidlabs.com). The product was originally presented as a solution to help patients with limb paralysis communicate with their caregivers. However, it can also be extended to education. For example, if someone reads a fingerprint in a foreign language and he/she does not know the language, the wearable can recognize it, automatically create a wordbook, and analyze the process of reading the fingerprint to help someone improve his/her reading comprehension skills. In recent years, there have been attempts to analyze users' brain wave responses and gaze movements when experiencing virtual reality images and game contents and to integrate these findings into the neuromarketing field. Humon, on the other hand, is a product that determines the lactic acid threshold by measuring how muscles consume oxygen. Lactic acid is a fat substance produced in the body during exercise. When the exercise intensity is increased, the speed at which lactic acid is produced is accelerated. Beyond a certain point, lactic acid builds up quickly in the body, resulting in poor exercise and a long recovery time. As a result, athletes are trained within the limits of lactic acid production, but it is quite cumbersome to collect blood samples in order to measure lactate acid levels on the field. The wearable form of Humon is an expanded digital health care device in that lactic acid is easily measured, enabling athletes to maintain maximum practice without the risk of injury. Many athletes are willing to pay for such a device, and if they are successful in expanding, they can bring about the anticipated benefits of this device.

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BIG DATA AND HEALTH CARE PLATFORMS

Many people make use of biometric information gathered by a variety of health care devices linked to smartphones, such as Fitbit devices. In addition, the development of medical information management schemes and the introduction of health information systems have greatly increased the possibility of using medical records stored in medical institutions. IBM has released a platform called the Watson Health Cloud that predicts that one person will be born and later die and ultimately will produce 1 million gigabytes of digital health information.7 We live in a world where big medical data are being compiled. With the development of sensor technology and analytical capabilities, we have gained new knowledge through big data, stemming from the collection of data that were not important in the current medical area.8

Big data can be divided into 2 types according to the interpretation level. The primary interpretation is the most common type, and it gives meaning to the data itself and its patterns. For example, Airsonea's wheezing instrument is a device for asthma patients.9 This is not a collection of medically accredited data, but it can be a viable alternative for people who have difficulty using a spirometer. Recently, menstrual blood has attracted attention as a new biometric target. Hence, when the menstrual cycle is collected during the menstrual period, a device known as a Loun Cup measures the amount and color of the menstrual blood and records the slope of the cup through a sensor in order to check the woman's health condition (www.loonlab.com). A second interpretation extends and reinterprets the meaning of the data obtained. For example, 23andMe analyzes genomic data collected from a variety of individuals in order to determine the ability of people or drugs to break down certain diseases (www.23andme.com). This is of great value in the marketplace, as pharmaceutical companies have access to this valuable information when making new drugs. It is also possible to detect metabolic diseases such as diabetes or dyslipidemia early through an app that manages the diet.10 In addition, it can be used as an identification tool for verifying the identity of an individual when considerable amounts of biometric information are gathered from a population.

The network effect refers to the process by which the value of existing participants is increased by the participation of others. In other words, the more people who use Uber or Airbnb as well as smartphones in general, the more the value of customers who use them increases. Here, the structure that creates the network effect is called the platform. In the digital health care field, Apple has released Healthkit, and Google has launched Google Fit. However, the more active companies are the telemedicine companies. For example, TelaDak is a digital health care platform that connects doctors who want to see patients remotely and patients who want to see a doctor. With this large telemedicine platform, doctors can easily find those who want telemedicine among patients and earn additional revenue. In addition, such a telemedicine company mitigates troublesome insurance claims. Validic, on the other hand, manages the data collected by health care products used by health care consumers and collects data where health records are needed, such as medical institutions (eg, Kaiser Permanente) or insurance companies or electronic medical records (eg, John Hancock and Cerner), making it a connecting platform. In recent years, with IBM Watson as an example, general-purpose technology has evolved into a health care platform for use in specific areas, such as medical imaging. With regard to chemotherapy, Memorial Sloan Kettering Cancer Center and MD Anderson Cancer Center collaborated to create Watson Oncology. Ultimately, a big data–based health care platform can help increase the number of e-patients through patient participation. Here, “e” means equipped, empowered, and enabled. Thus, the information and communications revolution can be a useful form of leverage to begin reducing the health disparity between the layers of chronic diseases such as cancer.11

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SUGGESTIONS AND PROSPECTS

The growth rate in this field has not been as rapid as was originally anticipated, as the medical profession is conservative and still mostly unfamiliar with doctors managing patients through digital health care. In addition, there are many regulatory barriers. An app known as BlueStar by WellDoc helps patients manage diabetes and provides disease management information to doctors in conjunction with an electronic medical record called Allscripts. Weldak proved that the app was effective in managing diabetes patients, publishing an article, and gaining approval from the US Food and Drug Administration.12 In addition, doctors can gain coverage if the app is prescribed to one of their patients. This is a good example of a well-equipped digital health care model, but the profits of the company that developed the technology have been limited. While many companies are developing business models, a major problem is to create profit structures while maintaining a steady number of users. In addition, because most developed countries utilize public health insurance, there is a sense of skepticism regarding whether patients can be covered by completely different types of insurance, such as that for digital health care. Patients also pay for the medical services (surgeries, blood tests, and drugs) that are tangible, but they are less willing to pay for health care delivered through digital apps. In addition, in shared living arrangements, one person may search for health information diligently, but another may turn off the system.13 Therefore, more time may be required for social recognition to change. Digital health care, however, is moving toward creating value while creating utility as well based on data collected beyond the level of that collected by sensors. Only organizations that have quickly entered the market and accumulated data and have already developed advanced algorithms based on the data can be competitive. However, digital health care companies that survive in the market will lead the change and will reorganize the health care sector. This is why we look to digital health care as the key to driving the fourth industrial revolution.

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REFERENCES

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Keywords:

digital health care; e-patients; telemedicine; wearable device

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