Yechiel N. Engelhard, MD, MBA, MHA

Expert Perspective
Yechiel N. Engelhard, MD, MBA

Expert Perspectives on Technology in Health Care: Part I

Yechiel N. Englehard, MD, MBA, MHA

Physician Entrepreneur
Former CEO and Founder of Gecko Health Inc.
Former Global Head of Digital Health at Teva Pharmaceuticals


Can you provide a description of some of the health-related technology that is currently available to providers and their patients?


In general, in the area of digital health, relative success stories span many areas including drug delivery; payment systems; vital sign sensors; data analysis for patient intake; technology platforms; the combination of hardware, sensors, drug delivery, and software for insulin delivery; and telemedicine. Drug delivery, online pharmacy, and drug management have had plenty of traction. Companies such as Capsule Corporation and PillPack, Inc. are on one end of the spectrum, while on the consumer or lifestyle end of the spectrum are Ro, Hims, and Hers. More and quicker adoption of health technology by large retailers is taking place within onsite digital clinics such as those provided by Best Buy, Walgreens, and CVS, to name a few.

Interest is growing in payer systems for providers as a way to manage health insurance risk by integrating technology within the health maintenance organization sector by companies that include Oscar and Omada Health. These companies use technology to improve patients’ relationships, access to treatment, and communication through efficient patient electronic health record applications. Large tech companies are entering this market by building and integrating systems of healthcare databases based on new infrastructure tools provided by Apple Inc., Microsoft Corporation, and Amazon Web Services.

Sensor usage is growing, and increasing use justifies the cost; a few examples are electrocardiogram watch applications (Apple Watch or Withings) and blood oxygen level measurements with some Samsung phone applications. More sensors are available for assessing vital signs from breathing to blood pressure by using images and better point-of-care diagnostics to home care sensors and small mobile devices, such as Butterfly Network, Inc.’s ultrasound and Eko Devices Inc.’s stethoscopes. Closed-loop insulin delivery is another interesting system that uses combined complicated hardware, sensors, drug delivery, and software with corporate players from Medtronic, Dexcom, and Bigfoot Biomedical. Beta Bionics, Inc. has recently completed private equity and venture capitalist funding to create a bionic pancreas system.

Artificial intelligence and machine learning tools provide a new line of solutions. These extend from drug discovery to monitoring to diagnostics. Immune monitoring has advanced with Athelas One for white blood cell and neutrophil counts. Also, Health Catalyst is a data and analytics technology service for healthcare organizations, and Phreesia automation helps healthcare organizations manage their patient intake process.

After building a clear model for their return on investment, some bigger success stories include initial public offerings for companies managing chronic conditions through technology platforms, such as Livongo for diabetes and Progyny for fertility, with self-insured employers as their main target.

Telemedicine had some setbacks with Teladoc and Am Well, but I see growing potential as they start to include remote diagnostics and automated patient processing.


What are some of the barriers to the uptake of health-related technology and how can they be addressed?


For patient uptake, there is still a large gap between access to technology and cost, especially in the chronically ill population with diseases that have higher prevalence in low-income demographics.

Over the years, there has been growing skepticism by physicians and industry about the real value of the various technologies because of a lack of controlled studies to show outcome and clear return on investment. Skepticism has increased even more with the low barrier of entry to new startups that made it even harder to separate the high- and low-quality products that can be offered today.

Generally in healthcare, but even more so in the mental and behavioral health fields, the number of providers is low; this shortage of resources has led to even less interest in engaging with what is still considered an experimental solution with low evidence-based support.

Payers were slow to implement and adopt new risk-based or value-based systems, and these systems are still not widely implemented. This was the basis for the revenue model of most health tech startups. Most solutions did not show significant returns on investment, which prevented adoption and partnership beyond small pilots. Self-insured employers have been playing a bigger part in the last couple of years. We saw a few interesting pilots, but still not a large distribution due to misalignment between the employers and the payers.

Companies like 23andMe exposed the data ownership and privacy issues that many patients have, which include fear that their data will be used against them at some point or that the safety of their data in the hands of a private company is still questionable.

Although the need for change in behavioral or mental health is obvious to the clinical and payer communities, the amount of real available solutions is still limited. Some of the more promising products we see are in telemedicine (eg, remote therapists), which can help with the burning issue of shortage of resources and improve use of existing resources. At this time, there is high use of secondary and tertiary healthcare services, such as a hospital emergency departments, for psychiatric episodes. For providers, some novel solutions would provide support to change the long wait times that exist today in the industry.


How can technology empower patients to take better control of their disease states?


Patients’ empowerment can take different shapes and forms, and not all patients want to be empowered. Patients may express a wish to maintain the physician-patient paradigm when it comes to decision-making. However, we know that increased ownership and responsibility by patients and caregivers over their disease management can have a positive effect on the medical journey and improve adherence to treatment through patients’ conscious decisions.

Technology supports increased ownership through tools and services that put the patient in the center, increase the level of patients’ engagement, and provide more transparency and insight for informed communication with clinicians. Technology such as consumer-facing apps, real-time biomarker sensors, clinical support decision systems, and telemedicine services, to name a few, can increase patients’ awareness and understanding of their disease, help them to be more knowledgeable while communicating with their providers, and put them in a better position to negotiate treatment decisions.

When these new tools are part of the clinical flow and integrated into a new care delivery process between providers and patients, we can usually find better patient satisfaction, improve quality of care, and have better outcomes.

To continue reading about how clinicians can better engage their patients to use health-related technology, as well as examples of successful implementation of technology in psychiatry practice, click through to Part II of this series, “Expert Perspectives on Technology in Health Care.”