2021 is known as the "first year" of domestic digital therapy, this year digital therapy really took root as a "seed", won the attention and expectations of all parties, and has also been widely questioned.
How will digital therapies grow in 2022? Is it to show vitality or to fade into silence and withering? The author conducts multi-dimensional and more in-depth thinking on this:
First, is digital therapy a new pot of old wine or an evolutionary deduction of Internet medical treatment?
The development of medical informatization has gone through four stages so far: the 1.0 stage of solving non-diagnosis and treatment business with charging as the center; the 2.0 stage of application subsystem informatization of each department with business as the core; the 3.0 stage of focusing on interconnection and interconnection to build an overall data integration platform, and the 4.0 stage of regional interconnection to achieve big data analysis, and the 4.0 stage of artificial intelligence to empower auxiliary diagnosis and treatment [1].
At present, the 3.0 era of medical informatization characterized by Internet medical treatment has not yet fully evolved, and the 4.0 stage of artificial intelligence empowerment to assist diagnosis and treatment has not yet been fully launched.
Internet medical treatment is an important feature of the 3.0 stage of medical informatization, which became a booming trend in 2015, although there has been significant progress in auxiliary diagnosis and treatment, health management, online registration, medical knowledge dissemination, Internet hospitals, etc., but it has never touched the core of medical treatment, that is, the replacement of clinicians' on-site diagnosis and treatment scenes.
No matter which is currently a well-known Internet medical manufacturer, when it was shouting to subvert the traditional medical ecology, it is now honestly doing the supplementary or auxiliary work of traditional medicine, and the current Internet medical treatment is to some extent saying that it has moved the "medicine to support medicine" online.
In the face of illness, the public medical system that occupies an absolutely dominant position firmly grasps health resources such as doctor resources, academic resources, and hardware resources, and Internet medical care cannot shake the main position of serious medical treatment.
Compared with traditional e-commerce, Internet medical care is always looking for a suitable conversion path. The concept of digital therapy that emerged in the United States in 2020 has suddenly attracted the attention of domestic and foreign countries, which undoubtedly makes the participants who are struggling to find a way to transform Internet medical treatment see the future direction, and there is a trend of direct evolution from medical informatization 3.0, but it remains to be seen whether it will be the direction of the medical informatization 5.0 era.
Second, landing transformation, digital therapy slammed the pain points of compliance and accessibility of traditional serious medical treatment
Digital therapy has a strong ability to transform and land, and the digital intervention technology is called "therapy", that is, the existing medical principles, medical guidelines or standard treatment protocols are transformed into application-driven interventions through digital means, which can effectively improve the compliance and accessibility of patient chronic disease management, and is an innovative method that breaks through the limitations of traditional drug treatment [2].
Although the extension of the service points of family doctors and community health service centers has been compensated, it is still difficult to compare with the universality touched by terminals in the internet era of data; and the weak layout of serious medical care in the stages of health management and disease prevention and disease rehabilitation, resulting in the difficulty of ensuring patient compliance, manifested in the lack of initiative of patients in their own lifestyle and health management. The continuity of patient health management and even the efficacy of drug therapy are greatly reduced by low compliance.
The essence of digital therapy is the digitization of services, according to the three directions that may be transformed in the future, it is split into three sub-concepts: digital vaccine, digital medicine, and digital medical order, corresponding to the three functions of prevention, treatment and rehabilitation.
The research and development of digital therapy products also draws on the genetic "target" concept of biomedicine, and effectively intervenes in the key factors that determine human health in the process of disease development through the underlying logic of basic medical principles. In general, diseases with long-term management, more interventions, clear clinical guidelines, lower levels of patient compliance and self-management are suitable for the development of digital therapy products. Digital therapy does not have limitations on the types of diseases, but rather has certain limitations on the diagnosis and treatment process and intervention methods of diseases [2].
Therefore, digital therapy mainly targets areas where traditional serious medical elements are ignored or have insufficient coverage capacity, greatly enhancing the accessibility of medical and health services and the compliance of medical and health service demanders.
Digital therapy, is it the concept of fireworks that is easy to cold, or the innovation of transformative medical and health services?
To see how far digital therapy can go, we first look at whether we can get the approval of the provider of medical and health services. In the process of providing prevention, diagnosis and treatment, health management, rehabilitation, etc., providers of medical and health services take whether they can reduce the workload of medical personnel, improve medical efficiency, improve medical quality, reduce admission rates, readmission rates and reduce unnecessary critical emergencies, especially whether they can significantly improve the terminal reach rate of health management services and whether they can greatly enhance the sense of acquisition of medical and health service recipients. This is the key to making the providers of medical and health services, and a large part of them are the key to the recognition, acceptance and participation of medical personnel in public medical institutions.
After obtaining the approval of the supplier, digital therapy is gradually integrated into the service system of the supplier, and gradually reflected in the latest disciplinary medical guidelines, and medical staff can apply or recommend the use of relevant specialized digital therapies in accordance with the guidelines in the service process, and integrate digital therapy into their own diagnosis and treatment and health management behaviors.
The second is to be recognized by the payer. When digital therapy through the research path of evidence-based medicine strongly proves that the efficacy of digital therapy after the participation of significantly improved efficacy and service efficiency, service cost reduction, especially the cost of medical insurance can be greatly reduced, after the health technology assessment (HTA), the mainland medical insurance as the main body of the payer will gradually consider the digital therapy into the payment system, While it will be a long time to realize the imaginary scenario of digital therapy being issued directly in a doctor's prescription and making patients pay, it is very likely that the policy space for digital therapy to achieve the incentive of the balance of the total health insurance will be great.
Commercial insurance will even accept digital therapy earlier, and even participate in the research and development, promotion and operation of digital therapy enterprises, provided that digital therapy can greatly improve the stickiness of users through the positive feedback experience design of products.
But the core is still the recognition of the demand side of medical and health services, that is, the demand for medical and health services can accept the services of digital therapy and is willing to pay for the efficacy of digital therapy. This step may not be achieved in the short term, most patients at the current stage can only accept the cost of drugs and surgical treatment in serious medical treatment, and it is very difficult to increase the cost of medical staff to break the situation of "using medicine to support medicine", and it will take time to pay for the invisible virtual part of digital therapy.
Therefore, the participants in digital therapy should fully consider the acceptance of the provider, demand side and payer of medical and health services, and make a step-by-step and phased breakthrough, so that digital therapy can become a real reform and innovation of medical and health services, rather than becoming the self-congratulation of the medical Internet community.
2022 is a critical year for digital therapy to take root, germinate and derive
The era of mobile Internet from the proposal or introduction of a new concept can always bring people a refreshing, to the real boom, it is 3-5 years, or even faster. If the first three years have not been able to gain a foothold in many doubts, it is likely that the future will fall silent, or be replaced by the concept of renewal, more logical self-consistency, and more adaptability to the system. Therefore, 2022 is a critical year for digital therapy, and this year will be an important period for it to root downwards, germinate upwards, and reproduce to its surroundings.
Rooting Down: Digging deep into value orientations and proving the value of digital therapy. Compared with traditional therapies, digital therapy needs to consolidate its own underlying logic, based on evidence-based medicine, with the participation of clinicians and relevant MDT (multidisciplinary consultation) teams; pay attention to the needs and value of doctors in medical and health services, so that digital therapy can be recognized and participated by doctors.
On this basis, digital therapy verifies the scientific rationality of the clinical path of digital therapy by analyzing a large amount of clinical data and connecting the in-hospital information system and clinical real-world data. Carry out key pipeline research on digital therapy, take compliance and accessibility as the guide, make substantial progress in evidence-based medicine in the pipelines of depression, diabetes, cognitive impairment in the elderly, etc., with the participation of clinicians, especially the participation of general practitioners (family doctors), conduct cohort studies, conduct double-blind comparisons, comprehensively compare the health intervention effects under the digital therapy system, cost-utility analysis and other indicators, and the research results need to be published in authoritative medical journals and journals recognized by the medical community. As soon as possible, an editorial board composed of a large number of senior medical experts and medical informatization professionals will be formed to compile and publish the annual "Guidelines for Clinical Diagnosis and Treatment of Digital Therapy", digital evidence-based medicine characterized by the application cycle of data collection and feedback has gradually emerged, and more mature developed products have obtained the NMPA (State Food and Drug Administration) medical device registration certificate.
Upward germination: Widely recognized by many parties, strengthen the penetration into all aspects of medical and health services. Widely strive for the support of medical and health service providers, especially the participation of general practitioners/family doctors in the whole life cycle management, deeply penetrate into the process of prevention, diagnosis and treatment, health management, rehabilitation, etc., to improve the efficiency of the supplier's work, improve the quality of the supplier's medical care, reduce unnecessary workload, reduce the cost of the supplier's service as the goal, play an advantage in compliance and accessibility, so that the supplier has a sense of achievement in providing medical and health services; obtain the support of the payer with strong evidence of cost-effectiveness, and become the drg/ DIP's powerful auxiliary tools, the ability to save insurance funds, lay the foundation for future medical insurance, and also become an important support for the early entry of commercial insurance; appropriate use of Internet marketing skills, in the young white-collar groups and other groups that are easy to accept new things to find a digital therapy pipeline (such as anxiety disorders and other mental disorders), expand the influence of the demand side, and gradually get wide recognition from society.
Derivative to the side: it can penetrate into the medical and health information ecosystem with points and surfaces, and expand into a forest. At present, informatization in the field of medical and health services, digital technologies such as meta-universe, medical informatization, mobile medical, medical artificial intelligence, medical community platform... Digital therapy is not a system that can penetrate the entire medical and health service ecosystem, but needs to be integrated into the overall ecosystem and promoted in an orderly manner, empowering each other and developing in a coordinated manner.
Coupled with the fact that in 2022, the state is expected to introduce clearer regulatory requirements for this field and introduce a clearer medical device registration path to guide enterprises, and more outstanding digital therapy innovative enterprises and industry associations will emerge in the future, and form digital therapy standards that conform to the domestic medical environment in the development and exploration.
In 2022, after achieving downward rooting, upward germination, and side derivation, digital therapy will be full of clouds and can be expected.
Author: Zheng Wentao, General Manager of the Intelligent Medicine Department of Shanghai International Human Phenotype Research Institute, the views in the article only represent the author's position.
【Reference】
1. "Internet + Medical: Reconstructing the Medical Ecology" Internet Medical China Association / Li Weiming / Wang Jing, January 2016
2. China Digital Therapy White Paper 2.0 (Arterial Network, Eggshell Research Institute), October 2021
*Cover image source: 123rf
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