The case for inclusive co-creation in digital health innovation
Broadly, digital health refers to the use of information and communications technologies in medicine and other health professions to manage illness and promote wellness3. More specifically, it includes the use of wearable devices, mobile health, telehealth, health information technology, and telemedicine3. To propose best practices for responsible digital health innovation, Landers et al. collected and analyzed insights from 46 digital health stakeholders in Switzerland through the ECOUTER methodology, a participatory form of qualitative research2. This approach ultimately enabled them to identify three clusters of governance and innovation best practices in digital health, among which inclusive co-creation is particularly important.
Inclusive co-creation refers, according to the stakeholders surveyed in this study, to the collaboration of regulators, patients, and citizens throughout the digital health innovation process and ensures that ethical and societal issues in these innovations, such as lack of patient centricity, trust, and autonomy, are addressed2. It is notable that amongst the 46 stakeholders recruited to participate in this study, including CEOs, product managers, investors, and policy makers, there were zero healthcare practitioners (HCPs) and only two patients2. In fact, Landers et al. specifically categorize HCPs and patients as “Implementors & end-users” rather than as “Innovators.”2 It is no wonder, then, that HCPs are not mentioned in the above definition of inclusive co-creation, but nonetheless puzzling that their perspective would be omitted from a study designed to identify best practices for addressing issues intimately embedded in the physician-patient relationship. It is well-recognized that the development and management of digital health products requires a deep understanding of the healthcare system, patient needs, medical protocols, clinical workflow, and regulatory requirements—knowledge that HCPs (and patients and / or caretakers) uniquely possess. Landers et al., however, are not fully to blame for this omission—clinicians’ voices have long been missing from the digital health landscape. Indeed, so too have the voices of patients and caretakers, though this particular piece will focus on the role of HCPs.
The breakneck pace of innovation within digital health, accelerated by the COVID-19 pandemic, has outpaced the inclusion of HCPs via the development of incentives, education, and regulations. As such, a fight-or-flight response has become common amongst clinicians, embodied in widespread reluctance to adopt digital health tools and defense of their traditional responsibilities4. If such tools lack both clinical relevance and buy-in from HCPs and patients, they are bound to fail. In fact, a recent cross-sectional observational analysis of 224 digital health companies in the U.S. found that 44% of them had a clinical robustness score of 0 (out of 10), highlighting a major gap in healthcare technology today5.
Digital health is often positioned as a vehicle for technological transformation, but there is no doubt that it fundamentally reshapes the physician-patient relationship and role of clinicians as well4. On many levels, then, it is incumbent upon innovators and regulators to adopt an approach to HCPs characterized by collaboration rather than division.
