Read Our Mobile Health founder Julie Bretland’s perspective on what needs to be done to make digital health a part of our health ecosystem in the current issue of New Statesman’s Spotlight on Health. 

​Israel is leading the way in digital health integration. 100% of the Israeli population has access to their full personal health records online via their smartphone; they can schedule appointments, renew prescriptions, and even have an online visit to their physician.
 
Yossi talks of his unique window on this changing landscape: “I continue to practice medicine, not just because people and the art of diagnosing and healing are my personal and moral passion, but also because it presents me with the opportunity to experience, in first-hand, the needs and gaps for patients, clinicians, and organisations. That gives me a unique perspective when it comes to translating those needs into solutions which aim to combine technologies and human experiences.”
 
Through his experience leading the digital transformation of Israel’s largest health organisation, Yossi learned that digital health can’t be deployed as if it was a standalone technology solution. For it to be adopted it must be warmly embraced by the different stakeholders and interact with the existing healthcare infrastructure and solutions. Yossi explains his experience with mHealth apps:
 
“Healthcare is a challenging environment – very traditional, virtually immune to change, and overwhelmed by regulatory, legal and ethical complexities. Medical teams are an essential component in the adoption of mHealth solutions. If your physician sees the mHealth solution as one that enables him to provide better, more personalised and more efficient care, you will also look at it as a medical device rather than as a nice-to-have app. The internalisation of the value of mHealth solutions by the medical team personnel and their will to convey this value to their patients is crucial.”
 
That insight was what led Yossi and his team to the concept of prescribed apps.
 
Apps as prescribed clinical interventions
 
Today, physicians in Israel routinely prescribe apps for a range of purposes, including for chronic disease management such as diabetes prevention and Inflammatory Bowel Disease, ADHD, and medication adherence. Research has shown that using apps as health interventions does deliver measurable improved clinical outcomes. Yossi refers to prescribed apps as “pills composed of digital molecules”. That integration of health apps into practice didn’t happen overnight. Yossi talks about some of the barriers they had to overcome:
 
“Physicians are used to practicing medicine in a certain way, so in-order for app prescription to become part of their routine practice, they need to be educated on the value, the supporting evidence, the way to convey it to their patients, and the right way of using these “digital pills” so to maximise their potential benefits. In our organisation, we built a dedicated team which was responsible for managing the change associated with the adoption of mHealth solutions by the medical teams. We developed methodologies and processes aimed at engaging physicians, nurses and other medical team members, explaining to them the vision and making them curious and excited about how significantly these solutions can contribute to the quality of medicine they provide. Our approach appealed to their logical heads but also their hearts. That was key to drive a change in their beliefs about health apps as clinical interventions.”
 
“Alongside practical challenges like reimbursement; fear, suspicion, reluctance to change are all barriers. These physicians are not used to thinking about apps as medical interventions and the path to changing this is a journey rather than a one-off seminar. Even for the ones who are more inclined to change and who are more tech-savvy, app prescription requires a change in state-of-mind, training and practicing. It’s like learning and adopting a totally new treatment protocol after being used to a certain way of doing things for years. For change to happen you need to embed these new interventions into the existing workflow. You need to reduce the logistical hurdles while also addressing the emotional ones.”
 
There are also hurdles to be overcome on the patients’ side. Most patients are still not used to interventions that aren’t drugs. Yossi’s experience was the more the physician was engaged, the better they would emphasise the app as a bespoke clinical intervention to the patient. The doctor-patient relationship is the key to patients adopting mHealth solutions. 

​Evidence base for health apps
 
There is a growing body of literature about the clinical efficacy and health economic returns of digital health interventions. Individual studies support specific interventions but also hint towards a "class effect" that suggests when health apps are designed and deployed in the right way they can be very effective in improving outcomes, empowering the patient-physician relationship and reducing costs. Still, methods for assessing and evaluating mHealth solutions are in their early days, and advancements are required on all fronts –  including clinical outcomes, user experience, privacy, security, economic models.  
 
“Differentiating the truly digital therapeutic apps from ones that are not properly evaluated is crucial,” says Yossi. 

​The future of healthcare
 
We asked Yossi to share his perspective on how healthcare is changing: “We are about to experience one of the most remarkable changes in the history of modern healthcare. New mobile technologies, consumer trends, reimbursement models are converging to fundamentally change the industry, and address the challenge of delivering improved outcomes in a cost-effective way. The reimagining of healthcare is already underway and it will continue to accelerate. People will get more involved in their health, more engaged, healthcare will become more participatory and more personalised. The pace of change will increase as more millennials start to become “consumers” of healthcare. This is already happening, and this wave of change will grow whether we lead it or whether we physicians and the other healthcare stakeholders will be forced into it. I believe it is always better to lead because it allows you to influence the change and navigate the journey versus being carried away by hyped trends.”
 
“Digital health and the promise it brings to patient centricity and healthcare personalisation is just beginning. What we are seeing now is the tip of the iceberg. I feel really privileged to be part of this evolution of healthcare. My driving force and life mission is to expand this promise on a global scale, making my humble contribution to a healthier humanity. In order for this evolution to succeed, this requires a collaborative effort – with governments, health professionals, regulatory systems, tech innovators and consumers joining hands.”