HITLAB summit warns that digital health for all will need careful investment

NEW YORK CITY—“Digital health will cease to exist,” read large on the screen behind Merck Global Health Initiative Fund President Bill Taranto at the second annual HITLAB Innovators Summit in New York City.

“I don’t mean that literally. It’s not going to disappear. What I’m actually saying is it’s going to be integrated seamlessly into healthcare,” Taranto said.

Digital health conferences earlier this year, like HIMSS and ViVE, basked in the splendor of emerging tech including generative AI. While large language models are still making waves more than three months after ChatGPT-4 dropped, initial excitement is giving way to strategic planning. Speakers at the 2023 HITLAB summit held last week on the Columbia University campus emphasized that with AI sticking around and digital health being the new norm, the next step is optimization, implementation strategy and digital equity for all.

“The point solutions that you see today will soon no longer be point solutions,” Taranto said in a presentation on his predictions for digital health. “We’re hoping for full integration into the healthcare system.”

Praises for remote patient monitoring were sung more than once during the conference. Taranto sees potential for the tool when coupled with telehealth and other technologies on patient engagement platforms as opposed to telehealth-only strategies, which he said has been over-hyped.

Jamie Meyerson, vice president of network strategy and operations at Maven Clinic, took her time at the conference to point to the advantages of remote patient care in the maternal mortality crisis.

Divya Yerraguntla, senior vice president of demand generation and sales enablement at Syneos Health, spoke about how interoperability and seamless integration of digital health tools such as RPM can help connect community health partners to larger systems in order to address social determinants of health.

Digital health integration faces a notable challenge when AI comes into the mix, Taranto warned. Due to the highly regulated nature of healthcare, he expects friction as the tech is still being ironed out. When it comes to clinical practice, he sees AI being adopted in especially cautious steps as model inputs are negotiated and outputs are scrutinized.  

However, when it comes to administrative and operational functions, dramatic room for improvement remains. With 30% of wasted spending in healthcare, Taranto sees the possibility for AI eventually becoming a huge asset to hospital administration. But even in operations, integration must be cautious.

“Hallucinations aren’t acceptable when it comes to AI,” he said. “It needs to be audible. Black box models won’t fly with the regulatory agencies or customers.”

Taranto, Meyerson, Yerraguntla and a slew of other speakers took time out of the three-day conference’s speed presentation style to emphasize that while tech adoption is rampant, integration is not successful until life-changing advancements touch all patients.

Cesar Herrera, co-founder and CEO of Yuvo Health, spoke with Brenton Fargnoli, M.D., managing partner at AlleyCorp Healthcare, on the HITLAB stage about the next wave of value-based care and how tech can ensure that disenfranchised communities reap the benefits.

Yuvo helps bring value-based care models and, ultimately, revenue to federally qualified health centers by taking on downside risk on their behalf. Community health centers are banned from being saddled with the risk themselves. Despite a slowing market, the startup recently completed a $20 million funding round. Herra said that while investors are hesitant to invest in the Medicaid space, he sees notable room for growth.

“We’re not a point solution; we’re more of an ecosystem,” Herrera said. “I love when there are more organizations that are going into this market, creating those different solutions because I can partner with them. Medicaid serves about a third of the U.S. population. There’s a lot to go around, a lot of opportunities state by state for us to be able to support.”

David Berger, M.D., CEO of SUNY Downstate Medical Center, took the entirety of his session to assess the plethora of disparities that exist in digital health and pose a risk of propagating inequity. He began by showing a map of Brooklyn where the center is located to highlight the primary care desert that was created during the COVID-19 pandemic.

On top of a lack of access to physical care, Berger reminded the audience that the digital divide includes both patients and providers. Only 57% of U.S. adults who make less than $30,000 a year have broadband internet, he said. While older populations are more savvy with new tech, he expressed concern when point solutions aren’t standardized and create their own hurdles for adoption.

But the digital divide extends beyond patients, Berger said. The providers he oversees have what he calls “Epic envy.” According to Berger, when he joined at SUNY Downstate, the organization’s electronic health record system was five updates behind. Not only does that mean increase tedium and burnout but also revenue loss through incorrect documentation and missed reimbursement opportunities.

Even when marginalized populations get the right tools, they are not always calibrated for all. Berger referenced the reported failure of RPMs that cannot read things like blood oxygen levels on people with darker skin tones.

He then jumped to a lack of transparency and understanding in algorithms. When it comes to hospital ranking, SUNY Downstate loses out when patient satisfaction surveys are included and weighted in rankings without including surveys in Haitian Creole, half of the hospital’s catchment population.

On the individual level, algorithms are being implemented throughout the country to flag patients most at risk for bad outcomes. But Berger advised those in attending to proceed with caution, not rely on algorithms that aren’t yet fully tested for bias.

“I am really excited about digital health,” Berger said. “I think digital health long term will ameliorate a lot of the disparities we see in the delivery of healthcare. However, it's not going to be a straight line to get there; there's going to be a lot of bumps in the road until we really achieve healthcare equity or healthcare justice.”