Combating Time in Digital Health Design
Designing digital health products can, at times, be much more complicated than developing regular technology. Not only are you dealing with the human body which can react and respond in numerous variable and unexpected ways, but you are on the front lines fighting against another force - time.
Whether it is growth or deterioration, the passing of time leads to massive changes on both a biological and a physical level. Digital health products are up against everything from microscopic cell growth and division to physically apparent weight increases and decreases. There is perhaps no stage of life where these changes are more fast-paced and important than during pregnancy.
Women rapidly over the course of 9 months go from housing an embryo to size of a kidney bean to a baby the size of a watermelon. Tracking and monitoring this period of life is by no means easy to achieve and has been the challenge faced by OBGYNs over the ages. To make matters more complicated, there are still aspects of pregnancy and development that are a mystery even in our age of scientific achievements. For example, the rate of early stillbirth has remained constant overtime, despite our medical successes, and each year in the United States on average 24,000 stillbirths occur, many unexplained.
With so many altering variables and universal questions, it is therefore incredibly impressive when digital health products manage to surmount some of the odds and achieve success. It is even more exciting when these products focus on the needs of women who have so frequently been left outside the doors of the tech industry.
The Evolution of Women's Health
Today, we have slowly, but surly, seen an increase in innovation around women’s health. Developers and programmers have begun to see beyond the old idea that all women need is an app to track their menstrual cycle and have instead expanded into improving digital health for fertility, prenatal, postnatal, and mental well-being needs.
One of the most exciting companies that I have seen this year working in the prenatal application field is the organization Babyscripts, who is using their digital health application to disrupt the traditional OBGYN model of care and successfully enhance birth outcomes. Their virtual care model situates itself within the gap that is created between appointments and utilizes what they call “precision prenatal care” to allow providers to offer a complete care spectrum.
A platform bought by providers, Babyscripts allows different models to be purchased and utilized by doctors depending on the patients they serve. Models such as the the basic schedule optimization is designed for healthy, low-risk mom while other models are utilized for high-risk patients or Medicaid patients. While differing in schedule, all models allow for enrolled patients to be guided via mobile application through every gestation period with "practice-specific, Provider-approved tasks related to nutrition, exercise, and other behaviors that support a healthy pregnancy”.
In the first trimester, “Mommy Kits” are also sent to each patient which allows metrics such as blood pressure and weight to be taken at home, in real-time, by expectant mothers. Providers are then able to practice remote monitoring and can easily see, even before the next appointment, if measurements are veering off course and a pregnancy is heading down a course where intervention is needed. The ability to detect problems sooner and simply optimize scheduling and monitoring has proven to lead to better birth outcomes.
When speaking with Babyscripts founder Anish Sebastian, he noted that an observational study done by the Department of Obstetrics & Gynecology at the George Washington University Hospital between July 2014 and January 2015 found that, “…this platform demonstrated that automated alerts may be an effective way to notify the patient and provider regarding abnormal change in weight or blood pressure”.
A Look into the Future
What is incredibly exciting about this platform is not necessarily only the technology. While it is a true testament to success in tech design, it also highlights an even greater aspect - that it is possible for digital health to alleviate overburdened structural systems and costs.
In the United States, where maternity coverage and care significantly lags behind peer nations, the cost of prenatal care and pregnancy is no laughing matter. A typical ultrasound can run around $385 and Chronic Villus Sampling can range from $1,300-$4,800 and these are only some of the procedures undergone during the first trimester (Parasail). Once you continue to add on costs such as appointments, prenatal vitamins, and blood work you are already reaching a very high total, and this is even without the astronomical cost of an actual delivery.
Applications like Babyscripts have demonstrated how savings can be had during the prenatal stage not by cutting coverage and quality of care, but by increasing efficiency. By using remote monitoring to decrease the number of prenatal appointments women must attend you are not only freeing up the physician and alleviating structural complications in the health system, but you are also saving the women unnecessary appointment and procedure costs. Every unnecessary appointment she has to attend comes with the trade off of missing work or other activities. Furthermore, the efficiency of those necessary appointments are heightened and care is actually improved by allowing physicians to be notified immediately when physiological markers suggest an issue with the pregnancy. In the long-term, this increases the likelihood of positive birth outcomes and could potentially trickle down to savings in neonatal care and post-delivery care.
While it may seem like an obvious solution, increasing efficiency has not been the general step taken in the United States healthcare ecosystem when it comes to women’s health. The more common approach taken by governing bodies has been to cut funding and resources, which only increases the gap of health between genders and also economic well-being as women unduly are carrying the financial burden of pregnancy and childbirth.
With Babyscripts, the focus on designing products specifically for Medicaid patients also is a true step forward in recognizing that all individuals should receive the best healthcare possible, regardless of their economic status. In the past, digital health products have too often focused on simply developing new applications and costly procedures to heighten the experience of the wealthy. Organizations that are recognizing that economic stratification should not overly prohibit potential innovation in healthcare are the ones that we should be championing and allocating resources to. It is through investment in the overall public’s health that we will be able to alleviate systematic pains and increase quality of care.