Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

The Burden of Digital Health in Chronic Disease

SUMMARY:

  • Digital health has had a dramatic impact on healthcare.

  • Chronic diseases continue to be a prevalent concern with more than two-thirds of Medicare beneficiaries having at least 2 chronic diseases.

  • Adoption of digital tools in patients with chronic disease is limited due to several factors

  • Most digital tools address one individual disease.  Therefore, patients with chronic diseases may need multiple tools, making their use burdensome.

REVIEW

  • In 2023 approximately 194 million (76.4%) of U.S. adults, reported at least 1 chronic disease.

    • 130 million (51.4%) reported multiple chronic conditions

  • Among the 15 chronic conditions examined by the CDC, as of 2010:

    • 64% of patients had 3 or less chronic conditions

    • 23% had 4-5 chronic conditions

    • 14% had 6 or more chronic conditions

  • The number of chronic conditions increased with age.

Use of healthcare services increase with increased number of chronic conditions

  • ·As a bare minimum, the functions digital device should be able to accomplish for a patient with chronic disease(s) would be to track, record and visualize:

    • Disease symptoms

    • Medication intake

    • Blood test results

    • Hospital test results

    • Physical activity

    • Appointment scheduling

    •  Additional desirable attributes would include:

      • Vital signs

      • Smoking

      • Diet/nutrition

      • BMI/weight

      • Communications with providers

      • Notifications generated

  • Recently, Thuy et al (JAMA Network Open. 2025;8(4):e257288. doi:10.1001/jamanetworkopen.2025.7288) identified all digital health tools and their functions including: software as a medical device; implanted devices; wearables; external devices; environmental devices run by software; health applications on smartphones.

  • A total of 148 digital tools were identified via 3 different FDA database searches.

  • A total of 140 elementary functions and conditions were identified from the above lists.

    • The median number of functions provided by a digital tool was 2 with a range of 1 to 22

    • 38 devices had only 1 function

    • Of the 140 functions:

      • 39 (28%) were considered not important

      • 7 (5%) were considered important by all reviewers

  • Digital health tool functionality identified were grouped as:

    • Recording, tracking or visualization of health parameter

    • Informational or educational

    • Maintaining motivation

    • Communicating with providers

    • Communicating with coaches, peers, care givers, etc

    • Provide just in time interventions

    • Without just in time interventions

    • Other

Clinicains were then given a hypothetical case of a 79 year old woman with 5 chronic conditions of moderate severity.

  • Chronic Obstructive Pulmonary Disease

  • Diabetes (Type 2)

  • Hypertension

  • Osteoarthritis

  • Osteoporosis

  • Based on the digital tool analysis, the hypothetical patient would, at best have to use 13 apps and 7 devices to benefit from functions considered to be important

CONCLUSIONS:

  • Actual implementation of digital health technologies in patients with chronic diseases remains challenging.

  • One size does not fit all for the current digital health tools.  Use of enough tools to provide the minimum amount of information place too large a burden on patients with chronic diseases.

  • Future tools should consider an alternative perspective from the current “one device – one illness” approach with functions, tasks and data to an interoperative approach considering what is important to patients and providers.

Erkan Hassan