The potential of digital health to provide a comprehensive framework for the research, prevention and treatment of chronic disease is being inhibited by the failure of national health systems to reimburse it and integrate it into routine care.

This is the stark warning of a recent position paper from European cardiology leaders published in the European Journal of Preventive Cardiology, which suggests that while there is a rise in the adoption of patient apps linked to medical devices, the information generated is still treated as an add-on rather than being integrated into healthcare delivery.

Other barriers include entrenched attitudes which see digital health as an additional task rather than part of care delivery, and concerns about privacy and data security.

Many of these barriers can be overcome, say the authors, by the development of new pathways incorporating digital health, and greater interoperability to help technologies talk to hospital and primary care systems. But unless these issues are addressed by investment and innovation, health systems will continue to struggle to care in a worsening situation, as people live longer with chronic conditions.

“We can manage by creating models of care that incorporate existing technologies, but the main reason this has not been done is that there is no shared strategy among national legislators, industry, hospitals, physicians and patient organisations,” said co-author Professor Enrico Caiani, past chair of the European Society of Cardiology (ESC) working group.

What’s the impact?

The paper is critical of the lack of appropriate reimbursement models and the complexity of health service systems in most European countries, which have inhibited the widespread adoption of digital health services. Rather than being restricted to the cost of patient care, models should remunerate start-up investment and make the business case for new digital health-based strategies.

What’s the trend?

Technology developers need to adopt a more consultative approach, addressing common concerns about security and data privacy, and being more transparent about which apps are approved to work with medical devices.

“Companies need to involve physicians and patients in the design of technologies because if they care not acceptable to the end user they will never be adopted,” said Professor Caiani. “Technologies that create an additional task for doctors and reduce their time with patients are a non-starter.”

The paper also throws down the gauntlet to patient organisations, suggesting that they join forces with national cardiac societies to drive changes in their countries’ use of technologies in routine healthcare.

On the record

“It is vital that healthcare professionals and patients are part of the discussion on how we can modernise care using digital technologies to support high quality evidence-based practice that brings good results and experience of care for people with, or at high risk of, cardiovascular disease,” said Professor Martin Cowie, chair of the ESC Digital Health Committee.