Digital health and precision prevention: shifting from disease-centred care to consumer-centred health

Abstract

Digital disruption and transformation of health care is occurring rapidly. Concurrently, a global syndemic of preventable chronic disease is crippling healthcare systems and accelerating the effect of the COVID-19 pandemic. Healthcare investment is paradoxical; it prioritises disease treatment over prevention. This is an inefficient break-fix model versus a person-centred predict-prevent model. It is easy to reward and invest in acute health systems because activity is easily measured and therefore funded. Social, environmental and behavioural health determinants explain ,70% of health variance; yet, we cannot measure these community data contemporaneously or at population scale. The dawn of digital health and the digital citizen can initiate a precision prevention era, where consumer-centred, real-time data enables a new ability to count and fund population health, making disease prevention 'matter'. Then, precision decision making, intervention and policy to target preventable chronic disease (e.g. obesity) can be realised. We argue for, identify barriers to, and propose three horizons for digital health transformation of population health towards precision prevention of chronic disease, demonstrating childhood obesity as a use case. Clinicians, researchers and policymakers can commence strategic planning and investment for precision prevention of chronic disease to advance a mature, valuebased model that will ensure healthcare sustainability in Australia and globally.

Precision Public Health for Non-communicable Diseases: An Emerging Strategic Roadmap and Multinational Use Cases

“…Precision public health (PPH) seeks to create an agile, responsive and data-driven public health system that strengthens current evidence-based approaches. PPH aims to improve population health by integrating data and digital technology to guide precision decisions, interventions and policy (10,11). From a digital perspective, the foundation of creating a PPH system is harvesting "organic" data that is collected automatically, routinely and in real-time via digital health infrastructure (e.g., electronic medical/health records, personal health records, genomics, billing/claims, mobile health, digital wearables, social media) (11,12).…”

“…PPH aims to improve population health by integrating data and digital technology to guide precision decisions, interventions and policy (10,11). From a digital perspective, the foundation of creating a PPH system is harvesting "organic" data that is collected automatically, routinely and in real-time via digital health infrastructure (e.g., electronic medical/health records, personal health records, genomics, billing/claims, mobile health, digital wearables, social media) (11,12). From a public health perspective, organic data is repurposed data (from clinical or social systems, as examples) to improve public health and is not collected through a specific research design (13).…”

“…Designed data is bespokeit has been designed for a specific purpose and is often singleuse, or repeated-use for the same purpose. Harvesting organic data has advantages of volume, contemporaneity and granularity and can thus improve decisions based upon designed data (11). The U.S. National Health and Nutrition Evaluation Survey (NHANES), for example, only includes a few thousand people per year whereas emerging surveillance systems leveraging electronic health record data typically include millions of people.…”

“…The data requirements are diverse as NCDs are driven by a complex system of social, environmental, behavioral, biomedical and commercial determinants and NCD prevalence can change slowly over the lifecourse. The social, environmental, and behavioral determinants primarily exist in communities where, historically and compared to the acute healthcare sector, there has been little investment in digital health and analytics and so surveillance and targeting interventions has been difficult (11,(17)(18)(19).…”

Challenges in the Adoption of eHealth and mHealth for Adult Mental Health Management—Evidence from Romania

“…The concept of eHealth refers to medical practice supported by electronic and communication processes. While some specialists refer to eHealth as the equivalent of health informatics, covering all electronic or digital processes in healthcare [ 9 ], others consider eHealth as referring to healthcare services using the Internet [ 10 , 11 ]. eHealth is a widely used concept that encompasses a range of services or systems that are at the interface between healthcare and information technology.…”