Author + information
- Mary Norine Walsh, MD, FACC, President, American College of Cardiology∗ ( and )
- John S. Rumsfeld, MD, PhD, FACC, Chief Innovation Officer, American College of Cardiology
- ↵∗Address for correspondence:
Dr. Mary Norine Walsh, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
Driven by exponential growth in computing power, digital technologies have successfully transformed most sectors of the economy—ranging from finance to entertainment—with one prominent exception: healthcare. Certainly, medicine is high tech in many ways, with continued advances in medical device and imaging technologies serving as obvious examples of this. However, despite billions of dollars in investment in digital health technologies by both start-ups and established technology companies (1), healthcare delivery transformation still lags. In fact, even as our daily lives continue to be changed by companies such as Amazon, Apple, and Google, these tech giants are still struggling to figure out healthcare. Why?
There are numerous reasons why the digital transformation of healthcare is lagging, but several stand out:
• Healthcare is not entertainment. The healthcare system is complex, and for the most part, the culture and structures of healthcare are not set up to absorb innovation. As such, the mere availability of new digital health technologies will not transform care delivery.
• The stakes in healthcare are actually high: these are sometimes truly life-or-death decisions. Healthcare rightfully requires evidence for technology solutions before clinical adoption, with careful assessment of their effects when integrated into care. Despite much hype, such evidence is largely lacking for digital health technologies to date, and there is a paucity of focus on how to integrate them into care.
• Many tech companies lack clinical insight. Some mistakenly believe that a given technology—in and of itself—will transform care. Others do not have a good match between their technology and an important clinical problem that needs to be solved. Many do not know how to approach clinical utility testing and evaluation of effectiveness and safety of technology when deployed in clinical care.
• Electronic health records (EHRs) were a first step in the digital transformation of healthcare, but many consider this a misstep. Dissatisfaction and criticism abound, including that EHRs are largely billing platforms; make healthcare less efficient from the clinical perspective, contribute to burnout; harm clinician-patient interactions; and are barriers to implementing other digital health technologies (2,3). Digital health companies cite EHRs as major barriers to integrating their technologies into care.
• Digital health companies have often been fearful of entering the healthcare regulatory process. Importantly, the U.S. Food and Drug Administration has recently released a digital health innovation action plan, and is launching a novel pilot program to facilitate digital health product approvals (4,5). To date, however, many companies have chosen not to aim innovation at the clinician-patient interface, instead solely developing consumer products. Such products can obviously be valuable, but are unlikely to drive healthcare delivery transformation.
• Last—although certainly not least—there is the continued issue of nonaligned incentives from a health policy and payment perspective. Although there is much talk about population management and some growth in alternative payment models, for the most part, there are not aligned incentives or payment models in place to support digital health transformation of care delivery. Many, if not most, digital health solutions lack a clear business model in the current healthcare environment in the United States.
Against this backdrop, the American College of Cardiology (ACC) launched an ambitious Innovation Strategy in 2016. Under the guidance of the Board of Trustees, the strategy is intended to advance the ACC mission to “transform cardiovascular care and improve heart health” and help the ACC achieve its vision to create “A world where innovation and knowledge optimize cardiovascular care and outcomes” (6). The innovation strategy is designed to enable the ACC to lead, facilitate, and partner in the digital transformation of healthcare (Figure 1):
• Lead Define the roadmap for innovation in cardiovascular care. Provide clinical and scientific thought leadership in the identification of critical problems to solve in healthcare; define how to leverage technology to solve those problems; and demonstrate how to evaluate and then integrate solutions in care.
• Facilitate Promote advancement of innovation in cardiovascular care through career and professional development of members interested in innovation topics and entrepreneurship; and participate in innovation activities that promote interaction of the clinical and technology sectors (e.g., crowdsourcing, pitch events, promotion of innovation networks and communities, and so on).
• Partner Leverage ACC assets like education, advocacy, quality, and science (including the National Cardiovascular Data Registry) and seek novel partnerships and innovation projects across the healthcare and technology sectors (Figure 2). These partnerships and projects are intended to position ACC members and the organization as leaders and key collaborators in the development, evaluation, and implementation of innovation solutions to transform care and improve health outcomes.
The ACC Innovation Strategy is currently focused on 6 key innovation topic areas (Figure 1):
• Digital health: wearables, biosensors, mobile applications, telehealth, and so on;
• Health analytics: big data analytics, machine learning/artificial intelligence, and so on;
• Precision health: advancing individualized diagnosis and treatment, utilizing “omics” and/or other novel data sources or approaches;
• Care delivery innovation and population health management: leveraging technology and analytics to support novel modes of care delivery or management of populations of patients, achieving more efficient care and improved health outcomes; and
• Health technology evidence: promoting evidence across innovation topic areas and the entire spectrum of health technology, ranging from apps to medical devices.
The ACC Innovation Strategy is still in the early stages of implementation. Many potential projects and activities are in developmental stages. However, the promise of pursuing such a strategy can be seen in the following example activities from last year:
• The ACC hosted a multistakeholder Innovation Summit in fall 2016, with participants across the healthcare sector ranging from patient/consumer groups to government. At the Summit, there was a clear, siren call that a clinically and scientifically focused organization like the ACC should assert a leadership role in the digital transformation of healthcare. This has been borne out in subsequent interactions across the technology sector and among healthcare stakeholders.
• Building on input from the Innovation Summit, ACC members with expertise in innovation topics developed the 2017 Roadmap for Innovation—ACC Health Policy Statement on Healthcare Transformation in the Era of Digital Health, Big Data, and Precision Health. This ACC health policy statement is published in this issue of the Journal (7).
• The ACC organized a member Innovation Workgroup in 2016, and following recent approval by the Board of Trustees, this will become a new Member Section on Healthcare Innovation. The new Innovation Section has multiple goals, including professional development related to innovation topics. The Section will also help position the ACC as a thought leader in innovation through its activities, and it will help guide the ACC’s innovation strategy in the future. The new Member Section on Healthcare Innovation will be open to all ACC members starting this fall.
• ACC partnered in 2016 with Google Health Search, so that answers to cardiovascular questions would be anchored in ACC/American Heart Association guideline recommendations (8).
• ACC is partnering with angelMD to give interested ACC members the opportunity to evaluate start-up technology companies and access educational materials on topics such as entrepreneurship.
• The ACC and angelMD are also partnering on “shark tank” competitions for digital health and medical devices at ACC.18 in Orlando in March 2018. The competitions will be held in the new Future Hub: The Future of Health Technology and Innovation space on the Expo floor.
• The ACC is partnering with the data science group of the Yale Center for Outcomes Research and Evaluation to launch an Institute for Computational Health. The goals of this Institute are to work with novel data resources and apply advanced analytics (machine learning/artificial intelligence) to improve the methods and results of data science (predictive models, and so on). Stay tuned for additional innovation projects as part of this partnership!
• The ACC partnered with the Israel Innovation Institute to conduct a Global Digital Health Challenge. A total of 40 digital health start-up companies applied, and the top 10 competed in the challenge event in Tel Aviv on October 3, 2017. The 4 winning digital health companies will now go on to implement proof-of-concept projects in clinical settings.
• The ACC is collaborating with Stanford University and the Cardiovascular Research Foundation on a Clinical and Digital Research Ecosystem, intended to advance novel, efficient clinical research across the spectrum of health technology.
Health technology will continue to advance at an ever-increasing pace, and the digital transformation of healthcare delivery is a certainty. However, key questions remain, including how digital transformation happens, over what time frame, and whether ACC members and the organization have passive or active roles. Choosing the latter, the ACC has launched an Innovation Strategy, advocating that digital health technologies must be effective and safe, improve efficiency of care, improve patient-clinician interaction, and be supported by payment models. The road to innovation is challenging, but the opportunity is great to lead and to help ensure that the digital transformation of healthcare is a positive one.
- 2017 American College of Cardiology Foundation
- ↵The wonder drug: a digital revolution in health care is speeding up. The Economist. March 2, 2017. Available at: https://www.economist.com/news/business/21717990-telemedicine-predictive-diagnostics-wearable-sensors-and-host-new-apps-will-transform-how. Accessed October 11, 2017.
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- ↵U.S. Food and Drug Administration, Center for Devices and Radiological Health Digital Health Program. Digital health innovation action plan. Available at: https://www.fda.gov/downloads/MedicalDevices/DigitalHealth/UCM568735.pdf. Accessed October 11, 2017.
- ↵U.S. Food and Drug Administration. FDA news release: FDA selects participants for new digital health software precertification pilot program. September 26, 2017. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm577480.htm. Accessed October 11, 2017.
- ↵American College of Cardiology Mission and Vision Statements. Available at: http://www.acc.org/about-acc. Accessed October 30, 2017.
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