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Digital Health Course, Fall Semester 2021, University of St. Gallen

Can medical Alexas make us more healthy? (The New York Times, April 2021), Wearables as a tool for measuring therapeutic adherence in behavioral health (npj Digital Medicine, May 2021), Improving community healthcare screenings with smartphone‐based AI technologies (The Lancet Digital Health, May 2021), Predictive analytics and tailored interventions improve clinical outcomes (npj Digital Medicine, June 2021), H1 2021 secured $14.7B in digital health funding, already surpassing all of 2020ʹs funding (Rock Health, 2021)

What are the implications and rationale behind the recent developments in the field of digital health?

Digital Health is the use of information and communication technology for the prevention, management and treatment of diseases. It covers topics such as digital health interventions, digital biomarker research, digital coaches and healthcare chatbots, telemedicine, mobile and wearable computing, self-tracking, personalised medicine, connected health, smart homes or smart cars.

In the 20th century, healthcare systems specialised in acute care. In the 21st century, we now face the challenge of dealing with the specific characteristics of chronic conditions. These are now responsible for around 70% of all deaths worldwide and 85% of all deaths in Europe and are associated with an estimated economic loss of $7 trillion between 2011 and 2025. Chronic diseases require an intervention paradigm that focuses on prevention and lifestyle change. Lifestyle (e.g., diet, physical activity, tobacco, or alcohol consumption) can reduce the risk of suffering from a chronic condition or, if already present, can reduce its burden. However, a lifestyle change is only implemented by a fraction of those affected, partly because of missing or inadequate interventions or health literacy, partly due to socio‐cultural influences. Individual personal coaching of these individuals is neither scalable nor financially sustainable.

Against this background, the question arises on how to develop evidence-based digital health interventions (DHIs) that allow medical doctors and other caregivers to scale and tailor long‐term treatments to individuals in need at sustainable costs. At the intersection of information systems research, computer science, behavioural medicine, and health economics, this lecture has the objective to help students and upcoming healthcare executives interested in the multi‐disciplinary field of digital health to better understand the need, design and assessment of DHIs.

After the course, students will be able to…

  1. understand the importance of DHIs for the management of chronic conditions
  2. understand the anatomy of DHIs
  3. know frameworks for the design of DHIs
  4. know evaluation criteria for DHIs
  5. know technologies for DHIs
  6. assess DHIs
  7. discuss the advantages and disadvantages of DHIs

Course content

To reach these learning objectives, the following topics are covered in the lecture and will be discussed based on concrete national and international examples including DHIs from the Centre for Digital Health Interventions (www.c4dhi.org), a joint initiative of the Department of Management, Technology and Economics at ETH Zurich and the Institute of Technology Management at the University of St.Gallen:

1. Motivation for Digital Health

  • The rise of chronic diseases in developed countries
  • The discrepancy of acute care and care of chronic diseases
  • Lifestyle as medicine and prevention
  • From excellence of care in healthcare institutions to excellence of care in everyday life

2. Anatomy of Digital Health Interventions

  • Just-in-time adaptive interventions
  • Digital biomarker for predicting states of vulnerability
  • Digital biomarker for predicting states of receptivity
  • Digital coaching and healthcare chatbots

3. Design & Evaluation of Digital Health Interventions

  • Overview of design frameworks
  • Preparation of DHIs
  • Optimization of  DHIs
  • Evaluation of DHIs
  • Implementation of DHIs

4. Digital Health Technologies

  • Technologies for telemedicine
  • Mobile medical devices
  • Virtual, augmented and mixed reality applications incl. live demonstrations
  • Privacy and regulatory considerations

Course structure and indications of the learning and teaching design

The course is structured in two parts and offers live on-site sessions and complementary online lessons. In the first part, students will learn and discuss the topics of the four learning modules in weekly on-site sessions. Complementary learning material (e.g., video and audio clips), multiple-choice questions and exercises are provided via the online learning platform.

In the second part, students work in teams and will use their knowledge from the first part to critically assess digital health interventions. Each team will then present and discuss the findings of the assessment with their fellow students who will provide peer reviews. Additional on-site coaching sessions are offered to support the teams with the preparation of their group presentations.

Course literature

  1. Cohen AB Dorsey ER Mathews SC et al. (2020) A digital health industry cohort across the health continuum Nature Digital Medicine 3(68), 10.1038/s41746‐020‐0276‐9
  2. Collins LM (2018) Optimization of Behavioral, Biobehavioral, and Biomedical Interventions: The Multiphase Optimization Strategy (MOST) New York: Springer, 10.1007/978-3-319-72206-1
  3. Coravos A. Khozin S. and K. D. Mandl (2019) Developing and Adopting Safe and Effective Digital Biomarkers to Improve Patient Outcomes Nature Digital Medicine 2 Paper 14, 10.1038/s41746‐019‐0090‐4
  4. Fleisch E Franz C Herrmann A (2021) The Digital Pill: What Everyone Should Know about the Future of Our Healthcare System, Emerald Publishing: Bingley,UK, 10.1108/9781787566750
  5. Katz DL Frates EP Bonnet JP Gupta SK Vartiainen E and Carmona RH (2018) Lifestyle as Medicine: The Case for a True Health Initiative American Journal of Health Promotion 32(6), 1452-1458, 10.1177/0890117117705949
  6. Kvedar, JC, Fogel AL, Elenko E and Zohar D (2016) Digital medicine’s march on chronic disease Nature Biotechnology 34(3), 239-246, 10.1038/nbt.3495
  7. Kowatsch T Otto L Harperink S Cotti A Schlieter H (2019) A Design and Evaluation Framework for Digital Health Interventions it ‐ Information Technology 61(5‐6), 253‐263, 10.1515/itit‐2019‐0019
  8. Kowatsch T Fleisch E (2021) Digital Health Interventions, in: Gassmann O Ferrandina F (eds): Connected Business: Creating Value in the Networked Economy, Springer: Berlin, 10.1007/978-3-030-76897-3_4
  9. Kowatsch T Schachner T Harperink S et al (2021) Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study, Journal of Medical Internet Research (JMIR) 23(2):e25060 10.2196/25060
  10. Kowatsch T Lohse KM Erb V et al (2021) Hybrid Ubiquitous Coaching With a Novel Combination of Mobile and Holographic Conversational Agents Targeting Adherence to Home Exercises: 4 Design and Evaluation Studies, Journal of Medical Internet Research (JMIR) 23(2):e23612, 10.2196/23612
  11. Nahum‐Shani I Smith SN Spring BJ Collins LM Witkiewitz K Tewari A Murphy SA (2018) Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support Annals of Behavioral Medicine 52 (6), 446‐462, 10.1007/s12160-016-9830-8
  12. Sim, I. (2019) Mobile Devices and Health The New England Journal of Medicine, 381(10), 956‐ 968, 10.1056/NEJMra1806949

Mandatory material

The mandatory material will be provided via the online learning platform.

Additional course information

This lecture builds the foundation for the Digital Health Project course offered in the spring semester of 2022. Here, interdisciplinary teams of students will develop a smartphone-based and chatbot-delivered digital health intervention with MobileCoach (www.mobile-coach.eu), an open-source platform for digital health interventions and ecological momentary assessments.

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Summary

Digital Health Course, University of St.Gallen, Fall Semester 2021, No 11,202,1.00, 2 ECTS, Wednesdays, 4:15 p.m. – 6:00 p.m, room 23-201 / 1st lecture will be held online via Zoom as described in the online learning platform, HSG Course and Examination Fact Sheet

Lecturer
Prof. Dr. Tobias Kowatsch
Prof. Dr. Tobias KowatschAssistant Professor for Digital Health at the University of St. Gallen and Scientific Director of the Center for Digital Health Interventions at ETH Zurich & University of St. Gallen
Contact Person & Teaching Assistant
Caterina Bérubé
Caterina BérubéPh.D. candidate and doctoral researcher at the Centre for Digital Health Interventions, ETH Zurich
MSc in Psychology with specialization in Social Psychology, Economic Psychology and Decision Science; Teaching Assistant Digital Health lecture