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Digital Health, Fall 2022, University of St.Gallen

The promise of the metaverse in cardiovascular health (European Heart Journal, 2022), Can Virtual Reality Help Ease Chronic Pain? (The New York Times Magazine, 2022), First of its Kind Alexa Experience Provides Hands‐Free Access at Home to General Medical Care (GlobeNewswire, 2022), Can digital technologies improve health? (The Lancet, 2021), Predictive analytics and tailored interventions improve clinical outcomes (npj Digital Medicine, 2021), Q1 2022 Digital Health Funding Reaches $6B Across 183 Deals (Rock Health, 2022)

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 and treatment of diseases in the everyday life of individuals. It is thus linked to topics such as digital health interventions, digital biomarkers, digital coaches and healthcare chatbots, telemedicine, mobile and wearable computing, self‐tracking, personalized medicine, connected health, smart homes, or smart cars.

In the 20th century, healthcare systems specialized in acute care. In the 21st century, we now face the challenge of dealing with the specific characteristics of non‐communicable diseases. 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 and mental diseases are characterized in particular by the fact that they 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. A corresponding change in lifestyle is, however, 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.

To this end, 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 health economics, behavioral medicine, information systems research, and computer science, 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

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 University of Zurich, ETH Zurich and 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

The Digital Health lecture is structured in two parts and follows the concept of a hybrid therapy consisting of live input sessions and complementary online lessons. In the first part, students will learn and discuss the topics of the four learning modules in weekly sessions. Complementary learning material (e.g., video and audio clips), multiple-choice questions and exercises are provided online.

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

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Summary

Digital Health Course, University of St.Gallen, Fall Semester 2022, 2 ECTS, Course & Examination Fact Sheet

Lecturer
Prof. Dr. Tobias Kowatsch
Prof. Dr. Tobias Kowatsch
Associate Professor for Digital Health Interventions, Institute for Implementation Science in Health Care, University of Zurich (UZH), Director, School of Medicine, University of St.Gallen (HSG), and Scientific Director, Centre for Digital Health Interventions, UZH, HSG & ETH Zurich, Switzerland
Google ScholarResearchGateORCiD
Contact Person & Teaching Assistant
Caterina Bérubé
Caterina BérubéPh.D. candidate and doctoral researcher at the Center for Digital Health Interventions
MSc in Psychology with specialization in Social Psychology, Economic Psychology and Decision Science; Teaching Assistant Digital Health lecture