Background: Significant investments in innovative technologies have the potential to achieve high-value care by (1) improving the individual experience of care, (2) the health of populations, and (3) reducing the per capita costs of care, the Triple Aim.^⁠ For example, Digital Therapeutics (DTx) are software-based health interventions for managing and treating diseases, and promoting health. DTx are used to deliver scalable educational (e.g., health literacy), behavioral (e.g., physical activity), or cognitive (e.g., mental resilience training) interventions at minimal marginal costs. In other European countries, such as Germany, medical doctors can already prescribe DTx, and health insurers reimburse them. However, sustained user engagement with DTx remains a significant challenge, and this limitation substantially compromises the effectiveness of DTx, particularly in the long term. Moreover, implementing novel DTx in routine healthcare can take several years and is increasingly burdensome and extremely expensive. For example, since 2024, clinicians and researchers have been confronted with novel regulatory requirements (e.g., EU’s Medical Device Regulation, Swiss IKT-Branchenstandard, Informationssicherheitsgesetz or MepV).

Objective: This UMZH technology initiative aims to develop PRECIOUS, a Design and Trial Service for Precision Digital Therapeutics (PDTx). PRECIOUS will support clinicians and researchers in designing, evaluating, and implementing regulatory-compliant educational, behavioral, or cognitive-focused PDTx, making high-quality UMZH treatments more efficient. In contrast to DTx, PDTx leverage sensor data streams to deliver highly personalized interventions at the most opportune moment, i.e., when someone is vulnerable and can receive, process, and use the support provided. PDTx are, therefore, designed to address the major shortcoming of existing DTx, i.e., long-term engagement.

Method: To make PRECIOUS as widely applicable and relevant to all UMZH hospitals, the following activities will be carried out in six work packages (WPs), which are led by the five digital health and implementation science professors of the UZH’s Institute for Implementation Science in Health Care (Profs. Kowatsch, von Wyl, Hastings, Clack and Naef): (WP1) gathering clinical and non-clinical requirements for PDTx from all co-applicants; (WP2) development of PRECIOUS Beta by substantially extending the DTx platform MobileCoach Cloud (already used for educational purposes at UZH) to account for the novel clinical and regulatory requirements as well as three novel key innovations (predicting states of receptivity; generative AI-supported precision interventions; predicting and preventing non-adherence); (WP3) optimizing PRECIOUS Beta according to the feedback of all co-applicants resulting in the final PRECIOUS version; (WP4) developing educational material, a UMZH PDTx Summer School and a short course to accelerate the adoption of PRECIOUS; (WP5) validating and implementing the proposed sustainable reimbursement and intellectual property models; and (WP6) conducting knowledge exchange workshops to strengthen the link between this and existing initiatives (e.g., The LOOP Biomedical Informatics Platform (BMIP), ETH Zurich’s digital Trial Intervention Platform (dTiP), RMIS, clinic-specific platforms such as _fundament at PUK or Digital Health Zurich).

Expected Results: PRECIOUS will be a cloud-based software tool allowing clinicians and researchers to design, evaluate, and implement regulatory-compliant PDTx. It will, therefore, help accelerate the translation of PDTx from research to clinical practice and will be an important building block to make high-quality care at UMZH more efficient. PRECIOUS will also be one important step towards a UMZH Center of Excellence for Digital Health. Within this decade and this project, the UMZH has the potential to play a leading role in developing highly effective PDTx that (a) can be prescribed by medical doctors and (b) are reimbursed by Swiss health insurers given corresponding regulatory environments will be implemented.

Broader Implication: In the long run, UMZH can offer PRECIOUS to other hospitals and universities in Switzerland and internationally. With PRECIOUS, UMZH can become an incubator for innovative software-delivered interventions that reduce the health and economic burden of disease in Switzerland, Europe, and globally.

Why do we need Precision DTx?

Main Components of PRECIOUS

A national and international consortium supports PRECIOUS

DTx developed with a previous version of PRECIOUS

The following DTx have been developed with the Pathmate Cloud infrastructure by Pathmate Technologies, the predecessor of PRECIOUS:

1. Manoa: Blood pressure monitoring and lifestyle support
2. MySwissFoodPyramid: A health literacy intervention for the Swiss public
3. Ready 4 Life: A coaching intervention for young people that strengthens life skills such as stress management, social media use, gaming, and addiction prevention
4. Lasea Ruhe Coach
5. rauchfreiCoach

The following DTx have been developed and evaluated with MobileCoach (www.mobile-coach.eu), another predecessor of PRECIOUS. The Pathmate Cloud infrastructure was inspired by MobileCoach:

1. LvL UP: A Holistic Lifestyle Intervention for Singaporeans
2. CanRelax 2: A Mindfulness Intervention for Individuals with Cancer
3. BalanceUP: A Digital Coach to Facilitate a Balanced Lifestyle in Individuals With Headaches
4. MISHA: A Chatbot-Delivered Stress Management Coaching for Students
5. Benefit Move: A digital coach offering financial incentives for physical activity
6. SweetGoals: A digital coach for young adults with type-1 diabetes
7. Sleep Sensei: A digital cognitive behavioral therapy for insomnia
8. Pathmate 2: A digital coach for childhood obesity
9. PEACH: A digital personality development intervention
10. Elena+: A pandemic lifestyle care intervention
11. MAX: A digital health literacy coach for children with asthma
12. ABLE: A digital coach for seniors affected by cognitive decline
13. ALLY: A digital assistant to lift your level of activity
14. and many more, see here.

Related Initiatives and Work

1. Schlieter, H., Gand, K., Marsch, L. A., Chan, W. S., & Kowatsch, T. (2024) Scaling-up health-IT—sustainable digital health implementation and diffusion. Frontiers in Digital Health, 6. 10.3389/fdgth.2024.1296495
2. Jacobson, N., Kowatsch, T., & Marsch, L. (eds.) (2023) Digital Therapeutics for Mental Health and Addiction. Elsevier, Academic Press. 10.1016/C2020-0-02801-X
3. Kowatsch, T., & Fleisch, E. (2021) Digital Health Interventions. Connected Business: Create Value in a Networked Economy (pp. 71-95). Springer International Publishing. 10.1007/978-3-030-76897-3_4
4. Collins, L. M. (2018) Optimization of Behavioral, Biobehavioral, and Biomedical Interventions: The Multiphase Optimization Strategy (MOST). Springer: London, UK  10.1007/978-3-319-72206-1
5. 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
6. Fürstenau, D., Gersch, M., & Schreiter, S. (2023) Digital Therapeutics (DTx). Business & Information Systems Engineering, 65(3), 349-360. https://doi.org/10.1007/s12599-023-00804-z
7. DTx Alliance – DTx Evaluation Toolkit  & DTx Definition
8. DigitSanté

Dr. Marcia Nißen, Prof. Dr. Florian v. Wangenheim & Prof. Dr. Tobias Kowatsch

Prof. Dr. Michael Krauthammer, Medical Informatics, UZH

Prof. Dr. med. Nikola Biller-Andorno, Bioethics, UZH

Prof. Dr. med. Claudia Witt, Complementary and Integrative Medicine, UZH

Dr. med. Regina Grossmann, Clinical Trials Centre, USZ

Prof. Dr. Gerhard Schwabe, Information Systems, UZH

Prof. Dr. Urte Scholz, Health Psychology, UZH

Prof. Dr. Jürgen Bernard, Interactive Visual Data Analysis, UZH

Prof. Dr. Lena Jäger, Computational Linguistics, UZH

Prof. Dr. Catherine Jutzeler, Biomedical Data Science, ETH

Prof. Dr. med. Jörg Goldhahn, Digital Trial Innovation Platform, ETH

Dr. Maria Olivares, Innovation Hub, UZH

Maria Rosa (Rosy) Mondardini, Citizien Science Zurich, UZH

Prof. Dr. Lauren Clack, Implementation Science, UZH

Prof. Dr. Janna Hastings, Medical Knowledge and Decision Support, UZH

Prof. Dr. Rahel Naef, Implementation Science in Nursing, UZH

Prof. Dr. Viktor von Wyl, Digital and Mobile Health, UZH

Prof. Dr. Erich Seifritz, University Hospital of Psychiatry Zurich

Prof. Dr. Susanne Walitza, University Hospital of Psychiatry Zurich

Prof. Dr. med. Philipp Homan, University Hospital of Psychiatry Zurich

Prof. Dr. Birgit Kleim, University Hospital of Psychiatry Zurich

Prof. Dr. med. Sebastian Olbrich, University Hospital of Psychiatry Zurich

Prof. Dr. med. Andreas Wicki, Comprehensive Cancer Center Zürich, USZ

Prof. Dr. Dr. med. Heike Bischoff-Ferrari, Aging Campus Waid, UZH

Prof. Dr. med. Brigitte Leeners, Endocrinology, UZH

Prof. Dr. med. Caroline Lerchenmüller, Gender Medicine, UZH

Prof. Dr. med. Alexander Möller, Children’s University Hospital Zurich

Prof. Dr. med. Reto Sutter, BALGRIST University Hospital

Prof. Dr. Christian Ruff, Neuroeconomics, University of Zurich

Prof. Dr. med. David Blum, Palliative Care Centre, USZ

Prof. Andrew Hall, MD, PhD, Zurich Kidney Centre, USZ

Prof. Dr. med. Britta George, Zurich Kidney Centre, USZ

Prof. Dr. Heidi Petry, Centre for Clinical Nursing Science, USZ

Prof. Dr. Michael Schaub, Public Health and Addiction, UZH

Prof. Dr. med. Stefan Klöppel, University of Bern

Prof. Dr. Nicole Wenderoth, Singapore ETH Centre

Jacqueline Mair, PhD, Singapore-ETH Centre

Prof. Yih Yng Ng, MRCS, MBA, Nanyang Technological University, Singapore

Prof. Johan Gunnar Eriksson, PhD, National University of Singapore

Dr. Kelvin Li Zhenghao, Tan Tock Seng Hospital, Singapore

Prof. Oliver O. Aalami, MD, Stanford Byers Centre for Biodesign, US

Prof. John Torous, MD, MBI, Harvard Medical School, US

Prof. Varun Mishra, PhD, Northeastern University, US

Prof. Catherine Stanger, PhD, Dartmouth College, US

Prof. Nicolas Jacobson, PhD, Dartmouth College, US

Prof. Katharina Schultebraucks, PhD, New York University, US

Prof. Wai Sze Chan, PhD, The University of Hong Kong, China

Prof. Christin Scholz, PhD, University of Amsterdam, Netherlands

Prof. Eun Lee, PhD, Pukyong National University, South Korea

Dr. Dirk Volland, Dr. Claire-Michelle Sévin, Andreas Filler, Pathmate Technologies

January 2025 – December 2026

This project is funded by the University Medicine Zurich.