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Digital health education: imperfect to imperative

October 2019—Arlen Meyers, MD, MBA, is a passionate advocate for educating medical students and practicing physicians about digital health technologies and their role in patient care. Without increased emphasis on organized digital health education, the medical field cannot fully embrace such technologies, says Dr. Meyers, president and CEO of the Society of Physician Entrepreneurs and co-editor of Digital Health Entrepreneurship, released this year by Springer Books. Dr. Meyers is also professor emeritus of otolaryngology at the University of Colorado School of Medicine and a member of the faculty at the University of Colorado Denver Business School. CAP TODAY recently spoke with Dr. Meyers about digital health education.

Why should medical school curricula include required courses in digital health for all students?
In my view, the purpose of medical education is to graduate people who serve the interests of their communities in an equitable fashion, and I do not believe that is the present case. The world has changed into what we now describe as the “fourth industrial revolution,” which is driven by cyber intelligence. So if the physician of the future—or the present—is required to have the necessary knowledge, skills, attitudes, and competencies to thrive in the fourth industrial revolution, then digital health and digital health entrepreneurship need to be a required part of the curriculum.

How do you define digital health?
My view is that digital health is the application of information and communications technologies to exchange medical information for various uses. It could be prevention. It could be treatment. It could be rehab. It could be diagnosis. Digital health incorporates many different subcategories, including telemedicine, big data, analytics, patient portals, and smartphone apps.

How do you think medical schools should incorporate digital health into their curricula?
I think it starts with a mandatory digital health survey course, and then if people decide they want to get further into the weeds, they can. But, unfortunately, particularly at residency training, the notion of teaching digital health is how to remember your user name and password on five different EMR systems and the network. And how to look up data—what was the CBC on patient X yesterday? That’s not my notion of digital health.

I try to use terms that physicians are used to understanding, like anatomy and physiology. How are things built—anatomy. How do things work—physiology. To understand the cyberworld, you have to understand how it’s built: What are the routers and the switches and the Internet? How does Google work? You must have some data literacy. And there’s also embryology: How is this world developing and how is it evolving? What is the impact of 5G on digital health? Those kinds of questions.

Barriers to digital health dissemination and implementation “are not being satisfactorily addressed in medical school, in residency, in clinical practice, and at the level of medical specialty societies,” says Dr. Arlen Meyers. (Photo courtesy of University of Colorado Denver)

Once you understand the basic science, you need to understand what I would call the clinical science. In other words, how are companies and doctors and patients using this stuff? What are the use cases? What are the business models? What works and what doesn’t? What is the clinical evidence that a technology is safe and effective and does what it’s supposed to do?

The third part is digital health innovation and entrepreneurship: How do you create this stuff? How are digital health products and services designed, developed, tested, validated, deployed, and transferred to human subjects?

Do you see more medical schools incorporating a digital health curriculum?
Are we seeing mandatory preclinical digital health courses in medical schools as the norm? No. But there are several examples of digital health education in other settings. The AMA, several years ago, created a website called the Physician Innovation Network. It was an attempt to create a space where people could collaborate, particularly by matching physicians who are interested in working with digital health startups with companies interested in working with physicians. That’s an effort to not just educate physicians about digital health but also to give them nonclinical career development opportunities. The University of Colorado, where I work, offers business school courses in its digital health curriculum for students pursuing a master’s of information sciences degree. There are many online courses on digital health that are free, through Coursera and Harvard’s EdX, for example. And there are digital health accelerators and incubators popping up all over the country as part of the same initiative.

Why do you think medical schools have been slow to adopt digital health curricula?
One, resistance to change. Two, lack of time. Three, you’re going to have to displace something in the curriculum to add digital health, and there’s a lot of faculty with vested interests who don’t want to see that happen. You need money to support the program. You need faculty who are experienced and know what they’re talking about. You need leadership that sees the need to do it. You need to have the dean of the medical school say, “We’re going to do this,” and then you have to have faculty champions who are going to execute it.

For practicing physicians, what are the biggest issues and concerns with regard to digital health technology?
To me, the biggest issue is making technology adoption decisions. The problem is there are so many digital health technologies that doctors are confused about which ones work, which ones are safe and effective, and what are the unintended consequences, the adverse events, the complications. That’s the clinical issue. And then there’s the business issue: How am I going to get paid to do this? What’s in it for me? Why should I even bother with this? And then there are the ethical issues: What about bias in artificial intelligence? Suppose the computer tells me to do something and things go south—who gets sued? There is a whole list of barriers to digital health dissemination and implementation that need to be addressed. And in my view, they are not being satisfactorily addressed in medical school, in residency, in clinical practice, and at the level of medical specialty societies. Those are the issues that we have to deal with and those are the conversations that should be occurring with medical students, but they’re not.