Join CardioNerds Co-Founder Dr. Dan Ambinder, Dr. Nino Isakadze (EP Fellow at Johns Hopkins Hospital), Dr. Karan Desai (Cardiology Faculty at Johns Hopkins Hospital and Johns Hopkins Bayview) join Digital Health Experts, Dr. Francoise Marvel (Co-Founder of Corrie Health and Co-Director of Johns Hopkins Digital Health Lab) and Dr. David Cho (Chair of the ACC Health Care Innovation Council) for another installment of the Digital Health Series. In this specific episode, we discuss pearls, pitfalls and everything in between for the emerging digital health innovator. This series is supported by an ACC Chapter Grant in collaboration with Corrie Health. Notes were drafted by Dr. Karan Desai. Audio editing was performed by student Dr. Shivani Reddy.

In this series, supported by an ACC Chapter Grant and in collaboration with Corrie Health, we hope to provide all CardioNerds out there a primer on the role of digital heath in cardiovascular medicine. Use of versatile hardware and software devices is skyrocketing in everyday life. This provides unique platforms to support healthcare management outside the walls of the hospital for patients with or at risk for cardiovascular disease. In addition, evolution of artificial intelligence, machine learning, and telemedicine is augmenting clinical decision making at a new level fueling a revolution in cardiovascular disease care delivery. Digital health has the potential to bridge the gap in healthcare access, lower costs of healthcare and promote equitable delivery of evidence-based care to patients.

This CardioNerds Digital Health series is made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Nino Isakadze and Dr. Karan Desai.  

Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values.

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1. A critical first step in developing a digital health intervention is defining the clinical problem rather than developing the technology itself.
   
2. Most digital transformations – whether in medicine or other industries – require several iterations for the technology to develop and demonstrate value. A key aspect of this iterative process was human-centered design: involving patients, their families, and other end-users early in the development of the digital health intervention.
   
3. Dr. Marvel and colleagues have developed a 6-step process for innovators to consider in taking a concept to product.
   

1. In this episode, we discussed with Dr. Marvel and Dr. Cho some general concepts on how to develop digital health interventions (DHI). DHIs have a broad definition, including any software or hardware application used to improve access, quality, efficacy or efficiency and they exist in various modalities (e.g., text message, mobile apps, wearables).
   
2. Dr. Marvel has previously authored a roadmap for digital health intervention that provides guidance for an interdisciplinary approach to developing effective and evidence-based DHIs. As discussed on the episode, a critical first step is defining the clinical problem an innovator is attempting to solve instead of attempting to develop the technology solution first and then adapting it to the problem.
   
3. Drs. Marvel and Cho emphasized that most digital transformations – whether in medicine or other industry – require several iterations for the technology to develop and demonstrate value. Frequent assessment in a structured manner will help the intervention mature over time. Dr. Marvel noted that a key aspect of this iterative process was human-centered design: involving patients, their families, and other end-users early in the development of the DHI.
   
4. For instance, with Corrie Health, Dr. Marvel noted that patients who had suffered acute myocardial infarction were involved in a Patient Advisory Board, demonstrations were held for the Patient Advisory board, and patients invited to participate on the research team.
   
5. Our experts also noted there is a wealth of literature on the common barriers in DHI adoption, including regulatory and cost requirements. Data security and interoperability are other major concerns for digital health innovators. An understanding of the healthcare ecosystem can help innovators recognize these barriers early in the design process.
   
6. In the aforementioned article, Dr. Marvel and colleagues define a stepwise process to help innovators bring their concept to product:
   

• Early multidisciplinary accelerators compromised of a variety of stakeholders
  
• Establishment of institutional navigators who can provide a pathway through institutional roadblocks and operational factors
  
• Encouraging mentorship and championship from faculty-level and administration
  
• Devotion of administrative/business/finance leadership to create sustainable business models to address the reimbursement and policy landscapes
  
• Creation of expedited IRB pathways for low-risk DHIs
  
• The design of systematic processes to access patient evaluations of new technologies and consumer-centered design.
  

1. Marvel FA, Wang J, Martin SS. Digital Health Innovation: A Toolkit to Navigate From Concept to Clinical Testing. JMIR Cardio. 2018 Jan 18;2(1):e2. doi: 10.2196/cardio.7586
   
2. Glaser J and Shaw S. Digital Transformation Success: What Can Health Care Providers Learn from Other Industries. NEJM Catalyst. 2022 Mar 22. doi: 10.1056/CAT.21.0434