Can Digital Therapeutics Revolutionize Medicine?

Can Digital Therapeutics Revolutionize Medicine?

How technology will take treatment beyond pills and procedures
Conor Farese
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The next era of digital health has arrived, and it’s booming. In the not-too-distant future, patients with chronic obstructive pulmonary disease could be equipped with a sensor that monitors their medication and inhaler use and prevents acute events. People suffering from clinical depression could be prescribed an app-based therapeutic program in place of a drug.

Beyond the typical trackers and quantified-self apps, digital therapeutics are clinically validated and formally regulated products that help prevent, manage, or treat specific medical conditions. These new treatments could be prescribed by doctors, reimbursed by insurance, and used as a way for patients to get beyond sole reliance on the traditional pill or procedure. Digital therapeutics offer a wildly different vision of the patient experience, an opportunity to redefine medicine, and a forcing function for pioneering entirely new business models.

The digital therapeutics global market is estimated at $1.8 billion today, but predicted to reach $7.1 billion by 2025. Much of the growth is predicted to come through investment from traditional pharma, but there are several new players emerging from the tech and start-up worlds as well with the hopes of evolving into a digital therapeutic. Omada Health, which creates behavior change programs for managing chronic disease, makes its hundreds of thousands of patients feel seen and heard with personal coaching. Click Therapeutics develops software to support smoking cessation and address major depressive disorder in adults. The meditation app Headspace has convinced more than a million people to integrate meditation into their daily lives, with proven wellness benefits.

Companies like these are revealing transformative new approaches to helping patients tackle the thorny challenges at the core of chronic disease, mental health disorders, and a growing number of other diagnoses—and in the process, they’re creating and growing thriving markets where none existed before.

Might these digital products, one day soon, be prescribed by a physician who is concerned about her patients’ heart disease, diabetes, or weight? If Tesla released software that clinically validated reductions in car accidents, even for the most dangerous drivers, would that qualify as a digital therapeutic? We are just beginning to imagine and design the future of this industry.

But these products still face the age-old challenge: how to get people to actually use them. If patients don’t love and trust the experience enough to sustain engagement over long periods, many of these therapies—and products—will fail.

Any new approach needs to begin with the needs of real people, and to follow those needs toward products that are not only desirable, but also have viable business models behind them. Here are our four big takeaways drawn from IDEO’s experience working in this field, designing digital therapeutics that engage patients—and the market.

Put down the competitive landscape report

Innovations in science and health tend to be incremental, but by looking to other industries, it’s possible to identify opportunities for more radical change. Studying analogous experiences—services, products, and other offerings that deliver something tangentially related but not exactly the same—will clarify what kinds of experiences give patients a sense of meaning, delight and value.

A partner of ours in the biotech industry recently launched its first digital therapeutic, focused on helping patients manage diabetes. In piloting the experience, we encountered a big challenge: Patients were struggling to connect the at-home testing device to the bluetooth on their phones. Without it, the experience fell apart.

Instead of buying all of our competitors’ devices to look at their solutions, we brainstormed a list of organizations that were particularly good at helping people with a set of complex instructions—IKEA, ballroom dance instructors, piano teachers, NASA-to-spacecraft communications specialists, and others. We discovered that LEGO had made its first bluetooth-connected toy and—master of instruction that it is—had created instructions to guide even little kids through a simple series of steps. Inspired by LEGO, the team created a new set of instructions. Once they were integrated into the patient onboarding experience, nearly every patient was able to connect their medical device to their phones.

Prioritize the patient

It can be easy to fall into the trap of addressing the needs of payers and providers above the patients’. After all, if a digital therapeutic isn’t reimbursable, the underlying business may not be successful; and if a physician doesn’t know it well enough to prescribe it, a company can’t increase market share. These are critical pieces of the puzzle, but they need to come after the foundational concern of any new digital health venture: fitting your therapy into patients’ lives.

During early stages of design, we rely on user research to inspire countless possibilities, and revisit our insights when we need to refine (or flip) our ideas. User research informs the business model, helps define the path to market, and may also lead to other product features.

What does this look like in practice? Consider the digital mental health company Headspace. Headspace was designed to teach people the fundamentals of meditation, engaging them in an experience that might encourage practice and adherence over time. Initially, Headspace played with incentives like badges and friendly social competition, but it slowly came to understand that the most profound motivation was mental health itself. The company prompted meditators to remember why they meditate, and asked them who in their lives would be better off because they meditated. This consistent call for reflection and awareness led to higher overall engagement.

Headspace’s popularity has catapulted the company to $100M in annual revenue and more than a million subscribers. Once the company designed an experience that people loved, subscribers embraced the product and took it upon themselves to host Facebook groups, meet-ups, and events. Headspace then opened up partnerships within the formal health industry, adapting to the needs and requirements of providers, payers, and regulators. Today, Headspace is a benefit offered to employees of over 350 large companies worldwide, and providers and health systems across the globe offer it to their patients. If you design an effective product that patients love, players in the health system have incentive to offer access.

Design with and for your most extreme, hard-to-engage patients

Designing for extreme users illuminates the wide range of people who might use a product. In IDEO’s earlier days, we saw this most clearly when we designed physical products like ice cream scoopers and pizza slicers for older adults, people with arthritis, and children with limited motor skills. We ended up creating something those populations could use, but in doing so, we developed a universally easier user experience. The product design outshone its competitors and became a top consumer choice.

In the world of digital therapeutics, this approach might entail designing for patients with limited experience using digital technology, or focusing on patients living with multiple chronic conditions, or with profound barriers to accessing care. These patients can help shape a more equitable and inclusive therapeutic experience.

One of our most challenging digital therapeutic projects involved creating an app-based experience to combat depression. To engage with potential users, we traveled to the rural Rocky Mountains to an isolated community where we met Dan, a cowboy and rancher living 40 miles away from his closest neighbor. Dan had struggled with depression for most of his adult life. On a good day, it was hard for him to get out of bed. On a hard day, he struggled with suicidal thoughts.

Before talking to Dan, we considered all of the technological features that could encourage adherence, like enabling offline access and fast download speed in low-bandwidth contexts. But through talking to Dan, it became clear that the tactical challenges weren’t the biggest problem to solve. Even in more populated areas, depression itself can be isolating. Dan helped us co-design a digital tool that even he would be willing to come back to, day after day. One of the key features a digital therapeutic could offer would be connection to others—in real life—and a chance not only to receive help, but to give it. Informed by Dan’s story, we designed an experience that could connect people living with depression to each other and engage them as supporters, mentors, and advocates.

Launch a thousand prototypes

One of the biggest challenges facing health innovation today is the belief that you need to have a solution before you really grasp what people want and how they want it. That’s how the industry is constructed. You would never write a grant proposal without telling the funder exactly what you will deliver, nor allocate budget at a pharmaceutical company without a detailed plan and anticipated ROI.

For digital therapeutics, those constraints are blown wide open. Our task is to come up with as many ideas as we can and test what will actually stick. Prototypes pave the way to a solid, working product, and patient input on prototypes can be used in countless safe, thoughtful ways.

Recently, we worked on a digital therapeutic that helps people manage the tremors associated with motor disabilities such as Parkinson’s Disease. Instead of the typical treatment, which solely relies on an oral medication known to have serious side effects, we were tasked with working on a software and hardware system that delivers targeted electric pulses to the part of the brain that calms tremors. We began with a long list of open questions about what patients living with Parkinson’s would find acceptable, usable, and engaging.

When we went into the field to interview patients, we quickly realized that they had no idea what it might be like to rely every day on a digital device that’s crucial to their health. They were curious about the inner workings of the therapy, and asked questions about the technical, logistical, and philosophical implications.

Our first prototypes included a dozen hats, headbands, or pillows that a patient might wear to charge the implanted device. We also prototyped many digital interactions, from Alexa add-ons to iPhone apps, that might guide them to administer digital medication. To take advantage of bio-monitoring data, we created numerous dashboards, exports, and communication portals that might help patients, providers, and caretakers make sense of what was happening neurologically.

A lot of those ideas were failures, but the things we learned were priceless. For example, it turns out that despite the growing number of retirees on Alexa, many of our patients didn’t trust a voice-controlled app with a task this important. It also turns out that the headgear a person needed to wear could easily make them feel embarrassed, unattractive, or emasculated. One of the most important discoveries was that faster charging is not better, if slower charging meant you could fold laundry, watch your favorite TV show, or weed the garden at the same time. At the end of the day, we designed a hundred prototypes before we landed on the key value propositions, features, and usability standards that would shape the experience.

Tying it all together

Breakthrough products and experiences like Click Therapeutics and Headspace all align with the framework outlined above. But to be clear: They aren’t successful because they have a silver bullet for engagement or the best theory of behavioral economics. They are market-movers because they focused on their users and designed their products around what they found. That led to creating something people love, and success quickly followed. It’s a formula you can apply to creating your own digital therapeutics—or any product you want users to love enough to use in their daily lives.

Illustrations by Nien-Ken Alec Lu.

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Conor Farese
Senior Business Designer
Conor Farese helps companies think critically and creatively about their businesses, and helps translate new ideas and products into reality. Conor brings his expertise in business design to IDEO’s work in health, contributing to projects spanning from creating new models for value-based care to envisioning the latest digital therapeutics.
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