The article explores a digital injustice that is occurring across the country: that digital solutions intended to increase health care access and quality often neglect those that need them most. It further shows that when it comes to digital innovation, health care professionals and technology companies rarely have any incentives to focus on underserved populations. Nevertheless, we argue that the technologies that are leaving these communities behind are the same ones that can best support them. The key is in leveraging these technologies with: (a) design features that accommodate various levels of technological proficiency (eliteracy), (b) tech-enabled community health workers and navigators who can function as liaisons between patients and clinicians, and (c) analytics and customer relationship management tools that enable health care professionals and support networks to provide the right interventions to the right patients. Finally, we argue that community health care workers will need to be incentivized to play a larger role in building and adopting innovations targeting the underserved. Narrative: Heart Failure and the Failure of Remote Monitoring Jeremy lives in a small subsidized housing development with his mother and three sisters. At 52, he struggles with heart failure with reduced ejection fraction. This year alone, he has visited the emergency department four separate times. Luckily, a nearby hospital has recently been focusing on reducing readmission rates for heart failure in response to increasing incentives related to value-based care. The hospital is exploring promising technologies that might help Jeremy: inexpensive remote monitoring devices that are connected wirelessly to a broadband router through Bluetooth ® . The solutions require Jeremy to use a scale and arm blood pressure cuff to record daily metrics that are sent wirelessly to his cardiologist. The idea is that, if clinicians can monitor Jeremy on a real-time basis, they can evaluate his health to see if he is deteriorating or stable. They can then use this information to proactively schedule an appointment or to make a medication adjustment. The solution, like many designed to prevent costly emergency visits or readmissions postdischarge, is considered to be integral in bending the cost curve and improving health. The problem is that none of these solutions are working. Jeremy is only becoming sicker and more frustrated. He lives in a home where wireless

Background: The Network of Digital Evidence (NODE) was formed to further advance the field of health information technology (HIT) and evidence-based digital medicine at different healthcare institutions nationwide. As the NODE network reviewed the state of the field, it was noted that despite substantial financial and human capital investments, the processes and results of HIT innovation seem chaotic and subpar, especially in comparison to the more well-established drug and device industries. During the course of this white paper, we will explore the causes for this observed phenomenon as well as propose possible solutions to improve the state of HIT. Methods: We compared the entire process of discovery, proof of concept, Food and Drug Administration (FDA) review, and postmarket monitoring and distribution/implementation of HIT innovations to the equivalent processes for drugs and devices. Whereas drug and device innovations are subject to a standardized pipeline of production, HIT innovations are not held to equivalent standards. Conclusions: As a result, HIT lags behind the more mature drug and device industries in producing effective and reliable products. This leads to an inefficient use of already scarce healthcare resources. The authors believe that the HIT industry must adopt many of the mechanisms implemented by the drug and device industries as dictated by their innovation pipelines of discovery, proof of concept, FDA review, and postmarket monitoring and distribution/implementation. We propose an eight-point plan to fundamentally evolve the HIT lifecycle, including reforms for institutions such as neutral government agencies, new health system boards and management systems, modified incentive structures, improved relationships with financial investors and start-ups, patient engagement, and enhanced mechanisms to improve HIT adoption.

This article examines the challenges of broad adoption of digital solutions within the healthcare industry and why evidence is so critical for advancement of digital health technologies. It then illustrates how emerging nonprofits are positioned to help the ecosystem overcome these challenges and to catalyze the process of matching the right evidence-based solution to the right clinical challenge.

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Over the last several years, there has been rapid growth of digital technologies attempting to transform healthcare. Unique features of digital medicine technology lead to both challenges and opportunities for testing and validation. Yet little guidance exists to help a health system decide whether to undertake a pilot test of new technology, move right to full-scale adoption or start somewhere in between. To navigate this complexity, this paper proposes an algorithm to help choose the best path toward validation and adoption. Special attention is paid to considering whether the needs of patients with limited digital skills, equipment (e.g., smartphones) and connectivity (e.g., data plans) have been considered in technology development and deployment. The algorithm reflects the collective experience of 20+ health systems and academic institutions that have established the Network of Digital Evidence for Health, NODE.Health, plus insights from existing clinical research taxonomies, syntheses or frameworks for assessing technology or for reporting clinical trials.