On this week’s episode, RJ Kedziora discusses how digital health tools have evolved over the years, where the future may be headed, and what challenges remain regarding reimbursement and patient engagement.

Good morning, everybody. I’m RJ Kedziora, co-founder and CEO of Estenda Solutions. We are a professional services-focused digital health software development company working in data analytics and AI projects for over the last 20 years. It’s a little scary to be saying I’ve been doing this for 20 years, but it’s been a fascinating journey, working in the space of digital health over the years.

We got our start with a congressional grant for the development of a diabetes disease management solution back in the early 2000s. We’ve been trying to improve the health and wellness of patients and outcomes, either directly with the patients or helping providers by developing solutions that make a difference in the world.

As part of that journey, I’ve worn the early devices and used early technologies, and digital health solutions have impacted patient outcomes in projects we’ve worked on. Across the industry, digital health solutions are easier to access and, typically, more affordable, and can help solve some of the issues around equity.

Today, there’s an obesity challenge in America, if not the world. There are mental health crises. And there are not enough healthcare professionals to take care of all the people that have these needs. This is where I’ve seen digital health solutions impacting the population.

When you think of digital health, there are lot of different ideas and areas, but what does digital health actually mean? It can mean telemedicine, remote monitoring, clinical decision support systems, and interoperability between systems.

We tend to focus on the idea of wearables—mobile health solutions. How can we better understand what’s going on in our bodies? So much of how we can impact our health is outside of those four walls of the hospital. If you can eat better, move more, decrease anxiety—even being more social has an impact on your health and can increase your longevity. We need to care for ourselves. Not many people understand what that means. Digital health solutions can help with that.

Think of your day-to-day: as you’re going throughout your life, what do you have with you? Your smartphone. That’s a huge opportunity that we can take advantage of as the healthcare industry, as medical professionals. If you think of a person with a chronic condition, how does this make a difference in their lives?

We’ve done a lot of work in diabetes, but also hypertension and blood pressure management. When we got started, it was finger sticks and understanding your blood glucose. It hurts, unfortunately, to take your blood. It’s also costly to access those needles, so people didn’t typically do that. It offered a single point in time to understand what’s going on inside your body. How do you make decisions with that data?

In the early days, we did a lot of work around that, how to make decisions with limited information. Fast forward 20 years now, and we have continuous glucose monitoring (CGM). It can tell you what’s going on inside your body each minute. Even if you don’t have diabetes, CGM devices are available in the market to better understand what’s going on with your body.

I don’t have diabetes, so I used one of these devices for people without diabetes. I’m fascinated by the science. I’ve helped develop algorithms to improve insulin recommendations and treatments over the years. To understand that when I eat a meal and go for a walk, that makes a difference in my health—to see that reflected in the numbers—is very powerful. That’s what digital health tools have enabled over the years, for people with chronic conditions to have a better understanding of what’s going on and how they can improve their health and treatment.

Today, AI is starting to have an impact in this area. There’s been a lot of work in terms of evaluating images and using clinical support decision algorithms. But as you get more and more data, it becomes difficult for us as individuals, as humans or even doctors, to be able to discern patterns and trends. How do we use AI to figure that out?

Even in diabetes, I’ve seen companies further defining type 1 and type 2 diabetes into subgroups to figure out better treatment options. In the area of diabetic retinopathy, we look at an image of your retina or the back of your eye. The AI can detect whether you’re male or female, which is just fascinating. Looking at this image, you or I can’t figure that out. We’re still not entirely sure how the computer pulls it off, but it just demonstrates AI’s capabilities.

There are probably 300,000 or so digital health applications on the market. How do you know one is better than the other? There’s a lot of anecdotal evidence. Does your physician recommend it to you? What kind of research has been done? Back in the mid 2010s, digital therapeutic apps came around and are gaining steam. There’s a couple dozen digital therapeutic apps on the market right now.

The idea behind these is the difference between drugs versus minerals and supplements that you can buy at your pharmacy. With supplements, there is some evidence that they can make an improvement in your health, but there are no viable, scientific claims that these can diagnose and treat a particular condition. Then you have drugs: medications that have gone through extensive research and FDA review. They are intended to treat, diagnose, or alleviate a particular condition. That’s the difference between digital health applications and digital therapeutics.

Digital therapeutics have gone through that extensive scientific research and FDA review and approval. It’s a higher bar to be able to say you are a digital therapeutic application. A key to the evolution of these systems is that they’ll be reimbursable. A physician would prescribe one of these digital therapeutic applications to you, you would use it, and you are not paying for it. The insurance company’s paying for it.

For a digital health solution, one of the challenges is how we pay for it. It’s one thing for an individual to pay a dollar or two for a mobile health application, but the insurance company has much larger pocketbooks and are going to see the benefits of improving the patient’s health.

Unfortunately, that reimbursement process has stalled out over the last few years. At the end of last year, 2024, there were some new regulations and reimbursement set up. As things change in the US administration, we’ll see where that all falls. But I’m excited by the idea of improving health within the government, so I’m looking forward to what comes from that perspective.

Reimbursement is a challenge in digital health, and that’s part of the challenge in how healthcare works today. If I develop a digital health application, or we’re working with a client that is taking one to market, you have to think about how it’s getting in the hands of the patient, who’s paying for it, and who’s using it. Very often, that’s the same person.

If you use Microsoft Word, you or your company is paying for it. If you buy a car, you are buying and using it. It’s very tied to you as an individual. But in digital health, the insurance company could be paying for it or advocating its use, the physician is prescribing it to you, and then you, as a patient, are the one that has to use it day to day. So along with that reimbursement question, how does the physician or patient become aware of these solutions?

Think of the drug market. All the pharmaceutical companies have armies of salespeople that are going out and talking to physicians and healthcare providers to make sure they’re aware of a particular drug. It’s a little harder in the digital health world because the economics aren’t there just yet. Then, once you do get beyond these challenges, how do you keep the patient engaged? Unfortunately, with a lot of digital health solutions, there is a drop off. It is difficult, but we’re always trying to develop new methodologies to keep the patient engaged.

As for what’s happening and what’s coming up, I’ve experienced a lot over the last two decades and the future is so bright that I think we have to wear shades, as the old song goes. 2025 is going to be fascinating, particularly around the combination of digital health devices like the wearables, remote monitoring, and AI. If you look at AI and GenAI, the large language models of today, that’s such a huge opportunity.

There’s a lot of apprehension in healthcare, which I understand, about the idea that AI may hallucinate and make up information. But what I find fascinating about the use of AI, even with where it is today, is that this is the worst it’s ever going to be. It’s only going to get better. How do we embrace it today?

Humans are very capable of making mistakes. There is a reason for second opinions. Not knocking any physician or healthcare professional out there; we’re all human. We make mistakes. We have put in policies and procedures to deal with that. How do we use the power of generative AI solutions, acknowledging that they can make mistakes, and putting policies and procedures in place to mitigate the impact?

How do we use it to explore new ideas and interact with the patient? As researchers have looked at responses created by the generative AI, consistently, they’re ranked as being more empathetic toward patients than the email replies or notes created by physicians. People get tired; the computer doesn’t. It’s fascinating that we’ve seen this consistently, that AI replies are deemed as more empathetic.

It’s also an opportunity to meet patients where they are in their health journey. As an example, my sister is studying for her PhD in quantum mechanics. I have no idea what she’s talking about, but I can ask ChatGPT to explain that to me like I’m in kindergarten, and it makes it much more palatable and understandable. If I still don’t understand it, I can ask it to find an example. We can use AI to meet a patient where they are in their health journey and their health literacy journey.

If you get diagnosed, God forbid, with cancer, and from that point on, you’re not hearing anything the physician says, you can go back, take your notes, and use the AI to better understand what’s happening. You need to then coordinate with your practitioner to make sure the information is accurate. Always crosscheck because of the AI’s tendency to make up stuff.

But if you’re not using AI today, I think you must start using it. It’s a major disruptor. I put it in the category of the printing press, electricity, and the internet. It is going to make a significant impact on our world. Some have even called it “humanity’s greatest invention.” It is going to change society.

There are going to be stumbling steps. It is going to have challenges. Society will have to change because of it, but ultimately, you need to use this. How can we use AI to improve the health and wellness of our fellow humans?

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

This transcript has been edited for readability.