“We identified all DHTs [digital health technologies] prescribable for a hypothetical patient with 5 chronic conditions (type 2 diabetes, hypertension, chronic obstructive pulmonary disease [COPD], osteoporosis, and osteoarthritis), and assessed the number of DHTs this patient should be prescribed to receive benefits from functions health professionals considered important. We chose to evaluate devices involving hardware and standalone apps together to reflect patients’ perspective, as patients would have to cope with tasks from all DHTs, regardless their nature. [..]
We defined DHTs as all software as a medical device (SaMD); implanted, wearable, external, or environmental medical devices driven by software; and health applications (run on smartphones or computers). To be eligible, the DHTs had to be applicable for the hypothetical patient (ie, they were intended for monitoring, treating, and/or managing diabetes, hypertension, COPD, osteoarthritis, and/or osteoporosis and intended for older female patients), intended to be used outside of clinical settings, and intended to be used by patients. [..]
We screened 12 346 entries in the FDA databases and 540 entries in the ORCHA App Library and identified 148 unique DHTs (68 [46%] from FDA databases) that could be prescribed to the hypothetical patient. Most DHTs were intended for monitoring, treating, and/or managing diabetes (57 DHTs [39%]), hypertension (25 DHTs [17%]), and COPD (20 DHTs [14%]). In addition to condition-specific DHTs, 58 DHTs (39%) aimed to help users have a healthy lifestyle (eg, smoking cessation, healthy nutrition), and 12 DHTs (8%) aimed to help users with pain management. Of all DHTs, 143 DHTs (97%) were intended for single conditions and problems, and 127 DHTs (86%) were accessible over-the-counter.
The identified DHTs offered 140 elementary functions to monitor, treat, and/or manage the patient’s conditions (Table 2). The median (IQR) number of elementary functions provided by a DHT was 2 (1-4), with a range of 1 to 22; 38 DHTs (26%) had only 1 function.
Functions for recording, tracking, or visualizing health-associated parameters were offered by 111 DHTs (75%). This group of functions included both monitoring of physiological parameters (eg, blood glucose) and tracking symptoms, medications, and nutrition using self-reported data. [..]
Functions for providing information or education were offered by 35 DHTs (24%). This group of functions used electronic learning courses, short videos, podcasts, articles, or blogs. [..]
Functions for maintaining motivation were offered by 34 DHTs (23%). This group of functions included activities to set goals, track progress, or remind patients of care routine (eg, taking measurements or using medications). [..]
Functions for communicating with health professionals were offered by 30 DHTs (20%). [..]
Functions for communicating with coaches, peers, and loved ones were offered by 22 DHTs (15%). [..]
Functions providing digital therapeutics with just-in-time interventions (often involving alerts, prompt notifications, or feedback) were offered by 14 DHTs (10%). [..]
Functions providing digital therapeutics without just-in-time interventions were offered by 54 DHTs (37%). Interventions ranged from pharmacological interventions (eg, insulin delivery systems) to cognitive behavioral therapeutics (eg, for smoking cessation), and AI-based chat (eg, for smoking cessation). [..]
Other functions were offered by 23 DHTs (16%). These functions included subscribing the blood tests at home, booking appointment with health care practitioners, setting smart shopping lists, or helping patients organize their health schedules (eg, to-do-list activities or clinic schedules).
Of all DHTs, 96 DHTs (65%) involved hardware (eg, wearable devices) and provided 87 elementary functions. There were 52 DHTs (35%) that were standalone apps and provided 103 functions.
Among 140 identified elementary functions, 39 (28%) were not considered important, 101 (72%) were considered important by at least 1 health professional, 28 (20%) by at least 3 health professionals, 14 (10%) by at least 4 health professionals, and 7 (5%) by all 5 health professionals. These 7 functions included 1 function for booking appointment with health care practitioners and 6 functions for recording, tracking, or visualizing blood pressure, blood test results, hospital test results (eg, radiology images, examinations), medication intake, physical activities, and symptoms across all conditions.
This systematic review found that a hypothetical patient with 5 chronic conditions would need to use at least 13 apps and 7 devices to benefit from functions health professionals considered important, with 3 apps solely intended for diabetes because none of them covered all functions considered important by health professionals. Our study emphasized the quickly increasing number of apps and devices patients would need to use when their number of conditions or health problems increases, with risks of unintended interactions, alert fatigue, and loss of effectiveness of DHTs. The cumulative burden generated by DHTs is more than their number and potential redundancies: patients may have to familiarize and routinize their lives with different interfaces, connect and manage multiple accounts on online platforms, and potentially deal with contradictory information provided by uncoordinated apps, devices, and people involved (eg, online coaches, clinicians from platforms).
Our research also highlighted the large number and variety of prescribable DHTs. Clinicians willing to use digital medicine would have to choose among 148 DHTs prescribable to the hypothetical patient, including 57 DHTs intended for type 2 diabetes. These figures are only the tip of the iceberg, as our search was focused on the very few DHTs approved by the FDA and/or recommended by ORCHA; that does not compare with the approximately 310 000 health apps available worldwide in 2022. The number of DHTs identified paralleled the variety of functions they offered; however, not all functions are equal in the eyes of health professionals. Clinicians considered that 28% of functions were not useful and 5% were considered important for most patients with the conditions.
While previous studies have highlighted that DHTs target individual conditions, ours is among the first to demonstrate how this fails to address multimorbidity, with a discrepancy between how DHTs are developed and marketed, ie, within silos and disease-by-disease, and the epidemiological reality of chronic conditions, that is 50% of patients with chronic conditions have multiple chronic conditions. [..]
The findings of this systematic review suggest that the current state of DHTs might generate an important burden for patients with chronic conditions, who often have multiple health problems and conditions. While disease-specific DHTs offer specialized support but may burden patients with multimorbidity, broader DHTs with hundreds of functions are unrealistic and inefficient, as each patient may need only a few functions. The potential solutions include advancing the interoperability of DHTs to create an integrated ecosystem where multiple apps and devices are processed and integrated to harmonize patient interfaces, tasks, alerts, and feedbacks; developing standardized interfaces with recognizable elements to reduce the complexity for patients; promoting communication and education on DHTs for clinicians and patients to enhance their digital health literacy and awareness of DHTs; and following the principles of minimally disruptive digital medicine (eg, clinicians should pay attention to patients’ life circumstances, gradually introduce DHTs by prescribing 1 by 1, assess the usefulness of the digital program regularly, offer timely adjustments). To this end, future DHTs may be designed to include only functions that patients and clinicians considered important and be organized in modules, each covering a condition or function, minimizing the burden to clinicians of responding to data returning from multiple DHTs per patient. Our results also call for comparative information about functions, tasks, and burdens associated with DHTs (eg, need to create an account, need to answer questionnaires) and tools presenting this information to support shared decision-making. It is necessary to change the perspective of digital medicine, often focused on products, to recenter it on patients’ needs and capacities, pursuing minimally disruptive digital medicine.”
Full article, NTT Phi, VM Montori, M Kunneman et al., JAMA Network Open, 2025.4.25