Beyond Pills: How Digital Therapeutics Are Redefining Chronic Care
By Arunima Rajan
Dr. Aditi U. Joshi is the Executive Director of Telehealth.org, an emergency physician, digital health consultant and bestselling author of Telehealth Success: How to Thrive in the New Age of Remote Care. In an interview with Arunima Rajan, Dr. Joshi says the most successful digital tools demonstrate clinical efficacy, clinician adoption, seamless integration, and patient adherence.
Dr. Joshi, as we see a global pivot from pills to devices in chronic care, could you share specific examples where digital therapeutics have tangibly transformed patient outcomes in your experience?
Absolutely. One striking example is the use of app-based cognitive behavioural therapy (CBT) for chronic pain management. Patients who had been on long-term opioid therapy were able to reduce or even eliminate their dependence by integrating digital CBT alongside physical therapy. Another area is diabetes management which has quite a bit of research. Continuous glucose monitoring (CGM) devices that are paired with AI-driven coaching apps have shown significant improvements in glycemic control, reducing A1C levels without increasing medication burden.
Dr. Aditi U. Joshi, Executive Director, Telehealth.org
In your decade-long journey with telehealth, have you encountered cases where a digital intervention—say, a remote monitoring device or an app-based behavioural programme—proved to be a game changer compared to traditional medication?
Certainly. We have to stress that long term health is predicated on great preventive care. Digital interventions that offer reminders on sleep, exercise, nutrition, screening exams can all be used in this manner. For chronic diseases, I can think of a few cases. One case that stands out involved a remote heart failure monitoring programme. A patient who lived in a rural area was flagged by their wearable device for early signs of decompensation, something that often has them present to the ER and get admitted to the hospital. This patient's changes were flagged well before they exhibited noticeable symptoms. Their doctor initiated a telehealth intervention, adjusted their diuretics, preventing an ER visit and potential hospitalisation. This case alone highlighted how remote monitoring can shift care from reactive to proactive, improving both outcomes and cost-effectiveness.
How do you reconcile the rapid advances in digital therapeutics with the time-tested protocols of emergency medicine? Could you highlight a scenario where integrating a digital solution directly impacted acute care delivery?
Emergency medicine tends to be ripe for innovation due to the high stakes environment and the fact that we have protocols that exist to ensure safety and timely intervention.
Digital tools can be used to augment real-time decision-making because of it. For example, a recent integration involved AI-driven sepsis detection in ERs. The predictive analytics flagged at-risk patients based on vitals and lab trends. In one instance, a patient with vague symptoms was identified by the system, leading to early sepsis intervention, significantly improving their outcome. While those examples exist, I should stress they are used as an adjunct. We have not fully gone over to a digital solution but we use the tools to help flag warning signs for earlier intervention.
Equity in healthcare is crucial. Can you offer specific examples of digital therapeutics that have successfully bridged the care gap in underserved communities, ensuring patients get quality, personalized treatment without geographical constraints?
One example is using AI-powered chatbots in community clinics with a shortage of healthcare professionals. In Latin America, there is a project that provides maternal health guidance via text based AI tools, reducing pregnancy-related complications. Similarly, remote patient monitoring for hypertension in Black and Indigenous communities in the U.S. has improved blood pressure control rates through culturally tailored digital coaching. All of these examples are not hindered by geography. I will say the one caveat is having a thorough understanding of the community's needs. In the maternal health guidance example, this would not have worked without the program leads ensuring the patients had access to connectivity and devices.
With devices and apps offering tailored care, what innovations have you seen that provide concrete benefits in managing chronic conditions like diabetes or hypertension? Any specific programmes or platforms that stand out?
These two diseases are both common and have significant impacts on our long term health so it should be no surprise there is concrete investment into solving them with new technologies. One standout is Omada Health’s digital coaching platform, which uses behavioural science to drive lifestyle changes. Another is Livongo, which has demonstrated reductions in A1C and improved adherence through AI-based coaching. The shift is from episodic clinic visits to continuous, personalised engagement. This is a recognition that our 'health' is not simply when we are at the doctor's office or checking our vital signs at home. The digital therapeutics recognise this is a daily and constant process. Instead of having patients have to think through it themselves, it allows a digital tool to monitor it and track it for them. This is proving more effective in chronic disease management.
From your vantage point at Telehealth.org, could you discuss a particular instance where a digital tool not only met clinical standards but also seamlessly integrated into existing care workflows to enhance overall patient care?
A great example is the integration of remote cardiac monitoring into routine primary care. There are a number of tools that meet clinical standards per the FDA. However that isn't the only requirement as there has to be clinical utility and evidence demonstrated in research. A network that embedded wearables into post-discharge care for cardiac patients was able to look at real-time ECG data, prompting early tele consults. This works seamlessly since cardiologists would evaluate an ECG anyway. Digital tools can manage patient reminders, data uploads and pushing them out to the cardiologists to evaluate. This saves both time and integrates into clinical practice.
Data security is a pressing concern in digital health. Have you come across examples of how companies are effectively addressing these challenges while still delivering cutting-edge therapeutic benefits?
Data security is a major concern, and frankly, there are still real issues with the limits of what is required within HIPAA. Still, companies are ensuring compliance. There have been missteps such as patient data being sent to Big tech due to a loophole in where the patient data was sitting. However, it was remedied. AI models have to be especially secure as it relies on data to work. One promising approach is homomorphic encryption, which allows AI models to analyse patient data without exposing raw information. For example, Apple Health securely integrates with hospital EHRs without compromising patient privacy. Blockchain technology is built on this need and is being piloted for maintaining the integrity of patient records while preventing unauthorised access. I advise anyone who is building or using digital tools to have a very frank discussion before using tools on what the security protocols are. It is going to save time in compliance discussions down the line.
As an advisor on research and investments, what criteria or real-world performance markers have you observed in successful digital therapeutics solutions that set them apart from the rest? Any case studies that particularly resonate?
Digital health solutions are not researched in exactly the same way as medications or clinical protocols, however, we have come a long way since having almost no usable information. In general, I've found the most successful digital tools demonstrate three key factors: clinical efficacy (validated by peer-reviewed trials), clinical utility (or clinicians actually prescribing them), seamless interoperability with existing healthcare
systems, and patient adherence. A case study that stands out is Biofourmis’ AI-powered analytics for heart failure, which has proven to reduce readmission rates by over 30%. Biofourmis has been around for a while and has worked on improving all four areas I mention. They are not the only ones as there has been a growing and sustained recognition that digital health has to fit into the general growth trends of medicine and healthcare.
Considering the diverse patient populations you work with, can you share an example where digital therapeutics provided a personalised approach that traditional interventions struggled to achieve?
Telehealth is for any type of patients; adding digital therapeutics is the next natural step of improving remote care. I'll use an example from mental health as it continues to be the biggest use-case for telehealth. This case was a digital mental health intervention for veterans with PTSD which used adaptive AI to personalise cognitive-behavioural therapy based on patient engagement levels. Veterans who previously struggled with adherence to in-person therapy found it easier to interact with an AI-driven model tailored to their specific symptoms and engagement patterns. This kind of personalisation is what is needed for the next level of telehealth and this is where digital therapeutics excel.
Looking ahead, what breakthrough—be it a novel device, an AI-powered platform, or a unique integration of remote monitoring—do you believe holds the most promise to redefine chronic care, based on specific projects or pilots you’ve encountered?
AI-powered precision medicine will redefine not only chronic care, but preventive and public health also. For chronic care, I have been intrigued by the use of digital twins, essentially using virtual models of individual patients that predict how different treatments will affect them. I am not sold on using that information without fully understanding it, but having these models can give both clinicians and patients better decision making information. I'd also like to see remote devices, such as CGMs, work autonomously in a closed loop system to optimise blood glucose. All of these innovations have the potential to make chronic disease management truly individualised.