In 2018, there were around 26.73 million active users of Fitbit products. We know that engagement and interest from consumers in fitness and wellness devices is continuing to grow, but beyond this, it is important to understand how people are engaging with the changing healthcare ecosystem, and what their willingness is to adopt new digital health solutions.

While there is certainly an ample supply of digital health solutions on the market, the demand for these, particularly from consumers, remains widely unknown. HealthXL wanted to gain an understanding on the general consumer perception of these solutions, so we conducted a survey online in February 2019 as part of our Q1 Report on Virtual Health Assistants (VHAs).

VHAs are relational agents or interfaces that are infused with the knowledge of a specific domain that supplement the need for humans in wellness, healthcare, disease management. VHAs enable sharing data, and boost health system capabilities without having to add more bodies. VHAs aim to streamline the healthcare experience for everybody - patients, payers and caregivers. VHAs may take any form factor - they may be voice-based through a home assistant or chat-based via your phone or desktop. AI is generally the underlying technology enabling the conversational element of virtual health assistants.

In this weeks blog, we examine the results of our survey to gain an insight into consumer adoption, awareness, and trust in VHAs, and to explore how our findings may correlate with consumer perceptions of the broader digital health space.

In order for digital health solutions to become an integral part of healthcare delivery, there needs to be awareness of the solutions from all key stakeholders, and to scale, the solution needs to be adopted and trusted by the end-user (patient/healthcare provider) to ensure continued use.

Consumer Survey- What We Found

Some of the key findings from our consumer survey included:

• Large proportion of consumers leverage the internet for health guidance and information
• The most significant perceived benefit of VHAs from consumers is for diagnostic support/ symptom assessment
• Consumers do not fully trust VHAs -  60% stated that they would feel the need to get a second opinion from a doctor

Consumer Awareness

To investigate how aware the general population is of VHAs, we asked survey respondents to identify what online tools, if any, they had used for health guidance and information.

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• 94% of the sample had leveraged the internet for some sort of diagnostic support or condition management guidance.

• Only 32% of respondents had actually used a Virtual Health Assistant.

An interesting divide appeared in the survey results, highlighting the willingness of the sample to use the internet for guidance but a shortfall when it came to those who had actually leveraged a VHA, or digital health solution per se, to date. This highlights a notable opportunity to tap into the willingness of populations to access health support and also the need to champion validated and well connected sources of information to guide them.

When analysing these results, it is important to consider the demographics of the respondents, and how representative they are of the general population. We had respondents from a varied geographic distribution, with the majority based in the US, followed by the EU.  Due to the nature of our survey being carried out online, it is unsurprising that the majority of respondents (48%) are digital natives, aged between 25-34 years old.

It is important to note that the majority of our survey responses, therefore, reflect the views of millennials. With millenials making up nearly a quarter of the total U.S. population, their needs are highly relevant. Their expectations are changing, driven by increased service and experience expectations in healthcare and comparisons with other industries.

A similar result was observed in a recent report by Oliver Wyman, which explored how awareness and engagement with the changing healthcare model differs among generations. They found that in general, younger generations were more willing to engage with new models of care, with 14% of millennials saying that they had ‘remotely interacted with a doctor via phone, chat, video chat, or another method’, compared with only 9% of the silent generation.

This is an interesting observation when compared to the growing numbers of solutions that are targeted at this generation. Within the VHA space in particular, voice assistants for senior and elderly care is one of the most densely populated categories. While these solutions have the potential to aid in tasks like medication reminders and remote monitoring, it is imperative that they are designed with the end user in mind, recognising that many people within this demographic may be lacking awareness and an understanding of these emerging models of care.

Consumer Adoption

While voice enabled health solutions have only recently made it into consumer consciousness, the survey results presented voice solutions on par in terms of consumer usage with 47% having used text based VHAs and the remaining 53% having interacted with a purely voice based or a hybrid solution.

Out of the 32% who claimed to have used a VHA, there were a number of recurring providers listed including Babylon Health, Ada Health, Google, Alexa and WebMD.

Consumers also flagged the most promising use cases for VHAs as diagnostic support (72%) followed by a relatively level playing field for management of a condition, access to education and lastly, navigating insurance plans.

The findings from our HealthXL survey correlates with those of others in the industry who have also looked at consumer adoption on digital health solutions. Rock Health, for example, showed that adoption of digital health solutions for diagnostic support has grown over time, with respondents reporting using wearables more and more to manage a disease and using them less to merely motivate a physically active lifestyle.

The use of digital health solutions for diagnostic support, particularly in the triage and symptom checker space, have benefits for key stakeholders across the entire ecosystem. For patients, the solutions provide a route by which they can save money, by reducing unnecessary face-to-face visits and increasing access to appropriate services and referrals. For providers, they enable the expansion of care services while simultaneously reducing in-person visits and healthcare practitioner burden and workload. For payers, they can leverage such solutions to scale their care management capabilities, and for pharma, they provide information to ongoing symptom management.

Consumer Trust

With only 32% of respondents stating they have used a VHA or Chatbot, we wanted to explore how much trust consumers have in these solutions, and if a lack of trust was a factor contributing to limited adoption. The results showed that 48% of respondents said they would trust a VHA, while 46% expressed a general willingness to adopt if the right information was available.

60% of respondents noted that they would feel the need to get a second opinion from a doctor, which indicates a lack of confidence in the information received when using VHAs. These solutions must mature and gain trust in order to fulfil the promise of reducing costs and improving outcomes.

The survey results highlight that in order to have wider adoption of these solutions, it is necessary for consumers (and other stakeholders) to be supported to understand their options when it comes to VHAs, and how this usage sits with their regular interactions with the healthcare system.

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Clinician Survey: What We Found

In tandem with our consumer survey, we reached out to a number of clinicians around the world to gauge their perception of the emerging VHA solutions being increasingly leveraged by their patients and targeted at their own practice.

A shared awareness of what VHA and digital health solutions are on offer to consumers, in addition to an understanding of how clinical stakeholders perceive these solutions is necessary to continue their effective scaling. This increased awareness across the board, in addition to regulatory and tech advances will ultimately lead to increased trust and adoption.

Some of the key findings from our clinical survey included:

• Large proportion of clinicians saw VHAs being more promising in supporting and encouraging self-management
• Very few clinicians surveyed are already using or recommending VHAs to their patients, however, all surveyed see themselves doing so in the future
• The most significant perceived barrier to clinical adoption is doubt in the general tech maturity in addition to concerns around data security and workflow integration

Clinical Awareness

Awareness is the first step towards adoption of VHAs in clinical communities and beyond. Interestingly, the HealthXL Clinician survey on VHA perceptions highlighted a correlation between the most promising use cases identified by clinicians and the number of solutions on the market that are focused on addressing these use cases, namely those encouraging and supporting self management. A resounding 80% of clinicians identified ‘Encouraging Self-Management and Medication Adherence’ as the most promising use case for VHA. Of the solutions we identified in our landscape analysis, the majority of companies on the market are focused on this sub-segment of disease management including self management and medication adherence.

Remote monitoring of vitals came in second with 70% of respondents seeing VHA potential to support their patients, a capability that often goes hand in hand with encouraging certain self-management behaviours. This highlights a lacking feedback loop that traditionally exists in healthcare and a real problem that VHAs may be able to support addressing.  

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In order to realise this potential continued clinical awareness of the general VHA applications available to consumers should be encouraged in order to allow clinical stakeholders to appropriately respond to, guide and support their patients to appropriately integrate reliable solutions into their health plans.

Clinical Adoption

Many VHAs have gained momentum by making their way directly into the hands of consumers through app stores and sleek websites, however, the clinical community presents a harder nut to crack as highlighted by our survey. Our own research has shown us that a larger proportion of companies in this space are leading with a patient first approach.

While 90% of clinicians surveyed claimed to not currently use any form of VHA as a part of their practice or interactions with patients, 100% of respondents said that they would feel comfortable recommending a VHA to patients in the future given some progress in the field and increased awareness of the key opportunities and limitations. This insight suggests that while clinicians recognise the potential of VHAs, they believe that the technology is not ready yet. Innovators will have some way to go before VHAs are confidently integrated into clinical practices as standard of care, but with the right level of dialogue and necessary steps towards clinical validation and RWE, it is only a matter of time before these solutions become a clinical companion.

Clinical Trust

The perception that the underlying artificial intelligence powering these VHAs is not mature enough is a key barrier to overcome before we see widespread adoption of VHAs by clinicians with 72% of clinician respondents citing this as the key barriers to their lack of adoption in their own practices. Clinicians do not want another tool that will fragment care further, so VHAs must have the capability to seamlessly integrate into existing workflows, for both the clinician and the patient, and provide insightful and actionable information.

There are also significant concerns regarding privacy and data security which are preventing clinicians from recommending VHAs to patients. With the recent announcement of Amazon’s Alexa becoming HIPAA compliant through combined efforts from healthcare providers and Amazon alike, we are making progress towards validating these solutions.

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So, Where Do We Go From Here?

Many push factors are at play encouraging the scale of VHAs serving clinicians and consumers.

Impactful and long term adoption of VHAs by clinicians and consumers will be dependant on building trust in the technology’s capability and clinical validity in addition to building a shared understanding of the different VHA application types on offer.

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Full report available HERE

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**methodology - Consumer Survey: Leveraged Amazon Mechanical Turk to survey a random sample of 50 consumers globally, using Mechanical Turk masters criteria, in February 2019. Clinician Survey: We reached out to 11 clinicians globally to gauge their perception of the space.

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Upcoming HealthXL Q2 Report - Digital Health Evidence Review 2019

Our Q2 Report is brewing - Digital Health Evidence Review 2019. The report aims to identify, categorize, and summarise all existing, relevant studies in digital health. Through this report, we want to establish a clear understanding of the existing body of clinical evidence for digital health, its maturity, current gaps and needs. Do you have specific questions on clinical validation for DH? Reach out to us - we'd love to get your ideas and answer your pain points.

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