Harnessing the power and promise of digital medicine

By Susan E.W. Spencer

As a young cardiologist, David D. McManus, MD’02, MSc’12, saw life as a practicing physician being spent more and more in the digital world. Medical charts were converted to electronic health records, fundamentally changing how health professionals communicated. Technology companies were developing devices and applications to make diagnoses.

But doctors were spending long hours keeping up with patient data entry in a platform largely set up for administrative use. Burnout from overflowing inboxes was growing. And for the most part, lengths of stay weren’t getting shorter, patient satisfaction hadn’t improved, patients weren’t taking fewer medications and health equity hadn’t budged.

“Digital medicine is medicine, but as any practicing health care provider would tell you, the tools designed to support patient care were in control of the provider, not the other way around,” said Dr. McManus, the Richard M. Haidack Professor in Medicine and chair and professor of medicine.

Digital medicine includes a spectrum of technological tools—from wearable devices that track activity to artificial intelligence (AI) to aid diagnosis, to providing remote patient care, to amassing enormous databases of electronic records and imaging data. Seeing its untapped promise, McManus consulted with like-minded colleagues and pitched a plan in late 2019 to UMass Chan leadership.

“We needed to figure out how to pull data from people into care; we needed to think about how we deliver that care; we needed to use technology to improve outcomes, drive better quality and improve efficiency,” he said.

Then the COVID-19 global pandemic hit.

The pandemic served as a catalyst for health care providers, patients and, importantly, insurers, to embrace telehealth visits. Patients who thronged to overflowing emergency departments with respiratory symptoms needed to be triaged fast. Remote testing and public health surveillance for the rapidly evolving SARS-CoV-2 virus needed to be developed, tested and deployed.

UMass Chan was awarded $123 million from the National Institutes of Health the largest grant in the Medical School’s history—to coordinate clinical studies for the nationwide push for fast, accessible COVID-19 testing under the Rapid Acceleration of Diagnostics (RADx) program. McManus served as co-principal investigator for RADx Tech, the specific initiative of UMass Chan’s focus, with Bryan Buchholz, PhD, chair and professor of biomedical engineering at UMass Lowell.

The RADx grant and concurrent successful development by UMass Chan researchers of a digital tool to assess COVID-19 patients, called Decompensation Electronic COVID Observational Monitoring Platform Triage, or DECOMP-Triage, confirmed to McManus and a growing cadre of scientists that UMass Chan could be a national leader in multidisciplinary digital medicine.

“Over the past 50 years, UMass Chan has been a place willing to innovate and willing to try new stuff,” McManus said. “It has also always been very connected to training tomorrow’s physicians and nurses, and to engaging patients in the design of their health care.”

A program is born

In January 2021, McManus was appointed chair of the Department of Medicine, and the Program in Digital Medicine was launched.

“What we have is aspirational,” said Neil B. Marya, MD’12, assistant professor of medicine and a co-director of the Program in Digital Medicine.

Apurv Soni, MD, PhD’21, assistant professor of medicine, and Honghuang Lin, PhD, professor of medicine, share program co-directing duties.

Nancy Anoruo, MD, MPH, assistant professor of medicine, serves as director of innovation.

Dr. Marya, a gastroenterologist, said his role is largely as a mentor to junior faculty working to get their digital medicine projects off the ground and as program director for the fellowship in digital medicine.

Marya’s research focuses on AI and machine learning, especially in pancreatic cancer. His lab has been developing an AIbased tool that can analyze images generated from endoscopic procedures to help improve the diagnosis of cancer. The device is currently being used in a feasibility study at UMass Chan and has already proved capable of accurate cancer diagnostics and providing real time feedback to endoscopists. A full clinical trial is expected to start in the fall.

In partnership with the Mayo Clinic, Marya’s team is developing a device that can provide instant feedback from AI in real time, rather than just from recorded images.

“I think the sky is the limit once we start deploying these AIs in real time,” he said.

Dr. Soni said his interest was sparked a few years ago in a project investigating smartphone technologies for atrial fibrillation (AFib). Stroke, which can be caused by AFib, is the third largest killer of adults in India, Soni explained. He approached McManus, who was also studying smartphones to screen for AFib, about trying out the technology in India.

Soni and a few other medical students spent a summer in India training community health workers who went from house to house, screening for AFib.

“Lo and behold, we found and published in the International Journal of Cardiology that not only is prevalence of AFib higher than previously reported in India; it’s actually higher than what’s observed in the U.S. and Europe,” said Soni.

Soni said he envisions the Program in Digital Medicine as “an incubation space to discuss ideas with faculty, students and top leaders in digital medicine and implement digital medicine projects that can demonstrate the art of possibilities within health care.”

Illustrating the program’s multidisciplinary approach, Dr. Lin joined UMass Chan from Boston University in 2022 as a biostatistician with extensive experience in machine learning, genetics and digital medicine.

Lin is also an investigator of the renowned Framingham Heart Study, which has been collecting longitudinal health data across three generations. A recent project analyzing physical activity data from participants’ Apple Watches found that a higher number of daily steps is associated with a lower cardiovascular disease risk.

Another project of Lin’s explores voice recognition technology to predict the likelihood of developing Alzheimer’s disease in the next five to 10 years among people with a genetic predisposition for the disease.

Dr. Anoruo became interested in digital health applications while finishing her residency in internal medicine at UMass Chan. She worked with the Department of Population & Quantitative Health Sciences on mobile health interventions to help people quit smoking and saw outcomes that, “far surpassed what we were able to do clinically with medications and other modalities,” she said.

Anoruo was inspired to complete a fellowship in health technology innovation and biodesign at Harvard University. Seeing the possibilities for solving medical care problems that previously seemed too large or inaccessible, Anoruo came back to UMass Chan as a leader in the Program in Digital Medicine.

Her research focuses on digital therapeutics, software as a medical device and digital transformation of care delivery models.

“We find there’s a lot of power in being able to harness technology and figure out where the gaps are, and how we can close them,” she said.

Collaboration with UMass Memorial Health

While UMass Chan Medical School scientists are reimagining the future of health care, faculty work closely with UMass Memorial Health’s Center for Digital Health Solutions to put new concepts and tools into practice.

“In some ways, the Program in Digital Medicine is the breakthrough arm of our academic medical center, while the Center for Digital Health Solutions is the follow-through lever,” Soni said.

Anoruo is putting her digital medicine acumen into clinical practice in UMass Memorial Health’s Hospital at Home program. Physicians visit their hospital-level patients in the patients’ own homes through telehealth and use biosensor equipment to gather vital data. Research shows there is a lower risk of hospital readmission, higher patient satisfaction and lower risk of hospital-acquired complications, among other benefits.

“We’re finding that the outcomes are amazing,” said Anoruo. “We’ve pushed the boundaries of what people thought would be possible as far as delivering medicine, and now we have an entire acute care hospital wing that is completely virtual.”

Digital medicine is also transforming how UMass Chan’s clinical partner delivers behavioral health care. Edwin D. Boudreaux, PhD, professor of emergency medicine and a psychologist by training, is the principal investigator on a four-year, $4.4 million National Institute of Mental Health effectiveness-implementation trial called Telehealth to Improve Prevention of Suicide (TIPS) in emergency departments. Using telehealth for behavioral health evaluations for patients who have suicide risk addresses some of the problems of long waits, transfers between hospitals to emergency mental health services and lack of mental health resources in rural communities.

Dr. Boudreaux said that electronic health records and digital tools allow for the standardization of mental health and suiciderisk screening and encourage a “system-based thinking” to prevent suicide.

“We have a better ability to detect risk when it’s there, we have a better ability to triage the risk and figure out whether this person really needs immediate care, or whether they can receive care in a less intensive setting,” said Boudreaux. “We can make sure that patients get the care that they need, and they’re not being ignored.”

From COVID-19 to the future of health care

“COVID has changed entire health systems,” said MD/PhD student Carly Herbert, a digital medicine trainee mentored by Soni. “We’ve had to adapt really quickly to the arrival of COVID, and then the rapid adoption of telehealth, of mass vaccination campaigns, of distributing rapid antigen tests globally. I think it’s spurred all these methodologies that can be used in so many other ways.”

Herbert finds digital medicine appealing because it also offers a way to expand access to care and reduce health disparities, something she cares deeply about.

Herbert and Soni pioneered a “siteless” study to assess the efficacy of rapid antigen testing at home. The digital recruitment and enrollment strategies allowed them to enroll participants from 47 states in the RADx Test Us At Home study and generate representative, regulatory-quality data on an accelerated timeline to inform policy decisions at a national level. The study’s findings influenced the Food and Drug Administration’s safety communication regarding serial testing for at-home antigen tests.

As with any major advance in health systems, the digital revolution comes with challenges too. UMass Chan faculty cited potential hurdles, from normal growing pains of going from startup to sustainable operation; supporting researchers, health care teams and patients with a new mindset; ethical questions around AI versus visual diagnosis; whether payment models will support remote care after the pandemic wanes; and the importance of upholding the humanistic aspect of medicine.

With these caveats, UMass Chan’s leaders along the digital medicine path say the vision is worth striving for.

“It’s really about problem-solving,” said McManus. “It’s about listening to patients, engaging populations, addressing inequities and driving improvement. We want to turn the tables on technology and make it so that our patients, our sons and daughters and parents, have the health care systems and tools that they need. We might be wildly ambitious, but I think that if we leave health care a little bit healthier through our work in the digital world, that would be a wonderful deliverable for us at UMass Chan.” ■