The rise of digital health

In the emergency department (ED), Dr. Megan Ranney sees a wide range of patients. Some she wishes would have come in earlier, some she probably could have saved a trip, and then others whose condition is dire. All of them have something in common, though–having the ability to be in touch remotely before the event might have changed their outcome.

"When I take care of someone who comes in with a gunshot wound or having been in a fight, there's a lot of steps that got them there," says Ranney. "I often think about what I could have done to save them from whatever problem brought them to the ED that day."

Since she started practicing as an emergency physician, Ranney has seen the range of those real-world problems grow, including a huge increase in the number of young patients coming in with mental health problems. "We've seen this tremendous rise in young adults and youth with depression, suicidal thoughts, kids that are experiencing bullying," says Ranney. "It is a huge issue, and it's one that we have insufficient resources to deal with."

In an effort to identify folks at risk and deliver interventions to them, Ranney and her team are working with faculty across Brown and the Division of Biology and Medicine to expand the definition and utility of digital health, particularly for vulnerable populations. "Hopefully," she says, "[I can] change those patterns and help keep those kids or young adults from coming back to the ED or having something worse happen."

Bridging the gap

Ranney's work focuses on expanding points of contact with patients through the use of what we typically consider casual communication tools–social media networks, apps on phones and wearable technology.

"Patients come to me for a few hours of their life," says Ranney. "But it's all the rest of their life that determines their health." The ability to be in touch when patients are facing certain issues, she argues, will allow caregivers to guide people to better health by providing a better understanding of the whole patient. And she believes that technology can help bridge that gap.

Early in her career wearables only existed in labs, but now as they have become more accurate, they are common practice in research. "As we work with computer scientists who have advanced analytics skills, we're able to use the data from wearables in more transformative ways," she says.

Benjamin Pallant MD’22, a student who does research on Ranney's team, adds, "Doctors often see the same thing over and over and try to help one patient at a time. But when you see a pattern, that is something that aligns well with a digital approach. It is able to help many different people with a single format of intervention."

With this in mind, Eric Bai ’16 MD’21, another student working with Ranney, is developing a project called ED smart notifications. "There's so much going on in the ED that it's easy to miss the warning signs of someone who's going to come back very soon or someone who's about to overdose on opioids," says Bai. "Identifying the key determining factors [of a crisis is] a really good use of technology and it helps clinicians identify which patients require additional referrals or supportive services. I think [that] can go a long way toward preventing poor outcomes."

A comprehensive approach to predicting risk

Ranney emphasizes the importance of recognizing when someone is at risk, especially considering the health care crises we are seeing in society today. "When I first started in medicine, there was no opioid epidemic," says Ranney. "We've seen a rise in prescribing, then a rise in overdoses. Now we are seeing a cohesive public health approach to address those issues, and we're working to develop technology-based interventions to help reduce the risk of overdose."

Another key focus area for her work is violence prevention, which includes intimate partner violence, domestic violence, bullying and cyber-bullying, physical fights and gunshots. "We know we can make a difference," says Ranney, "if we intervene at the right time and in the right way."

Ranney's work has shown that just the simple intervention of asking patients how they're doing and replying with targeted text messages helps decrease the frequency of physical fights. "You can decrease all the downstream problems that happen–depression, substance abuse, worse violence in the future," says Ranney. "This is really cutting edge for where I see health care going. We are not going to be able to confine health care in the walls of a hospital or clinic."

Megan Ranney MD, MPH, is an associate professor of emergency medicine, associate professor of health services, policy and practice, and founding director of the Center for Digital Health.