Essential engineering skills in Digital Health

Digital Health represents the fast-growing industry at the intersection of healthcare and technology. From the hospital to the home, from the outdoors to the gym, it is becoming an increasingly important part of our lives.

For engineers, it represents an area of enormous opportunity, but can hide many challenges. What follows is an outline of the key skills and competencies that an engineer must possess to thrive in digital health.

Design

• Designing websites, apps and interfaces for digital health is particularly difficult. One of the key challenges is related to the different target demographics. In particular, while most digital design patterns, templates and themes cater to the younger generation, many healthcare-related technologies are built with the somewhat older user in mind. Therefore, the designer of a digital health service should be ready to investigate deeper into the services’ target audience and identify the best way to produce a modern yet comfortable design and interaction. For instance, a web application for heart conditions can be very different to one for exercise and fitness.
• It is applies to most services, especially healthcare: we are not our own customers. The User Interface/User eXperience (UI/UX) of a digital health service must be able to adapt to the user journey, based on the particular interaction and value proposition. Some healthcare services start with the symptoms, and evolve into diagnosis and treatment. Others focus on chronic conditions whose treatment (and, thus, online interaction) is much longer and includes many milestones. For example, consider the differences of a service to aid people suffering from depression, and compare it to one supporting epilepsy patients.
• Have you ever come across a site that doesn’t seem trustworthy? Unless you are a designer, you may not be able to identify the reasons you feel this way. However, in healthcare, reliability and credibility are of utmost importance. The designer must be well-versed in the elements that can convey these qualities, including colors, fonts, images, animation etc. A platform for cancer patients needs to build much more trust and project more authority, compared to most running companion applications, for instance.
• Given the increasing uptake of mobile browsing, it goes without saying that any website out there must be responsive. However, the limitations of mobile devices must be acknowledged, and the designer should carefully apply the usability best practices to the specific needs of the website’s users. Consider, for example, how difficult it is for most users beyond a certain age to stay focused on a small mobile screen and tap — particularly if the website provides rich media or complicated medical terminology. And keep in mind that not all of your users have the latest iPhone!

Front-end Development

• Web developers who have worked on medical websites have grown accustomed to rigid structures for each webpage, especially if it includes forms for medical data entry. While this is no longer entirely true, input and interaction are still very important in the digital health realm; some people regard entering their credit card details less stressful than medical data. It is important for the web developer to work closely with the medical expert on the team in order to help users cut through the long names and repetitive input. Haven’t you wondered why your hospital needs your medical history every single time? Let’s fix that.
• Browsing speed is of the essence when one is concerned about their health or diagnosis, and it is an opportunity for a developer to shine. Use every tool in your arsenal to make the experience as quick and smooth as possible. For instance, large, high-resolution images are common in healthcare and medical practice (and can be multiple MBs in size); allow the uploading of a pathology report to be done in the background; use modern frameworks that reduce page reloads, etc.
• Put your hand up if you like old, outdated browsers. Yep, nobody does — except the IT departments of large corporations and organizations (including hospitals, medical offices, insurance companies, etc), and those middle-aged people who have a desktop computer and change their mouse pointer daily, for fun. Well, guess what, they are your users and your customers, and they come first. An experienced front-end developer will work with the rest of the team to enable cross-browser compatibility, optimize the interaction across browsers, and balance the bleeding-edge with what the user wants.
• It should be a given, but building secure websites and applications is still a challenge. Security and confidentiality of medical data is of paramount importance and all user inputs must be properly validated and tested with all the corresponding injection scenarios. Equally important is for the developer to stay on top of the latest breaches and lead the effort to keep the front-end secure, and the users confident.

Yes, sometimes an algorithm is necessary to diagnose obesity

Back-end Development

• Behind the scenes of a great digital health solution is a set of well-engineered back-end components. The developer should be familiar with the established ways that can enable rapid evolution of this otherwise rigid infrastructure. The back-end developer who is experienced in design patterns, modern frameworks, modularity and extensibility will excel — and help build a service that can adapt much faster than the monolithic healthcare systems of our times.
• The spectrum of digital health solutions is very broad — but can raise substantial challenges if the back-end is not engineered properly. For example, imagine a service initially built for multiple sclerosis patients to coordinate with their caregivers; after increased adoption and broader interest, the company behind the service decides to offer it to diabetes patients as well. If the back-end developer has built the components in a modular, abstract way, most of the logic and data elements will be reusable without much modification.
• No solution is an “island”: integration with third-party services is quite common among mature digital health services. If you are a developer experienced in synchronous and asynchronous API calls, callbacks, message queues, deadlock prevention and so on, you will help the platform scale well and offer great benefits to its users.
• Clearly, intimate knowledge of databases is a must for any back-end developer. For a digital health solution, it is important to understand the depth of data that may need to be collected: clinical and medical data is notoriously complicated, with rigid structures and important standards. Furthermore, and depending on the desired user interaction and experience, the database design must balance the principles of normalization with the speed of operations as well as the desired expandability of the solution.

Architecture

• In healthcare, the privacy, security and anonymity of data is everyone’s job. But the burden falls on the Architect’s shoulders to ensure that the ever-increasing data collection requirements of the business observes the most stringent data protection measures available. Regardless of the company’s size, regardless of the job title, the overall architecture must respect the users’ wishes, and the law. Some software architects feel uncomfortable having to follow such complicated and often unclear guidance, but for digital health this is an essential skill.
• Current trends and economics point to a cloud-based, tiered architecture. This is not rocket science; it is essential for the architecture lead to be familiar with the intricate details of IaaS, PaaS, SaaS, etc., and what they mean for the software, the company and its users and clients.
• Architectures can be notoriously complicated, or swift and simple. No user really cares, as long as they are extensible and can cater to today’s needs as well as future evolution. This is why having a flexible architecture following solid principles is important for the long term prospects of a digital health company. Furthermore, it is always important to keep data and devices in mind when constructing and updating the architectural blueprint.
• “Open data”: if you have not heard about it, fear not — it is the industry’s way of saying “we need to ensure interoperability and flexibility of data sharing for healthcare”. In practice, this means that the 20th century way of hiding data and metadata is no longer viable. And digital health technologists must lead the way in sharing and leveraging data for the benefit of their users and clients.

Credit: Mike Lee

Hardware engineering

• Wearables and other devices are fast becoming the latest trend in digital health. Most of them are actually related to fitness (i.e. not necessarily health) but that does not diminish their value. In terms of fitness, and if we accept that very little “fitness” comes with stationary life, the key word is “accelerometer”. Starting with custom devices, and early smartphones, this set of capabilities allows devices to detect movement to a decent approximation. And it is an important skill for a hardware engineer in digital health!
• Imagine a medical device that you wear on your wrist, which reads an array of values from your skin, the environment, anywhere. This is where sampling techniques become very important. Their failure (?) has been widely publicized. And failing to get this right is like building a website that does not load.
• Would you want to wear a fantastic medical device on your wrist, if it weighed half a kilo? Didn’t think so. A lot of progress has been made to bring down the weight of these devices, and knowing how to do this without diminishing the value and accuracy is certainly a very advantageous skill.
• Would you buy a watch with a battery that lasts 18 hours? Perhaps. A lot of innovation these days comes in the form of reducing power drain and thus increasing battery life. If you can do that with smaller, lighter batteries, more power to you (excuse the pun)!

Credit: Intel Free Press

Mobile apps

• Mobile apps represent the bulk of consumer digital health solutions nowadays. Designing a mobile app can be quite straightforward, but doing it right is as complicated as ever. As with any mobile app, getting the visuals and notifications right are essential. For bonus points in digital health applications, one needs to focus on engagement and interaction, which must respect that the usage patterns in healthcare applications are very different from the entertainment or communications apps.
• Take it easy with integrations & notifications: some people may want to be notified when they have had too much cake, but the challenging thing about health is that we only pay real attention to it when we are sick. And when you’re sick you want solutions — not to link your Twitter account with your blood pressure monitor. An engineer who is empathetic and can relate with the target audience is a rare breed here.
• Borrowing done right is a talent. When the most trendy app starts featuring swiping left and right to indicate preferences, for instance, chances are that the shift will affect most applications. However, engineers should not lose sight of the customers’ journey, and their particular, healthcare-related needs.
• If you’ve worked on an app before, you know the #1 problem: Discoverability. This is where the intersection of product management, marketing, design, engineering, and growth hacking shines. Being an engineer, you can do all of these simultaneously J. To get your app discovered, downloaded and used, the focal point must, once again, be the “customer’s journey”. For instance, getting a prescription prepared through a previously unknown app for the first time is probably not the best idea when you’re already sick. The good thing is that your customers’ pain may be so clear that you could just ask for their preferences. Of course, this may a bit too much to ask from engineers — but think about the benefits of co-designing your apps with your customers.

If you found that these are skills you already possess, then you may be ready for a career in the promising field of digital health.

And, regardless, don’t miss the opportunity to enter the Found.ation Tech Talent Pool and increase your chances of landing that dream job!