Digital health: vantage points and the silent rise of the empowered patient
Technological change often causes temporal institutional instability in many industries or fields, because it challenges existing roles and rules of the game. Digital technologies fostered even the creation of entirely new markets (i.e. digital commerce or online advertising). Digital Health emerges as an interstice between multiple fields and therefore it brings together multiple stakeholders, with competing expectations, demands, values and rules of the game. Building upon the theory of strategic fields and insights from the institutional logics perspective, I attempt to reveal the emerging process of the Digital Health field. The research questions of this qualitative study are 1) what are the adjacent fields and the pre-existing conditions which led to the formation of Digital Health; and 2) what are the incumbent and challenger logics and who are their representative stakeholders. Additionally, based on its empirical findings, this research has the goal to validate or challenge several theoretical assumptions about field emergence.
I used an inductive case study design at the field level of analysis. Inductive case studies are qualitative approaches suitable for investigating new or poorly understood phenomena (see Stanford’s Kathleen Eisenhardt[i]’s work on inductive case studies). Data was collected between 2011 and 2014 and it goes back to 1999, although I focus on data from 2007 onwards. The launch of the first smart phone (2007) marked the proliferation of mobile and sensing consumer technologies, and renewed the interest in digitizing health. Data sources spanned over several countries (manly USA and several European countries). These sources were: industry conferences or events, commercial or public organization websites, webinars, public interviews, presentations, blogs, industry reports and regulatory documents. Data was identified through a snowball effect[ii], guided by the researcher’s interactions with the industry and materials available. This methods of collecting data may be perceived as opportunistic, but it offers the advantage of allowing the emergence of themes and “unique case features”.[iii] Data was first organized historically, to allow for longitudinal analysis. Then, as themes (fields, stakeholders and logics) emerged, data was tagged accordingly. This process was validated by constantly referring to extant theories, consultations with other researchers and re-examination of data.
This is an ongoing research, and therefore findings are preliminary. 1) Digital Health emerges at the confluence of three fields: healthcare, consumer digital technologies and medical devices. The preconditions of change have been indentified for each field (i.e. for the consumer digital technology field: the unfinished character of the digital products, the democratization of digital technology and the rise of platform economics). 2) Stakeholders have been identified based on their field level interactions. They are healthcare professionals, healthcare managers, patients, carers, wellness aware people, state, insurers, investors, Digital Health technology producers, integrators, distributors, telecommunications providers, pharmacological companies, research institutions and consultancy companies. The incumbent logic is the medical profession logic, whilst the challenger is the citizen logic. I present the stakeholders and how they gravitate around one of the main logics, or how they combine or elude them.
The additional goal of this research was to consider the empirical findings against existing theoretical assumptions about field emergence. This research shows how new rules of the game (institutional arrangements) may be caused by changes in delivery channels and re-evaluation of ownership (herein, ownership over the medical act and its outputs: data, diagnostic and treatment).
Although this research is ongoing, it offers a broad picture of the Digital Health field. Theoretically, this study contributes to an underdeveloped stream of research in organizational studies, the emergence of new fields. The analysis reveals the adjacent fields, the preconditions for the Digital Health’s emergence, the two main competing logics at play, and finally the stakeholders and their reactions to technological change. The rise of the citizen logic, as opposed to the medical profession logic, points towards the re-evaluation of laypeople’s role in healthcare by proposing a new, “empowered patient”. At a practical level, this study may allow stakeholders to better envision themselves in relation to others, and therefore it has the potential to inform business decisions or regulations.
[i] Eisenhardt, K. M. (1989). Building Theories From Case Study Research. The Academy of Management Review, 14 (4), 532-550. Additionally, Eisenhardt, K. M., Graebner, M. E. (2007). Theory Building from Cases: Opportunities and Challenges. Academy of Management Journal, 50 (1), 25–32.
[ii] See above, and additionally Gawer, A., & Phillips, N. (2013). Institutional Work as Logics Shift: The Case of Intel’s Transformation to Platform Leader. Organization Studies, 34(8), 1035–1071.
[iii] Eisenhardt, K. M., Graebner, M. E. (2007). Theory Building from Cases: Opportunities and Challenges. Academy of Management Journal, 50 (1), 25–32.