Dr. Charlotte Lee, U.K. Director of digital mental health company Big Health, started her professional life as a ballerina. For a time she even danced with the Royal Ballet in London. But when it came time to decide if she was going to pursue the route of prima ballerina, she decided that the path didn’t allow her to explore her scientific side, so she opted for medical school. 

“I hoped that being a doctor would allow me to do both the art and the science of treating patients. I wanted to see people as a whole rather than a constellation of organs that have things wrong with them,” she told MobiHealthNews. 

In medical school she quickly began to hone in her innovation interests – looking for opportunities to come up with tech savvy solutions to hospital problems.

“While I was going through medical school I felt that 'practiced medicine' was still in the phase of butterfly counting: These are the known knowns. This is the process to manage a condition. I wasn’t being taught how to innovate or improve patient care, which was the innovation element that I felt was lacking.”

When she was a junior doctor she began to explore the world of digital health, first founding a startup with a fellow doctor, and then taking part in the Darzi Fellow program, a U.K.-based initiative that allows healthcare professionals to dive into the innovation industry. While her first startup came to a halt after her cofounder relocated, Lee’s interest in digital health did not stop. 

She did a stint in consulting, aiming to better understand the clinical space from a procedural standpoint, but after two years left to start a digital health accelerator. 

“I realized that digitization of healthcare was an inevitability and I wanted to get in front of the wave, rather than be carried by it,” Lee said. “Throughout my years in medicine and consulting I was always trying to find my niche. Whilst the work was always interesting I never felt satisfied with doing just medicine or consulting. I wanted to build services that treated millions of people, innovate and solve complex problems within healthcare systems, work cross-functionally, and bring concepts to life. I've found my niche now in digital health.”

But even when working with the digital health companies in her accelerator, something didn’t feel quite right. She said she didn’t feel she was seeing innovation that was going to fundamentally change healthcare. 

“Big Health came along and I realized they were taking healthcare delivery into a new phase – where you actually had fully automated treatment,” Lee said. 

In particular, Lee said she was excited by the research and validation efforts that Big Health was working on. 

After starting at Big Health she quickly rose up the ladder and was named the U.K. director of the company. This not only launched her into a leadership position, but also into the world of digital therapeutics. 

Over the last few years she has seen the world of digital therapeutics rise, and has learned about some of the challenges posed in the space, including the notoriously difficult reimbursement strategy. 

“The digital therapeutics road map is the polar opposite of bringing a pharmaceutical to market. In the latter, there is a really clear reimbursement pathway that lays out the requirements for generating clinical research and evidence for value, with an established pedigree of companies that have done it many times before with healthcare systems. The challenge for pharmaceuticals is in scalable distribution. It’s the opposite for digital therapeutics, where there is very little clarity around the reimbursement strategy, but, due to its digital nature, [it] is extremely scalable. For example, we've been able to actively manage population rollouts covering almost six million people with a four-person team.”

However, she sees the space having potential in the future. In particular, she sees a space for patients to be able to seek out their own evidenced-based treatments. Today’s healthcare model isn’t sustainable, she said, due to the lack of manpower. But, she said, in Big Health’s research, it found that patients who self-refer have remission and engagement rates similar to those who have a referral through a doctor. 

As the conversation around health equity continues, so does the conversation around digital tools and equity. 

“I think there's also potential for digital therapeutics to meet the needs of deprived or marginalized communities,” she said. “The current accepted paradigm within healthcare is reliant on having a clinician in the room. We know the NHS could be doing a lot more around access for hard-to-reach communities. But when you have an army of clinicians that are educated in a particular way, and come from a particular background, it's no wonder that those accessing services are from dominant cultural groups. 

"Lots of work is being done in this area, but I think we're missing a trick if we don't consider digital therapeutics. Online programs can be destigmatized and highly accessible, available in different languages, and easily shareable, which means you can get over some of those barriers to access."

However, there are always two sides to every coin, and these disparities can also be exposed unless the right thought is given to implementation. 

“Digital health can increase those disparities. In a broad sense, many of these products have been built for people who have a reliable internet connection, or have a sophisticated device which can handle complex graphics. It automatically pushes out anyone who may be less confident with a device, or has fewer resources to spend on digital infrastructure. I think this is where partnerships with local communities and charities are actually really important. A solution could be really simple, for example, using the local library WiFi connection and computers. Our industry needs to work harder around translating digital therapy into something that is accessible to everyone.”