Rethinking Digital Self-Care: From User Burden to System Leverage

The digital health industry is rapidly developing new self-care apps and tools, but many digital self-care solutions add complexity, increase inequity or fail to scale. Patients need smarter, integrated care rather than just more dashboards. The study redefines digital self-care as a strategic infrastructure challenge rather than merely a tech opportunity. It offers a framework to shift from user burden to systemic leverage, emphasising empathy, governance, value-based healthcare and interoperability.

Key Points

• Digital self-care must integrate into real-world care systems to deliver sustainable impact.
• Value, equity and integration are essential pillars of effective digital health solutions.
• Co-design with users ensures tools are trustworthy, usable and culturally appropriate.
• Interoperability using standards like HL7 FHIR is key to scalability and continuity of care.
• Funding models should reward outcomes, not app usage or service volume.

From Tools to Ecosystems

Digital self-care is too often introduced as a single-purpose app—counting steps, measuring sleep or offering mental health prompts. While technically sound, these tools often lack integration with care delivery systems. They don’t exchange data with electronic health records (EHRs), don’t align with reimbursement and don’t scale beyond individual curiosity.

What is the result of the current situation? Digital fatigue, silos of unstructured data and disillusioned users. What we need is not another isolated point solution, but embedded tools that support the entire care pathway—from prevention to recovery and from lifestyle to diagnostics. Ecosystem thinking is not a luxury; it’s a necessity.

Strategic Anchors: Value, Equity, Integration

A truly sustainable digital self-care model rests on three strategic anchors:

• Value: This refers to outcomes that are important to patients, measured against the cost of providing care, in accordance with value-based healthcare principles. The question we need to ask ourselves is: “Does the tool contribute to better decision-making, reduce unnecessary visits or improve the quality of life?”
• Equity: The design of digital tools should be inclusive, ensuring they are accessible to populations with limited digital literacy or access, rather than only serving those who are already connected.
• Integration: Digital self-care must function inside real-world workflows—clinical, financial and operational—and connect to shared data standards, such as HL7 FHIR (Fast Healthcare Interoperability Resources).

These pillars are interdependent: without value, there’s no justification; without equity, there’s no legitimacy; without integration, there’s no sustainability.

From Innovation to Integration: Why Strategy Matters

In boardrooms and ministries alike, there's growing pressure to “go digital.” However, without a clear strategy, even the most promising innovation becomes an orphaned tool.

Successful digital self-care solutions are not defined by flashy design or AI hype, but by their ability to embed in national health priorities. Whether it's reducing emergency department visits, enabling remote triage or supporting self-monitoring of chronic conditions, each solution must fit a broader ecosystem. Integration is not an afterthought—it’s the foundation.

Investors, too, are shifting focus from user acquisition metrics to real-world health impact. A scalable model requires alignment with procurement policies, clinical guidelines and long-term financing structures.

The User as Stakeholder, Not Receiver

Digital tools often fail because they treat the user as a passive recipient, not an active co-creator. Scandinavian studies (Berg et al. 2017) have long warned of the disconnect between technology design and the realities of front-line care.

Instead, co-design must be a foundational principle. This means:

• Involving patients, caregivers and clinicians early in the design process.
• Testing assumptions with ethnographic research and qualitative feedback.
• Adapting content for language clarity, cultural nuance and low-literacy populations.

It is not the tool's technical sophistication that drives its adoption, but rather its trustworthiness, usability and user agency.

Embedding Strategic Insight into Digital Self-Care

As the Chair of the AI in Cardiology working group and a long-time advisor to healthcare boards, investors and ministries, I have witnessed both the promise and pitfalls of digital interventions in healthcare. Digital self-care, in particular, holds immense potential, but only when it is developed and governed as an integral part of the healthcare infrastructure, rather than as an isolated product. From early detection in heart failure to the use of digital triage tools in primary care, success is not solely dependent on innovation; it requires effective integration as well.

Key performance indicators (KPIs), developed through collaborative efforts across national health systems, are essential for evaluating the efficacy and equity of digital self-care initiatives. These indicators include metrics such as user satisfaction, dropout rates, adaptation to digital literacy and alignment with care delivery standards. Global networks like ISfTeH emphasise the importance of these metrics to ensure that digital health tools provide measurable value for patients as well as for healthcare systems.

Measuring What Matters: Input and Impact Indicators

Evaluation of digital self-care must consider both immediate user interaction metrics (input measures) and broader system-level performance indicators (strategic KPIs). This dual lens ensures tools are not only used but also useful and aligned with value-based goals.

Input Measures That Matter

These are real-time, experience-level metrics that offer insights into user behaviour, engagement and tool performance within context (see Table 1).

Strategic KPI Framework

Key performance indicators (KPIs) should align with overarching system goals, including safety, equity and measurable value. These KPIs ensure accountability for implementing digital self-care initiatives and guide investment decisions (see Table 2). Strategic KPIs link user-level impacts to long-term transformations within the system.

Interoperability and Infrastructure: Why FHIR Matters

Interoperability is not a technical luxury—it’s what makes scale possible. HL7 FHIR is the global standard that enables applications, platforms and providers to exchange health data securely and consistently.

A digital self-care tool lacking FHIR compatibility becomes isolated. In contrast, one that incorporates FHIR can:

• feed real-time dashboards for clinicians;
• participate in public health surveillance;
• ensure continuity of care across providers.

Interoperability remains a fundamental requirement in healthcare. Tools built on open standards such as HL7 FHIR facilitate connectivity with electronic health records and national health infrastructures, promoting scalability, sustainability and safety. Countries that have adopted FHIR as part of their national eHealth architecture, such as Estonia and Singapore, are significantly ahead in developing reliable digital services. They demonstrate improved continuity of care and reduced duplication of services. These insights form the foundation of my advisory work, where interoperability, governance and patient-centred care come together.

Governance, Trust and Value-Based Alignment

The work of Michael Porter and Robert Kaplan on value-based healthcare offers a powerful lens for rethinking how we fund and scale digital self-care. In their seminal Harvard Business Review article “How to Pay for Health Care,” they argue that payment models must be directly tied to outcomes that matter to patients, not to the volume of services delivered.

“You can’t improve health by paying for services—you improve health by paying for outcomes.” Porter & Kaplan, Harvard Business Review

This concept is particularly relevant in the digital self-care domain, where success cannot be measured by downloads or time spent in an app, but by improved well-being, avoided complications and reduced system strain.

Porter and Kaplan propose bundled payments that cover the full cycle of care, rewarding providers for prevention and sustained outcomes. Digital self-care fits naturally into this framework. When a chatbot prevents a clinic visit or a remote-monitoring tool flags early deterioration, that digital intervention deserves recognition and funding. However, this only works when governance, reimbursement and infrastructure align.

Bundled payments reward continuity, prevention and impact—not volume. That’s where digital self-care belongs.

If digital self-care is to become a foundation of future health systems, it must be governed accordingly.

Governance is about more than cybersecurity—it’s about establishing legitimacy and accountability. This includes:

• Clear compliance with GDPR, national health laws and the EU AI Act.
• Transparent policies on data ownership and consent.
• Alignment with value-based purchasing: no outcome, no payment.

Trust is not just a user sentiment—it’s a system requirement.

From Pilot to Practice: Strategic Recommendations

Here are some recommendations to move a digital health pilot beyond experimentation:

• Governance first: Treat regulation as an enabler, not a constraint.
• Co-create with users: Build solutions with those they’re meant to serve.
• Tie funding to outcomes: Align budgets with measurable system gains.
• Design for equity: Make inclusion and accessibility design imperatives.
• Use common standards: Require FHIR for every scalable solution.
• Embed in national policy: Elevate digital self-care from pilot to infrastructure.

Ultimately, digital self-care should empower users without burdening them with poorly integrated technology. It should facilitate individuals through ethically designed, system-supported, and value-aligned pathways. My work at the intersection of AI, cardiology, and global health strategy aims to champion this vision.

Conclusion: From Buzzword to Building Block

Digital self-care has the potential to alleviate system pressure, increase access and empower patients. However, potential alone does not equate to impact.

To close the gap, we must reframe digital self-care not as a wellness product but as an integral part of health system infrastructure. That means focusing on regulation, reimbursement and interoperability. It requires finding a shared language, establishing common goals and using shared data.

For health leaders, the mandate is clear: transition from applications to architecture, from hype to health equity and from digital noise to systemic change.