Digital health continues to redefine the way that patients and clinicians interact with the health care system and each other. With each passing day, there is another app, wearable or mobile device brought into the market. Given the high prevalence and economic burden, cardiovascular diseases are a popular target for many of these new digital tools. However, the majority of tools are marketed directly to consumers with limited or no data regarding their stated benefits or possible harms. This lack of data has led to a critical need for cardiologists to design and perform clinical trials with adequate scientific rigor to fill the growing data void at the intersection of digital health and cardiology.

One academic cardiologist who has heeded this call with full force is Sanjeev Bhavnani, MD, an academic cardiologist and physician-scientist in health care innovation at Scripps Clinic and Research Foundation in La Jolla, CA. Bhavnani agreed to sit down for an interview to tell us about his career and provide guidance for FITs with an academic interest in digital health.

1. Tell us briefly about your work and training background, and how it led you towards an academic career in technology and digital health research?
   
   Presently, I am a faculty member within the division of cardiology and a physician-investigator at Scripps Clinic. On the clinical side, my focus is general cardiology, heart failure, coronary care unit and imaging. On the academic side, I lead a team designing clinical trials and patient care programs with new health care innovations including mobile technologies, digital health and big data. Looking back, it is surprising how various experiences came together that led me to this type of work. As a medical student, I collaborated on a startup to create an implantable heart attack sensor. It was exciting at that phase of training to see from the ground up all the various technical, clinical and funding requirements for a new idea. Residency and fellowship were different, but I was fortunate to have great mentor that exposed me to trial design and registry development. We were focused on quality reporting with implantable devices. Prior to my current role, I was a "Wireless Health Scholar" at our research center where I was involved in the development of new digital health clinical trial methodologies.
   
   
2. What do you consider to be a few of the largest areas of clinical investigation over the next five years?
   
   In relation to scientific investigation, the area that we will see the most rapid growth is new data applications in health care. These applications include artificial intelligence, machine learning and natural language processing, and their approaches to achieve personalized medicine. We have already seen promising examples in radiology, ophthalmology and echocardiography. In five years, other exciting areas will be nanosensor and implantable technologies for physiologic monitoring and drug delivery. Although these areas are in their infancy, current academic-clinical-industry partnerships and the cross-translation of experiences from other fields into health care will result in a new paradigm for risk prediction, automation and ultimately for how we deliver patient care. For these pursuits to be effective, it will require strong clinical input from a variety of health care practitioners and patients especially. The latter of which is an exciting innovation within itself.
   
   
3. Much of the digital health focus is on how it can improve the way we practice and interact with our patients. What has been your experience with translating the results of your academic work into clinical practice?
   
   This question is the ultimate objective of digital health. If we ask, "How does data generated at home get into EMRs and for clinical decision support?" we can see how challenging it is and how many steps are required to achieve this type of integration. A focal point of our innovation laboratory is to begin answering this question and figuring out how digital health is used at the bedside and for remote patient monitoring.
   
   Translating results from research studies has required us to apply clinical informatics approaches, interoperability standards and create new clinical workflows. Each of these has been a learning experience and required us to work with multidisciplinary teams and those with expertise in health IT, data science, billing and coding, and technology transfer, and to forge partnerships with new technology developers. By designing trials and gaining ideas on how new technologies are used by study participants, patient data is generated and outcomes are measured. This has been integral as we look to design new technology-enabled programs for clinical practice.
   
   
4. Public Health Service grant funding, including the National Institutes of Health (NIH), is becoming more challenging to obtain. What has you been your strategy for getting work funded in a particularly new field in cardiology?
   
   The good news is that innovation with digital health is exciting for many – including a variety of funders. As ideas are generated, we have applied to funding agencies such as the NIH and other public sources but have had to look to other investigator-initiated grants with industry, foundations and philanthropic sources. Primary sources of funding must also be your division and health care organization. A different approach, but one that has been impactful, has been crowdfunding. We have learned that it is one thing to come up with a new idea but a different thing when trying to convey that information to the public. The lessons learned with how to communicate ideas have been valuable as research proposals or patient-care programs come together. We have also looked to a wide variety of funding sources for "startup" funds that get ideas off the ground, which becomes important before applying for career awards or multi-year grant submissions. It takes just one idea to get going.
   
   
5. What would be your top advice for FITs who are interested in pursuing an academic career in technology and digital health research?
   
   Get out there! Collaborate, partner and share what you are trying to achieve. The requirements I have with FITs and trainees that work with our group are to attend conferences, participate in think tank meetings and get to know activities in your local area. Getting involved will lead to collaborations that you may not have expected. It will also give you perspectives about what is on the horizon and how to keep up-to-date. As you come up with new ideas, create a "design criteria" and the steps you had to fulfill. It will be helpful as ideas grow in sophistication and will allow you to determine skill sets that you need to acquire. The skill I needed to acquire was informatics, so getting trained and board certified has been instrumental. My top advice is to reach out to the ACC and members that you may be interested in working with. I have had the privilege to work with several members on ACC's Innovation Group – John S. Rumsfeld, MD, PhD, FACC; Partho P. Sengupta, MD, FACC; Harlan N. Krumholz, MD, FACC; and many others – who have provided opportunities to collaborate and helped guide the development of new ideas. Working with like-minded people and those that are willing to contribute to your development will lead to a successful and enjoyable career as a digital health clinical investigator.

This article was authored by Arash Harzand, MD, MBA, Fellow in Training (FIT) at Emory University in Atlanta, GA.