"How to Save a Life": A Premortem for Pediatric Digital Health

Digital health tools (e.g., apps, text messaging, telehealth, and social media) have been employed with pediatric populations for approximately two decades. As such, digital health is a scientifically mature field, ready for critical evaluation of the challenges and opportunities of using technology to equitably improve child health and health care. This commentary describes the application of a premortem exercise to forecast failures (i.e., "causes of death") of pediatric digital health and strategies to prevent them.

With a convenience sample of trainees and early-, mid-, and later-career pediatric psychology professionals interested in digital health (n = 14), we conducted a one-time, premortem exercise (i.e., a collaborative discussion to envision a failure and work backward) to brainstorm potential threats and opportunities for advancing pediatric digital health.

We came to consensus on five core themes related to digital health threats and opportunities: (a) We became stuck in proving efficacy and did not make an impact; (b) We assumed we knew more than youth and their families; (c) We replicated, exacerbated, or created new disparities compared to in-person care; (d) We underestimated the importance of a human touch; and (e) We did not know how to advocate for digital health as a clinical transformation.

This commentary serves as a discussion point for identifying the strategic priorities of today (e.g., designing tools collaboratively with youth, planning for clinical implementation from inception) that can advance the development and impact of digital health tools and services for pediatric populations.