There is an old architectural parable concerning the construction of a university campus. When four modern towers were completed around a central square, the university rector was astonished to find the courtyard left as an unpaved expanse of lawn. When he demanded to know why the pathways had not been laid, the architect replied:

“The work is finished for now. In twelve months, let us look down from the top floor. The students will have walked across the grass, carving trample paths between the buildings. Where they have walked, we will lay our tarmac.”

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Modern medicine is obsessed with the existential; digital software is concerned with the relational. The collision of these two worldviews explains why digital health has produced so many press releases and so little actual transformation.

In healthcare regulatory parlance, an intervention is deemed relevant only if it demonstrates an existential impact: clinical trial evidence showing a statistically significant mitigation of a specific disease marker or mortality rate. This standard was forged in the era of synthetic molecules and titanium hip implants, where a device or drug acts directly upon the human organism.

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