The ‘Matryoshka’ model for framing digital health

Visualize this model for expanding patient outreach efforts – your virtual care strategy inside your digital front door strategy inside your digital strategy.

Photo courtesy: The Museum of Russian Art

Healthcare providers have been experimenting with digital patient engagement strategies for the last decade. Like many technology initiatives in healthcare, however, expansion and adoption has often been slow, siloed and secondary.  

When COVID-19 hit, providers rapidly implemented alternate pathways to care that limited physical interaction to prevent the spread of infection, reserving in-person care for the influx of patients who experience complications from the virus. Almost overnight, patients were interacting with their healthcare providers in a digital-first manner, and the experiences didn’t always align with the consumer-friendly streamlined journeys to which people had grown accustomed in other sectors, such as retail, banking, travel and hospitality.

In addition to driving explosive growth in telehealth and remote care options, the pandemic also catalyzed the “consumerism of healthcare,” which see patients as consumers who have options when shopping for healthcare. This trend is coupled with the “retailization of healthcare” where Walgreens, CVS, Walmart and Amazon are driving further disruption and pressures on traditional healthcare organizations.

With these forces in play, healthcare organizations now are looking to solidify their strategic position in digital health. This goes far beyond improving telehealth platforms and workflows. In many cases, organizations need to architect and execute a virtual enterprise-wide strategy to maintain a competitive posture in an increasingly crowded and mobile market.

Today, digital capabilities supporting a comprehensive and seamless patient experience are paramount to attract and retain consumers, drive loyalty, reduce provider burnout, enable clinicians to practice at the top of their license and maintain continuity of care for patients. Setting and executing a digital technology strategy requires an understanding of patient expectations regarding services and care delivery as well as the interrelationships between various digital technologies in meeting those goals. 

'Nesting doll' model – digital strategy / digital front door / virtual care

In this quickly evolving arena, there has been some blurring of terminology and concepts, including digital health, digital front door and virtual care. These important initiatives are distinct but interrelated.

The Matryoshka (Russian nesting doll) model, first used in the software engineering industry, is a powerful way to bring order to any business challenge.

Digital Strategy:

Using this model, the largest doll represents the overall digital strategy. The overarching vision is framed, and the initiatives and solutions necessary for effective implementation are outlined in a nested, integrated fashion.  

Digital Front Door:

The next “doll” in this framework is the digital front door – encompassing aspects of digital marketing combined with the platforms patients use to digitally access and engage with the health system.

This front door often includes the provider’s web presence, social media accounts, SMS text capabilities, chatbots, patient reminders and other outward-facing technologies and apps. It includes a significant amount of conventional marketing technologies, too, including customer relationship management platforms, which are commonplace at business-to-consumer organizations.

For healthcare providers, the goal is to enable frictionless access and outreach to attract and retain patients and build brand loyalty. 

Virtual Care:

Inside this paradigm, the third doll is virtual care, which encompasses digital interactions between patients and providers throughout the care lifecycle. It includes a patient portal, synchronous video and telephone visits, asynchronous engagements and remote patient monitoring.

The focus of virtual care is to facilitate convenient, appropriate care and efficient clinical workflows. This helps foster customer loyalty because, let’s face it, people like the convenience of telehealth.

Supporting the overall digital experience are technologies that enable boundaryless healthcare experiences beyond front-end interactions. These include personal health records management, illness exposure tracking tools, referral management support and more. 

Technology is the easy part

Digital healthcare strategy is deeper than the various enabling technologies. Organizational strategy, culture and operational models all will inform a provider’s digital footprint.

Organizational strategy:

As example, an organization may strategically decide to focus on the digital front door instead of virtual care given market demographics, competitive positioning or a host of other factors. This direction will inform their marketing and technology investments – and potentially their market foothold.

Operational models & stakeholder involvement:

Within a given strategy, there are key differences in the decision-makers and stakeholders. For example, a virtual care and telehealth solution can only be effectively implemented with input from key clinical and IT leadership.

A digital front door initiative, on the other hand, is much broader. It requires participation not only by clinical and IT leaders, but also by a health system’s web and marketing teams. An effective digital front door experience must be the product of an enterprise-wide collaboration.


COVID-19 accelerated digital consumer sentiments that were taking root before the pandemic. The growing desire for patients to have online experiences with their healthcare providers that mirror their convenient, easy interactions in other industries has made a provider’s “web-side manner” almost as important as its bedside manner counterpart.


Delivering an optimal digital experience demands a comprehensive and interconnected digital strategy that streamlines access and care, delivering inviting and convenient options for patients to engage with their healthcare providers.

About the authors

Laura Kreofsky is vice president of strategy for Pivot Point Consulting

Nick Loftin heads up Pivot Point’s virtual care practice 

Pivot Point Consulting is a health IT consulting firm and works with provider organizations and technology firms nationwide to help craft and execute successful digital strategy, patient experience and virtual care initiatives.

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