(Toronto, April 15, 2026) JMIR Publications today released a compelling new analysis in its News and Perspectives section exploring the implementation gap that prevents digital mental health tools from reaching the masses. In the report, JMIR Correspondent Trevor van Mierlo synthesizes critical themes from the San José State University Health TechQuity conference, arguing that while the industry has mastered the creation of evidence-based tools, it has failed to build the infrastructure necessary to deliver them at a population scale.
The article, " From Innovation to Infrastructure: Why Digital Behavioral Health Still Struggles to Scale ,” highlights a striking tension: despite a decade of rapid innovation in digital therapeutics and AI-enabled systems, waitlists for behavioral health care remain at record highs. The author notes that digital behavioral health’s central challenge is no longer a lack of effective tools, but a fundamental failure in Knowledge Translation, the process of moving evidence-based interventions from research settings into real-world use.
The analysis suggests that meaningful progress in digital health requires the alignment of three interdependent layers:
Innovation: The development of new tools.
Evidence: The validation of those tools through research.
Infrastructure: The systems required to deliver those tools at scale.
While the field has excelled in the first two categories, the report argues that Infrastructure remains underdeveloped. Without systems capable of onboarding and integrating tools into existing health care workflows, even the most effective apps and AI systems remain confined to research studies or limited pilot programs.
A core theme of the report is that infrastructure is the primary mechanism for health equity. Ankolekar points out that when validated interventions exist but are not delivered at scale, access becomes concentrated among those already served by well-resourced institutions. To achieve true "TechQuity," the focus must shift from individual tool efficacy to population-level effects.
The report calls for a new era of coordination between technology developers, risk-averse health care systems, and funding models. By aligning these disparate logics, the industry can move beyond individual pilot success toward a future where digital health tools are a standard, accessible component of the public health infrastructure.
Please cite as:
van Mierlo T. From Innovation to Infrastructure: Why Digital Behavioral Health Still Struggles to Scale. J Med Internet Res 2026;28:e97118
URL: https://www.jmir.org/2026/1/e97118
DOI: 10.2196/97118
About JMIR Publications News and Perspectives
JMIR Publications is a leading open access publisher of digital health research. The News and Perspectives section is the newest addition to its portfolio, established to bring the rigor and integrity of academic publishing to scientific journalism. The section features well-researched, expert-driven content from the Scientific News Editor, Kayleigh-Ann Clegg, PhD, and a network of specialist JMIR Publications Correspondents to keep the digital health community informed, inspired, and ahead of the curve.
About JMIR Publications
JMIR Publications is a leading open access publisher of digital health research and a champion of open science. With a focus on author advocacy and research amplification, JMIR Publications partners with researchers to advance their careers and maximize the impact of their work. As a technology organization with publishing at its core, we provide innovative tools and resources that go beyond traditional publishing, supporting researchers at every step of the dissemination process. Our portfolio features a range of peer-reviewed journals, including the renowned Journal of Medical Internet Research.
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Journal of Medical Internet Research
Commentary/editorial
People
From Innovation to Infrastructure: Why Digital Behavioral Health Still Struggles to Scale
13-Apr-2026
The author is the founder and a scientific architect of the Evolution Health platform and consults on academic and commercial digital mental health initiatives. The views expressed in this article are those of the author.