Digital Apps in Healthcare

A specialist insight

We use our mobile phones for a wide range of things; everything from booking hotels, trains, holidays, to online banking and Friday night pizza.

Increasingly, we are using our phones or wanting to use our phones, for health care.

Many people already have fit bits and similar devices or apps that measure the number of steps taken in a day or track weight gain and loss.

Whether at home, at work or on the move, we want to access things digitally because it’s easy. But of course, Healthcare is so often not.

There are apps already out there to access your personal health record, although mostly only enable access to GP records at present and only where those records have been made available by the GPs – companies such as Evergreen or Patient Access provide apps to deal with this.

There are apps to order repeat prescriptions and get them delivered to your home, such as Echo. In fact, most of the GP system vendors offer patient access to records, appointments and prescriptions, if this has been allowed by your local surgery.

With young and old using digital more and more, with what seems like near-universal coverage of smartphones across the population (75% of adults own a smartphone, 60% own a tablet), we are on the verge of a digital health revolution.

In all of this, however, we cannot forget those who do not have access to digital technology.

 

Although Digital health services are one route, they are unlikely to ever be the only route.

We have 3 questions to ask in my view:

Firstly, with around half a billion health apps in the Apple and Android stores, how do clinicians know which ones are safe and useful to recommend or prescribe? And how to do patients know which are best?

Secondly, how can NHS services in the UK transform to meet the changing needs of the population around how they want to access healthcare, when services are already stretched, and finances are tight, even with the recent announcements of more funding for NHS IT.

Thirdly, how can digital health suppliers and providers work with NHS clinicians, managers and organisations to deliver augmented care, different service models, to work with the NHS, rather than just thrusting digital tech upon them?

 

A recent trial by Google Deepmind and Moorfields eye hospital showed diagnostics around eye disease of similar rates to those that a doctor might initially diagnose.

However, the very nature of the digital marketplace, aside from the digital health marketplace, is that with 75 health apps alone being added every day to the global app store, that kind of clinical trials rigour used for medical evidence is very hard to do - maybe even impossible.

Juliet Bauer and Hazel Maria Jones and their teams at NHS Digital in England have been doing a lot of work in the digital health apps space.

 

They have developed the NHS Apps library, with over 70 apps, it is growing exponentially. They have been through a rigorous assessment that looks at usability, data security, interoperability with other systems – a range of factors, to give a level of comfort that the apps selected are better than many others available.

The NHS itself is now delivering the NHS App which will enable online GP appointment booking, repeat prescriptions and online information.

Of course, these things exist in other apps already, and it will be interesting to see what the NHS App does to the market for these private sector provided apps.

All the GP systems providers have a personal health record, and there are several ways you can digitally order prescriptions.

 

Perhaps the key challenge; even more than the challenges of new technology; is adapting existing services to work in a digital age.

 

Why can’t you Skype with your GP? Or why can’t you telephone your consultant? Well, the answer is you can. The technology already exists, and there is already a high level of interest for remote consultations – but this technology has yet to be scaled for wide use, and many clinicians remain to be convinced of the benefits over traditional face to face consultations or even, a phone call.

If you are elderly and infirm, and have a limited network of support, travelling to a hospital for an appointment of limited value is costly, time consuming and exhausting.

You can access your GP medical record, but it requires your GP to make it available. You can book appointments online, but it requires your GP to make those available too. I recently gained access to my own personal health record, via my local surgery - once in, there were online bookable appointments available, but a fraction of the total number of appointments delivered daily.

You can book hospital appointments online, but E-Referrals only covers first GP to Consultant outpatient appointments (around 30% of outpatients record in England), and to reach 100% will have taken 15 years if the target is hit at the end of 2018. Whilst reaching 100% for this type of appointment is great, we need to push towards 100% (as or near as) for all.

 

The challenge? The point? Alongside any snazzy new tech, must come the transformational piece.

 

That means engagement with clinicians and service managers, funding the headspace for these experienced professionals to work with digital colleagues inside and outside the NHS to deliver new ways of working, and the funding to enable this transformation to take place.

Even with the recently announced 3% or so of additional NHS funding, independent analysts such as the Kings Fund, Nuffield Trust and Health Foundation all feel that 4-5% is really required to “get ahead”.

The recent speech by Matt Hancock (Secretary of State for Health in England) was much welcomed – an honest appraisal of the challenges, but an honest ‘call to arms’ to move to a more digitally enabled NHS. It was refreshing and inspiring.

The recent announcements of over £600M new investment in England in NHS IT are also welcomed. This will drive forward IT and Digital in the NHS. However, it’s also worth remembering, if you take the number of organisations in the NHS and divide by the money, you can also see how much more will be needed – far more than the average 2% of so spent on IT in each organisation at present, and with some wide variations as well.

 

With this transformation we must be ensuring the same high quality of care.

You may have read about various Doctor on Demand services, mainly operating in the private sector, such as Babylon for example. There have been some serious concerns raised around the quality of the answers given via their artificial intelligence engine.

Their NHS GP at Hand service in London, proved popular amongst many younger, fitter more mobile patients. Over 25,000 signed up but did not fit the way GP practices are paid and operate, nor did it reasonably deal with the harder, sicker patients to manage.

 

This desire for digital health services, needs matching to the need for safe digital health services.

 

This leads us to the final question – how digital suppliers and providers can work with the NHS and healthcare professionals to deliver digitally enables services.

Despite what is said, there are many examples of digital and information technology supporting healthcare on a day to day basis. It may be a longer journey than many would like to achieve a “Digitally enabled health service”, but the journey has already begun.

 

Here are just a few examples, I have had the pleasure to work with recently…

MedxNote are working with Southampton, a Global Digital Exemplar, to deliver clinical chat bots to support clinicians in their day to day clinical activities and provide a new way to connect with the electronic patient record systems hospitals increasingly have.

Healthy.io have been working with Salford, another Global Digital Exemplar, to deliver their dip.io solution, which enables home based urine tests, without the need for the patient to travel, and the impact on their day, but also the transport and parking issues often faced.

Elemental are supporting the NHS, local government, housing associations and the community sector to manage the non-medical wellness of people, supporting them through social prescribing to help them and their communities become and stay healthy.

Innova are working to support people in their homes, around medication and surveillance, to help keep them out of the hospital.

 

There are many organisations, large and small delivering a wide range of patient facing and clinician facing digital health and care apps.

For certain, more digital enabled health services are on their way – with technology such as AI, video, telehealth all being used.

Ensuring that there is both the evidence base around especially the more heavily clinical apps, and the transformational change support to embed these suitably into healthcare, supporting and enhancing clinicians in the care they provide, but not limiting or replacing – or even worse, causing any harm - will be they keys to the success of digital in health, and the speed of its uptake.

 

To view the video trailer and full video version of this blog (made before some of the most recent announcements) please visit:

https://youtu.be/mUIy4cYqeV0

https://m.youtube.com/watch?feature=youtu.be&v=w302O0v7Yh8

 

Thank you to Sally Wrightson, Lou Garton and Anna Brees for helping in the making of the video. And thank you to all those in the NHS and NHS supplier community, working hard each day to deliver all health services, including the digitally enabled one.

Written by Martin Bell

Martin Bell runs The Martin Bell Partnership, an independent consultancy specialising in strategic advice and guidance and practical support for healthcare and healthcare IT organisations, the NHS and other health care providers. A former CIO in the NHS and former executive of one of the UKs largest clinical system providers, Martin has two decades of experience in health.

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