02.10.17
18 months in UK digital health
Source: NHE Sep/Oct 17
Yinka Makinde, programme director at DigitalHealth.London, takes a look at the areas of digital best practice that have emerged in the NHS over the past 18 months – as well as those where providers need to catch up.
A lot has happened in the digital health ecosystem in the UK over the last 18 months.
There has been a growth in initiatives targeted at mainly driving take-up and adoption of digital health solutions, such as DigitalHealth.London, Innovation Technology Tariff, Innovation Technology Payment, NHS Apps library, and national procurement opportunities such as the Digital Diabetes Prevention Programme and National Cancer Vanguard Early Diagnosis Industry Challenge.
More recently, the Office for Life Sciences launched a £35m Digital Health Technology Catalyst Fund for health technology SMEs. A new NHS Digital Academy, conceived by NHS England, was launched officially at NHS Expo 2017. The Academy aims to “nurture strong digital leaders who are capable of delivering transformational change so that patient care, and the way that organisations operate, can benefit from the many improvements and innovations modern technology has to offer”, said Rachel Dunscombe, CEO of the NHS Digital Academy.
NHS England appointed for the first time a director of digital experience, and for NHS England (London), a new medical director for primary care and digital transformation. The 44 sustainability and transformation partnerships (STPs) across the country launched their digital roadmaps, whilst 17 acute trusts and seven mental health trusts were announced as the global digital exemplars to pioneer best practice and the use of technology across the NHS.
DigitalHealth.London Accelerator launched its second cohort of 30 companies, whilst the National Innovation Accelerator launched its second call for innovations. NHS England completed a national pilot of 111 Online where four different digital platforms were tested.
With so much activity and ‘noise’, one might assume that the adoption of innovative solutions across the NHS has dramatically increased during that time. There has been some, but progress is still painfully slow. In fact, in a recent global study involving 19 countries, the UK ranked only 18th in terms of percentage of the general population who had used connected care technology to monitor any health indicators in the past 12 months, at 31% – with UAE (74%), Saudi Arabia (70%), Canada (67%) and Argentina (58%) ranking the highest. The US in this same study ranked 10th, and the 19-country average was 45%.
Without the release of promised funds to exploit innovation and the space to experiment and ‘fail fast’ without being penalised, continued slow progress will be made, one fears. There are other issues too which affect the pace.
Motivational conflict
There remains conflict in the motivations between the payers, providers and suppliers. Digital health suppliers are driven in the most part by traction, revenue and ‘investability’ for survival. Profit comes much later in this sector. Demonstrable traction helps prove demand, boosting ‘investability’. This means that for any implementation, the company is motivated to drive adoption through marketing and incentives. However, for the ‘system’, driving up demand for a service may not be the intended end game; rather, the aim may be providing an alternative channel for existing demand.
Access to data
It is access to data, and lots of it, that will separate the winners from the losers in this challenging marketplace, and will be needed to validate the economic value case of any solution – particularly for companies building solutions based on artificial intelligence and machine learning technologies.
It’s not a secret that digital health companies struggle to gain access to data in order to validate their solutions for both cost-effectiveness and outcomes. Provider-led competitions and collaborations must find ways to make this data more readily available to enable trials and full-blown implementations.
Fostering risk-sharing
A company, by its very commercial nature, needs to be able to survive financially in order to be able to continue to participate in and support pilots, trials and full projects. I’ve noticed that not all ‘industry’ opportunities/calls offer reimbursement to the successful companies during the trial phase. This needs to change.
Is there a way we can foster a better ‘risk sharing’ culture? One where the NHS recognises the frailty of the SME and its need to cover basic costs in order to stay the course for long enough? Where suppliers recognise that the NHS increasingly must deliver value from use of public funds, and demonstrate this in as short a time as possible?
Signs of growth
There are some signs of encouragement, with a now growing number of healthcare organisations and leaders within them championing the digital agenda to drive the transformation of care delivery. Chelsea and Westminster Hospital NHS FT is a good example and has backed the implementation of several innovative solutions recently, including Perfect Ward – to reduce the time it takes to conduct ward accreditations by half; Medopad – for remote monitoring of patients with heart failure; and Physitrack – to speed up the recovery of patients in the musculoskeletal services.
West Middlesex University Hospital has recently committed to an augmented reality innovation, Proximie, that allows doctors to virtually transport themselves into any operating room or clinic to guide, train, teach and support other surgeons and medical experts within the trust. Guy’s and St Thomas’ NHS FT has seen a 40% reduction in Did Not Attends and efficiency savings of £1m to £3m per year through using DrDoctor.
The London Ambulance Service implemented Perfect Ward digital innovations across 70 sites serving eight million people. North West London Collaboration of eight CCGs trialled and evaluated three digital solutions to support Type 2 diabetic patients to self-care, using the innovations Oviva, OurPath and Changing Health. These are just a few examples of how NHS organisations are beginning to embrace the opportunities that digital innovations hold.
Future opportunities
Key waves of activity that will gather pace in the coming months include nudging the GP provider community to actively engage digital solutions to help free up GP capacity, as well as make efficiency savings in outpatients through the adoption of innovations to support remote diagnosis, virtual consultations, and advice and guidance.
Cybersecurity, in the wake of recent cyber-attacks, also cries for a solution. Shared data to drive population health. Standards – both safety and interoperability and clarity around a minimum requirement around an evidence base. Other areas offering opportunities for transformation include digital therapeutics (e.g. Sleepio), machine learning (e.g. DeepMind), portable diagnostics (e.g. AliveCor), Blockchain, connected communities (e.g. Health Unlocked), and the smartphone.
At DigitalHealth.London we look forward to remaining a strong force in facilitating this activity, and building the ecosystem for digital health.
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