Comment

Crossing the digital health chasm

Alison Marshall, professor of health technology and innovation at the University of Cumbria, considers whether the NHS is stuck in a digital health chasm when it comes to innovation uptake.

For some time now I have been studying the adoption and diffusion of new ideas involving the use of digital technology in health and social care, to improve services, benefit patients or service users, and make staff more efficient. Often, adoption of an innovation is led by a visionary clinician or manager. There may be training sessions, possibly a pilot, and ideally opportunities for other staff to try out the technology before using it in service delivery. The process by which the innovation is taken up by the whole organisation involves a series of individuals engaging and making a choice.

Everett Rogers was one of the first people to consider how new ideas are diffused and adopted. He developed his thinking in a book called Diffusion of Innovations, first published in 1962. Rogers categorised consumers into five different types – innovators, early adopters, early majority, late majority and laggards – in their attitudes and perceptions of new products or technologies. The innovators are people who love to try out new things, take risks, and to have all the latest gadgets or products in their field. Early adopters are more measured, but will also use their own judgement confidently; they may be opinion leaders and are often visionary. The early majority and late majority, between them, make up two-thirds of the population. Early majority wait to see proof of benefits and value to them, but will adopt innovations earlier than the average. Late majority adopters wait until there is very little risk and a large body of evidence. Laggards will resist adoption of a technology for as long as they possibly can.

Rogers’ work attempts to understand the different market segments and how they should be targeted. His work was developed further in a book called ‘Crossing the Chasm’ by Geoffrey Moore, first published in 1991. Moore looked particularly at the case of high technology products aimed at mainstream customers. He identified ‘the chasm’ between early adopters and the early majority. His view is that innovators and early adopters are motivated by the advantages and ingenuity of a technology or innovation. They are impressed by how something works, what it can do and how well it has been designed. The early majority and late majority are not interested in any of those things. They are only interested in whether it can solve a problem. They need to see more proof and – crucially – they need to be convinced by people like them. Early majority consumers are suspicious of early adopters and innovators, who they think are techies with no understanding of the coal face problems.

Is digital health stuck in the chasm between early adopters and the early majority? Do we have lots of isolated groups of early adopters and innovators evangelising ineffectually, but failing to convince the majority users? Have we focused too much on proving the technical viability and not enough on understanding why healthcare users may find digital tools useful?

If so, what we can learn is that it’s critically important to move the discussion much more towards solving business and clinical problems and much less from the features of the particular technology. This could mean focusing much more on improving patient experience, reducing staff stress levels and increasing productivity, reducing unplanned interventions, etc.

Maybe there needs to be a change of language too. The language used in digital health has never been straightforward and consistently used. We have moved from ‘tele-everything’ and e-health, but there are still many alternatives – digital health, technology-enabled care services, connected health. This reflects the immaturity of the industry and the fact that it has not yet reached the mainstream. Terminology still focuses very much on the technology. It is a bit like saying ‘the internal combustion engine’ instead of ‘the car.’

I have worked in digital health for many years and I think it is just starting to move into the mainstream. If large-scale adoption is going to occur, we need to really understand the mainstream users, their needs and preferences. We need to find a way to have these conversations in a ‘technology-agnostic’ framework, so that mainstream users can gain confidence to make their own decisions.

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