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The digital health revolution

As digital health and artificial intelligence (AI) clinical lead at NHS England, Dr Indra Joshi is involved in several national initiatives designed to realise the full potential of digital health and technology in the NHS. Here, she explains the projects she is co-leading with national partners to ensure the health service takes full advantage of the digital health revolution.

The pace and scale of health technology innovation is presenting the healthcare system with sizeable challenges and some great opportunities – and the growth of digital health is no exception.

Digital health is rapidly and dramatically changing the lives of patients and the way healthcare is delivered. It is enabling the NHS to improve the use of information and patient data, supporting faster diagnosis, streamlining hospital systems, and opening up new, smarter ways to provide personalised care.

At the heart of this revolution are innovators and researchers developing digital health solutions that have the potential to radically improve the way healthcare is planned and delivered. More and more, we are seeing new digital technologies such as smartphone apps being introduced to the health and care system. The problem for commissioners and clinicians is: which products do they choose? How can they be confident that the product being pitched to them will meet their needs and benefit patients? Meanwhile, developers can become frustrated by a complex healthcare system that is difficult to navigate and makes them jump through lots of hoops.

If the digital sector follows the Silicon Valley mantra of ‘move fast, break things’ to foster innovation and discovery, then the health service approach is akin to ‘move slowly, avoid harm.’ Viewed in this way, you can begin to understand where the challenges are – but equally, you can see how overcoming them will enable innovators and the NHS to realise the full potential of digital health technology and reap the benefits for the good of everyone.

A framework to support innovation

There is a clear need for a framework that makes it easier for innovators and tech start-ups to work with the grain of the healthcare system and understand what the NHS expects of them in return. Such a framework also needs to help commissioners by supporting their decision-making and selecting products that have strong potential to improve patient care. Helpfully, this is already being developed by national healthcare organisations. Working in partnership, the Department of Health and Social Care, NHS England, NHS Digital, NICE, Public Health England (PHE), MedCity, and DigitalHealth.London have been engaging with industry, commissioners and innovators to understand what is required to cultivate the ideal conditions for health technology to thrive in the UK.

Over the next few months, we should begin to see the building blocks and tools in place to create a safe and trusted environment in which innovation can flourish. This will include:

• A set of principles to encourage good practice in AI and ensure the NHS is using only the best technologies;
• Tangible standards and guidance to help innovators get a clear idea of what evidence is needed for digital products that will guarantee patient benefits;
• A system for selecting promising technologies (including digital) and routing them through the healthcare system.

New code of conduct

Announced by health minister Lord O’Shaughnessy at September’s NHS Innovation Expo, the initial new ‘Code of Conduct for Data Driven Health and Care Technology’ encourages companies to follow a set of 10 principles. These principles outline the rules of engagement between industry and the healthcare system, making it safer to develop technologies that can help the NHS tackle conditions like cancer.

The code enables the health and care system to guide development of new data-driven technology and sets clear guidelines to protect patient data. It also ensures the health and care system gets a good deal on future partnerships with technology companies. It provides a strong footing to deepen trust between patients, clinicians, researchers and innovators.

NICE evidence standards

As part of the government’s code of conduct, NHS England has been working with NICE, PHE, MedCity, NHS Digital and DigitalHealth.London to develop a new set of standards and guidance to support companies and commissioners to understand what good evidence looks like for digital health innovations. The evidence standards will categorise innovative technologies, identify any potential risks, and determine what evidence is needed on clinical effectiveness and economic value to support use in the NHS.

This will enable better commissioning, and help innovators to understand how the NHS makes decisions and the standards of evidence expected of them.

The framework has been developed in conjunction with industry, commissioners, academics, accelerators, and clinicians, among others, to ensure it covers the breadth of experiences in this area and supports evidence generation for different types of technologies. This will enhance understanding between innovators and healthcare commissioners, improving the way promising technologies are introduced into the NHS so clinicians and patients can benefit.

The standards will be freely available online in December through NICE, and will be shared through partners to ensure they are utilised and that there is a consistency of evidence across all new innovations.

HealthTech Connect

The upcoming standards complement other work being taken forward by NICE, NHS England, and industry partners. A new online system called HealthTech Connect will enable health technology companies to signal whether they want to put their product forward for evaluation or access support to develop the evidence they need to demonstrate effectiveness and value for money.

The secure system will be free to use and will help developers of digital health, medical devices and diagnostic technology with the implementation of their products and adoption in the NHS. It will connect companies to the right support at the right time. Technologies that are digital will automatically be directed to the standards so that they can access the tailored support that they need. HealthTech Connect is going through final stages of testing with companies at the moment and will be available for wide use in early 2019.

Transforming healthcare

Tackling the challenges and realising the opportunities of health technology can only be achieved by working in partnership across healthcare at local, regional and national level. Taken together, these new tools and resources will transform the way the healthcare system identifies and implements the best health technology for the NHS, supporting innovation in UK life sciences and delivering significant benefits for patients.

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