This week we launched our latest report Connected health: How digital technology is transforming health and social care, which analyses opportunities and barriers to the adoption of technology enabled care (TEC). While the emphasis is on the UK, many of the challenges and potential solutions are relevant to most health economies facing rising demand for services in the face of constrained supply of health and social care resources. The report considers how digital technology is shifting the dynamics between patients and clinicians, and helping providers to work differently.
Using technology to enhance health and social care delivery is not new; telephone consultations, personal alarms and web-portals have been around for years and have grown in popularity over the last decade. The difference today is the increasing functionality of mobile technologies and in particular the smart phone, as well as the proliferation in health apps and wearable technology.
Indeed, in the UK, some 75 per cent of the UK population now goes online for health information, 70 per cent of the adult population owns a smartphone, with the over 55 age group recording the highest growth rate; and there are currently more than 100,000 health apps that can be downloaded from the various app platforms. Other notable developments are the availability of healthcare wearables, such as digital blood pressure monitors and glucose sensors, and patient and provider access to real-time healthcare data and information. Additionally smartphones are incorporating a growing range of sensors which monitor changes in physiology.
The exponential growth in the capability and capacity of the technology has led to a number of concerns from actual and potential users, including patients and staff uncertainty as to which apps or wearables are most reliable and trustworthy. Indeed, one of the biggest concerns identified by doctors, is about evidence of outcomes. In response agencies like the US Food and Drug Administration or NHS Choices and its NHS Health Apps Library have developed criteria which judge apps for safety and technical proficiency. For example:
- For apps to be included on the NHS Choices search website, which in early 2015 lists around 300 apps, they must be reviewed by a technical team (testing relevance, legal compliance and data protection), then by a clinical team (to test scientific rigour)
- PatientView, an independent organisation that works closely with patients and health and social campaigning groups worldwide, has developed a systematic method of appraising health apps. As of March 2015, there are 358 apps recommended for the Apple platform and 233 for Android, with smaller numbers recommended for use on other platforms.
Globally, there are cultural and regulatory barriers to the adoption of TEC, the extent of which varies from country to country. A consultation exercise by the European Commission in 2014 identified widespread concerns about issues such as quality, reliability, data overload, privacy and security. Although concerns about the cost-effectiveness of TEC are lessening due to the improving quality and reliability of devices and apps and the falling cost of digital technology.
A further problem is that TEC solutions have been technology-driven, often without the involvement of those people they are aimed at. HCPs are often reluctant to engage with technology, partly due to the scale and pace of changes, and partly through lack of education and training and concerns over liability and funding.
Technology has the power to improve access to healthcare services, especially for people with mobility problems. This is recognised by the UK government, but there are concerns about inequality of access to the technology due to the cost and differences in broadband speeds. There are also challenges due to the lack of interoperable patient records.
Putting aside these concerns, the potential for digital technology to transform services, as the report shows, is enormous. In particular it is an important driver of patient engagement, and can help shift the balance of power from the traditional approach, where the patient is dependent on healthcare staff for information and support to one where they are co-producers in managing their own health.
Digital technology is also key to the service integration agenda, helping to improve communication within and between provider organisations. It can also help increase productivity, improve patient monitoring, reduce avoidable service use, improve outcomes and deliver cost savings. As healthcare shifts towards a patient-centred, outcome-based delivery model, digital technology will be an essential partner in health and social care transformation.
An important development as a result of the use of digital technology is new entrants into the healthcare market, comprising global technology companies such as Apple and Google, pharmaceutical companies (which are among the most active publishers of health apps), medical technology companies and indeed supermarkets. Their involvement raises the possibility of new healthcare provider models and approaches to health research transforming the patient experience.
Innovations in science and technology today will transform healthcare tomorrow. At the moment, the pace of change in the technology is increasing at an exponential rate, but the question remains whether developments will provide little more than hype for the healthcare industry, or whether they will truly transform care.