On Wednesday 27 May, Deloitte hosted a Cambridge Health Network event using our latest report ‘Connected health: how digital technology is transforming health and social care’ as a catalyst for the ensuing debate. Over 120 people from the public, private and voluntary sectors attended, from health and social care providers to life sciences and technology companies, including a number of digital health start-ups and social enterprises. What the majority of attendees had in common was a belief that the time has arrived for digital technology to be adopted at scale to help transform patient care and improve the efficiency, effectiveness and cost of care delivery.
The Centre’s report set the scene highlighting why the time is ripe for wider adoption of digital technology. This included the fact that three quarters of people in the UK now go online for health information and over 70 per cent own a smartphone, giving them access to over 100,000 health apps, albeit fewer than 500 of these apps are actually endorsed by NHS Choices or the European Health Apps Directory. As a result the foundations are now in place to change ways of working and empower patients to manage their own health more effectively, but for the connected health infrastructure to be effective, a number of barriers need to be overcome, including:
- the cultural resistance of provider organisations
- the lack of interoperability and connectivity standards or a clear legal and regulatory framework
- patient and clinician concerns over data protection, safety, quality and liability issues
- the lack of robust reliable evidence on outcomes and inadequate funding models.
However, there are also increasing examples of evidence based good practice emerging that show how early adopters are overcoming these barriers and demonstrating the benefits for connected patients and connected providers. There are also examples of new entrants entering the provider market either as stand-alone providers or, more likely, as partners. The potential for digital health to transform healthcare delivery was demonstrated by presentations from the other two panel members from Philips Healthcare and uMotif.
Philips HealthTech provides personalised, integrated solutions based on systems integration, connected devices, big data and analytics. These span diagnostic imaging to pathway re-design and from technology enabled hospital care to supported self-care for people with long term conditions. Globally, Philips’ enterprise wide solution is already monitoring more than 190 million patients a year and providing home care to some six million patients a year. More specifically, Philips’ electronic intensive care unit (eICU) programme is deployed by over 400 hospitals with evidence of significant improvements in outcomes. Moreover, its preference is to work in partnership allowing joint learning and joint improvement; recognising that the challenge is bigger than any one company can solve.
uMotif is a UK based socially minded company deploying a clinically led patient engagement and self- management digital health platform. It currently covers 12 conditions from diabetes and Parkinsons to oncology and mental health and partners with more than 40 organisations across the UK, US and Australia. Its motto is people first, supporting patients, clinicians and carers by using intuitive, digital technology to help people self-care and avoid unnecessary hospital admissions. Its focus is on managing and controlling symptoms, given that symptoms, not sensors, lead to hospital admissions.
Some of the questions from the lively debate that followed include:
Will a market conducive to tech innovations sweep away all of the competition or will nothing much happen or is there a third way?
The panellists suggested that big changes will happen when the public start demanding innovation. While this is not yet happening fully, people are becoming more educated and tech savvy suggesting we are at a tipping point. Rather than a third way, there may be four or more new ways of managing and delivering care.
Which technology deployments might require a formal evaluation, like a randomised controlled trial (RCT) and which do not?
The panellists agreed that evidence is important as clinicians (and the public) need convincing of the merits or otherwise but that RCTs take time and the market is moving too fast for traditional evaluation. The ideal, therefore, would be to collect strong evidence as the technology is rolled out (real time evidence) on both safety and benefits – based on what needs to be proved and to whom – while striking a balance between having evidence and applying judgement to say “yes, this has potential”.
How does the technology apply to social care and what is its role in the integration of care and supporting people to live meaningful lives in the community and residential settings?
The panel believed that the political climate and recent policy initiatives indicate that technology is crucial to both integration and in helping address the challenge of increasing demand, fewer staff and cost pressures at every point of care. They pointed to examples of how digital technology is supporting better care at home and in care homes, for example in helping to improve the confidence of carers and reduce unnecessary hospital admissions.
How do the economics of patient power work?
The panel acknowledged the challenge in demonstrating the economic benefits but felt increasing evidence was emerging. Philips expect to publish the results of detailed modelling about the economics of tech and hospital avoidance in the near future and uMotif’s business case and case studies in the report illustrate some of the cost and productivity savings achievable. However, while there is a clear business case for the top five to seven per cent of the acute care pyramid, the lower down the pyramid you go, the longer the time lapse needed to see the benefit. Moreover, the savings are usually to the whole system requiring a more strategic view. The shift to outcomes based commissioning should help, but there is also value in people understanding their own data.
A key question left hanging was to what extent were people over-estimating the degree of change in two years but underestimating the change that will happen in five years. Also how doctors in training now will face a very different world and the opportunity to teach the new workforce new skills and abilities to enable them to take advantage of the fantastic opportunities made possible by technology. Throughout the debate the importance of changing culture and behaviours also resonated, all subjects that I plan to return to in future blogs.
In summarising the discussion there was a consensus that digital technology is key to tackling the current financial challenges facing the UK and is central to supporting the shift to a more patient-centred, outcome-based, health and social care delivery model.