How to scale digital health in a post Covid world
The ten weeks to June 2020 brought more seismic change in healthcare than the previous ten years. Before the crisis, digital adoption was slow; the hundreds of smaller organisations that together form the NHS each had their own priorities and operational requirements. That created a labyrinthe of commissioning processes for innovators to navigate.
Of the digital tools many GP practices already had – video conferencing and electronic prescribing, for example – usage typically remained low. Healthcare professionals either didn’t have enough trust in new systems, the time to implement them, or the training budget to get to grips with them. Healthcare lagged far behind other sectors in digital transformation.
Not any more. Red tape is out and “move fast, [don’t] break things” is in, as clinicians nationwide turn to tech to reach patients they can no longer see in person. Almost three quarters (71%) of patients are now accessing healthcare via either telephone or video consultations, up from 26% a year earlier, while only 7% are attending face to face appointments.
In a stark departure from old ways, procurement for the video conferencing platforms that make this possible took just two days. NHS Digital, meanwhile, successfully launched Microsoft Teams for 1.25 million healthcare professionals – the health service’s largest ever rollout of its kind – in a matter of weeks. As Sarah Wilkinson, NHS Digital CEO, put it, the “time-consuming blockers” have been eradicated.
Now the benefits of these technologies have been realised, we’re unlikely to see a return to the pre-crisis form of care delivery. That’s the first legacy of Covid-19.
It’s not the only one; the second, more pressing legacy is the tidal wave of patient demand on the horizon as many thousands of people who’ve avoided seeking care, or had operations postponed, or suffered illnesses gone undiagnosed, enter the health system en masse. There’s lots of evidence to suggest that large numbers of people have been in real need of treatment they haven’t received, for whatever reason, since the crisis began.
In Italy, national statistics showed mortality in conditions other than covid-19 increased by around 12,000 over the five weeks to the end of March, with cancer patients at particularly high risk. According to the Royal College of GPs, overall clinical activity in the UK has been down by around a quarter during the crisis with hospital beds lying empty, suggesting a similar trend in the UK. A&E attendances are down 57%. Doctors warn of a “ticking time bomb”.
When we find a vaccine, these trends will be reversed – and may very well overwhelm the system more completely than we feared would Covid-19.
There is, however, a way to mitigate that risk: digital health interventions. Just as video consultations are already improving patient outcomes at scale by maintaining access to care, digital platforms for managing long term conditions will increase patient self-efficacy and reduce reliance on healthcare professionals, diagnostic platforms will streamline the care pathway and free up clinicians’ time, and e-triage will create efficiencies in urgent care delivery and reduce hospital waiting times.
That’s just three examples among hundreds of clinically validated digital health innovations. The potential for change is huge. But in order to realise that potential, first we need to make sure these innovations can be scaled safely, quickly and effectively – and win the confidence of the patients who use them.
We can achieve this by:
1. Investing in the frameworks that build trust
The opportunity to deliver new health interventions is enormously promising. But there are still major hurdles along the way; many of the current legal, regulatory and evaluation frameworks for digital health haven’t kept pace with innovation, and they’re not fit for purpose.
AI, for example, will power much of the healthtech of the 2020s – but gaining regulatory approval for this technology ranges from difficult to impossible. AI innovators need to align with multiple rulebooks from multiple organisations (the MHRA, NICE, CQC and ICO all currently play a role, among others), and that takes time – lots of it – and hinders progress. In machine learning, the most complex area of AI, no route to NHS approval currently exists at all, because we simply don’t know enough about how it forms decisions and whether it can be used safely in practice.
So we must make it simpler and faster for innovators to prove their technologies, by investing more in the capability – through the NHS AI Lab, for example – to create effective regulation for digital health.
2. Taking lessons from the trailblazers on engaging users
We have a lot to learn from the sectors which have already succeeded in digital transformation at scale and at pace.
Take banking, a highly regulated environment with a centuries-long tradition of doing business in the same way. App-based challenger banks like Monzo, which counts over 2 million users, have overturned that tradition and brought large numbers of customers online, primarily by focussing on user experience. Monzo is designed with users, not for them, and the big six are now scrambling to catch up.
Or retail: there are lessons for healthcare in the omni shopping experience – the seamless transition from offline to online interactions and vice versa – that forward-thinking brands have created. One example is the Starbucks loyalty card: unlike traditional, physical cards, it exists only within the Starbucks app – but users can check and credit their points balance over the phone, on the Starbucks website, within the app or in person in-store. Just as a patient should be able to update their electronic health record in real time on their way to a GP surgery, Starbucks customers can update their account in the queue for the till.
These are insights we can apply to healthcare; by focussing first and foremost on the end user and, crucially, making it easy, we can rapidly accelerate user adoption.
3. Designing to bridge social divides
A major risk of the current pace of transformation is that existing social divides will be exacerbated. Recent research showed introducing new technologies for self-managing long term conditions, which disproportionately affect the more vulnerable groups in society, may in fact disadvantage them further still; around 10% people in the UK lack internet access, rising to as many as 25% of those with a disability. 21% of adults, typically in the poorest communities, lack basic digital skills, while 16% are unable to fill out an online form.
This is why post-covid health interventions need to be universally available, both online and offline, and built for all people; co-creating digital health products with the people who use them is key. Then we must check, and double check for readability and ease of use, keep all content free from judgement or blame, and, most importantly, provide ongoing, human support.