Foreword

Welcome to the Deloitte Centre for Health Solutions report Connected health: How digital technology is transforming health and social care.

Connected health or technology enabled care (TEC) is the collective term for telecare, telehealth, telemedicine, mHealth, digital health and eHealth services. TEC involves the convergence of health technology, digital, media and mobile telecommunications and is increasingly seen as an integral part of the solution to many of the challenges facing the health, social care and wellness sectors, especially in enabling more effective integration of care.

TEC seeks to improve people's ability to self-manage their health and wellbeing, alert healthcare professionals to changes in their condition and support medication adherence. For health and social care providers, it can help deliver safer, more efficient and cost-effective care.

Digital technology is advancing exponentially and its cost is plummeting. At the same time the demand for and cost of healthcare is rising, which is challenging most health economies across the world. The need to adopt technology to help meet these challenges seems obvious, but healthcare continues to lag behind other industries in using technology with service users, in this case, patients and carers.

This report analyses opportunities and barriers to the adoption of TEC based on extensive literature reviews, discussions with stakeholders and our work with commissioners, providers and technology companies. It focusses on the United Kingdom market but in a global context drawing on examples of good practice from the UK and other countries, including the United States, where many healthcare providers lead the field in their adoption of digital technology.

The report considers the barriers to adoption, shifting dynamics between patients and clinicians, and how technology can help providers to work differently. The intention is to provoke discussion and offer readers examples of solutions that may fit their situation.

The task now is for healthcare providers, commissioners and payers across the UK to adopt TEC at scale and we hope this report provides a useful stimulus for doing so. As ever we welcome your feedback and comments.

Executive summary

This report provides a current review of the ways in which digital technology is changing health and social care delivery, with an emphasis on the UK.

Connected health, also known as technology-enabled care (TEC), involves the convergence of health technology, digital media and mobile devices. It enables patients, carers and healthcare professionals (HCPs) to access data and information more easily and improve the quality and outcomes of both health and social care.

TEC is capable of providing cost-effective solutions at a time when the demands on health and social care services continue to increase due to the UK's growing and ageing population, the rising costs of advanced medical treatments, and severely constrained health and social care budgets. Indeed, wide scale adoption of TEC will be essential for sustaining the future health and social care system.

Opportunities for using mobile technology have improved in the last few years with the growing population of smartphone and tablet users in the UK, even among older age groups, supported by a proliferation of health apps, although only a few are currently being used extensively. Other notable developments are the availability of healthcare 'bio- sensing' 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.

However there are various barriers to the deployment of TEC: many of these were identified in a consultation exercise by the European Commission in 2014, with widespread concerns about issues such as quality, reliability, data overload, privacy and security. However there are now fewer concerns about the cost-effectiveness 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 the 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.

In the past year, the UK governments have refreshed their digital health strategies. For example, NHS England established a National Information Board in 2014 to take forward the government's TEC strategy, with similar developments in the other devolved nations. Indeed, the integrated healthcare systems in Scotland and Northern Ireland have been at the forefront in exploiting TEC opportunities.

Mobile technology can empower patients and carers by giving them more control over their health and making them less dependent on HCPs for health information. They can use digital technology to research information online, share experiences and identify treatment options. Its use in providing access to information and education is an important driver of patient engagement. The most widely available health apps have been fitness, medical reference and wellness apps. While these apps provide information, many currently lack the functionality to do more in relation to health.

The capabilities of apps and wearables are improving as a result of developments in technology. Other aspects of the growing uses of TEC are remote monitoring of changes in the health status of patients (home telehealth) and the use of digital messages to remind or alert patients to adhere to their long-term course of treatment or therapy.

Growth in the use of TEC has implications for healthcare providers. For example, there is increasing potential to support the shift of some 'hands on' treatment in primary care clinics and hospitals to home care via the use of digital communication such as e-visits, e-prescriptions and remote monitoring. There is enormous potential for further improvements across many aspects of health care provision – GP practices, residential and nursing homes and hospitals, and in particular areas such as mental health care – but only if the existing barriers can be overcome.

Developments are supported by the entry into the healthcare market by global technology companies such as Apple and Google, and by the involvement of pharmaceutical companies (which are among the most active publishers of health apps). 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, in areas such as middleware, digital imaging and improved digital sensors. 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?

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