The digital revolution, has completely transformed how we access, collect and transmit information. In the last decade the 'internet of things' and the increasing capacity and capability of smartphones, tablets and more recently wearables, have had a profound impact on society as a whole. Changing consumer expectations, behaviours and demand. In response, businesses are constantly adapting and innovating from contactless and online banking services to smart energy meters and now the 'connected homes'. Our report in 2015 Connected Health: how digital technology is transforming health and social care and our more recent research for our report Vital signs: how to deliver better healthcare across Europe suggests that healthcare may in fact be at a tipping point in its digital revolution.
Digital health technology
A key requirement for the adoption of digital health technology is in being able to harness the power of connectivity, so that healthcare (or aspects thereof) can be monitored and managed remotely, in real time. The wide proliferation of health apps (165,000 and counting) has changed the digital health landscape, albeit only a small percentage are currently used at scale (for example the top ten pharma apps generate 66 per cent of downloads)i. The focus of many of these health apps wearables has largely been on helping people to improve their own health and well-being, but increasingly are apps and bio-sensing wearables are now being used to monitor changes in health vital signs. This is enabling users and clinicians to better monitor and treat conditions. However, despite clear consensus from most stakeholders that such technologies have significant potential to support patient self-care and reduce the demand on healthcare systems, their use has still not been mainstreamed. A key reason is often the lack of clinician and patient involvement in design, but also concerns about data privacy and security.ii
NHS support for digital initiatives to help people manage their own heath
Earlier this year, the NHS Innovation Accelerator (NIA) programme, which supports developers with tried-and-tested innovations, revealed that more than three million patients had begun tapping into new apps, safety devices, on-line networks, and a stream of other new technologies and services during the year of operation in 2015-16. Examples of innovations supported by the scheme, which have now been given the green light with regard to being routinely commissioned by the NHS, include:
- MyCOPD - an app which allows patients with Chronic Obstructive Pulmonary Disorder to self-manage their condition on their phone or tablet
- AliveCor - a mobile heart monitor that instantly captures electrocardiogram (ECG) recordings, allowing the user to detect, monitor and manage heart arrhythmias
The idea of a more virtual healthcare service is gaining traction across the UK, for example, the Chief Executive of NHS England has indicated publicly that virtual healthcare has a strong future in the UK, and in August 2016 announced a new £100 million funding pot to aid selected NHS trusts in becoming centres of global digital excellence (CODE). This announcement of funding support for these CODE institutions follows other recent pronouncements by NHS England stating that technology which enables patients to manage their own health is the key to improving care, promoting efficiency and cutting costs throughout the NHS.iii
Overcoming the financial barrier to adoption of innovation within the NHS
NHS England has recently announced that a new Innovation and Technology tariff category will be introduced into the NHS aimed at removing the need for multiple local price negotiations, by guaranteeing automatic reimbursement when an approved innovation is used. The idea is that this will allow NHS England to negotiate national 'bulk buy' price discounts on behalf of hospitals, GPs and patients. A move designed to accelerate uptake of new med-tech devices and apps for patients with diabetes, heart conditions, asthma, sleep disorders, and other health conditions,(e.g. pregnancy). Developers of med tech devices and apps from around the world have been invited to join the new Innovation and Technology tariff, which provides a clear "route to market" for innovations.iv
This new innovation diffusion funding mechanism is consistent with the policy direction recommended in the Department of Health's recently published Accelerated Access Review.v Seen as a blueprint for national action in setting out the important practical steps to support a systems-based approach to a whole life sciences ecosystem, improving uptake of innovations. We will continue to monitor the extent to which it helps overcome the barriers we have previously identified:
- stakeholders and organisations are not aligned with the explicit goal of working together to bring innovations more reliably and rapidly to patients
- many incentives in the current system are counterproductive for the adoption of innovation data and evidence is not being used as an effective enabler
- cultural barriers such as risk aversion and mistrust between NHS and industry.vi
The opportunities for digital health technology to help deliver better healthcare across Europe
Health systems in Europe are diverse, the result of history, culture and the economic and political environment in which they operate. Understanding what makes an effective healthcare system is therefore quite challenging, as discussed in the above mentioned report Vital signs: how to deliver better healthcare across Europe.vii
These challenges are both similar to all countries and familiar to all health stakeholders, from unrelenting demand pressures, due to increases in the size and ageing of the population to growing public expectations for more personalised and convenient services. Other challenges include the increasing costs of providing healthcare, driven by the availability of new technology, innovative medical equipment and pharmaceutical interventions and a desire to provide high-quality care, equitable access and optimal outcomes within an affordable, and sustainable, cost envelope.
What differs is how each country approaches these challenges, what they are prepared to pay and what they are prepared to trade off or prioritise. Our report examines health system performance through the lens of seven 'Vital Signs', identifying what good care might look like, highlighting key performance metrics, a patient portrait and examples of good practice for each vital sign. It also suggests a number of key enablers to help transform healthcare services, grouped under three headings, systems and processes, workforce and technology.
The seven vital signs cover: Prevention and health promotion; Primary care today and tomorrow; Productivity in hospitals; Palliative and end-of-life care; Patient engagement and empowerment; Population health management; and Partnerships between industry, providers and academia. While no country has yet developed the perfect healthcare system, we believe that addressing the seven 'Vital Signs' will, over time, through wider adoption of the key enablers, should help all countries to improve efficiency and cost-effectiveness; reduce health inequalities and address variation in healthcare performance both between and within countries.viii
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