In this post originally written for the BMJ and posted on blogs.bmj.com/ce, Prof Elizabeth Murray talks about digital health interventions in the NHS.
Digitising the NHS is back in the news with the publication of the Wachter report on using IT in the NHS to achieve healthcare’s triple aim of better health, better healthcare and lower cost. As Wachter says, not “giving highest priority to digitisation would be a costly and painful mistake”.
Although the report focuses on digitising secondary care, many of the recommendations are equally applicable to digital health interventions (DHI). DHI are interventions delivered on a digital platform, such as the web or mobile phones, which aim to deliver health care or health promotion, including behaviour change, self-management support, or treatments such as Internet Cognitive Behavioural Therapy (ICBT). Because of their potential to combine personalisation with scalability, they hold out real hope for delivering better health, better healthcare and lower costs, but the potential has yet to be realised, despite the millions of commercial “health apps” available.
Achieving the potential of DHI will require investment, research and development. Wachter recommends the NHS “digitise for the correct reasons” – for DHI this means identifying a clear clinical need, where a treatment or education programme is known to improve health, and where the treatment or education can be delivered effectively and at lower cost, on a digital platform compared to face to face. For the benefits of scalability to be realised, DHI must reach large sections of the population, but at present, low engagement by users often limits effectiveness. As Wachter says “it is better to get digitisation right than to do it quickly” and “health IT Systems must embrace user-centered design”. Developing DHI that are effective, acceptable to patients and health care professionals and that fit with NHS workflows takes time, effort and substantive user design. Our self-management programme for people with type 2 diabetes (HeLP-Diabetes) took 2 years to develop, and involved a multi-disciplinary team of patients, clinicians, behavioural scientists, health service researchers, software and web-designers. It was developed around user requirements, had a strong theoretical underpinning, and all content was evidence-based. We believe that this extensive input was essential for achieving the high levels of acceptability to patients and health care professionals, as well as the effectiveness and cost-effectiveness demonstrated in an RCT (submitted for publication).
Wachter also emphasises the importance of investing in effective implementation of digital resources, advising that benefit realisation requires ongoing investment, workforce development, and adaptive, as well as technical, change. Our work with HeLP-Diabetes reinforces this advice. We showed that if health professionals invested a small amount of time (less than 5 minutes) in promoting the programme and encouraging patients to use it, uptake was significantly increased, and the digital divide was overcome. However, many general practices struggled to invest even this small amount of time.
Are DHI worth the investment in research and implementation? For answer, I’d like to quote Wachter again:
“To those who wonder whether the NHS can afford an ambitious effort to digitise in today’s environment of austerity and a myriad of ongoing challenges, we believe the answer is clear: the one thing that NHS cannot afford to do is to remain a largely non-digital system. It is time to get on with IT.”