Many have criticised the NHS's sluggishness in joining the digital revolution. While, as consumers, our lives have been transformed by a plethora of online services and information sources, the health service has been comparatively slow off the mark.
But while the NHS is struggling to keep up as a service, patients are becoming increasingly interested in using their smartphones to manage their health and care. And technology developers are eager to oblige: there are already over 165,000 health apps on the market.
Meanwhile, policy-makers have encouraged patients to go online to book appointments, order prescriptions and access their records. Yet while the health app and wearable market seems to be booming, uptake of official online channels remains low.
Our new research looks at the impact of patients engaging with digital tools such as apps and online services and how the NHS can harness the growing enthusiasm for health care technology.
One of the biggest benefits of digital technology is that it can equip patients with the confidence to manage their own health and care. Although the majority of apps have not been evaluated, we are already seeing positive impacts on behaviour change, diet monitoring, physical activity and chronic condition management from ones that have. Wearable technologies like Fitbits have also had some success in improving physical activity and weight loss.
Likewise, granting patients access to their own medical records online encourages them to manage their own care. People often gain a better understanding of their health through their own records, which can lead to more productive conversations with their GP. Equally, professionals find their jobs are made easier by patients attending appointments pre-prepared with a list of informed queries and concerns. Record access can then allow doctors and their patients to decide on the best course of action together – based on the patient’s preferences.
Online networks that allow patients to connect with each other and share tips on how to manage their condition improve outcomes and provide valuable support for patients. Patients Like Me is a good example. A person with any condition can complete profiles on the site, including their diagnoses, symptoms and treatments, and are invited to complete treatment evaluations, noting any side effects, adverse reactions and positive benefits. This information is then aggregated and available to all members of the site so patients can learn about new or potential treatments.
So what’s the downside?
There’s some good work happening, but it is not all positive or straightforward.
Although some apps are starting to return positive results, most of them haven’t been officially evaluated. And of the ones that have been, many are inaccurate, ineffective or do not protect patient data.
Maintaining long-term engagement with consumer devices is also a significant challenge; many people get bored after the initial novelty wears off. And almost all apps are developed with a single condition in mind. A lot of patients who would benefit significantly from support to better manage their health have multiple long-term conditions. At the moment this means they will need several apps, making it even less likely that they’re going to stick with them.
While online access to records can be valuable for patients, we do not properly understand how they impact on demand for services. Some have suggested they can release administrative efficiencies – by removing the need for patients to call their practice for test results, for example. But in one large study in the United States, online access to records and clinicians via email actually increased GP appointments, telephone consultations, A&E attendances and hospital admissions.
And patient access to records also raises a number of concerns. It’s possible that patients could be harmed by having access to their record or their data could be exploited. Where full record access is granted – with referral letters and free text entered by clinicians – professionals are also concerned about the extent to which third-party data is shared.
And perhaps most importantly, many people simply struggle to understand health information. Recent studies suggest 60 per cent of working-age people in the UK find health information containing both words and numbers too complex. Some people also struggle to identify trusted sources of online information. And millions of people in the UK are still offline or lack basic digital skills. Many of these are the people at most risk of social exclusion, such as those aged 65 and over, the unemployed and people with disabilities.
Do the pros outweigh the cons?
The NHS stands to benefit greatly from engaging with patient technology. But it won’t be a quick win. It will need an upskilled workforce, a new approach to supporting patients to look after themselves, more evidence and a lot of regulatory measures in place.
Professionals will need to actively engage with consumer technology: where apps have been prescribed, estimates suggest engagement is 10 per cent higher – and 30 per cent higher for fitness apps. But before they can do that they need support, including assurance that the technologies are accurate and effective, and guidance about how to use patient data appropriately.
We will need a workforce that has the time and the resources to support sustained self-care, encourage digital uptake and improve health literacy – particularly for those at risk of exclusion. Health coaches, public health nurses and volunteers in the community and general practice could all help with this. There are opportunities to build on a range existing of self-care initiatives throughout the country.
Investment and concerted effort is needed to make this work successfully and at scale, and it is a mistake to think that encouraging self-care through apps will be a 'magic bullet' for reducing deficits. But there is potential for significant improvements in patients’ quality of life, confidence and ability to manage on their own, which may lead to savings in the longer term.
By creating an environment for self-care and innovation to flourish, the NHS might be able to finally join the digital revolution.
Castle-Clarke S (2016) 'Is patient technology just what the doctor ordered?'. Nuffield Trust comment, 16 November 2016. https://www.nuffieldtrust.org.uk/news-item/is-patient-technology-just-what-the-doctor-ordered