This reports sits alongside a series of summaries on technology implementation, drawing on findings from the Care City project.
While the Covid-19 pandemic led to a large increase in the use of technology in health care, many are concerned about the impact of the increased use of digital tools on access to services and quality of care, with the pandemic also putting a spotlight on the risks of digital exclusion. While digital innovation has the potential to help alleviate some of the pressures the NHS finds itself under following the pandemic, implementing innovations and supporting people to use them are not a quick fix.
The Care City Test Bed was a project involving the implementation of six digital innovations between June 2019 and August 2020. It aimed to test those innovations in a real-world setting to understand the factors that support patient and staff engagement in the use of digital health care innovations. The Nuffield Trust conducted a mixed-methods evaluation of the project, and this summary report brings together findings relevant to patient engagement with digital innovations. The challenges and insights we identified are likely to be relevant to other health care systems, and other uses of digital technology within health care.
Digital health innovations can be used to enhance care, but should not be framed as a replacement for face-to-face support. Instead, it is important to take a person-centred approach whereby digital tools are offered as part of a wider set of options based on an individual’s particular preferences and needs. Multiple complex factors can influence patient uptake and engagement with digital tools, such as the wider clinical context, people’s individual attitudes towards their own condition, motivation and privacy concerns. So, while digital health innovations may not work for everyone, there are things that can be put in place to optimise the process for those that use them. Our evaluation highlighted the following key points:
- The point at which the innovation is offered can have a significant impact – face-to-face referral by a trusted person may influence the willingness of a person to begin using digital innovations. Staff who offer innovations and support people to use them should receive sufficient training. This includes identifying and, where possible, addressing technical concerns that people have at the beginning, by providing support with downloading or getting started, for example. Ongoing training needs should be identified and addressed throughout.
- The process for implementing innovations and supporting people to engage can be time-consuming and resource-intensive – capacity, time and resources should be built into implementation programmes to enable this to happen effectively.
- Regular, ongoing support from the health care team is essential – digital innovations are one part of a person’s pathway of care and should be integrated with their wider care plan. Some initial concerns were raised by patients that they would not receive the same level of support from their health care team if they were using an app. It was therefore fundamental to reassure them that this would not be the case. Maintaining access to existing modes of care is essential in order to ensure that those who do not wish to use digital innovations do not miss out. It is important to recognise the value of friends and family in providing support and encouraging motivation, but also consider exploring opportunities for enabling peer support for people using digital health innovations.
- Issues with technology access can arise throughout – it is not just an initial barrier and can affect ongoing engagement from people who would otherwise be keen to use technology for their health care. Innovators and implementation teams should remain open and flexible to amending the innovations or the way they are being applied to address emerging challenges and improve accessibility.