Technology is revolutionising NHS care and, at the forefront of this, are apps and data platforms that promote seamless data-sharing and digital first care powered by artificial intelligence (AI). The concurrent rise of wearables is also engaging patients in the direct management of their care, with increasing expectation around better access to products and services online, says Hamza Drabu, partner and specialist in health tech at legal firm DAC Beachcroft. He looks at how the NHS is currently using digital tech – and identifies areas where it could be improved
It’s clear that digital care has a huge amount to offer by creating better access to shared patient information and the opportunity to redesign patient pathways via online support. These new pathways can act to reduce pressure on primary care systems by reducing unnecessary appointments and speeding up referral times for patients.
In a recent report published by DAC Beachcroft, projects that are paving the way for reform in healthcare are examined in more detail. One such example is a collaboration between West London NHS Trust and the GP-led London Central and West Unscheduled Care Collaborative (LCW), where LCW provides video conferencing support to care homes. LCW has redesigned care pathways to provide access to care home staff, via telephone or video conference, directly to an advanced nurse practitioner who can discuss the needs of the patient to support decision-making. The project is already seeing promising results in terms of improvements in care provision – and reducing the historically high use of emergency services for this population.
Paving the way for change
There are also dedicated digital first providers emerging in primary care, alongside a commitment in the NHS Long Term Plan for all patients to have access to ‘digital first’ consultations by 2023/24. GP at Hand is a good example of this, with around 40,000 patients registered to that service. In our report it is noted that one barrier to implementation of such services is people’s willingness to accept that the service is at least as good as the alternative.
Babylon’s AI-powered health check is also primed to help patients understand how their lifestyle choices affect their mental and physical health. The future aim of this technology is to incorporate information from genome analysis and wearable technology in order to create a ‘digital twin’ for its users. This twin will assess the patient on their risk of 20 diseases based a control group of peers, empowering the patient to reduce the health risks that they are particularly vulnerable to.
Other examples in the report look at how AT Medics is using its own analytics tool to examine population health data and improve care at scale, through empowering better decision-making around care. This use of large-scale data to evaluate, plan and improve care has already been a ‘game-changer’ and is aligned to the policy set out in the NHS Long Term Plan, which focuses on a population health approach, informed by data, with primary care at the heart of this through primary care networks.
A key example that AT Medics gives is in the prioritisation of diabetes care and management, which has resulted in them becoming top in the country for the proportion of its patients in diabetes management in just over a year from launch of the project. Critical to the success of the project was the ability to deliver all the recommended care processes for triple target management of the disease.
AT Medics has taken a similar approach to public health, improving shingles, influenza vaccination coverage and cervical screening uptake. The transparency the data gives means they can clearly see areas for improvement and the capacity needed within their own workforce to deliver this, as well as the ability to monitor the improvements.
Opportunities, and challenges
There are, of course, both opportunities and challenges around the adoption of digital healthcare technology. In a primary care setting, the reimbursement system is not currently set up in a way that is designed for remote consultations; work is being undertaken at a national level to consider this further. Similarly, the regulation of digital health services by the Care Quality Commission (CQC) is still in its early stages, and open dialogue with regulators – in order that they can understand both the implications of the digital health solution, as well as the safeguards needed – will help safe development and implementation. In each case, there is a need to ensure proper risk assessment takes place to ensure patient safety and commissioners will need to consider this when purchasing digital health technology.
Clarity around minimum standards for new healthcare technologies is critical for external investment; parts of this piece of the jigsaw are already being addressed nationally, for example, through NICE’s evidence standards framework for digital health technologies.
Yet the most important part of this jigsaw is the engagement of clinicians. Whilst there has been clear enthusiasm for the technology itself from health and social care secretary Matt Hancock, the real driver of transformation will flow from ensuring that user needs are at the heart of the design of any digital health technology, and clinicians themselves are behind the implementation.